Psychological Adjustment of Healthcare Workers in Italy during the COVID-19 Pandemic: Differences in Stress, Anxiety, Depression, Burnout, Secondary Trauma, and Compassion Satisfaction between Frontline and Non-Frontline Professionals

Emotional Responses of Hospital Staff to the DASS-21 Survey During Mass COVID-19 Testing After the Relaxation of Prevention and Control Measures in Zhejiang, China, and Their Change Trajectory

Aim

To investigate the emotional response of hospital staff to the Depression Anxiety Stress Scale-21 (DASS-21) over the COVID-19 pandemic and after the relaxation of prevention and control measures in Zhejiang Province, China, and identify influencing factors.

Design

Multicenter online cross-sectional design.

Methods

From January 10, 2023, to January 20, 2023, 1054 hospital employees in Zhejiang, China, were recruited using WeChat. Data was gathered via online, self-administered surveys. T-tests and one-way analyses of variance, Pearson's correlation analysis, and multiple linear stepwise regression analyses were used to examine the data.

Results

More than 90% of hospital employees were infected with COVID-19. Through regression analysis, the following variables were found to be independent predictors of emotional response to DASS-21: resilience (-13.346, P < 0.0001), sleep (14.689, P < 0.0001), friend support (-4.278, P < 0.0001), education level (2.699, P = 0.007), and marriage (-2.214, P = 0.027). The emotional responses were not as severe as predicted, but they were still well above the Chinese norm. A longitudinal comparison of DASS-21 emotional responses with similar studies showed a parabolic downward trend over time.

Conclusion

Our results identified education level, marriage, friend support, resilience, and sleep as independent predictors of emotional responses to the DASS-21 among hospital workers in this outbreak. Improving the mental resilience and sleep status of staff is a key target. Unmarried medical personnel with higher education should be given greater attention and support by management. In addition, there is still room for further improvement in the government and societal responses to similar outbreaks. The study also found a parabolic downward trend in DASS-21 emotional responses among hospital workers during the COVID-19 outbreak over time.

The mental health of staff at violence against women organizations during the COVID-19 pandemic: Findings from a mixed-methods study of service providers in Canada's largest city

OBJECTIVES

Staff at violence against women (VAW) organizations provide essential services for survivors of violence. The increase in VAW during the COVID-19 pandemic placed additional pressures on VAW staff. We investigated the impacts of the pandemic on the mental health of VAW staff in the Greater Toronto Area to inform recommendations for policy and practice.

METHODS

We conducted a community-based, mixed-methods study on the processes, experiences, and outcomes of adapting VAW programming during the pandemic using a sequential explanatory approach. Throughout 2021, we conducted a survey of direct support and leadership staff who worked on VAW services ("VAW staff") followed by semi-structured interviews with VAW staff purposively sampled from the survey. We descriptively analyzed quantitative survey data on the mental health of 127 VAW staff. We then applied thematic analysis to qualitative data from 18 interviews with VAW staff. We used the qualitative data to support interpretation and enrich the quantitative findings regarding staff mental health.

RESULTS

In the survey, 81% of leadership and 61% of direct support staff indicated that their work was more distressing during the pandemic. Participants reported moderate symptoms of vicarious trauma and mild symptoms of anxiety and depression. We generated three themes from the qualitative data to help explain these findings: (1) challenges related to changing work environments; (2) distress over not meeting client needs; and (3) difficulties in adapting self-care strategies in response to pandemic stressors.

CONCLUSION

VAW organizations require increased resources and flexible funding to hire and retain more staff to respond to higher and more complex caseloads during public health emergencies. With more structural supports in place, VAW organizations could create more time and space to develop their trauma-informed organizational practices: for example, establishing a culture of connection and learning among staff virtually and in-person and facilitating a range of self-care opportunities.

Online yoga programme for resident physicians in Québec: an evaluation of feasibility and impact on mental health

OBJECTIVES

To evaluate the feasibility of the Bali Yoga Programme for Residents (PYB-R), an 8-week virtual yoga-based intervention and determine its impact on the mental health of resident physicians.

DESIGN

Single-group repeated measures study.

SETTING

Associations from the four postgraduate medical education programmes in Québec, Canada.

PARTICIPANTS

Overall, 55 resident physicians were recruited to participate of which 53 (96.4%) completed the assessment pre-PYB-R. The postintervention assessment was completed by 43 residents (78.2%) and 39 (70.9%) completed all phases (including 3-month follow-up). Most were in their first year (43.4%) or second year (32.1%) of residency. The majority were female (81.1%) with a mean age of 28±3.6 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was feasibility as measured by participation in the PYB-R. Secondary outcome measures were psychological variables (anxiety, depression, burn-out, emotional exhaustion, compassion fatigue and compassion satisfaction) and satisfaction with the PYB-R. Residents were further subgrouped based on the quality of work life and a number of PYB-R sessions attended.

RESULTS

The attrition rate for programme completion was 19%. Of the 43 residents who completed the PYB-R, 90.6% attended between 6 and 8 sessions. Repeated-measures analysis of variances (ANOVAs) at three time points (baseline, PYB-R completion and 3-month follow-up) confirmed a decrease in scores for depression and anxiety, and an increase in scores for compassion satisfaction. No changes were observed in the other psychological variables evaluated. ANOVAs also confirmed that a better quality of life at work helps develop compassion satisfaction, a protective factor to compassion fatigue. Most participants (92.9%) indicated they were satisfied or very satisfied with the quality of the programme.

CONCLUSIONS

A virtual yoga-based programme is feasible and has lasting positive effects for up to 3 months on the mental health of resident physicians. Further research is warranted to validate these findings using a larger sample of residents with a control group.

Healthcare Provider Experiences With Unvaccinated COVID-19 Patients: A Qualitative Study

IMPORTANCE

In the setting of an active pandemic the impact of public vaccine hesitancy on healthcare workers has not yet been explored. There is currently a paucity of literature that examines how patient resistance to disease prevention in general impacts practitioners.

OBJECTIVES

The COVID-19 pandemic created unprecedented healthcare challenges with impacts on healthcare workers' wellbeing. Vaccine hesitancy added complexity to providing care for unvaccinated patients. Our study qualitatively explored experiences of healthcare providers caring for unvaccinated patients with severe COVID-19 infection in the intensive care setting.

DESIGN

We used interview-based constructivist grounded theory methodology to explore experiences of healthcare providers with critically ill unvaccinated COVID-19 patients.

SETTING AND PARTICIPANTS

Healthcare providers who cared for unvaccinated patients with severe COVID-19 respiratory failure following availability of severe acute respiratory syndrome coronavirus 2 vaccines were recruited from seven ICUs located within two large academic centers and one community-based hospital. We interviewed 24 participants, consisting of eight attending physicians, seven registered nurses, six critical care fellows, one respiratory therapist, one physiotherapist, and one social worker between March 2022 and September 2022 (approximately 1.5 yr after the availability of COVID-19 vaccines in Canada).

ANALYSIS

Interviews were recorded, transcribed, de-identified, and coded to identify emerging themes. The final data was analyzed to generate the thematic framework. Reflexivity was employed to reflect upon and discuss individual pre-conceptions and opinions that may impact collection and interpretation of the data.

RESULTS

Healthcare providers maintained dedication toward professionalism during provision of care, at the cost of suffering emotional turmoil from the pandemic and COVID-19 vaccine hesitancy. Evolving sources of stress associated with vaccine hesitancy included ongoing high volumes of critically ill patients, resource shortages, and visitation restrictions, which contributed to perceived emotional distress, empathy loss, and professional dissatisfaction. As a result, there were profound personal and professional consequences for healthcare professionals, with perceived impacts on patient care.

CONCLUSIONS

Our study highlights struggles of healthcare providers in fulfilling professional duties while navigating emotional stressors unique to vaccine hesitancy. System-based interventions should be explored to help providers navigate biases and moral distress, and to foster resilience for the next major healthcare system strain.

Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care

OBJECTIVE

To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services.

DESIGN

Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021).

METHODS

The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health.

RESULTS

The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care.

CONCLUSIONS

Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality.

IMPLICATIONS

The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk.

REPORTING METHOD

We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Caring through crisis: The professional quality of pediatric nurses during the COVID-19 pandemic

PURPOSE

This study described pediatric nurses' professional quality of life during COVID-19 and explored demographic/clinical practice factors independently associated with compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS).

DESIGN AND METHODS

The Relational Caring Complexity Theory was used. This study employed a cross-sectional, descriptive, correlational design to describe professional quality of life of pediatric nurses (demographic questionnaire and ProQOL 5 measure) working during the COVID-19 pandemic.

RESULTS

From 150 pediatric nurses, the mean scores were CS 40.8 (± 4.8), BO 22.6 (± 4.7), and STS 22.8 (± 5.8). Results of the multiple regression revealed that two variables, deployed to the same unit versus not deployed (β = 2.424, p = .02) and currently practicing in perioperative/ambulation settings versus intensive care (β = -0.272, p = .03), were independently associated with CS. Deployed to the same unit versus not deployed was found to be independently and significantly associated with BO (β = -0.28, p = .005). The number of patients cared for with COVID-19 (β = 0.196, p = .03) was significantly associated with STS.

CONCLUSIONS

While the overall response was positive, these nurses were more likely to experience BO when deployed to the same area (likely a COVID-19 adult unit) and STS as they cared for more patients with COVID-19.

PRACTICE IMPLICATIONS

Leaders should be aware of the impact of caring in times of crisis. Decentralized staffing may help meet emergent needs on a particular shift, but ensuring deployed nurses are well-supported is vital.

Fear of the unknown: Experience of frontline healthcare workers with coping strategies used to face the COVID 19 pandemic

The COVID 19 pandemic presented various challenges among health care workers, one of them being the impact it has on mental health. The psychological problems such as anxiety, depression, insomnia and stress, all consequences of the pandemic cause psychopathological outcomes reverberating negatively on the emotional well-being of health care workers. This study aimed to explore the experience of frontline healthcare workers (HCWs) during the COVID-19 pandemic in a middle-income country in Latin America and to identify the coping mechanisms they used to face stressful situations during this time. A qualitative study based on an interpretative paradigm was conducted allowing to examine complex, ambiguous and emotionally loaded topics to explore in detail the experience of frontline HCWs during the COVID-19 pandemic. Through convenience sampling eleven frontline HCWs were recruited to participate in semi-structured interviews. An inductive analysis was done with four pre-established categories: the experience of HCWs during the attention of COVID-19 patients, the experience during their own infection, the experience during the work reintegration and the coping mechanisms used. Our results show that fear and uncertainty predominated throughout the attention of COVID-19 patients. Participants used both coping strategies based on problem-solving efforts, such as routine changes, and emotional management efforts, like social support or psychological counselling. The choice of coping strategies was influenced by their personal beliefs, past emotional experiences, and prior medical formation. These findings provide public and private institutions insight for creating effective policies, based on the HCWs' preferences, to promote their psychological well-being.

Occupational Stress in Healthcare Professionals in Spain: A Multicenter Study

Introduction: Occupational stress significantly impacts healthcare professionals in the Spanish public hospital system. This study, conducted from April to June 2022, focuses on analyzing stress levels using the Nursing Stress Scale through an online survey. Methods: A cross-sectional study was carried out using an online survey from April to June 2022 in four hospitals. The Nursing Stress Scale was used to comprehensively assess stress levels among healthcare professionals. Results: The findings revealed a substantial contrast in stress outcomes based on personal circumstances. Healthcare professionals in stable partnerships and with children exhibited lower stress levels, acting as protective factors during the pandemic. Conversely, those engaged in rotating shifts, especially those working over 60 h per week, showed a sevenfold increase in high-stress probability (p < 0.05). Temporary contract holders and those with heightened exposure to COVID-19 reported elevated stress levels, highlighting the complex dynamics impacting the mental well-being of healthcare workers. Conclusions: Findings emphasize the necessity for targeted interventions to safeguard healthcare professionals' well-being, focusing on the psychological consequences of factors like rotating shifts and extended working hours. Protective elements such as stable partnerships and parenthood could serve as a foundation for initiatives supporting work-life balance, potentially involving government policies and hospital management.

Support Needs of Labor and Delivery Nurses After Traumatic Experiences

OBJECTIVE

To examine the effect of psychological distress, overall distress, and institutional support following a traumatic workplace event on absenteeism, turnover intention, and resilience among labor and delivery nurses.

DESIGN

A quantitative cross-sectional survey.

SETTING

Online distribution from January 13, 2021, to February 2, 2021.

PARTICIPANTS

A nationwide convenience sample of labor and delivery nurses recruited from the Association of Women's Health, Obstetric and Neonatal Nurses (N = 171).

METHODS

Participants completed a survey that included the Second Victim Experience and Support Tool-Revised and the Second Victim Support Desirability survey. We compared available versus desired support options using descriptive analyses. We examined levels of psychological distress and lack of institutional support in relation to turnover intention, absenteeism, and resilience using multiple regression analyses.

RESULTS

Participants identified and described various traumatic experiences in the workplace, including neonatal and maternal death, complicated births, and workplace violence. Participants indicated that the available support services did not meet their needs. Psychological distress, overall distress, and lack of institutional support were associated with absenteeism and turnover, whereas only institutional support was associated with resilience.

CONCLUSION

Labor and delivery nurses encounter various traumatic events in the workplace, and the support services provided after an event do not meet their needs. Additional research is needed to understand the scope of the problem and investigate best practices to assist labor and delivery nurses following traumatic events.

Informal Peer Support and Intentional Acts of Kindness May Attenuate the Impact of Work-Related Stressors on Compassion Satisfaction, Secondary Traumatic Stress, and Burnout of Emergency Medical Services Clinicians

OBJECTIVE

Emergency medical services (EMS) Code Lavender was developed to support EMS clinicians after stressful events via consistent recognition of events, informal peer support, and intentional acts of kindness. This study evaluated changes in burnout screening tool responses of EMS clinicians in response to program implementation and the coincidental start of coronavirus disease 2019.

METHODS

Anonymous surveys with demographic questions and 2 burnout screening tools were distributed before program implementation (spring 2020) and 20 months later (fall 2021). Analysis included t-tests, Fisher exact tests, and multivariable linear regression.

RESULTS

Seventy-seven preprogram (59% response rate) and 108 intraprogram (88% response rate) survey responses were included. No changes existed between preprogram and intraprogram responses across all subscale scores. Sex was associated with depersonalization subscale scores, with men having scores 1.53 (95% confidence interval [CI] 0.11-2.95) higher than women. Compared with emergency medical technicians, paramedics had higher compassion satisfaction (OR 3.50; 95% CI 1.79-5.70) and personal accomplishment scores (OR 2.40; 95% CI 1.08-3.71). Transport nurses had higher personal accomplishment (OR 3.29; 95% CI 1.18-5.40), depersonalization (OR 3.73; 95% CI 1.19-6.26), and rates of burnout symptoms (OR 0.54; 95% CI 0.09-0.98) than emergency medical technicians.

CONCLUSION

The organizational commitment, peer support, and authentic leadership of EMS Code Lavender may attenuate work-related stressors among EMS clinicians.

The Effect of Coronavirus (COVID-19) on Job Satisfaction, Work Stress and Burnout of Healthcare Workers: A Systematic Review and Meta-Analysis

Background

We aimed to examine the job satisfaction (JS), work stress (WS) and burnout (B) levels of healthcare workers (HCWs), who are at the forefront of the fight against the coronavirus (COVID-19) epidemic process, which negatively affects the whole world, by meta-analysis.

Methods

Articles, theses and papers in the literature before the COVID-19 (2014-2019) and during COVID-19 (2020-2022) were systematically reviewed. The sample size of 54 studies conducted from 13 countries was 49.139. Data analysis was performed with the Comprehensive Meta-analysis (CMA) 3.0 Version program.

Results

According to the random effect model analysis result, a negative, significant and low-level relationship was found between WS and JS, before and during COVID-19. There was a negative, significant and medium level relationship between JS and B. It was found positive, significant and high-level relationship between WS and B. Human development level (HDL) has a moderating effect on WS and B. In addition, sample size has moderating effect on WS and JS.

Conclusion

During the prolonged COVID-19 pandemic, HCWs have experienced more burnout due to strict isolation, working conditions requiring overtime, fatigue, insomnia and concerns about virus transmission. Intense work tempo, inadequate health equipment, patient deaths, and low wages are the factors that decrease JS and increase WS and B. It is recommended to improve working conditions globally and provide financial support and mental health protection for HCWs.

Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

Background

Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic.

Objective

The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis.

Methods

We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up.

Results

For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048).

Conclusion

The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

Work & life stress experienced by professional workers during the pandemic: a gender-based analysis

The COVID-19 pandemic impacted work and home life exacerbating pre-existing stressors and introducing new ones. These impacts were notably gendered. In this paper, we explore the different work and home life related stressors of professional workers specifically as a result of the COVID-19 pandemic through the gender-based analysis of two pan Canadian surveys: The Canadian Community Health Survey (2019, 2020, 2021) and the Healthy Professional Worker Survey (2021). Analyses revealed high rates of work stress among professional workers compared to other workers and this was particularly notable for women. Work overload emerged as the most frequently selected source of work stress, followed by digital stress, poor work relations, and uncertainty. Similar trends were noted in life stress among professional workers, particularly women. Time pressure consistently stood out as the primary source of non-work stress, caring for children and physical and mental health conditions. These findings can help to develop more targeted and appropriate workplace mental health promotion initiatives that are applicable to professional workers taking gender more fully into consideration.

Determinants of burnout in Canadian health care workers during the COVID-19 pandemic

Background: Health care workers (HCWs) are among the most vulnerable groups to experience burnout during the coronavirus (COVID-19) pandemic. Understanding the risk and protective factors of burnout is crucial in guiding the development of interventions; however, the understanding of burnout determinants in the Canadian HCW population remains limited.Objective: Identify risk and protective factors associated with burnout in Canadian HCWs during the COVID-19 pandemic and evaluate organizational factors as moderators in the relationship between COVID-19 contact and burnout.Methods: Data were drawn from an online longitudinal survey of Canadian HCWs collected between 26 June 2020 and 31 December 2020. Participants completed questions pertaining to their well-being, burnout, workplace support and concerns relating to the COVID-19 pandemic. Baseline data from 1029 HCWs were included in the analysis. Independent samples t-tests and multiple linear regression were used to evaluate factors associated with burnout scores.Results: HCWs in contact with COVID-19 patients showed significantly higher likelihood of probable burnout than HCWs not directly providing care to COVID-19 patients. Fewer years of work experience was associated with a higher likelihood of probable burnout, whereas stronger workplace support, organizational leadership, supervisory leadership, and a favourable ethical climate were associated with a decreased likelihood of probable burnout. Workplace support, organizational leadership, supervisory leadership, and ethical climate did not moderate the associations between contact with COVID-19 patients and burnout.Conclusions: Our findings suggest that HCWs who worked directly with COVID-19 patients, had fewer years of work experience, and perceived poor workplace support, organizational leadership, supervisory leadership and ethical climate were at higher risk of burnout. Ensuring reasonable work hours, adequate support from management, and fostering an ethical work environment are potential organizational-level strategies to maintain HCWs' well-being.

Measuring the psychosocial impact of COVID-19 by means of the "international student well-being study questionnaire": Evidence on Italian university students

Background

The COVID-19 pandemic appeared as an unpredictable disruption of daily activities. This situation produced a unique mental health impact for the general population, youth, and vulnerable groups. A documented consequence has been alcohol abuse and impaired mental health. To our knowledge, no published study has yet evaluated the rates of depressive symptoms, academic frustration, and substance abuse in the Italian student population in the COVID era linking them to sociodemographic variables.

Aims

To investigate the incidence of depressive symptoms, academic frustration, and substance abuse students developed in one university in Northern Italy during the first COVID-19 outbreak, using a student wellbeing framework borrowed from Allardt's and Bronfenbrenner's theories.

Methods

Descriptive statistics, correlations, Wilcoxon test and factorial ANOVA were performed on data gathered through an online questionnaire sent to a convenience sample of university students. Data collection occurred between 18 May and June 21, 2020.

Results

According to the framework used, Being was the dimension of sociodemographic variables, Having was economic support and Loving was social support. Students experienced academic frustration and related depressive symptoms. Male gender seemed to be less affected by the depressive syndrome. With regard to economic support and related repercussions on depressive symptoms, students who reported that they could not obtain a loan showed significantly higher depressive symptoms. Students benefiting from greater financial support showed less academic frustration. Age appeared to be a predictor of academic frustration since young students proved to be the most frustrated. The examined students' population showed a significant decrease in alcohol and cigarettes consumption.

Conclusions

Having and Being dimensions influenced depression and academic frustration. Having and Loving dimensions were related with use of substances. The study findings support the implementation of interventions to help students, at a psychological, social, financial level aiming at fostering the quality of students' educational life.

The perioperative experience and needs of hepatocellular carcinoma patients in interventional therapy: a phenomenological qualitative study

OBJECTIVE

This study aims to investigate the perioperative experience and needs of patients with liver cancer for interventional therapy, in order to provide the basis for further improving a patient's medical experience and satisfaction.

METHODS

A semi-structured in-depth interview was conducted for 16 patients with liver cancer in interventional therapy using the phenomenological research method of qualitative research. The themes were analyzed, summarized, refined and extracted using the Colaizzi analytical procedure.

RESULTS

The study results revealed that the perioperative experience and needs of patients with liver cancer for interventional therapy could mainly be summarized into seven themes: anxiety, fear and helplessness; not understanding the specific procedures of interventional therapy; worrying that the disease would not be treated as expected; lack of understanding of perioperative adverse reactions and the inability to cope with these; concern on the financial burden of health care costs on families; concerned on the physical and mental health of the dependent; the further improvement of diagnosis and treatment procedures.

CONCLUSION

Patients with liver cancer undergo a complex psychological experience during interventional therapy. In clinical practice, a patient's psychological needs and changes should be valued, in order to provide a targeted psychological intervention, health guidance and social support, thereby improving the medical experience and satisfaction of patients.

Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study

BACKGROUND

The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs.

OBJECTIVE

This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic.

METHODS

Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ≥1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave.

RESULTS

We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48%) attended >1 session. The study participants were predominantly female individuals (40/50, 80%) and comprised physicians (17/50, 34%), nurses (9/50, 18%), and other HCWs (24/50, 48%), who were largely from Ontario (41/50, 82%). Of 50 attendees, 26 (52%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92%). The most cited reasons for attending the program were to relax (38/48, 79%), manage stress or anxiety (36/48, 75%), wish for loving kindness or self-compassion (30/48, 64%), learn mindfulness (30/48, 64%), and seek help with emotional reactivity (25/48, 53%). Qualitative interviews with 15 out of 50 (30%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants' needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate.

CONCLUSIONS

The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs.

The nurse faculty role: A lived experience of mentoring nurses while coping with anxiety during the COVID-19 pandemic

WHAT IS KNOWN ON THE SUBJECT?: Anxiety is common in women, nurses and nurse educators and can negatively impact overall mental well-being and work-life satisfaction. Anxiety increased during the COVID-19 pandemic. Hope is a personal resource that can be employed to help cope with anxiety. Professional identity, 'our why', is important to recognize and revisit as a way to add value to daily work in anxious times. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Compassion fatigue has contributed to burnout and turnover of nurses and nursing faculty. Knowing our 'why' helps understand the motivation in our work. Using hope as a personal resource, and sharing my lived experience, could be useful to other nursing faculty struggling with anxiety. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: There is a need for mental health resources within healthcare and education systems to support nurses and nurse educators not only during the COVID-19 pandemic but through future healthcare crises. Support programmes and interventions need to be developed to sustain and retain both nurses and nursing faculty.

ABSTRACT

BACKGROUND: Providing patient care and nurse education in today's healthcare environment is high-stress, often resulting in high-anxiety among both nurses and nurse educators. The impact of the COVID-19 pandemic on nurse faculty is largely unexplored.

AIMS

The aim was to share the experience of living and work working with anxiety in the nurse faculty role during the COVID-19 pandemic.

MATERIALS & METHODS

This is a lived experience narrative of one nurse faculty member.

RESULTS

Through daily purposeful self-motivation and reflection, yoga, and brief outdoor respites, the author was able to strengthen professional identity, to see value in her work and to activate the personal resource of hope (Nursing Management, 52, 2021, 56; Journal of Occupational and Organizational Psychology, 93, 2020, 187).

DISCUSSION

'Nursing faculty are essential to the profession' and likely experienced 'emotional exhaustion' during the pandemic (Nursing Education Perspectives, 42, 2021, 8) in their efforts to buoy students. It needs to be acknowledged that nursing faculty can experience anxiety, secondary trauma (International Journal of Environmental Research and Public Health, 17, 2020, 8358) and compassion fatigue, through listening to students' experiences and offering reinforcement during chaotic times.

CONCLUSION

Little is known about what nursing faculty experienced as they attempted to support students (Nursing Education Perspectives, 42, 2021, 285). It is hoped that by sharing this lived experience, nurses and nurse faculty will understand how employing hope as a personal resource and re-engaging with their professional identity will help them cope with the significant stresses that future healthcare pandemics or disasters may bring.

Occupational Stress Levels among Radiologists and Radiographers in Hungary during the COVID-19 Era

The COVID-19 pandemic has heightened stress levels, potentially affecting the occupational wellbeing of radiographers and radiologists. Our study aimed to assess occupational stress levels within the radiology department and identify contributing factors. A cross-sectional survey was conducted between September and November 2022, with participants comprising radiographers and radiologists affiliated with the Hungarian Society of Radiographers and the Hungarian Society of Radiologists. The online survey collected socio-demographic and COVID-19 data, and the participants completed an effort-reward imbalance questionnaire. The analysis of 406 responses revealed significantly higher effort-reward imbalance (ERI) levels among the radiologists compared to the radiographers (p < 0.05). The healthcare professionals with over 30 years of experience exhibited significantly lower ERI levels than those with 1-9 years, 10-19 years, or 20-29 years of experience (p < 0.05). Additionally, the individuals aged 31-40 demonstrated higher ERI levels compared to their counterparts aged 19-30, 41-50, and over 51 (p < 0.05). The respondents cohabiting with a spouse/partner reported significantly higher stress levels than their single colleagues (p < 0.05), while the dog owners exhibited significantly lower ERI levels (p < 0.05). Elevated occupational stress highlights specific groups requiring targeted interventions to reduce stress and mitigate burnout among radiologists and radiographers.

Stronger together: learner reactions on a team-based, interprofessional first death simulation experience

Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.

Factors contributing to the burnout of the faculties of a medical university in Iran: A cross-sectional study

BACKGROUND AND AIMS

Faculty members confront a variety of obstacles over time, the most recent of which is the coronavirus disease 2019 pandemic, which may increase their vulnerability to burnout (BO). This study aims to examine BO in medical school faculties, as well as the factors that lead to BO and well-being in them.

METHODS

This cross-sectional study was conducted in 2021 using online questionnaires completed by 222 faculty members of a medical university in Iran. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Well-being index (WBI) were used. Additionally, we gathered individual-level profiles (demographic, well-being) and occupational information (job profile, attitude toward work).

RESULTS

A total of 60 (27%) faculties reported having high BO, and 112 (50.5%) reported having low well-being. Being female (odds ratio, OR = 2.69), having time to spend with the family (OR = .26), the intent of turnover (OR = 8.65), job recommendation to the offspring (OR = .26), and experiencing violence last year (OR = 2.97) were some of the individual-level factors and job-related attitudes associated with a higher BO. In the neural network for BO, the most important variables were the intention of turnover, followed by adequate family time.

CONCLUSION

One third of the responding faculty reported severe BO, and BO was found to be significantly associated with lower well-being. The increased levels of BO and a decreased experience of well-being were both associated with a higher intention of turnover. According to the study, it is important to pay attention to both clinical and nonclinical field faculty members, female faculty members, those who have a high workload, and members who have experienced violence in the workplace. By acknowledging the unique challenges and experiences faced by these individuals, tailored measures can be developed to address their specific concerns and foster a supportive and inclusive environment.

Compassion satisfaction, burnout, and secondary traumatic stress among nurses after the second wave of the COVID-19 pandemic

Background

Nurses frequently experience compassion fatigue and burnout, which impact their personal lives and patient care. The COVID-19 pandemic additionally caused stress, uncertainty, and fear of death among healthcare professionals.

Aim

To assess professional quality of life (ProQoL) among nurses after the second wave of the COVID-19 pandemic.

Material and Methods

A web-based cross-sectional study was conducted among 203 nurses using a purposive sampling technique in the month of September to December 2021. Data were collected using a self-administered ProQoL scale version 5.

Statistical Analysis

Descriptive and inferential statistics were used. Kolmogorov-Smirnov test, Mann-Whitney U, and Kruskal-Wallis H test were used. Bivariate correlations were used to correlate the main variables. Multiple linear regression analysis was also performed.

Results

The majority of the nurses reported a moderate level of compassion satisfaction (CS) (62.6%), burnout (BO) (66.0%), and secondary traumatic stress (STS) (63.1%). Residence and education emerged as a factor whether the nurses experienced BO or STS, respectively. Additionally, CS negatively correlated with BO (r = -0.732: P < 0.001) and STS (r = -0.141: p-0.04).

Conclusions

The majority of the nurses experienced moderate levels of CS, BO, and STS after the second wave of the COVID-19 crisis and nurse patient-ratio emerged as a significant factor to predict CS, BO, or STS. Hence, effective measures need to be implemented by hospital administration to enhance the nurses' satisfaction and reduce fatigue and burnout.

[The impact of the coronavirus pandemic on the mental health of critical care workers]

INTRODUCTION

The coronavirus pandemic has focused attention on the importance of critical care and highlighted the shortage of critical care specialists. Due to increasing workloads and high mortality rates, healthcare professionals were exposed to higher levels of physical and psychological stress during the pandemic than before.

OBJECTIVE

Our study investigated the effects of the coronavirus outbreak on the emotional, mental and moral stress of intensive care professionals.

METHOD

Our workgroup performed paper-based surveys among caregivers in the Department of Anaesthesiology and Intensive Therapy at Semmelweis University. The first survey was conducted at the start of the pandemic in 2020, the second survey was conducted after the third wave in 2021. We applied validated questionnaires (Professional Quality of Life, Demoralization Scale, Perceived Stress Scale, Impact of Event Scale, and Posttraumatic Growth Inventory), collected demographic data and information on lifestyle, recreation, dietary habits, and accepting psychological support.

RESULTS

The number and demographic characteristics of the participants in the two studies are different, reflecting the changes in the workforce during the pandemic. Our results revealed no differences between the working and socio-demographic groups before the outbreak, however, one year later, nurses scored significantly higher on all negative psychological scales compared to other groups. Only a minority of the respondents had sought psychological support (9.5-12.7%), although more than a third of respondents reported the need for psychological support. Employees in new work positions showed significantly increased posttraumatic growth (2.91 ± 0.82 vs. 2.20 ± 1.06, p = 0.016).

DISCUSSION

These findings demonstrate that nurses are the most strained workgroup during an uncertain and stressful period. The available mental support alone is not enough to help caregivers.

CONCLUSION

Further steps are needed to improve the mental health of critical care workers. Orv Hetil. 2023; 164(42): 1646-1655.

Psychosocial impact of COVID-19 pandemic: experience of healthcare workers in Qatar

Background

The COVID-19 pandemic has had a profound and global impact on healthcare systems worldwide, presenting unprecedented challenges for healthcare workers (HCWs) on the front. We aimed to evaluate the prevalence of anxiety and depression symptoms during the coronavirus pandemic among healthcare professionals in Qatar.

Methods

A cross-sectional study where an electronic questionnaire containing demographics, and psychosocial questions were made on Google Docs and Microsoft Team, and were sent through email and WhatsApp to healthcare workers, including doctors, nurses, allied health and others working at Hamad Medical Corporation in Qatar, from June 1, 2021, to January 1st 2023. ANOVA, t-test and multiple linear regression were used to see the association between the psychological factors and sociodemographic variables using STATA version 17 software.

Results

A total of 829 participants were included in this study (response rate: 55%). The average age of the participants is 36.0 ± 7.1; 65.9% were males; 2.3% were doctors and 53% were nurses, 38.7% were allied healthcare professionals and 6% were others. Psychological, social effects, and workplace were shown to significantly related to their marital status, career, and hospital setting (p < 0.01 for each). Similar to this, dealing with COVID-19 patients and their education level with the length of time working at the designated facility were all connected with the health professional safety score (p < 0.05).

Conclusion

During the COVID-19 epidemic, healthcare workers in Qatar experienced a high incidence of negative psychosocial symptoms. To alleviate these outcomes, it would be useful to implement screening procedures for such symptoms and to devise preventive measures accordingly.

Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational Well-Being of Mental Health Professionals: An International Study

BACKGROUND

Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies have examined the effects of the pandemic on mental health professionals despite the heightened demand for their services.

METHOD

A multilingual, longitudinal, global survey was conducted at 3 time points during the pandemic among members of the World Health Organization's Global Clinical Practice Network. A total of 786 Global Clinical Practice Network members from 86 countries responded to surveys assessing occupational distress, well-being, and posttraumatic stress symptoms.

RESULTS

On average, respondents' well-being deteriorated across time while their posttraumatic stress symptoms showed a modest improvement. Linear growth models indicated that being female, being younger, providing face-to-face health services to patients with COVID-19, having been a target of COVID-related violence, and living in a low- or middle-income country or a country with a higher COVID-19 death rate conveyed greater risk for poor well-being and higher level of stress symptoms over time. Growth mixed modeling identified trajectories of occupational well-being and stress symptoms. Most mental health professions demonstrated no impact to well-being; maintained moderate, nonclinical levels of stress symptoms; or showed improvements after an initial period of difficulty. However, some participant groups exhibited deteriorating well-being approaching the clinical threshold (25.8%) and persistently high and clinically significant levels of posttraumatic stress symptoms (19.6%) over time.

CONCLUSIONS

This study indicates that although most mental health professionals exhibited stable, positive well-being and low stress symptoms during the pandemic, a substantial minority of an already burdened global mental health workforce experienced persistently poor or deteriorating psychological status over the course of the pandemic.

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.

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Background and Objectives: Nitrous oxide (N2O) has recently emerged as a cheap alternative to other recreational substances. Although legally available, its chronic use is associated with severe neurological and hematological complications due to the irreversible inactivation of vitamin B12. While no reliable data on abuse of N2O in Italy have been provided to date, we assessed the knowledge, attitudes, and practices of Italian medical professionals on the management of N2O abuse cases. Materials and Methods: A cross-sectional study was performed as a web-based survey through a series of Facebook discussion groups (targeted medical professionals: 12,103), and participants were specifically asked about their previous understanding of N2O abuse and whether they had or not any previous experience in this topic. Results: A total 396 medical professionals participated in the survey. Overall, 115 participants had previous knowledge about N2O abuse (29.04%), with higher odds for professionals with a background in emergency medicine (adjusted odds ratio (aOR) 3.075; 95% confidence intervals (95%CI) 1.071 to 8.828) and lower for specialists in psychiatry (aOR 0.328; 95%CI 0.130 to 0.825). Knowledge status on N2O abuse was largely unsatisfying, as knowledge status, reported as a percent value, was estimated to 45.33% ± 24.71. Having previously managed a case of N2O abuse was associated with higher risk perception of the actual severity of this condition (aOR 5.070; 95%CI 1.520 to 16.980). Conclusions: Our study suggests that N2O poisoning cases are occurring in Italian settings but are not reasonably reported to national authorities. As substantial knowledge gaps of Italian medical workforces were identified, we cannot rule out that the actual abuse of N2O in the population may be far larger than currently suspected.

Risk factors of developing psychological problems among frontline healthcare professionals working in the COVID-19 pandemic era: a meta-analysis

BACKGROUND

This study sought to evaluate the risk factors behind developing psychological problems as per specific mental health assessment instruments. This study focuses specifically on frontline healthcare professionals of the COVID-19 pandemic era, and evaluated the psychological assessment of frontline healthcare professionals.

METHODS

Studies reporting on the psychological assessment of frontline healthcare professionals were retrieved from the PubMed, Embase, Web of Science, Ovid, EBSCO, and Cochrane Library databases. The recommended method was used to assess the risk of bias of the included studies. The random-effects method was applied when significant heterogeneity was observed.

RESULTS

The combined results from the 20 included articles indicated that frontline healthcare professionals had a higher risk of developing anxiety in comparison with non-frontline healthcare workers, with similar levels of depression scoring were observed. Healthcare providers aged > 40 years had a lower probability of developing anxiety and seemed to experience minimal depression. Conversely, frontline workers had a higher incidence of anxiety than that of depression. Being single (not in a relationship) could influence the PHQ-9 scores instead of those concerning the GAD-7. The gender gap was not proven to be significantly wide between healthcare professionals with or without anxiety; however, being male was proven to be positively correlated with depression.

CONCLUSION

In general, the risk factors for susceptibility to psychological problems among frontline healthcare professionals during the COVID-19 pandemic concerned those of a lower age, being single, being male, and being engage in frontline healthcare work.

Assessment of the factors affecting health profession students' emergency transition during the COVID-19 pandemic: A cross-sectional study

Objective: This study aimed to identify the factors that affected health profession students' emergency transition during the COVID-19 pandemic and to explore strategies that may help students be better prepared for any future health crises. Participants: This study population included 73 students that were originally enrolled in one online section (n = 49) and one face-to-face section (n = 24) of a healthcare administration course before the transition. Methods: The cross-sectional study was conducted and the anonymous survey data were analyzed using SPSS and a Man-Whitney U test. Results: Of the 73 students, 48 completed the survey, with a response rate of 66% (48/73). There was a statistically significant difference in the perceived COVID-19 impact (z=-3.339, p = 0.001) and difficulty transitioning during the pandemic (3-2.142, p = 0.032) between both groups. The top three hindering factors were stress and anxiety, difficulty focusing on studying at home, and time management due to uncertainty. Conclusions: The study findings suggest strategies that may help students with adequate knowledge and capabilities in managing stress, anxiety, and unprecedented challenges in the future.

Risk factors for healthcare professionals' mental health during the COVID-19 pandemic: a systematic review

The aim of the present study was to map the available evidence on the mental health risk factors of frontline health professionals during the COVID-19 pandemic. This is a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was independently carried out by four researchers, following the selection criteria in the electronic databases: PubMed Central, Ovid Technologies, GALE Academic Onefile, Science Citation Index Expanded. The data processing used Zotero software, responsible for creating and importing items according to the criteria established by the research. A total of 18,733 articles were found, of which 2,722 were excluded by the Zotero software because they were in duplicate, and another 366 were manually excluded. After applying the selection criteria, 43 articles entered the final analysis of this review. It is recommended that new scientific research be carried out, especially focusing on the analysis of health workers' mental health, aiming at providing the basis to create and implement public mental health programs and policies for workers.

Psychosocial status and risk perception among Iranian healthcare workers during the fifth wave of the COVID-19 pandemic

BACKGROUND

Healthcare workers (HCWs) are essential resources, and their health and wellbeing are key not only for offering constant and useful care facilities to clients, but also for maintaining the safety of the workforce and patients. The risk of severe mental health problems among HCWs may have increased during large outbreaks of COVID-19. To evaluate the psychosocial status and risk perception of HCWs who participated in treating COVID-19 patients in Northern Iran, we performed a web-based cross-sectional study.

METHODS

The web-based cross-sectional design was applied between June 27 and September 2, 2021. Using convenience sampling, 637 HCWs were recruited from hospitals in Northern Iran (Mazandaran). The HCWs completed self-report questionnaires that included a sociodemographic information form, the 12-item General Health Questionnaire, Impact of the Event Scale-Revised, Risk Perception Questionnaire, and Anxiety Stress Scale-21. The data were analyzed via descriptive and inferential statistics and univariate/multivariate logistic regression to assess the risk factors linked to each psychosocial consequence.

RESULTS

The results reveal that the COVID-19 pandemic had an adverse psychosocial influence on HCWs, which was already apparent 1.5 years after the crisis began. Based on the results, 71.6%, 55.6%, and 32.3% of HCWs reported having anxiety, depression, and stress symptoms, respectively, since the outbreak of this disease. The logistic regression models displayed that marital status, having children, and working hours with patients were all risk factors of psychosocial impairment.

CONCLUSIONS

The outbreak of COVID-19 can be considered an important experience of a bio-disaster resulting in a significant rate of psychiatric problems in HCWs. There is a need for designing and promoting supportive programs to help HCWs cope and to improve their psychosocial state, and the present study has detected for whom psychosocial support may be effective and practical 1.5 years after the primary outbreak. Moreover, detecting and managing concerns and reducing infection-related embarrassment/stigma are essential for improving HCWs' mental health.

COVID-19 and healthcare worker mental well-being: Comparative case studies on interventions in six countries

Healthcare worker (HCW) mental well-being has become a global public health priority as health systems seek to strengthen their resilience in the face of the COVID-19 pandemic. Analysing data from the Health System Response Monitor, we present six case studies (Denmark, Italy, Kyrgyzstan, Lithuania, Romania, and the United Kingdom) as a comparative review of policy interventions supporting HCW mental health during the pandemic. The results illustrate a wide range of interventions. While Denmark and the United Kingdom built on pre-existing structures to support HCW mental wellbeing during the pandemic, the other countries required new interventions. Across all cases, there was a reliance on self-care resources, online training tools, and remote professional support. Based on our analysis, we develop four policy recommendations for the future of HCW mental health supports. First, HCW mental health should be seen as a core facet of health workforce capacity. Second, effective mental health supports requires an integrated psychosocial approach that acknowledges the importance of harm prevention strategies and organisational resources (psychological first aid) alongside targeted professional interventions. Third, personal, professional and practical obstacles to take-up of mental health supports should be addressed. Fourth, any specific support or intervention targeting HCW's mental health is connected to, and dependent on, wider structural and employment factors (e.g. system resourcing and organisation) that determine the working conditions of HCWs.

Intensive care nurse managers' experiences during the first wave of the Covid-19 pandemic: Implications for future epidemiological crises

BACKGROUND

Nurse managers play an important role in coordinating the multidisciplinary teamwork, which is specifically important in emergency and crises situations like the COVID-19 pandemic. The aim of this qualitative study is twofold: (1) to explore the experiences of the Intensive care units (ICU) nurse managers regarding their work during the first wave of the COVID-19 pandemic, and (2) to analyse what implications might be provided based on experiences of nurse managers for future possible epidemiological crises.

METHODS

In-depth phone interviews were conducted to explore the experiences of ward managers-nurses (n = 15) working in different hospitals across Poland. Interviews were taped and transcribed verbatim, and then qualitatively analysed.

RESULTS

Three main categories were identified: (1) Challenge of working with the unknown, (2) Nurse managers' expectations, and (3) Methods of coping and received support. The COVID-19 pandemic strongly affected the work of ICU nurse managers and uncovered the malfunctioning of the healthcare system.

CONCLUSION

It is important to improve the knowledge and competence of hospital management personnel through exercises and in-service training on how to handle emergencies in order to improve the management of healthcare facilities, increase the safety of patients and employees, and the quality of healthcare.

Coping and Quality of Life Differences between Emergency and Rehabilitation Healthcare Workers

Audit and Feedback (A&F) is a systematic process involving the collection of data, which are subsequently compared with the established reference standards and then subsequently disseminated to healthcare providers through feedback meetings. This allows continuous improvement to be ensured in the quality of care processes. Often, the parameters taken into account concern only the patient and the treatment processes, neglecting other variables. Quality of life in the workplace and coping skills are determining variables for the clinical performance of all healthcare professionals. For this reason, in this study, these variables were investigated and differences were highlighted in two different role categories and context: cardiovascular emergency and neurological rehabilitation. A psychological screening was carried out by sending the computerized Coping Orientation to Problems Experienced-Nuova Versione Italiana (COPE-NVI) and Professional Quality of Life Scale-5 (ProQoL) questionnaires to all healthcare workers involved. Ninety-five healthcare providers (mean ± SD age: 47 ± 10.4 years; 37.9% male) answered the questionnaire and were assigned into two groups (G1 and G2) based on the ward in which they worked. These were further divided into two subgroups (R1 and R2) based on their role. The obtained results show that avoidance strategies are used more by health professionals working in rehabilitation (G2) wards than in intensive-care units (G1). Moreover, in G1 nurses, physical therapists and speech therapists (R2) obtained higher scores in terms of turning to religion (TR) and compassion satisfaction (CS), while physicians and psychologists (R1) obtained higher scores on the burnout scale (BO). The TR score for R2 was found to be higher, even in G2. The response trend of the two groups in the different departments was analyzed and commented on.

Compassion fatigue and compassion satisfaction among Romanian emergency medicine personnel

Background

Contemporary scientific literature has emphasized two specific aspects of healthcare professionals: compassion satisfaction and compassion fatigue. In the context of the COVID-19 pandemic, which has placed significant strain on health systems and healthcare workers, the Russian-Ukrainian crisis appears to have a magnifying effect, particularly on mental health.

Methods

The aim of the present study was to investigate the relationship between threat perception, daily worries, and professional quality of life in a sample of Emergency Medicine Personnel during two major events mentioned above. The sample included 372 participants (56.7% nurses and 43.3% physicians) from emergency units in five county hospitals in the Eastern region of Romania.

Results

The study revealed that threats related to the pandemic were positively linked to secondary traumatic stress, and daily worries were positively linked to both secondary traumatic stress and burnout. Threats generated by the war did not manifest a direct relation with any of the indicators of professional quality of life, but daily worries generated by war positively predicted both secondary traumatic stress and burnout.

Conclusion

Both the pandemic, which involved cumulative exposure, and the war, which involved a lower and more distant level of exposure, had the potential to generate worries and predict a low quality of life. However, our results did not reveal any association between threats, worries, and compassion satisfaction. As a result, this positive indicator of quality of life remained stable despite the presence of threats and worries.

A new form of checking obsessive-compulsive disorder in physicians: Another consequence of the COVID-19 pandemic. A case series

The current article provides information that facilitates early identification of a new form of checking obsessive-compulsive disorder (OCD) detected in physicians during the COVID-19 pandemic. This article describes three cases of professional checking OCD in physicians. Physicians with checking OCD are obsessively concerned about making a mistake that will result in fatal consequences. The most frequent strategies of neutralization include avoiding direct contact with patients by taking sick or vacation leaves; compulsively studying for many hours daily (neglecting other aspects of life); checking the status of their patients by arranging additional follow-up consultations or making phone calls even out of working hours; repeatedly checking the medical history of their patients, and persistently recalling the last appointment. Physicians with check OCD often seek reassurance from their colleagues and consult the scientific literature for information about issues they used to be competent in. These patients may also experience anticipatory anxiety and mental blocks. However, egodystony is milder than in other forms of OCD. The COVID pandemic may have exacerbated these neutralization behaviors, since it has forced physicians to adapt to a new work environment. The recommended treatments (Exposure with Response Prevention Therapy or/and SSRI) provide beneficial effects in a short time.

Evaluation of Nurses' Vaccine Hesitancy, Psychological Resilience, and Anxiety Levels During COVID-19 Pandemic

OBJECTIVE

This study aimed to evaluate the vaccine hesitancy, psychological resilience, and anxiety levels of nurses during the COVID-19 pandemic.

MATERIALS AND METHODS

This cross-sectional study was conducted with 676 nurses working at the survey time. Sociodemographic features, the status of hesitancy against the COVID-19 vaccine, the Coronavirus Anxiety Scale, and the Brief Resilience Scale were used in the questionnaire form to collect the data.

RESULTS

Most participants (68.6%; n=464) stated they were hesitant about the COVID-19 vaccine. A sig- nificantly higher rate of hesitancy was detected in the age group of 20-39 years, those who did not have COVID-19 vaccine, and those who did not think the COVID-19 vaccine is protective (P < .05). It was determined that 6.8% (n=46) of the nurses had COVID-19 anxiety. A significantly higher rate of anxiety was detected in the age group of 40 years and older, those working in the emergency department, and those working in the COVID-19 unit during the pandemic period (P < .05). The median Brief Resilience Scale score of nurses is 19(6). A negative, weak, and significant relationship was found between the Brief Resilience Scale and Coronavirus Anxiety Scale scores (P = .001).

CONCLUSION

During the pandemic, higher rates of anxiety were detected in healthcare personnel and those working in COVID-19 units. It was also found that as the level of anxiety increased, the level of psychological resilience decreased. To reduce the anxiety level and strengthen the psychological resilience of nurses, the cornerstones of the health system, fast, effective, and curative interventions should be made.

A Cross-Sequential Study of the Effect of the Coronavirus Disease 2019 Pandemic on the Risk of Anxiety and Depression of Royal Flying Doctors Staff, an Australian Air Medical Organization

OBJECTIVE

This cross-sequential study examines whether the coronavirus disease 2019 pandemic affected the mental health of staff working at an Australian air medical service, the Royal Flying Doctors Service South Eastern (RFDSSE) Section.

METHODS

The risk of anxiety and depression was measured using a prospective anonymized online survey using the Hospital Anxiety and Depression Scale, which was answered by 119 employees. This cross-sequential study was completed in December 2021 with reference to 2 time points: now and the beginning of the pandemic. A high risk of anxiety was defined using a Hospital Anxiety and Depression Scale score of 11 to 21 (low risk: 0-10). Chi-square testing was used to compare subgroups at single time points. McNemar testing was used to compare the risk of anxiety and depression between the beginning of the pandemic and December 2021.

RESULTS

Employees recalled a higher risk of anxiety at the beginning of the pandemic (29%) compared with December 2021 (16%) (P = .012). At the beginning of the pandemic, nonoperational staff members were more anxious than operational staff (P = .019). One third (31%) of operational staff members were concerned about dying at the beginning of the pandemic.

CONCLUSION

Our findings demonstrate that RFDSSE employees recalled higher levels of anxiety at the beginning of the pandemic compared with their risk in December 2021. Operational and nonoperational staff have different mental health needs; anxiety experienced by nonoperational staff during a pandemic should not be underestimated. The overall prevalence of anxiety and depression is high, suggesting health care staff in an air medical service may require extra psychological support. Other air medical organizations may reflect on our study findings and plan how to better support their own staff as a result.

The relationships between the healthy nurse, Healthy Nation program, RN perceptions of their work system, and health-related quality of life

BACKGROUND

There is limited research on the effects of nationally oriented health care workforce interventions on RNs' perceptions of their work systems and health-related quality of life (HRQOL).

PURPOSE

Guided by a systems framework, we examined the association of being affiliated with an organization partnered with the American Nurses Association's Healthy Nurse, Healthy Nation (HNHN) program on RNs' perceptions of their work systems and HRQOL.

METHODS

We performed a correlational, cross-sectional secondary analysis of a national RN sample (N = 2,166) with case-control matching. We used multiple linear and logistic regressions to evaluate our research questions.

DISCUSSION

Affiliation with an HNHN partner organization was directly associated with more desirable work system perceptions, and indirectly associated with greater HRQOL. Organization-level workplace interventions hold promise to improve RN working conditions and well-being.

CONCLUSION

There is an ongoing need to continue developing and evaluating scalable workplace well-being interventions for health care organizations.

Professional challenges of nurses working during the SARS-CoV-2 virus pandemic

OBJECTIVES

The diverse list of tasks and needs related to the SARS-CoV-2 pandemic may lead to different professional experiences in nurses working with patients infected with and not infected with SARS-CoV-2. The aim of the study was to measure the professional challenges of nurses working during the SARS-CoV-2 pandemic in Poland.

MATERIAL AND METHODS

The study was conducted in 2021 in a group of 151 nurses. The following scales were used: the Perceived Stress Scale (PSS-10), the General Self-Efficacy Scale (GSES), the Impact of Event Scale - Revised (IES-R), the Minnesota Satisfaction Questionnaire (MSQ-SF), the Areas of Worklife Survey (AWS) and the Maslach Burnout Inventory - Human Services Survey (MBIHSS).

RESULTS

Nurses working with patients infected with SARS-CoV-2 showed a positive correlation between workload and emotional exhaustion (ρ = 0.26, p = 0.02), as well as positive correlations among control, community and depersonalization (ρ = 0.25, p = 0.02; ρ = 0.23, p = 0.04). Among nurses working with uninfected patients, positive correlations were found among control, community, fairness and emotional exhaustion (ρ = 0.40, p = 0.000; ρ = 0.41, p = 0.000; ρ = 0.25, p = 0.03), as well as correlations between control and depersonalization (ρ = 0.33, p = 0.01), and among control, community and personal accomplishment (ρ = 0.23, p = 0.05; ρ = 0.27, p = 0.02).

CONCLUSIONS

Nurses working during the SARS-CoV-2 pandemic with infected and uninfected patients both experienced a variety of psychosocial challenges in coping with the demands of their work, social relationships and personal life. Int J Occup Med Environ Health. 2023;36(1):112-24.

Prevalence of burnout among healthcare professionals during the COVID-19 pandemic and associated factors - a scoping review

The outbreak of the COVID-19 pandemic exerted significant mental burden on healthcare workers (HCWs) operating in the frontline of the COVID-19 care as they experienced high levels of stress and burnout. The aim of this scoping review was to identify prevalence and factors associated with burnout among HCWs during the first year of the COVID-19 pandemic. A literature search was performed in PubMed, Web of Science, and CINAHL. Studies were selected based on the following inclusion criteria: cross-sectional, longitudinal, case-control, or qualitative analyses, published in peer-reviewed journals, between January 1, 2020 and February 28, 2021. Studies carried out on other occupations than healthcare workers or related to other pandemics than COVID-19 were excluded. Following the abstract screen, from 141 original papers identified, 69 articles were eventually selected. A large variation in the reported burnout prevalence among HCWs (4.3-90.4%) was observed. The main factors associated with increase/ decrease of burnout included: demographic characteristics (age, gender, education level, financial situation, family status, occupation), psychological condition (psychiatric diseases, stress, anxiety, depression, coping style), social factors (stigmatisation, family life), work organization (workload, working conditions, availability of staff and materials, support at work), and factors related with COVID-19 (fear of COVID-19, traumatic events, contact with patients with COVID-19, having been infected with COVID-19, infection of a colleague or a relative with COVID-19, higher number of deaths observed by nurses during the COVID-19 pandemic). The findings should be useful for policy makers and healthcare managers in developing programs preventing burnout during the current and future pandemics. Int J Occup Med Environ Health. Int J Occup Med Environ Health. 2023;36(1):21-58.

The Impact of COVID-19 Pandemic First Wave on Healthcare Workers: A New Perspective from Qualifying PTSD Criterion A to Assessing Post-Traumatic Growth

Post-traumatic growth (PTG) and specific traumatic events have been poorly explored in the literature focusing on post-traumatic stress disorder (PTSD) among healthcare workers (HWs) tackling the COVID-19 pandemic. In a large sample of Italian HWs, we investigated the kinds of traumatic events and whether PTG affects the risk of PTSD, along with its prevalence and features, during the first COVID-19 wave. COVID-19-related stressful events, Impact of Event Scale-Revised (IES-R) and PTG Inventory-Short Form (PTGI-SF) scores were collected through an online survey. Out of 930 HWs included in the final sample, 257 (27.6%) received a provisional PTSD diagnosis based on IES-R scores. Events referring to the overall pandemic (40%) and to a threat to a family member (31%) were reported as the most stressful events. Female sex, previous mental disorders, job seniority, unusual exposure to sufferance and experiencing a threat to one's family significantly increased the provisional PTSD diagnosis' risk, while being a physician, the availability of personal protective equipment and moderate/greater scores on the PTGI-SF spiritual change domain were found to be protective factors.

Prevalence of Burnout in Healthcare Workers of Tertiary-Care Hospitals during the COVID-19 Pandemic: A Cross-Sectional Survey from Two Central European Countries

COVID-19 has led to an unprecedented strain on healthcare workers (HCWs). This study aimed to determine the prevalence of burnout in hospital employees during a prolonged pandemic-induced burden on healthcare systems. An online survey among employees of a Czech and Slovak university hospital was conducted between November 2021 and January 2022, approximately when the incidence rates peaked in both countries. The Maslach Burnout Inventory-Human Services Survey was applied. We obtained 807 completed questionnaires (75.1% from Czech employees, 91.2% from HCWs, 76.2% from women; mean age of 42.1 ± 11 years). Burnout in emotional exhaustion (EE) was found in 53.2%, depersonalization (DP) in 33%, and personal accomplishment (PA) in 47.8% of respondents. In total, 148 (18.3%) participants showed burnout in all dimensions, 184 (22.8%) in two, and 269 (33.3%) in at least one dimension. Burnout in EE and DP (65% and 43.7%) prevailed in physicians compared to other HCWs (48.6% and 28.8%). Respondents from COVID-19-dedicated units achieved burnout in the EE and DP dimensions with higher rates than non-frontline HCWs (58.1% and 40.9% vs. 49.9% and 27.7%). Almost two years of the previous overloading of healthcare services, caused by the COVID-19 pandemic, resulted in the relatively high prevalence of burnout in HCWs, especially in physicians and frontline HCWs.

Pshychological Resilience and Percieved Stress Level in Nurses: Experience of Nurses in Turkey

OBJECTIVE

To determine the effect of psychological resilience levels of nurses on perceived stress levels in this study.

METHODS

The research was carried out with 153 nurses. Socio-demographic Questionnaire, The Brief Resilience Scale, and Perceived Stress Scale were used as data collection tools.

RESULTS

The nurses' total Brief Resilience Scale score average was 17.72 ± 4.48, and the total Perceived Stress Scale score average was 31.74 ± 7.18. There was a negative and moderately significant relationship between the resilience and stress level of the nurses. During the pandemic process, the level of stress that nurses perceive increases as their psychological resilience decreases.

CONCLUSION

Psychological resilience and coping with stress are traits that can be improved. It is important to establish strategies to increase the resilience of nurses and improve their ability to cope effectively with stress.

Psychosocial and Health Effects of the COVID-19 Pandemic Experienced by Staff Employed in Social Welfare Facilities in Poland and Spain

The COVID-19 pandemic had a very significant negative impact on the physical and mental health of various professional groups. Therefore, the aim of this study was to assess the psychosocial and health effects of the COVID-19 pandemic experienced by staff employed in social welfare institutions in Poland and Spain. The study involved 407 people, including 207 from Poland and 200 from Spain (346 women and 61 men), working in social care facilities. The research tool was the authors' questionnaire consisting of 23 closed-ended, single- or multiple-choice questions. The study has indicated that the COVID-19 pandemic had negative health and psychosocial effects on employees of social welfare facilities. In addition, it has been shown that the severity of the psychosocial and health effects of the COVID-19 pandemic differed between the countries studied. Employees from Spain statistically significantly more often declared deterioration in most of the surveyed indicators, except for mood deterioration, which was experienced more by employees from Poland than their peers from Spain.

Resilience as a protective factor on the quality of life (QoL) of Indian nursing students during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic negatively impacted the quality of life of individuals around the world, including health care professionals. There has been little research that examines the role of resilience concerning the impact of COVID-19 on the quality of life of nursing students. This study aimed to determine how resilience influenced the quality of life among nursing students during the COVID-19 pandemic.

METHODS

A cross-sectional research design was adopted for this study. A total of two hundred sixty-eight nursing students from three universities, South India responded in the web-based survey. Data was collected using self-reported questionnaires in June 2021.

RESULTS

Our findings revealed that the participants' resilience was normal, which had a moderate impact on the quality of life of nursing students during the COVID-19 pandemic. The COVID-19 impact on QoL significantly differed with year of education (F = 3.087; p < 0.02) and university (F = 6.697, p < 0.001). Bivariate analysis revealed significant inverse relationships between the impact of COVID-19 on quality of life with resilience (r = -0.259; p < 0.001) and perceived knowledge on COVID-19(r = -0.168; p < 0.006).

CONCLUSION

In our study, we found that resilience had a moderate impact on the quality of life of nursing students during the COVID-19 pandemic. Therefore, it is important to promote students' resilience and improve their quality of life during stressful situations.

Professional Quality of Life, Work-Related Stress, and Job Satisfaction among Nurses in Saudi Arabia: A Structural Equation Modelling Approach

Objective

To examine the interrelated impacts of work-related stress, compassion satisfaction (CS), and job satisfaction on burnout (BO) and secondary traumatic stress (STS) among nurses using structural equation modelling (SEM).

Methods

A cross-sectional design was used to survey 727 nurses at a teaching hospital in eastern Saudi Arabia. Three scales were used: the Quality of Life (ProQOL) scale, the Nursing Stress Scale (NSS), and the Job Satisfaction Survey (JSS). Data were analysed using SPSS and Analysis of Moment Structures (AMOS), and SEM analysis was conducted to confirm the interrelations among variables.

Results

The final model had a good fit for the obtained data (X ² = 2.726, RMSEA = 0.032). Stress is directly related to BO and STS, and the following variables were directly related to STS: job satisfaction, BO, and CS. Lastly, BO mediated the relationship between stress and STS.

Conclusion

It is crucial to analyze the effect of stress, CS, and job satisfaction which seems to have a positive and negative impact on nurses' BO and STS. Therefore, implementing a management strategy to manage stress and satisfaction can enhance nurses' quality of life, support the maintenance of positive attitudes, and enhance the standard of patient care.

Psychological Distress of Healthcare Workers in 4 Hospitals Compared to General Population During the First Italian Wave of COVID-19 Pandemic

COVID-19 caused important consequences on public health, economy, physical, and mental health of people. The aim of this study was to evaluate the impact of COVID-19 on frontline workers, comparing them with their colleagues who had no contact with the patients and with the general population, by administering an online questionnaire based on the Distress Questionnaire-5 (DQ5). The study was carried out during the first Italian wave of COVID-19 pandemic from 1st to 30th of April. Participants were divided in 3 groups: group 1 is general population group that includes the general population which are quarantined but not isolated, group health care staff not working in COVID-19 hospitals, and group 3 healthcare staff group working in COVID-19 hospitals. The survey was carried with the Distress Questionnaire-5 (DQ5) as a tool to detect the psychological distress and mental health problems. A total of 2983 people participated in this survey. Seven hundred and twenty four out of 1123 (64%) were employers of the 4 hospitals included in this study. Particularly among the respondents, 2259 (75.7%) were general population, 502 (16.8%) were health care staff not working in COVID-19 hospitals, while 222 (7.4%) were health care staff working in covid-19 hospitals. Health care personnel working in COVID-19 hospitals (DQ-5 = 13, 10-16) had less psychological distress compared with health care staff not working in COVID-19 hospitals (DQ-5 = 14, 11-16) and general population (DQ-5 = 14, 11-17; P = .04). The regression model showed that people aged 26 to 35 (OR: 2.06, 95% CI: 1.21-3.48) and female (OR: 2.35, 95% CI: 1.95-2.83) were significantly at risk to develop a DQ-5 ≥ 11. During the first Italian wave of COVID-19 pandemic, healthcare personnel working in COVID-19 hospitals had less psychological distress compared with health care staff not working in COVID-19 hospitals and general population, probably because they were prepared to face situations like outbreak or emergencies.

Mobile opportunity against stress: Open study protocol on the effectiveness of a mobile platform for stress self-management in the post-pandemic era

Mobile health platforms have shown promise in the management of various mental health conditions (including stress, anxiety, and depression) and cognitive behavioral strategies emerged as a popular and effective option offered by the platforms. This paper presents the protocol of a study aimed to test the effectiveness of a mobile platform that uses cognitive-behavioral strategies for stress self-management in the Tuscany region (Italy). The mobile app is adapted to the specific needs of each vulnerable population for which it is designed: young and older people, healthcare professionals, entrepreneurs. The app will be evaluated on the following outcomes: (i) perceived susceptibility and severity of the pandemic situation, perceived benefits, and costs of preventive health behaviors, (ii) knowledge about Covid-19 preventive behaviors and negative consequences of social distancing, (iii) stress and psychopathological symptoms (i.e., anxiety, depression, and post-traumatic stress symptoms) and cognitive distortions. If successful, we expect that the platform could give various groups clinical benefits by providing symptom self-monitoring and early intervention, consolidating the number of mental health programs available, and decreasing barriers to treatment-seeking. This population-level approach has the potential to improve mental health outcomes in pandemic periods for many people.