Nursing work intention, stress, and professionalism in response to the COVID-19 outbreak in Iran: A cross-sectional study

Improving Willingness to Care and Training Needs for PLWHA from the Perspective of Student Nurses in China: A Qualitative Study

People living with HIV and AIDS (PLWHA) deserve equitable and high-quality care. Current HIV and AIDS nursing education may not adequately prepare student nurses for the complexities of caring for PLWHA, and the perspectives of student nurses have not been sufficiently revealed in nursing education research. This study aimed to explore the viewpoints of student nurses with AIDS care experience on methods to improve their care willingness for PLWHA and to identify their educational and training needs. A descriptive qualitative study design was employed, interviewing 18 undergraduate student nurses from 14 tertiary hospitals across 7 provinces in China. Content analysis of transcripts revealed insightful suggestions for improving nursing students' willingness, such as increased HIV and AIDS education and training, psychological preparation, positive role modeling, raising awareness about AIDS patients, and fostering nursing professionalism. Highlighted education and training needs include progress in HIV and AIDS treatment, preventive measures, psychological support for PLWHA, post-exposure protocols, and HIV-infected risk behaviors. These findings highlight the need for HIV and AIDS education, psychological support training, and stigma-reduction strategies. This study provides valuable insights that could inform policymakers, educators, and healthcare providers on preparing future nurses to meet the complex needs of PLWHA.

Development and psychometric evaluation of nurse's intention to care for patients with infectious disease scale: an exploratory sequential mixed method study

AIMS

Nurses who care for patients with infectious disease may experince significant stress and negative psychological reactions. The intention of nurses to care is a complex and multifaceted concept that is influenced by a range of factors. Therefore, this study was conducted to explain the concept of nurses' intention to care for patients with infectious disease and then develop a reliable and valid scale to measure this concept accurately in Iranian nurses.

DESIGN

This study is a cross-sectional study with a sequential-exploratory mixed-method approach from May 2022 to July 2023. The concept of nurses' intent to care for patients with infectious disease was explain using deductive content analysis, and item pools were generated. In the sconed step the samples were 455 nurses. Data was collected by an online form questionnaire using a convenience sampling technique. In this step to determine the psychometric properties of nurse's intention to care for patients with infectious disease scale (NICPS), face and content validity performed. Then construct validity was determined and confirmed using exploratory and confirmatory factor analysis followed by convergent and divergent validity respectively. Finally, scale reliability including stability and internal consistency were evaluated.

RESULTS

The finding showed that NICPS with seventeen items were classified into three factors namely "Social support" with seven items, "Spiritual motivation" with six items and "Job satisfaction" with four items. These three factors explained 56.14% of the total variance. The fit indices showed that the model has a fit and acceptable (TLI, CFI, IFI > 0.9; PNFI, PCFI > 0.5, REMSEA > 0.049, CMIN/DF = 2.477). Reliability revealed acceptable internal consistency and stability (> 0.7).

CONCLUSION

The finding showed that NICPS has three factors in Iranian nurses. Nursing managers can use these results to provide training and support intervention for nurses in order to increase their intention to care for this patient. Also, the NICPS is a reliable and valid for evaluating this concept in future studies.

Perceptions of Healthcare Safety Nets among Tertiary Hospital and Long-Term Care Hospital Nurses during the COVID-19 Pandemic: A Q-Methodological Approach

This study was conducted to identify the types of perceptions toward healthcare safety nets. This study applied a Q-methodology. From a Q-population of 91 samples that included a review of the related literature and interviews with five tertiary hospital nurses and five long-term care (LTC) hospital nurses, 33 Q-samples were selected. The data were analyzed with the PC-QUANL program. We recruited 32 nurses in a tertiary hospital and 33 nurses in an LTC hospital. The perceptions of the healthcare safety net of tertiary hospital nurses were categorized into four types: (1) systematic system request; (2) realistic work support; (3) government support; and (4) emotional support. The perceived subjectivity of the healthcare safety net of LTC hospital nurses were categorized into four types: (1) reward system and facility environmental support; (2) realistic work support; (3) social prevention infrastructure support; and (4) government support. This study provides basic data for these different hospital settings, as well as to inform future government policy and system improvements in an era characterized by infectious diseases. Specifically, this study presents the types of perceptions of healthcare safety nets of nurses in two hospital settings that deliver care for patients.

Effect of the COVID-19 pandemic on depression, perceived stress and hypochondria of frontline dental staff (FDS): A cohort study

BACKGROUND

The coronavirus 2019 (COVID-19) pandemic had several mental effects on medical staff.

OBJECTIVE

This study intended to evaluate deviations in Frontline Dental Staff (FDS) depression, perceived stress and hypochondria during the COVID-19 outbreak, and to assess whether the existence of potential risk-factors influenced these symptoms over time.

METHODS

This prospective cohort study surveyed FDS three periods from February 1, 2021 to April 8, 2022. FDSs' mental health was assessed through Beck Depression Inventory, Cohen Perceived Stress and the Evans Self-Illness Questionnaires; multivariate linear regression were used to identify potential factors associated with changes on each outcome (depression, perceived stress and hypochondria) over time. All analyses were performed in STATA ver.14.

RESULTS

In a total of 635 FDS, about 69%, 83%, and 71% reported relative depression, 77%, 87%, and 64% reported moderate to high stress level, and 60%, 76% and 74% reported moderate hypochondriac from first, second, and third survives, respectively. The mean and standard deviation of the variables increased dramatically at second survive (July 17 to October 21, 2021) and decreased again at third survive significantly. Being female, working in public sector, and low socioeconomic level were main predictors of higher levels of depression (p < 0.001) and perceived stress (p < 0.001). Perceived stress was a strong predictor of high-level depression (t  =  7.79, p < 0.001).

CONCLUSION

FDSs' depression, stress and hypochondria were high and positively associated with being female, working in public-sector, and low socioeconomic level. To increase the effectiveness and decrease work burnout, psychological support should be provided.

An assessment of organizational well-being, organizational health, and work-related stress: A cross-sectional study of nurses involved with COVID-19 interventions

BACKGROUND

Nurses have been affected by stress, developing many related consequences during the health emergency caused by the SARS-CoV-2 (COVID-19) pandemic. It is essential for healthcare organizations to protect their human resources because there is a strong correlation between the health status of healthcare workers and the quality of care provided.

OBJECTIVE

The aim of the study was to measure the perception of the organizational health level of the workplace among COVID-19 nurses (i.e. nurses who directly dealt with COVID-19 countermeasures) as an influence on work quality and work-related stress.

METHODS

A cross-sectional study was carried out by administering the Nursing Questionnaire on Organizational Health (QISO) to nurses in contact with COVID-19 patients. The search period ranged between August and September 2021 with nurses who work and/or worked in Lazio.

RESULTS

123 questionnaires were collected. The scores with a value below the recommended level (2,6) are: "Comfort of the working environment" (mean = 2,57; SD = 0,66); "Valorization of skills" (mean = 2,40; SD = 0,62); "Openness to innovation" (mean = 2,46; SD = 0,77); "Satisfaction with top management" (mean = 2,48; SD = 0,81); the inverse scale "Fatigue" (mean = 2,94; SD = 0,55).

CONCLUSION

Management of healthcare organizations should define action strategies to promote and increase organizational well-being and reduce work-related stress risk factors. Some action strategies that could be used include improving the elements of the work environment to make it more comfortable for workers; strengthening and improving communication; improving the relationship between nurses and senior management; and establishing a team of experts for psychological assistance.

Professional commitment and willingness to care for people living with HIV among undergraduate nursing students: The mediating role of empathy

BACKGROUND

As future registered nurses, undergraduate students play a vital role in integrated care for acquired immunodeficiency syndrome; hence, there is a need to examine factors that can increase their willingness to care for persons with such conditions.

OBJECTIVE

This study examined the relationship among nursing professional commitment, empathy, and willingness to care for people living with human immunodeficiency virus and acquired immunodeficiency syndrome among undergraduate student nurses, and the mediating role of empathy in this relationship.

DESIGN

Quantitative, cross-sectional design.

SETTINGS

Nursing schools from five provinces of China, including Hunan, Jiangxi, Guangxi, Henan, and Hebei.

PARTICIPANTS

A total of 747 undergraduate student nurses were recruited via cluster sampling.

METHODS

Online survey was used to collect data. Nursing Willingness Questionnaire, Professional Commitment Scale, and Jefferson Scale of Empathy were the scales used to measure the variables. Structural equation modeling was used to determine significant relationships.

RESULTS

Respondents' professional commitment and empathy demonstrated moderate positive associations with willingness to care. Empathy demonstrated a 21 % mediating effect on the effect of professional commitment and willingness to care (p < 0.05).

CONCLUSIONS

Findings highlight the enabling role of professional commitment and empathy in improving undergraduate student nurses' willingness to care for persons living with human deficiency virus. Nurse educators can help improve the impact of students' professional commitment on their willingness by using educational strategies that enhance their empathy.

Investigation of Fear of COVID-19, Work Stress and Affecting Factors in Prehospital Emergency Healthcare Workers

Background: Since healthcare workers work in the same environment with infected patients, they have a higher risk in terms of COVID-19 transmission compared to other parts of society, and accordingly, they experience more stress. Purpose: The aim of this study to investigate the fear of COVID-19, work stress, and affecting factors in prehospital healthcare workers. Methods: The research has a descriptive and cross-sectional design. The research was completed with a total of 399 individuals. Data were collected online using an introductory information form, the Fear of COVID-19 Scale, and the General Work Stress Scale. Results: The level of fear of COVID-19 was higher in women compared to men (B=-1.451, p=0.012), in married individuals compared to singles (B=-1.667, p=0.011), in those with low income compared to those with moderate or high income (B=-2.259, p

Relationship between mental workload and hospital infection in the ICU

BACKGROUND: Nursing is among the most stressful professions. Studies that examine possible factors that influence the mental workload (MWL) of nurses are of fundamental importance, because through these results, efforts can be concentrated on improving their working conditions more efficiently. OBJECTIVE: To investigate the influence of hospital infection on the MWL of nurses in an intensive care unit (ICU). METHOD: Cross-sectional and descriptive study, with a quantitative approach. Three research instruments were used: a sociodemographic questionnaire, the NASA Task Load Index (NASA-TLX) and the Nursing Work Index-Revised Brazilian version (B-NWI-R). The sample consisted of 30 nurses from the ICU of a public hospital in João Pessoa city, Brazil, during the daytime period, and the Spearman correlation test (α= 0,05) was applied to verify associations. RESULTS: There was a high MWL among nurses, with a NASA-TLX weighted average of 66.38 (SD±15.0). Correlations were found between the levels of hospital infection in the ICU and the MWL of the nurses (r = 0.654, p <  0.01); in the nurses’ care of patients with urinary tract infection, the correlation is 0.546, p <  0.01; if care is provided to patients with lung problems, the correlation is 0.563, p <  0.01 The ICU presented a favorable environment to nursing practices, with means lower than 2.5, according to the B-NWI-R. CONCLUSION: The MWL of the nurses was associated with the hospital infection levels of the intensive care sector studied. It was found that the MWL of nurses in relation to hospital infection in the ICU increased by 42.8% . This MWL is impacted by 29.8% when nurses’ care is linked to patients with urinary infection. But if care is provided to patients with lung problems, this percentage rises to 31.7%

Burnout and psychological symptoms in healthcare workers during the COVID-19 pandemic: Comparisons of different medical professions in a regional hospital in Turkey

BACKGROUND: Early studies have revealed the psychological effects of the COVID-19 outbreak on healthcare workers (HCWs). Burnout and psychological outcomes of different medical professions during the pandemic have not yet been addressed. OBJECTIVE: The study aimed to investigate the burnout, depression, anxiety, and psychological distress levels of HCWs, and to determine the predictive factors of burnout in different professions of frontline HCWs during the pandemic. METHODS: This cross-sectional study included 253 HCWs (79 physicians, 95 nurses, and 79 other-HCWs). The Maslach Burnout Inventory, Beck Depression Inventory, Beck Anxiety Inventory, and Impact of Event Scale-Revised, and Sociodemographic Form were used. RESULTS: Emotional exhaustion was significantly higher in physicians and nurses than in other frontline HCWs. While depersonalization was significantly higher in physicians than nurses / other HCWs, levels of avoidance, hyperarousal and intrusion were found to be higher in other HCWs / nurses than physicians. Depression was the most effective predicting variable for burnout, following age, quarantine, supervisor’s/team leader’s attitude, hyperarousal and avoidance. CONCLUSIONS: It has been observed that depending on the uncertainty and life risk of the pandemic in HCWs involved in the treatment of COVID-19, physicians who are the decision-making authorities in the treatment process used more depersonalization than nurses and other HCWs. Nurses and other-HCWs had significantly higher distress symptoms than physicians. Both future research and psychosocial services should address those with high depressive symptoms as a potentially fragile subgroup for burnout among HCWs, and investigate and develop evidence-based interventions that can provide mental well-being, and prevent burnout.

Predictive variables for feelings of sadness and depression while working remotely in Brazil during the COVID-19 pandemic

BACKGROUND: Remote work was evidenced in the pandemic and studies in this area increased. Most studies focus on professionals of companies or professors/students in the academic environment. At the same time, non-academic staff, that provide all the support required for the core activities of the institutions (research/teaching/extension activities) have been neglected. OBJECTIVE: This article aims to exploratory analyse which variables (interruptions when working remotely (1), health concerns (2) and fear of contracting coronavirus (3), anxiety and concern about professional career (4), frustration to have cancelled plans and missed opportunities (5) and gender (6)) can impact feelings of sadness and depression experienced by non-academic staff of a university working remotely. METHODS: Using a database on behaviour and feelings of non-academic staff from a Brazilian university working remotely during the COVID-19 pandemic, a binary logistic regression model was structured. In an exploratory manner, six independent variables (presented in the previous item) were analysed in terms of their ability to predict the dependent variable (feelings of sadness and depression). RESULTS: The results presented the prediction power of the independent variables for the dependent variable. The variables regarding concern with their health, increased anxiety and concern about their career presented Odds Ratios of 3.6 (1.4–8.5 –95% C.I.) and 3.3 (2.2–5.0 –95% C.I.), respectively, standing out from the other variables. CONCLUSIONS: These results focus on staff at one institution, but they can contribute to better understand feelings and behaviours experienced by professionals working remotely and provide information for debates on the field of COVID-19-related changes of work.

Difference in Pandemic-Related Experiences and Factors Associated with Sickness Absence among Nurses Working in COVID-19 and Non-COVID-19 Departments

Background: The aim of this study is to determine the main variables associated with nurses’ sickness absence (SA) and to improve the prediction of SA based on pandemic-related experiences. The second aim is to examine the differences between COVID-19 (CoV) and non-COVID-19 (non-CoV) nurses in levels of post-traumatic stress disorder (PTSD) symptoms, personality traits, coping strategies and professional stressors experienced. Methods: This historical prospective study enrolled 1305 nurses from the University Hospital of Split, Croatia. A total of 380 subjects participated in the study, 163 non-CoV and 217 CoV subjects. Nurses’ pandemic-related experience questionnaires, Big Five Inventory (BFI), Post-traumatic Stress Disorder Checklist (PCL-5), Coping Inventory for Stressful Situations (CISS) and Occupational Stress Questionnaire, were used for evaluation. Results: Non-CoV nurses felt more fear of infection, were more socially distanced, had more PTSD symptoms and neuroticism and felt more stress due to public criticism and job requirements compared to CoV nurses; p < 0.001. The groups of SA users and non-SA users could be distinguished based on predictor variables in CoV and non-CoV nurses, with a correct classification of 84.8% vs. 79.1%. Conclusions: It was possible to predict the probability of using SA among nurses due to pandemic professional experience, personality traits and coping strategies.

Demographic, Lifestyle, and Physical Health Predictors of Sickness Absenteeism in Nursing: A Meta-Analysis

Background

Sickness absenteeism is an area of concern in nursing and is more concerning given the recent impacts of the COVID-19 pandemic on healthcare. This study is one of two meta-analyses that examined sickness absenteeism in nursing. In this study, we examined demographic, lifestyle, and physical health predictors.

Methods

We reviewed five databases (CINAHL, ProQuest Allied, ProQuest database theses, PsycINFO, and PubMed) for our search. We registered the systematic review (CRD de-identified) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Additionally, we used the Population/Intervention/Comparison/Outcome Tool to improve our searches. Results: Following quality testing, 17 articles were used for quantitative synthesis. Female employees were at higher risks of sickness absenteeism than their male counterparts (OR = 1.73; 95% CI: 1.33-2.25). Nursing staff who rated their health as poor had a greater likelihood of experiencing sickness absence (OR = 1.38; 95% CI: 1.19-1.60). Also, previous sick leave predicted future leaves (OR = 3.35; 95% CI: 1.37-8.19). Moreover, experiencing musculoskeletal pain (OR = 2.41 95% CI: 1.77-3.27) increased the likelihood of sickness absence with greater odds when it is a back pain (OR = 3.05; 95% CI: 1.66-5.62). Increased age, physical activity, and sleep were not associated with sick leave.

Conclusion

Several variables were statistically associated with the occurrence of sickness absenteeism. One primary concern is the limited research in this area despite alarming rates of sick leave in healthcare. More research is required to identify predictors of sickness absence, and thereby, implement preventative measures.

The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic

BACKGROUND

In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses' mental health is of importance.

OBJECTIVE

This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis.

RESULTS

The mean scores for nurses' moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014).

CONCLUSION

The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.

Working conditions and anxiety levels of employees who have to work during the COVID-19 pandemic

BACKGROUND

This study aims to evaluate the anxiety levels of employees by determining the working conditions and protective practices in the workplace of individuals who had to work during the COVID-19 pandemic.

METHODS

The cross-sectional study was carried out with 801 employees from different sectors who continued to work during the COVID-19 pandemic.

RESULTS

The mean age of the employees was 33.1±10.3 years, and 63.4%were male while 46.1%were workers. The GAD-7 anxiety level mean score of the participants was determined as 6.6±5.1. Per this, 25.2%of the participants showed a high tendency to anxiety and 38.5%showed a moderate tendency. A statistically significant difference was found between anxiety level and gender, sector and profession. Besides, there was a statistically significant difference between the perception of workplace risk, the way of transportation to the workplace, the social distance in the workplace, measures taken for COVID-19 in the workplace, and anxiety levels (p < 0.05). In the multiple regression analysis, age, gender, work sector, COVID-19 anxiety levels, infection status, knowledge level and life satisfaction levels were determined as effective predictors on common anxiety disorder and explained 23.2%of the developed model variance (R2 = 0.232, p≤0.001).

CONCLUSION

During the pandemic, it was determined that the anxiety susceptibility levels of the employees were very high and their protective practices against COVID-19 in the workplace were insufficient.

Stress level and sleep quality of nurses during the COVID-19 pandemic

BACKGROUND

COVID-19 infection is transmitted easily and quickly, and nurses constitute the riskiest group of healthcare workers. Therefore, they may experience high levels of stress and sleep problems.

OBJECTIVE

This study was conducted in order to evaluate the stress levels and sleep quality of nurses working during the COVID-19 pandemic.

METHODS

The cross-sectional study was conducted with 316 nurses working in a pandemic hospital in a city center. A descriptive form, the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS) were used to collect data.

RESULTS

A positive, moderately significant correlation was found between the average PSQI score of nurses and the average perceived stress score (p≤0.001). Multiple regressions determined that shift work, stress level, a coworker having COVID-19, being out of home due to the risk of transmission, and having a person older than 65 in the home were effective predictors of sleep quality (R2 = 33.5, p≤0.001). Age, years worked, fear of infecting the family with COVID-19, receiving COVID-19 education, regular nutrition, and sleep quality were effective predictors of stress level (R2 = 32.2, p≤0.001).

CONCLUSION

It was determined that nurses have low sleep quality and high stress levels during the pandemic process.

The healthy behaviours and COVID-19 mortality among Iranian women: a case-control study

BACKGROUND

Women are among the susceptible groups to Coronavirus disease-19 (COVID-19) in Ardabil, north-west of Iran, despite the current global status. The underlying causes of high incidence and fatality rate of women in Ardabil are not fully understood. Hence, this study aimed to investigate the healthy behaviours in women of Ardabil and its relationship with COVID-19 mortality.

METHODS

We conducted a case-control study to compare the adherence to health protocols and behaviours with respect to COVID-19 between the infected (261 patients) and healthy (515 persons) women. Health protocols and behaviours such as using mask, gloves, disinfectants, history of travelling and contacting, and attending various gatherings and places during the COVID-19 pandemic along with demographic variables were defined as independent variables, and COVID-19 death rate was defined as the dependent variable. Multivariable logistic regression methods were used to explore the risk factors associated with COVID-19 mortality.

RESULTS

Chi-square and Fisher tests showed significant differences between infected and healthy women in terms of history of contact and traveling (p < 0.05), wearing mask (p < 0.001), going to work place (p < 0.001), and attend public gatherings (p = 0.038). Multivariable logistic regression disclosed that the age group over 80 years: 8.97 times (95% CI 2.27-29.85), women with underlying chronic diseases: 4.14 times (95% CI 1.61-10.64), and obese women: 3.01 times (95% CI 1.04-6.03) were more likely to die from COVID-19 than other women.

CONCLUSION

Considering the high incidence and mortality rate in Ardabil women due to COVID-19 and the corresponding health behavioural factors, special emphasis should be given to the increase of women awareness on the importance of healthy behaviours, diet, and life-style.

Effects of the Resilience of Nurses in Long-Term Care Hospitals during on Job Stress COVID-19 Pandemic: Mediating Effects of Nursing Professionalism

Purpose: To investigate nursing professionalism as a mediating factor in the relationship between resilience and job stress levels for nurses working in long-term care hospitals during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted from January to March 2021 in seven long-term care hospitals in the Seoul metropolitan area to measure resilience, nursing professionalism, and job stress among nurses. Simple and multiple regression analyses along with the Sobel test were performed to verify the mediating effect of nursing professionalism. Results: Data from 200 nurses were included in the final analysis. Results showed that individual and occupational characteristics could lead to differences in nurses’ resilience, job stress levels, and nursing professionalism. Nursing professionalism had a significant mediating effect on the relationship between resilience and job stress levels. The effect of resilience on job stress levels was significant (β = −0.16, p = 0.024). After controlling for nursing professionalism, the effect declined and was not statistically significant (β = −0.09, p = 0.251). Conclusion: There is a need to increase individual resilience and nursing professionalism through intervention programs and policy proposals to manage job stress among long-term care hospital nurses during the COVID-19 pandemic.

Healthcare Safety Nets during the COVID-19 Pandemic Based on Double Diamond Model: A Concept Analysis

The purpose of this study was to analyze the concept of the "healthcare safety net" during the COVID-19 pandemic. Walker and Avant's process of concept analysis was used in this systematic literature review. The attributes of the concept of a healthcare safety net during the COVID-19 pandemic were found to be: (a) capacity, (b) accessibility, (c) health equality, and (d) education. In consideration of these defining criteria, antecedents to the concept were identified as: (a) the COVID-19 pandemic, (b) health inequalities (internal factors and external factors), and (c) healthcare systems (health insurance, screening, protective equipment, medicine, and medical services). Consequences of the concept were: (a) meeting healthcare needs, (b) quality of life, and (c) a decrease in morbidity and mortality. A healthcare safety net is an important concept during the COVID-19 pandemic. In situations like COVID-19, healthcare safety nets are designed to meet safety needs, improve quality of life, and reduce patient turnover and mortality. Based on the results of this study, the development of standardized tools for measuring a healthcare safety net as well as that of policies and systems for resolving a healthcare safety net in the COVID-19 situation is recommended.