Nursing staff fatigue and burnout during the COVID-19 pandemic in Greece

Indicators of technostress, their association with burnout and the moderating role of support offers among nurses in German hospitals: a cross-sectional study

OBJECTIVES

To examine the level of indicators of technostress among nurses with and without a leadership position, the relationship between indicators of technostress and burnout and the moderating role of support offered by employers. The availability of support offers and further needs of nurses were also explored.

DESIGN

Cross-sectional online survey.

SETTING

Acute care hospitals in Germany.

PARTICIPANTS

303 nurses (73.3% female) who have worked at the hospital for at least 1 year and a minimum of 10 hours per week.

PRIMARY AND SECONDARY OUTCOME MEASURES

Indicators of technostress (complexity, overload, usefulness, lack of technical support and unreliability) served as predictors in multiple linear regression analyses to examine their association with the primary outcome burnout. Support of employers was included as a moderator variable. Validated subscales from the Digital Stressors Scale and Copenhagen Burnout Inventory as well as open-ended questions were applied.

RESULTS

There were no differences in the level of indicators of technostress found between nurses with and without a leadership position. Techno-overload (β=0.259, p=0.004) and techno-complexity (β=0.161, p=0.043) were significantly associated with burnout. Support by the employer moderated the relationship between lack of technical support and burnout significantly (R² change=0.026, F(1,292)=7.41, p=0.007). Support offers such as training, IT service and contact persons on the ward helped nurses to be more confident in the use of information and communication technologies. However, they expressed further needs with regard to these and new offers.

CONCLUSIONS

There was an association between two indicators of technostress and burnout. Therefore, particular attention should be paid to supporting nurses in terms of techno-overload and techno-complexity. Furthermore, there is still a need for customised support and further offers from employers in the use of digital technologies.

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months after the COVID-19 pandemic began: A cross-sectional study

BACKGROUND

Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts.

PURPOSE

To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress.

DESIGN

Cross-sectional.

METHODS

Data were collected online mainly through state board and nursing association listservs between July-September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting.

RESULTS

Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices.

CONCLUSION

Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices.

RELEVANCE TO CLINICAL PRACTICE

Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

The relationships between nurses' resilience, burnout, perceived organisational support and social support during the second wave of the COVID-19 pandemic: A quantitative cross-sectional survey

AIMS

To examine the level of resilience and burnout among British nurses during the second wave of the COVID-19 pandemic and the influence of personal, social and organisational factors on nurses' resilience and burnout.

BACKGROUND

Nurses experienced excessive workload and emotional demands over a prolonged period during the COVID-19 pandemic which may have led to exhaustion. Little research has examined the correlation between the pandemic variables, nurses' resilience and burnout during the second wave of the COVID-19 pandemic.

DESIGN

This study utilised a descriptive, cross-sectional research design.

METHODS

A cross-sectional and self-report survey involved 111 staff nurses, who completed a self-administrated questionnaire between January and April 2021. A STORBE checklist was used to report the study results.

FINDINGS

The study found that nurses experienced a high level of burnout and low to moderate levels of resilience. The study revealed significant negative relationships between the level of burnout and perceived organisational support and nurses' resilience. The impact of the COVID-19 pandemic on nurses' social roles and their worries about patient safety were positively correlated with burnout. The perceived organisational support, the impact of the COVID-19 pandemic on nurses' social roles and the level of resilience were significant factors for burnout.

CONCLUSIONS

Nurses experienced a high level of burnout during the second wave of the COVID-19 pandemic, which may be influenced by how they felt their organisations supported them. Nurses' feelings that the pandemic affected their social roles were associated with increasing their burnout.

RELEVANCE TO CLINICAL PRACTICE

Strategies should be developed to address staff burnout and resilience. Nurse managers and educators should play leadership roles in creating professional training to include competencies and psychological preparedness for disasters and to implement strategies to increase the organisational commitments to staff safety and well-being.

Nightmare distress, insomnia and resilience of nursing staff in the post-pandemic era

Introduction

The pandemic has led to notable psychological challenges among healthcare professionals, including nurses.

Objective

Our aims of this study were to assess insomnia and nightmare distress levels in nurses and investigate their association with mental resilience.

Methods

Nurses participated in an online survey, which included the Nightmare Distress Questionnaire (NDQ), Brief Resilience Scale (BRS) and Athens Insomnia Scale (AIS). Demographic information, such as age, professional experience and gender, was also collected.

Results

The study included 355 female and 78 male nurses. Findings revealed that 61.4% had abnormal AIS scores, 7% had abnormal NDQ scores and 25.4% had low BRS scores. Female nurses had higher AIS and NDQ scores but lower BRS scores compared to males. BRS demonstrated negative correlations with both AIS and NDQ. Multiple regression analysis indicated that NDQ accounted for 24% of the AIS variance, with an additional 6.5% explained by the BRS. BRS acted as a mediator, attenuating the impact of nightmares on insomnia, with gender moderating this relationship.

Conclusions

Nursing staff experienced heightened sleep disturbances during the pandemic, with nightmares and insomnia being prevalent. Nightmares significantly contributed to insomnia, but mental resilience played a vital role in mitigating this effect. Strategies are warranted to address the pandemic's psychological impact on nursing professionals.

The effects of post-COVID-19 fatigue in nurses on organizational outcomes

This study was conducted to determine the effects of fatigue in nurses with confirmed COVID-19 infection on organizational outcomes. The study was carried out with the participation of 200 nurses who had tested positive for COVID-19 in the last eighteen months and had COVID-19-related fatigue complaints. Data were collected between October 2022 and February 2023 using a questionnaire consisting of the Chalder Fatigue Scale, the Work Alienation Scale, the Turnover Intention Scale, and the Employee Performance Scale. Fatigue was the most common symptom of COVID-19 in this study, as in other results. The number of being infected with COVID-19 and education levels were found to be significant predictors of post-COVID-19 fatigue. Post-COVID-19 fatigue had an effect on turnover intention and alienation to work, but it did not affect employee performance. In this study, the effects of post-COVID-19 fatigue on organizational outcomes such as employee performance, turnover intention, and work alienation were determined. Therefore, regardless of its source, fatigue should be dealt with managerially, and preventive policies and procedures should be developed.

A Moderated Mediation Model of the Influence of Cynical Distrust, Medical Mistrust, and Anger on Vaccination Hesitancy in Nursing Staff

During the pandemic, nurses experienced anger that stemmed from a sense of threat, frustration, or even a sense of injustice. The purpose of this study was to examine the relationship between vaccination hesitancy, anger, cynicism, and medical mistrust among nurses, as there are no relevant studies in the literature. This study was conducted online by completing self-report questionnaires. The Dimensions of Anger Reactions-5, the 8-item "Cynical Distrust" scale, and the Medical Mistrust Multiformat Scale were used. For vaccination hesitancy, two questions with a 5-point scale were used: one question examining hesitancy to get vaccinated with the COVID-19 vaccine, and another question examining hesitancy to get vaccinated with the influenza vaccine. In total, 387 nurses (66 men and 321 women) participated in this study. Nurses showed statistically greater hesitancy toward the COVID-19 vaccine compared to hesitancy toward the influenza vaccine. The variation in vaccine hesitancy was explained by the scores in the Medical Mistrust Multiformat Scale, the Dimensions of Anger Reactions, and the Cynical Distrust Scale. The Medical Mistrust Multiformat Scale mediated the relationship between the Cynical Distrust Scale and total vaccine hesitancy. The Dimensions of Anger Reactions Scale significantly moderated the indirect effect of the Cynical Distrust Scale on total vaccine hesitancy through the Medical Mistrust Multiformat Scale. In conclusion, it is highly likely that anger is involved in reported vaccine hesitancy both by activating schemas of distrust in others and by adopting anti-systemic views of mistrust in the medical system.

Identifying the communication of burnout syndrome on the Twitter platform from the individual, organizational, and environmental perspective

Addressing the escalating prevalence of burnout syndrome, which affects individuals across various professions and domains, is becoming increasingly imperative due to its profound impact on personal and professional aspects of employees' lives. This paper explores the intersection of burnout syndrome and human resource management, recognizing employees as the primary assets of organizations. It emphasizes the growing importance of nurturing employee well-being, care, and work-life balance from a human resource management standpoint. Employing social media analysis, this study delves into Twitter-based discourse on burnout syndrome, categorizing communication into three distinct dimensions: individual, organizational, and environmental. This innovative approach provides fresh insights into interpreting burnout syndrome discourse through big data analysis within social network analysis. The methodology deployed in this study was predicated upon the enhanced Social Media Analysis based on Hashtag Research framework and frequency, topic and visual analysis were conducted. The investigation encompasses Twitter communication from January 1st, 2019, to July 31st, 2022, comprising a dataset of 190,770 tweets. Notably, the study identifies the most frequently used hashtags related to burnout syndrome, with #stress and #mentalhealth leading the discussion, followed closely by #selfcare, #wellbeing, and #healthcare. Moreover, a comprehensive analysis unveils seven predominant topics within the discourse on burnout syndrome: organization, healthcare, communication, stress and therapy, time, symptoms, and leadership. This study underscores the evolving landscape of burnout syndrome communication and its multifaceted implications for individuals, organizations, and the broader environment, shedding light on the pressing need for proactive interventions. In organizations at all levels of management, the concept of burnout should be included in the value philosophy of organizations and should focus on organizational aspects, working hours and work-life balance for a healthier working environment and well-being of employees at all levels of management.

Long-term healthcare professionals' experiences of burnout and correlation between burnout and fatigue: a cross-sectional study

OBJECTIVES

The aim of the study was to analyze the long-term burnout levels of healthcare professionals (HCPs) working in Slovenian nursing homes during the fifth wave of the pandemic; to compare the results of similar facilities in 2020 and 2013; and to examine the correlation between demographics and burnout and fatigue among HCPs.

MATERIAL AND METHODS

The study used a descriptive, correlational cross-sectional method.

RESULTS

In the fifth wave, HCPs suffered more from emotional exhaustion, depersonalization and lack of personal accomplishment than in the first wave of the pandemic and in the spring of 2013. The HCPs caring for COVID-19 patients and younger women had higher rates of burnout and fatigue than other occupational groups. There is a strong positive correlation between burnout and fatigue.

CONCLUSIONS

There is an urgent need to address the problem of fatigue and burnout with administrative measures. Int J Occup Med Environ Health. 2023;36(3):396-405.

Feasibility of biomarkers to measure stress, burnout and fatigue in emergency nurses: a cross-sectional study

INTRODUCTION

Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting.

METHODS AND ANALYSIS

A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers.

ETHICS AND DISSEMINATION

Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.

Anxiety and Insomnia Mediate the Association of Fear of Infection and Fatigue: A Cross-Sectional Survey of Nurses Deployed to a COVID-19 Epicenter in China

Background

This study aimed to test the mediating role of anxiety and insomnia in the association between fear of infection and fatigue.

Methods

A cross-sectional questionnaire survey was conducted on the nurses deployed to Heihe. A serial multiple mediation model was established to determine the role of anxiety and insomnia in the association between fear of infection and fatigue.

Findings

Over half (53.0%) of the study participants reported experiencing fear of infection despite stringent personal protection measures. The scores of anxiety (11.87±5.19), insomnia (16.33±5.95), and fatigue (45.94±12.93) were moderately correlated, with a Pearson correlation coefficient ranging from 0.501 to 0.579. Anxiety, either alone or in combination with insomnia, mediated the association between fear of infection and fatigue.

Conclusion

The findings suggest that anxiety and insomnia play a mediating role in the relationship between fear of infection and fatigue. These results emphasize the importance of implementing targeted mental health interventions and work arrangements to address the well-being of healthcare professionals.

The relationship between mental fatigue and social responsibility among nurses who provided care to patients with coronavirus disease 2019: a cross-sectional study

BACKGROUND AND AIM

Mental fatigue (MF) was a major challenge for nurses during the coronavirus disease 2019 (COVID-19) pandemic. Nurses' sense of responsibility towards their patients and societies may influence their MF. This study aimed to assess the relationship between MF and social responsibility (SR) among nurses who provided care to patients with COVID-19.

METHODS

This cross-sectional descriptive-analytical study was conducted in 2021. Participants were 258 nurses randomly selected from eleven COVID-19 care hospitals in Tehran, Iran. Data were collected using three self-report instruments, namely a demographic questionnaire, the Mental Fatigue Scale, and the Social Responsibility Questionnaire. The SPSS software (v. 16.0) was used to analyze the data at a significance level of less than 0.05.

RESULTS

The mean scores of MF and SR were 31.73 ± 7.35 and 3.45 ± 0.35, respectively. The highest and the lowest scored SR subscales were ethical responsibilities with a mean of 3.67 ± 0.42 and economic responsibilities with a mean of 2.93 ± 0.62. MF had a significant negative correlation with legal responsibilities and a significant positive correlation with economic responsibilities (P < 0.05). The only significant predictor of SR was financial status which significantly predicted 4.3% of the variance of SR (P < 0.05).

CONCLUSION

More than half of the nurses who provided care to patients with COVID-19 suffered from MF and their mental fatigue had a significant correlation with their legal and economic responsibilities. Healthcare authorities and policymakers need to develop programs to reduce nurses' MF and improve their satisfaction.

Anger and Aggression in Relation to Psychological Resilience and Alcohol Abuse among Health Professionals during the First Pandemic Wave

Mental health problems, behavior changes, and addictive issues have been consistently documented among healthcare workers during the pandemic. The objective of this study was to investigate the levels of anger and aggression in relation to psychological resilience and alcohol abuse among healthcare workers during the first wave of the COVID-19 pandemic. A total of 120 physicians and 123 nurses completed an online survey of the Dimensions of Anger Reactions-5 (DAR-5), the Brief Aggression Questionnaire (BAQ), the Brief Resilience Scale (BRS), and the Alcohol Screening questionnaire CAGE which is an acronym for the focus of the questions (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers). Demographic and professional data were also recorded. A total of 53 men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale and one out of ten respondents presented with current problematic alcohol use. Male participants demonstrated lower scores on the DAR-5 scale compared to females. Individuals with current problematic alcohol use displayed higher scores on the BAQ compared to those without alcohol use disorders. Regression analysis revealed that 16.4% of the variance in the BAQ scores can be attributed to scores on the DAR-5, 5.9% to the BRS scores, 2.1% to the CAGE scores, 1.7% to gender, and 1.2% to years of work experience. Mediation analysis highlighted the role of psychological resilience as a negative mediator in the DAR-5 and BAQ relationship. Professional experience and alcohol abuse emerged as positive and negative risk factors contributing to aggression and psychological resilience. The findings hold practical implications for implementing interventions to strengthen resilience in order to compensate for aggressive tendencies and discourage addictive issues.

Sleep Disturbance and Occupational Fatigue in Emergency Nurses of Public Hospitals in Greece: A Cross-Sectional Study

The emergency department (ED) is a stressful workplace for nurses, due to heavy workload and work shifts, which affect sleep quality, causing occupational fatigue. As a result, nurses burn out and turn over and quality of care is impaired. The aim of this study was to investigate sleep disturbance (SD) and occupational fatigue (OF) in emergency nurses of public hospitals in Greece. This descriptive cross-sectional study was conducted in the ED of tertiary public hospitals in Greece from September 2019 to October 2021, after the approval from the scientific and ethical committee of hospitals and the full informed consent of participants. The Standard Shift work Index (SSI) questionnaire was used, which includes 12 question groups about sleep habits and OF evaluation for shift workers, as nurses. Two hundred and ten ED nurses were recruited for the purpose of the study. In this research their quality of life, sleep completeness, and fatigue levels were studied. A moderate level of SD (total score = 70.54) of nurses was found that was related to marital status, presence of children, and underlying diseases (p = 0.012, p = 0.024, and p = 0.002, respectively). OF was assessed at low levels (score = 27.34) and was mainly related to age, with younger nurses reporting less fatigue compared with older nurses. The effect of work shifts in SD and OF of ED nurses was well documented. ED nurses' OF was correlated with increased SD, age, and marital status. Further research is needed for a better assessment and understanding of the factors that influence SD and OF of ED nurses to plan a strategy to optimize sleep patterns of work shift ED nurses.

Family support, anger and aggression in health workers during the first wave of the pandemic

Introduction

Anger is considered as one of the basic human emotions, constituting the affective component of aggression. In the first year of the pandemic, the intense pressure on healthcare workers resulted in the deterioration of their psychosocial problems.

Objective

The aim of this study is to investigate the relationship between family support, anger, and aggression.

Methods

The present study included physicians and nurses who completed an online survey of Dimensions of Anger Reactions-5 (DAR-5), a Brief Aggression Questionnaire (BAQ) and a Family Support Scale (FSS). Before completing the questionnaires, participants were asked to state their gender, years of work, age, and profession.

Results

Fifty-three men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale. Male participants displayed lower DAR-5 scores compared to women. Female participants displayed lower FSS scores compared to men, but higher scores when compared with earlier measures. Regression showed that 15.2% of the variance in BAQ scores can be explained by DAR-5 scores, with an additional 3.8% explained by FSS scores, while an additional 2.3% is explained by years of working experience. Mediation analysis highlighted the role of family support as a negative mediator in the DAR-5 and BAQ relationship.

Conclusion

During the first year of the pandemic, there was an increase in the sense of family support among female health workers. One-third of the participants displayed increased anger scores. Family support acts as a mediator by preventing anger derailing into aggression. In healthcare worker support programs, it seems necessary to entail a specific section on anger management.

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis

Introduction

The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses.

Aim

To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic.

Materials and methods

In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded.

Results

60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support.

Conclusions

Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

Burnout, mental health, physical symptoms, and coping behaviors in healthcare workers in Belize amidst COVID-19 pandemic: A nationwide cross-sectional study

BACKGROUND

Healthcare workers are vulnerable to burnout, especially during the COVID-19 pandemic in the low resource settings. Belize is a small Central American developing country known for its chronic healthcare worker shortage and this is the first study to assess burnout prevalence and its associated factors among healthcare workers in Belize.

AIM

To evaluate the prevalence of burnout and its associated factors in HCWs in Belize covering multiple domains (mental health, physical symptoms, and coping behaviors) during the COVID-19 pandemic.

METHODS

A cross-sectional survey that was developed and validated by a panel of experts was delivered online to all the healthcare workers in Belize from September to November 2021. Burnout was assessed using Copenhagen Burnout Inventory. Depression and anxiety screening was carried out using the Patient Health Questionnaire - 2 (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2). Burnout associated factors were estimated using logistic regression models.

FINDINGS

Of the total of 263 participants, 27.76% had overall burnout: 56.65% had personal, 54.37% had work-related, and 19.39% had patient-related burnout. Burnout was positively associated with anxiety (OR: 3.14 [1.67, 5.92]), depression (OR: 4.45 [2.30, 8.61]), intentions of quitting their jobs (OR: 2.59 [1.49, 4.51]), health status worsening (OR: 2.21 [1.26, 3.87]), multiple physical symptom presentation (OR: 1.19, [1.10, 1.29]), and use of multiple maladaptive coping behaviors (OR: 1.66, [1.30, 2.12]).

INTERPRETATION

Healthcare workers in Belize showed substantial levels of burnout which were significantly associated with using maladaptive coping behaviors, presenting multiple physical symptoms, quitting their jobs, health status worsening, and other mental health issues. These findings should be used to develop and implement programs such as regular health check-ups, health promotion awareness campaigns, and worker recruitment strategies which would improve the working conditions, quality of life, and psychological well-being of our healthcare workers.

Risk Factors Surrounding an Increase in Burnout and Depression Among Health Care Professionals in Taiwan During the COVID-19 Pandemic

OBJECTIVES

This study aimed to investigate the risk factors surrounding an increase in both burnout levels and depression among health care professionals in Taiwan through use of a longitudinal study design.

DESIGN

This is a 2-year observational study that took place from January 2019 to December 2020.

SETTING AND PARTICIPANTS

Data among health care professionals were extracted from the Overload Health Control System of a tertiary medical center in central Taiwan.

METHODS

Burnout was measured through use of the Chinese version of the Copenhagen Burnout Inventory (C-CBI), whereas depression was ascertained by the Taiwanese Depression Questionnaire. Each participant provided both burnout and depression measurements during a nonpandemic period (2019) as well as during the COVID pandemic era (2020). Risk factors surrounding an increase in burnout levels and depression were analyzed through a multivariate logistic regression model with adjusting confounding factors.

RESULTS

Two thousand nineteen participants completed the questionnaire over 2 consecutive years, including 132 visiting doctors, 105 resident doctors, 1371 nurses, and 411 medical technicians. After adjustments, sleeplessness, daily working hours >8, and stress due to one's workload were all found to be risk factors for an increase in depression levels, whereas sleeplessness, lack of exercise, and stress due to one's workload were all found to be risk factors for an increase in personal burnout level. Being a member of the nursing staff, a younger age, sleeplessness, and lack of exercise were all risk factors for an increase in work-related burnout levels.

CONCLUSIONS AND IMPLICATIONS

Poor sleep, lack of exercise, long working hours, and being a member of the nursing staff were risk factors regarding an increase in personal burnout, work-related burnout levels and depression among health care professionals. Leaders within the hospital should investigate the working conditions and personal habits of all medical staff regularly and systematically during the COVID-19 pandemic and take any necessary preventive measures, such as improving resilience for nursing staff, in order to best care for their employees.

Inborn errors of metabolism refuse to stay-at-home: Experiences of a state-wide biochemical genetics service during the COVID-19 pandemic

AIM

The New South Wales (NSW) biochemical genetics (BG) service in Australia developed business continuity plans (BCPs) in response to the COVID-19 pandemic to ensure the essential service remained operational. This article aims to discuss the effects of the COVID-19 BCPs on the NSW BG service and patient care.

METHODS

BCPs were developed that included charting of NSW BG service workflow and services against staff resources and clinical impact on patients. The effect of the BCPs was analysed quantitatively by reviewing key performance indicators (result turnaround time, frequency and severity of clinical incidents and laboratory nonconformities) and qualitatively from staff feedback generated by a BG laboratory-wide survey.

RESULTS

Alternative BCPs were implemented during the pre-defined period March 2020 to November 2021 (inclusive), to reflect changes in COVID-19 community transmission, vaccination rates; and health orders. Operation of our essential pathology service was maintained, with no significant difference observed in key performance indicators when compared to pre-COVID. During the pre-defined period of the COVID-19 pandemic, staff reported increased levels of both work- and out-of-work-related stress.

CONCLUSION

The successful continuation of the BG service, with no statistically significant impact on patient care and delivery of essential services, can be attributed to strategic planning and timely implementation of these BCPs. In conjunction with the resilient and robust attitude of the staff during this ever-changing situation, this experience has served as an invaluable tool for future disaster management planning.

The Mediating Role of Depression and of State Anxiety οn the Relationship between Trait Anxiety and Fatigue in Nurses during the Pandemic Crisis

The coronavirus pandemic (COVID-19) is a global health crisis with a particular emotional and physical impact on health professionals, especially nurses. The aim of this study was to investigate the prevalence of anxiety, depression and fatigue and their possible relationships among nurses during the pandemic. The study population consisted of nurses from five tertiary-level public hospitals in Athens who completed the Fatigue Assessment Scale (FAS), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) questionnaires. Gender, age and years of work experience were recorded. The study was conducted from mid-November to mid-December 2021. The sample included 404 nurses (69 males and 335 females) with a mean age of 42.88 years (SD = 10.90) and 17.96 (SD = 12.00) years of work experience. Symptoms of fatigue were noted in 60.4% of participants, while 39.7% had symptoms of depression, 60.1% had abnormal scores on state anxiety and 46.8% on trait anxiety, with females showing higher scores on all scales (p < 0.05). High positive correlations (p < 0.01) were found between the FAS, BDI, State Anxiety and Trait Anxiety scales. Regression analysis showed that 51.7% of the variance in FAS scores can be explained by trait anxiety, an additional 6.2% by the BDI and 1.2% by state anxiety. Mediation analysis showed that state anxiety and BDI mediate the relationship between trait anxiety and FAS. Finally, BDI was found to exert a moderating role in the relationship between trait anxiety and fatigue. In conclusion, our study showed that nurses continue to experience high rates of anxiety, depression and fatigue. The variation in fatigue appears to be significantly dependent on trait anxiety. Depressive symptomatology and state anxiety exert a parallel positive mediation on the relationship between trait anxiety and fatigue, with depression exhibiting a moderating role in this relationship.

Psychosocial Burden and Quality of Life of Surveyed Nurses during the SARS-CoV-2 Pandemic

This study analyzes the impact of occupational burnout on the quality of life (QOL) of nurses surveyed during the SARS-CoV-2 pandemic. A total of 668 active nurses employed in public hospitals in Podkarpackie voivodeship (Poland) were surveyed. Throughout the pandemic, all wards where responders worked had a division into so-called "clean" and "dirty" zones, as well as balanced working hours. The research used the authors' survey questionnaire Maslach Burnout Inventory (MBI) and the Polish version of the World Health Organization Quality of Life Instrument Short Form (WHOQOL-BREF). Descriptive statistics were used in the analysis of the collected material, while correlations between ordinal or quantitative variables were made using Spearman's-rho coefficient. According to 94.0% of respondents, stress is an integral part of the nursing profession. The mean of the respondents' MBI burnout was 50.83 +/- 9.05 pts. The respondents' overall quality of life also averaged 65.74 +/- 13.12 pts. There were negative statistically significant correlations between the MBI and BREF domains, most of which were characterized by clear strengths of association. Higher exhaustion in various occupational aspects is associated with poorer quality of life in individual domains.

Interdisciplinary Collaboration and Communication Among Doctors and Nurses in ICUs During the COVID-19 Pandemic and Their Importance in Professional Life Quality Improvement

To investigate interdisciplinary cooperation and communication among doctors and nurses along with its role in improving the quality of their professional life, a cross-sectional survey was designed. The study was carried out from February to April 2021 through the application of an anonymous, structured, self-completed, closed-ended questionnaire in a convenience sample consisting of 110 healthcare professionals currently working in the intensive care units (ICUs) of three distinct hospitals (response rate: 76.4%). It was observed that medical personnel manifested a more positive stance toward interdisciplinary collaboration than nursing while women seemed to believe more than men that nurses' administrative skills are not valued enough by doctors. Nurses with limited work experience reported that doctors show scarce respect to nurses in the presence of patients' parents and companions while male nurses acknowledged more the provision of multidimensional care given to patients. Occupational stress, professional satisfaction, and burnout levels were mainly moderate across study participants.

Well-Being, Occupational Fatigue, and Sleep Quality among Filipino Nurses working during COVID-19

Fatigue is a common symptom experienced by nurses before the pandemic, but this experience is heightened by the coronavirus (COVID-19) pandemic. The literature has ample evidence of nurses experiencing occupational or work-related fatigue. In addition, human error is a significant consequence of fatigue that can significantly impact patient outcomes and be devastating for a nurse. Guided by Lazarus and Folkman's Transactional Theory of Stress and Coping, we conducted a descriptive, correlational and cross-sectional study aimed to 1) explore the level of occupational fatigue and sleep quality among Filipino nurses working during the COVID-19; 2) determine the relationships between occupational fatigue, sleep quality, and subjective wellbeing among Filipino nurses working during COVID-19 pandemic. One hundred twenty-six Filipino nurses across the United States working during the pandemic were surveyed using RedCap. The study showed that Filipino nurses had moderate to high acute and chronic fatigue levels, lower intershift recovery, and good sleep quality. Evidence and opportunities for health care administrations to create strategies to enhance the wellbeing of their largest and most valuable workforce.

Psychometric properties and factor structure of the Vietnamese Copenhagen Burnout Inventory

OBJECTIVES

This article examines the validity and reliability of the Vietnamese version of the Copenhagen Burnout Inventory (CBI-V) among hospital nurses in Vietnam in 2022.

METHODS

This article examined data from 587 nurses in two city hospitals in Vietnam in 2022. The reliability was determined via internal consistency (Cronbach's alpha coefficient) and test-retest reliability (Intraclass correlation coefficient). Factorial and construct validity of CBI-V were explored with confirmation factor analysis (CFA), exploratory factor analysis (EFA), and correlations with other mental health outcomes (measured by the depression, anxiety, and stress scale), job performance (Work Health Performance Questionnaires), work engagement (Utrecht work engagement), and quality of life (EQ-5D-5L). Statistical analyses were performed using SPSS 20.0 and AMOS 20.0.

RESULTS

Cronbach's alpha coefficients of CBI-V's three subscales showed good internal consistency (from 0.87 to 0.91). CFA showed a good fit of the three-factor model with the current data. EFA results showed that all items were loaded in accordance with the CBI's original three constructs, excluding work burnout item 7, forming the fourth factor with a single item. All of CBI-V's three subscales correlated with other constructs in expected directions.

CONCLUSION

The CBI-V showed good validity and reliability among hospital nurses. It can be a reliable tool to measure burnout among nurses in a low- and middle-income country in Vietnam during such a crisis as COVID-19. Future studies should examine the construct of the Copenhagen Burnout Inventory in different occupation groups.

Social Support Mediates the Relationship between COVID-19-Related Burnout and Booster Vaccination Willingness among Fully Vaccinated Nurses

COVID-19 booster doses for high-risk groups such as nurses are necessary to reduce the impacts of the pandemic and promote public health. We examined the relationship between COVID-19-related burnout and booster vaccination willingness among nurses, and we assessed whether social support can buffer this relationship. We conducted a cross-sectional study with 963 fully vaccinated nurses working in healthcare settings in Greece. We used the multidimensional scale of perceived social support to measure social support and the COVID-19 burnout scale to measure COVID-19-related burnout. We measured vaccination willingness with a scale from 0 (extremely unlikely to take a booster dose) to 10 (extremely likely). Among nurses, 37.1% reported being very likely to be vaccinated, 34.4% reported being uncertain about their likelihood of vaccination, and 28.6% reported being very unlikely to be vaccinated with a booster dose. We found that COVID-19-related burnout reduced vaccination willingness, while social support functioned as a partial mediator of this relationship. In conclusion, nurses who experienced burnout were less likely to accept a booster dose. Furthermore, increasing nurses' social support reduced the negative effects of burnout, resulting in improved booster vaccination willingness. Immunization awareness programs should be implemented in order to address nurses' concerns and support booster doses.

A Meta-Analysis on Remote HRI and In-Person HRI: What Is a Socially Assistive Robot to Do?

Recently, due to the COVID-19 pandemic and the related social distancing measures, in-person activities have been significantly reduced to limit the spread of the virus, especially in healthcare settings. This has led to loneliness and social isolation for our most vulnerable populations. Socially assistive robots can play a crucial role in minimizing these negative affects. Namely, socially assistive robots can provide assistance with activities of daily living, and through cognitive and physical stimulation. The ongoing pandemic has also accelerated the exploration of remote presence ranging from workplaces to home and healthcare environments. Human-robot interaction (HRI) researchers have also explored the use of remote HRI to provide cognitive assistance in healthcare settings. Existing in-person and remote comparison studies have investigated the feasibility of these types of HRI on individual scenarios and tasks. However, no consensus on the specific differences between in-person HRI and remote HRI has been determined. Furthermore, to date, the exact outcomes for in-person HRI versus remote HRI both with a physical socially assistive robot have not been extensively compared and their influence on physical embodiment in remote conditions has not been addressed. In this paper, we investigate and compare in-person HRI versus remote HRI for robots that assist people with activities of daily living and cognitive interventions. We present the first comprehensive investigation and meta-analysis of these two types of robotic presence to determine how they influence HRI outcomes and impact user tasks. In particular, we address research questions regarding experience, perceptions and attitudes, and the efficacy of both humanoid and non-humanoid socially assistive robots with different populations and interaction modes. The use of remote HRI to provide assistance with daily activities and interventions is a promising emerging field for healthcare applications.

Burnout status of healthcare workers in the world during the peak period of the COVID-19 pandemic

During the COVID-19 pandemic, healthcare workers have a high workload and have been exposed to various psychosocial stressors. This study aimed to evaluate health workers during the COVID-19 pandemic in the world. The method used in this research is qualitative with a literature review approach. The data sources in this study were taken from the Scopus database using the keywords "health workers," "burnout," AND "coronavirus" from the time range of 2020 to April 25, 2022. From the determination of the time range, 150 documents emerged. This study revealed that the Pearson correlation between total burnout scale scores on healthcare workers, professionals, exhaustion, mental, stress, personal, depression, symptoms, emergency, system, job, and impact indicated that overall burnout scores were associated with depression and anxiety. Stress symptoms had correlation values ranging from 0.84 to 0.73. Job burnout had a significant relationship with exhaustion at 0.89; depression r = 0.73), impacting a score of 0.66. At the same time, the fulfillment of professional and interpersonal disengagement showed a Pearson correlation between the total burnout scale scores on health workers, professionals, exhaustion, mental, stress, personal, depression, symptoms, emergency, system, job, and impact. Overall, the participants in health care workers worldwide experienced high levels of psychological distress. We also found that health workers dealing with COVID-19 pandemic patients were more likely to experience depression, stress, and burnout than health staff who were not personally involved in medical work. Furthermore, this study will be a follow-up study using the Work Ability Index (WAI) to measure work ability and work satisfaction.

Influencing factors of fatigue among public health nurses during the COVID-19 pandemic: A cross-sectional study

OBJECTIVE

This study investigated the effects of occupational stress, anxiety, depression, and sleep disturbance on the level of fatigue among public health nurses (PHNs).

DESIGN

The study had a cross-sectional, correlational survey design.

MEASURES

A total of 198 PHNs were enrolled from 30 public healthcare centers/offices. Data were collected between May and July 2021 using a structured questionnaire to investigate the general characteristics, occupational stress, anxiety, depression, sleep disturbance, and fatigue of the participants. Descriptive statistics and multiple regressions were used to determine fatigue and its influencing factors among PHNs.

RESULTS

The participants showed high fatigue and occupational stress levels due to a lack of rewards. The percentage of participants with mild-to-severe anxiety and mild-to-severe depression, and those who identified themselves as poor sleepers were 44.9%, 50.5%, and 70.2%, respectively. High levels of sleep disturbance (β = .23, p < .001), occupational stress (β = .21, p < .001), anxiety (β = .20, p = .016), depression (β = .17, p = .043), being younger (β = -.15, p = .004), and being a regular worker (β = .13, p = .017) were influencing factors of fatigue.

CONCLUSIONS

Individual efforts and organizational interventions to enhance sleep quality are needed to relieve fatigue among PHNs. Further, organizational support can be considerate of young nurses and regular workers, and alleviate their occupational stress. Moreover, anxiety and depression should be managed efficiently to reduce fatigue.

The moderating effect of burnout on professionalism, values, and competence of nurses in Saudi Arabia amidst the COVID-19 pandemic: A structural equation modeling approach

Aim

To examine the moderating effect of burnout on the relationship between nurses' competence, professional competence and professional values.

Background

There is a preponderance of burnout studies of nurses before and during the COVID‐19 pandemic. However, little is known about burnout's moderating influence on nurses' professionalism, competence and values during the ongoing pandemic.

Methods

This study used a correlational, cross‐sectional design and convenience sampling to recruit 809 Saudi nurses employed in four government hospitals. Four self‐report instruments were used to collect data from August 2021 to March 2022. Spearman Rho, structural equation modelling and multi‐group moderation analysis were used to analyse the data.

Results

Most of the participants had high burnout. There was a moderate to high correlation between the dimensions of professional competence, nurse professional values, burnout and nurse competence. Both professional competence and nurse professional values significantly affected nurse competence. Nurse professional values also had a direct effect on professional competence. Professional competence and nurse professional values on nurse competence may vary among those with low, moderate and high levels of burnout, suggesting the moderating effect of burnout.

Conclusions

The positive impacts of nurse professional values and professional competence on nursing competence were validated in this study, as was the evidence of burnout's moderating effect on the studied connections. To avoid burnout, it is necessary to increase organizational knowledge and support for nurses, their working conditions and the environment through strategies that promote well‐being and empowerment.

Implications for nursing management

Nurse managers can implement policies to help nurses minimize burnout and improve their professional values and competence. Management policies may be considered include increased staffing, opportunities to improve technical abilities through education and vocational training programs, and increased diversity of job assignments.

Frontline nurses' burnout and its associated factors during the COVID-19 pandemic in South Korea

Background

The Coronavirus disease pandemic is a global health crisis with psychological consequences for healthcare workers.

Purpose

To identify the prevalence and potential factors influencing burnout among frontline nurses in South Korea.

Methods

This cross-sectional study comprised 161 nurses who voluntarily participated in the survey through advertisements at a general hospital. Data on sociodemographic and professional characteristics, insomnia, depression, anxiety, stress, and burnout were collected via an online questionnaire in 2021.

Results

Among the participants, 90 had a high level of burnout. Overall, 59.6 %, 23.0 %, 36.0 %, and 17.4 % of nurses experienced insomnia, depression, anxiety, and stress, respectively. The results showed that the assigned number of patients, insomnia, and depression were the major factors affecting burnout levels of nursing staff.

Conclusions

Frontline nurses were the main force in the fight against public health emergencies. The government and medical institutions must consider professional and psychological factors in ameliorating burnout and safety for nurses.

Stress management in nurses caring for COVID-19 patients: a qualitative content analysis

BACKGROUND

Being in the frontline of the battle against COVID-19, nurses need to be capable of stress management to maintain their physical and psychological well-being in the face of a variety of stressors. The present study aims to explore the challenges, strategies, and outcomes of stress management in nurses who face and provide care to COVID-19 patients.

METHODS

The present study is a qualitative descriptive work that was conducted in teaching hospitals affiliated with Shiraz University of Medical Sciences, Iran, from June 2020 to March 2021. Sixteen nurses who were in practice in units assigned to COVID-19 patients were selected via purposeful sampling. Data were collected through semi-structured, individual interviews conducted online. The collected data were analyzed using MAXQDA 10 according to the conventional content analysis method suggested by Graneheim and Lundman.

RESULTS

The data collected in the interviews resulted in 14 subcategories under 4 main categories: providing care with uncertainty and anxiety, facing psychological and mental tension, creating a context for support, and experiencing personal-professional growth.

CONCLUSIONS

The nurses caring for COVID-19 patients needed the support of their authorities and families to stress management. Providing a supportive environment through crisis management training, providing adequate equipment and manpower, motivating nurses to achieve psychological growth during the pandemic can help them manage stress.

Impact of SARS-CoV-2 Pandemic on Psychosocial Burden and Job Satisfaction of Long-Term Care Nurses in Poland

Psychosocial consequences of the coronavirus pandemic are severe for health care workers due to their higher levels of exposure. Nurses often experience tremendous psychological pressure as a result of their workload in a high-risk environment. The purpose of this study was to determine the impact of the SARS-CoV-2 pandemic on the psychosocial burden and job satisfaction of nurses employed in long-term care. One hundred thirty-eight nurses employed in long-term care participated in the study. The respondents were 96.4% female and 3.6% male. The mean age of the respondents was 53.99 (standard deviation-4.01). The study was conducted between February and June 2021. The research tool was a standardized psychosocial risk scale questionnaire, which is a scientifically validated diagnostic tool with high reliability and accuracy coefficients. The primary tests used during the statistical analyses were non-parametric Mann-Whitney U (for two samples) and Kruskal-Wallis (for more than two samples) tests for assessing differences. During these analyses, in addition to standard statistical significance, appropriate p-values were calculated using the Monte Carlo method. Correlations between ordinal or quantitative variables were made using Spearman's rho coefficient. The results obtained allow us to conclude that the respondents rated the characteristics present in the workplace that constitute psychosocial risks at an average level. Emotional commitment and continuance-type commitment to the respondents' job position were also at a medium level. Respondents' self-rated ability to work for nurses employed in long-term care during the SARS-CoV-2 pandemic and commitment to patient care was high at 4.0 and 4.18, with a maximum of 5 points.

Burnout, Depression and Sense of Coherence in Nurses during the Pandemic Crisis

During the COVID-19 pandemic, the risk to nurses' mental health has increased rapidly. The aim of the study was to investigate the prevalence of depression and burnout and to evaluate their possible association with the sense of coherence in nursing staff during the pandemic crisis. The Copenhagen Burnout Inventory questionnaire, Beck's Depression Inventory, and the Sense of Coherence questionnaire were completed by 101 male and 559 female nurses. Individual and demographic data were recorded. Regarding depression, 25.5% of respondents exhibited mild depression, 13.5% moderate depression and 7.6% severe depression. In the burnout scale, 47.1% had a pathological value. Female nurses had higher burnout (t test p < 0.01, 49.03 vs. 38.74) and depression (t test p < 0.01, 11.29 vs. 6.93) scores compared to men and lower levels in the sense of coherence (p < 0.05, 59.45 vs. 65.13). Regression evidenced that 43.7% of the variation in the BDI rating was explained by the CBI, while an additional 8.3% was explained by the sense of coherence. Mediation analysis indicated a partial mediation of burnout in the correlation between sense of coherence and depression. The sense of coherence acted as a negative regulator between burnout and depression.

Physical problems and fatigue level of nurses during the COVID-19 pandemic

PURPOSE

This study was conducted to examine the physical problems and fatigue levels experienced by nurses during the COVID-19 pandemic.

METHOD

A descriptive and correlational design was used. The study data were collected in a state and a university hospital in the center of this province between September and December 2020. The population of the study included 460 nurses in these two hospitals, and the sample consisted of 377 volunteer nurses, which represented 81.95% of the population. Data collection tools included a "Personal Information Form," a "Nurses' Physical Problems Questionnaire," and the "Chalder Fatigue Scale (CFS)".

RESULTS

The mean score of the nurses on the total CFS was 20.14 ± 6.72. The mean CFS score of nurses who worked in the university hospital compared to the score of those who worked in the state hospital and the score of those who experienced health problems during the COVID-19 pandemic compared to the score of those who did not was significantly higher (p < .05). Regarding the physical problems that the nurses experienced, the highest rate of "yes" responses was given to the question "Have you experienced sweating in PPE?" (94.2%), while the lowest rate of "yes" responses was given to the question "Have you experienced a risk of falling due to the shoe covers you wore on your feet?" (48.0%).

CONCLUSION/IMPLICATIONS FOR PRACTICE

The CFS scores of the nurses who said "Yes" to all physical problems evaluated in this study were found to be significantly higher (p < .05). Nurses' work-related fatigue is recognized as a threat to nurse health and patient safety. By providing adequate staffing levels to frontline nurses in the COVID-19 pandemic, nurse managers can effectively reduce or prevent pandemic fatigue and improve their physical health.