Workplace Cognitive Failure among Nurses during the COVID-19 Pandemic

Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study

AIM

To examine the relationships between nurses' exposure to workplace violence and self-reports of workplace cognitive failure.

DESIGN

A cross-sectional study.

METHODS

An online questionnaire was administered in April 2023 to nurses in Michigan, US. Structural equation modelling was used to examine effects of physical and non-physical workplace violence (occupational stressors) and work efficiency and competence development (occupational protective factors) on workplace cognitive failure.

RESULTS

Physical violence was a significant predictor of the action subscale of cognitive failure. There were no direct effects of non-physical violence, workplace efficiency, or competence development on any of the workplace cognitive failure dimensions. Both types of violence and efficiency had significant indirect effects on workplace cognitive failure via work-related exhaustion. Work-related exhaustion predicted significantly higher scores for workplace cognitive failure.

CONCLUSION

Workplace violence and work efficiency exhibited primarily indirect effects on workplace cognitive failure among nurses via work-related exhaustion.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses experiencing workplace violence may be at increased risk for workplace cognitive failure, especially if they are also experiencing work-related exhaustion. Workplaces that nurses perceive as more efficient can help to mitigate the effects of violence on nurses' cognitive failure.

IMPACT

This study addressed the possible effects of workplace violence as well as work efficiency and competence development on nurses' cognitive failure at work. Analyses revealed primarily indirect effects of workplace violence, and indirect protective effects of work efficiency, on nurses' cognitive failure via work-related exhaustion. This research has implications for healthcare organizations and suggests that efforts made by healthcare workplaces to prevent violence and work-related exhaustion, and to enhance work efficiency, may help to mitigate workplace cognitive failure among nurses.

REPORTING METHOD

We have followed the STROBE checklist in reporting this study.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or public contribution.

Sleep of Nurses: A Comprehensive Scoping Review

AIM

To map the extent, range and nature of studies that examine sleep of nurses and identify how sleep has been examined in relation to the different aspects of nurses' health and nursing work and practice.

DESIGN

A scoping review.

DATA SOURCES

A search of five electronic databases including MEDLINE, Embase, EMcare, PsycINFO (using the Ovid platform) and Scopus was undertaken in May 2023 to identify primary studies that examined nurses' sleep.

REVIEW METHODS

This review was undertaken in accordance with the Joanna Briggs Institute methodology for scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

RESULTS

This review included 1040 studies from a wide range of countries. Most studies were observational in design and examined nurses working in the acute care sector. Studies were mostly descriptive (32%) or discussed sleep as a workforce issue (21%) or lifestyle behaviour that is important for the health of nurses working clinically (27%). A range of different sleep parameters were examined, with sleep quality the focus of most studies, especially in relation to well-being.

CONCLUSION

There has been an exponential increase in the number of studies that examine nurses' sleep. Efforts to examine the sleep of nurses are beginning to align with contemporary understandings and methodological approaches to examining sleep. However, this field of research could benefit from better consistency in the definition and reporting of sleep, prioritising objective measures of sleep and improving understanding of the relative and combined importance of different dimensions of sleep.

IMPACT

This review provides a comprehensive overview of studies that examine nurses' sleep. Findings highlight areas of growing interest, areas in need of further research and methodological considerations to strengthen research in this field.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. REGISTRATION DOI: https://doi.org/10.17605/OSF.IO/RZC4M.

Fading Focus: Addressing the Association Between Challenge Stressors, Role Blurring, Insomnia, Fatigue, and Workplace Cognitive Failure

The primary goal of the present study is to inspect the plausible job-related (i.e., challenge stressors and role blurring) and individual factors (i.e., fatigue and insomnia) that potentially lead to work-related cognitive failures among healthcare staff. Through the judgmental sampling technique, data was collected from healthcare personnel in Iran. The results revealed that challenge stressors in the form of time pressure, job responsibility, and work overload are significantly related to role blurring. Moreover, role blurring increases fatigue and insomnia among medical staff, and both insomnia and fatigue cause workplace cognitive failure. The results also confirm the mediation effect of role blurring in the association between challenge stressors, insomnia, and fatigue. According to the results, insomnia and fatigue similarly mediate the role blurring on workplace cognitive failure association. Theoretical implications, useful suggestions for practitioners, and prospective research avenues are debated in the study.

The effect of ear acupressure on occupational cognitive failure in nurses after the COVID-19 crisis: a randomized controlled clinical trial

BACKGROUND

In the aftermath of the COVID-19 pandemic, nurses reported varying degrees of cognitive failure. To prioritize patient safety in clinical settings, it is important and necessary to address and mitigate the symptoms of cognitive failure among nurses.

AIM

This study was conducted in Iran to evaluate the impact of ear acupressure on occupational cognitive failure in nurses.

METHODS

This randomized controlled clinical trial was conducted with 54 nurses who experienced cognitive failure in 2022. Sampling was performed by convenience. Fifty-six nurses who scored 40 or higher on the occupational cognitive failure questionnaire were randomly assigned to either the intervention group (28 subjects) or the sham group (28 subjects). In the intervention group, pressure was applied to the shen-men point, zero point, hippocampus, master cerebral, brain, and memory 1 and 2 of the earlobes for six weeks using Vaccaria seeds. In the sham group, a sticker without seeds was applied at the same points as in the intervention group, and no pressure was applied. Cognitive failure was assessed at the beginning of the study (T0), at the end of the intervention (sixth week of study, T1), and four weeks after the end of the intervention (tenth week of study, T2). The data were collected using contextual data questionnaires and the Occupational Cognitive Failure Questionnaire (OCFQ). The data obtained from 54 nurses (28 in the sham group and 26 in the intervention group) were analyzed by SPSS v16 using repeated-measures ANOVA.

RESULTS

The two groups had no significant differences regarding background variables. The between-group analysis revealed a significant interaction effect of time and intervention on cognitive failure (F = 60.320, p < 0.001, effect size = 0.537). The cognitive failure score in the intervention group was significantly lower at the end of the intervention and one month later than that in the sham group (p < 0.001). Within-group analysis revealed a significant difference in the cognitive failure scores of the intervention group at T0, T1, and T2 (61.231 ± 14.230, 34.000 ± 14.659, and 29.808 ± 14.266, respectively; F = 52.331, p < 0.001, effect size = 0.677). However, in the sham group, the cognitive failure score exhibited a brief but significant increase at T0, T1, and T2 (54.786 ± 11.239, 56.250 ± 10.950, and 56.000 ± 11.337, respectively; F = 6.369, p = 0.006, effect size = 0.191).

CONCLUSION

Auriculotherapy has shown promise in improving occupational cognitive failure in nurses. It is recommended that nurses consider incorporating auriculotherapy as a complementary treatment modality, particularly through self-treatment programs, when experiencing symptoms of cognitive impairment.

TRIAL REGISTRATION NUMBER (TRN)

IRCT20100211003329N10 DATE OF REGISTRATION: 04/11/2022.

Neurofilament light chain and glial fibrillary acid protein levels are elevated in post-mild COVID-19 or asymptomatic SARS-CoV-2 cases

Given the huge impact of the COVID-19 pandemic, it appears of paramount importance to assess the cognitive effects on the population returning to work after COVID-19 resolution. Serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) represent promising biomarkers of neuro-axonal damage and astrocytic activation. In this cohort study, we explored the association between sNfL and sGFAP concentrations and cognitive performance in a group of 147 adult workers with a previous asymptomatic SARS-CoV-2 infection or mild COVID-19, one week and, in 49 of them, ten months after SARS-Cov2 negativization and compared them to a group of 82 age and BMI-matched healthy controls (HCs). sNfL and sGFAP concentrations were assessed using SimoaTM assay Neurology 2-Plex B Kit. COVID-19 patients were interviewed one-on-one by trained physicians and had to complete a list of questionnaires, including the Cognitive Failure Questionnaire (CFQ). At the first assessment (T0), sNfL and sGFAP levels were significantly higher in COVID-19 patients than in HCs (p < 0.001 for both). The eleven COVID-19 patients with cognitive impairment had significantly higher levels of sNfL and sGFAP than the others (p = 0.005 for both). At the subsequent follow-up (T1), sNfL and sGFAP levels showed a significant decrease (median sNfL 18.3 pg/mL; median sGFAP 77.2 pg/mL), although they were still higher than HCs (median sNfL 7.2 pg/mL, median sGFAP 63.5 pg/mL). Our results suggest an ongoing damage involving neurons and astrocytes after SARS-Cov2 negativization, which reduce after ten months even if still evident compared to HCs.

COVID-19 Courtesy Stigma among Healthcare Providers in India: A Study of Stigma Management Communication and its Impact

In early 2020, the first wave of the COVID-19 pandemic hit India, generating one of the highest rates of infection and death in the world. Meanwhile, healthcare workers experienced stigma and discrimination due to their association with COVID-19 patients. This study analyzed healthcare workers' experience of courtesy stigma in India, the communication strategies they used to manage stigma, and the impact on their mental health. A cross-sectional survey of 150 healthcare workers in India showed that almost 50% experienced discrimination due to their association with COVID-19 patients. Using Confirmatory Factor Analysis and Structural Equation Modeling, this study found that experience of discrimination was associated with perceived courtesy stigma. Two stigma management strategies (reducing offensiveness and passive acceptance) mediated the relationship between perceived courtesy stigma and perceived stress and depression. Participants also reported engaging in stigma management strategies of bonding with other healthcare professionals and passive acceptance of the stigma more than reducing stigma and displaying/disclosing stigma. We conclude that perhaps due to depletion of cognitive and emotional resources, healthcare workers engaged more in social support (bonding) and passive stigma acceptance strategies to alleviate the stress associated with providing COVID-19 patient care. Practical and theoretical implications are further discussed.

Increased Substance Use among Nurses during the COVID-19 Pandemic

There is growing evidence that the COVID-19 pandemic has had a severe impact on the nursing profession worldwide. Occupational strain has disrupted nurses' emotional wellbeing and may have led to negative coping behaviors, such as increased substance use, which could impair cognitive functioning. The aim of this study was to examine whether increased substance use in a sample of U.S. nurses during the pandemic was related to greater workplace cognitive failure. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). A path model was used to test the direct effects of reported increased substance use on workplace cognitive failure and via parallel psychological mediators. The model had excellent fit to the observed data, with statistically significant, unique mediating effects of greater symptoms of anxiety (b = 0.236, z = 2.22, p = 0.027), posttraumatic stress disorder (b = 0.507, z = 4.62, p < 0.001) and secondary trauma (b = 1.10, z = 2.82, p = 0.005). Importantly, the direct effect of increased substance use on workplace cognitive failure was not statistically significant independent of the mediators (b = 0.133, z = 0.56, p = 0.576; 95% confidence interval: -0.33, 0.60). These results point to the importance of further delineating the mechanistic pathways linking adverse stress to workplace cognitive failure. As we emerge from the pandemic, healthcare systems should focus resources on supporting cognitive health by addressing the psychological and emotional welfare of nurses, many of whom may be struggling with residual trauma and increased substance use.

[Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic]

Background and objectives: An increase in emotional disturbances and complaints about cognitive performance has been observed in Latin American healthcare workers during the SARS-CoV-2 pandemic, which can affect attention capacity and increase the levels of stress and burnout of these professionals. The objective was to analyse subjective cognitive complaints (SCC) and associated factors in health personnel during the COVID-19 pandemic in five Latin American countries.Methods: Multicentre cross-sectional study, which included 3,738 professionals from Colombia, Chile, Argentina, Ecuador, Bolivia, and Peru. The Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) was used to assess depression, and the Mini-Z to assess Burnout. For the SCC, an item on cognitive concerns in attention and memory was used.Results: The prevalence of cognitive complaints was 69.2%. The factors associated with a higher risk of SCC were the scores in the GAD-7, PHQ and Mini-Z, in addition to being part of the Ecuadorian health personnel.Conclusions: There is a high prevalence of SCC in health personnel, which is modulated by emotional states and stress.

Impact of the First Phase of the COVID-19 Pandemic on the Acquisition of Goods and Services in the Italian Health System

The emergency caused by the escalation in the COVID-19 pandemic, which became widespread starting on 31 January 2020, put a strain on the Italian National Health System and forced purchasing centres to deviate from the ordinary general principles dictated by current legislation. The aim of this paper is to describe how Spedali Civili Hospital in Brescia challenged the crisis, structured itself optimally, followed simplified procedures, launched new processes, and opened up more Intensive Care Unit beds to accommodate the high number of COVID cases. From an analysis of the equipment variation in terms of increased purchases, subsequent installations, and tests carried out compared with the pre-pandemic period, we report the difficulties that hospitals had to face in the first phase of the pandemic and how they were able to respond to their needs. Our data clearly displayed how the pandemic situation led to a deep internal reorganisation and that the drafting of simpler, effective, and adaptable procedures represents a first key element to ensure receptivity and responsiveness in the management of ordinary and non-ordinary events such as this pandemic condition.

The Correlation between Nurses' COVID-19 Infections and Their Emotional State and Work Conditions during the SARS-CoV-2 Pandemic

The COVID-19 pandemic caused by the SARS-CoV-2 virus has significantly influenced the functioning of Polish hospitals, and thus, the working conditions of nurses. Research on the presence of specific negative emotions in nurses may help identify deficits in the future, as well as directing preventive actions. The present research was performed among nurses (n = 158) working in Polish healthcare facilities during the third wave of the COVID-19 pandemic caused by the SARS-CoV-2 virus, where Group A (n = 79) consisted of nurses diagnosed with COVID-19, and Group B (n = 79) nurses who have never been infected with COVID-19. To perform the research, the Courtauld Emotional Control Scale (CECS), Trait Anxiety Scale (Polish: SL-C) and the authors' survey questionnaire were used. A positive test result was generally determined more often among nurses who indicated a noninfectious ward as their main workplace, compared to nurses employed in infectious wards (64.55% positive vs 33.45% negative). Over a half of the subjects identified moderate levels of emotion suppression as the method to regulate strong emotions, while one-quarter cited high levels of suppression. Anxiety was suppressed at high and moderate levels by 97% of the subjects, depression by 86.71%, and anger by 79.48%. Infection with COVID-19 results in a higher level of anxiety and depression, as well as a feeling of increased work load.