The role of risk perception in willingness to respond to the 2014-2016 West African Ebola outbreak: a qualitative study of international health care workers

Occupational safety and health of nurses during the COVID-19 pandemic, the missing part of quality care: a qualitative study

OBJECTIVE

This study explored the consequences of COVID-19 on the occupational safety and health of nurses.

DESIGN

Qualitative conventional content analysis.

PARTICIPANTS

14 nurses selected by purposeful sampling method.

SETTING

Five educational and non-educational hospitals in the Northwest of Iran.

DATA COLLECTION AND ANALYSIS

Semistructured interviews were used for data collection and analysed using conventional content analysis.

RESULTS

Two main categories have emerged from the data: reduced quality of professional life and post-traumatic growth. Reduced quality of professional life, which has two subcategories including job dissatisfaction and burnout, has a negative nature, and has had many negative effects on the physical, mental and well-being of nursing personnel during the coronavirus era. On the other hand, post-traumatic growth, with two subcategories that include promoting safe behaviour and gaining a positive self-concept, has a positive nature.

CONCLUSIONS

Maintaining the occupational health and safety of nurses plays an important role in providing quality services to patients. Therefore, it is necessary for managers and policymakers to use the experiences related to the COVID-19 crisis, to prevent negative factors and strengthen positive factors, to maintain the safety and occupational health of nurses, and increase the quality of care.

Paramedics' experiences of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases: a qualitative study

BACKGROUND

Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases.

METHODS

This exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics' experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers.

RESULTS

Nine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers.

CONCLUSIONS

This study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.

Nurses' coping strategies caring for patients during severe viral pandemics: A mixed-methods systematic review

BACKGROUND

Nurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well-being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.

AIM

To explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.

DESIGN

A mixed-methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.

METHODS

A mixed-methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self-Regulatory Common-Sense Model.

RESULTS

In total, 71 peer-review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS-CoV-2 / COVID-19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well-being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.

CONCLUSIONS

It is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.

RELEVANCE TO CLINICAL PRACTICE

Nurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a literature review study.

PHYSICIANS’ MORAL DUTIES DURING PANDEMICS

Background

Pandemics with devastating morbidity and mortality have occurred repeatedly throughout recorded history. Each new scourge seems to surprise governments, medical experts, and the public. The SARS CoV-2 (COVID-19) pandemic, for example, arrived as an unwelcome surprise to an unprepared world.

Discussion

Despite humanity's extensive experience with pandemics and their associated ethical dilemmas, no consensus has emerged on preferred normative standards to deal with them. In this article, we consider the ethical dilemmas faced by physicians who work in these risk-prone situations and propose a set of ethical norms for current and future pandemics. As front-line clinicians for critically ill patients during pandemics, emergency physicians will play a substantial role in making and implementing treatment allocation decisions.

Conclusion

Our proposed ethical norms should help future physicians make morally challenging choices during pandemics.

Mental health status of healthcare providers during the Covid-19 pandemic: A cross-sectional study across India

Background

From the beginning of the Covid-19 pandemic, studies have observed an increased prevalence of psychological symptoms in the general population and healthcare providers. We studied the prevalence of psychological symptoms among the latter.

Methods

We did this study using a self-administered questionnaire among healthcare providers across India who were involved in caring/treating patients. The questionnaire collected information on demographics, Depression, Anxiety and Stress Scales (DASS-21) and semi-structured questions related to the Covid-19 pandemic.

Results

A total of 612 healthcare providers participated in the study; 254 were doctors of various specialties and 358 were nursing care-providers. According to the DASS-21 assessment, the prevalence of depression was 12.4%, anxiety was 19.1% and stress was 10.8%. The prevalence of psychological problems was more among nursing staff compared to doctors (depression risk ratio [RR] 2.4, anxiety RR 1.73 and stress RR 2.93) and they were equal among both genders (depression RR 1.05, anxiety RR 1.06 and stress RR 1.21).

Conclusions

Our study shows that there is a higher prevalence of depression, anxiety and stress among healthcare providers, particularly among nursing care-providers. We suggest psychological interventions to nursing care-providers and also those who are vulnerable among doctors, to improve their mental health status.

Psychophysical Risk Perceptions and Sleep Quality of Medical Assistance Team Members in Square Cabin Hospitals: A Repeated Cross-Sectional Study

Objective: This study aimed to evaluate the association between the perceptions of psychophysical risks and sleep quality of Medical Assistance Team Members (MATMs) in Square Cabin Hospitals. Methods: Repeated cross-sectional data collection was conducted in Square Cabin Hospitals during two large-scale lockdowns. The first wave was sampled from MATMs dispatched to Wuhan and the second was from MATMs dispatched to Shanghai. Participants completed online questionnaires comprised of the Risk Perception Questionnaire (RPQ), Positive and negative emotions scale (PANAS), and Sleep Quality Scale (SQS), measuring the psychophysical risk perceptions about the MATMs’ current work, emotional states, and sleep quality. Changes across two waves of data collection were statistically parsed using the exploratory factor analysis and regression models. Results: Data of 220 participants from first-wave samples [S1] and 300 from second-wave samples [S2] were analyzed. Participants reported more worries about physical risks, such as inadequate protection methods and being infected, and S1 rated higher on all risks compared with S2 (as the biggest p-value was 0.021). Across the different situations, the dominant emotional states of MATMs were positive; a higher level of psychophysical risk perceptions, negative emotional states, and poor sleep quality were consistently interrelated. The psychophysical risk perceptions predicted sleep quality. Negative emotions as a state variable intensified the relationship between physical risk perceptions and sleep quality (b_{indirect effect} = 1.084, bootstrapped CI = [0.705, 1.487]). Conclusions: The results provide important evidence that MATMs’ higher level of psychophysical risk perceptions associated with negative emotions could indicate worse sleep quality.

Employer and Co-worker Perspectives on Hiring and Working with People with Mental Health Conditions

The purpose of this study was to understand perspectives towards hiring and working with people with mental health conditions (PMHC). Semi-structured interviews with 25 employers and 20 co-workers were carried out. Thematic analysis was used to analyse the data. The barriers to hiring and working with PMHC identified through the interviews were concerns about safety, incompetence, PMHC not being able to get along with others, requiring more training and supervision as well as medical costs and reputational risks to the hiring organisation. Employers and co-workers suggested that improving mental health literacy of staff, pairing the PMHC with trained work buddies, having access to mental professionals when needed, and providing incentives for hiring PMHC such as tax rebates are likely to improve attitudes towards hiring and working with PMHC. Their suggestions for the additional supports required should be considered when developing initiatives to promote inclusivity of PMHC in workplaces.

Riesgo, incertidumbre y covid-19 entre el personal médico de consultorios adyacentes a farmacias de Oaxaca de Juárez

Durante la pandemia de covid-19, el personal médico de los consultorios adyacentes a farmacias (CAF), un servicio de salud privado, desempeñó un rol fundamental en la medida que el 76 % de las personas con síntomas de covid-19 acudieron al sector privado. A partir de un abordaje teórico provisto por la antropología médica, se analiza cómo se configura la percepción del riesgo de médicos(as) de consultorios ubicados en Oaxaca de Juárez. Con base en entrevistas a profundidad realizadas a ocho médicos(as), se muestra que la percepción del riesgo está motivada, entre otros factores, por su condición de vulnerabilidad, la percepción del consultorio como entorno «peligroso» o las conductas de rol definidas por la profesión médica. Además se plantea que, ante la incertidumbre, la reproducción del saber médico se constituye como la práctica de reducción del daño más efectiva.

COVID-19 infection prevention and control procedures and institutional trust: Perceptions of Palestinian healthcare workers

Background

Lack of trust in institutional control measures during Coronavirus disease 2019 (COVID-19) outbreaks may affect healthcare workers' (HCWs) levels of stress and wellbeing, and as a consequence, may influence their trust and confidence in their organization. This study aims to understand factors associated with healthcare workers perceptions of trust in organizational preparedness, communication, and infection risk during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among HCWs (n = 876) in 16 COVID 19 healthcare facilities between October and December 2020 in Palestine (Gaza Strip, West Bank and East Jerusalem). A stratified purposive sample using an online self-administered Arabic version of a questionnaire was used for data collection. The questionnaire used for this study was adapted from the World Health Organization Blueprint Novel Coronavirus Perceptions of healthcare workers regarding local infection prevention and control procedures for a COVID-19 research protocol.Data were analyzed using Statistical Package for Social Sciences software version 23. In the bivariate analysis, T-test, one-way ANOVA and χ2 test were used at a significant p-value < 0.05. In the multivariable logistic regression analyses, the adjusted odds ratios and its 95% confidence intervals are presented.

Results

Findings showed that confidence in the systems' ability to manage COVID-19 cases, encouragement and support from senior medical/nursing staff to apply recommended IPC measures, and good levels of mental health increased trust in the organization. Additionally, receiving proper training on IPC procedures for other communicable diseases, having access to clear policies and procedures related to IPC procedures for COVID-19, and providing PPE during the previous clinical shift also increased trust. However, the intention to use recommended PPE when treating patients with suspected or confirmed COVID-19 when having access to it and feeling emotional was negatively correlated with this trust.

Conclusions

HCWs should be provided with clear, accessible communications about policies and protocols, as well as training about infection prevention and control, personal protective equipment, and support during pandemics to increase their trust in the healthcare system. Additionally, the improvement in HCWs' wellbeing can be attributed to a greater sense of trust in institutions.

The experience of European hospital-based health care workers on following infection prevention and control procedures and their wellbeing during the first wave of the COVID-19 pandemic

Background

Working under pandemic conditions exposes health care workers (HCWs) to infection risk and psychological strain. A better understanding of HCWs’ experiences of following local infection prevention and control (IPC) procedures during COVID-19 is urgently needed to inform strategies for protecting the psychical and psychological health of HCWs. The objective of this study was therefore to capture the perceptions of hospital HCWs on local IPC procedures and the impact on their emotional wellbeing during the first wave of the COVID-19 pandemic in Europe.

Methods

Participants were recruited in two sampling rounds of an international cross-sectional survey. Sampling took place between 31 March and 17 April 2020 via existing research networks and between 14 May and 31 August 2020 via online convenience sampling. Main outcome measures were behavioural determinants of HCWs’ adherence to IPC guidelines and the WHO-5 Well-Being Index, a validated scale of 0–100 reflecting emotional wellbeing. The WHO-5 was interpreted as a score below or above 50 points, a cut-off score used in previous literature to screen for depression.

Results

2289 HCWs from 40 countries in Europe participated. Mean age was 42 (±11) years, 66% were female, 47% and 39% were medical doctors and nurses, respectively. 74% (n = 1699) of HCWs were directly treating patients with COVID-19, of which 32% (n = 527) reported they were fearful of caring for these patients. HCWs reported high levels of concern about COVID-19 infection risk to themselves (71%) and their family (82%) as a result of their job. 40% of HCWs considered that getting infected with COVID-19 was not within their control. This feeling was more common among junior than senior HCWs (46% versus 38%, P value < .01). Sufficient COVID-19-specific IPC training, confidence in PPE use and institutional trust were positively associated with the feeling that becoming infected with COVID-19 was within their control. Female HCWs were more likely than males to report a WHO-5 score below 50 points (aOR 1.5 (95% confidence interval (CI) 1.2–1.8).

Conclusions

In Europe, the COVID-19 pandemic has had a differential impact on those providing direct COVID-19 patient care, junior staff and women. Health facilities must be aware of these differential impacts, build trust and provide tailored support for this vital workforce during the current COVID-19 pandemic.

Stressors faced by healthcare professionals and coping strategies during the early stage of the COVID-19 pandemic in Germany

BACKGROUND

The COVID-19 pandemic has exerted great pressure on national health systems, which have aimed to ensure comprehensive healthcare at all times. Healthcare professionals working with COVID-19 patients are on the frontline and thereby confronted with enormous demands. Although early reports exist on the psychological impact of the pandemic on frontline medical staff working in Asia, little is known about its impact on healthcare professionals in other countries and across various work sectors. The present cross-sectional, online survey sought to investigate common work stressors among healthcare professionals, their psychological stress as well as coping resources during the pandemic.

METHODS

A sample of 575 healthcare professionals (57% male) in three different sectors (hospital, prehospital emergency care, and outpatient service) reported their experiences concerning work and private stressors, psychological stress, and coping strategies between April 17, 2020 and June 5, 2020. To capture pandemic-specific answers, most of the items were adapted or newly developed. Exploratory factor analyses (EFA) were conducted to detect underlying latent factors relating to COVID-specific work stressors. In a next step, the effects of these latent stressors across various work sectors on psychological stress (perceived stress, fatigue, and mood) were examined by means of structural equation models (SEM). To add lived experience to the findings, responses to open-ended questions about healthcare professionals' stressors, effective crisis measures and prevention, and individual coping strategies were coded inductively, and emergent themes were identified.

RESULTS

The EFA revealed that the examined work stressors can be grouped into four latent factors: "fear of transmission", "interference of workload with private life", "uncertainty/lack of knowledge", and "concerns about the team". The SEM results showed that "interference of workload with private life" represented the pivotal predictor of psychological stress. "Concerns about the team" had stress-reducing effects. The latent stressors had an equal effect on psychological stress across work sectors. On average, psychological stress levels were moderate, yet differed significantly between sectors (all p < .001); the outpatient group experienced reduced calmness and more stress than the other two sectors, while the prehospital group reported lower fatigue than the other two sectors. The prehospital group reported significantly higher concerns about the team than the hospital group (p < .001). In their reports, healthcare professionals highlighted regulations such as social distancing and the use of compulsory masks, training, experience and knowledge exchange, and social support as effective coping strategies during the pandemic. The hospital group mainly mentioned organizational measures such as visiting bans as effective crisis measures, whereas the prehospital sector most frequently named governmental measures such as contact restrictions.

CONCLUSION

The study demonstrated the need for sector-specific crisis measures to effectively address the specific work stressors faced by the outpatient sector in particular. The results on pandemic-specific work stressors reveal that healthcare professionals might benefit from coping strategies that facilitate the utilization of social support. At the workplace, team commitment and knowledge exchange might buffer against adverse psychological stress responses. Schedules during pandemics should give healthcare workers the opportunity to interact with families and friends in ways that facilitate social support outside work. Future studies should investigate cross-sector stressors using a longitudinal design to identify both sector- and time-specific measures. Ultimately, an international comparison of stressors and measures in different sectors of healthcare systems is desirable.

Exploration of Factors Influencing Nurses’ Preparedness and Response to the COVID-19 Outbreak

Introduction and Objective

Nurses as the core of the health care workforce affect an organization's preparedness and response. This study explores the factors and unique determinants influencing nurses’ preparedness and response to the coronavirus disease 2019 (COVID-19) outbreak in Singapore.

Methods

This qualitative phenomenological study utilized purposive sampling and in-depth interviews with 10 registered nurses and two enrolled nurses who had worked or were still working in an infectious disease (ID) hospital during the COVID-19 outbreak at the point of recruitment. The data were collected from September 2020 to December 2020.

Results

(1) Before the outbreak: Factors such as knowledge, skills, and experiences that enhanced nurses’ adaptability and response through training and exposure prior to the outbreak influenced preparedness. In addition, the importance of nurses’ knowing their purpose and the role of their institute during the outbreak also influenced preparedness. (2) The COVID-19 phase: Factors such as the novelty of the disease, communication, load and demand, and coping mechanisms affected participants’ working response to the outbreak. (3) Learning and looking forth: Lessons learnt to enhance preparedness and response to future outbreaks, and positive sentiments as part of the nation's effort to combat the disease.

Conclusion

Ground nurses should be actively involved in outbreak planning to gain a better view of their responsibilities and unpredictable events that may occur. A transparent and bidirectional communication among management and nurses is crucial amidst rapid changes in an outbreak to strike a balance between the needs of nurses and leadership and to enhance nurses’ resilience throughout this challenging journey.

Healthcare workers' anxieties and coping strategies during the COVID-19 pandemic in Turkey

PURPOSE

This study aimed to investigate the anxiety levels of healthcare workers and the coping strategies they used for stress during the COVID-19 pandemic.

DESIGN AND METHODS

This descriptive cross-sectional study was carried out in April 2020 in Turkey with 444 healthcare workers via three online questionnaires: A participant information form, the State Anxiety Inventory (SAI), and the Ways of Coping Questionnaire.  FINDINGS: Healthcare workers might be considered to experience more anxiety during the pandemic than shown in the studies conducted before the pandemic. Significant differences in SAI score were found in terms of age, gender, and education status.

PRACTICE IMPLICATIONS

Age, gender, and some variables related to the pandemic affected the anxiety levels and coping strategies of healthcare workers.

Household Preparedness and Perceptions of Workforce Preparedness During Pandemics: A Health Care Employee Survey at the US Department of Veterans Affairs

OBJECTIVE

To examine the effects of household preparedness on perceptions of workplace preparedness during a pandemic among all employees at the US Department of Veterans Affairs (VA) medical facilities.

METHODS

The VA Preparedness Survey (October-December 2018, Los Angeles, CA) used a stratified simple random, web-based survey. Multivariate statistical analyses examined the effect of household preparedness on perceptions of workforce preparedness during a pandemic: institutional readiness; desire for additional training; and understanding their role and its importance.

RESULTS

VA employees totaling 4026 participated. For a pandemic, 55% were confident in their VA medical facility's ability to respond, 63% would like additional training, 49% understood their role during a response, and 68% reported their role as important. Only 23% reported being "well prepared" at home during major disasters. After controlling for study-relevant factors, household preparedness was positively associated with perceptions of workforce preparedness during a pandemic.

CONCLUSIONS

Efforts to increase household preparedness for health care employees could bolster workforce preparedness during pandemics. Organizations should consider robust policies and strategies, such as flexible work arrangements, in order to mitigate factors that may serve as barriers to household preparedness.

The Effects of COVID-19 Risk Perception on Travel Intention: Evidence From Chinese Travelers

This study attempts to assess the relationship between risk perception, risk knowledge, and travel intentions of Chinese leisure travelers during the COVID-19 pandemic in the framework of social contagion and risk communication theories by analyzing a sample of 1,209 travelers through structural equation modeling (SEM) and path analysis. We used the process macro of Hayes to analyze the moderation effects of age, gender, and education between risk perception, media and interpersonal communication, and risk knowledge. It was found that travelers were more concerned about self-efficacy than severity. Risk perception of travelers predicts the information-seeking process of tourists. This process helps travelers to accumulate risk information that influences their travel intentions. Travelers give more importance to interpersonal (contagion) communication in making a traveling decision. Demographic factors influence traveling decision-making; women travelers were found to be more risk resilient than men. Young travelers seek information at low- and old travelers at high-risk levels. Marketing implications also provided.

Rapid Assessment of COVID-19 Screening Program for Travelers in Iran: A Qualitative Study

OBJECTIVE

Coronavirus disease 2019 (COVID-19) screening stations set up by Iranian Red Crescent Society have been available for 17 d with the aim of identifying and treating people with coronavirus, reducing road trips, and sensitizing people to the problem. This study aims to investigate the challenges of the procedure.

METHODS

A qualitative study was used to find the challenges of the COVID-19 screening centers. Volunteers, branch managers, and headquarter managers of the Iranian Red Crescent Society participated in this study applying snowball sampling. Data were collected by means of in-depth semi-structured telephone interviews in April 2020 after completion of the fever screening plan. All interviews were recorded and transcribed verbatim, always with prior permission of interviewees.

RESULTS

The interviews with 20 participants in the plan indicated 6 relevant challenges, including logistics, lack of planning, lack of coordination, legal challenges, mental health, and ethical challenges.

CONCLUSIONS

The results indicated that, although establishing fever detection centers in Iran was a rapid response to COVID-19, it had significant flaws in the structure and adversely affected volunteers' and staff's health and financial resources. Therefore, well-structured protocols are required for similar responses in the future.

Factors Influencing Health Care Workers' Willingness to Respond to Duty during Infectious Disease Outbreaks and Bioterrorist Events: An Integrative Review

BACKGROUND

Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond.

AIM

The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events.

METHODS

An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool.

RESULTS

A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics.

CONCLUSIONS

By comprehensively identifying the facilitators and barriers to HCWs' WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.

Knowledge, attitude, and practice of health professionals in Ethiopia toward COVID-19 prevention at early phase

INTRODUCTION

Coronavirus disease (COVID-19) is a potentially lethal disease having significant public health concerns. As the disease is new, nothing has been intervened yet. Therefore, here we show the health worker's knowledge, attitude, and practice toward COVID-19.

METHODS

The online cross-sectional study design was conducted from April to May 2020, among Ethiopia health workers. The data were collected online, downloaded by an Excel sheet, and transferred to IBM SPSS version 24. Using questionnaire containing four parts sociodemographic, knowledge, attitude, and practice assessing. Linear logistic regression and binary logistic regression were performed to test the association between the dependent and the independent variables. We reported the 95% confidence intervals of adjusted odds ratios with a statistical significance level at less than 0.05 p-values.

RESULTS AND CONCLUSION

A total of 441 health workers were included in this study. The majority of participants were from urban (88.7%), nurses (53.1%), male (88.4%), and have a degree educational level (66.7%). The mean knowledge level of respondents was 10.13 ± 0.057 standard deviation. The majority of respondents had a positive attitude toward control of COVID-19, 88%, and 77% of respondents had confidence that Ethiopia will control COVID-19. Similarly, male (2.746, 95% confidence interval (1.23, 6.02)) and good knowledge level (1.98, 95% confidence interval (1.01, 3.09)) were found to be a determinant for attitude regarding control of COVID-19. Good knowledge level 1.6 (1.02, 2.6), male sex 2.2 (1.07, 4.6), masters 2.33 (1.06, 5.08), and medical doctors 5.99 (1.76, 20.4) to practice wearing a mask when going out of the home. Knowledge, attitude, and practice of the participant health workers are considerable, but may not be enough to control the disease. Sex, age, and profession of the health workers were determinant factors for knowledge about COVID-19. Therefore, training has to be considered for updating health care workers on COVID-19 prevention and controlled at the national level.

Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19

Background

In the case of people who carry an increased number of anxiety traits and maladaptive coping strategies, psychosocial stressors may further increase the level of perceived stress they experience. In our research study, we aimed to examine the levels of perceived stress and health anxiety as well as coping styles among university students amid the COVID-19 pandemic.

Methods

A cross-sectional study was conducted using an online-based survey at the University of Debrecen during the official lockdown in Hungary when dormitories were closed, and teaching was conducted remotely. Our questionnaire solicited data using three assessment tools, namely, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WCQ), and the Short Health Anxiety Inventory (SHAI).

Results

A total of 1320 students have participated in our study and 31 non-eligible responses were excluded. Among the remaining 1289 participants, 948 (73.5%) and 341 (26.5%) were Hungarian and international students, respectively. Female students predominated the overall sample with 920 participants (71.4%). In general, there was a statistically significant positive relationship between perceived stress and health anxiety. Health anxiety and perceived stress levels were significantly higher among international students compared to domestic ones. Regarding coping, wishful thinking was associated with higher levels of stress and anxiety among international students, while being a goal-oriented person acted the opposite way. Among the domestic students, cognitive restructuring as a coping strategy was associated with lower levels of stress and anxiety. Concerning health anxiety, female students (domestic and international) had significantly higher levels of health anxiety compared to males. Moreover, female students had significantly higher levels of perceived stress compared to males in the international group, however, there was no significant difference in perceived stress between males and females in the domestic group.

Conclusion

The elevated perceived stress levels during major life events can be further deepened by disengagement from home (being away/abroad from country or family) and by using inadequate coping strategies. By following and adhering to the international recommendations, adopting proper coping methods, and equipping oneself with the required coping and stress management skills, the associated high levels of perceived stress and anxiety could be mitigated.

Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: A qualitative inquiry

Background

The COVID-19 outbreak has gravely impacted the physical and psychological health of people. As the outbreak is ongoing, it is crucial to equip the emergency healthcare workers (HCWs) to be medically and psychologically prepared.

Objective

To examine the psychological impact of COVID-19 on emergency HCWs and to understand how they are dealing with COVID-19 pandemic, their stress coping strategies or protective factors, and challenges while dealing with COVID-19 patients.

Methods

Using a framework thematic analysis approach, 15 frontline emergency HCWs directly dealing with COVID-19 patients from April 2, 2020 to April 25, 2020. The semi-structured interviews were conducted face-to-face or by telephone. Data were analyzed using thematic analysis.

Results

Findings highlighted first major theme of stress coping, including, limiting media exposure, limited sharing of Covid-19 duty details, religious coping, just another emergency approach, altruism, and second major theme of Challenges includes, psychological response and noncompliance of public/denial by religious scholar.

Conclusions

Participants practiced and recommended various coping strategies to deal with stress and anxiety emerging from COVID-19 pandemic. Media was reported to be a principal source of raising stress and anxiety among the public. Religious coping as well as their passion to serve humanity and country were the commonly employed coping strategies.

Nurses' perceptions of the role of health organisations in building professional commitment: Insights from an israeli cross-sectional study during the COVID-19 pandemic

AIMS

To reveal the factors associated with nurses' professional commitment during the COVID-19 pandemic.

BACKGROUND

During the first wave of the COVID-19 pandemic, the Nursing Division at the Israeli Ministry of Health and partners conducted a study to examine the nurses' perceptions towards a set of personal and professional circumstances that may affect their performance.

METHOD

A cross-sectional Web-based study was conducted in Israel. Study' participants included 817 community and hospital nurses. The Occupational Commitment Scale for Health Professionals during pandemic (PanHP-OCS) was used to gather data. Univariate and multivariate analyses explored associations between the PanHP-OCS score and demographic and professional variables.

RESULTS

About 40% of 817 respondents reported having managerial roles (n = 320). Those who received specific pandemic-focused training had significantly better PanHP-OCS scores (p < .001). Most respondents expected their organisation to provide them emotional support. Linear regression explored the organisational commitment factor as the greatest contributor to nurses' professional commitment (β = 0.284, p < .001).

CONCLUSION

To enhance the nurses' professional commitment during the COVID-19 pandemic, training and emotional support must be emphasized in all types of nurses' workplaces.

IMPLICATIONS FOR NURSING MANAGEMENT

In a pandemic, health organisations must provide dedicated pandemic training, including proactive emotional support for nurses. Special attention should be given to community care.

Determinants of Workforce Preparedness during Pandemics Among Healthcare Workers at the U.S. Department of Veterans Affairs

OBJECTIVE

An infectious disease outbreak can place a significant burden on healthcare systems, however, our understanding of the broader healthcare workforce's preparedness during a pandemic is limited. This study examines factors that influence perceived workforce preparedness at the U.S. Department of Veterans Affairs (VA) during a pandemic.

METHODS

The VA Preparedness Survey was a random, anonymous, web-based survey fielded nationwide October to December 2018. Multivariate statistical analyses examined the effects of study relevant factors (sociodemographic, work-related, general health, and household-related characteristics of VA employees) on perceptions of workforce preparedness, including institutional readiness and understanding of individual roles during a pandemic.

RESULTS

Four thousand and twenty-six VA employees responded. Overall, 55% were confident in their VA medical facility's ability to respond; 49% understood their role; and 68% reported their role to be important during a pandemic. After controlling for study-relevant factors, household preparedness, having plans that address the health care needs of family members, and higher self-reported health status were associated with all 3 workforce preparedness variables. Clinical staff (compared to non-clinical staff) were less likely (OR:0.80, 95% CI:0.68-0.94, P < .01) to have confidence in their medical facility's ability to respond but more likely (OR:1.77, 95% CI:1.49-2.10, P < .001) to believe their role was important. Employees who have been at the VA longer (OR:1.07, 95% CI:1.01-1.14, P < .05) or have experienced a disaster while working at the VA (OR:1.29, 95% CI:1.04-1.59, P < .05) were more likely to understand their role during a pandemic.

CONCLUSION

The findings from this study suggest the need for identifying ways to increase VA employees' confidence in their medical facility's ability to respond to a pandemic; develop trainings to improve understanding of their different yet critical roles, for both clinical and non-clinical staff, during a pandemic; create different workforce trainings for newly hired employees; and identify ways to improve household preparedness for a pandemic outbreak.

Interventions to Improve the Willingness to Work Among Health care Professionals in Times of Disaster: A Scoping Review

The critical role of the health workforce in the function of the health care system is undeniable. In times of disaster and public health emergency, the importance of this valuable resource for the organization multiplies. This scoping review was conducted to identify, analyze, and categorize interventions to improve willingness to work in times of disaster as well as the existing knowledge gaps in the topic. For this purpose, four databases were searched. These included Scopus, PubMed, WOS, and World Health Organization observatory, and they were searched for papers published from July 2000 to September 2020. Studies of the English language that described strategies to improve human resources for health willingness to work during times of disaster/public health emergency were included. Full-text papers were screened by authors and data extraction was done according to self-designed form. Framework analysis identified key interventions based on human resources for health action framework. From 6246 search results, 52 articles were included, a great portion of which was published in 2020 probably due to the COVID-19 pandemic. Northern America was the region with most studies. From 52 included studies, 21 papers have reported the interventions to improve willingness to work and 31 papers have explored factors that affected a willingness to work. The interventions used in the studies were categorized into five themes as Leadership, Partnership, Financing, Education, and Organizational policies. The most and least interventions were financial and partnership respectively. The review identified a wide range of feasible strategies and interventions to improve human resources for health's willingness to work at times of disaster that are expected to be effective. Organizations should let the staff know these decisions and as a necessary step in every organizational intervention remember to evaluate the impacts.

Emergency Healthcare Providers' Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies

This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers at hospitals in the southern region of Saudi Arabia by using a quantitative survey (Fight or Flight). The results showed that participants’ willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%). A lack of confidence and the absence of safety assurance for healthcare workers and their family members were the most important reasons cited. The co-variation between age and education versus risk and danger by Spearman’s rho confirmed a small negative correlation between education and danger at a 95% level of significance, meaning that educated healthcare workers have less fear to work under dangerous events. Although the causes of unsuccessful management of disasters and emergencies may vary, individuals’ characteristics, such as lack of confidence and emotional distractions because of uncertainty about the safety issues, may also play a significant role. Besides educational initiatives, other measures, which guarantee the safety of healthcare providers and their family members, should be established and implemented.

All for One and One for All: Voluntary Physicians in the Intensive Medicine Units During the COVID-19 Outbreak in Spain

OBJECTIVES

Our purpose was to determine the intensive care units' (ICU's) medical staff surge capacity during the coronavirus disease 2019 (COVID-19) outbreak in Spring 2020 in Spain.

METHODS

A multicenter retrospective survey was performed addressing the medical specialties present in the ICUs and the increase in bed capacity during this period.

RESULTS

Sixty-seven centers (62.04%) answered the questionnaire. The ICU bed capacity during the pandemic outbreak increased by 160% (95% confidence interval [CI], 128.97-191.03%). The average number of beds per intensive care medicine (ICM) specialist was 1.5 ± 0.60 and 3.71 ± 2.44 beds/specialist before and during the COVID-19 outbreak, respectively. Non-ICM specialists and residents were present in 50 (74.63%) and 23 (34.3%) ICUs during the outbreak, respectively. The number of physicians (ICM and non-ICM residents and specialists) in the ICU increased by 89.40% (95% CI, 64.26114.53%). The increase in ICM specialists was, however, 4.94% (95% CI, -1.35-11.23%). Most non-ICM physicians were anesthetists, followed by pediatricians and cardiologists.

CONCLUSIONS

The majority of ICUs in our study were able to rapidly expand critical care capacity by adapting areas outside of the normal ICU to manage critically ill patients, and by extending the critical care staff with noncritical care physicians working as force multipliers.

Courage, Fortitude, and Effective Leadership of Surgical Teams During COVID-19

The world as we once knew it has been drastically altered secondary to coronavirus disease 2019 (COVID-19). The impact of these changes, particularly for those practicing in the medical profession, extends beyond the physical to the psychological, emotional, and spiritual. We discuss the factors that contribute to these stresses, way to manage them, and how we as leaders of our teams can inspire resilience and help our colleagues endure these most difficult times.

Ebola, COVID-19, and emerging infectious disease: lessons learned and future preparedness

PURPOSE OF REVIEW

To highlight the lessons learned from the Ebola outbreak that may inform our approach to the COVID-19 pandemic, particularly related to the widespread disruption of healthcare, ophthalmic disease manifestations, and vision health systems strengthening for future outbreaks.

RECENT FINDINGS

Coronavirus disease 2019 (COVID-19), first detected in China in December 2019, has become a worldwide health emergency, with significant disruption of all aspects of society, including travel, business, and medical care. Although this pandemic has had unprecedented effects on healthcare delivery in the United States, experiences from recent Ebola virus disease (EVD) outbreaks in Africa provide insight and inform our approach to COVID-19 and outbreak preparedness. Like COVID-19, the rapid emergence of Ebola required new clinical and surgical approaches to understand its associated spectrum of ophthalmic complications and the potential for Ebola viral persistence within the eye and in tear film. Recent reports of ophthalmic findings associated with COVID-19 include conjunctivitis, retinopathy, and molecular evidence of virus within the tear film in a minority of cases. Yet, more rigorous approaches to understand ophthalmic disease and transmission risk associated with COVID-19 are needed. Gaps also remain in our understanding of eye disease associated with other high priority emerging infectious diseases including Nipah, Lassa fever, Marburg virus, and others.

SUMMARY

Thoroughly understanding the ophthalmic findings and transmission risk associated with COVID-19 is paramount during this pandemic, providing additional measures of safety while resuming ophthalmic care for all patients. Vision health systems preparedness measures developed during recent EVD outbreaks and the current pandemic provide models for ophthalmic clinical practice, research, and education, as we continue to address COVID-19 and future emerging infectious disease threats.

Otolaryngology Resident Practices and Perceptions in the Initial Phase of the U.S. COVID-19 Pandemic

OBJECTIVE

The coronavirus 2019 (COVID-19) pandemic has had widespread implications on clinical practice at U.S. hospitals. These changes are particularly relevant to otolaryngology-head and neck surgery (OHNS) residents because reports suggest an increased risk of contracting COVID-19 for otolaryngologists. The objectives of this study were to evaluate OHNS residency program practice changes and characterize resident perceptions during the initial phase of the pandemic.

STUDY DESIGN

A cross-sectional survey of U.S. OHNS residents at 81 programs was conducted between March 23, 2020, and March 29, 2020.

RESULTS

Eighty-two residents from 51 institutions (63% of invited programs) responded. At the time of survey, 98% of programs had enacted policy changes to minimize COVID-19 spread. These included filtered respirator use for aerosol-generating procedures even in COVID-19-negative patients (85%), decreased resident staffing of surgeries (70%), and reduced frequency of tracheotomy care (61%). The majority of residents (66%) perceived that residents were at higher risk of contracting COVID-19 compared to attendings. Residents were most concerned about protective equipment shortage (93%) and transmitting COVID-19 to patients (90%). The majority of residents (73%) were satisfied with their department's COVID-19 response. Resident satisfaction correlated with comfort level in discussing concerns with attendings (r = 0.72, P < .00001) and inversely correlated with perceptions of increased risk compared to attendings (r = -0.52, P < .00001).

CONCLUSION

U.S. OHNS residency programs implemented policy changes quickly in response to the COVID-19 pandemic. Sources of resident anxieties demonstrate the importance of open communication and an integrated team approach to facilitate optimal patient and provider care during this unprecedented crisis.

LEVEL OF EVIDENCE

4. Laryngoscope, 130:2550-2557, 2020.

Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID‑19) in Hubei, China

Background

Throughout China, during the recent epidemic in Hubei province, frontline medical staff have been responsible for tracing contacts of patients infected with coronavirus disease 2019 (COVID-19). This study aimed to investigate the psychological impact and coping strategies of frontline medical staff in Hunan province, adjacent to Hubei province, during the COVID-19 outbreak between January and March 2020.

Material/Methods

A cross-sectional observational study included doctors, nurses, and other hospital staff throughout Hunan province between January and March 2020. The study questionnaire included five sections and 67 questions (scores, 0–3). The chi-squared χ² test was used to compare the responses between professional groups, age-groups, and gender.

Results

Study questionnaires were completed by 534 frontline medical staff. The responses showed that they believed they had a social and professional obligation to continue working long hours. Medical staff were anxious regarding their safety and the safety of their families and reported psychological effects from reports of mortality from COVID-19 infection. The availability of strict infection control guidelines, specialized equipment, recognition of their efforts by hospital management and the government, and reduction in reported cases of COVID-19 provided psychological benefit.

Conclusions

The COVID-19 outbreak in Hubei resulted in increased stress for medical staff in adjacent Hunan province. Continued acknowledgment of the medical staff by hospital management and the government, provision of infection control guidelines, specialized equipment and facilities for the management of COVID-19 infection should be recognized as factors that may encourage medical staff to work during future epidemics.

Healthcare Ethics During a Pandemic

As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives?With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel struggle with acute shortages of equipment-both to treat patients and protect themselves. With their personal and possibly their family's lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks-including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers' risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal.

Influence of trust on two different risk perceptions as an affective and cognitive dimension during Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea: serial cross-sectional surveys

OBJECTIVES

This study aimed to assess the affective and cognitive risk perceptions in the general population of Middle East respiratory syndrome (MERS) during the 2015 MERS coronavirus (MERS-CoV) outbreak in South Korea and the influencing factors.

DESIGN

Serial cross-sectional design with four consecutive surveys.

SETTING

Nationwide general population in South Korea.

PARTICIPANTS

Overall 4010 respondents (aged 19 years and over) from the general population during the MERS-CoV epidemic were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcome measures were (1) affective risk perception, (2) cognitive risk perception, and (3) trust in the government. Multivariate logistic regression models were used to identify factors (demographic, socioeconomic, area and political orientation) associated with risk perceptions.

RESULTS

Both affective and cognitive risk perceptions decreased as the MERS-CoV epidemic progressed. Proportions of affective risk perception were higher in all surveys and slowly decreased compared with cognitive risk perception over time. Females (adjusted OR (aOR) 1.72-2.00; 95% CI 1.14 to 2.86) and lower self-reported household economic status respondents were more likely to perceive the affective risk. The older the adults, the higher the affective risk perception, but the lower the cognitive risk perception compared with younger adults. The respondents who had low trust in the government had higher affective (aOR 2.19-3.11; 95 CI 1.44 to 4.67) and cognitive (aOR 3.55-5.41; 95 CI 1.44 to 9.01) risk perceptions.

CONCLUSIONS

This study suggests that even if cognitive risk perception is dissolved, affective risk perception can continue during MERS-CoV epidemic. Risk perception associating factors (ie, gender, age and self-reported household economic status) appear to be noticeably different between affective and cognitive dimensions. It also indicates that trust in the government influences affective risk perception and cognitive risk perception. There is a need for further efforts to understand the mechanism regarding the general public's risk perception for effective risk communication.

Nurses' experiences of health concerns, teamwork, leadership and knowledge transfer during an Ebola outbreak in West Africa

AIM

To describe nurses' experiences of health concerns, teamwork, leadership and management and knowledge transfer during an Ebola outbreak in West Africa.

DESIGN

The study has a qualitative descriptive design.

METHODS

The 44 nurses who had worked in an Ebola Treatment Centre in Kenema in 2014 and 2015 were invited by email to respond to a questionnaire. The qualitative, open-ended answers were analysed using a thematic analysis. Data have been coded systematically, with the identification of semantic patterns presented in four themes.

RESULTS

The themes are as follows: personal health management-a way to feel safe and secure for delegates and affiliates; pre-deployment training-crucial for a joint value base and future collaboration; the importance of a professional democratic approach and being a good role model; and the value of timely in-depth knowledge transfer of experienced former delegates.

Local Preparedness for Infectious Disease Outbreaks: A Qualitative Exploration of Willingness and Ability to Respond

As ecologic, social, and economic conditions continue to facilitate the emergence and transmission of infectious diseases, local health department workers' willingness to respond will remain vital to the United States' ability to recognize and respond to new and emerging disease threats. As demonstrated by heavy occupational morbidity and mortality associated with the 2014 Ebola outbreak, infectious disease response can pose serious risks to the health workforce and presents many ethical and logistical challenges. To explore willingness to respond to an infectious disease outbreak among local health departments-the hub of the public health emergency preparedness system-we conducted focus groups with 46 local health department staff attending 2 national conferences. We examined perspectives from our participants on how local health department employees learn about and articulate their professional commitment to the department, the ways in which local health department leaders support local health department employees in responding to an outbreak, and how local health department staff articulate their responsibilities to their families. We conclude with a proposal for how a web of ethical commitments likely influences willingness to respond. These commitments and their relationship to willingness to respond should be explored further.

Must I Respond if My Health is at Risk?

BACKGROUND

Widespread epidemics, pandemics, and other risk-prone disasters occur with disturbing regularity. When such events occur, how should, and will, clinicians respond? The moral backbone of medical professionals-a duty to put the needs of patients first-may be sorely tested.

DISCUSSION

It is incumbent on health care professionals to ask what we must do and what we should do if a dangerous health care situation threatens both ourselves and our community. Despite numerous medical ethical codes, nothing-either morally or legally-requires a response to risk-prone situations from civilian clinicians; it remains a personal decision. The most important questions are: What will encourage us to respond to these situations? And will we respond? These questions are necessary, not only for physicians and other direct health care providers, but also for vital health care system support personnel. Those who provide care in the face of perceived risk demonstrate heroic bravery, but the choice to do so has varied throughout history. To improve individual response rates, disaster planners and managers must communicate the risks clearly to all members of the health care system and help mitigate their risks by providing them with as much support and security as possible.

CONCLUSIONS

The decision to remain in or to leave a risky health care situation will ultimately depend on the provider's own risk assessment and value system. If history is any guide, we can rest assured that most clinicians will choose to stay, following the heroic example established through the centuries and continuing today.