Worries, Preparedness, and Perceived Impact of Covid-19 Pandemic on Nurses' Mental Health

Leveraging a Global Partnership to Address COVID-19-Related Mental Health Challenges

INTRODUCTION

The COVID-19 pandemic profoundly affected nurses globally. As frontline workers, nurses faced increased responsibilities amid challenges such as isolation, infection risks, family obligations and disrupted social support systems. Coping with these challenges was associated with adverse mental health outcomes.

AIM/QUESTION

This perspective paper examines a collaboration between two schools of nursing in the United States and India to address these mental health challenges.

METHODS

Faculty from both institutions identified key mental health topics, leading to five webinars that delved into topics such as acute and long-term impacts of COVID-19 on nurse mental health, coping mechanisms, caregiving responsibilities and children's needs during the pandemic.

RESULTS

Impressively, over 11,000 nurses from 60 countries engaged, fostering a global platform for sharing evidence-based knowledge, experiences and strategies.

IMPLICATIONS FOR PRACTICE

This partnership exemplifies the value of international collaboration. By pooling resources and expertise across cultural contexts, the initiative not only disseminated crucial knowledge but also cultivated a sense of global community among nurses. The success of this collaboration underscores the potential of such global partnerships for healthcare institutions worldwide, offering avenues to share best practices and enhance support systems for nurses confronting similar crises globally.

Psychometric Evaluation of the Brief-COPE Inventory and Exploration of Factors Associated with Perceived Stress among Peruvian Nurses

BACKGROUND

This study aimed to analyze the psychometric properties of the Brief-COPE Inventory and to determine its concurrent validity by examining its association with perceived stress among Peruvian nurses.

METHODS

A psychometric study was conducted with 434 Peruvian nurses to evaluate the psychometric properties of the Brief-COPE Inventory through confirmatory factor analysis. Three stepwise variable selection regression models were implemented.

RESULTS

The three-factor model of the Brief-COPE Inventory demonstrated adequate fit indices (root mean square error of approximation = 0.052, standardized root mean square residual = 0.068, and both the comparative fit index and the Tucker-Lewis index = 0.95). Additionally, the factors were significantly correlated (p < 0.001), and the reliability was adequate (ω = 0.90). Nurses reported a medium level of perceived stress, with associated factors including having received stress management training, fear of COVID-19, and problem-focused coping strategies (p < 0.05).

CONCLUSION

This study confirms that the Brief-COPE Inventory is a valid tool for measuring coping strategies among Peruvian nurses due to its good model fit, excellent reliability, and concurrent validity with perceived stress. However, further research is needed to assess its validity in the specific areas of performance perceived by nursing professionals.

Psychological resilience factors in intensive care nursing: a hybrid multi-criteria decision-making model

PURPOSE

To analyze the key factors influencing the psychological resilience of intensive care unit (ICU) nurses during the COVID-19 pandemic and put forward suggestions promoting resilience based on key improvement factors and clinical experience.

METHODS

Data were collected from 35 ICU nurses in a hospital in Zhejiang Province, China, through a questionnaire survey conducted between January and February 2023. The Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was then used to construct and visualize the relationship structure between the factors. The DEMATEL-based Analytical Network Process (DANP) was applied to determine the influential weights of all factors. Finally, the key improvement factors were identified using importance-performance analysis (IPA).

RESULTS

Based on the cause-effect impact network diagram (CEIND), it was concluded that (C 11), (C 22), and (C 32) are the key factors that promote the improvement of psychological resilience among ICU nurses. Additionally, these factors were the key factors that influence psychological resilience. The confidence levels of these results and the gap were 99.6% and 0.4%, respectively, which exceed the threshold value of 95%, indicating good stability. Finally, for the case hospitals, (C 13) was identified as the key improvement factor.

CONCLUSIONS

Hospital administrators should support ICU nurses in enhancing their psychological resilience during major epidemics by: (i) Providing training on comprehensive protective measures and nursing skills; (ii) Effectively managing the human resources of nurses in the hospital to reduce their workload; (iii) Increasing social and organizational support for nurses to alleviate anxiety caused by large-scale public health events and improve their psychological resilience.

A network analysis of the interrelationships between depression, anxiety, insomnia and quality of life among fire service recruits

Background

Research on the mental health and quality of life (hereafter QOL) among fire service recruits after the end of the COVID-19 restrictions is lacking. This study explored the network structure of depression, anxiety and insomnia, and their interconnections with QOL among fire service recruits in the post-COVID-19 era.

Methods

This cross-sectional study used a consecutive sampling of fire service recruits across China. We measured the severity of depression, anxiety and insomnia symptoms, and overall QOL using the nine-item Patient Health Questionnaire (PHQ-9), seven-item Generalized Anxiety Disorder scale (GAD-7), Insomnia Severity Index (ISI) questionnaire, and World Health Organization Quality of Life-brief version (WHOQOL-BREF), respectively. We estimated the most central symptoms using the centrality index of expected influence (EI), and the symptoms connecting depression, anxiety and insomnia symptoms using bridge EI.

Results

In total, 1,560 fire service recruits participated in the study. The prevalence of depression (PHQ-9 ≥ 5) was 15.2% (95% CI: 13.5-17.1%), while the prevalence of anxiety (GAD-7 ≥ 5) was 11.2% (95% CI: 9.6-12.8%). GAD4 ("Trouble relaxing") had the highest EI in the whole network model, followed by ISI5 ("Interference with daytime functioning") and GAD6 ("Irritability"). In contrast, PHQ4 ("Fatigue") had the highest bridge EI values in the network, followed by GAD4 ("Trouble relaxing") and ISI5 ("Interference with daytime functioning"). Additionally, ISI4 "Sleep dissatisfaction" (average edge weight = -1.335), which was the central symptom with the highest intensity value, had the strongest negative correlation with QOL.

Conclusion

Depression and anxiety were important mental health issues to address among fire service recruits in the post-COVID-19 era in China. Targeting central and bridge symptoms identified in network analysis could help address depression and anxiety among fire service recruits in the post-COVID-19 era.

Nurses Lived Experiences, Burdens and Coping Strategies During COVID-19 Pandemic

This is a qualitative phenomenological study that was designed to navigate through nurses' lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses' lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses' eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.

Evaluating the interactive impact of acculturative stress and anxiety sensitivity on behavioral health outcomes among Latinx during a period of high COVID-19 impact

As a multi-systemic disease, COVID-19 infection engendered a rise in co-occurring mental and physical health symptoms, particularly affecting the Latinx population. The current work sought to evaluate the main and interactive influence of acculturative stress and anxiety sensitivity in terms of mental and physical health symptoms among 181 Latinx persons (30.4% female, Mage = 34.1 years, SD = 8.20). Data were collected during a period of high COVID-19 impact (2020-2021) and analyses included five separate, two-step hierarchical regressions that were conducted for each of the criterion variables: (1) fear of coronavirus; (2) somatic symptoms; (3) fatigue severity; (4) anxiety symptoms; and (5) depression symptoms. For all analyses, step 1 covariates included years living in the U.S. COVID-19 impact, gender identity, education, and work life distress and home life distress. Results revealed an interactive effect of anxiety sensitivity and acculturative stress on COVID-19 fear, unique main effects for both anxiety sensitivity and acculturative stress on COVID-19 related fear and somatic symptoms, and main effects for anxiety sensitivity alone in relation to fatigue severity, anxiety, and depression. Overall, this study represents an initial investigation of the associations between acculturative stress, anxiety sensitivity, and a range of salient COVID-19 related outcomes among Latinx persons.

Work-related psychosocial challenges and coping strategies among nursing workforce during the COVID-19 pandemic: a scoping review

BACKGROUND

Nurses and midwives have been stretched by the COVID-19 pandemic amidst the heroic roles they have played during the peak of the COVID-19 pandemic. Nurses stood tall among their peers in the healthcare industry saving lives. The pandemic has had a toll on nurses physically, psychologically, and socio-economically. The numerous deaths have traumatized nurses coupled with the fear of possible infection. Nurses have seen their colleagues and loved ones lose their lives to the pandemic, nevertheless, they still render care to patients no matter the circumstances. Due to that, it is imperative to ascertain the extent to which nurses who are much needed in healthcare delivery have been affected by this pandemic. This scoping review used Arksey and O'Malley's review methodology to investigate the nature of work-related psychosocial challenges nurses encountered during the peak of the pandemic, noting the major contributors to the challenges and the coping strategies used to address them.

METHODS

We performed a scoping review and searched for articles from five databases including PUBMED, CINAHL, SCOPUS, Google Scholar, and Grey literature from December 2019 to December 2021. A total of 7,334 articles were retrieved for the study but 45 met the inclusion criteria.

RESULTS

Work-related psychosocial challenges identified included stress, burnout (emotional exhaustion and depersonalization), Post-Traumatic Stress Disorder, depression, sleeplessness, and anxiety. Factors that accounted for the challenges were inadequate personal protective equipment (PPEs), discomfort using the PPEs, extreme workload, and fatigue. Nurses experienced job insecurity, business closure, and separation from family and loved ones, and these contributed to their challenges. Strategies used to deal with the challenges centred on emotion-focused and problem-focused coping.

CONCLUSIONS

The study recommends regular counselling and support for all nurses working at the frontline to help them better cope with the devastating effects of the pandemic so that they could build resilience towards future pandemics.

Mediating effect of work stress in the relationship between fear of COVID-19 and nurses' organizational and professional turnover intentions

Nursing is one of the most stressful and high-risk professions. It is important to identify the psychological problems experienced by nurses during the COVID-19 pandemic and examine the relationship between these problems to devise measures that can properly address them. This study examined mediating effect of work stress in the relationship between fear of COVID-19 and nurses' organizational and professional turnover intentions. Using a cross-sectional research design, this study was conducted on 486 nurses working in seven hospitals in Turkey. The mean age of the participants was 35.24 ± 6.81 and 59.9 % of them were women. The Fear of COVID-19 Scale, the General Work Stress Scale, and the Turnover Intention Scale were used to collect data. A mediation model showed that fear of COVID-19 was positively associated with work stress and organizational and professional turnover intentions. The model also revealed that work stress was positively associated with organizational and professional turnover intentions. Furthermore, the results demonstrated that fear of COVID-19 did not only have a direct effect on organizational and professional turnover intentions but also had an indirect effect on it via increased work stress. Findings improve our understanding of the role of work stress in the relationship between fear of COVID-19 and organizational and professional turnover intentions. The findings are fruitful for tailoring and implementing intervention programs to reduce the adverse psychological impacts of COVID-19 on nurses.

Concerns, perceived impact, practices, preventive measures, and stress among healthcare workers during COVID-19 pandemic in Malaysia

Introduction

Healthcare workers (HCWs) have been continually exposed to patients with COVID-19 and are at higher risk of contracting the disease. Their psychological health is important for overall wellbeing and productivity, which could lead to a reduction in human errors during the pandemic crisis. This study aimed to measure the level of concerns, work practices, adequacy of preventive measures among HCWs, and the impacts on their life and work, including mental health status during the second wave of the COVID-19 pandemic in Malaysia.

Methods

An online questionnaire was distributed randomly to 1,050 HCWs from the Ministry of Health facilities in the Klang Valley who were involved directly in managing or screening COVID-19 cases from May to August 2020. The questionnaire was divided into five domains, which were concerns, impact on life and work, practice, perceived adequacy of preventive measures, and Revised Impact of Event Scale (IES-R). Logistic regression was used to identify sociodemographic predictors of the five domains.

Results

A total of 907 respondents (86.4%) participated in this survey. Approximately half of the respondents had a low concern (50.5%), most of them had a good practice (85.1%), with 67.5% perceiving there were adequate preventive measures, and they perceived the outbreak had a low impact (92%) on their life and work. From the IES-R domain, 18.6% of respondents potentially suffered from post-traumatic stress disorder (PTSD).

Conclusion

During the second wave of the COVID-19 outbreak in Malaysia, HCWs practiced high levels of precautions and preventive measures because they were aware of the risk of infection as an occupational hazard. With the adequate implementation of policy and control measures, the psychological wellbeing of the majority HCWs remained well and adequately supported.

Factors associated with poor mental health outcomes in nurses in COVID-19-designated hospitals in the postepidemic period in Guangdong Province: a cross-sectional study

OBJECTIVE

The early days of the COVID-19 pandemic placed enormous pressure and subsequent negative psychological problems on nurses, but at this stage of the year-long COVID-19 outbreak, the level of stress and negative emotions that nurses experience is unclear. Our study attempted to assess the factors influencing mental health status in nurses during the postepidemic period of COVID-19.

DESIGN

Cross-sectional study.

SETTING

COVID-19 designated hospitals.

PARTICIPANTS

1284 Chinese nurses.

MAIN OUTCOME MEASURES

Electronic questionnaires, including the Chinese version of the Perceived Stress Scale (CPSS) and Symptom Checklist-90 (SCL-90), were distributed for self-evaluation. Regression analysis was used to analyse the associated factors of psychological stress among variables such as age, years of nursing experience, weekly working hours, anxiety symptoms, somatisation symptoms and compulsive symptoms.

RESULTS

A total of 1284 respondents from COVID-19-designated hospitals in Guangdong Province were studied. The average CPSS score for all respondents was 22.91±7.12. A total of 38.5% of respondents scored ≥26 on the CPSS, indicating a significant degree of psychological stress. Nurses with high psychological stress had higher levels of anxiety symptoms (41.7% vs 8.0%), somatisation symptoms (31.4% vs 7.7%) and compulsion symptoms (62.3% vs 27.0%) than nurses with low psychological stress. Stepwise multiple linear regression revealed that weekly working hours, years of nursing experience, anxiety symptoms, somatisation symptoms and compulsion symptoms had a linear relationship with the participants' psychological stress scores.

CONCLUSION

Nurses experienced significant physical and psychological risk while working in the postepidemic period. Our findings suggest that nurses still need support to protect their physical and mental health.

COVID-19 Pandemic Impact on Undergraduate Nursing Students: A Cross-Sectional Study

COVID-19 is a challenge for education systems around the world. This study aimed to evaluate the perceived impact of the COVID-19 pandemic on nursing students, by assessing their emotions, the level of concern in contracting the virus and their perceived stress. We conducted an observational cross-sectional study. A total of 709 nursing students completed an anonymous questionnaire. The levels of anxiety and stress were assessed using the generalized anxiety disorder scale and the COVID-19 student stress questionnaire, respectively. In total, 56.8% of the sample often or always found it difficult to attend distance-learning activities. The main difficulty referred to was connection problems (75.7%). The mean generalized anxiety disorder score was 9.46 (SD = 5.4) and appeared almost homogeneous among students across the three years of study; most of the students showed mild (35%) to moderate (27%) levels of anxiety; 19% had severe anxiety. The overall COVID-19 stressor mean scores were 11.40 (SD = 6.50); the majority of the students (47.1%) showed scores indicative of moderate stress, 25% showed low stress levels, and 28% showed high-stress levels. Improvements and investments are needed to ensure high-quality distance learning, adequate connectivity, technical support for students, as well as strategies to promote mental health.

Behavioral Intentions and Factors Influencing Nurses' Care of COVID-19 Patients: A Cross-Sectional Study

Objective

Behavioral intentions to care for patients with infectious diseases are crucial for improving quality of care. However, there have been few studies of the behavioral intentions and factors influencing patient care by clinical nurses during the COVID-19 pandemic. This study aims to explore cognition, attitudes, subjective norms, self-efficacy, and behavioral intentions of clinical nurses while caring for COVID-19 patients and to explore any influencing factors.

Method

A cross-sectional survey was conducted of nurses through convenience sampling in southeast China from February 2020 to March 2020. The questionnaire was developed based on the theory of planned behavior and self-efficacy.

Results

A total of 774 nurses completed the survey. Of these, 69.12% (535/774) reported positive behavioral intentions, 75.58% (585/774) reported a positive attitude, and 63.82% (494/774) reported having the confidence to care for patients. However, the lack of support from family and friends and special allowance affected their self-confidence. Attitude, self-efficacy, subjective norms, and ethical cognition were significantly positively correlated with behavioral intentions (r = 0.719, 0.690, 0.603, and 0.546, respectively, all P < 0.001). Structural equation model showed that self-efficacy, attitude, ethical cognition, and subjective norms had positive effects on behavioral intentions (β = 0.402, 0.382, 0.091, and 0.066, respectively, P < 0.01). The total effect of behavioral intentions was influenced by attitude, ethical cognition, self-efficacy, and subjective norms (β = 0.656, 0.630, 0.402, and 0.157, respectively, P < 0.01). In addition, ethical cognition had a positive mediating effect on behavioral intentions (β = 0.539, P < 0.001).

Conclusion

The study results indicated that attitude, ethical cognition, and self-efficacy were the main factors influencing nurses' behavioral intention. Efforts should be made to improve nurses' attitude and self-efficacy through ethical education and training to increase behavioral intentions to care for patients with infectious diseases, which will improve the quality of nursing care.

Clinical Training during the COVID-19 Pandemic: Experiences of Nursing Students and Implications for Education

The COVID-19 pandemic has caused difficulties in the organization of clinical classes for nursing students. It is therefore important to explore students’ experiences related to participation in clinical classes during the pandemic and to draw conclusions that will allow for the introduction of innovations enabling the development of the required professional competencies as part of training during current and future pandemic restrictions. In this study, we aimed to explore the experiences of nursing students related to clinical education during the COVID-19 pandemic and to identify practical implications for this education in the future. A qualitative study was performed based on individual interviews among Polish nursing students (n = 20). The study is reported using the COREQ checklist. Content analysis was applied, and five main categories were identified, including ‘the key role of clinical mentor’, ‘theory-practice gap’, ‘ambivalent emotions and ethical challenges’, ‘to be part of the team’, and ‘strengthened professional identity’. The results of our research indicate that higher education institutions should implement clear strategies to support students, both in terms of psychological support and compensation of professional skills, the development of which might be limited during the pandemic. Modern technologies, including medical simulations, virtual reality, artificial intelligence, and telemedicine should be used in the practical teaching of nursing students to educate them on how to cope with difficult, new situations, build decision-making skills, and solve problems.

Positive Effects on Emotional Stress and Sleep Quality of Forest Healing Program for Exhausted Medical Workers during the COVID-19 Outbreak

This study targeted medical workers, who are currently being subjected to an excessive workload and emotional stress during the COVID-19 outbreak. Various treatment programs, such as a relaxation program to relieve stress, a walk in the forest, and woodworking were provided to the participants as forest healing therapies. We enrolled 13 medical workers (11 females, 2 males). Before and after forest healing therapy, stress and sleep-related questionnaires and levels of salivary cortisol, dehydroepiandrosterone sulfate (DHEA-S), and melatonin were measured and compared. The improvement of the perceived stress scale and the decrease of DHEA-S, a stress index, showed statistically significant results. However, although this study was conducted with a small number of participants and has a limitation in that the therapy occurred over a short period of only 1 night and 2 days, the trend of supporting results remains positive. As such, the authors propose forest healing therapy as one intervention to relieve the job stress for this group of workers.

The impact of nurses' sense of security on turnover intention during the normalization of COVID-19 epidemic: The mediating role of work engagement

BACKGROUND

COVID-19 pandemic has entered a normal stage in China. During this phase, nurses have an increased workload and mental health issues that threaten the sense of security. Poor sense of security may have a considerable impact on turnover intention through low work engagement. It was challenging to maintain the nurse workforce. Fewer studies have been conducted on the effect of nurses' sense of security on their turnover intention in that phase. This study aimed to investigate the interrelationship between nurses' sense of security, work engagement, and turnover intention during the normalization phase of the epidemic in China and to explore the impact of sense of security on turnover intention.

METHODS

A cross-sectional survey was conducted from September 2020 to May 2021 in Guangdong Province, China. Data were collected online using Sense of Security Scale for Medical Staff (SSS-MS), Utrecht Work Engagement Scale (UWES), and Turnover Intention Scale. Pearson's correlation analysis was used to assess the correlation between sense of security, work engagement, and turnover intention. The hypothesis model used multiple linear regression models and the bootstrapping procedure to analyze the relationship between these variables.

RESULTS

Data were collected from 2,480 nurses who met the inclusion criteria. Over half(64.5%) of nurses had a high and very high turnover intention. After controlling the demographic and working variables, sense of security (β = 0.291, P < 0.001) had a direct positive effect on work engagement. Sense of security (β = -0.447, P < 0.001) and work engagement (β = -0.484, P < 0.001) had a direct negative effect on turnover intention. Sense of security and all of its components were associated with turnover intention through the partially mediating effects of work engagement.

CONCLUSIONS

Nurses' turnover intention was at a high level during the normalization phase of the epidemic. Sense of security and its components act as positive resources to reduce turnover intention by improving work engagement. Policy makers and managers may pay attention to the needs of nurses' sense of security, which may be a new perspective to help managers reduce their turnover intention and stabilize the nurse team.