Pregnancy-related psychopathology: A comparison between pre-COVID-19 and COVID-19–related social restriction periods

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic impacted in a still undefined way pregnant women’s mental health. There are reports of mood and affect changes in the general population and the suggestion that similar changes occur also in the pregnant population. The greater vulnerability of women during the COVID-19 restriction period may translate into a greater risk for mental disorders in the gestational period. We hypothesised that pregnant women in the pre-pandemic period would have less psychopathology and more psychological support than pregnant women during the pandemic restriction period.AIMTo compare pregnant women for anxiety, prenatal depression, psychopathology, and social support before and after the awareness of the pandemic.METHODSWe administered to women willing to participate in their 2^nd-3^rd trimesters of pregnancy the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory Form Y (STAI-Y), and the Symptom CheckList-90-Revised (SCL-90R); we further collected sociodemographic variables and explored women’s social support. The comparison was cross-sectional. The first sample was termed nonCOVID-19 because data were gathered before the COVID-19 outbreak (January 2020-February 2020) was declared, and the second sample termed COVID-19 because participants were already subjected to the COVID-19–related restrictive measures (January 2021-February 2021). Since normal distribution was not met (Shapiro-Wilk test applied), we applied nonparametric Mann-Whitney’s U-test to compare psychometric tests. Ethical standards were met.RESULTSThe nonCOVID-19 group reported higher support from partners only, while the COVID-19 group reported multiple support (χ² = 9.7181; P = 0.021); the nonCOVID-19 group scored higher than the COVID-19 group only on state anxiety among psychometric scales [STAI-Y1, nonCOVID-19 median = 39 (95%CI: 39.19-51.10) vs COVID-19 median= 32 (95%CI: 30.83-38.90); Mann-Whitney’s U=117.5, P = 0.00596]. Other measures did not differ meaningfully between the two groups. Scores on the EPDS, the state and trait subscales of the STAI-Y, and most SCL-90R subscales inter-correlated with one another. The anxiety component of the EPDS, EPDS-3A, correlated poorly with other measures, while it was the Global Symptom Index of the SCL-90-R that correlated most strongly with most measures. Our results are at odds with most literature and do not confirm increased depression and anxiety rates in pregnant women during the pandemic.CONCLUSIONThe ability of pregnant women to deal with novel generalised threats involves mobilization of inner resources. Increasing sources of social support may have produced anxiolysis in the COVID-19 sample.     

Fear,anxiety and depression among pregnant women during COVID-19 pandemic: impacts of healthy eating behaviour and health literacy

IntroductionThe COVID-19 pandemic has been influencing people’s psychological health, especially in pregnant women. We aimed to examine associated factors of fear of COVID-19, anxiety and depression among pregnant women during the pandemic where the impacts of healthy eating behaviour (HES) and health literacy (HL) were emphasized.MethodsA cross-sectional study was conducted between 14 February 2020 and 31 May 2020 in 18 health centres and hospitals across Vietnam. Data of 518 pregnant women were analysed, including socio-demographics, pregnant-related factors, HES, HL, health-related behaviours, fear of COVID-19 scale (FCoV-19S), anxiety (using the generalized anxiety disorder (GAD-7)) and depression (using the patient health questionnaire with 9 items (PHQ-9)). Regression analysis was utilized to explore the associations.ResultsPregnant women with higher scores of HES and HL had lower likelihood of anxiety (odds ratio, OR, 0.79; 95% confidence interval (95%CI), 0.73, 0.87; p < .001; and OR, 0.94; 95%CI, 0.90, 0.99; p = .018) and depression (OR, 0.84; 95%CI, 0.78, 0.91; p < .001; and OR, 0.96; 95%CI, 0.91, 0.99; p = .044), respectively. Pregnant women being employed had a lower FCoV-19S score (regression coefficient, B, −1.46; 95%CI, −2.51, −0.40; p = .007). Besides, other significant predictors of anxiety were eating healthier during the pandemic, unchanged or more physical activity, elevated gestational age and smoking. Other significant predictors of depression were eating healthier during the pandemic, elevated gestational age and smoking.ConclusionsAmong others, HES and HL had positive impacts on protecting pregnant women against anxiety and depression. Improving HES and HL should be addressed as a strategic approach to improve reproductive health during the pandemic.

KEY MESSAGE

• The COVID-19 pandemic influences antenatal mental disorders with the higher level as opposed to that before the pandemic.
• Healthy eating behaviour and better health literacy (HL) had critical roles in lowering prenatal anxiety and depression during the COVID-19 crisis.
• Strategic approaches for improving healthy eating and HL should be recommended for protecting pregnant women from mental health problems during the pandemic.

     

Knowledge and attitudes of family members towards postpartum depression

BackgroundPostpartum depression (PPD) has been recently recognized as a public health issue. While family members play an important role in early recognition of PPD among women, research that explores family members awareness on PPD is limited from India.AimTo explore the knowledge and attitudes of family members towards postpartum depression.MethodsThis was a cross-sectional survey carried out among family members of postpartum women (N = 202) at a pediatric tertiary care center. The data was collected through face to face interview technique using a structured questionnaire.ResultsThe mean scores on knowledge (18.92 ± 3.27) attitude (31.39 ± 4.91) scales suggest that a majority of the participants had a good level of knowledge (54%) and positive attitudes (69.7%) towards women with postpartum depression. However, misconceptions and negative stereotypes related to postpartum depression still prevailed. Family members who had a good level of education (χ2 = 4.21, p < 0.05) and had come across women with postpartum depression (χ2 = 13.27, p < 0.001) hold positive attitudes towards postpartum depression compared to family members with a lower level of education and those did not come across women with postpartum depression.ConclusionThe findings of the present study suggest the need for educational campaigns to improve perinatal mental health literacy and address prejudices and negative stereotypes related to postpartum depression among family members.     

Factors associated with nurses emotional distress during the COVID-19 pandemic

BackgroundNurses are among the frontline healthcare workers directly impacted by the burden of the coronavirus disease of 2019 (COVID-19) pandemic. This study aimed to examine the prevalence of emotional distress and the associated factors among nurses practicing in South Dakota during the COVID-19 pandemic.MethodsAn online survey was conducted among practicing, licensed nurses in South Dakota during the pandemic (July 2020 – August 2020). Emotional distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). Logistic regression models were performed to examine the association of emotional distress and the three DASS-21 subscales with: sociodemographic and work environment factors (e.g., work setting, job satisfaction, number of COVID-19 cases seen at the facility, preparedness, concerns with worsening pre-exiting mental health conditions due to the pandemic, and contracting the illness).ResultsAmong 1505 participants, overall emotional distress was reported by 22.2%, while anxiety, depression and stress were 15.8%, 14.5% and 11.9%, respectively. Factors associated with moderate to severe emotional distress, depression, anxiety, and stress were as follows: concerns for worsening of pre-existing mental health conditions, job dissatisfaction, encountering higher number of COVID-19 cases at one's work facility, feeling unprepared for the pandemic, and concern for contracting the illness (all p < 0.05).ConclusionsOur study suggests a high prevalence of emotional distress among nurses and highlights the factors associated with emotional distress during the COVID-19 pandemic. Promoting appropriate support is imperative to reduce nurses' emotional distress and promote psychological well-being during the COVID-19 world health crisis and in future pandemics.     

Cross-sectional study of pain-related variables before and during the COVID-19 pandemic in patients with COPD

BackgroundThe impact of the COVID-19 pandemic influences of COPD patients. The worsening of their health status may contribute to a higher pain prevalence.AimThe aim of this study was to analyze the pain-related variables before and during the COVID-19 pandemic in patients with chronic obstructive pulmonary disease.MethodsIn this cross-sectional case-control study, stable patients with chronic obstructive pulmonary disease without a COVID-19 diagnosis were evaluated before and during the pandemic. The main outcomes were the pronociceptive pain profile (general pain sensitivity, pain intensity, pain interference, and pressure pain sensitivity) and the psychological vulnerability (perceived health status, anxiety, and depression).ResultsOur results showed that patients with chronic obstructive pulmonary disease during COVID-19 pandemic experienced higher general pain sensitivity and intensity with statistical differences in pain interference (p < .001), being the overall perceived health status lower than before the pandemic (p < .05).ConclusionsWe concluded that patients with chronic obstructive pulmonary disease during the COVID-19 pandemic showed a rise the pronociceptive pain profile accompanied by increased psychological vulnerability.     

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it

BackgroundAlthough the emotional and psychological impact of nurses’ work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health.AimThe objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors.DesignA cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021.MethodsSociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates.FindingsAbout 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses.ConclusionGiven the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated.ImpactGiven these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.     

Postpartum depression: Mental health literacy of Indian mothers

BackgroundPostpartum depression is a significant public health issue. It is important to understand new mothers' awareness on depression during the postpartum period.AimThis study was aimed to understand the postpartum depression literacy of postpartum women.MethodsThis was a cross-sectional survey carried out among randomly selected mothers (N = 279) attending a paediatric tertiary care center. The data was collected through face-to-face interview technique using a structured questionnaire.ResultsOur findings revealed that merely 50.7% of the postpartum mothers had an adequate level of knowledge on postpartum depression. Postpartum depression literacy was significantly associated with participants' age (P < 0.01), income (p < 0.006) and occupational status (P = 0.013).ConclusionThe findings of the present study highlight specific gaps in postpartum depression literacy which may compromise the help-seeking behaviours of postpartum mothers. The findings also suggest an urgent need to sensitize women about postpartum depression.     

The Impact of COVID-19 Surge on Clinical Palliative Care: A Descriptive Study From a New York Hospital System

ContextIn spring 2020, New York experienced a surge of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) disease, as part of a global pandemic. There are limited data on populations of COVID-19–infected patients seen by palliative care services.ObjectiveTo describe a palliative care population at one New York hospital system during the initial pandemic surge.MethodsThis repeated cross-sectional, observational study collected data on palliative care patients in a large health system seen during the COVID-19 outbreak and compared it with pre-COVID data.ResultsPalliative service volume surged from 678 (4% of total admissions) before COVID-19 to 1071 (10% of total admissions) during the COVID-19 outbreak. During the outbreak, 695 (64.9%) of the total palliative patients tested positive for the virus. Compared with a preoutbreak group, this COVID-19–positive group had higher rates of male (60.7% vs. 48.6%, P < 0.01) and Latino (21.3% vs. 13.3%; P < 0.01) patients and less white patients (21.3% vs. 13.3%; P < 0.01). Our patients with COVID-19 also had greater prevalence of obesity and diabetes and lower rates of end-stage organ disease and cancers. The COVID-19–positive group had a higher rate of intensive care unit admissions (58.9% vs. 33.9%; P < 0.01) and in-hospital mortality rate (57.4% vs. 13.1%; P < 0.01) than the preoutbreak group. There was increased odds of mortality in palliative care patients who were COVID-19 positive (odds ratio = 3.21; 95% confidence interval = 2.43–4.24) and those admitted to the intensive care unit (odds ratio = 1.45; 95% confidence interval = 1.11–1.9).ConclusionDuring the initial surge of the COVID-19 pandemic in New York, palliative care services experienced a large surge of patients who tended to be healthier at baseline and more acutely ill at the time of admission than pre–COVID-19 palliative patients.     

The effect of psychosocial risk factors on postpartum depression in antenatal period: A prospective study

PurposeThe aim of this study was to determine the psychosocial risk factors that may increase the risk of developing postpartum depression (PPD) symptoms in the antenatal period at postpartum 6–8 weeks.MethodsThis study was a prospective longitudinal design, in which women completed questionnaire measures both at the third trimester of pregnancy and 6–8 weeks after birth. The present study was conducted in the women's clinic of a Medical Faculty Hospital in the Central Anatolia region of Turkey between March 15 and August 15, 2019. A total of 245 pregnant women in the third trimester were included in the study. Data were collected using a sociodemographic and obstetric data collection form, Pregnancy Psychosocial Health Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Edinburgh Postnatal Depression Scale.ResultsForty-four (18%) of the 245 women had scores above the cut-off point (>13) in EPDS. Being subjected to violence from husband or another male member of the family during pregnancy, having problems in marriage, depression, anxiety, and high levels of perceived stress affect the risk of developing PPD by 55% (χ² = 101.034, P < 0.001). It was observed that those who scored low on the psychosocial health scale, those who experienced unplanned pregnancy, those with pregnancy that was not wanted by the husband, those who were emotionally abused, and those who experienced a sad event in their families were more sensitive to PPD symptoms.ConclusionsPsychosocial health, perceived stress, and psychosocial risk factors, such as depression and anxiety, during pregnancy are important determinants of postpartum depressive symptoms.     

Surveillance for Pressure Injuries on Admission to Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic

ObjectiveTo determine if the incidence of pressure injuries (PIs) on admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early coronavirus disease 2019 (COVID-19) pandemic period.DesignRetrospective survey chart review of consecutive cohorts. Admissions to 4 acute IRHs within 1 system of care over the first consecutive 6-week period of admitting patients positive for COVID-19 during the initial peak of the COVID-19 pandemic, April 1-May 9, 2020. A comparison was made with the pre–COVID-19 period, January 1-February 19, 2020.SettingFour acute IRHs with admissions on a referral basis from acute care hospitals.ParticipantsA consecutive sample (N=1125) of pre–COVID-19 admissions (n=768) and COVID-19 period admissions (n=357), including persons who were COVID-19–positive (n=161) and COVID-19–negative (n=196).Main Outcome MeasuresIncidence of PIs on admission to IRH.ResultsPrevalence of PIs on admission during the COVID-19 pandemic was increased when compared with the pre–COVID-19 period by 14.9% (P<.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19–positive and COVID-19–negative (35.4% vs 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient presented with, worsened during the COVID-19 period compared with pre–COVID-19 (χ² 32.04%, P<.001). The length of stay in the acute care hospital before transfer to the IRH during COVID-19 was greater than pre–COVID-19 by 10.9% (P<.001).ConclusionsDuring the early part of the COVID-19 pandemic time frame, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues and potential future pandemics that place strain on medical resources.     

Pilot trial evaluating maternal docosahexaenoic acid consumption during pregnancy: Decreased postpartum depressive symptomatology

ObjectiveDocosahexaenoic acid (DHA, 22:6, n-3) is a major structural component of neural tissue critical to neurotransmission and mood regulation. Poor maternal dietary intake coupled with accelerated maternal-fetal transfer of DHA compound risk for maternal deficiency. The objective of this investigation was to determine if maternal DHA supplementation is efficacious in reducing symptoms of postpartum depression.MethodsThis pilot investigation was a randomized, double-blinded, placebo controlled investigation of the role of DHA in preventing risk for postpartum depression. Women were assigned to: i) Placebo (no DHA, corn oil capsule), ii) DHA (300 mg DHA, fish oil capsule). Capsules were consumed from 24 to 40 weeks gestation (1 capsule 5 days/week). Forty-two participants were recruited (n = 20, intervention; n = 22, placebo). Maternal DHA status and depressive symptoms were followed from 24 to 40 weeks gestation using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Postpartum Depression Screening Scale (PDSS) from 2 weeks to 6 months postpartum.ResultsPDSS total scores were significantly lower (p = 0.016; 46.03 ± 2.17, intervention vs. 52.11 ± 2.4, placebo) in the intervention group with less anxiety/insecurity (p = 0.03), emotional lability (p = 0.04) and loss of self (p = 0.02).ConclusionsWomen in the DHA intervention group had fewer symptoms of postpartum depression compared to the placebo group. These results support the notion that the consumption of DHA by pregnant women can be efficacious in preventing depressive symptoms and highlight a need for further larger-scale investigations using the PDSS in tandem with a diagnostic evaluation.     

Relationship of fear of COVID-19 and pregnancy-related quality of life during the COVID-19 pandemic

AimThe aim of this study was to determine the relationship between fear of COVID-19 and quality of life in Iranian pregnant women during the COVID-19 pandemic.MethodsThis cross-sectional study was carried out on 250 Iranian pregnant women. Data was collected through questionnaires including demographic and obstetric characteristics, fear of COVID-19 and quality of life. An adjusted general linear model was used to determine the relationship between variables.ResultsThere was a negatively significant relationship between fear of COVID-19 and quality of life (P < 0.001). Based on the adjusted general linear model, it was expected that if COVID-19 fear score increased, the quality of life score would decrease significantly (B = -0.21, 95%CI: −0.34 to −0.09, P = 0.001).ConclusionThis study indicated a reverse correlation between fears of COVID-19 and quality of life. Therefore, developing appropriate interventions in order to overcome the fear caused by COVID-19 are recommended to improve pregnant women's quality of life.     

Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study

BackgroundThe relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period.ObjectivesWe investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms.DesignA prospective cohort study design was used.SettingMaternity unit of a medical center.ParticipantsThis study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected.MethodsPain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression.ResultsAfter adjusting for covariates, women who had perineal pain at 4–6 weeks postpartum showed an increased risk for depression at 4–6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4–6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (β = 0.63, p = 0.02). Any pain intensity score at 3–5 days postpartum predicted depression at 3 months (β = 0.01, p = 0.04). Women with high depression scores at 3–5 days had a two- or three-fold higher risk for depression at 4–6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively).ConclusionsOur study provides robust evidence that perineal pain 4–6 weeks postpartum is associated with depressive symptoms 4–6 weeks and 6 months postpartum; pain at 3–5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3–5 days postpartum, predict depressive symptoms during the 6-month postpartum period.     

Australian and Danish nurses’ and midwives’ wellbeing during COVID-19: A comparison study

BackgroundMost investigations of nurses’ and midwives’ psychological wellbeing during the COVID-19 pandemic have been conducted in a single setting.AimTo assess and compare the psychological wellbeing of nurses and midwives in Australia and Denmark during the COVID-19 pandemic.MethodsNurses and midwives employed at four metropolitan health services in Australia and one in Denmark completed an anonymous online survey, which assessed depression, anxiety, and stress symptoms (The Depression, Anxiety and Stress Scale - 21 Items (DASS-21)), and sociodemographic and employment factors.FindingsCompleted surveys were received from 3001 nurses and midwives (1611 Australian and 1390 Danish). Overall, approximately one in seven of the nurses and midwives surveyed reported moderate to extremely severe levels of depression (n = 399, 13.5%), anxiety (n = 381, 12.9%) and stress (n = 394, 13.4%). Australian nurses’ and midwives’ scores on all DASS-21 subscales were significantly higher (representing higher levels of depression, anxiety and stress) than the scores for the Danish nurses and midwives. Fewer years of clinical experience, living in Australia and being employed on a part-time basis were significantly associated with higher levels of psychological distress.DiscussionA considerable proportion of nurses and midwives experienced distress during the COVID-19 pandemic; however, the proportion and severity varied by country. Australian nurses and midwives experienced higher levels of distress than their Danish colleagues.ConclusionNurses and midwives working in countries with relatively low numbers of COVID-19 cases and deaths are also likely to experience psychological distress. Nurses and midwives would benefit from targeted country-specific support and wellbeing initiatives.     

Depressive Symptoms Associated With Musculoskeletal Pain in Inactive Adults During COVID-19 Quarantine

BackgroundDepression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level.AimTo describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels.DesignCross-sectional study.MethodsThis research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872; 58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants’ level of physical activity.ResultsDepressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain.ConclusionDuring the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants.     

Examining emergency medical services' prehospital transport times for trauma patients during COVID-19

IntroductionLonger prehospital times were associated with increased odds for survival in trauma patients. The purpose of this study was to determine how the COVID-19 pandemic affected emergency medical services (EMS) prehospital times for trauma patients.MethodsThis retrospective cohort study compared trauma patients transported via EMS to six US level I trauma centers admitted 1/1/19–12/31/19 (2019) and 3/16/20–6/30/20 (COVID-19). Outcomes included: total EMS pre-hospital time (dispatch to hospital arrival), injury to dispatch time, response time (dispatch to scene arrival), on-scene time (scene arrival to scene departure), and transportation time (scene departure to hospital arrival). Fisher's exact, chi-squared, or Kruskal-Wallis tests were used, alpha = 0.05. All times are presented as median (IQR) minutes.ResultsThere were 9400 trauma patients transported by EMS: 79% in 2019 and 21% during the COVID-19 pandemic. Patients were similar in demographics and transportation mode. Emergency room deaths were also similar between 2019 and COVID-19 [0.6% vs. 0.9%, p = 0.13].There were no differences between 2019 and during COVID-19 for total EMS prehospital time [44 (33, 63) vs. 43 (33, 62), p = 0.12], time from injury to dispatch [16 (6, 55) vs. 16 (7, 77), p = 0.41], response time [7 (5, 12) for both groups, p = 0.27], or on-scene time [16 (12−22) vs. 17 (12,22), p = 0.31]. Compared to 2019, transportation time was significantly shorter during COVID-19 [18 (13, 28) vs. 17 (12, 26), p = 0.01].ConclusionThe median transportation time for trauma patients was marginally significantly shorter during COVID-19; otherwise, EMS prehospital times were not significantly affected by the COVID-19 pandemic.     

Nurses' pandemic lives: A mixed-methods study of experiences during COVID-19

BackgroundThe US healthcare settings and staff have been stretched to capacity by the COVID-19 pandemic. While COVID-19 continues to threaten global healthcare delivery systems and populations, its impact on nursing has been profound.ObjectivesThis study aimed to document nurses' immediate reactions, major stressors, effective measures to reduce stress, coping strategies, and motivators as they provided care during COVID-19.DesignMixed-methods, cross sectional design. Participants responded to objective and open-ended questions on the COVID-19 Nurses' Survey.ParticipantsThe survey, was sent to nurses employed in health care settings during the pandemic; 110 nurses participated.ResultsImmediate reactions of respondents were nervousness and call of duty; major stressors were uncertainty, inflicting the virus on family, lack of personal protective equipment (PPE), and protocol inconsistencies. Effective measures to reduce stress identified were financial incentives and mental health support. Most frequently used coping strategies were limiting televised news about the virus, talking with family and friends, and information, Motivators to participate in future care included having adequate PPE and sense of duty. Bivariate analysis of outcomes by age group, education, work setting, and marital status was performed. Nurse respondents with higher advanced degrees had significantly less fear than those with BSN-only degrees (p < .05).Of respondents who were married/living with a partner, 85.9% listing “uncertainty about when the pandemic will be under control” as a major stressor (p < .05), while 62.8% of those who were single/divorced/widowed (p = .015) did so. Further, 75% of respondents working in critical care listed “mental health services” as important (p = .054). Four major qualitative themes emerged: What is going on here?; How much worse can this get?; What do I do now?; What motivates me to do future work?ConclusionThe study found nurses were motivated by ethical duty to care for patients with COVID-19 despite risk to self and family, leaving nurses vulnerable to moral distress and burnout. This research articulates the need for psychological support, self- care initiatives, adequate protection, information, and process improvements in the healthcare systems to reduce the risk of moral distress, injury and burnout among nurses.