Anxiety, Burnout and Depression, Psychological Well-Being as Predictor of Healthcare Professionals' Turnover during the COVID-19 Pandemic: Study in a Pandemic Hospital

Migration intentions among nursing students in a low-middle-income country

BACKGROUND

Migration among skilled labour has been noted as one of the major issues in recent times, especially among health workers. Data from the United Nations show that almost two thirds of people migrating are labor migrants and international migrants constitute 3.5% of the global migration population. Out of the millions of people who migrate across the globe, health workers, especially nurses form a greater portion of these numbers. This study explored nursing students' intention to migrate to other countries after completing their programs.

METHOD

A descriptive cross-sectional design approach was adopted using self-administered questionnaire that contain aspects of open-ended questions. A sample size of 226 nursing students were recruited using convenient sampling technique.

RESULTS

The results overall, revealed that 226 nursing students participated in the study. Out of this, most of the respondents 42.5% were aged between 25 and 30 years with majority 53.1% being males. Also, 35% of the participants were married with more than half 59.7% of the respondents being Christians. The results further revealed that most of the participants 64.2% had intention of migrating to other countries. Among those who intended to migrate, 11.7% identified lack of jobs, 39.3% identified low salaries in Ghana while 50.3% identified bad working conditions. The rest 2.8% attributed their intentions to migrate to educational opportunities. Common places of destination included Canada, USA, UK and Australia.

CONCLUSION

The outcome of this study points to the urgent need for low-income countries such as Ghana to urgently put in measures to curb the menace of brain drain among nurses. Improvement in working condition of nurses must be prioritized to motivate their stay.

What does "urgency" mean when prioritizing cancer treatment? Results from a qualitative study with German oncologists and other experts during the COVID-19 pandemic

PURPOSE

Cancer care in Germany during the COVID-19 pandemic was affected by resource scarcity and the necessity to prioritize medical measures. This study explores ethical criteria for prioritization and their application in cancer practices from the perspective of German oncologists and other experts.

METHODS

We conducted fourteen semi-structured interviews with German oncologists between February and July 2021 and fed findings of interviews and additional data on prioritizing cancer care into four structured group discussions, in January and February 2022, with 22 experts from medicine, nursing, law, ethics, health services research and health insurance. Interviews and group discussions were digitally recorded, transcribed verbatim and analyzed using qualitative content analysis.

RESULTS

Narratives of the participants focus on "urgency" as most acceptable criterion for prioritization in cancer care. Patients who are considered curable and those with a high level of suffering, were given a high degree of "urgency." However, further analysis indicates that the "urgency" criterion needs to be further distinguished according to at least three different dimensions: "urgency" to (1) prevent imminent harm to life, (2) prevent future harm to life and (3) alleviate suffering. In addition, "urgency" is modulated by the "success," which can be reached by means of an intervention, and the "likelihood" of reaching that success.

CONCLUSION

Our analysis indicates that while "urgency" is a well-established criterion, its operationalization in the context of oncology is challenging. We argue that combined conceptual and clinical analyses are necessary for a sound application of the "urgency" criterion to prioritization in cancer care.

Variables that predict nurses' job stress and intention to leave during the COVID-19 pandemic in Turkey

AIM

To investigate the variables predicting job stress and intention to leave the job among nurses during the COVID-19 pandemic in Turkey.

DESIGN

This research was designed as an analytical cross-sectional study.

METHODS

The population of the study consisted of 450 nurses working in a training and research hospital (N = 450). The study sample consisted of 178 nurses who worked in that hospital between February and July 2021. The Nurse Information Form, Job Stress Scale, and Intention to Leave Scale were used as data collection tools. The independent-sample t-test, one-way analysis of variance, and Pearson correlation analysis were applied for univariate analysis while multiple regression analysis was used for multivariate analysis.

RESULTS

It was determined that the main factors predicting nurses' job stress levels were their Intention to Leave Scale scores, level of organizational satisfaction. The main factors predicting intention to leave were their Job Stress Scale scores, working conditions, and job satisfaction. A positive moderate correlation was found between job stress and intention to leave.

CONCLUSION

This study demostares that among nurses during the COVID-19 pandemic, the predictors of job stress were intention to leave and organizational satisfaction, while the predictors of turnover intention included job stress, working conditions, and job satisfaction. Hospital managers, especially nursing services managers, should develop strategies for extraordinary situations such as pandemics and evaluate the professional satisfaction of nurses while providing a healthy working environment.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives

Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.

Work stress and burnout among emergency physicians: a systematic review of last 10 years of research

AIM OF THE STUDY

First, to provide a synthesis and analysis of available scientific literature regarding the level of work stress and burnout among emergency physicians. Second, to identify the effect of the specific work situation-related factors.

METHODS

A systematic search was performed in NCBI PubMed and Embase. Comparative primary studies, both systematic review and cross-sectional, quantifying burnout in emergency physicians were included. Only studies published between 2011 and 2022 were retained. Synonym sets were compiled for the search key for 'burnout & stress', 'emergency', 'physician' and 'burnout & posttraumatic stress disorder'.

RESULTS

Thirty-five papers were retained for further research. Emergency physicians scored significantly higher for all dimensions of burnout compared to other healthcare professions. Significant correlations for burnout were found with work characteristic and organizational factors. Critical incidents and aggression were identified as the most important acute work characteristics and organizational factors impacting emergency physician's mental wellbeing including the development of posttraumatic stress disorder. Moreover, personal factors such as age, personality, and coping strategies also play an important role in the development of burnout as well as work-related trauma.

CONCLUSION

Available studies show that emergency physicians report higher scores of emotional exhaustion and depersonalization when compared to other healthcare professionals. Work characteristics contribute to this, but work-related traumatic incidents and aggression are important determinants. Personal characteristics such as age, personality type D, previous experiences and coping strategies seem to be determining factors likewise. Emergency physicians showed a high risk for developing burnout and work stress-related problems.

Work-family conflict among primary health workers during the COVID-19 pandemic: Its mediating role in the relationship between workload and job burnout

AIMS AND OBJECTIVES

This study explores the situation of workload, work-family conflict and job burnout among primary health workers in China in the context of COVID-19 and identifies the mediating effect of work-family conflict between workload and job burnout.

BACKGROUND

Since the breakout of the COVID-19 pandemic, primary health workers have been working on the frontline of the epidemic and may experience increasing workload, work-family conflict and job burnout. It is important to focus on the issue of how to alleviate job burnout of primary health workers.

DESIGN

A cross-sectional study (STROBE) was used.

METHODS

Data were collected from 785 primary health workers in China. Multiple regression analysis was used to examine the mediating effect of work-family conflict between workload and job burnout.

RESULTS

18.7%, 10.4% and 39.5% of respondents had high job burnout in the dimensions of emotional exhaustion, depersonalization and personal accomplishment, respectively. 34.6% of the respondents had high or very high workload, and 12.8% of the respondents had high or very high work-family conflict. Results of multiple regression analysis indicated that work-family conflict mediated the relationship between workload and job burnout. Workload (β = .163, CI = .207-.549) and work-family conflict (β = .211, CI = .311-.640) positively influenced job burnout, and workload (β = .428, CI = .375-.508) positively influenced work-family conflict.

CONCLUSION

The study indicated that primary health workers experienced a high level of job burnout, especially in the personal accomplishment dimension. Furthermore, this study verified the mediating effect of work-family conflict between workload and job burnout.

RELEVANCE TO CLINICAL PRACTICE

Some interventions for alleviating workload, work-family conflict and job burnout should be taken, including workplace assistance programmes, family-friendly policies and a well-integrated healthcare system.

NO PATIENT OR PUBLIC CONTRIBUTION

This study does not involve patient or public contribution in any part.

IMPACT STATEMENT

Nurses and other primary health workers are health gatekeepers of residents and play a vital role in the healthcare system. Due to the breakout of COVID-19, they have taken more work and are more vulnerable to work overload, work-family conflict and the consequent job burnout. Some interventions should be taken to effectively alleviate their job burnout and improve their health and performance.

Stress and burnout amongst mental health professionals in Singapore during Covid-19 endemicity

The COVID-19 pandemic has exerted a huge emotional strain on mental health professionals (MHP) in Singapore. As Singapore transited into an endemic status, it is unclear whether the psychological strain has likewise lessened. The aims of this study were to investigate the levels of stress and burnout experienced by MHP working in a tertiary psychiatric hospital in Singapore during this phase of COVID-19 endemicity (2022) in comparison to the earlier pandemic years (2020 and 2021) and to identify factors which contribute to as well as ameliorate stress and burnout. A total of 282 MHP participated in an online survey in 2022, which included 2 validated measures, namely the Perceived Stress Scale and the Oldenburg Burnout Inventory (OLBI). Participants were also asked to rank factors that contributed the most to their stress and burnout. Between-group comparisons were conducted regarding stress and burnout levels among MHP across different demographic groupings and working contexts. In addition, OLBI data completed by MHP in 2020 and 2021 were extracted from 2 published studies, and trend analysis was conducted for the proportion of MHP meeting burnout threshold across 3 time points. We found that the proportion of MHP meeting burnout threshold in 2020, 2021 and 2022 were 76.9%, 87.6% and 77.9% respectively. Professional groups, age, years of experience and income groups were associated with stress and/or burnout. High clinical workload was ranked as the top factor that contributed to stress and burnout while flexible working arrangement was ranked as the top area for improvement so as to reduce stress and burnout. As such, policy makers and hospital management may want to focus on setting clear mental health targets and facilitate manageable clinical workload, build manpower resiliency, optimize resources and provide flexible work arrangements to alleviate stress and burnout among MHP.

Nursing students' experiences of teaching and learning during the COVID-19 pandemic: a systematic review and meta-synthesis of qualitative studies

INTRODUCTION

During the COVID-19 pandemic, the sudden transition to virtual learning led to several challenges for nursing students. This study aimed to synthesis nursing students' experiences of teaching and learning during the COVID-19 pandemic.

CONTENT

A meta-synthesis of qualitative articles were conducted. Three online databases were searched from December 2019 to December 2022. Qualitative studies and qualitative sections of mixed method studies were included.

SUMMARY

Twenty-four qualitative studies and seven mixed-method studies were included in the review. The findings consisted of one main theme "educational transformation", and three categories "challenging face-to-face clinical training", "transition from face-to-face to virtual education", and "support continua". The evidence indicated that during this health-related crisis, most of the training was provided as distance learning in various forms. According to the findings, distance education alone cannot replace face-to-face education and is suggested to be considered as a supplementary learning method.

OUTLOOK

This study provides a comprehensive understanding of nursing students' experiences during the COVID-19 pandemic, offering practical implications for educators and institutions globally. The lessons learned can inform strategic decisions, policies, and practices to enhance the resilience and adaptability of nursing education in the face of unforeseen challenges.

Effect of mode of healthcare delivery on job satisfaction and intention to quit among nurses in Canada during the COVID-19 pandemic

The COVID-19 pandemic resulted in a major shift in the delivery of healthcare services with the adoption of care modalities to address the diverse needs of patients. Besides, nurses, the largest profession in the healthcare sector, were imposed with challenges caused by the pandemic that influenced their intention to leave their profession. The aim of the study was to examine the influence of mode of healthcare delivery on nurses' intention to quit job due to lack of satisfaction during the pandemic in Canada. This cross-sectional study utilized data from the Health Care Workers' Experiences During the Pandemic (SHCWEP) survey, conducted by Statistics Canada, that targeted healthcare workers aged 18 and over who resided in the ten provinces of Canada during the COVID-19 pandemic. The main outcome of the study was nurses' intention to quit within two years due to lack of job satisfaction. The mode of healthcare delivery was categorized into; in-person, online, or blended. Multivariable logistic regression was performed to examine the association between mode of healthcare delivery and intention to quit job after adjusting for sociodemographic, job-, and health-related factors. Analysis for the present study was restricted to 3,430 nurses, weighted to represent 353,980 Canadian nurses. Intention to quit job, within the next two years, due to lack of satisfaction was reported by 16.4% of the nurses. Results showed that when compared to participants who provided in-person healthcare services, those who delivered online or blended healthcare services were at decreased odds of intention to quit their job due to lack of job satisfaction (OR = 0.47, 95% CI: 0.43-0.50 and OR = 0.64, 95% CI: 0.61-0.67, respectively). Findings from this study can inform interventions and policy reforms to address nurses' needs and provide organizational support to enhance their retention and improve patient care during times of crisis.

Burnout and turnover intention of primary health care providers during the COVID-19 pandemic in China

OBJECTIVES

This study explored the changes and new characteristics of burnout and turnover intention of primary health care (PHC) providers during the COVID-19 pandemic in China.

STUDY DESIGN

This was a cross-sectional study.

METHODS

This study investigated 1326 PHC providers during the COVID-19 outbreak in 2022 in one district of Shanghai, China. Independent t-test or one-way analysis of variance (ANOVA) test were used to analyse the between-group variation of variables associated to burnout and turnover intention. Then, hierarchical regression analysis was used to further determine the impact of certain variables on burnout and turnover intention, the relationship of burnout on turnover intention and the possible moderating effect.

RESULTS

The results showed that there was no significant change in the prevalence of overall burnout of PHC providers compared to the pre-epidemic period; however, there was a significant increase in high-level burnout. No significant change in turnover intention at the moderate level and above was observed. During the COVID-19 pandemic, PHC providers who were older, married, local and had a higher skill level had higher burnout, while PHC providers who were male, unmarried, non-local and separated from their family had a higher turnover intention. It was shown that burnout, with its three sub-dimensions, was a good predictor of turnover intention. The impact of burnout on turnover intention was shown to be alleviated by certain variables, including being married, living locally and receiving benefit packages, including the preferential education policy for children and talent incentive policies.

CONCLUSIONS

Results from this study have highlighted the importance of paying attention to vulnerable groups of PHC providers, for example those who are separated from their families, during emergency situations. Various incentive tools could be comprehensively used to ensure the stability and efficiency of PHC human resources.

Explainable Depression Detection Based on Facial Expression Using LSTM on Attentional Intermediate Feature Fusion with Label Smoothing

Machine learning is used for a fast pre-diagnosis approach to prevent the effects of Major Depressive Disorder (MDD). The objective of this research is to detect depression using a set of important facial features extracted from interview video, e.g., radians, gaze at angles, action unit intensity, etc. The model is based on LSTM with an attention mechanism. It aims to combine those features using the intermediate fusion approach. The label smoothing was presented to further improve the model's performance. Unlike other black-box models, the integrated gradient was presented as the model explanation to show important features of each patient. The experiment was conducted on 474 video samples collected at Chulalongkorn University. The data set was divided into 134 depressed and 340 non-depressed categories. The results showed that our model is the winner, with a 88.89% F1-score, 87.03% recall, 91.67% accuracy, and 91.40% precision. Moreover, the model can capture important features of depression, including head turning, no specific gaze, slow eye movement, no smiles, frowning, grumbling, and scowling, which express a lack of concentration, social disinterest, and negative feelings that are consistent with the assumptions in the depressive theories.

Hidden and Understaffed: Exploring Canadian Medical Laboratory Technologists' Pandemic Stressors and Lessons Learned

(1) Background: The COVID-19 pandemic has highlighted the critical role of medical laboratory technologists (MLTs) in the healthcare system. Little is known about the challenges MLTs faced in keeping up with the unprecedented demands posed by the pandemic, which contributed to the notable staff shortage in the profession. This study aims to identify and understand the stressors of MLTs in Canada and the lessons learned through their lived experiences during the pandemic. (2) Methods: In this descriptive qualitative study, we conducted five semi-structured focus groups with MLTs working during the pandemic. The focus group sessions were audio-recorded and then transcribed verbatim. Thematic analysis was used to inductively code data and identify themes. (3) Results: A total of 27 MLTs across Canada participated in the study. Findings highlighted four key themes: (i) unexpected challenges navigating through the uncertainties of an ever-evolving pandemic; (ii) implications of staff shortage for the well-being of MLTs and quality of patient care; (iii) revealing the realities of the hidden, yet indispensable role of MLTs in predominantly non-patient-facing roles; and (iv) leveraging insights from the COVID-19 pandemic to enhance healthcare practices and preparedness. (4) Conclusion: The study provides in-depth insight into the experiences of MLTs across Canada during the pandemic. Based on our findings, we provide recommendations to enhance the sustainability of the laboratory workforce and ensure preparedness and resiliency among MLTs for future public health emergencies, as well as considerations as to combating the critical staff shortage.

The role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses: a multicenter cross-sectional study in China

BACKGROUND

A high turnover rate in nursing has become a global concern. Mental health issues may increase the turnover intention of nurses and lead to turnover behaviors. However, very little is known about the role of bidirectional associations between emotional exhaustion and depression/anxiety on turnover intention. This study aimed to examine the associations among depression, anxiety, emotional exhaustion and turnover intention, and to test the role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses.

METHODS

An online multicenter cross-sectional study was conducted in Hunan Province, China, from December 2021 to February 2022. The questionnaire collected data from the Turnover Intention Scale, the Emotional Exhaustion Scale, the Patient Health Questionnaire-2, and the Generalized Anxiety Disorder Scale-2, as well as sociodemographic information. Data analysis was performed by univariate analysis, Pearson correlation analysis, multiple linear regression analysis, and structural equation modeling.

RESULTS

The average turnover intention score among Chinese nurses was 14.34 ± 3.75. The prevalence of depression and anxiety was 25.9% and 22.3%, respectively. Depression (r = 0.378, P < 0.001), anxiety (r = 0.391, P < 0.001), and emotional exhaustion (r = 0.532, P < 0.001) were positively associated with turnover intention. Emotional exhaustion partially mediated the associations between depression/anxiety and turnover intention, with both mediating effects accounting for 60.7%. The mediating ratios of depression/anxiety on the associations between emotional exhaustion and turnover intentions were 17.6% and 16.5%, respectively.

CONCLUSIONS

Depression, anxiety, and emotional exhaustion showed significant positive effects on turnover intention among nurses. Emotional exhaustion played a partial mediation role between depression/anxiety and turnover intention, while depression/anxiety played no significant mediation role between emotional exhaustion and turnover intention.

Physicians' Turnover Intention During the "Post-COVID-19" Era: Risk and Protective Factors

PURPOSE

This research investigates risk and protective factors affecting physicians' turnover intention during the post-COVID-19 era.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional online survey study of 958 physicians working in Lombardy (Northern Italy) hospitals was conducted.

FINDINGS

In the post-COVID-19 era, burnout significantly increases physicians' turnover intention. The same is true for fear of being infected by COVID-19 (FIC), which indirectly affects turnover intention via burnout. The higher FIC and burnout, the higher intention to leave the job or working unity. Self-efficacy significantly decreases turnover intention by reducing FIC and burnout.

ORIGINALITY/VALUE

Implementing turnover preventive programs in healthcare professionals is essential, mainly reducing BO and promoting physicians' personal resources, such as self-efficacy.

The shared and dissociable aspects of burnout, depression, anxiety, and irritability in health professionals during COVID-19 pandemic: A latent and network analysis

Burnout syndrome (BS) has been classified as an independent 'work-related phenomenon', however, there is still an important discussion on whether BS is a unique clinical construct due to the overlapping symptoms with other domains of negative affect such as symptoms of depression, anxiety, and irritability. Thus, we investigated the common and dissociable aspects between BS and domains of negative affect such as depression, anxiety, and irritability through a cross-sectional study with 3428 essential service professionals from a national project during the COVID-19 pandemic. Participants were assessed with Burnout Assessment Tool (BAT) and the Patient-Reported Outcomes Measurement Information System (PROMIS) scales to assess the severity of depression, anxiety, and irritability. The discriminability between the constructs was investigated using correlation tests, Bifactor Exploratory Structural Equation Modeling Bifactor (ESEM), and network analyzes. The mean correlation among the four subscales of BAT-12 was stronger with each other than with depression, anxiety, and irritability. Both ESEM and network analysis, despite showing shared characteristics, clearly delineated that Burnout domains were dissociable from other domains of negative affect. Our findings corroborate the ICD-11 strategy to include BS as a separate entity that cannot be fully explained by variance accounted for by other domains.

"I believe…" - graduating midwifery students' midwifery philosophies and intentions for their graduate year: A longitudinal descriptive study

OBJECTIVE

Midwifery graduates may experience transition shock that makes them question their fit for their workplace and the profession and in extreme cases, may lead to them leaving. Understanding graduate midwives' worldviews, job intentions and work experiences is important to inform retention strategies. Factors such as having a strong professional identity and experiencing strong job satisfaction are important for midwife retention. Conversely, stress, trauma and work-life imbalances are examples of factors that lead to attrition from midwifery. Transition shock experienced by some graduates can exacerbate these factors if not managed effectively. This study aimed to identify causes and impact of any changes in graduate and early career midwives' philosophy, practice, and intention to stay in the profession.

DESIGN, SETTING AND PARTICIPANTS

We invited the 2021 and 2022 cohorts of graduating midwifery students from all educational pathways in Victoria, Australia to participate in a longitudinal descriptive study using a questionnaire with both closed and open -ended questions. This paper reports the findings from 16 participants that completed the first survey of a five-year longitudinal descriptive study.

FINDINGS

The sixteen participants predominantly held a woman centred philosophy and ideally wanted to work in a midwife-led model of care. Although excited about moving into practice, they also disclosed a sense of needing to 'survive' in a maternity care system that their beliefs were not fully in alignment with.

KEY CONCLUSIONS

The hopes, expectations and concerns of midwifery students who are anticipating moving into practice in this study resonate with those previously reported and demonstrate the need to consider personality-job fit in supporting this vulnerable group to transition.

IMPLICATIONS FOR PRACTICE

This study provides insights into graduating midwives' hopes for, expectations of, and concerns about transitioning into practice that may inform the design of transition programs and support expansion of midwifery led models of care.

The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress: a longitudinal study of Canadian health care workers during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs' perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.

Methods

A total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress.

Results

Associations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.

Discussion

To ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment.

Impact of the COVID-19 pandemic crisis on turnover intention among nurses in emergency departments in Thailand: a cross sectional study

BACKGROUND

During the COVID-19 pandemic in Thailand, a large volume of COVID-19 patients were referred to hospital emergency departments (EDs). This increased job demand and job strain among ED nurses, resulting in a high risk of intention to leave their organization.

AIMS

To investigate turnover intention during the COVID-19 pandemic among ED nurses and examine the effect of organizational resources, maladaptive regulation, and job burnout on nurses' turnover intention.

METHOD

This cross-sectional study investigated 322 ED nurses. We divided participants into two groups: dark-red zone areas (pandemic crisis areas) and non-red zone areas (non-pandemic crisis areas). Descriptive statistics, Pearson's correlation analysis, and multiple linear regression (forward stepwise method) were used to analyze factors that predicted turnover intention.

RESULTS

Most participants were female and the mean age was 34.54 years. During COVID-19 pandemic crisis, 72.8% of ED nurses in dark-red zone areas desired to leave their organization. The factors of motivation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in dark-red zone areas. Low availability of organizational resources was associated with an increase in the turnover intention rate. Maladaptive regulation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in non-red zone areas.

CONCLUSION

Exhaustion and cognitive impairment stand as significant facets of burnout linked to the intention of turnover among ED nurses. To address this, we recommend fostering secure workplace settings and implementing interventions that alleviate job demands and strains for ED nurses, potentially reducing turnover intentions.

Evaluation of the reboot coaching workshops among urology trainees: A mixed method approach

Background

Urology trainees experience high burnout, and there is an urgent need for acceptable and effective interventions. The current study evaluated Reboot coaching workshops (Reboot-C), a tailored intervention based on cognitive-behavioural principles, with urology trainees.

Objective

Our primary objective was to evaluate the acceptability of Reboot-C among urology trainees. In addition, this study aimed to investigate whether there were changes in confidence, resilience, depression and burnout levels.

Materials and method

A single-arm design was used, including pre- and post-online questionnaires and semi-structured interviews.

Result

Twenty-one urology trainees replied to the survey, attended both Reboot-C workshops and responded to the post-intervention questionnaire. Thirteen of 21 (61%) urology trainees participated in the interview. Participating in Reboot-C was associated with significant improvements in resilience and confidence and a significant reduction in burnout. However, there was no significant reduction in depression. Qualitative data indicated that Reboot was acceptable and helped participants develop useful skills.

Conclusion

These findings pave the way for more conclusive studies on the efficacy of Reboot-C for surgeons.

Nowcasting the 2022 mpox outbreak in England

In May 2022, a cluster of mpox cases were detected in the UK that could not be traced to recent travel history from an endemic region. Over the coming months, the outbreak grew, with over 3000 total cases reported in the UK, and similar outbreaks occurring worldwide. These outbreaks appeared linked to sexual contact networks between gay, bisexual and other men who have sex with men. Following the COVID-19 pandemic, local health systems were strained, and therefore effective surveillance for mpox was essential for managing public health policy. However, the mpox outbreak in the UK was characterised by substantial delays in the reporting of the symptom onset date and specimen collection date for confirmed positive cases. These delays led to substantial backfilling in the epidemic curve, making it challenging to interpret the epidemic trajectory in real-time. Many nowcasting models exist to tackle this challenge in epidemiological data, but these lacked sufficient flexibility. We have developed a nowcasting model using generalised additive models that makes novel use of individual-level patient data to correct the mpox epidemic curve in England. The aim of this model is to correct for backfilling in the epidemic curve and provide real-time characteristics of the state of the epidemic, including the real-time growth rate. This model benefited from close collaboration with individuals involved in collecting and processing the data, enabling temporal changes in the reporting structure to be built into the model, which improved the robustness of the nowcasts generated. The resulting model accurately captured the true shape of the epidemic curve in real time.

Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey

PURPOSE

There is evidence for mental burden and moral distress among healthcare workers during the pandemic. However, there is scarcity of analyses regarding possible correlations of mental burden and moral distress in this context. This study provides data to quantify mental burden and possible associations with moral distress among physicians and nurses working in oncology in Germany.

METHODS

We conducted a cross-sectional online survey with physicians and nurses working in oncology in Germany between March and July 2021. Next to sociodemographic characteristics and working conditions, mental burden and moral distress were assessed using standardized instruments. Binary multivariate logistic regression using the enter method was performed in order to explore the relationship between mental burden and moral distress.

RESULTS

121 physicians and 125 nurses were included in the study. Prevalence of clinically relevant depressive symptoms, anxiety, somatic symptoms, burnout symptoms and moral distress was 19.2, 14.5, 12.7, 46.0 and 34.7% in physicians and 41.4, 24.0, 46.8, 46.6 and 60.0% in nurses respectively. Mental burden was significantly associated with moral distress, being female/diverse, younger age < 40 and increase in workload. Nurses who felt sufficiently protected from COVID-19 reported significantly less moral distress.

CONCLUSION

To improve pandemic resilience, there is a need to ensure safe working environment including psychosocial support. Further evidence on risk and protective factors for moral distress is needed to be able to develop and implement strategies to protect healthcare workers within and beyond the pandemic.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

Exploring the Mental Health Challenges of Emergency Medicine and Critical Care Professionals: A Comprehensive Review and Meta-Analysis

Burnout and depression are global problems affecting healthcare providers, especially those working in stressful departments such as emergency departments (EDs) and critical care units (CCUs). However, pooled data analysis comparing healthcare providers operating in the ED and CCU is yet to be conducted. Therefore, this meta-analysis was systematically conducted to investigate and compare the prevalence of burnout and depression among emergency medicine (EM) and critical care medicine (CCM) professionals. We systematically searched for articles related to our research topic using the database search method and manual search method, which involved reviewing the reference lists of articles from electronic databases for additional studies. After screening the literature from the databases using the eligibility criteria, a quality appraisal using the Newcastle-Ottawa scale was performed on the eligible studies. In addition, a meta-analysis using the Review Manager software was performed to investigate the prevalence rates of burnout and depression. A total of 10 studies with 1,353 EM and 1,250 CCM professionals were included for analysis in the present study. The pooled analysis did not establish any considerable differences between EM and CCM healthcare workers on the prevalence of high emotional exhaustion (EE) (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 0.46-2.19; p = 0.98), high depersonalization (OR = 1.16; 95% CI = 0.61-2.21; p = 0.64), low personal accomplishment (PA) (OR = 0.87; 95% CI = 0.67 - 1.12; p = 0.28), and depression (OR = 1.20; 95% CI = 0.74-1.95; p = 0.45). Moreover, pooled data showed no considerable differences in EE scores (mean difference (MD) = -1.07; 95% CI = -4.24-2.09; p = 0.51) and depersonalization scores (MD = -0.31; 95% CI = -1.35-0.73; p = 0.56). However, EM healthcare workers seemed to have considerably lower PA scores than their CCM counterparts (MD = 0.12; 95% CI = 0.08-0.16; p < 0.00001). No considerable difference was recorded in the prevalence of burnout and depression between EM and CCM healthcare workers. However, our findings suggest that EM professionals have lower PA scores than CCM professionals; therefore, more attention should be paid to the mental health of EM professionals to improve their PA.

Shifting Professional Identity Among Indonesian Medical Practitioners During the COVID-19 Pandemic

The COVID-19 pandemic has had a significant impact on medical practitioners' professional identities due to its novelty and intensity. Using constructivist grounded theory, we investigated how the COVID-19 pandemic shifted individuals' identities as medical practitioners in Indonesia, where the pandemic caused high death rates among healthcare workers, particularly medical practitioners. By interviewing 24 medical practitioners and analyzing relevant documents and reports, we developed a grounded theory of professional identity shifts. We found two patterns: (1) identity growth, in which the medical practitioners thrive and claimed stronger professional identities, and (2) psychological and moral distress leading to attrition, facilitated adaptation, or professional identity collapse. We also found several primary protective factors including religious beliefs, good leadership, team cohesion, healthy work boundaries, connection to significant others, and public acknowledgment. Without adequate protective factors, medical practitioners experienced difficulties redefining their professional identities. To cope with the situation, they focused on different identities, took some time off, or sought mental health support, resulting in facilitated adaptation. Others resorted to attrition or experienced professional identity collapse. Our findings suggest that medical practitioners' experience of professional identity shifts can be improved by providing medical practitioners with opportunities for knowledge updates, better organizational leadership and work boundaries, strategies to enhance team cohesion, and other improvements to medical systems.

Hotel Employees' Burnout and Intention to Quit: The Role of Psychological Distress and Financial Well-Being in a Moderation Mediation Model

Continuous changes, such as pandemics and increasing competition, as well as high workload, affect the workplace behavior of hotel organizations today, resulting in employee burnout and intention to quit. The purpose of this research was to investigate the effect of burnout on intention to quit among male hotel employees, integrating the mediating effect of psychological distress and moderating effect of financial well-being. Male employees in four- and five-star hotels in the UAE completed a total of 304 questionnaires. All direct relationships were positive and statistically significant, there was a partial mediating relationship, and only one of the moderating effects was statistically significant. This study found that burnout predicts the intention to quit as well as psychological distress. Psychological distress partially mediates the relationship between burnout and the intention to quit. Financial well-being moderates the relationship between burnout and psychological distress-making this relationship stronger for employees with high-income prospects-but not the relationship between burnout and intention to quit; regardless of the financial well-being of the employee, burnout will lead to the intention to quit their job. Hotel organizations must be aware of the consequences of employee burnout and concentrate on identifying and treating its causes.

Nursing During a Disaster Starts With Education

Future nurses, both entry level and advanced practice, are pivotal to the nation's disaster response. They are critical frontline, acute, primary, and public health workers in the United States and internationally. To respond well, they must be taught how to prepare and intervene appropriately. This preparation is multidimensional and includes not only concrete knowledge but mental, emotional, and ethical preparation for the realities of working and providing care while affected by chaos. Training should be experiential and reflective and expose students to the interprofessional nature of disaster planning and response. New nurses, as they enter practice, as the COVID-19 pandemic has demonstrated, may also take on the role of a frontline disaster responder. The ability to effectively respond and access available resources to care for patients is required. Schools of nursing and nursing faculty increasingly will be required to include disaster preparedness as an integral part of the nursing curriculum.

The effect of macro-control and organizational support perception on nurses and physicians intention to quit during the COVID-19 pandemic

AIM

The aim of this study is to determine the effect of organizational support and COVID-19 macro-control perception levels on intention to quit in physicians and nurses.

BACKGROUND

During the pandemic process, healthcare workers faced great health risks and workloads. Many health workers are considering quitting their job.

METHOD

A cross-sectional and explanatory research. The sample of the study consisted of 300 nurses and 73 physicians. To collect data, COVID-19 perception of macro-control, perceived organizational support, and intention to quit scales were used. Structural equation modeling was used.

RESULTS

COVID-19 macro-control perception and perceived organizational support have a negative effect on the intention to quit. The perceived organizational support has a partial mediating role, on the COVID-19 macro-control perception and the intention to quit.

CONCLUSION

This study demonstrated that the macro measures taken against the pandemic and the organizational support received by the nurses and physicians, who are the main actors in the fight against the epidemic, negatively affected their intention to leave.

IMPLICATIONS FOR NURSING PRACTICE AND CLINICAL RELEVANCE

To reduce the intention to quit health workers during the COVID-19 pandemic, scientific-based macro-control measures should be taken, and organizational support should be provided.

Burnout, resilience and the quality of life among Malaysian healthcare workers during the COVID-19 pandemic

Background

Healthcare workers have to deal with highly demanding work situations, making healthcare as one of the most challenging professions. Up to now, far too little attention has been paid to burnout, resilience and the quality of life among Malaysian healthcare workers. Therefore, this paper explores the correlation between burnout, resilience and quality of life among Malaysian healthcare workers during the COVID-19 pandemic.

Method

A total of 394 healthcare workers reported their responses on Maslach Burnout Inventory questionnaire, World Health Organization Quality of Life (WHOQOL)-BREF, and Brief Resilience Scale. Respondents were contacted through convenience sampling method and targeted population constituted Malaysian healthcare workers aged 18 years and above.

Results

For occupational exhaustion, about 50.5% of participants have moderate degree, 40.6% have high degree, and 8.9% have low degree of burnout. Health workers from age 25 to 35 years have lower physical health compared to health workers aged <25 years (coefficient = -0.77, p = 0.021). Similarly, healthcare workers who were working more than 10 h every day were more likely to report poor psychological health (coefficient = -2.49, p = 0.06). Positive correlation between physical and psychological health was observed. Further, a negative correlation was found between occupational exhaustion and the quality of life.

Conclusion

It is important to target physical as well as psychological wellbeing of the healthcare workers. Also, it is important to understand the contribution of long working hours in declining the quality of life of the healthcare workers. Thus, allocating fixed working hours for healthcare workers would bring a much-required change.

Surviving the storm: A pragmatic non-randomised examination of a brief intervention for disaster-affected health and social care providers

Disasters affect the well-being of individuals, families and communities. Health and social care providers are essential in response and recovery efforts and are among the most vulnerable to negative physical and mental health impacts of a disaster. Few evidence-based interventions are available to address the psychological needs of providers. The aim of this study was to examine the psychological distress of health and social care providers before and after participating in the brief group intervention, Resilience and Coping for the Healthcare Community (RCHC) and its expanded version, RCHC+. We conducted a pragmatic non-randomised cluster trial with 762 health and social care providers in south Texas and Puerto Rico post-Hurricanes Harvey and Maria. Participants completed surveys assessing post-traumatic stress (PTSD), anxiety, burnout and secondary traumatic stress (STS) prior to intervention delivery and at two time points post-intervention. We calculated the frequency of symptom cut-off scores at baseline, then estimated multilevel ordinal models to examine changes in symptoms across time. Prior to participation in the RCHC (approximately 12 months after the hurricanes), providers reported high levels of PTSD, anxiety and STS symptoms. After participation, providers in both intervention conditions reported a significant reduction in PTSD symptoms from baseline that was sustained over both time points. The likelihood of a reduction in symptoms of anxiety and STS from baseline was sustained at both time points for participants in the RCHC+ condition. These findings indicate that both the RCHC and RCHC+ interventions may reduce psychological distress for health and social care providers and could be an important part of advance planning to support provider's mental health during and after a disaster. Further examination of the RCHC in other disaster contexts could provide additional insight into the responsiveness of the intervention to reducing psychological distress symptoms.

Job Motivation, Burnout and Turnover Intention during the COVID-19 Pandemic: Are There Differences between Female and Male Workers?

The working conditions during COVID-19 highlight the relevance of workers and their occupational health and well-being. The pandemic has caused adverse effects on workers and sharpened social and economic problems, such as a gender gap. In this study, with a multisector sample of 1044 Ecuadorian workers, we present a gender analysis where we evaluate how burnout can mediate the relationship between motivation and workers’ intention to leave their jobs in the COVID-19 context. To test the proposed hypothesis, structural equation model (SEM) was used. In the proposed conceptual model, turnover intention was considered as the dependent variable, the two dimensions of motivation (intrinsic and extrinsic) were the independent variables and burnout was tested as a mediating variable. Consistent with pre-COVID-19 research, our findings confirm the incidence of job motivation on burnout and turnover intention. Additionally, through Sobel’s criteria, we determine that burnout has a mediating effect between job motivation and turnover intention. In terms of gender, we find different results for female and male workers through critical ratios. Our study indicates that female and male workers’ burnout and turnover intentions levels are different when intrinsic motivation is present. In contrast to pre-COVID-19 studies that indicated no gender differences on these variables, we associate these results to gender roles in lockdown conditions during the pandemic.

Analysis on Burnout, Job Conditions, Alexithymia, and Other Psychological Symptoms in a Sample of Italian Anesthesiologists and Intensivists, Assessed Just before the COVID-19 Pandemic: An AAROI-EMAC Study

Background. It was previously reported that health care professionals working in the fields of anesthesiology and emergency are at higher risk of burnout. However, the correlations between burnout, alexithymia, and other psychological symptoms are poorly investigated. Furthermore, there is a lack of evidence on which risk factors, specific to the work of anesthetists and intensivists, can increase the risk of burnout, and which are useful for developing remedial health policies. Methods. This cross-sectional study was conducted in 2020 on a sample of 300 professionals recruited from AAROI-EMAC subscribers in Italy. Data collection instruments were a questionnaire on demographic, education, job characteristics and well-being, the Maslach Burnout Inventory Tool, the Toronto Alexithymia Scale, the Symptom Checklist-90-R, and the Rosenberg Self-Esteem Scale administered during refresher courses in anesthesiology. Correlations between burnout and physical and psychological symptoms were searched. Results. With respect to burnout, 29% of individuals scored at high risk on emotional exhaustion, followed by 36% at moderate–high risk. Depersonalization high and moderate–high risk were scored by 18.7% and 34.3% of individuals, respectively. Burnout personal accomplishment was scored by 34.7% of respondents. The highest mean scores of burnout dimensions were related to dissatisfaction with one’s career, conflicting relationships with surgeons, and, finally, difficulty in explaining one’s work to patients. Conclusions. Burnout rates in Italian anesthesiologists and intensivists have been worrying since before the COVID-19 pandemic. Anesthesiologists with higher levels of alexithymia are more at risk for burnout. It is therefore necessary to take urgent health policy measures.

How to Alleviate Hotel Employees’ Job Stress in the Associations between Job Stressors and Its Consequences

This study investigates the relationship between job insecurity, job stress, and the psychological well-being of hotel employees, and the moderating effect of emotional regulation control on the causal relationship between job stress and psychological well-being. A valid sample of 428 employees was used from three five-star hotels and two four-star hotels in Seoul and Busan, South Korea, for hypothesis testing. After confirming the construct validity and reliability of all measurements, a structural equation modeling and multi-group analysis examine the postulated hypotheses. The findings are as follows: (1) the positive effect of job insecurity on job stress is significant; (2) job stress negatively and significantly mediates the linkage between hotel employees’ job insecurity and psychological well-being, while the direct effect of job insecurity on psychological is not significant; (3) the negative relationship between hotel employees’ job stress and psychological well-being is dramatically alleviated by the seeking support strategy; (4) hotel employees’ active coping strategy also has a palliative negative effect of job stress on psychological well-being; (5) however, avoidance is not an effective strategy for stress relief in the context of hotel employees’ job stress and well-being due to the COVID-19 and job insecurity.

Job Satisfaction and Burnout in Croatian Physiotherapists

BACKGROUND

Physiotherapists are important healthcare professionals in modern and multidisciplinary health forces. However, they are exposed to a high risk of occupational burnout, which is associated with reduced job satisfaction. Job satisfaction is essential for medical professionals because it directly influences patient safety and the quality of medical care. Therefore, this study aimed to determine the association between sociodemographic variables of Croatian physiotherapists, job satisfaction, and occupational burnout.

METHODS

A cross-sectional study was performed among 404 physiotherapists using a sociodemographic questionnaire, the Job Descriptive Index (JDI), and Oldenburg Burnout Inventory (OLBI).

RESULTS

The study group of Croatian physiotherapists was marked by a high level of job satisfaction and occupational burnout. However, a higher level of occupational burnout is associated with lower job satisfaction. The main determinants of job satisfaction were younger age, female gender, less work experience, and married or partnership. At the same time, a higher level of occupational burnout was associated with working in government institutions and being single.

CONCLUSIONS

As a reaction to psychological stress at work with the main components of exhaustion and disengagement, occupational burnout is negatively associated with job satisfaction. Therefore, assessing the factors influencing job satisfaction and burnout in the workplace can help develop physiotherapists' mental health prevention strategies.

Predictors of Healthcare Professionals' Work Difficulty Perception during the COVID-19 Pandemic: Study of Work Environment in a Pandemic Hospital

COVID-19 has dramatically changed the work environment in healthcare, which is creating an additional burden for healthcare professionals. In this study, we investigate the factors that trigger professionals to have negative perceptions of their jobs during the pandemic. A cross-sectional survey is used for this study. The respondents are selected based on convenience random sampling. We use 345 questionaries for the analysis. Respondents are health care professionals (nurses, doctors, midwives, technicians, etc.) working in a pandemic hospital in Turkey. We run a multivariable logistic regression model to analyze the predictors of work difficulty perception. The model is adjusted for the respondents’ demographical characteristics and emotional wellbeing. We found that depression and burnout are significantly correlated with the perception of job difficulty (OR Severe PHQ-9 = 10.8, p = 0.004; OR Severe Burnout = 7.83, p < 0.001). The professionals who are changed from one department to another are also more likely to perceive the job as difficult (OR Department Change = 1.60, p = 0.045). However, the professionals that received sufficient applause from society are more likely to think that they did not face any difficulties doing their job during the pandemic (OR Applause = 0.56, p < 0.016). Anxiety, monetary motivation, religious beliefs, and information availability did not contribute to the perceived difficulty in their jobs. Thus, efforts need to be made to give them more social support and smooth their changes in departments and functions to facilitate their jobs.