Hospital Preparedness, Resilience, and Psychological Burden Among Clinical Nurses in Addressing the COVID-19 Crisis in Riyadh, Saudi Arabia

Organizational resilience and its implications for healthcare workers in the COVID-19 pandemic: A literature review

Background

Organizational resilience is crucial in supporting the well-being of healthcare workers and ensuring the quality of healthcare services during crises like the COVID-19 pandemic. This study aims to comprehensively review organizational resilience of healthcare facilities in terms of its conception, measurement, and impacts on healthcare workers during the COVID-19 pandemic.

Methods

A search was conducted in four databases (PubMed, ScienceDirect, PsycINFO, and Web of Science) for empirical articles considering organizational resilience among healthcare facilities during the COVID-19 pandemic from 2019 to 2024. Several keywords from three categories ("COVID-19", "organizational resilience," and "healthcare facilities") were used, and RAYYAN was used to manage references.

Results

Four empirical articles from 172 studies were included, which encompassed a total sample of 6,606 healthcare workers from Switzerland, Saudi Arabia, Iran, and Türkiye. Organizational resilience could influence the individual resilience of healthcare practitioners, enhance crisis management and ensure safety performance. The strategies of enhancing organizational resilience at healthcare worker level included staff training, crisis management protocols, collaboration promotion, and stress management approaches. The ones at health facility level included government intervention, funds for hospital preparedness, competency-based crisis management, and mental health programs for healthcare workers. Our review also suggests a lack of empirical studies, no commonly used measurement instruments, and the heterogeneity of study contexts in the research of organizational resilience in public health.

Conclusions

This review highlights effective strategies to enhance the organizational resilience of healthcare workers and examines their impact during the COVID-19 pandemic. Immediate government action, funding to support hospital preparedness, and the formation of flexible healthcare teams are essential to strengthen organizational resilience among healthcare workers for future crises.

Conflict occurrence and preferred management styles among ICU nurses during the first wave of COVID-19 pandemic: A cross-sectional study in Saudi Arabia

BACKGROUND

Intensive care units (ICUs) have been overwhelmed by the increasing number of coronavirus disease 2019 (COVID-19) cases, causing psychological burdens, stress, and various types of conflict among nurses.

AIM

To examine the occurrence, type, and intensity of conflict and preferred management styles among ICU nurses during the COVID-19 pandemic.

STUDY DESIGN

This cross-sectional descriptive study was conducted in a government hospital in Saudi Arabia using a convenience sample of 95 nurses from three ICUs. Data were collected using an e-questionnaire comprising the Nursing Conflict Scale, Rahim Organizational Conflict Inventory-II, and sociodemographic variables.

RESULTS

Most participants reported exposure to moderately (64.2%) or highly (34.79%) intense conflict during the pandemic. The competitive (2.23 ± .472) and intragroup (2.23 ± .385) types of conflict were the most frequently reported. The preferred conflict management style was collaborating (21.85 ± 5.49), followed by accommodating (18.39 ± 4.03). Pearson's correlation analysis showed that age, years of experience, and education were significantly associated with conflict type and management style. Preparedness to care for suspected or confirmed COVID-19 cases was associated with interpersonal conflict (r = .20, p = .04).

CONCLUSIONS

The participants experienced moderate- to high-intensity conflict; however, they employed constructive rather than destructive management styles.

RELEVANCE TO CLINICAL PRACTICE

Nurse leaders, policymakers, and educators must initiate transformational intervention programmes to enhance and sustain nurses' competencies in constructive conflict management strategies. Interpersonal communication and crisis management training programmes should be formulated to raise nurses' awareness and enhance their competencies vis-à-vis taking a positive approach to overcoming various conflict types and levels, particularly during crises.

Mental Illnesses and Quality of Sleep Among Nurses Working at a Tertiary Hospital in Riyadh During the COVID-19 Pandemic

Objectives This study primarily aimed to estimate the prevalence of mental illnesses (depression, anxiety, and stress) along with the poor quality of sleep, with a secondary focus on determining whether there was an association between mental health and quality of sleep among nurses working at King Khalid University Hospital, Riyadh, Saudi Arabia, during the COVID-19 pandemic. Methods A cross-sectional study was conducted from June to December 2021 during the COVID-19 pandemic on 309 nurses from different departments at King Khalid University Hospital. Depression, anxiety, and stress were measured by the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21), and sleep quality was measured by the Pittsburg Sleep Quality Index (PSQI) via an online survey. Results The prevalence of depression, anxiety, and stress was 30.4%, 43.7%, and 16.5%, respectively, while 61.5% showed poor sleep quality. The association between poor quality of sleep and the other outcome variables of mental health (depression, anxiety, and stress) was highly significant (p<0.0001). Conclusion Nurses have reported an increased prevalence of depression, anxiety, stress, and poor quality of sleep during the COVID-19 pandemic, making them particularly vulnerable to mental illnesses and sleep difficulties in the event of future pandemics. There is a clear link between mental health issues and poor quality of sleep, necessitating the provision of psychological support for nurses. Enhancing sleep quality is recommended as a way to decrease the prevalence of mental health concerns.

The impact of COVID-19 on patient engagement with primary healthcare: lessons from the saudi primary care setting

BACKGROUND

There have been significant achievements in controlling COVID-19 in Saudi Arabia (SA), but as in most healthcare settings worldwide, health services have been seriously disrupted. Also, with pandemic control measures such as lockdowns and curfews, and innovations such as digital health services, the delivery of primary healthcare (PHC) services has dramatically changed. However, little is known about patients' experiences of PHCs during the pandemic, their views on the pandemic-related interventions in SA, and patient views on impact on their medical care.

METHODS

Qualitative semi-structured online interviews were conducted for twenty-four Saudi patients across SA aged 18 and above who were diverse in terms of age, gender, education and health status. Data were analysed using thematic analysis yielding four major themes as an impact of COVID-19 on patient engagement with PHCs.

RESULTS

The COVID-19 pandemic has had profound mixed impacts on patient engagement with PHC in SA. Fear of infection or of breaking lockdown rules has negatively impacted the utilisation of PHCs but positively changed patients' attitudes towards seeking medical help for self-limiting conditions. The pandemic has also negatively impacted routine preventive care at PHCs, especially for patients with long-term health conditions. The mandatory use of some digital health services in SA that existed pre-pandemic has provided patients with a perception of better care during the pandemic. Yet, a lack of awareness of optional digital health services, such as virtual clinics, hindered optimal use. Despite pandemic-related disruption of patient engagement with PHCs, the reduced waiting time in PHC centres and healthcare providers' communication and empathy during the pandemic contributed to patients' perceptions of better care compared to pre-pandemic. However, patients living outside the main cities in SA perceived care quality as less good during the pandemic compared to PHCs in the main cities in SA.

CONCLUSION

The lessons learned from patients' experiences and views of PHCs during the pandemic were beneficial in promoting patient engagement with PHCs. The digital health services mandated in response to the pandemic have accelerated digital health innovation in SA and allowed patients to recognise the benefits of digital health. This has huge potential for increasing continuous patient engagement with PHCs. Yet, patients' experiences of digital health services during the pandemic are essential for informing appropriate implementation and utilisation of e-health services. Patients' positive experiences of PHCs during the pandemic, such as the reduction in waiting times and the perception of improved healthcare providers' professionalism, communication and empathy, can be built on to sustain engagement with PHC services. These findings might have significance for clinicians and policymakers to support patient engagement with PHCs, particularly in healthcare systems like SA that struggle with the overuse of emergency departments (EDs) for PHC-treatable conditions.

Influence of the Psychological Effect of COVID-19 on Saudi Student Nurses' Attitudes toward Nursing and Their Future Career Plans

BACKGROUND

The effects of COVID-19 on the attitude of student nurses toward the nursing profession remain unclear because few studies have been conducted on this topic. Thus, this study examines the influence of the psychological effects of COVID-19 on student nurses' attitudes toward the nursing profession and their desire to become nurses.

METHOD

The study utilised a quantitative, cross-sectional, and observational design. It surveyed a convenience sample of 726 student nurses in Saudi Arabia during the first semester of the 2021-2022 academic year.

RESULTS

The students reported low levels of COVID-19 fear, anxiety, stress, phobia, and obsession. The students reported positive attitudes toward the nursing profession and 86.0% highlighted their desire to continue with nursing as their future profession. Gender, knowing someone infected with COVID-19, confidence in the government's pandemic response, fear, anxiety, and phobia were significant predictors of the nurses' attitudes. Community, family members in the profession, "COVID-19-related anxiety", and "preference for the nursing profession" were significant predictors of the student's desire to continue nursing.

CONCLUSIONS

Living in a rural community, having family members in the nursing profession, having low levels of COVID-19-related anxiety, and having positive attitudes toward nursing increased the likelihood of nursing students continuing their nursing careers during the COVID-19 pandemic.

Supporting Mental Health and Psychological Resilience Among the Health Care Workforce: Gaps in the Evidence and Urgency for Action

Since the COVID-19 pandemic started, health care workers have faced various challenges to their mental health due to extreme working conditions. Yet these workers have continued to deliver care in the face of stressors and death among their patients, family, and social networks. The pandemic highlighted weaknesses within our health care work environment, especially pertaining to a need to provide increased psychological resilience to clinicians. There has been little research to determine the best practices for psychological health in workplaces and interventions to improve psychological resilience. Although some studies have attempted to provide solutions, there are noteworthy gaps in the literature on effective interventions to use in the time of crisis. The most common include an absence of preintervention data concerning the overall mental well-being of health care workers, inconsistent application of interventions, and a lack of standard assessment tools across studies. There is an urgent need for system-level strategies that not only transform the way workplaces are organized, but also destigmatize, recognize, support, and treat mental health conditions among health care workers. There is also need for more evidence-based resources to improve resilience on the job, and thereby increase clinicians' capacity to address new medical crises. Doing so may mitigate rates of burnout and other psychological conditions in times of crisis among health care workers.

The role of school organizational conditions in teacher psychological resilience and stress during COVID-19 pandemic: A moderated mediation model

Educational revisions facilitate the relief of teacher stress by means of enhancing school organizational conditions. However, limited research has explored the effects of school organizational conditions on teacher stress in China. Using a sample of 734 primary and secondary school teachers from 30 provinces or municipalities of China, this study examined the effects of school organizational conditions on teacher stress in China, with a particular focus on the mediating role of psychological resilience and moderating role of perceived COVID-19 crisis strength. The results demonstrated that school organizational conditions were negatively associated with teacher stress. Furthermore, psychological resilience partially mediated the relation between school organizational conditions and teacher stress. In addition, perceived COVID-19 crisis strength significantly moderated the direct and indirect relations between school organizational conditions and teacher stress. The relations between school organizational conditions and teacher stress and between school organizational conditions and psychological resilience were stronger for teachers who perceived low levels of COVID-19 crisis strength. However, the indirect relation between psychological resilience and stress was stronger for teachers who perceived high levels of COVID-19 crisis strength. Implications have been provided accordingly.

Hospital architecture in times of crisis

In times of crisis, such as public health emergency, military conflict or natural disaster, health systems face immense pressures. Large-scale crises continue to appear at irregular intervals and healthcare facilities should be prepared to react quickly and flexibly to the increased need for treatment and care. This paper aims to outline key concepts related to healthcare architecture during a mass-scale crisis, discuss challenges, and suggest solutions. Although the field lacks robust research evidence, lessons learned from past and ongoing events clearly indicate that advance planning is essential for effective crisis response. The crisis response has three guiding principles -adaptability, flexibility, and creativity. The interventions can focus on adapting existing healthcare facilities, building new units, and repurposing civil facilities for hospitals. A wide range of building typologies can be utilised, including modular containers, tents, lightweight structures, and repurposing civil buildings and public spaces. These interventions must be quick, economic, durable, and easily deployable. Temporary facilities must ensure an effective spatial platform for patients and staff, establish links with existing services, and consider post-crisis life of interventions. While these principles can be considered for any type of healthcare facility and any type of crisis, end-results will depend on baseline infrastructure and available resources.

Analysis of mental health effects among nurses working during the COVID-19 pandemic: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Working on the frontline during the pandemic has had a negative impact on the mental health of health professionals. A significant proportion experienced anxiety, insomnia, posttraumatic stress or depression. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Analysis and synthesis of the evidence of the impact of the COVID-19 pandemic on the mental health of nurses based on their work context. There exists a gap in the literature as no studies were found that analysed the effects on nurses' mental health according to the level of care they worked in (hospital-primary care-nursing home). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is an urgent need to assess and respond to the impact of COVID-19 on the physical and mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions. ABSTRACT: Introduction Health professionals have suffered negative consequences during the COVID-19 pandemic. No review has specifically addressed the impact of the pandemic on the mental health of nurses exclusively according to the work context. Aim To analyse the impact of the COVID-19 pandemic on the mental health of nurses who have worked in hospitals, primary care centres and social health centres. Method PubMed, CINAHL, PsychINFO and Cochrane databases were searched (Prospero number: CRD42021249513). Out of 706 papers, 31 studies (2020-2021) were included in the systematic review. A qualitative synthesis method was used to analyse the data. Results Most studies were conducted in hospitals or frontline settings. The prevalence of moderate-to-severe symptoms was for anxiety 29.55%, depression 38.79%, posttraumatic stress disorder 29.8%, and insomnia 40.66%. Discussion This review highlights the mental health effects among nurses working in acute hospital settings. It also evidences a data gap on mental health effects among nurses working in primary health care and in nursing homes. Implications for practice In the post phase of the pandemic, there is an urgent need to assess and respond to the impact on the mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions.

Emerging Nurse Manager’s Resilience and Their Empowering Behavior during COVID-19

Background: The COVID-19 pandemic exacerbated tensions and tested the resiliency of many nursing leaders. Resilience enables head nurses to cope with their work environment challenges, and maintain healthy psychological activity. Moreover, their empowering behavior represents the vehicle to transform traumatic events such as the COVID-19 pandemic to create a high-quality work environment. Aim: To explore the relationship between nurse manager resilience and empowering leader behavior during COVID-19. Method: This is a descriptive correlational study. The study subjects consisted of two groups: head nurses (44) and staff nurses (284). The study was conducted at Benisuef University Hospital. Two tools were used for collecting data; nurse managers’ resilience scale, and staff nurses’ perceived empowering behavior during the COVID-19 pandemic via questionnaire. Results: In total, 50% of nurse managers had high resilience skills levels, about one-third of them (34.1%) had moderate levels and only 15.9% had low resilience skills levels. Furthermore, with regard to empowering leadership behavior levels as perceived by staff nurses during COVID-19; 66.9% of them perceived it high, 29.2% reported a moderate level of empowering behavior, and only 3.9% perceived low levels. Finally, there was a highly statistically significant positive correlation between nurse manager’s resilience skills levels and staff nurses’ perception of empowering behavior during COVID-19. Conclusions: Half of the nurse managers had high resilience skills, and only 15.9% had low levels. Two-thirds of staff nurses perceived high levels of their nurse manager’s empowering behavior during COVID-19, in comparison to only 3.9% who perceived low levels. There was a highly statistically significant positive correlation between nurse manager’s resilience skills levels and perceived empowering behavior during COVID-19.

La resiliencia como predictora del impacto negativo (depresión, ansiedad y estrés) del COVID-19 en médicos de atención primaria

Antecedentes

Objetivo

Método

Resultados

Conclusiones

Healthcare Workers' Resilience Toolkit for Disaster Management and Climate Change Adaptation

Climate change has been recognised as a multiplier of risk factors affecting public health. Disruptions caused by natural disasters and other climate-driven impacts are placing increasing demands on healthcare systems. These, in turn, impact the wellness and performance of healthcare workers (HCWs) and hinder the accessibility, functionality and safety of healthcare systems. This study explored factors influencing HCWs' disaster management capabilities with the aim of improving their resilience and adaptive capacity in the face of climate change. In-depth, semi-structured interviews were conducted with thirteen HCWs who dealt with disasters within two hospitals in Queensland, Australia. Analysis of the results identified two significant themes, HCWs' disaster education and HCWs' wellness and needs. The latter comprised five subthemes: HCWs' fear and vulnerability, doubts and uncertainty, competing priorities, resilience and adaptation, and needs assessment. This study developed an 'HCWs Resilience Toolkit', which encourages mindfulness amongst leaders, managers and policymakers about supporting four priority HCWs' needs: 'Wellness', 'Education', 'Resources' and 'Communication'. The authors focused on the 'Education' component to detail recommended training for each of the pre-disaster, mid-disaster and post-disaster phases. The authors conclude the significance of the toolkit, which provides a timely contribution to the healthcare sector amidst ongoing adversity.

Investigating Organizational Learning and Adaptations for Improved Disaster Response Towards "Resilient Hospitals:" An Integrative Literature Review

Background:

For hospitals, learning from disaster response efforts and adapting organizational practices can improve resilience in dealing with future disruptions. However, amidst global disruptions by climate change, the coronavirus disease 2019 (COVID-19) pandemic, and other disasters, hospitals’ ability to cope continues to be highly variable. Hence, there are increasing calls to improve hospitals’ capabilities to grow and adapt towards enhanced resilience.

Aim:

This study aims two-fold: (1) to characterize the current state of knowledge about how hospitals are gaining knowledge from their responses to disasters, and (2) to explore how this knowledge can be applied to inform organizational practices for hospital resilience.

Method:

This study used Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection and framework for data analysis, Covidence software, and Medical Subject Headings (MeSH) terms and keywords relevant to “hospitals,” “learn,” “disaster response,” and “resilience.” The quality appraisal used an adapted version of the Mixed Methods Assessment Tool (MMAT).

Results:

After applying inclusion and exclusion criteria and quality appraisal, out of the 420 articles retrieved, 22 articles remained for thematic and content analysis. The thematic analysis included the hospital’s functional (operational) and physical (structural and non-structural) sections. The content analysis followed nine learning areas (Governance and Leadership, Planning and Risk Assessment, Surveillance and Monitoring, Communication and Network Engagement, Staff Practices and Safety, Equipment and Resources, Facilities and Infrastructure, Novelty and Innovation, and Learning and Evaluation).

On applying the Deming cycle, only four studies described a completed learning cycle wherein hospitals adapted their organizational structures using the prior experience and evaluation gained in responding to disaster(s).

Conclusions:

There is a gap between hospitals’ organizational learning and institutionalized practice. The conceptualized Hybrid Resilience Learning Framework (HRLF) aims to guide the hospitals’ decision makers in evaluating organizational resilience and knowledge.

In the face of disasters, both the stressful factors and the coping strategies that affect the health care workers (HCWs) should be substantially considered.

Building resilient hospitals in the Eastern Mediterranean Region: lessons from the COVID-19 pandemic

Since the COVID-19 pandemic began, hospitals in the Eastern Mediterranean Region (EMR) have faced significant challenges in providing essential services, while simultaneously combatting this pandemic and responding to new and ongoing shocks and emergencies. Despite these challenges, policy-makers and hospital managers adapted their hospital responses to maintain operations and continue providing essential health services in resource-restraint and fragile and conflict affected, offering valuable insights to others in similar contexts. The aim of this paper is to share the lessons learnt from hospital responses to COVID-19 from the EMR. To do this, we triangulated findings from literature review, open-ended online surveys and 46 in-depth key informant interviews from 18 EMR countries. Qualitative findings from semistructured key informant interviews along with the open-ended survey responses resulted in nine major themes for lessons learnt in the EMR. These themes include Preparedness, Leadership and Coordination, Communication, Human Resources, Supplies and Logistics, Surge Capacity and Essential Services, Clinical Management (including Rapid Identification, Diagnosis and Isolation), Infection Prevention and Control, and Information and Research. Each of the nine themes (domains) included 4-6 major subthemes offering key insights into the regional hospital response to health emergencies. Resilient hospitals are those that can provide holistic, adaptable, primary-care-based health systems to deliver high-quality, effective and people-centred health services and respond to future outbreaks. Both bottom-up and top-down approaches are needed to strengthen collaboration between policy-makers, hospitals, front-line workers and communities to mitigate the continued spread of SARS CoV2, build resilient hospital systems and improve public health preparedness and emergency response.

The effect of the COVID-19 pandemic on health care workers' anxiety levels: a meta-analysis

Background

The COVID-19 pandemic has been declared a public health emergency of international concern, causing excessive anxiety among health care workers. Additionally, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable information. A meta-analysis was performed for this study with the following two aims: (1) to examine the prevalence of anxiety among health care workers and determine whether it has increased owing to the COVID-19 pandemic and (2) to investigate whether there has been an increase in publication bias.

Methods

All relevant studies published between 2015 and 2020 were searched in electronic databases (namely Web of Science, PubMed, Embase, PsycInfo, PsyArXiv, and medRxiv). The heterogeneity of the studies was assessed using the I 2 statistic. The effect size (prevalence rate of anxiety) and 95% CI for each study were also calculated. We used moderator analysis to test for the effect of the COVID-19 pandemic on health care workers' anxiety levels and to detect publication bias in COVID-19 studies. We assessed publication bias using funnel plots and Egger's regression.

Results

A total of 122 studies with 118,025 participants met the inclusion criteria. Eighty-eight articles (75,066 participants) were related to COVID-19, 13 articles (9,222 participants) were unrelated to COVID-19 (i.e., articles related to other outbreaks, which were excluded), and 21 preprints (33,737 participants) were related to COVID-19. The pooled meta-analysis prevalence was 33.6% (95% CI [30.5-36.8]; 95% PI [6.5-76.3]). Moderator analysis revealed no significant differences between articles related to COVID-19 and those unrelated to COVID-19 (p = 0.824). Moreover, no significant differences were found between articles and preprints related to COVID-19 (p = 0.843). Significant heterogeneity was observed in each subgroup. An Egger's test revealed publication bias in both articles and preprints related to COVID-19 (p < 0.001).

Conclusions

Determining whether the anxiety state of health care workers is altered by the COVID-19 pandemic is currently difficult. However, there is evidence that their anxiety levels may always be high, which suggests that more attention should be paid to their mental health. Furthermore, we found a substantial publication bias; however, the quality of the studies was relatively stable and reliable.

Modulating Elements of Nurse Resilience in Population Care during the COVID-19 Pandemic

COVID-19 has significantly affected the work environment of nurses. In the face of the challenges posed by stressors in clinical practice, some nurses adapt and prove to be resilient. In the face of the COVID-19 pandemic, the nature of care itself and the new ways of working are potentially very stressful. We aim to analyze the resilience of care nurses to the psychological impact of the COVID-19 pandemic. This study is a systematic review of nurse caregiver resilience to the COVID-19 pandemic in 2021. Our search was conducted in the WOS, Medline/PubMed, Cochrane, BVS/LILACS, and Cuiden databases. The inclusion criteria were: studies published in Spanish or English; carried out from March 2020 to May 2021 on nurses caring for patients with COVID-19; and investigating the factors influencing the psychological impact, resilience, strategies to develop it, and interventions to promote it during this pandemic and others, such as SARS, MERS, or ebola. The quality of the studies and the risk of bias were evaluated following ICROMS, STROBE and AMSTAR-2 criteria. Twenty-two studies were selected. Most of the studies highlighted the presence of stressors in nurses, emphasizing those of the environment, which converged in dysfunctional responses that hurt their resilience. The most persuasive factors were social and organizational support. Coping strategies developed by nurses and especially interventions by organizations were detected as instruments to foster resilience, but have not been well researched. Resilience has a key moderating role in mitigating the psychological impact of nurses in the face of the COVID-19 pandemic.

The impact of the COVID-19 pandemic on the mental health of medical staff considering the interplay of pandemic burden and psychosocial resources-A rapid systematic review

BACKGROUND

In times of the global corona pandemic health care workers (HCWs) fight the disease at the frontline of healthcare services and are confronted with an exacerbated load of pandemic burden. Psychosocial resources are thought to buffer adverse effects of pandemic stressors on mental health. This rapid review summarizes evidence on the specific interplay of pandemic burden and psychosocial resources with regard to the mental health of HCWs during the COVID-19 pandemic. The goal was to derive potential starting points for supportive interventions.

METHODS

We conducted a rapid systematic review following the recommendations of the Cochrane Rapid Reviews Methods Group. We searched 7 databases in February 2021 and included peer-reviewed quantitative studies, that reported related data on pandemic stressors, psychosocial resources, and mental health of HCWs.

RESULTS

46 reports were finally included in the review and reported data on all three outcomes at hand. Most studies (n = 41) applied a cross-sectional design. Our results suggest that there are several statistically significant pandemic risk factors for mental health problems in HCWs such as high risk and fear of infection, while resilience, active and emotion-focused coping strategies as well as social support can be considered beneficial when protecting different aspects of mental health in HCWs during the COVID-19 pandemic. Evidence for patterns of interaction between outcomes were found in the context of coping style when facing specific pandemic stressors.

CONCLUSIONS

Our results indicate that several psychosocial resources may play an important role in buffering adverse effects of pandemic burden on the mental health of HCWs in the context of the COVID-19 pandemic. Nevertheless, causal interpretations of mentioned associations are inadequate due to the overall low study quality and the dominance of cross-sectional study designs. Prospective longitudinal studies are required to elucidate the missing links.

Impact of the COVID‐19 pandemic on pediatric oncology providers globally: A mixed‐methods study

Background

Coronavirus disease 2019 (COVID‐19) disrupted pediatric oncology care globally, increasing demands on health care providers (HCPs) who adapted to continue care. This study sought to characterize the pandemic's impact on pediatric oncology HCPs worldwide.

Methods

A 60‐item survey focused on changes to clinical care, resources, and effects on clinicians. A diverse subgroup of institutions was purposefully selected for focus groups that explored teamwork, communication, and changes to care delivery.

Results

The survey included 311 responses from 213 institutions representing 79 countries. Sixteen institutions participated in 19 multidisciplinary focus groups in 8 languages. Decreased clinical staff availability was cited by 51% of institutions as a major impact. Staffing modifications included decreased provider availability (66% of institutions), roles or responsibility changes, and transfer outside the specialty. Physical effects included frequent COVID‐19 illness; 8% of respondents reported HCP deaths. Fifty percent of providers did not have the necessary personal protective equipment. HCPs also experienced psychological distress and financial concerns. Findings indicated more frequent impact on nurses than other providers. Impacts were described across all hospital resource levels, with staffing modifications more frequent in countries with higher COVID‐19 incidence (P < .001) and mortality rate (P = .004). Focus groups revealed negative impacts were stabilized by increased teamwork, communication, contributions outside usual roles, policies aimed at optimizing safety, and feeling that they were contributing.

Conclusions

COVID‐19 had a profound impact on the pediatric oncology workforce, creating challenging modifications to staffing and resulting in physical, psychological, and financial distress. Despite these challenges, HCPs caring for children with cancer came together to continue to provide high‐quality care.

This mixed‐methods study reveals the impact that the coronavirus disease 2019 (COVID‐19) pandemic has had on pediatric oncology providers globally, and it highlights the importance of implementing strategies to protect the health care workforce during challenging situations.

COVID-19 Pandemic Preparedness in Egypt's Teaching Hospitals: A Needs Assessment Study

Introduction

Regular collection and monitoring of data describing the dynamics of the utilization of healthcare services, especially in teaching hospitals (TH), which provide model quality medical services, are critical for COVID-19 pandemic preparedness.

Methods

The researchers analyzed data and information derived from service statistics reports from June 1st to July 15th, 2020 in terms of hospital resources, as well as utilization patterns of beds, ICU, and ventilators, for 11 screening hospitals affiliated with the General Organization of Teaching Hospitals and institutes in Egypt assigned by the Ministry of Health and Population to provide medical care for COVID-19 patients. Hospital indicators in terms of COVID-19 screening services, as well as utilization patterns of inpatient beds, ICU beds, and ventilators were computed.

Results

A total of 78,869 non-medical personnel and 2,176 medical personnel were presented with COVID-19 triage symptoms. Investigations conducted in the targeted 11 hospitals delineated that 22.2% of non-medical personnel and 27.9% of medical personnel were COVID-19 PCR-confirmed cases. The inpatient bed occupancy rate was 70% for non-medical patients and 67% for medical staff patients. For ICU, the bed occupancy rate was 92 % for non-medical patients and 88% for medical patients. Among the confirmed cases, 38% of medical patients utilized a ventilator vs. 36% of medical personnel cases. Hospital ranking according to utilization pattern among non-medical personnel, Hospital H ranked first in terms of the high load of screening services. Hospital C ranked first regarding the number of confirmed cases, whereas Hospital D ranked first for high ICU utilization among all teaching hospital ICU cases. With respect to medical personnel, Hospital G ranked first for the high load of screening services for the total studied cases. Hospital G ranked first for the number of confirmed cases. Hospital B ranked first regarding high ICU utilization among all teaching hospital ICU cases.

Conclusion

Teaching hospitals have demonstrated preparedness for the COVID-19 pandemic by maintaining an inpatient bed occupancy rate of 70% or less and ventilator utilization at <40% of confirmed cases. However, the ICU bed occupancy rate was more than 90% indicating a shortage of resources. In addition, there is variance across hospitals regarding caseload for resource reallocation decisions.

COVID-19 crisis: Influence of eHealth literacy on mental health promotion among Saudi nursing students

Objective

This study aims to determine the influence of eHealth literacy on mental health promotion among Saudi nursing students.

Method

This cross-sectional study was conducted from 19 April to 21 May 2020. A total of 468 nursing students responded to the self-administered online survey. Two instruments, namely, the eHealth Literacy Scale and the Positive Mental Health Scale, were used. Statistical tools such as frequency, percentage, mean, and standard deviation were used for the descriptive analysis. Multiple regression analysis was employed to analyse the relationship between eHealth literacy, health promotion, and its predictors.

Results

The results showed that 30.3% of nursing students were dissatisfied with their general health. Students perceived high self-assessed eHealth literacy and positive mental health. Students in the 4th year had lower scores than those of students in the 2nd year. Nursing students perceived that the quarantine and public social distancing lowered their mental health scores. Finally, the eHealth literacy mean scores resulted in a 0.21-point increase in the positive mental health scores.

Conclusion

The finding of the study shows that the eHealth literacy positively influnce the mental health status of Saudi Nursing students.

Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis

INTRODUCTION

COVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic.

MATERIAL AND METHODS

We performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI.

RESULTS

We included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8-41.3), anxiety 39.7(95%CI: 34.3-45.1), stress 36.4% (95%CI: 23.2-49.7), fear 71.3% (95%CI: 54.6-88.0), burnout 68.3% (95%CI: 54.0-82.5), and low resilience was 16.1% (95%CI: 12.8-19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30-1.68) and nurses (OR = 1.21; 95%CI = 1.02-1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49-1.85), (Nurse: OR = 1.36; 95%CI = 1.16-1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28-1.97).

CONCLUSION

In conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.

Prevalence of Psychological Impacts on Healthcare Providers during COVID-19 Pandemic in Asia

COVID-19 has impacted people psychologically globally, including healthcare providers. Anxiety, depression, and stress are the most common impacts that have affected these people. Thus, this study was aimed to ascertain the estimated prevalence of psychological impacts among healthcare providers in the Asian region. A systematic search was performed in the MEDLINE, CINAHL, and Scopus databases for original research articles published between 2020 and April 2021. Only studies published in English were included. The quality of data was assessed using the Joanna Briggs Institute Meta-Analysis, and the analysis was performed using generic inverse variance with a random-effects model by Review Manager software. A total of 80 studies across 18 countries in Asia region were pooled to assess the data prevalence on anxiety (34.81% (95% CI: 30.80%, 38.83%)), depression (34.61% (95% CI: 30.87%, 38.36%)), stress (31.72% (95% CI: 21.25%, 42.18%)), insomnia (37.89% (95% CI: 25.43%, 50.35%)), and post-traumatic stress disorder (15.29% (95% CI: 11.43%, 19.15%)). Subgroup analyses were conducted across regions, type of healthcare providers, sex, and occupation. This review has identified a high prevalence of anxiety, depression, stress, and insomnia but a low prevalence of post-traumatic stress disorder among healthcare providers in Asia regions. Effective intervention support programs are urgently needed to improve psychological health of healthcare providers and maintaining the health system.

Healthcare worker resilience during the COVID-19 pandemic: An integrative review

AIM

The purpose of this review was to examine resilience among healthcare workers during the coronavirus-disease-2019 (COVID-19) pandemic.

BACKGROUND

The COVID-19 pandemic has caused an unprecedented strain on healthcare workers internationally. Rising infection rates, inadequate personal protective equipment, and the lack of availability of hospital beds has resulted in further deterioration of the already-fragile mental health of healthcare workers. Resilient workers have lower rates of burnout and improved patient outcomes.

EVALUATION

PubMed and the Cumulative Index to Nursing and Allied Health Literature databases were searched using the terms resilience, nurse and COVID-19 to identify studies on resilience during the COVID-19 pandemic. Results were organized by outcome measures for comparison.

KEY ISSUES

Resilience scores among frontline healthcare workers worldwide during the COVID-19 pandemic in the studies reviewed were overall found to be in the moderate range. Data from the United States showed a decrease in nurse resilience, whereas participants from China had increased resilience compared with pre-pandemic levels.

CONCLUSIONS

Building resilience in nurses and other healthcare workers can serve as a protective factor against negative outcomes related to the job, including burnout, anxiety and depression, and can improve patient outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies for building resilience in healthcare workers are discussed.

Psychological Impact of COVID-19 on Frontline Healthcare Workers in Saudi Arabia

This study assesses the determinants and severity of psychological distress among frontline Ministry of Health workers within Saudi Arabia during the rapid acceleration phase of the coronavirus disease 2019 (COVID-19) epidemic. Moreover, we assess distress sustainability and stress-coping behaviors. We conducted an online national cross-sectional survey. The Kessler Psychological Distress Scale (k10) is a highly reliable instrument used to assess depression and anxiety. We evaluated stress-coping behavior and the persistence of the disorders. Binary logistic regression identified the sociodemographic factors related to severe distress. The prevalence of severe psychological distress among COVID-19 frontline healthcare workers (HCWs) was 27.3%. Factors associated with severe psychological distress in multiple regression analyses were male gender (p < 0.001), working for >45 hours/week (p = 0.009), age of >40 years (p = 0.038), years of experience for more than seven years (p = 0.048), Asir region (p = 0.003), and using psychological services (p < 0.001). The prevalence of severe psychological distress was 27.3%. Factors associated with severe psychological distress in multiple regression analyses were male gender, working >45 hours/week, age, years of experience, region, and using psychological services. The results form a foundation for targeted psychological health support services at the individual and institutional levels to prevent progression to mental illness.