Experiences and Psychological Adjustments of Nurses Who Voluntarily Supported COVID-19 Patients in Hubei Province, China

Alone yet accountable, the unseen buffers: A qualitative study of nurses' experiences working in home care during the COVID-19 pandemic

BACKGROUND

Norwegian society's resilience during the COVID-19 pandemic resulted in low mortality rates and moderate economic decline. The accessible primary healthcare system played a vital role in this, especially in the care of elderly and chronically ill patients. However, nurses in home care experienced emotional burdens, ethical dilemmas and limited access to protective equipment. These challenges were overshadowed by media coverage of hospital struggles, and municipal home care services were oddly absent from post-pandemic reports. This research therefore aimed to explore and describe how nurses experienced working in home care during the pandemic.

METHODS

We designed a qualitative study and conducted semi-structured interviews with nine home care nurses from different municipalities in Southeast Norway. Systematic text condensation inspired by Malterud was employed for data analysis.

RESULTS

Nurses' experiences were described through two categories: 'adapting approaches' and 'adapting work practices'. The results showed how nurses often felt alone while simultaneously shouldering a significant responsibility for patients facing a novel and unfamiliar illness. The pandemic necessitated treating patients in their own homes to minimise infection risks, intensifying the nurses' treatment responsibilities. Furthermore, limited access to medical expertise and physical separation from management due to remote work accentuated feelings of isolation and amplified the nurses' responsibility for patient care. Additionally, the nurses encountered frequent changes in work routines, demanding adaptability.

CONCLUSION

This study underscores the significant role of home care nurses, who, despite feeling professionally isolated and unsupported, demonstrated impressive adaptability. They served as a crucial buffer in the healthcare system, ensuring vulnerable individuals received essential care. This highlights the importance of a robust primary healthcare system with a skilled nursing workforce that can work autonomously, shoulder responsibility, and make clinical decisions, even when medical expertise is less readily available. It also reminds us that healthcare preparedness depends on collaborative efforts across all sectors.

The challenges of voluntary care provision for hospitalized patients with COVID-19: A qualitative study of the public volunteers' experiences

INTRODUCTION

During the COVID-19 pandemic, there was a remarkable increase in public volunteering for the care of hospitalized patients. They faced challenges during their voluntary care provision. This study aimed at exploring public volunteers' experiences of the challenges of the voluntary care provision to hospitalized patients with COVID-19.

METHODS

A descriptive qualitative study with an inductive content analysis method was conducted, 2022-2023. Eighteen public volunteers providing care to hospitalized patients with COVID-19 were purposefully selected among 10 hospitals, specialized in COVID-19 care in Tehran and Shiraz, Iran. Data were collected over 7 months through in-depth semistructured interviews and concurrently analyzed using conventional content analysis methods.

FINDINGS

The challenges of voluntary care provision to hospitalized patients with COVID-19 were illustrated in five main categories, each with two subcategories. The categories included structural challenges, interpersonal conflicts, financial constraints, covert participation and the deteriorating condition of care provision. The subcategories comprised lack of volunteer recruitment bases, ineffective organization of voluntary activities, pervasive distrust, heightened risk of clinical errors, conflicts between volunteer commitments and primary occupation, lack of financial support, lack of family support, isolation by friends, mental trauma and physical exhaustion.

CONCLUSION

Public volunteers encounter diverse challenges while providing care to hospitalized patients with COVID-19, which negatively impacts their motivation to serve. By addressing these challenges, we can create a more supportive environment for volunteers and enhance the quality of care provided to patients during public health emergencies. Identifying such challenges can assist healthcare managers and policymakers develop effective strategies to mitigate mounting difficulties and enhance volunteer services, thereby improving the overall quality of care provided to patients during public health crises.

PATIENT CONTRIBUTIONS

Participants were identified and recruited after the study objectives were explained in person to the managers. The participants were approached and interviewed by one author. Participation was voluntary and the participants did not receive any financial compensation for their time.

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.

Work and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic

OBJECTIVE

To assess the relationship between psychopathological symptoms and the social, clinical, and occupational profile of nurses in the Amazon region of Brazil during the COVID-19 pandemic.

METHODS

A descriptive cross-sectional online study was conducted in 2020 with 261 nurses. The Symptom Assessment Scale-40 was utilized.

RESULTS

The presence of pre-existing conditions before the pandemic was associated with psychotism (p=0.044). Experiencing constraints and/or violence at work during the pandemic was associated with somatization (p=0.025), and working hours were associated with anxiety (p=0.025). Nurses predominantly exhibited symptoms related to fear (33.7%), tension (34.5%), and a sense that something is wrong in the mind (22.6%).

CONCLUSIONS

A significant association was observed between working hours and anxiety symptoms, the experience of constraints and/or violence at work during the COVID-19 pandemic and somatization symptoms, as well as between pre-existing conditions and psychotism symptoms related to COVID-19.

Nurse managers' experience during the COVID-19 pandemic in China: A qualitative study

AIMS

The aim of the study was to explore the experiences of female new nurse managers during the COVID-19 pandemic.

DESIGN

This was a phenomenological study, and qualitative descriptive analysis was used.

METHODS

New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face-to-face with a semi-structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven-step method.

RESULTS

Four main themes and 10 sub-themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work-related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles.

CONCLUSIONS

New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation-oriented work environment for new nurse managers.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Reflections of nurses in the fight against COVID-19 in Hubei: a qualitative study

OBJECTIVES

To explore the reflections and experiences of nurses who were deployed to the frontline to combat COVID-19 in Wuhan, China. In order to gain insights that can be useful in developing cultivating positive professional values and attitudes towards future public health emergencies.

DESIGN

Qualitative study using semistructured interviews. Data were transcribed and analysed using the Colaizzi's 7-step method. The study is reported in accordance with the consolidated Standards for Reporting Qualitative Research.

SETTING

Telephonic interviews with nine participants who were deployed from Nanjing to Hubei Province for the fight against COVID-19.

PARTICIPANTS

Of 11 volunteer nurses deployed to Hubei Province for the fight against COVID-19, two nurses did not finish the interview because of their working hours. The remaining nine were recruited through purposive sampling using the following criteria: nurses who were deployed at the first stage and those who verbally agreed and signed an informed consent form to participate in the study.

RESULTS

Three thematic categories and subthemes that were identified from the analysis were as follows: (1) 'Assertive attitude to fight against the pandemic', included three subthemes: 'Inner calling towards professional accountability for saving lives', 'Extrinsic support that facilitates the commitment to the nursing profession' and 'Holistic value ascribed to the nursing profession'. (2) 'Challenges associated with the anti-pandemic mission', included 'overcoming challenges around the strict requirements for personal protection' and 'Fear and uncertainty over the rapid progression of the disease'. (3) 'Unbearable heaviness and lightness of being a nurse', with two subthemes: 'the heavy crown of the anti-pandemic hero' and 'eternal reverence without regrets'.

CONCLUSIONS

As reflected by the nurses on frontline combating COVID-19, it was necessary to inculcate professional nursing values in them, as only their dedication and selflessness could improve humanity's chances against the disease.

Trajectory analysis of the work and life experience of healthcare workers during the COVID-19 pandemic: a longitudinal qualitative study

BACKGROUND

The COVID-19 pandemic has posed a global health threat and has had a profoundly negative impact on the work and lives of healthcare workers. However, few people know how their experiences have evolved over time.

AIMS

To describe healthcare workers' experiences during clinical responses to COVID-19 and how they changed over time.

DESIGN

A longitudinal qualitative study.

METHODS

We undertook a series of four semi-structured qualitative interviews of 14 healthcare workers called as 1st responders to the COVID-19 pandemic. Participants were recruited through purposive snowball sampling. Interviews were undertaken between May 2020 and May 2022 and trajectory approach was used to reveal individual experiences over time. This paper follows the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Data analysis yielded the following four themes: (1) Changes in emotions; (2) Changes in organization and management of care; (3) Changes in knowledge and capabilities; and (4) Changes in outlook on life and career.

CONCLUSION

Healthcare workers have become stronger in the pandemic and have demonstrated a high degree of professional loyalty and responsibility. However, there is a need to focus on the issue of jealousy and create a harmonious and safe work environment to reduce harm to healthcare workers. Additionally, human resource management strategies must support well-being of healthcare workers and maximize the efficiency of human resource utilization to enable them to respond to current and future needs and emergencies.

Critical care nursing policy, practice, and research priorities: An international cross-sectional study

PURPOSE

To examine the status of critical care nursing internationally, assess the impact of the COVID-19 pandemic, and identify research priorities by surveying professional critical care nursing organizations (CCNOs) worldwide.

DESIGN

A descriptive survey methodology was used. This study is the sixth worldwide quadrennial review to assess international critical care nursing needs and provide evidence to inform critical care nursing policy, practice and research priorities globally.

METHODS

The sixth World Federation of Critical Care Nurses survey of CCNOs was emailed to potential participants from countries with CCNOs or known critical care nurse leaders. Data were collected online using Survey Monkey™. Responses were entered into SPSS version 28 software (IBM Corp.) and analyzed by geographical region and national wealth group.

FINDINGS

Ninety-nine national representative respondents participated in the survey (70.7% response rate). The most important issues identified were working conditions, teamwork, staffing levels, formal practice guidelines, wages, and access to quality education programs. The top five CCNO services that were of most importance were providing national conferences, local conferences, workshops and education forums, practice standards and guidelines, and professional representation. Important pandemic-related services and activities provided by CCNOs included addressing emotional and mental well-being of nurses, providing guidance related to nurse staffing/workforce needs, assisting to coordinate efforts to obtain personal protective equipment supplies, serving as a country liaison with the World Health Organization's COVID-19 response activities, and assisting in the development and implementation of policies regarding standards of care. The most important contributions expected from the World Federation of Critical Care Nurses were standards for professional practice, standards for clinical practice, website resources, professional representation, and providing online education and training materials. The top five research priority areas were: stress levels (inclusive of burnout, emotional exhaustion and compassion fatigue); critical care nursing shortage, skill mix and workforce planning; recruitment, retention, turnover, working conditions; critical care nursing education and patient outcomes; and adverse events, staffing levels, patient outcomes.

CONCLUSIONS

The results highlight priority areas for critical care nursing internationally. The COVID-19 pandemic impacted critical care nurses as direct care providers. As a result, addressing the ongoing needs of critical care nurses remains a priority area of focus. The results also highlight important policy and research priorities for critical care nursing globally. Results of this survey should be incorporated into strategic action plans at the national and international levels.

CLINICAL RELEVANCE

Issues of importance to critical care nurses including research and policy priorities during and following COVID-19 are now clarified through this survey. The impact and importance that COVID-19 has had on critical care nurses and their preferences and priorities are provided. Clear guidance to leaders and policy makers on where critical care nurses would like to see greater focus and attention to help strengthen the contribution of critical care nursing practice to the global healthcare agenda.

Exercise, diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study

BACKGROUND

Healthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear.

PURPOSE

To quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges.

METHODS

Nurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days.

FINDINGS

Participant average sleep quantity did not meet national recommendations; night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants.

DISCUSSION

Nurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.

Psychological stress and psychological support of Chinese nurses during severe public health events

The domestic health care system has been facing a difficult task, especially in medical care, and Chinese nurses are under tremendous psychological pressure. Psychological support is a protective factor to relieve stress. This study examined the stress level and characteristics of Chinese nurses with different psychological support-seeking behaviours. Data from online questionnaires for this cross-sectional study were collected between January 2020 and February 2020 and yielded 2248 valid questionnaires for analysis with a response rate of 99.8%. General information of the respondents was also collected. The nurses' stress levels were assessed using the Perceived Stress Scale (PSS-10). T tests, chi-square tests, and linear regression were used to examine the relationships among the factors. The results of this survey showed that between January and February 2020, 26.9% of nurses received psychological counselling, and the proportion was higher among men and nurses with lower education. The PSS-10 was related to gender, age group, provincial severity, and confidence in the control of the epidemic. The results showed that psychological support can effectively improve the confidence of domestic nurses in the face of arduous work and effectively relieve the psychological pressure caused by a heavy workload.

The impact of caring for COVID-19 patients on nurse professional identity: A cross-sectional study using propensity score analysis

Objective

To examine the impact of caring for COVID-19 patients on the professional identity of nurses.

Methods

An online survey was conducted between 19 May and 7 August 2020 in 11 Chinese cities, including Dongguan, Foshan, Guangzhou, Hong Kong, Huizhou, Jiangmen, Macao, Shenzhen, Zhaoqing, Zhongshan, and Zhuhai. Propensity score matching was used to adjust for confounding variables between nurses with and without experience caring for COVID-19 patients. To analyze the impact of caring for COVID-19 patients on nurses' professional identity, a nominal logistic regression model was used rather than an ordinal regression model because the parallel regression assumption was violated.

Results

After propensity score matching, the final sample contained 1,268 participants, including 634 nurses who cared for COVID-19 patients. During the COVID-19 outbreak, 88.6% of nurses had high levels of professional identity. Nurses who cared for COVID-19 patients had the lowest percentage of high score level on the professional identity subscale for "sense of organizational influence," as did nurses who did not care for COVID-19 patients. The findings indicated that nurses who cared for COVID-19 patients were 17.95 times more likely to have a high professional identity than a low professional identity (95% CI 2.38-135.39, p = 0.005), after completely controlling for the other factors. There were significant differences between nurses who cared for COVID-19 patients and those who did not in scores on the subscales of professional identity, except for the subscales "sense of self-decision-making" (χ² = 4.85, p = 0.089) and "sense of organizational influence" (χ² = 4.71, p = 0.095).

Conclusion

Nurses' professional identity is positively impacted by their experience caring for COVID-19 patients. Caring for COVID-19 patients should be highlighted as an opportunity to enhance nurses' professional identity. To further enhance the professional identity of nurses, we call for visible nursing leadership during the COVID-19 pandemic and improve their working environment.

COVID-19 and the Mental Health of Nursing Professionals in Brazil: Associations between Social and Clinical Contexts and Psychopathological Symptoms

The COVID-19 pandemic has had an important negative psychological impact on people worldwide, especially nursing professionals who seem to be more vulnerable to the development of psychopathological symptoms. Objective: To analyze relationships between variables from the social and clinical contexts with psychopathological symptoms in nursing professionals from different geographic regions of Brazil during the COVID-19 pandemic. Methods: Cross-sectional study carried out with 1737 nursing professionals from the five regions of Brazil. Data collection was carried out online with a questionnaire made available via Google Forms containing sociodemographic, occupational, and clinical questions, and the Symptom Assessment Scale-40-R, for the assessment of psychopathological symptoms. Differences between mean scores for the severity of psychopathological symptoms were assessed using the Mann-Whitney and Kruskall-Wallis tests. Results: There was a significant difference in the psychoticism domain scores according to Brazilian geographic region, with greater severity among professionals from the North and Northeast regions when compared with those from the South region. Social context variables (gender, age group, and marital status) and clinical variables (psychological and psychiatric follow-up; psychological or emotional support by the institution; family member, friend, neighbor, or co-worker with COVID-19, and death among them; use of psychiatric medication without a medical prescription; and taking steps to take care of their mental health) were significantly related to psychopathological symptoms. Conclusions: The results point to the importance of mental health promotion strategies for professionals through psychological or emotional support, as evidence indicates that this support can be a predictor of reduced psychological distress.

Experiences and needs of front-line nurses during the COVID-19 pandemic: A systematic review and qualitative meta-synthesis

Background

Front-line nurses have played a critical role during the coronavirus disease 2019 (COVID-19) pandemic. A number of qualitative studies reported front-line nurses' experiences and needs in caring for patients with COVID-19. However, the application of evidence from a single qualitative study to guide clinical practice has limitations. This study aimed to explore front-line nurses' experiences and needs during the COVID-19 pandemic through a qualitative meta-synthesis.

Methods

Seven databases were searched from 1 December 2019 to 20 January 2022, including PubMed, Web of Science, Cochrane COVID-19 study register, CINAHL, PsycINFO, MedRxiv, and bioRxiv. The quality of included studies was appraised using the Critical Appraisal Skills Program (CASP) qualitative research appraisal tool. Meta-synthesis was used to synthesize the data from included studies.

Results

A total of 70 studies were included, and five synthesized findings were developed: (1) Although nurses actively devoted themselves to fighting against COVID-19, considering their professional responsibility and historical previous experience with mankind, they were not invulnerable; (2) There were various difficulties and challenges in caring for patients with COVID-19, including fear related to providing patients with care, shortage of protective equipment and manpower, and negative attitude of family members; (3) Facing difficulties and challenges, nurses could only partly cope by using mixed means to overcome those, including media, learning, gaining skills, responding together, and organizational assistance; (4) To better respond to the COVID-19 pandemic, nurses' needs should be paid attention to. Counseling, training, information, resources, and investment are pivotal; (5) Despite the hardships, nurses became stronger and gained gratitude, positivity, mental peace, and confidence.

Conclusions

This study reveals that the psychological experiences of front-line nurses varied, and they faced a variety of challenges. Although nurses had some coping strategies, they still needed multifaceted support to meet the challenges.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO: CRD42021255468.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

Stress management in nurses caring for COVID-19 patients: a qualitative content analysis

BACKGROUND

Being in the frontline of the battle against COVID-19, nurses need to be capable of stress management to maintain their physical and psychological well-being in the face of a variety of stressors. The present study aims to explore the challenges, strategies, and outcomes of stress management in nurses who face and provide care to COVID-19 patients.

METHODS

The present study is a qualitative descriptive work that was conducted in teaching hospitals affiliated with Shiraz University of Medical Sciences, Iran, from June 2020 to March 2021. Sixteen nurses who were in practice in units assigned to COVID-19 patients were selected via purposeful sampling. Data were collected through semi-structured, individual interviews conducted online. The collected data were analyzed using MAXQDA 10 according to the conventional content analysis method suggested by Graneheim and Lundman.

RESULTS

The data collected in the interviews resulted in 14 subcategories under 4 main categories: providing care with uncertainty and anxiety, facing psychological and mental tension, creating a context for support, and experiencing personal-professional growth.

CONCLUSIONS

The nurses caring for COVID-19 patients needed the support of their authorities and families to stress management. Providing a supportive environment through crisis management training, providing adequate equipment and manpower, motivating nurses to achieve psychological growth during the pandemic can help them manage stress.

Documenting response to COVID-individual and systems successes and challenges: a longitudinal qualitative study

Background

This study aimed to document the evolution of perceptions of frontline healthcare workers (FHCW) regarding their well-being and the quality of health systems' response to the COVID-19 pandemic over four months in Pakistan.

Methods

We conducted this prospective longitudinal qualitative study during the four months (June–September 2020) coinciding with the peak and trough of the first wave of Pakistan's COVID-19 pandemic. We approached frontline healthcare workers (physicians and nurses) working in emergency departments (ED) in two hospitals using the WhatsApp group of the Pakistan Society of Emergency Physicians (PSEM). Participants were asked to self-record their perception of their wellness and their level of satisfaction with the quality of their hospitals' response to the pandemic. We transcribed, translated, and analysed manually using MAXQDA 2020 software and conducted the thematic analysis to identify themes and sub-themes.

Results

We invited approximately 200 FHCWs associated with PSEM to participate in the study. Of the 61 who agreed to participate, 27 completed the study. A total of 149 audio recordings were received and transcribed. Three themes and eight sub-themes have emerged from the data. The themes were individual-level challenges, health system-level challenges, and hope for the future. Sub-themes for individual-level challenges were: fear of getting or transmitting infection, feeling demotivated and unappreciated, disappointment due to people’s lack of compliance with COVID-19 protocols, physical exhaustion, and fatigue. For the healthcare system, sub-themes were: Infrastructure, logistics, management, and communications response of the hospital/healthcare system and financial stressors. For sub-themes under hope for the future were the improved disease knowledge and vaccine development. The overall perceptions and experiences of FHCWs evolved from fear, grief, and negativity to hope and positivity as the curve of COVID-19 went down.

Conclusion

This study shows that the individuals and systems were not prepared to deal with the challenges of the COVID-19 pandemic. The findings highlight the challenges faced by individuals and health systems during the wake of the Covid-19 pandemic. The healthcare workers were emotionally and physically taxed, while the health systems were overwhelmed by COVID-19. The overall perceptions of FHCWs evolved with time and became negative to positive as the curve of COVID-19 went down during the first wave of COVID-19 in Pakistan.

Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff

Introduction

Emergency Department (ED) nurses and Emergency Medical Services (EMS) Staff are faced with several stressors daily, such as the COVID 19 pandemic situation, which affects the health and the quality of services to patients. Spiritual coping with stress is an attempt to overcome the stress on the basis of what is transcendent. The use of spiritual coping strategies helps a person to overcome tensions caused by the work environment.

Objective

The current study aimed to investigate occupational stress and its relationship with spiritual coping among ED nurses and EMS staff.

Materials and methods

This study was descriptive-correlational research. Using convenience sampling methods, 516 ED nurses and EMS staff were enrolled in the study. The study instruments included demographic information, HSE Occupational Stress, and spiritual coping questionnaires. Data were analyzed using SPSSv.22 software and the descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression.

Results

The highest and lowest levels of occupational stress were the dimensions of “demand” (2.96 ± 0.65) and “role” (3.89 ± 0.81) respectively. Multiple linear regression analysis showed that positive spiritual coping, negative spiritual coping, workplace, service location, type of employment, and work position were important factors affecting the occupational stress of ED nurses and EMS staff, which accounted for 0.34% of the variance.

Conclusion

The findings showed the need to improve the work environment for ED nurses and EMS staff, including changes in physical working conditions, salaries, and better employment conditions. Training programs are recommended to reduce stress through the use of positive spiritual coping strategies.

Health care workers' experiences during the COVID-19 pandemic: a scoping review

BACKGROUND

COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers' (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs' experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included.

RESULTS

161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs' well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs' personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs' experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs' experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries.

DISCUSSION

This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs' experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs' circumstances.

CONCLUSIONS

Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.

Critical Care Nurses' Experiences During the COVID-19 Pandemic: A US National Survey

BACKGROUND

Given critical care nurses' high prepandemic levels of moral distress and burnout, the COVID-19 pandemic will most likely have a tremendous influence on intensive care unit (ICU) nurses' mental health and continuation in the ICU workforce.

OBJECTIVE

To describe the experiences of ICU nurses during the COVID-19 pandemic in the United States.

METHODS

Nurses who worked in ICUs in the United States during the COVID-19 pandemic were recruited to complete a survey from October 2020 through early January 2021 through social media and the American Association of Critical-Care Nurses. Three open-ended questions focused on the experiences of ICU nurses during the pandemic.

RESULTS

Of 498 nurses who completed the survey, 285 answered the open-ended questions. Nurses reported stress related to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. Nurses perceived inadequate leadership support and inequity within the health care team. Lack of consistent community support to slow the spread of COVID-19 or recognition that COVID-19 was real increased nurses' feelings of isolation. Nurses reported physical and emotional symptoms including exhaustion, anxiety, sleeplessness, and moral distress. Fear of contracting COVID-19 or of infecting family and friends was also prevalent.

CONCLUSIONS

Intensive care unit nurses in the United States experienced unprecedented and immense burden during the COVID-19 pandemic. Understanding these experiences provides insights into areas that must be addressed to build and sustain an ICU nurse workforce. Studies are needed to further describe nurses' experiences during the COVID-19 pandemic and identify effective resources that support ICU nurse well-being.

The Experiences of Nurses of Infectious and Non- Infectious Wards of Caring COVID-19 Patients in a Big Hospital in Iran: A Qualitative Study

Background

Nurses play a very important role in caring for patients with coronavirus disease-19 (COVID-19). They are on the frontline fighting COVID-19. The objective was to explore the experiences of nurses in the surgical and infectious wards about caring for patients with COVID-19 in a large and tertiary care hospital in Iran.

Materials and Methods

This was a qualitative study. Semi-structured qualitative interviews were conducted with 18 nurses in the Imam Reza Hospital Complex from April to May 2020, Mashhad, Iran. Data analysis was performed using the method proposed by Lundman and Granheim. The Maxqda10 software was used.

Results

The experiences were summarized into three categories: (1) experiencing new feelings and relationships with colleagues and patients, (2) viewpoints about managers' performance, and (3) concern about getting infected with COVID-19. Findings reflected similar experiences on personal protective equipment between nurses in the surgical and infectious wards. Experiencing new feelings and relationships with colleagues and patients and concern about getting infected and spreading the COVID-19 were mostly expressed by infectious nurses and surgical nurses, respectively.

Conclusions

This research results provide evidence of the experiences of infectious and non-infectious disease nurses who are currently caring for COVID-19 patients. Due to some differences between the experiences of these two groups in COVID-19, it is suggested to pay more attention to the needs and required skills in the staff mix during a crisis.

Professional and psychological perceptions of emergency nurses during the COVID-19 pandemic: A qualitative study

AIM

To explore the changing roles and responsibilities, difficulties, feelings, and coping strategies of emergency nurses during the COVID-19 pandemic.

METHODS

This study was conducted as a qualitative study using a phenomenological approach. A total of 12 emergency nurses were recruited using purposive sampling from a COVID-19-designated hospital in Konya, Turkey for qualitative study. Data were collected through semi-structured individual interviews in January 2021. The data were analyzed using the content analysis method with the MAXQDA 2020 software program. The study conforms to the consolidated criteria for reporting qualitative research checklist.

RESULTS

Four theme categories emerged from the data analysis: (a) "Increasing roles and responsibilities as an emergency nurse"; (b) "Difficulties of working in pandemic conditions"; (c) "Emotional responses in the pandemic"; and (d) "Strategies for coping with the effects of the pandemic". In this study, it was determined that emergency nurses had increased roles and responsibilities due to physicians being in the background, fulfilled their roles and responsibilities in a chaotic working environment, experienced many positive and negative feelings together or gradually, and applied individual coping strategies.

CONCLUSIONS

This study indicated that emergency nurses fulfilled their increasing roles and responsibilities on the frontlines in a chaotic working environment during the pandemic. Despite many negative feelings, it was determined that they tried to show psychological adjustment and resilience with a strong professional commitment and social support.

The Psychological Impact of COVID-19 on Front Line Nurses: A Synthesis of Qualitative Evidence

Caring for people with COVID-19 on the front line has psychological impacts for healthcare professionals. Despite the important psychological impacts of the pandemic on nurses, the qualitative evidence on this topic has not been synthesized. Our objective: To analyze and synthesize qualitative studies that investigate the perceptions of nurses about the psychological impacts of treating hospitalized people with COVID-19 on the front line. A systematic review of qualitative studies published in English or Spanish up to March 2021 was carried out in the following databases: The Cochrane Library, Medline (Pubmed), PsycINFO, Web of Science (WOS), Scopus, and CINHAL. The PRISMA statement and the Cochrane recommendations for qualitative evidence synthesis were followed. Results: The main psychological impacts of caring for people with COVID-19 perceived by nurses working on the front line were fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, and frustration. The fear of infecting family members or being infected was the main repercussion perceived by the nurses. Other negative impacts that this review added and that nurses suffer as the COVID-19 pandemic progress were anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal. Resilience was a coping tool used by nurses. Conclusions: Front line care for people with COVID-19 causes fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, frustration, anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal in nurses. It is necessary to provide front line nurses with the necessary support to reduce the psychological impact derived from caring for people with COVID-19, improve training programs for future pandemics, and analyze the long-term impacts.

"It Was Never Enough": The Meaning of Nurses' Experiences Caring for Patients during the COVID-19 Pandemic

This study's aim was to understand nurses' caring experiences during the recent pandemic in the United States. Using an interpretive phenomenological approach, 15 participants provided the meaning of the care they provided. Five major themes were interpreted: If not us, then who?; Accepting uncertainty; It was never enough; Finding self and our voices in a new role; and Believing it was worth it. The study results have implications for psychiatric-mental health nurse clinicians as they identify and meet the needs of individuals of this vulnerable group. Research that uncovers the meaning of the caring experiences of front line nurses can illuminate the discipline's current understanding of this phenomena.

Impact of COVID-19 on Lifestyle, Personal Attitudes, and Mental Health Among Korean Medical Students: Network Analysis of Associated Patterns

The current COVID-19 pandemic have affected our daily lifestyle, pressed us with fear of infection, and thereby changed life satisfaction and mental health. The current study investigated influencing cascade of changes during the COVID-19 among the lifestyle, personal attitudes, and life (dis)satisfaction for medical students, using network-based approaches. This cross-sectional survey used self-reports of 454 medical students during June and July of 2020. Depressive mood, anxiety, and intention to drop out of school were observed in 11.9, 18.5, and 38.3% of medical students, respectively. Directed acyclic graph that estimated directional propagation of the COVID-19 in medical students' daily lives initiated from the perception of unexpected event, propagated to nervous and stressed feeling, trouble relaxing, feeling like a failure, and were followed by trouble concentrating, feeling loss of control for situation, and fear of infecting colleagues. These six features were also principal mediators within the intra-individual covariance networks comprised of changed lifestyle, personal attitude, and mental health at COVID-19 pandemic. Psychosocial supports targeting nervousness, trouble relaxing and concentrating, fear of spreading infection to colleagues, feelings of a failure or loss of situational control are required for better mental health of medical students during the COVID-19 pandemic.

Mental Health in Health Students during Coronavirus Disease-19: Systematic Review

Purpose: This study aims to examine the description of mental health characteristics of health students who conducted studies during the COVID-19 pandemic. Methods: The design of this study is to use a systematic review approach by collecting several articles from a database that has been selected consisting of Springer. , ScienceDirect and ProQuest with articles published in 2020. Search for articles was carried out by entering the keyword "mental health AND student AND COVID-19". The search for this article was limited to inclusion criteria and exclusion criteria. The inclusion criteria in this study were health students who were still conducting studies during the COVID-19 pandemic and a cross-sectional study design, while the exclusion criteria were non-health students, only abstracts and books, and letters to the editor. Results: After a search on the selected database, the results are 677 Springer articles, 554 direct articles, and 1348 ProQuest articles. 11 were removed for duplicates, 444 full texts were reviewed and 6 articles matched inclusion and exclusion criteria. The results of the 6 articles that were reviewed showed that the majority of health students reported mental health problems such as anxiety, depression, stress, and another emotional status. Where moderate and severe levels of anxiety were experienced by some Health students who carried out education during the Covid-19 pandemic. Conclusion: The COVID-19 pandemic has an impact on psychological conditions, especially on health students who are carrying out their education. Students report poor mental health conditions while carrying out home education by learning online during the COVID-19 pandemic.

Barriers and Facilitators of Nurses' and Physicians' Willingness to Work during a Respiratory Disease Outbreak: A Mixed-Methods Systematic Review

This review was undertaken to identify the perceived barriers and facilitators of nurses’ and physicians’ willingness to work during a respiratory disease outbreak. This mixed-methods systematic review involved the extraction of data from the electronic databases PubMed, Web of Science, CINAHL, and PsycINFO and from a manual search of articles published between 2003 and April 2021. The quality of the included studies was assessed using a mixed-method appraisal tool. A total of 29 studies were eligible for inclusion: 21 quantitative and 8 qualitative. Using the Integrated Behavioral Model, perceived barriers and facilitators were identified under seven categories: demographics, attitude, perceived norm, personal agency, knowledge and skills to perform the behavior, environmental constraints, and habit. The results of this study broaden the understanding of various factors that affect nurses’ and physicians’ willingness to work during a respiratory disease outbreak. These findings will facilitate the modification of current pandemic workplace staffing strategies and practices and will inform preparedness planning for similar situations in the future.

A Phenomenological Study of Nurse Managers' and Assistant Nurse Managers' Experiences during the COVID-19 Pandemic in the United States

Aim

To understand the experiences of hospital nurse managers and assistant nurse managers during the COVID‐19 pandemic in the United States.

Background

Little research has been published about the experiences of nurse managers during the COVID‐19 pandemic. Experiences of front‐line nurses have been well documented. This is the first phenomenological study to date in the United States on experiences of hospital nurse managers during the COVID‐19 pandemic.

Design

Phenomenological qualitative approach.

Methods

Thirteen managers, seven nurse managers and six assistant nurse managers were interviewed about their experiences using audio–video teleconferencing and a semi‐structured interview guide. Consolidated Criteria for Reporting Qualitative Research criteria for reporting qualitative research were used.

Results

The four major themes that emerged were as follows: being there for everyone; leadership challenges; struggles, support and coping; and strengthening my role. There were 11 subthemes.

Conclusions

A major focus of nurse managers during the pandemic was psychosocial support of front‐line nurses while at the same time experiencing stress and exhaustion themselves.

Implications for nursing management

More attention on the psychosocial needs of nurse managers, interventions to allay their exhaustion and provisions for readily available support are warranted.