Mental well-being of intensive care unit nurses after the second surge of the COVID-19 pandemic: A cross-sectional and longitudinal study

ObjectivesTo determine the impact of the second surge of the COVID-19 pandemic (October 2020 to June 2021) on mental well-being of intensive care unit nurses and factors associated with mental health outcomes.MethodsAn online survey was available for Dutch intensive care unit nurses in October 2021, measuring mental health symptoms; anxiety, depression (Hospital Anxiety and Depression Scale), and post-traumatic stress disorder (Impact of Event Scale-6). Additionally, work-related fatigue was measured using the Need For Recovery-11 questionnaire. Previous data from the first surge (March until June 2020) were used to study mental well-being longitudinally in a subgroup of intensive care unit nurses. Logistic regression analyses were performed to determine factors associated with mental health symptoms.ResultsIn total, 589 nurses (mean age 44.8 [SD, 11.9], 430 [73.8 %] females) participated, of whom 164 also completed the questionnaire in 2020. After the second surge, 225/589 (38.2 %) nurses experienced one or more mental health symptoms and 294/589 (49.9 %) experienced work-related fatigue. Compared to the first measurement, the occurrence of mental health symptoms remained high (55/164 [33.5 %] vs 63/164 [38.4 %], p = 0.36) and work-related fatigue was significantly higher (66/164 [40.2 %] vs 83/164 [50.6 %], p = 0.02). Granted holidays as requested (aOR, 0.54; 95 % CI, 0.37–0.79), being more confident about the future (aOR, 0.59; 95 % CI, 0.37–0.93) and a better perceived work-life balance (aOR, 0.42; 95 % CI, 0.27–0.65) were significantly associated with less symptoms.ConclusionThe second surge of the COVID-19 pandemic further drained the mental reserves of intensive care unit nurses, resulting in more work-related fatigue.     

Mental health of the Slovak population during COVID-19 pandemic: A cross-sectional survey

BACKGROUNDPopulation’s mental health surveillance is essential for knowing the distribution of mental well-being and mental disorders in the society. This allows for the establishment, evaluation, and revision of preventive measures and curative services. The results of such monitoring should serve as a database for evidence-based mental health policy. Mental disorders are among the top ten causes of burden globally and crisis situations such as the pandemic increase the risk of mental health problems, as they cause constant fear of contagion and the implementation of restrictive measures. The impact of the coronavirus disease 2019 (COVID-19) pandemic on the general population of the Slovak Republic has not yet been studied. The hypothesis was that more than one fifth of the population (women to a greater extent) will have symptoms of anxiety and depression.AIMTo assess the mental health of the general Slovak population aged 15 years and older in the summer of 2021 by determining the prevalence of depressive and anxiety symptoms.METHODSAn anonymous cross-sectional survey was implemented in a sample of 1501 respondents in the summer of 2021 during the COVID-19 pandemic. The inclusion criteria were age of 15 years and older and ability to complete the survey questionnaire online or in a face-to-face interview. The survey assessed anxiety symptoms by the seven-item general anxiety disorder and depressive symptoms by the nine-item patient health questionnaire instruments. Recognized cut-off scores of 10 or greater were used for both. RESULTSAnxiety symptoms were present in 19.32% and depression in 24.65% of the sample. Symptoms of both disorders were more common in females: 15.00% of males and 24.00% of females experienced anxiety symptoms, and 19.00% of males and 30.00% of females experienced symptoms of depression. Symptoms of both disorders were the most common in the youngest age group (15-25 years old): One fifth of males (20.29%) and one third of females (35.32%) had symptoms of anxiety, and 26.09% males and 43.79% females had symptoms of depression. Mean score for anxiety was 5.44 [standard deviations (SD) = 4.96] for the overall sample, 6.15 (SD = 5.14) for females, and 4.67 (SD = 4.63) for males. The youngest females of the 15-25 years age group had the highest score (7.55, SD = 5.27) among all age groups, for both sexes. Mean score for depression was 6.74 for the overall sample (SD = 5.75), 7.43 for females (SD = 5.87), and 5.99 (SD = 5.52) for males. The highest depression score was observed in the youngest females of the 15-25 years age group (9.34, SD = 6.07). We found a significant association between anxiety or depressive symptoms and younger age [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.16-2.45 and OR: 1.65, 95%CI: 1.17-2.34, respectively], being female (OR: 1.86, 95%CI: 1.42-2.42 and OR: 1.76, 95%CI: 0.20-0.29, respectively), and having primary education (OR: 1.66, 95%CI: 1.08-2.54 and OR: 1.65, 95%CI: 1.16-2.63, respectively).CONCLUSIONResults of our study indicate that anxiety and depression are frequent in the Slovak Republic during the COVID-19 pandemic. This important observation should serve as an information basis for the development of effective mental health policies, consisting of preventive programs, and early detection and effective treatment services. The study results provide strong argument for the necessity of mental health reform that is currently being shaped in the Slovak Republic.     

The effect of video visitation on intensive care unit patients and family members outcomes during the COVID-19 pandemic: A randomised controlled trial

ObjectiveTo investigate the effect of video visitation on intensive care patients’ and family members’ outcomes during the COVID-19 pandemic.DesignThis is a randomised controlled trial.SettingAn adult intensive care unit in a tertiary hospital in Beijing, China.MethodsA total of 121 adults, who were >18 years of age, conscious, able to communicate verbally, and admitted to the intensive care unit for over 24 hours were randomised into the intervention (video visitation) (n = 65) and control (n = 56) Groups. A total of 98 family members participated. Patient primary outcomes included anxiety and depression, measured using the Hospital Anxiety and Depression Scale. Secondary outcomes included patient delirium and family anxiety assessed using the Confusion Assessment Method scale and Self-Rating Anxiety Scale, respectively; and patient and family satisfaction, measured using a questionnaire routinely used in the hospital.ResultsThere were no statistically significant differences between the groups in patients’ anxiety (t = 1.328, p = 0.187) and depression scores (t = 1.569, p = 0.119); and no statistically significant differences in delirium incidence between the groups (7.7 % vs 7.1 %, p > 0.05). There were no significant differences in changes in family members’ anxiety scores (t = 0.496, p = 0.621). A statistically significant difference in satisfaction was found between the two group patients (86.1 % vs 57.2 % of patients were satisfied with using video visitation, p < 0.05), and the result of family members’ satisfaction was also statistically significant (88 % vs 62.5 % of family members were satisfied with using video visitation, p < 0.05).ConclusionVideo visitation did not seem to influence anxiety, but the use of video visitation can improve the patient and their family members’ satisfaction. Future research is needed to determine the feasibility of embedding video visitation into routine practice, and the optimal frequency and length of video visitation in relation to patients’ and family members’ outcomes.Implications for clinical practiceVideo visitation improved patient and family members' satisfaction. Therefore, clinicians should consider using video visitation when face to face visit is restricted. Video visVitation did not reduce patient anxiety significantly in this study maybe because the average length of intensive care stay was too short. Future research is needed on its effect on long term intensive care patients.     

Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey

ObjectiveVaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear.MethodsThis is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality).ResultsA total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06–1.99 and OR: 1.42, 95% CI: 1.03–1.96, respectively) compared to the vaccinated group.ConclusionDespite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.     

The impact of a three-tiered model of nursing redeployment during the COVID-19 pandemic: A cross-sectional study

ObjectiveThe COVID-19 pandemic resulted in extreme system pressures, requiring redeployment of nurses to intensive care units. We aimed to assess the impacts of a 3-tiered pandemic surge model on nurses working in intensive care units during the COVID-19 pandemic.MethodologyIn this cross-sectional study, 931 nurses (464 intensive care and 467 redeployed nurses) who worked within four adult units in Western Canada during pandemic surge(s) were invited via email to participate in a survey. The survey explored the impact of redeployment, rapid unit orientations, just-in-time training, and the 3-tiered model of nursing during pandemic surge. Burnout was measured utilizing the Copenhagen Burnout Inventory questionnaire.ResultsA total of 191 survey responses were retained (59 intensive care nurses and 132 redeployed). Survey results are reported by tier, with outcomes varying based on team leadership, intensive care unit, and redeployment nursing roles. Burnout in personal and workplace domains was present amongst all nursing tiers, while only team leadership roles experienced burnout in the patient domain. Overall, team leadership roles and permanent intensive care nurses experienced the highest rates of burnout. Redeployed nurses reported numerous aids to success including support from colleagues, prior experience, and educational supports. Skill-based orientation, ongoing education, optimized scheduling, role clarity, and mitigators of psychological impacts were identified by respondents as potential facilitators of redeployment and surge models.ConclusionNurses working within this tiered model experienced high degrees of burnout, with highest prevalence amongst team leads and intensive care nurses. Optimization of support for and interventions aimed at improving well-being are important considerations going forward.Implications for clinical practiceTargeted strategies are required to support education, role transition, and optimize competency and role clarity during nursing redeployment for overcapacity surge. Essential strategies to support redeployed nurses include individualized competency assessments pre-redeployment and prior to role transitions, pairing redeployed nurses with the same intensive care nurse consistently, and availability of a nurse educator or resource for additional just-in-time training supports. Contingency disaster strategies should also include interventions targeting staff wellness and prevention of burnout, as well as identify scenarios in which redeployment may increase risks of psychological harm. Debriefing and peer-to-peer support models may increase the efficiency of psychological support for nurses, though additional research is required. Lastly, given enaction of tiered models of nursing care is largely a novel occurrence in the intensive care unit, leadership training is required to support frontline nurses taking on supervisory roles within these team models.     

The impact of COVID-19 on the mental health workforce: A rapid review

The COVID-19 pandemic led to significant adaptations to healthcare. Provision of mental healthcare in a changing environment presented healthcare workers with unique challenges and demands, including changes in workload and expectations. To inform current and future healthcare service responses, and adaptations, the current review aimed to collate and examine the impact of the pandemic on mental healthcare workers (MHWs). We conducted a rapid systematic review to examine the overall impact of the COVID-19 pandemic on MHWs. Searches were conducted in Ovid Medline and PsycInfo and restricted to articles published from 2020. Inclusion criteria specified articles written in English, published in peer-reviewed journals, and that examined any outcome of the impact of COVID-19 on MHWs; 55 articles fulfilled these criteria. Outcomes were categorized into ‘work-related outcomes’ and ‘personal outcomes’. Mental healthcare workers worldwide experienced a range of work-related and personal adversities during the pandemic. Key work-related outcomes included increased workload, changed roles, burnout, decreased job satisfaction, telehealth challenges, difficulties with work-life balance, altered job performance, vicarious trauma and increased workplace violence. Personal outcomes included decreased well-being, increased psychological distress and psychosocial difficulties. These outcomes differed between inpatient, outpatient and remote settings. The COVID-19 pandemic significantly altered the delivery of mental healthcare and MHWs experienced both work-related and personal adversities during the COVID-19 pandemic. With the continuation of changes introduced to healthcare in the initial stages of the pandemic, it will be important to maintain efforts to monitor negative outcomes and ensure supports for MHWs, going forward.     

Coronavirus disease 2019 crisis in Paris: A differential psychological impact between regular intensive care unit staff members and reinforcement workers

BackgroundIntensive care unit (ICU) healthcare workers (HCWs) are at the forefront of the coronavirus disease 2019 pandemic. To overcome the lack of human resources during this crisis, some ICUs had to mobilise staff from a reinforcement pool, with no or outdated ICU experience. This study aimed to investigate and to compare the psychological impact of the pandemic on regular ICU staff members and reinforcement workers.Material and methodsSelf-assessment questionnaires were completed by HCWs who worked from March 1 to April 30, 2020, in our 16-bed neurological ICU at La Pitié-Salpêtrière Hospital in Paris, France, which was converted to a COVID ICU. The Hospital Anxiety and Depression Scale, the Post-traumatic Stress Disorder Checklist for DSM-5, McGill Quality of Life Questionnaire-Revised, and 10-item Connor-Davidson Resilience Scale were used to assess anxiety, depression and post-traumatic stress disorder, quality of life, and resilience, respectively.ResultsSixty-nine ICU HCWs completed the survey (37 from the team of regular staff members, i.e., from the public health service, and 32 from a reinforcement pool, either from non-ICU public health service or from private healthcare interim employment agencies). Prevalence of anxiety, depression, and post-traumatic stress disorder symptoms was high, at 19%, 9%, and 16%, respectively, with limited impairment in quality of life or resilience scores. Depression symptoms were observed more in regular staff members than in welcomed reinforcement workers, at 16% and 0%, respectively.ConclusionsThese results revealed that during the pandemic, HCWs from the team of regular staff members were at greater risk of developing psychological disorder compared with reinforcement workers, with higher levels of depressive symptoms.     

重症监护病房护士工作压力源与心理健康水平的相关性研究

目的 :揭示重症监护病房 (ICU)与普通内科护士工作压力源和心理健康水平的差异 ,研究ICU护士工作压力源与心理健康之间的关系。方法 :采用问卷调查法对重庆市 5所三甲医院ICU及普通内科护士的工作压力源、心理健康及其相互关系做了调查。结果 :ICU护士工作压力源部分因素和症状自评量表 9个因子得分显著高于普通内科护士 ,ICU护士工作压力源部分因素与心理健康水平显著正相关。结论 :ICU护士工作压力大 ,是心理健康水平低的一个因素 ,建议管理者采取切实有效的措施维护ICU护士的心理健康。     

重症监护病房患者的心理压力分析与护理

目的研究重症监护病房(ICU)患者的心理压力因素及其心理疏导护理。方法采用ICU病人心理护理调查量表对入住ICU的清醒患者进行心理调查,对61例ICU患者的心理压力因素进行了测定,针对患者的不良心理反应进行心理疏导工作。2周后,对其中52例患者进行第2次调查评估。结果ICU患者常见的环境压力因子为:害怕死亡、疼痛、有插管在鼻子或口中、不知道在ICU住多少天、思念配偶或恋人及担心费用问题等。绝大多数ICU患者存在不同程度的抑郁、焦虑等不良心理反应。结论针对ICU患者的心理压力因素及不良心理反应进行心理疏导工作,有助于患者的配合治疗及顺利康复。     

The mental health impact of the COVID-19 pandemic on Canadian critical care nurses

ObjectiveFocusing on Canadian critical care nurses (CCNs), the study objectives were to examine the impact of the COVID-19 pandemic on: mental health, quality of work life, and intent to stay in their current positions.Research designMixed-methods study using an online cross-sectional survey and integration of closed- and open-ended survey data.SettingCanadian CCNs working in an intensive care unit, high acuity unit, or intensive care step-down unit during the COVID-19 pandemic between May 2021 to June 2021.Main outcome measuresThe survey consisted of four instruments: (1) the impact of event scale – revised, (2) the depression, anxiety, and stress scale, (3) the professional quality of life scale, and (4) intent to turnover tool, as well as one optional open-ended question.ResultsFrom across Canada, 425 CCNs responded. The large majority reported symptoms of post traumatic stress disorder (74%), depression (70%), anxiety (57%), and stress (61%). All (100%) reported moderate to high burnout, 87% were suffering from signs of secondary traumatic stress, and 22% intended to quit their current employment. Qualitative analysis of written comments submitted by 147 (34.5%) of the respondents depicted an immense mental health toll on CCNs that stemmed from 1) failed leadership and 2) the traumatic nature of the work environment, that led to 3) a sense of disillusionment, defeat, and an intent to leave.ConclusionThe mental health toll of the pandemic has been significant for Canadian CCNs and highlights the urgent need for individual supports and systems level changes.     

Long-term effects of a tailored mindfulness-based program for Chinese intensive care unit nurses: A randomized parallel-group trial

AimThis study investigated the direct and long-term improvements that mindfulness-based interventions exert on intensive care unit nurses. We assessed an abbreviated four-week, twice-weekly mindfulness-based intervention program’s effect on work-related mental health variables and examined whether the intervention impact was maintained at two- and six-month follow-up assessments. We also examined the training program’s effects on work and life.BackgroundPrevious research has shown that mindfulness interventions exert positive effects immediately after treatment. However, few studies have examined whether treatment effects are maintained over time or under different circumstances. Moreover, treatment effects among Chinese intensive care unit nurses have rarely been examined.DesignWe conducted a randomized, non-blinded, parallel-group trial.MethodsParticipants included 90 intensive care unit nurses, divided into two cohorts, who participated in the program in October 2016 and April 2017. They completed validated measures of mindfulness, burnout syndromes, anxiety and depressive symptoms and well-being at baseline (T₁), immediately after intervention (T₂), two months after (T₃) and six months after (T₄) the intervention.ResultsWe observed a significant group effect (1) immediately post-intervention and two months after intervention for mindfulness; (2) at two months after intervention for anxiety, depression and subjective well-being and (3) at post-intervention, two months after and six months after for emotional exhaustion.ConclusionsThese findings suggest that the tailored four-week mindfulness-based intervention program improved intensive care unit nurses’ mental health, although further research is needed to verify its feasibility in a clinical working environment.     

Cardiovascular nurses' experiences of working in the COVID-19 intensive care unit: A qualitative study

BackgroundCardiovascular nurses’ skills and experiences of cardiac critical care, management of cardiovascular emergencies, and mechanical circulatory support have been considered vital in providing nursing care for COVID-19 patients in intensive care units during the COVID-19 pandemic. To our knowledge, there are no studies have focused on the contribution and experiences of cardiovascular nurses in the critical care of COVID-19 patients.ObjectivesTo explore the experiences of cardiovascular nurses working in a COVID-19 intensive care unit during the pandemic.MethodsThe study was conducted as a qualitative study with phenomenological approach in June-December 2020. Study data were gathered from ten cardiovascular nurses through semi-structured interviews.ResultsSix themes emerged from the interview data: the duties and responsibilities in a COVID-19 intensive care unit; the differences of COVID-19 intensive care unit practices from cardiovascular practices; the transferrable skills of cardiovascular nurses in a COVID-19 intensive care unit; the difficulties encountered working in a COVID-19 intensive care unit; the difficulty of working with personal protective equipment; and the psychosocial effects of working in a COVID-19 intensive care unit.ConclusionCardiovascular nurses made an important contribution to the management of nursing services with their experiences and skills in the COVID-19 pandemic.     

The Impact of the COVID-19 Pandemic on Surgeons' and Surgical Residents' Caseload,Surgical Skills,and Mental Health in Kuwait

IntroductionThe onset of the COVID-19 pandemic resulted in governments implementing new regulations to divert healthcare resources, which in return led to the postponement of elective and semi-elective surgical procedures. Therefore, many surgeons and as well as surgeons in training reported feeling redundant, which eventually resulted in psychological distress. This study aimed to assess the sociodemographic differences in the psychological impact resulting from the COVID-19 pandemic and outline the effect it had on surgical training.MethodsThis is a cross-sectional study conducted in Kuwait. Data were collected by distributing a questionnaire electronically to surgeons and surgeons in training. The survey included questions aimed at assessing both the effect of the pandemic on surgical training and the psychological impact it had on surgeons, assessing the latter using the Depression, Anxiety and Stress Scale-21 screening tool.ResultsThe response rate for the study was 52%, with the majority being junior male surgeons. A majority of surgeons in training reported postponement of their scheduled academic teaching sessions (78.9%) and pre-assigned surgical rotations (65.8%). In terms of the psychological impact of the pandemic, a majority of the participants reported an element of depression and stress, 61.2% and 55%, respectively, while approximately half, 48.1%, had symptoms associated with anxiety.ConclusionThe COVID-19 pandemic had a negative association with the psychological well-being of a significant proportion of surgeons and associated surgical training programs.     

Allied health surge capacity in Australian intensive care units during the COVID-19 pandemic: A cross-sectional survey

BackgroundBased on the early international COVID-19 experience, it was anticipated that intensive care services and workforces in Australia would be placed under similar pressure. While surge capacity of medical and nursing workforces was estimated, little was known about baseline allied health staffing, making it difficult to estimate surge capacity and coordinate planning.ObjectivesThe purpose of this study was to (i) capture baseline allied health staffing levels in Australian adult intensive care units (ICUs) prior to the COVID-19 pandemic emergence in Australia and (ii) describe the allied health pandemic planning and surge response in Australian ICUs during the early waves of the pandemic.MethodsThis was a cross-sectional, investigator-devised, prospective survey study. The survey was administered via the national chief allied health network to a convenience sample of senior ICU allied health clinicians at hospitals throughout Australia.ResultsA total of 40 responses were received from tertiary and metropolitan hospitals; 12 (30%) physiotherapists and eight (20%) occupational therapists were the most frequent respondents. Prior to the COVID-19 pandemic, 28 (70%) allied health respondents had a mean (interquartile range) of 1.74 (2.00) full-time equivalent staff designated to the ICU, where these ICUs had a mean of 21.53 (15.00) ventilator beds. Few respondents serviced their ICU on a referral-only basis and did not have dedicated ICU full-time equivalent (12; 20%). Surge planning was mostly determined by discussion within the ICU, allied health department, and/or respective disciplines. This approach meant that allied health staffing and associated decision-making was ad hoc at a local level.ConclusionsThe baseline rate of allied health coverage in Australian ICUs remains unknown, and the variability across allied health and within the specific disciplines is undetermined. Further research infrastructure to capture ICU allied health workforce data is urgently needed to guide future pandemic preparedness.