Protecting the psychological wellbeing of staff exposed to disaster or emergency at work: a qualitative study

Common stressors, coping processes, and professional help-seeking of medical professionals in Hong Kong: A qualitative study

Despite the high prevalence of perceived stress and mental health problems among medical professionals (MPs), their professional help-seeking is extremely low. This qualitative study explored MPs' stressors, stress-coping, barriers and facilitators of professional help-seeking. 10 MPs (30% male, Mage = 34.8 years) were recruited by purposive-sampling for views from different roles/settings. Thematic analyses revealed five central stressors: emerging novel diseases, challenges from technology-advancement, patient-communication difficulties, lack of workplace mental health care culture, excessive workload/manpower shortage. Participants predominantly used peer support/supervision and de-stress activities for stress-coping. Five factors affecting professional help-seeking were time constraint versus flexibility, mental health stigma versus de-stigmatization, concern over confidentiality/anonymity versus sense of privacy, worry about damage on professional role versus least work disruption, doubts of service providers versus perceived efficacy. All participants indicated a preference for online mental health service delivery. Results reflected unmet needs and service gaps from MPs' perspectives for the development of future interventions.

Exploring the consequences of nurses' involvement in disaster response: findings from a qualitative content analysis study

BACKGROUND

The presence of nurses during disasters can lead to many consequences. Understanding the nurses' experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters.

METHODS

This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data.

RESULTS

After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems.

CONCLUSION

Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.

Healthcare team resilience during COVID-19: a qualitative study

BACKGROUND

Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization.

METHODS

We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework.

RESULTS

Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance.

CONCLUSION

Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

A qualitative evaluation of weekly reflective practice sessions for the intensive care unit pharmacy team during the COVID-19 pandemic

Despite well-being initially being high on the agenda for UK health organisations, the COVID-19 pandemic has highlighted significant gaps around provision for well-being of pharmacists in the UK. The COVID-19 intensive care unit (ICU) environment exposed pharmacists to mental, physical and emotional challenges, including high levels of patient mortality.

OBJECTIVES

To provide an account of the experience of pharmacists working within an ICU at a large National Health Service hospital who attended reflective practice sessions throughout the first wave of the pandemic.

METHOD

A retrospective, cross-sectional design was used to gather information from eight participants who had attended nine, 30-minute weekly reflective practice sessions. Participants were invited to complete a 10-item online self-report questionnaire. The responses from the questionnaire were analysed using theoretical thematic analysis.

RESULTS

Seven participants completed the self-report questionnaire. Thematic analysis of responses identified four themes: (1) permission: both professional and personal 'permission' was necessary for participants to be present for the reflective practice sessions and to attend to their own well-being; (2) containing safe space: reflective practice sessions offered a consistently secure environment from which to explore topics which created challenge, personally and/or professionally; (3) connectedness: the impact of these sessions on participants' relationships with other attendees, as individuals and the group as a whole; and (4) emotional experience: increased awareness of developments around their expression, processing and management of emotion as a result of attending the sessions.

CONCLUSIONS

This study provides new and important insights into the use of reflective practice for pharmacists working in an ICU during the COVID-19 pandemic. Findings demonstrate heterogeneity in the experience of distress, the need to support the pharmacy profession, and the need to provide opportunities for staff to connect safely with colleagues during such crises. The impact of organisation-led support for the pharmacy profession is discussed as a future direction of research.

Wellness Warriors: a qualitative exploration of healthcare staff learning to support their colleagues in the aftermath of the Australian bushfires

PURPOSE

Healthcare staff are on the frontline during disasters despite any personal adversity and vicarious trauma they may be experiencing. Wellness Warrior training is a post-disaster intervention developed in response to the 2019-2020 Australian bushfires to support staff in a rural hospital located on the South Coast of New South Wales, Australia.

METHOD

This study explored the experiences and perspectives of 18 healthcare staff who were trained to provide emotional and peer support to their colleagues in the aftermath of a crisis. All the Wellness Warriors participated in semi-structured interviews between March and April 2020. Data were analysed using the reflexive thematic approach.

RESULTS

Healthcare staff reported developing interpersonal skills around deep listening and connecting with others which allowed for hearing the core of their colleagues' concerns. The training also helped staff to feel differently about work and restored their faith in healthcare leadership.

CONCLUSION

Wellness Warrior training provided staff with knowledge and skills to support their colleagues in the aftermath of a natural disaster and later during the COVID-19 pandemic. As such, these findings suggest that peer support programs such as Wellness Warriors could be one way healthcare organisations can attempt to alleviate the psychological impact of natural disasters.

Practical psychosocial care for providers of pre-hospital care: a summary of the report 'valuing staff, valuing patients'

BACKGROUND

Caring for people who are ill or injured in pre-hospital environments is emotionally draining and physically demanding. This article focuses on the Psychosocial and Mental Health Programme commissioned by the Faculty of Pre-Hospital Care (FPHC) at the Royal College of Surgeons of Edinburgh (RCSEd) in 2018 to investigate the experiences and needs of responders to pre-hospital emergencies and make recommendations. It summarises the report to FPHC published in 2022, and adds material from research published subsequently.

METHOD

FPHC appointed a team to undertake the work. Team members conducted a literature review, and a systematic review of the literature concerning the impacts on the mental health of pre-hospital practitioners. They conducted fieldwork, participated in training and had conversations with trainees and established practitioners, and took evidence from the Pre-hospital Emergency Medicine Trainees Association (PHEMTA).

RESULTS

The Results summarise the evidence-based theoretical background derived from the programme and practical guidance for practitioners, professional organisations, and employers who deliver pre-hospital care on the implications of, preventing and intervening with pre-hospital providers who experience psychosocial and mental health problems.

CONCLUSION

This paper summarises the outputs from a multidisciplinary programme of scholarship, research, and fieldwork. The authors condense the findings and the guidance developed by the Programme Team to provide a summary of the report and guidance on implementation. They believe that the recommendations are applicable to all healthcare organisations and particularly those that employ responders to emergencies and provide pre-hospital care.

Day to Day and Environmental Risk Factors for Psychological Distress Among Healthcare Workers: A Mixed Methods Analysis

OBJECTIVE

Despite a growing literature on mental health among clinical staff during COVID-19, factors shaping distress for nonclinical staff are understudied and may be driven by inequalities at work. We aimed to discuss the role of workplace factors in shaping psychological distress for a diverse group of clinical, nonclinical, and other health and hospital workers (HHWs).

METHODS

This convergent parallel mixed-methods study with HHWs in a US hospital system included an online survey ( n = 1127) and interviews ( n = 73) collected from August 2020 to January 2021. We thematically analyzed interviews; findings informed log binomial regression estimating risk factors for severe psychological distress (Patient Health Questionnaire - 4 item version [PHQ-4] scores of 9 or greater).

RESULTS

Qualitatively, day-to-day stressors fostered fear and anxiety, and concerns about work environments manifest as betrayal and frustration with leadership. Distress was associated with burnout, financial concerns, and feeling betrayed or unsupported by the institution and leadership. Staff in service versus clinical roles had higher risk for severe distress (adjusted prevalence ratio = 2.04, 95% confidence interval = 1.13-2.66); HHWs receiving workplace mental health support had lower risk (adjusted prevalence ratio = 0.52, 95% confidence interval = 0.29-0.92.

CONCLUSIONS

Our mixed-methods study underscores how the pandemic brought inequalities to the surface to increase distress for vulnerable HHWs. Workplace mental health activities can support HHWs now and during future crises.

Trends and ethical issues in nursing during disasters: A systematic review

BACKGROUND

During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to improve the quality of care and impact for nurses.

METHOD

This systematic review enrolled in the international registration with PROSPERO: CRD42022350765. We searched the following databases: PubMed, EBSCO MEDLINE, SCOPUS, ProQuest, ScienceDirect, and Sage Pub. The inclusion criteria were developed according to PICO and D; are Population (F): involving nurses; intervention/Exposure (I): disaster, Comparison (C): none; outcome (O): ethical practice. And Design (D): qualitative, quantitative, and mixed methods. Years of publication were 2012-2022, with full text in English. The quality of study assessment used was The Joanna Briggs Institute (JBI) Critical Appraisal tool and Mixed Methods Appraisal Tool (MMAT) version 2018. Analysis used PICO synthesis.

RESULTS

There were 15 studies reviewed from 2093 results, including cross-sectional (4/15, 26.6%), qualitative (9/15, 60%), and mixed methods (2/15, 13.3%) studies. The types of disasters were: COVID-19 (7/15, 46.6%), infectious (4/15, 26.6%), and all disaster events (4/15, 26.6%). The main themes were: (1) ethical issues in disasters have the potential to address ethical dilemmas, (2) factors applying nursing ethics to support ethical decision-making in disasters, (3) strategies for applying ethics and dealing with ethical issues in disasters, and (4) the impact of applying ethics in disasters.

CONCLUSION

Applying ethics nursing in a disaster is influenced by various factors. This framework for ethical nursing in disasters aims to help nurses, educational institutions, and policymakers develop schemes or scenarios to enhance responsible ethical decisions in disasters.

Individual and Work-Related Psychological Characteristics Contributing to Subjective Well-Being in Air Rescue Employees

OBJECTIVE

Air rescue staff are subject to stressors, including frequent traumatic events, shift work, and unfavorable conditions during rescue missions. We investigated subjective well-being among employees of the Swiss Air-Rescue organization and the potential determining factors, such as sense of coherence, self-esteem, coping, stress, and mental health status.

METHODS

All employees (N = 142) received a questionnaire battery composed of the Trier Inventory for the Assessment of Chronic Stress, the Salutogenic Subjective Work Analysis, the Stress Coping Questionnaire, the Health and Stress Questionnaire, the Sense of Coherence Scale 13-item scale, the Inventory for the Measurement of Self-Efficacy and Externality, the Brief Symptom Inventory, the 12-item General Health Questionnaire, and the Posttraumatic Stress Diagnostic Scale. A discriminant analysis was conducted (input: subjective well-being, output: potential determining factors). A total of 48 participants provided complete data.

RESULTS

The discriminant analysis was significant (χ² = 40.80, P < .001; correct classification: 89.4%) and revealed that sense of coherence (F_1,45 = 40.46) and self-esteem (F_1,45 = 36.20) were the most important discriminating factors for subjective well-being.

CONCLUSION

Sense of coherence and self-esteem play an important role in the subjective well-being of emergency and rescue personnel. Fostering these traits should be included in preventive programs.

Understanding the Mental Health Impacts of the COVID-19 Pandemic on Railway Workers: Risks and Protective Factors

OBJECTIVE

Railway workers have provided an essential service throughout the COVID-19 pandemic. This study explored the effects of COVID-19 on the mental well-being of railway workers (N = 906) in the United Kingdom during the third lockdown period.

METHOD

The online survey included measures of COVID-19-related risk factors (perceived risk, stress, burnout, trauma) and protective factors (resilience coping, team resilience, general help seeking) associated with mental well-being. Responses were analyzed using multiple regression and content analysis.

RESULTS

COVID-19-related risk factors negatively predicted well-being. Higher scores on adaptive resilience, intentions to seek help, and team resilience significantly predicted higher mental well-being scores. Mental health decline throughout the COVID-19 pandemic and concerns for the future were reported.

CONCLUSIONS

Building a resilient railway workforce requires attention to staff mental well-being and to ensuring that support systems are robust and accessible.

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study

BACKGROUND

Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews.

METHODS

We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD.

FINDINGS

The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1).

INTERPRETATION

The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention.

FUNDING

UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.

A Systematic Review of Heart Rate Variability as a Measure of Stress in Medical Professionals

Understanding the physiological effects of responding to crises is a critical component in understanding how to manage and prepare medical professionals to be crisis responders. Heart rate variability (HRV) is the variation in rate between a succession of R-R intervals. This variation is not only affected by physiological processes such as respiration or metabolic rate but is also directly controlled by the autonomic nervous system. As such, heart rate variability has been proposed as a noninvasive tool to measure the physiological stress response. The aim of this systematic review is to consolidate heart rate variability literature in the context of medical emergencies to determine if heart rate variability changes predictably from baseline when responding to medical crises. This may demonstrate utility as an objective, noninvasive measure of stress response. A systematic literature review of six databases yielded 413 articles, 17 of which met our inclusion criteria of being written in English, measuring HRV in healthcare providers, and measuring HRV in real or simulated medical resuscitations or procedures. Articles were then analyzed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. Out of the 17 articles reviewed, 11 demonstrated statistically significant results showing heart rate variability responding in a predictable manner to stress. Three articles utilized a medical simulation as the stressor, six used medical procedures, and eight used medical emergencies encountered during clinical work. Overall, a predictable trend in heart rate variability metrics of standard deviation from the mean value of normal-to-normal (N-N) intervals (SDNN), root mean square of the successive differences (RMSSD), mean number of times per time interval in which the change in successive normal sinus (N-N) intervals exceeds 50 ms (PNN50), low frequency % (LF%), and low-frequency-to-high-frequency ratio (LF/HF) was observed when responding to stress. This systematic literature review showed that heart rate variability among healthcare providers responding to stressful scenarios follows a predictable pattern of change and expands our understanding of the physiology of stress in healthcare providers. This review supports the use of HRV to monitor stress during high-fidelity simulation to ensure that appropriate physiological arousal is achieved during the training of medical personnel.

Emergency Medicine Residents' Perceptions of Working and Training in a Pandemic Epicenter: A Qualitative Analysis

INTRODUCTION

We sought to describe the range of emergency medicine (EM) resident physicians' perceptions and experiences of working and training during the initial coronavirus 2019 (COVID-19) pandemic surge at two, large-volume, urban training hospitals in Brooklyn, New York.

METHODS

A total of 25 EM resident physicians who worked at either of two large emergency departments (ED) from March 15-April 11, 2020 participated in semi-structured interviews conducted in July and August 2020. Interviews were conducted by the authors who were also emergency medicine resident physicians working in the ED during this time. We asked open-ended questions to residents about their experiences and emotions at work and outside of work, including their relationship with co-workers, patients, and their community. The interviews were audio-recorded and transcribed. We then conducted a thematic analysis to identify, classify, and define themes from interview transcripts. Iterative commonalities and differences between interview response themes were grouped to create a broadly applicable narrative of the residents' perceptions and experiences of working and training during this initial wave of a novel pandemic. Interviewees also responded to a demographics survey.

RESULTS

Study participants described four major aspects of their perceptions and experiences of working and training during the stated time, including emotional challenges such as anxiety and feeling underappreciated; protective thoughts, including camaraderie, and sense of duty; workplace challenges such as limited knowledge surrounding COVID-19 and a higher volume of acute patients; and adaptive strategies including increased communication with ED administrators.

CONCLUSION

Emergency medicine residents have a unique perspective and were key frontline hospital responders during a prolonged disaster and mass triage event within a local health system. Considering the chronic case and mortality fluctuations and new variants of COVID-19, as well as the anticipation of future infectious disease pandemics, we believe it is important for key decision-makers in resident education, hospital administration, and all levels of public health management to inform themselves about residents' emotional and workplace challenges when establishing hospital and residency program disaster protocols.

Burns incident responses worldwide and the role of burn speciality teams: a review

INTRODUCTION

Mass casualty incidents (MCIs) have a profound impact on health care systems worldwide. Following recent incidents within the United Kingdom (UK), notably terrorist attacks in Manchester and the Grenfell Tower fire in London, there has been a renewed interest in how the UK would cope with a burn MCI. A Burns Incidence Response Team (BIRT) is a new development incorporated into the Burn Annex of the NHS England National Concept of Operation for Managing Mass Casualties. It is a mobile advice team of healthcare professionals with burns expertise who can support the subsequent management of an MCI, and triage effectively. This review assesses the response to disasters worldwide, detailing national structure, and in particular the involvement of burn specialist teams. This review aims to highlight the roles of burns specialists, and their role within the UK.

METHOD

A review of Web of Science, PubMed, Embase, UK government reports, annexes and textbooks was conducted.

RESULTS

A search resulted in 826 sources; 42 articles were included in this review, with 9 additional sources. BIRTs are described in the NHS Guideline Concept of Operations for the Management of Mass Casualties: Burns Annex, published September 2020.

CONCLUSIONS

The implementation of a national burn response plan is a necessary step forward for effective management of these continuing MCIs. The available literature supports the need for preparation and organized response with a centralized control. Increased awareness and understanding of the role of BIRTs is important and highlights the need for specialist input in the long and short term. Factors which may affect the implementation of BIRT's need to be explored in further detail.

A Narrative Inquiry into the Practices of Healthcare Workers' Wellness Program: The SEED Experience in New South Wales, Australia

The 2019-2020 Australian bushfires followed by the COVID-19 pandemic brought the significant mental health implications of working in healthcare to the fore. The importance of appropriate support services to ensure the resilience and recovery of healthcare workers has been highlighted. In response to healthcare staff experiences during the bushfires, the SEED Wellness Program was created in 2020 in the Illawarra Shoalhaven Local Health District in New South Wales, Australia. SEED used a participant-led design to engage healthcare staff in workplace-based restorative activities. Guided by practice theory, this study aimed to identify and describe SEED wellness practices that supported healthcare staff. Thirty-three healthcare workers participated in focus groups or individual interviews between June 2021 and March 2022. The analysis involved inductive thematic individual and collective exploration of SEED practices, including co-analysis with participants. Eight core practices that supported participants' wellbeing were identified, including responsive and compassionate leading, engaging staff at every stage of the recovery process, creating a sense of connection with others, and collective caring. The study found that workplace wellness initiatives are optimised when they are place-based and grounded in local knowledge, needs, and resources incorporating a collective and supportive team approach. Moreover, to ensure engagement in, and sustainability of these initiatives, both bottom-up and top-down commitment is required.

The impact of COVID-19 pandemic on the psychological well-being among health care workers: A 6-month cohort longitudinal survey study

INTRODUCTION

Health care workers (HCW) have been identified as a risk group to suffer psychological burden derived from Coronavirus Disease 19 (COVID-19) pandemic. In addition, possible gender differences in the emotional reactions derived from COVID-19 pandemic have been suggested in this population. The aims of the study were to explore the impact of COVID-19 as well as possible gender differences on mental health status and suicidality in a cohort of HCW.

MATERIALS AND METHODS

One thousand four hundred and thirty-two HCW responded to an online survey including sociodemographic, clinical, and psychometric tests in May 2020 while 251 HCW answered in November 2020. Mental health status was measured by General Health Questionnaire 28 (GHQ-28) in both time periods.

RESULTS

HCW informed of a worsening in somatic symptomatology over the follow up period. Gender differences were found in all GHQ-28 dimensions as well in the total score of the questionnaire. Post-hoc analyses displayed significant interaction between the time and gender in somatic and anxiety dimensions as well as in GHQ-28 total score. Stress produced by COVID-19 spreading and the feeling of being overwhelmed at work resulted the main predictors of psychological distress although each domain is characterized by a specific set of predictors.

CONCLUSIONS

Somatic reactions represent the most sensitive dimension over the follow-up period. Moreover, women are characterized by a greater psychological distress at the beginning, although these differences tend to disappear over time. Finally, a complex network of factors predicted different dimensions of psychological distress, showing the complexity of prevention in high-risk populations facing major disasters.

Performance of Academic Staff during COVID-19 Pandemic-Induced Work Transformations: An IPO Model for Stress Management

The COVID-19 pandemic has adversely affected all spheres of services-related business, including the higher education sector. As a pre-emptive measure, almost all traditional educational institutions have been transformed into virtual organizations. This pandemic-induced work transition has created stress among academic staff and has hampered their performance. The present study aims to examine the impact of leadership behaviors, e-training, and employment security on the stress management process, consequently improving employee performance during and after the pandemic. Based on the IPO (input–process–output) model, this study examines the effect of leadership behavior, e-training, and employment security on teaching staff’s tasks and adaptive and contextual performance, mediated by stress management. To test the conceptual model, data were collected from the teaching staff of Malaysian universities. The structural equation modeling technique was used for data analysis, while bootstrapping with the maximum likelihood estimator was used to confirm the mediational role of stress management. The study revealed that task- and relation-oriented leadership behavior, e-training, and employment security positively influence stress management and employee performance in virtual organizations. Moreover, stress management acts as a full mediator in the relationship between leadership behavior and employee performance, while partial mediation occurs between e-training, employment security, and employee performance. This study offers valuable insights into the literature by proposing leadership behavior, e-training, and employment security as input in the stress management process to attain the performance output of teaching staff. Higher education institutions should come forward to assist their teaching employees in managing their stress levels for better outcomes.

Employee Job Satisfaction and Performance in Association With Workplace Responses to the 9/11 Attacks on New York City's World Trade Center

OBJECTIVE

Research is needed on disaster-affected workplaces, particularly on employee job satisfaction and performance, to inform workplace responses promoting employee postdisaster adjustment and wellbeing.

METHODS

Quantitative and qualitative data were collected from a volunteer sample of 255 employees of eight workplaces affected by the 9/11 attacks on New York City's World Trade Center nearly 3 years post disaster.

RESULTS

The effects of 9/11 on both job satisfaction and job performance were more negative than positive, especially for the Ground Zero employees. Effects on job satisfaction and job performance were generally congruent. Workplace responses focused on individual needs were perceived as positive and those focused on workplace needs as negative.

CONCLUSIONS

Workplace responses focused on business improvement intended to improve workplace performance may not have the desired effect and may reduce employee job satisfaction and performance.

Can servant leadership prevent hotel employee depression during the COVID-19 pandemic? A mediating and multigroup analysis

The hospitality industry has been severely hit by the COVID-19 pandemic, with changes that have harmed employees' psychological well-being. However, having supervisors who are servant may make a difference. With a focus on serving others and the care taken to ensure their employees' highest priority needs are served, these leaders could help employees feel less depressed in these complicated times. By instilling servant behaviors in followers that help them become people that others can trust or with whom they can develop friendships, leaders could help these employees earn greater levels of personal social capital (PSC) through which to more successfully address pandemic times, especially if furloughed. Using structural equation modeling to analyze a sample of 205 hotel employees in Spain, we found that servant leadership directly decreases depression, and that PSC mediates this relationship. Our multigroup analyses (MGA) findings also reveal that when these employees are furloughed, the negative effect of PSC and the mediating role of PSC in this relationship is stronger. New light is thus shed on how servant leadership is effective in reducing employee depressive symptoms in times of severe changes such as those produced by the COVID-19 pandemic.

Exploring the Factors of Employee Subjective Well-Being in the Midst of Health Threat: An Evidence from the U.S. Federal Government during the COVID-19

The recent COVID-19 pandemic posed a challenge to employee well-being and will have a lasting impact on how safe employees feel about their work environment. This study aims at examining: (1) the impact of safety perception of employees on their job attitudes; and (2) what factors affect their expectations that their organizations will effectively protect them from potential health threats. Using data from the U.S. Federal Government, this study divided organizational responses to COVID-19 aimed at protecting their employees into the following three types: protecting the employees while working on site, reducing the number of employees working on-site, and providing mental and health assistance. The effects of these organizational responses were analysed separately, and regression analysis was performed with these factors with regards to employees’ safety perception. The results showed that the first group of measures, protecting the employees while they are in the workplace, had generally the most significant influences on employees’ feeling of safety. The attempt to protect those in vulnerable medical conditions was also seen as significant. These findings show that organizations need to protect their employees in the workplaces during a health crisis.

Learning from terrorist mass casualty incidents: a global survey

BACKGROUND

Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses.

METHODS

We conducted a mixed methods study by email of clinicians' experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale.

RESULTS

Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement).

CONCLUSION

This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding. NHSH Clinical Effectiveness Unit project registration number: 2020/21-036.

A survey of coping strategies among clinical nurses in China during the early stage of coronavirus disease 2019 pandemic: A cross-sectional study

AIMS

To investigate coping strategies and identify their associated factors among Chinese clinical nurses during the early stage of coronavirus disease 2019 pandemic.

DESIGN

A cross-sectional study.

METHODS

This study was conducted in seven designated hospitals involved in the diagnosis and treatment of the coronavirus disease 2019 in the southwest of China between 1 February and 31 March, 2020. Multiple linear regression was conducted to explore the association of different factors with the coping strategies of nurses.

RESULTS

Nurses' positive coping was associated with higher psychological capital (B = 0.185, 95% CI 0.158-0.213), social support (B = 0.292, 95% CI 0.244-0.340) and lower frustration (B = -0.065, 95% CI -0.123 to -0.007). In contrast, higher frustration (B = 0.091, 95% CI 0.044-0.139), lower performance (B = -0.054, 95% CI -0.101 to -0.007) and psychological capital (B = -0.035, 95% CI -0.055 to -0.014) were associated with negative coping.

Reinforcement and Maintenance of Human Resources for Health Systems during Long-Term Crises: A Systematic Review of Systematic Reviews

BACKGROUND

Human resources are one of the most critical organizational resources, the reinforcement and maintenance of whom require much energy in health organizations, particularly in long-term crises. Many methods have been suggested in this regard; however, there is a need for their integration and clarification.

METHODS

We systematically searched the international databases, including PubMed, Scopus, and Web of Science, from 2003 to April 2021by using some relevant keywords. The quality of the included studies was assessed using the AMSTAR checklist.

RESULTS

The search resulted in 1613 papers, among which there were 16 systematic reviews. The studies addressed a wide range of problems and solutions. Twelve items and four items were classified with moderate quality (AMSTER score 5-8) and high quality (AMSTER score 9-11), respectively. Half of the studies (n = 8) dealt with mental and psychological problems resulting from crises as the most important factor in the decline of health system staff's durability in organizations. They also provided different solutions such as mental health counselling during and after the crisis, flexible work schedule, promoted trust in the organization, support of staff's family, and enhanced awareness to support employees. And the other articles addressed managerial problems as the most critical factor in the decline of health system staff's durability in organizations and proposed solutions such as suitable planning before, during, and after the crisis and the use of material and spiritual incentives to increase the employees' motivation and organizational resilience to maintain the staff.

CONCLUSION

In the present review study, three dimensions (namely, resilience, motivation-hygiene measures, and development of manager's soft skills) are considered as the main factors reinforcing and maintaining human resources in the health systems in long-term crises and disasters.

Emotional and psychological implications for healthcare professionals in disasters or mass casualties: A systematic review

AIM

To synthesize and describe the emotional and psychological implications for healthcare professionals who provided care in a mass casualty incident or disaster.

BACKGROUND

The experience of healthcare providers immersed in the actual uncertainty of an ongoing disaster is real, challenging, complex and strongly connected with emotions. Identifying these implications for healthcare professionals is essential for developing strategies to help these professionals deliver high-quality care.

EVALUATION

A systematic review was conducted in PubMed, CINAHL, Scopus, Nursing & Allied Health Database and PsycINFO using published data until February 2021 and following the PRISMA guidelines.

KEY ISSUES

Nineteen articles were included. Factors associated with negative psychological implications were identified and different strategies have been synthesized to prevent or reduce them when caring for the victims of a disaster.

CONCLUSIONS

Feelings of sadness, helplessness, fear and blockage, among others, were identified as common reactions among nurses and other healthcare professionals dealing in mass casualties or disasters. These reactions may lead to post-traumatic disorder, turning professionals into hidden victims.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizations, senior charge nurses and other health service managers need to foster resilience and flexibility among their workforce to improve self-care during a disaster, as well as ensure policies to address a lack of emotional preparedness among their personnel. Some strategies to consider include cognitive behavioural therapy, psychoeducation or meditation.

Status quo and influencing factors for anxiety, depression, and insomnia among 4 237 nurses in Hunan Province

OBJECTIVES

Public health emergencies have caused significant psychological burden on nurse and affect their mental health. After the coronavirus disease 2019 pandemic, the nurse's mental health has been paid much attention. This study aims to investigate status and influencing factors for anxiety, depression, and insomnia in nurses during the normalized epidemic period, and to further compare the risk of anxiety, depression, and insomnia among nurses at different levels of hospitals between front-line epidemic nurses and other nurses so as to provide a basis for mental health work, nursing management, and relevant study in hospital.

METHODS

A total of 4 237 nurses from all levels of hospitals in Hunan Province participated in the survey in December 2020. A self-designed anonymous questionnaire was used in this study. Anxiety, depression, and insomnia were assessed using Generalized Anxiety Disorder-7 items (GAD-7), Patient Health Questionnaire-9 items (PHQ-9), and Insomnia Severity Index (ISI), respectively. Descriptive statistical analysis was used to evaluate nurses' anxiety, depression, and insomnia; t-test, analysis of variance, and multiple linear stepwise regression analysis were used to analyze the influencing factors of nurses' anxiety, depression, and insomnia.

RESULTS

The scores of GAD-7 among 4 237 nurses were 4.44±4.20, with 10.3% of them experienced moderate to severe level anxiety. The scores of PHQ-9 were 6.03±4.76, with 17.5% of them experienced moderate to severe level depressive symptom. The scores of ISI were 8.37±5.42, with 12.3% of them experienced moderate to severe insomnia. There were significant differences in GAD-7, PHQ-9, and ISI scores among different groups of hospital levels, gender, professional title, position, education level, night shifts, and family monthly income (all P<0.05). Marital status, whether to participate in the front-line, and whether to participate in psychology training groups were not associated with anxiety, depression, and insomnia (all P>0.05). Gender, hospital level, professional title, educational background, more night shifts, and family monthly income were the influencing factors for the GAD-7 and PHQ-9 scores. Gender, length of service, position, hospital level, educational background, night shifts in the last year, and family monthly income were the influencing factors for ISI score.

CONCLUSIONS

There is no difference in the scores of the GAD-7, PHQ-9, and ISI between nurses whether to participate in the front-line, indicating that series of measures for front-line medical staff are effective in China.Meanwhile, some nurses experienced anxiety, depression, and insomnia, and attention should be paid to nurses with low position, more night shifts, lower-level hospitals, and families with low income. It is recommended that management policies, psychological support, and human resource protection should be given to relieve the pressure and maintain the mental health of nurses. At the same time, it is necessary to make mental health knowledge training as a routine training when responding to public health emergencies.

The Pandemic Is Not Occurring in a Vacuum: The Impact of COVID-19 and Other Disasters on Workforce Mental Health in Australia

OBJECTIVE

Prior to coronavirus disease (COVID-19), many Australians experienced extreme bushfires, droughts, and floods. A history of experiencing these events might be a risk factor for increased psychological distress during COVID-19. This study aimed to provide insight into the mental health of Australian workers during the initial COVID-19 outbreak, with an additional focus on whether previous disaster exposure and impact from that disaster is a risk factor for increased psychological distress.

METHODS

A snowball recruitment strategy was used. Participants (n = 596) completed an online survey, which included the Depression Anxiety Stress Scales-21, and questions related to mental health and disaster exposure.

RESULTS

Overall, 19.2%, 13.4%, and 16.8% of participants were experiencing moderate to extremely severe depression, anxiety, and stress symptoms, respectively. Multiple regression found that higher depression, anxiety, and stress symptoms were associated with a pre-existing mental health diagnosis; only higher stress symptoms were associated with having experienced a disaster, with impact, in addition to COVID-19.

CONCLUSIONS

People who have experienced impact from an additional disaster might need additional support to protect their mental health during COVID-19. A focus on the cumulative mental health impacts of multiple disasters and the implications for organizational communities where recovery work is undertaken, such as schools and workplaces, is needed.

Improving flood disaster preparedness of hospitals in Central Thailand: Hospital personnel perspectives

AIM

To improve hospitals disaster preparedness during floods.

BACKGROUND

The Thai flood disaster in 2011 struck several sectors, including hospitals. It is necessary to build a disaster preparedness system that ensures that hospitals have the capacity to respond effectively to any kind of disaster.

METHODS

This qualitative study was conducted using content analysis. Purposive sampling was used to select 15 participants, including doctors, nurses and other staff involved in disaster preparedness, and semi-structured interviews were conducted with them. The study was reported according to COREQ guidelines.

RESULTS

Healthcare personnel identified several ways in which flood disaster preparedness of hospitals may be enhanced. Three themes and eight subthemes were identified during the data analysis. The three themes were as follows: 1) ongoing efforts for flood prevention and mitigation at a national level; 2) developing operational guidelines to effectively prevent and resolve flood problems at provincial levels; and 3) increasing the levels of flood readiness at the hospital level.

CONCLUSIONS

The results of this study indicate strategies to help policymakers and health personnel enhance flood disaster preparedness measures at hospitals based on the experiences of hospital personnel involved in one of the worst flood disasters worldwide.

RELEVANCE TO CLINICAL PRACTICE

Hospitals alone cannot deal with unpredictable events; they need additional assistance in disaster preparedness. There are three levels at which improving hospital flood disaster preparedness can take place: national, provincial and hospital levels. Nursing professionals participate in hospital disaster preparedness and work with multidisciplinary teams to provide services. Nurses should be prepared for such participation, as their involvement, through tailored services for hospital disaster preparedness, can expand the literature on nursing knowledge to improve clinical outcomes.

Factors Associated With Post-traumatic Growth Among Healthcare Workers Who Experienced the Outbreak of MERS Virus in South Korea: A Mixed-Method Study

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' (HCWs) physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth (PTG), have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe their experience of developing PTG.

Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.

Results: We found resilience to have a significant impact on PTG (ß =0.486, p = 0.001). Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.

Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development.

Emotional intelligence, cortisol and α-amylase response to highly stressful hyper-realistic surgical simulation of a mass casualty event scenario

Lifetime exposure to stress leads to risk of suffering from cumulative detrimental physiological and psychological ailments. Due to the nature of healthcare and exposure to trauma, medical professionals are particularly susceptible to the negative impacts of high stress environments. emotional intelligence plays a role in ameliorating the risk of being negatively impacted by these stressors. As such, there is special interest to develop and implement training interventions for medical personnel that would allow them to improve emotional intelligence potential with the goal of enabling them to handle stress better and mitigate burnout. A hyper-realistic surgical simulation training session, replicating the intensity of a Mass-Casualty Event scenario, was implemented to allow medical professionals to experience this in real time. Overall, the training led to increased emotional intelligence, correlating with decreased hypothalamus-pituitary-adrenal axis and sympathetic nervous system stress biomarkers, cortisol and α-amylase. This novel training provides, at least, short-term improvements in emotional intelligence that is reflected with a physiological response. These results guide the ongoing effort to develop therapeutic tools to improve long term stress management, mitigate burnout and reduce post-traumatic stress risk after an exposure to a Mass-Casualty event scenario.

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This study examines the relationship between emotional intelligence and stress response.

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Higher values in self-perception and stress management correlate with lower cortisol and α-amylase values.

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Alpha-amylase is more predictive of pre-event emotional intelligence while cortisol levels are better for post-event.

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Training improves short-term emotional intelligence, that may be useful to enhance stress management and mitigate burnout.

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Monitoring α-amylase and cortisol levels may help identify individuals at risk or with lower resilience potential.

Does Self-Efficacy and Emotional Control Protect Hospital Staff From COVID-19 Anxiety and PTSD Symptoms? Psychological Functioning of Hospital Staff After the Announcement of COVID-19 Coronavirus Pandemic

OBJECTIVES

The aim of this study was to assess coronavirus disease 2019 (COVID-19) anxiety and posttraumatic stress disorder (PTSD) symptoms in the hospital staff, as well as to identify protective factors of COVID-19 anxiety once the coronavirus pandemic was announced in Poland.

METHODS

90 healthcare workers from the hospital in Poland completed validated self-report questionnaires assessing self-efficacy, emotional control, and PTSD symptoms; a questionnaire assessing COVID-19 anxiety; and a socio-demographic questionnaire. A multiple linear regression was conducted to assess the effects of gender, being directly vs indirectly exposed to patients, and general self-efficacy on COVID-19 anxiety.

RESULTS

The analysis showed that female (β = -0.271, p < 0.01) healthcare professionals indirectly exposed to patients (β = -0.336, p < 0.01) and those who reported lower levels of general self-efficacy (β = -0.295, p < 0.01) have a stronger tendency to experience COVID-19 anxiety [R 2 = 0.301, F(3,89) = 12.34, p < 0.01].

CONCLUSION

The findings show the importance of self-efficacy for dealing with COVID-19 anxiety. The internal coping strategies should be introduced to healthcare workers.

What role can videogames play in the COVID-19 pandemic?

Video games are often thought of as trite activities for younger generations. However, research in game studies over the last few decades have revealed that games can be valuable tools for growth and connection, particularly among older generations. Exploring the ways digital games can be used as tools for connection has gained increased attention in recent months with global quarantines as a result of COVID-19. This article reviews the research that has examined the utility of digital games for older adults, focusing specifically on the ways in which games can be tools for social connectedness and psychological healing for older adults and intergenerationally. Special focus will be placed on the role games can play for post-traumatic stress among first responders.

Effects of the COVID-19 pandemic on supply and use of blood for transfusion

The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. We systematically searched for relevant studies addressing the transfusion chain-from donor, through collection and processing, to patients-to provide a synthesis of the published literature and guidance during times of potential or actual shortage. A reduction in donor numbers has largely been matched by reductions in demand for transfusion. Contingency planning includes prioritisation policies for patients in the event of predicted shortage. A range of strategies maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. Sharing experience and developing expert consensus on the basis of evolving publications will help transfusion services and hospitals in countries at different stages in the pandemic.

Managing a Specialty Service During the COVID-19 Crisis: Lessons From a New York City Health System

The COVID-19 pandemic has stretched health care resources to a point of crisis throughout the world. To answer the call for care, health care workers in a diverse range of specialties are being retasked to care for patients with COVID-19. Consequently, specialty services have had to adapt to decreased staff available for coverage coupled with a need to remain available for specialty-specific emergencies, which now require a dynamic definition. In this Invited Commentary, the authors describe their experiences and share lessons learned regarding triage of patients, staff safety, workforce management, and the psychological impact as they have adapted to a new reality in the Department of Neurosurgery at Montefiore Medical Center, a COVID-19 hot spot in New York City.

Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises - Practical tips for an 'integrative resilience' approach

Public health crises, including pandemics, are associated with significant health risk and concomitant stress, fear, decreased sense of control, and uncertainty. Deleterious impact on both physical and mental health can result, including for healthcare professionals and health professions trainees. Changes in governmental policies and hospital protocols for healthcare professionals as well as disruption of educational formats and requirements for trainees can ensue. Difficult anxiety-provoking realities of public health crises including pandemics which involve caring for many seriously ill patients, moral distress including difficult care decisions, personal health risk, and/or potential risk to one's family can take a dire toll on the mental health of healthcare professionals at all stages of the professional lifecycle. Educational disruptions can create significant anxiety for trainees about completing requirements and achieving competencies. Within this, coping skills may be challenged and strengths may be elucidated as well. Such crises create an imperative for medical educators to support trainees' wellbeing through adaptive flexibility for curriculum innovation and culturally sensitive resilience and wellbeing interventions. Strategies ('tips') to optimize resilience and wellbeing with an integrative resilience approach of individual, learning environment, and organization/systems factors are presented.

What role can videogames play in the COVID-19 pandemic?

Video games are often thought of as trite activities for younger generations. However, research in game studies over the last few decades have revealed that games can be valuable tools for growth and connection, particularly among older generations. Exploring the ways digital games can be used as tools for connection has gained increased attention in recent months with global quarantines as a result of COVID-19. This article reviews the research that has examined the utility of digital games for older adults, focusing specifically on the ways in which games can be tools for social connectedness and psychological healing for older adults and intergenerationally. Special focus will be placed on the role games can play for post-traumatic stress among first responders.