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Alanazi SZ, Abusharha A, Afsar T, Trembley JH, Razak S. The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia. Front Psychiatry 2024; 15:1391586. [PMID: 38779548 PMCID: PMC11109750 DOI: 10.3389/fpsyt.2024.1391586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Background Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia. Methods This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire. Results The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001). Conclusion The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.
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Affiliation(s)
- Sattam Zaid Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Tayyaba Afsar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Janeen H. Trembley
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
- Minneapolis VA Health Care System Research Service, Minneapolis, MN, United States
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Hutchings HA, Rahman M, Carter K, Islam S, O'Neill C, Roberts S, John A, Fegan G, Dave U, Hawkes N, Ahmed F, Hasan M, Azad AK, Rahman MM, Kibria MG, Rahman MM, Mia T, Akhter M, Williams JG. Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study. BMJ Open 2024; 14:e079350. [PMID: 38453200 PMCID: PMC10921535 DOI: 10.1136/bmjopen-2023-079350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic. METHODS We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). RESULTS Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores. CONCLUSION We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.
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Affiliation(s)
| | - Mesbah Rahman
- Swansea Bay University Health Board, Port Talbot, UK
| | | | | | | | | | | | | | - Umakant Dave
- Swansea Bay University Health Board, Port Talbot, UK
| | - Neil Hawkes
- Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | | | | | | | - Md Golam Kibria
- Sheikh Russel National Gastroliver Institute, Dhaka, Bangladesh
| | | | - Titu Mia
- Mugda Medical College and Hospital, Dhaka, Bangladesh
| | | | - John G Williams
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
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Mejia CR, Serna-Alarcón V, Vilela-Estrada MA, Armada J, Ubillus M, Beraún-Barrantes J, Álvarez-Risco A, Del-Aguila-Arcentales S, Davies NM, Yáñez JA. Prevalence of post-traumatic stress disorder risk post-COVID-19 in 12 countries in Latin America: a cross-sectional survey. Front Public Health 2024; 11:1302694. [PMID: 38264243 PMCID: PMC10804613 DOI: 10.3389/fpubh.2023.1302694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Latin America was the region most affected by COVID-19 in the second quarter of 2020, and consequently, the impact on mental health requires evaluation. The aim of this study was to assess the risk of post-traumatic stress disorder (PTSD) caused by bereavement due to COVID-19 in 12 countries in Latin America. Methods The current study was an analytical cross-sectional study. Validated tests were applied for PTSD, depression, anxiety, and stress (DASS-21), questions about the respondent's condition or their environment, and demographic questions, as well as the length of the mourning period of suffering. Results The outcomes demonstrated that the PTSD risk increased for women (p < 0.001), when a friend or acquaintance had COVID-19 (p = 0.002), when a close relative died from COVID-19 (p = 0.010), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001), Costa Rica (p <0.001) or El Salvador (p = 0.005). On the other hand, there was less risk of PTSD at an older age (p <0.001) or if respondents had a sentimental partner (p = 0.025). In the case of severe PTSD, there was a greater gender risk for women (p <0.001), a close relative dying from COVID-19 (p = 0.017), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001) and Costa Rica (p = 0.002). It was also observed that there was less risk of severe PTSD at an older age demographic (p <0.001). Discussion It can be concluded that the percentages of PTSD are high in its clinical presentation as severe, especially among Latin American women.
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Affiliation(s)
| | - Víctor Serna-Alarcón
- Universidad Privada Antenor Orrego, Piura, Peru
- Hospital Regional José Cayetano Heredia, EsSalud, Piura, Peru
| | - Martín A. Vilela-Estrada
- Universidad Privada Antenor Orrego, Piura, Peru
- Hospital Regional José Cayetano Heredia, EsSalud, Piura, Peru
| | | | | | | | | | | | - Neal M. Davies
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
- Asociación Médica de Investigación y Servicios en Salud, Lima, Peru
| | - Jaime A. Yáñez
- Universidad Peruana de Ciencias Aplicadas, Facultad de Educación, Carrera de Educación y Gestión del Aprendizaje, Lima, Peru
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Covelli V, Camisasca E, Manzoni GM, Crescenzo P, Marelli A, Visco MA, Cafagna D, Marsicovetere V, Pesce M, Cantoia M. After the first lockdown due to the COVID-19 pandemic: Perceptions, experiences, and effects on well-being in Italian people. Front Psychol 2023; 14:1172456. [PMID: 37333603 PMCID: PMC10274577 DOI: 10.3389/fpsyg.2023.1172456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/30/2023] [Indexed: 06/20/2023] Open
Abstract
Background Since the COVID-19 pandemic and the subsequent measures of containment, multiple studies have been conducted aimed at assessing the impacts on people's psychophysical well-being; however, few studies have investigated the general population's perceptions, experiences, and effects by adopting a mixed-method approach. Methods A total of 855 Italian participants completed an online survey, conducted in the period following the first lockdown in Italy. Psychological well-being, perceived stress and COVID-19-related fears were assessed by standardized questionnaires (Psychological General Well-Being Index-Short version, Perceived Stress Scale 10, and Multidimensional Assessment of COVID-19-Related Fears). The process of sense-making of the experience during the lockdown period was also evaluated by means of an open-ended question. Results Participants reported a lower level of general well-being, and a higher level of both perceived stress and COVID-19-related fear during the lockdown period compared to the time of the survey (1 month after the resumption of activities). The thematic analysis of responses to the open-ended question revealed two factors and five clusters, which explain the thematic variance among the narratives: the first factor refers to the type of experience (emotional states and feelings vs. objective descriptions of daily activities), while the second concerns positive or negative connotations of the experiences reported. Conclusions This study explored the psychological impact of the first lockdown on people's well-being, and described the process of making sense of the experience during the lockdown 1 month after going back to previous habits. Results highlighted the effectiveness of the mixed-method approach for an in-depth and exhaustive investigation of people's psychological condition during and after the first lockdown.
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Affiliation(s)
| | | | | | - Pietro Crescenzo
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | | | | | - Dario Cafagna
- Faculty of Psychology, eCampus University, Como, Italy
| | | | - Mario Pesce
- Faculty of Psychology, eCampus University, Como, Italy
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Salazar K, Adams JL, Nies MA, Robinson R, Hedwig T, Hellem T. Our Patients Need Empathy Training across Healthcare Professions. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100011. [PMID: 37288677 DOI: 10.1016/j.ajpe.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/09/2023]
Abstract
Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.
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Affiliation(s)
- Krista Salazar
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | | | - Mary A Nies
- Idaho State University College of Health, Pocatello, ID, USA
| | - Renee Robinson
- Idaho State University College of Pharmacy, Anchorage, AK, USA
| | - Travis Hedwig
- University of Alaska Anchorage College of Health, Anchorage, AK, USA
| | - Tracy Hellem
- Montana State University Mark and Robyn Jones College of Nursing, Bozeman, MT, USA
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Geng W, Cao J, Hong X, Jiang J, Hu J, Duan Y, Wei J. Emotional distress and burnout at a fever clinic in China: Comparison between different periods of COVID-19. Front Psychiatry 2023; 14:1138361. [PMID: 36993920 PMCID: PMC10040564 DOI: 10.3389/fpsyt.2023.1138361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundFrontline healthcare workers (FHWs) experienced psychological stress and heavy workload during COVID-19 pandemic. This study examined the psychological symptoms and occupational burnout of FHWs in a fever clinic during different periods of the pandemic.MethodsA cross-sectional survey of FHWs in the fever clinic of a tertiary hospital was carried out during both the outbreak period and regular period of COVID-19. Psychological measurement instruments including Generalized Anxiety Disorder 7-item, the 9-Question Patient Health Questionnaire, the Maslach Burnout Inventory-Human Service Survey, and the General Self-Efficacy Scale were used to evaluate anxiety, depression, burnout, and self-efficacy, respectively. The correlation between clinical variables was explored.ResultsA total of 162 participants were involved in this study, including 118 FHWs during the outbreak period (Group 1) and 44 FHWs during the regular period (Group 2). Anxiety symptoms were more prevalent in Group 2 (x2 = 27.477) while depressive symptoms were significantly more prevalent in Group 1 (x2 = 69.538). Burnout rate was higher in Group 2 (x2 = 29.526). Self-efficacy was higher in Group 1 (t = 3.194). Burnout was positively correlated with anxiety symptoms (r2 = 0.424) and negatively correlated with self-efficacy (r2 = −0.312).ConclusionAnxiety, depressive symptoms and burnout were prevalent in FHWs during different periods of the COVID-19 pandemic. There is a tendency to be less depressed, but more anxious and burned out over time, although the severity of the pandemic is decreasing. Self-efficacy may be an important factor in protecting FHWs from occupational burnout. Support and intervention plans for FHWs should be made at the institutional level.
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Stogiannos N, Skelton E, Rogers C, Sharma M, Papathanasiou S, Venter RVD, Nugent B, Francis JM, Walton L, Sullivan CO, Abdurakman E, Mannion L, Thorne R, Malamateniou C. Leadership and resilience in adversity: The impact of COVID-19 on radiography researchers and ways forward. J Med Imaging Radiat Sci 2022; 53:S47-S52. [PMID: 36266172 PMCID: PMC9482835 DOI: 10.1016/j.jmir.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/07/2022] [Accepted: 09/13/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Nikolaos Stogiannos
- Division of Midwifery and Radiography, City, University of London, UK,Discipline of Medical Imaging & Radiation Therapy, University College Cork, Ireland,Medical Imaging Department, Corfu General Hospital, Greece,Corresponding author
| | - Emily Skelton
- Division of Midwifery and Radiography, City, University of London, UK,Department of Perinatal Imaging and Health, King's College London, UK
| | | | - Meera Sharma
- Division of Midwifery and Radiography, City, University of London, UK
| | | | - Riaan van de Venter
- Division of Midwifery and Radiography, City, University of London, UK,Department of Radiography, School of Clinical Care Sciences, Faculty of Health Sciences, Nelson Mandela University, South Africa
| | - Barbara Nugent
- Division of Midwifery and Radiography, City, University of London, UK,MRI Safety Matters organisation
| | - Jane M Francis
- Division of Midwifery and Radiography, City, University of London, UK
| | - Lucy Walton
- Division of Midwifery and Radiography, City, University of London, UK
| | - Chris O Sullivan
- Division of Midwifery and Radiography, City, University of London, UK
| | - Edwin Abdurakman
- School of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Liam Mannion
- Division of Midwifery and Radiography, City, University of London, UK
| | - Richard Thorne
- Division of Midwifery and Radiography, City, University of London, UK
| | - Christina Malamateniou
- Division of Midwifery and Radiography, City, University of London, UK,School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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Lin C, Siao S, Lin Y, Hsin P, Shelley M, Lee Y. Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID-19: A scoping review. J Nurs Scholarsh 2022; 55:79-96. [PMID: 36138561 PMCID: PMC9538970 DOI: 10.1111/jnu.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic. METHODS This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings. FINDINGS Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively. CONCLUSION The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics. CLINICAL RELEVANCE EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.
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Affiliation(s)
- Chia‐Hung Lin
- School of Nursing, College of MedicineNational Taiwan UniversityTaipeiTaiwan,Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
| | - Shu‐Fen Siao
- School of Nursing, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - You‐Jie Lin
- Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
| | - Pin‐Hsien Hsin
- Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
| | - Mack Shelley
- Department of Political Science, Department of StatisticsIowa State UniversityAmesIowaUSA
| | - Yen‐Han Lee
- Department of Health Sciences, College of Health Professions and SciencesUniversity of Central FloridaOrlandoFloridaUSA
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Davey Z, Srikesavan C, Cipriani A, Henshall C. It’s What We Do: Experiences of UK Nurses Working during the COVID-19 Pandemic: Impact on Practice, Identity and Resilience. Healthcare (Basel) 2022; 10:healthcare10091674. [PMID: 36141286 PMCID: PMC9498531 DOI: 10.3390/healthcare10091674] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 01/28/2023] Open
Abstract
The COVID-19 pandemic increased pressure on a nursing workforce already facing high levels of stress, burnout, and fatigue in the United Kingdom (UK) and internationally. The contribution of nurses to keeping the public safe was widely recognised as they met the challenges of delivering complex patient care during the healthcare crisis. However, the psychological impact of this on nurses’ health and wellbeing has been substantial, and the number of nurses leaving the profession in the UK is rising. The aim of this study was to explore the experiences of nurses working during the COVID-19 pandemic and the impact of this on their psychological health, wellbeing and resilience. The study is part of a wider project to develop and pilot an online resilience intervention for nurses during COVID-19. Five focus groups with 22 nurses were carried out online. Data was analysed thematically using the Framework Method. Four key themes relating to positive and negative impacts of working during the pandemic were identified: Rapid changes and contexts in flux; loss and disruption; finding opportunities and positive transformation; and reinforcing and strengthening identity. Implications for coping and resilience in nursing, nursing identities and workforce development are discussed.
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Affiliation(s)
- Zoe Davey
- Oxford Institute of Nursing Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0FL, UK
- Correspondence:
| | - Cynthia Srikesavan
- Oxford Institute of Nursing Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0FL, UK
| | - Andrea Cipriani
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, UK
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health, Oxford OX3 7JX, UK
| | - Catherine Henshall
- Oxford Institute of Nursing Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0FL, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health, Oxford OX3 7JX, UK
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