Mixed Method Study to Explore Ethical Dilemmas and Health Care Workers' Willingness to Work Amid COVID-19 Pandemic in Palestine

Covid-19 pandemic? Mental health implications among nurses and Proposed interventions

Background

With its abrupt and huge health and socio-economic consequences, the coronavirus disease (COVID-19) pandemic has led to a uniquely demanding, intensely stressful, and even traumatic period. Healthcare workers (HCW), especially nurses, were exposed to mental health challenges during those challenging times.

Objectives

Review the current literature on mental health problems among nurses caring for COVID-19 patients.

Methods

This is a narrative review and critical evaluation of relevant publications.

Results

Nurses experienced higher levels of stress, burnout, anxiety, depression, frustration, stigma, and depersonalization compared to other HCW. Factors that increased this symptomatology included concerns about infection or infection of family members, inadequate staff protective equipment, extended working hours, insufficient information, a reduced sense of security, and post-traumatic stress disorder. The factors that improved the psychopathology included a general positive attitude, job satisfaction, adequate information and education, harmonious group relationships, post-traumatic development, emotional intelligence, psychological counseling, mindfulness-based stress reduction, stable leadership, guidance, and moral and practical administrative support.

Conclusions

Recent studies clearly show that nurses, especially women, are the most vulnerable subgroup among HCW and are particularly prone to mental health impacts during the COVID-19 pandemic. The documented mental health vulnerability of frontline nursing staff during the COVID-19 pandemic requires preventive nursing management actions to increase resilience and to develop relevant defense mechanisms.

Assessment of Physicians' Willingness to Work with Patients Not Yet Diagnosed with COVID-19 in a Romanian Sample

BACKGROUND

The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk.

METHODS

In the summer of 2020, 1285 Romanian physicians participated in a single-center study. Participants (mean age = 48.21 years; 302 males and 982 females, all specialties) completed a series of single-item measures adapted from previous studies on work ethics and responsibility. This study used Mann-Whitney comparisons between physicians who reported that they knowingly had direct contact with COVID patients and those who did not regarding their willingness to work.

RESULTS

Compared with their colleagues, physicians who reported not knowingly having direct contact with COVID patients reported less access to protective equipment, less overall willingness to respond when asked to work with infected patients, more likely to work out of fear of losing their jobs, and fear of legal repercussions. They received less training in the use of protective equipment.

CONCLUSIONS

Physicians who worked with patients not yet diagnosed with COVID-19 were significantly less willing to work. The perception of invisible risk may explain the observed differences.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Impact of COVID-19 pandemic on health care workers (HCWs) in Sindh Province of Pakistan

BACKGROUND

In Pakistan, the COVID-19 outbreak posed a significant challenge for healthcare workers in the country's public hospitals. The HCWs faced several problems in terms of the COVID-19 pandemic. Therefore this study investigated how the COVID-19 pandemic has affected the medical staff at the public hospital in Sindh Province, Pakistan.

METHODS

In this study, a qualitative exploratory design was used. Semi-Structure interviews (SSI) were conducted by using an open-indeed questionnaire (OIQ) for data collection. An inductive approach was used for theoretical data analysis. A total of 320 HCWs participated to complete the criteria of the study from 10 different public hospitals.

RESULTS

The study result showed the Sindh public hospital's insufficient infrastructure, lack of health protective equipment, shortages of isolation rooms and beds, and emergencies during the COVID-19 pandemic caused HCWs to experience physical and psychological weariness, sleep disturbance, mental stress, and fear of infection.

CONCLUSION

The study concluded that public hospitals' insufficient infrastructure, furniture, emergency wards, and safety equipment during the COVID-19 pandemic significantly damaged HCWs' physical and psychological health, generating fear of infection and sleep disturbance. Additionally, Sindh healthcare workers' fear of illness and isolation may impair family connections.

Lessons for Medical and Health Education Learned from the COVID-19 Pandemic

Our paper analyzes lessons for medical education and health education stemming from the experience gained in the course of the COVID-19 pandemic. Moreover, it tackles the issue of the social health and psychological wellbeing of medical students involved in online education during the COVID-19 pandemic. The paper systematizes up-to-date data on how medical schools and universities have adapted to the conditions of the COVID-19 pandemic and implemented novel effective solutions for the learning process, such as transitioning from traditional in-person classes to online learning, incorporating virtual simulations and telemedicine experiences for clinical training, and collaborating with health authorities to provide support in testing and contact tracing efforts. The paper contains an analysis of various aspects of medical education, such as the changes in practical classes, the impact of the pandemic on the formation of communication skills, methods for assessing students' knowledge and skills, and many others. It also considers case studies related to the implementation of educational programs, methodologies, and novel digital technologies in a pandemic. Additionally, the paper features an empirical study that is based on the results of our own survey that was carried out with the help of a snowball convenient sampling that involved 710 medical students between 19 and 25 years of age (56% females and 44% males) from 4 Russian regions (Moscow, Krasnodar, Kazan, and Saint Petersburg). We applied the correlation between stress scores, anxiety scores, factors of stress, and strategies for coping with stress and various economic and demographic variables (age, environment, and gender) that were analyzed using the chi-square test. Our results demonstrate that over 85% of the students in our sample yielded an above-average vulnerability to stress due to the COVID-19 restrictions. At the same time, around 61% of the students experienced severe anxiety during online education in the COVID-19 pandemic. The important factors leading to stress and anxiety were the fear of getting infected and social distancing, and the best strategy to deal with stress and increase wellbeing was self-control. Through a comprehensive review of the literature and empirical estimations, our paper identifies key areas of improvement, including curriculum adaptation, technology integration, faculty development, student support, and interprofessional collaboration. The proposed recommendations aim at strengthening medical education systems and preparing healthcare professionals to effectively navigate future pandemics.

Factors associated with the SARS-CoV-2 infection among health professionals from university hospitals

to investigate factors associated with the SARS-CoV-2 infection among health professionals from university hospitals. a multicenter, mixed approach study with concomitant incorporated strategy, carried out with 559 professionals in the quantitative stage, and 599 in the qualitative stage. Four data collection instruments were used, applied by means of an electronic form. The quantitative analysis was performed with descriptive and inferential statistics and the qualitative data were processed by means of content analysis. the factors associated with the infection were as follows: performance of the RT-PCR test (p<0.001) and units offering care to COVID-19 patients (p=0.028). Having symptoms increased 5.63 times the prevalence of infection and adhering to social distancing most of the time in private life reduced it by 53.9%. The qualitative data evidenced difficulties faced by the professionals: scarcity and low quality of Personal Protective Equipment, work overload, physical distancing at work, inadequate processes and routines and lack of a mass screening and testing policy. the factors associated with the SARS-CoV-2 infection among health professionals were mostly related to occupational issues.

Evaluating the impact of COVID-19 pandemic on the physicians' psychological health: A systematic scoping review

Background

COVID-19 has endangered healthcare systems at multiple levels worldwide. Published data suggests that moral dilemmas faced during these unprecedented times have placed physicians at the intersections of ethical and unethical considerations. This phenomenon has questioned the physicians' morality and how that has affected their conduct. The purpose of our review is to tap into the spectrum of the transforming optics of patient care during the pandemic and its impact on psychological wellbeing of physicians.

Methods

We adopted the Arksey and O'Malley's framework, defining research questions, identifying relevant studies, selecting the studies using agreed inclusion and exclusion criteria, charting the data, and summarizing and reporting results. Databases of PubMed/Medline, Web of Science, Scopus, Science Direct, CINAHL, and PsycInfo were searched using a predefined search string. The retrieved titles and abstracts were reviewed. Later, a detailed full-text analysis of the studies which matched our inclusion criteria was performed.

Results

Our first search identified 875 titles and abstracts. After excluding duplicates, irrelevant, and incomplete titles, we selected 28 studies for further analysis. The sample size in 28 studies was 15,509 with an average size of 637 per study. Both quantitative and qualitative approaches were used, with cross-sectional surveys being utilized in all 16 quantitative studies. Using the data from semi-structured interviews, several discrete codes were generated, which led to the identification of five main themes; mental health, individual challenges, decision-making, change in patient care, and support services.

Conclusion

This scoping review reports an alarming rise in psychological distress, moral injury, cynicism, uncertainty, burnout, and grief among physicians during the pandemic. Decision-making and patient care were mostly regulated by rationing, triaging, age, gender, and life expectancy. Poor professional controls and institutional services potentially led to physicians' crumbling wellbeing. This research calls for the remediation of the deteriorating mental health and a restoration of medical profession's advocacy and equity.

Patience and its relationship to stress tolerance in relation to demographic factors of the medical system in Bethlehem Governorate during the COVID-19 pandemic

Objective

The present study aims to identify the relationship between patience and stress tolerance in the medical system in Bethlehem Governorate during the COVID-19 pandemic, as well as to identify the impact of several demographic variables on it.

Methods

A random sample of 160 members/workers of the medical staff completed the Patience Scale and Coping Processes Scale questionnaire.

Results

It showed there is a significant positive effect for patience on stress tolerance and there were statistically significant differences in the level of patience in favor of males and single workers. It was also found that there is no difference in the specific duties of a health care worker and no variance of statistical evidence was found in the level of patience due to work with COVID patients but there were differences in stress tolerance in favor of those who do not work with COVID patients. It was also found that there is a significance in the level of stress tolerance in favor of the National Center in regard to bearing pressure. The study findings indicate there was a negative correlation with statistical significance between stress tolerance and age. The nature of stress changes with age, from episodic to chronic, which in turn affects appraisal and coping processes.

Conclusion

This study, which was conducted on a sample of Palestinian medical workers in the Bethlehem area, showed that at the beginning of the pandemic, the medical system in Palestine was not ready to handle COVID-19, and had no precautions to prevent the disease. In spite of that, the doctors and nurses who were undergoing psychological pressure were able to stand at the front line and face the outbreak of the coronavirus.

Effect of COVID-19 Frontline Nurses' Profession Perception on Their Intention to Stay: The Mediating Role of Job Satisfaction

Introduction

Understanding the factors affecting the intention of frontline nurses during the coronavirus disease (COVID-19) pandemic to stay in the nursing profession is essential for developing strategies to overcome the challenges associated with the pandemic.

Objectives

This study aimed to examine the mediating effect of nurses' job satisfaction on the relationship between their sense of calling, job-esteem, and the intention to stay in their profession.

Methods

The study used a previously collected dataset, sourced from a dedicated COVID-19 hospital in Seoul City, South Korea. Original data were collected from June to July 2021. The study sample consisted of 134 nurses who provided direct care to patients. The intention to stay was measured with the following question: "Are you willing to work during this COVID-19 pandemic?". The Job Satisfaction Scale from the Korean Labor and Income Panel Study, Korean version of a Multidimensional Calling Measure, and Job-Esteem Scale for Hospital Nurses were utilized. Associations between the study variables were estimated using bivariate correlation analyses and bootstrapping mediation analyses.

Results

In the bivariate correlation analysis, nurses' sense of calling (r = .36, p < .001), job-esteem (r = .32, p < .001), and job satisfaction (r = .39, p < .001) were significantly associated with the intention to stay. In the mediation analysis, job satisfaction partially mediated the relationship between the sense of calling and the intention to stay (total effect; B = 0.410, p < .001) and fully mediated the relationship between job-esteem and the intention to stay (total effect; B = 0.549, p < .001).

Conclusion

Enhancing nurses' job satisfaction is crucial for fostering the retention of the nursing workforce amid the pandemic. Consequently, it is imperative to closely examine the job satisfaction and work environment of frontline nurses to identify areas in need of improvement. Addressing the factors that impede nurses' job satisfaction is essential to unlock the positive effects of a sense of calling and job-esteem.

Exploring primary healthcare practitioners' experiences regarding the coronavirus disease 2019 (COVID-19) pandemic in KwaZulu-Natal, South Africa

BACKGROUND

The coronavirus disease 2019 (COVID-19) has spread rapidly around the world since the initial outbreak in Wuhan, China. With the emergence of the Omicron variant, South Africa is presently the epicentre of the COVID-19 pandemic in sub-Saharan Africa. Healthcare workers have been at the forefront of the pandemic in terms of screening, early detection and clinical management of suspected and confirmed COVID-19 cases. Since the beginning of the outbreak, little has been reported on how healthcare workers have experienced the COVID-19 pandemic in South Africa, particularly within a low-income, rural primary care context.

METHODS

The purpose of the present qualitative study design was to explore primary healthcare practitioners' experiences regarding the COVID-19 pandemic at two selected primary healthcare facilities within a low-income rural context in KwaZulu-Natal, South Africa. Data were collected from a purposive sample of 15 participants, which consisted of nurses, physiotherapists, pharmacists, community caregivers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. Audio recordings were transcribed verbatim. Data were analysed manually by thematic analysis following Tech's steps of data analysis.

RESULTS

Participants reported personal, occupational and community-related experiences related to the COVID-19 pandemic in South Africa. Personal experiences of COVID-19 yielded superordinate themes of psychological distress, self-stigma, disruption of the social norm, Epiphany and conflict of interest. Occupational experiences yielded superordinate themes of staff infections, COVID-19-related courtesy stigma, resource constraints and poor dissemination of information. Community-related experiences were related to struggles with societal issues, clinician-patient relations and COVID-19 mismanagement of patients.

CONCLUSION

The findings of this study suggest that primary healthcare practitioners' experiences around COVID-19 are attributed to the catastrophic effects of the COVID-19 pandemic with the multitude of psychosocial consequences forming the essence of these experiences. Ensuring availability of reliable sources of information regarding the pandemic as well as psychosocial support could be valuable in helping healthcare workers cope with living and working during the pandemic.

Duty to Work During the COVID-19 Pandemic: A Cross-Sectional Study of Perceptions of Health Care Providers in Jordan

Introduction

This study aimed to assess perceptions of duty to work among health care providers during the coronavirus disease 2019 response and to identify factors that may influence their perceptions.

Methods

This was a cross-sectional study conducted from April 1, 2020, to April 20, 2020, using an online survey distributed to health care providers in Jordan. Descriptive statistics were used, as well as chi-square test for independence to assess relationships between variables.

Results

A total of 302 questionnaires were included. Commitment to serve the community was the primary reason for coming to work (36%), followed by commitment to faith (29.6%). The major perceived barriers for coming to work were lack of appropriate personal protective equipment and appropriate training (62.6% and 53.5%, respectively). Males perceived higher work obligations than females in all potential barriers (P < .05), except for the lack of appropriate training. Nurses perceived higher work obligations than other health care providers despite the lack of appropriate training (χ² = 11.83, P = .005), lack of effective vaccine or treatment (χ² = 21.76, P < .001), or reported infection among coworkers (χ² = 10.18, P = .03).

Discussion

While the majority of health care providers perceive an obligation to work during the coronavirus disease 2019 pandemic, specific conditions, mainly lack of protective gear and training, may significantly alter their perception of work obligation. Providing training and proper personal protective equipment are among the vital measures that could improve the work environment and work obligation during pandemic conditions.

Experiences of redeployed healthcare workers in the fight against COVID-19 in China: A qualitative study

Introduction

Public health responses were triggered while COVID-19 was spreading. China redeployed healthcare workers to serve the most vulnerable populations and communities in the initial epicentre—Wuhan. However, it is not known how redeployment processes impacted on healthcare workers in a pandemic crisis.

Aims

To explore the experiences and needs of frontline healthcare workers who were redeployed to care for COVID-19 patients in Wuhan, China, and understand the long-term impacts of the redeployment experience on their work and life.

Methods

A qualitative study was conducted with redeployed healthcare workers using semi-structured interviews and thematic analysis. This study is reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) guidelines.

Findings

A total of 20 redeployed healthcare workers (13 nurses and seven physicians) participated, and four themes were generated: (1) Initial feelings and emotions of redeployment—Participants experienced worries and concerns, a sense of isolation and loneliness on their arrival to the epicentre. (2) ‘It is like a war zone’—Healthcare workers faced a range of risks and challenges of caring for COVID-19 patients in Wuhan in the context of resource strain. (3) Uncertainty and coping strategies in patient care—Despite the hardships experienced, participants continued to deliver high-quality patient care including psychological care and palliative care, good communication and building mutual trusting relationships. (4) Reflection and far-reaching impacts of caring for COVID-19 patients—Participants felt motivated and encouraged as efforts were recognised by the government and wider society.

Conclusions

Redeployed healthcare workers shared their unique needs and experiences of coping with redeployment and challenges they faced in the context of resource strain, which has significant implications for policy and future practice. The reality of a pandemic may reduce healthcare workers’ willingness to work due to various reasons including inadequate preparedness of facilities and workplace safety. It is important to support frontline healthcare workers in order to maintain an adequate healthcare workforce in pandemic crises. Continuously evolving pandemic circumstances and uncertainty highlight the importance of an organized national pandemic response plan for subsequent waves of COVID-19 and future pandemics.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

Work Stress and Willingness of Nursing Aides during the COVID-19 Pandemic

Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, nursing aides (NAs) experienced greater work stress than they do typically because they worked in highly contagious environments. This may have influenced their work morale and willingness to work, which can reduce patient satisfaction, influence their physical and mental health, and even endanger patient safety or cause medical system collapse. Design: A cross-sectional survey with a structured self-report questionnaire was conducted. Setting and Participants: 144 NAs from a medical center in Central Taiwan participated. Methods: We recruited NAs through convenience sampling to discuss their work stress, willingness to work, and patients’ satisfaction with them during the COVID-19 pandemic. Result: Of the 144 recruited NAs, 115 (79.9%) were women and 29 (20.1%) were men, and 89 (61.8%) had completed COVID-19 training courses. NAs with different work tenure lengths exhibited significant differences in work stress (p = 0.022), willingness to work (p = 0.029), and patient satisfaction (p = 0.029) scores during the pandemic. Conclusion: The study findings provide crucial data for the management of NAs during pandemics to prevent them from neglecting patients due to excessive work stress or losing their willingness to work, which may cause the medical system to collapse.

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.

COVID-19-related anxieties: Impact on duty to care among nurses

Background

Duty to care is integral to nursing practice. Personal obligations that normally conflict with professional obligations are likely amplified during a public health emergency such as COVID-19. Organizations can facilitate a nurse’s ability to fulfill the duty to care without compromising on personal obligations.

Research Aim

The study aimed to explore the relationships among duty to care, perception of supportive environment, perceived stress, and COVID-19-specific anxieties in nurses working directly with COVID-19 patients.

Research Design

The study design was a cross-sectional descriptive study using an online survey. It was conducted at an ANCC Magnet® designated 385-bed acute care teaching hospital located in a suburban area.

Participants and Research Context

Included in this study were 339 medical surgical nurses working directly with COVID-19 patients during the early phase of the pandemic.

Ethical Considerations

The study was reviewed by the institution’s clinical research committee and determined to be exempt. A survey invitation letter with a voluntary implied consent agreement was sent to participants with a description of the research study attached to the anonymous survey.

Results

Nurses with specific COVID-19-related anxieties were more likely to agree that it was ethical to abandon the workplace during a pandemic.

Conclusions

Organizations can and ought to mitigate the negative effects of COVID-19 on duty to care in future pandemics and healthcare emergencies by incorporating several recommendations derived from this study.

The duty to care and nurses' well-being during a pandemic

Background:

The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns.

Aim:

This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to (1) identify nurses’ agreement with the duty to care despite high risks for themselves and/or their families, (2) describe nurses’ well-being and (3) describe the associations between well-being and the duty to care.

Research design:

Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution (snowball sampling).

Ethical considerations:

The Institutional Ethical Review Committees in both countries approved the study (CHUC_2020_33 and 27/2020).

Findings:

In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care.

Discussion:

Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being.

Conclusion:

Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic.

An evaluation of moral distress among healthcare workers during COVID-19 pandemic in Palestine

BACKGROUND

Moral distress among healthcare workers (HCWs) is considered a serious issue in all aspects of healthcare divisions, which needs an urgent intervention.

AIMS

The study aims at evaluating moral distress among HCWs which will help the healthcare management and decision-makers in hospitals and health centers to act in a comprehensiveness and effective way by reinforcing moral thinking and behavior in selected coronavirus (COVID-19) quarantine centers across Palestine.

METHODS

Ninety-four HCWs were selected by convenience sampling method. Data were collected using revised Corley's Standard Moral Distress (MD) Scale and analyzed using SPSS software version 23.

RESULTS

The mean score of MD for HCWs was low (1.24 ± 0.71). The mean score of MD severity was moderate (1.4 ± 0.93). The severity and frequency of MD in HCWs had a significant reverse relationship with years of experience, number of children of worker, and duration of work with COVID-19 patients.

CONCLUSION

It is important to create a professional psychological support system for HCWs to decrease MD when facing moral issues.

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically and morally challenging situations during the COVID-19 pandemic that increase their risk for the development of moral distress (MD) and moral injury (MI). To date, however, the global circumstances that confer risk for MD and MI in these cohorts have not been systematically explored, nor have the unique circumstances that may exist across countries been explored. Here, we sought to identify and compare, across the globe, potentially morally injurious or distressful events (PMIDEs) in HCWs and PSP during the COVID-19 pandemic. A scoping review was conducted to identify and synthesize global knowledge on PMIDEs in HCWs and select PSP. Six databases were searched, including MEDLINE, EMBASE, Web of Science, PsychInfo, CINAHL, and Global Health. A total of 1,412 articles were retrieved, of which 57 articles were included in this review. These articles collectively described the experiences of samples from 19 different countries, which were comprised almost exclusively of HCWs. Given the lack of PSP data, the following results should not be generalized to PSP populations without further research. Using qualitative content analysis, six themes describing circumstances associated with PMIDEs were identified: (1) Risk of contracting or transmitting COVID-19; (2) Inability to work on the frontlines; (3) Provision of suboptimal care; (4) Care prioritization and resource allocation; (5) Perceived lack of support and unfair treatment by their organization; and (6) Stigma, discrimination, and abuse. HCWs described a range of emotions related to these PMIDEs, including anxiety, fear, guilt, shame, burnout, anger, and helplessness. Most PMIDE themes appeared to be shared globally, particularly the 'Risk of contracting or transmitting COVID-19' and the 'Perceived lack of support and unfair treatment by their organization.' Articles included within the theme of 'Stigma, discrimination, and abuse' represented the smallest global distribution of all PMIDE themes. Overall, the present review provides insight into PMIDEs encountered by HCWs across the globe during COVID-19. Further research is required to differentiate the experience of PSP from HCWs, and to explore the impact of social and cultural factors on the experience of MD and MI.

Prevalence of SARS-CoV-2 antibodies in the Palestinian population: A primary health center-based cross-sectional study

This study aimed to assess the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) total antibodies in the north, middle, and south regions of West Bank and the prevalence of SARS-CoV-2 specific antibodies (IgA, IgM, and IgG) in the Palestinian population. This was a cross-sectional study. The serological and epidemiological data of 1269 persons were assessed. Participants were selected randomly among primary health care center attendees in Palestine between November 1, 2020 and December 31, 2020. All serum samples were tested for total antibodies using an enzyme-linked immunosorbent assay (ELISA) test. IgM, IgG, and IgA-specific antibody titers were measured using ELISA. The overall prevalence (with 95% confidence intervals [CIs]) of SARS-CoV-2 total antibodies and specific antibodies were estimated. A multivariate regression model was used to assess the predictive factors for SARS-CoV-2-specific antibodies. The overall seroprevalence of SARS-CoV-2 antibodies was 24·0% (95% CI, 21·7%–26·5%). Seroprevalence was significantly higher among people living in south West Bank (adjusted Odds ratio [aOR], 2·22; 95% CI: 1·58–3·11), people who had COVID-19 symptoms (aOR, 3·92; 95% CI, 2·83–5·43), people with a COVID-19 contact history (aOR, 1·44; 95% CI, 1·03–2·03), patients with hypertension (aOR, 1·57; 95% CI, 1·06–2·33), and non-smokers (aOR, 0·47; 95% CI, 0·31–0·72). A total of 171 blood samples from SARS-CoV-2-positive patients were chosen at random for additional serological testing. Specific IgM, IgG, and IgA antibodies were positive in 14·0% (95% CI, 9·2%–20·2%), 88·3% (82·5%–92·7%), and 42·1% (34·6%–59·9%) of the samples, respectively. SARS-CoV-2 antibodies were common among PHC center attendees and were significantly associated to sex, smoking, and COVID-19 contact history. However, considering that almost three-quarters of this population remains susceptible, maintaining public health measures and encouraging access to immunization is critical in protecting this population.

Work Stress Hampering Employee Performance During COVID-19: Is Safety Culture Needed?

During uncertain situations, such as the COVID-19 partial lockdown, maintaining satisfactory levels of employee performance (EP) is an important area of concern for many organizations. The current study examines the relationship of work stress due to COVID-19 (COVID-19 STR) and EP. Using social exchange theory (SET), safety culture (SC) is presented as a moderator for stress and performance relationships. A sample of 213 bank employees was collected using a convenient sampling method. Data were analyzed using stepwise linear regression and PROCESS Macro by Hayes (2013). Results revealed that COVID-19 STR has a negative impact on task and contextual performance (CP) and a positive impact on adaptive performance (AP). Similarly, the prevalence of SC significantly moderates the stress and performance relationships.

Demographic factors associated with COVID-19-related death in Palestine

Objectives

Understanding the case and death rates of COVID-19 in different countries should include socio-demographic variables to better guide health policies. We analysed COVID-19 cases in the Occupied Palestinian Territories (OPT) with attention to socio-demographic factors.

Study design

A retrospective chart review of laboratory confirmed COVID-19 cases was conducted between March and September 2020.

Methods

Demographic data such as age, gender, place of residence, pregnancy, and symptoms were analysed. Patients were divided into two outcome groups: discharged from quarantine restrictions and dead.

Results

A total of 15,338 confirmed cases was examined. COVID-19 cases tended to be young (48.2% were less than 30 years of age) with an average age of 34.3 ± 27.3, most were female (55.5%),and 20% smoked. Overall, 5183 (38%) were symptomatic and if pregnant, symptoms were more commonly reported (65.3%). The overall case-fatality was 0.93 [95% CI 0.83–1.04]. Males had a greater risk of death (OR = 2.7 [95%CI = 1.7–2.8], P < 0.001), as did those 60 years of age and older (OR = 52.0 [30.5–89.7], P < 0.001).

Conclusion

Early detection of socio-demographic risk factors helps understand the case distribution and guide better planning, especially in countries with limited resources. Better targeting of interventions may help to limit more expensive interventions such as intensive care admissions and avoid deaths. Such data are also important for planning vaccination campaigns.

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Data on high-risk groups in COVID 19 will help inform the national strategy.

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Women are more likely to develop COVID 19, but men are more likely to die from it.

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Spatial relation is also factored into COVID 19 deaths.

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There is a 52-fold higher risk of death among COVIDs aged 60 years and over.