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Watson VC, Begun S. Burnout in Social Work: A Review of the Literature within the Context of COVID-19. SOCIAL WORK IN PUBLIC HEALTH 2024:1-12. [PMID: 39523626 DOI: 10.1080/19371918.2024.2427759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Burnout in social work is a long-standing professional issue. Social workers work tirelessly to provide empathetic care to clients and communities. However, stressful work conditions can contribute to burnout, vicarious trauma, and compassion fatigue. While burnout has been studied extensively within social work practice, new data is emerging about COVID-19's unique impact on burnout among social workers. This review first discusses general factors that contribute to social workers' experiences of burnout, and then explores how issues related to the COVID-19 pandemic exacerbated burnout for social workers. COVID-19 also provided a learning opportunity for how burnout can be mitigated. The review concludes with a call to action for next steps in both research and policy pertaining to social work and burnout.
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Affiliation(s)
- Victoria C Watson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, USA
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, USA
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Sherman J, Petros S. Disbelief, Distress, & Distrust: Trending Institution Related Emotional Distress During COVID-19. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024:1-22. [PMID: 39361512 DOI: 10.1080/15524256.2024.2404461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
The COVID-19 pandemic had an unprecedented impact on the well-being of individuals working in the healthcare sector. Though many studies exist that focus on physician and nurse well-being, few have specifically identified stressors that affect professionals working within the end-of-life interdisciplinary team. The primary objective of this study was to expand research on moral distress and clinician well-being to include healthcare professionals working with patients with chronic and life-limiting illnesses during the COVID-19 pandemic. A survey approach was used with 110 professionals working within one hospital network's palliative and hospice team to identify key indicators of moral distress (using the MMD-HP scale) and professional well-being during the pandemic. Quantitative and qualitative analysis was completed to determine themes related to moral distress and professional well-being. Numerous themes were identified, including the importance of caseload, general support, team support, management, and professional flexibility. Additional end-of-life themes were identified, including the impact of death, lack of personal protective equipment, fear of transmitting the virus, COVID disbelief, and the inability of clinicians and/or family to be with patients in person. From the experience participants had during COVID-19, four areas of change were identified: professional resilience, management/ethics support, professional development, and physical and emotional safety.
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Affiliation(s)
| | - Shannon Petros
- Riverside Methodist Hospital, OhioHealth, Columbus, Ohio
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Abad-Corpa E, Rich-Ruiz M, Sánchez-López D, Solano Ruiz C, Casado-Ramírez E, Arregui-Gallego B, Moreno-Casbas MT, Muñoz-Jiménez D, Vidal-Thomàs MC, Company-Sancho MC, Orts-Cortés MI. Learning, internalisation and integration of the COVID-19 pandemic in healthcare workers: A qualitative document analysis. Nurs Inq 2024; 31:e12673. [PMID: 39297396 DOI: 10.1111/nin.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 10/23/2024]
Abstract
The COVID-19 pandemic triggered an unprecedented health crisis that impacted healthcare systems worldwide. This study explores how Spanish healthcare workers learned, internalised and integrated values and work behaviours during the COVID-19 pandemic and their impact on the personal sphere. This documentary research, using images, narratives and audiovisual content, was framed within the interpretative hermeneutic paradigm. Categories and subcategories emerged after a final theoretical sampling that focused on the analysis. Data triangulation between researchers favoured theoretical saturation. A total of 117 images and 27 texts were selected. The analysis identified three stages: bewilderment, seeking functionality in the chaos and integrating chaos into care. The data reflects how the need for security and knowledge, and the exhaustion and frustration caused by the initial working conditions, prompted adaptive responses. These responses involved focusing on problem-solving and strengthening group sentiments and solidarity. Subsequently, the data indicates the acceptance of new structural, organisational and communication aspects. The findings of the analysis will contribute towards finding a framework that can help understand community health crisis events.
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Affiliation(s)
- Eva Abad-Corpa
- Biosanitary Research Institute of Murcia (IMIB), University of Murcia-Murcia Health Service, Murcia, Spain
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- CIBER of Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Manuel Rich-Ruiz
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- CIBER of Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
- Maimonides Institute for Biomedical Research (IMIBIC), University of Cordoba (UCO), Reina Sofía University Hospital (HURS), Córdoba, Spain
| | - Dolores Sánchez-López
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
| | - Carmen Solano Ruiz
- Nursing Department, Alicante Institute for Health and Biomedical Research (ISABIAL, Group 23), University of Alicante, Alicante, Spain
| | - Elvira Casado-Ramírez
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- CIBER of Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Beatriz Arregui-Gallego
- Research Unit of the Primary Care Assistance Management (GAAP), Primary Care Biomedical Research and Innovation Foundation (FIIBAP), Madrid, Spain
| | - María Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- CIBER of Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Daniel Muñoz-Jiménez
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- El Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Hospital, Madrid, Spain
| | - M Clara Vidal-Thomàs
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion and Prevention (RICAPPS), Mallorca, Spain
- Primary Care Management of Mallorca, Balearic Islands Health Service, Institute for Health Research Illes Balears (IdisBa), Balearic Islands, Spain
| | - M Consuelo Company-Sancho
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion and Prevention (RICAPPS), Mallorca, Spain
- Directorate General of Public Health, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - María Isabel Orts-Cortés
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain
- CIBER of Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
- Nursing Department, Alicante Institute for Health and Biomedical Research (ISABIAL, Group 23), University of Alicante, Alicante, Spain
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Sprang G, Gusler S, Eslinger J, Gottfried R. The Relationship Between Secondary Traumatic Stress and Compassion Satisfaction: A Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2282-2296. [PMID: 37981840 DOI: 10.1177/15248380231209438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This systematic literature review examines the relationship between secondary traumatic stress (STS) and compassion satisfaction (CS) to identify the state of the science and directions for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to guide the identification and evaluation of studies. Eight academic databases were systematically searched between July and December of 2022 to identify articles and dissertations published in English or Hebrew between 2000 and 2022. Studies were considered for inclusion if they examined the relationship between STS and CS and met an established quality threshold. If studies used a mixed methods approach, only quantitative results were included in the review. The search strategy yielded 537 studies with 33 included in the final review. Findings of this review suggest experiences of high levels of STS can coexist with high levels of CS indicating that people can gain satisfaction from their work and experience STS. Most studies examined the relationship between STS and CS using bivariate analyses with variability found in the direction of the relationship. This variability was also found in multivariate studies included in this review. These findings suggest the need for interventions to address both STS and CS with attention paid to the potential negative impact of emotional contagion and the vulnerability of younger female practitioners. Future research should pay attention to the rigor of the analysis of STS and CS and the exploration of mediating or moderating mechanisms between these constructs.
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Affiliation(s)
- Ginny Sprang
- Department of Psychiatry and Center on Trauma and Children, University of Kentucky, Lexington, USA
| | - Stephanie Gusler
- Department of Psychiatry and Center on Trauma and Children, University of Kentucky, Lexington, USA
| | - Jessica Eslinger
- Department of Psychiatry and Center on Trauma and Children, University of Kentucky, Lexington, USA
| | - Ruth Gottfried
- The David Yellin Academic College of Education, Jerusalem, Israel
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Childs TM, Iachini AL, Reitmeier M, Browne T, DeHart D, Bengel A, Haynesworth M. Exploring Social Work Practitioners' Perspectives on the Contributors to Burnout since the COVID-19 Pandemic. SOCIAL WORK 2024; 69:142-150. [PMID: 38366254 DOI: 10.1093/sw/swae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 02/18/2024]
Abstract
Burnout has a historic and disproportionate impact on social workers and is one important contributor to the ongoing health and behavioral health workforce crisis in the United States. Little is known, however, about social workers' experiences of burnout and their perceptions of factors that contribute to burnout since the COVID-19 pandemic. This study sought to explore this by answering the following research questions: (a) To what extent are social workers in South Carolina experiencing burnout? and (b) What do South Carolina social workers view as the top reasons for burnout in their professional role? Seventy social work practitioners and leaders from South Carolina completed an online survey during Fall 2022 that included the Copenhagen Burnout Inventory and an open-ended question focused on identifying their perceptions of the top three reasons for burnout in the profession. Findings suggest that social workers in this study are experiencing moderate levels of burnout since the COVID-19 pandemic and report primarily organizational (83 percent) contributors to burnout. They also identified individual (36 percent), systemic (29 percent), and interpersonal (27 percent) contributors to burnout. Implications are discussed related to policy and practice responses to prevent and address burnout among social workers.
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Affiliation(s)
- Tasha M Childs
- PhD, LMSW, is assistant professor, School of Social Work, University of Missouri-Columbia, 701 Fifth Street, 726 Clark Hall, Columbia, MO 65203, USA
| | - Aidyn L Iachini
- PhD, LSW, is professor and associate dean for research and faculty, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Melissa Reitmeier
- PhD, LMSW, is director of field education and clinical professor, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Teri Browne
- PhD, LMSW, is dean and professor, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Dana DeHart
- PhD, is professor emerita, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Ala Bengel
- MSW, is HOPE-WWR project coordinator, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - My'Ashia Haynesworth
- is an MSW candidate, College of Social Work, University of South Carolina, Columbia, SC, USA
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Unjai S, Forster EM, Mitchell AE, Creedy DK. Predictors of compassion satisfaction among healthcare professionals working in intensive care units: A cross-sectional study. Intensive Crit Care Nurs 2023; 79:103509. [PMID: 37541068 DOI: 10.1016/j.iccn.2023.103509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/16/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE To determine the prevalence of compassion satisfaction, related factors, and predictors among healthcare professionals in Thai intensive care units. METHODS A cross-sectional study was conducted in 12 intensive care units at a university hospital in Thailand from August to November 2022. All nurses and doctors were invited to complete an anonymous online survey which included: the Professional Quality of Life Scale version 5, Connor-Davidson Resilience Scale, Passion Scale, Flourishing Scale, and Acceptance and Action Questionnaire. Descriptive statistics, Pearson's correlation coefficients, and hierarchical multiple regressions were used for data analysis in SPSS 28.0. RESULTS A total of 178 nurses and doctors participated (92.13% nurses, 89.89% female, mean 32.10 years). Average compassion satisfaction (assessed using the Professional Quality of Life Scale) was moderate, with a mean score of 37.94 (SD = 5.58). The final regression model predicting compassion satisfaction was significant and explained 65% of the variance in compassion satisfaction, F (11, 154) = 26.00, p < 0.001. Four out of 11 predictor variables made unique statistically significant contributions to the final model: resilience (β = 0.48, p < 0.001), harmonious passion (β = 0.24, p < 0.001), being a nurse (not a doctor; β = 0.17, p < 0.05), and holding a postgraduate qualification (β = 0.10, p < 0.05). CONCLUSION Most healthcare professionals in critical care units have a moderate level of compassion satisfaction, which is correlated with resilience, flourishing, and harmonious passion. Resilience and harmonious passion predict compassion satisfaction. These factors are modifiable through intervention. IMPLICATION FOR CLINICAL PRACTICE Assessment of staff psychological well-being can identify those at risk for stress and impaired professional quality of life. Resilience and harmonious passion predict compassion satisfaction and can be modified through psychological interventions to promote psychological well-being and professional quality of life in healthcare workers in intensive care units.
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Affiliation(s)
- Supan Unjai
- School of Nursing and Midwifery, Griffith University, Australia; Faculty of Nursing, Khon Kaen University, Thailand. https://twitter.com/@SupanUnjai
| | | | - Amy E Mitchell
- School of Nursing, Midwifery and Social Work, The University of Queensland, Australia; Parenting and Family Support Centre, School of Psychology, The University of Queensland, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Australia
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Heavner SF, Stuenkel M, Russ Sellers R, McCallus R, Dean KD, Wilson C, Shuffler M, Britt TW, Stark Taylor S, Benedum M, Munk N, Mayo R, Cartmell KB, Griffin S, Kennedy AB. "I Don't Want to Go to Work": A Mixed-Methods Analysis of Healthcare Worker Experiences from the Front- and Side-Lines of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5953. [PMID: 37297557 PMCID: PMC10252235 DOI: 10.3390/ijerph20115953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023]
Abstract
During the COVID-19 pandemic, healthcare workers (HCW) were categorized as "essential" and "non-essential", creating a division where some were "locked-in" a system with little ability to prepare for or control the oncoming crisis. Others were "locked-out" regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.
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Affiliation(s)
- Smith F. Heavner
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Mackenzie Stuenkel
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | | | - Rhiannon McCallus
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Kendall D. Dean
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Chloe Wilson
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Marissa Shuffler
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Shannon Stark Taylor
- Center for Family Medicine, Department of Medicine, Prisma Health, Greenville, SC 29605, USA
| | - Molly Benedum
- AppFamily Medicine, Department of Medicine, Appalachian Regional Healthcare System, Boone, NC 28607, USA
| | - Niki Munk
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Rachel Mayo
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | | | - Sarah Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Ann Blair Kennedy
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
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Harel D, Keisari S. Tele-Drama Therapy with Community-Dwelling Older Adults: A Field Training Project. Clin Gerontol 2023; 46:400-412. [PMID: 36794366 DOI: 10.1080/07317115.2023.2178353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES This paper explores a field training project of tele-drama therapy with community-dwelling older adults during COVID19. It merges three perspectives: the older participants' perspective, the students engaged in the field training, who conducted this remote therapy, and social workers. METHODS Interviews were conducted with 19 older adults. Focus groups were conducted with 10 drama therapy students and 4 social workers. The data were thematically analyzed. RESULTS Three themes emerged: the role of drama therapy methods in the therapeutic process, attitudes toward psychotherapy for older adults, and the phone as a therapeutic setting. These themes coalesced into a triangular model associating dramatherapy, tele-psychotherapy and psychotherapy with the older population. A number of obstacles were identified. CONCLUSIONS The field training project made a dual contribution to the older participants and the students. In addition, it promoted more positive attitudes among the students toward psychotherapy with the older population. CLINICAL IMPLICATIONS Tele-drama therapy methods appear to promote the therapeutic process with older adults. However, the phone session should be planned in advance in terms of time and place to ensure the participants' privacy. Field training of mental health students with older adults can promote more positive attitudes toward working with the older population.
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Affiliation(s)
- Dovrat Harel
- The Drama Therapy Program, Tel-Hai College, Upper Galilee, Israel.,The Interdisciplinary Research Center for Arts and Spirituality: Therapy, Education and Society, Tel-Hai College, Upper Galilee, Israel
| | - Shoshi Keisari
- Drama & Health Science Lab, the School of Creative Arts Therapies, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel.,Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel.,The Center for Research and Study of Aging, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
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Yeung NCY, Tang JLT, Lau STY, Hui KH, Cheung AWL, Wong ELY. 'Caring for the helpers': factors associated with professional quality of life among Hong Kong nurses during the fifth wave of the COVID-19 pandemic. Eur J Psychotraumatol 2023; 14:2183454. [PMID: 36927300 PMCID: PMC10026750 DOI: 10.1080/20008066.2023.2183454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Western studies have found that nurses are likely to experience both positive and negative emotions in their job, as a helping profession [professional quality of life (ProQoL)] during the coronavirus disease 2019 (COVID-19) pandemic, and that psychosocial and work-related variables (e.g. pandemic-related stressors, interpersonal and organizational support, coping strategies) are associated with such outcomes. However, relevant studies on nurses in the Asian context are limited. OBJECTIVE This study examined the psychosocial correlates of three indicators of ProQoL, i.e. compassion satisfaction, secondary traumatic stress (STS), and burnout, among nurses during the fifth wave of the COVID-19 pandemic in Hong Kong. METHOD Nurses in Hong Kong (N = 220) working in hospitals and community settings during the COVID-19 pandemic were recruited between 24 May and 27 June 2022 through nursing associations to complete an online survey measuring the aforementioned psychosocial variables. RESULTS Hierarchical regression results found that stressors from clinical work environments, insufficient emotional support, and less positive reframing were associated with poorer ProQoL (i.e. lower compassion satisfaction; higher STS and burnout) (β from 0.16, p > .05, to 0.44, p > .001). In addition, COVID-19-related worries/uncertainties and emotional processing were associated with higher STS (β from 0.21 to 0.23, p < .01), whereas insufficient organizational support for communication with the healthcare system was associated with higher burnout (β = 0.12, p < .05). CONCLUSIONS Our findings identified the important psychosocial determinants in ProQoL among nurses in Hong Kong and provide recommendations for services supporting the mental health of these nurses. Providing workshops for nurses to train their skills in coping with COVID-19-related uncertainties, worries, and stressors from the clinical work environment, in using adaptive coping strategies (e.g. positive reframing), and in soliciting emotional support from important others could facilitate their ProQoL. Moreover, the provision of organizational support through timely and transparent communication with the healthcare system could reduce STS in nurses.
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Affiliation(s)
- Nelson Chun Yiu Yeung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jeremy Lok Tin Tang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Stephanie Tsz Yung Lau
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kam Hei Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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