COVID-19 Wards Research Articles

Post-Traumatic Stress Disorder (PTSD) Among Healthcare Workers of Tertiary Care Hospitals of Rawalpindi; Amid the COVID-19 Pandemic

Objective: To determine the prevalence of PTSD symptoms and its severity among HCWs, amid the COVID pandemic in a tertiary care setting. Study Design: Cross sectional analytic study. Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from May to Aug 22. Methodology: The study was conducted on 173 healthcare workers of a tertiary care hospital. The sample size was calculated using the Rao-soft calculator. Validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and PTSD Checklist Civilian Version (PCL-C) were used to collect the data. Data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 26. Results: Out of 173 participants, majority of participants 90(52%) were male and single 103(63%). Mean age of the participating HCWs was 27(SD= 2.3). HCWs performing duties the in COVID-19 ward for one year were 66(38.2%) and majority were from Emergency medicine 61(35.3). Almost 150(86.71%) of HCWs did not experiencing any PTSD symptoms and those exhibiting a higher severity of symptoms were only 5(2.9%). There was no statistically significant difference in total and sub scales mean scores of IES-R among males and females (p= 0.28). Conclusions: Our study concluded that prevalence of symptoms of PTSD was significantly low in Health Care Workers despite of the fact, majority of doctor participants were working in COVID-19 ward for one year. The symptoms were evident among healthcare professionals, however there was modest severity.

Post-Vaccination COVID-19 Transmission among Healthcare Workers in a Tertiary Level Hospital in Nepal

Background and Aims: Frontline healthcare workers have faced an increased risk of contracting COVID-19 since the beginning of the pandemic. Nurses, in particular, faced a substantial risk compared to doctors, possibly due to their prolonged exposure to patients. Despite the vaccine coverage to healthcare workers before the second wave of the pandemic, breakthrough infection was unavoidable. Methods: This observational study was conducted at Shahid Gangalal National Heart Center, Kathmandu, Nepal, during the second wave of the COVID-19 pandemic. The study aimed to investigate COVID-19 infections among nursing staff, focusing on the number of infections, severity, the relationship between infections and time spent in the COVID ward, the comparison of infections among vaccinated and unvaccinated staff, and the effectiveness of infection control measures. Results: Among the 132 nursing staff, the overall positive rate after vaccination was 15.15%, with a breakthrough infection rate of 4.34%. Significant differences were observed in age and prior infection. However, no significant differences were observed among the type of family, education level, work experience, wards, total duty hours, level of PPE used, mask type, or mask reuse. Conclusion: Vaccines reduce the severity of infections but do not eliminate the risk, especially in high-exposure settings like healthcare facilities.

Innovative Regional Services and Heterogeneous Communication Channels: Results from the Nationwide German egePan Project for Pandemic Management.

Background: In the COVID-19 pandemic, novel regional services and communication channels emerged across all sectors of the German healthcare system. To contribute to pandemic preparedness, this study aims to describe newly established services in response to the COVID-19 pandemic from a stakeholder perspective and to examine the interprofessional communication channels, applying a nationwide cross-sectional approach. Methods: A nationwide sample of German healthcare stakeholders comprising general practitioners, associations of statutory health insurance physicians, hospital medical directors, local health departments, rescue coordination centres, medical directors of emergency services, outpatient nursing services, nursing homes, community care access centres, and hospital nursing managers was surveyed. A web-based questionnaire asked for their level of participation in newly implemented regional COVID-19 services and communication channels. Stakeholders' level of recommendation was measured using the Net Promotor Score (NPS), a metric that assesses their satisfaction towards the services surveyed. Results: In total, 1312 healthcare stakeholders participated in the survey. Diagnostic centres (23.0-90.9%), COVID-19 wards in hospitals (40.5-92.1%), emergency medical vehicles designated solely for COVID-19 patients (16.5-68.4%), and crisis intervention teams (11.6-30.6%) exhibited the highest rates of engagement. The services receiving the highest recommendation for future use were COVID-19 focus practices (NPS: 33.4-43.7), COVID-19 wards in hospitals (NPS: 47.6-84.4), transportation of COVID-19 patients exclusively by predefined professional groups (NPS: 12.5-36.4), and newly implemented digitally supported nursing services (NPS: 58.3-100.0). Telephones emerged as the most frequently used communication channel (58.0-96.7%), while email was the primary digital channel (23.7-81.5%). Conclusions: During the COVID-19 pandemic, Germany experienced significant variation in the implementation of pandemic-related services across healthcare sectors, with stakeholders prioritising services built on existing healthcare structures. Developing a proactive digital infrastructure to connect healthcare professionals from different sectors is crucial for better future pandemic management.

Nurses' perception of threats to human dignity in caring for patients with COVID-19: A qualitative study

PurposeIdentifying threats to patients' dignity is crucial for maintaining and promoting their dignity. Preserving patient dignity should be regarded as both a patient’s right and a moral obligation. This study was conducted to evaluate nurses' understanding of threats to human dignity in the care of patients with COVID-19. MethodsThis qualitative study was conducted using conventional content analysis in various clinical departments in Iran. Clinical nurses from different departments were selected through purposeful sampling. Data were collected via in-depth semi-structured interviews with 15 clinical nurses over two months in 2021 and analyzed using qualitative content analysis. ResultsDuring data analysis, two main categories and ten subcategories were identified: 1) Unethical behaviors (lack of respect for patient privacy, lack of patient involvement in decision-making procedures, ignoring the patient as an individual, aggressive behaviors, stigmatization, and failure to provide palliative and end-of-life care to patients and their families); 2) Organizational factors (inadequate financial support, lack of patient-care facilities, strict restrictions, and employing less experienced nurses in COVID wards). ConclusionThe present study showed that most participants expressed concerns about violations of patients' dignity and identified many threats to it. Based on the findings, it is suggested that other factors threatening patients' dignity be identified, the threats eliminated, and healthy treatment environments created to promote patients' dignity.

Prevalence of Anxiety and Suicidal Ideation in Nurses Working in COVID-19 Wards Compared to Nurses From Other Hospital Wards During the Pandemic

Background and Objectives: Investigating the level of anxiety and suicidal thoughts in nurses during the COVID-19 pandemic can play an important role in helping them clinically to prevent the development of psychological symptoms in them. In this regard, this study aims to investigate the prevalence of anxiety and suicidal ideation in nurses working in COVID-19 wards compared to nurses from other departments. Methods: In this analytical cross-sectional study, participants were 347 nurses from two hospitals (Shahid Beheshti and Kamkar) in Qom, Iran in 2021. Nurses were divided into two groups working in COVID-19 and non-COVID wards. The data collection tools were a demographic form, Beck’s anxiety inventory, and the Beck scale for suicidal ideation. The data was analyzed in SPSS software version 22 using independent t-test or ANOVA for quantitative data and chi-square test for qualitative data. The significance level was set at 0.05. Results: Among participants, 139(40.1%) were in the COVID group and 208(59.9%) were in the non-COVID group. Nurses in the COVID group had significantly higher anxiety scores than nurses in the non-COVID group (P<0.001), but there was no significant difference between COVID and non-COVID groups in suicidal ideation (P=0.979). Conclusion: There is a high prevalence of anxiety among nurses working in COVID-19 wards compared to nurses from other wards. Therefore, it is recommended to use psychological treatments to reduce the anxiety and suicidal thoughts of these nurses during the COVID-19 pandemic.

No Backstage: The Relentless Emotional Management of Acute Nursing Through the COVID-19 Pandemic.

To explore the impact of the COVID-19 pandemic on nurse's well-being, experiences of delivering healthcare within acute settings and their emotional management. Sequential mixed methods. February to July 2021 an online well-being survey was disseminated to nurses working in acute settings within one Scottish health board. In-depth interviews with a purposive sample of respondents were conducted. Survey data were analysed descriptively, and interview data using Framework analysis and emotional management as the theoretical framework. Well-being was poor overall. Infection control measures impeded interactions, with loss of connection between patients, families and nurses. Emotional work was extended in caring for patients and families when visits were forbidden or restricted. Disconnect between colleagues was intensely felt. On COVID and non-COVID wards, nurses were caring for patients with a significantly reduced workforce and often outside their clinical speciality. Nurses masked their own anxieties, fears, moral distress and exhaustion on the ward. Communal 'backstage' spaces, were reduced to enable more infection-control space but reduced opportunity for collegial support. Formal psychological intervention required access after shift, and/or nurses feared they could not contain their emotions afterwards. Working during the pandemic was emotionally and physically demanding for those in COVID a.nd non-COVID wards. Unintended consequences of infection control measures significantly extended nurses' emotional management, by caring for isolated patients and families but impeding opportunities to care for each other, compounding their emotions. There is a need to value emotional work in nursing to better support mental well-being. We advance the nursing emotional management literature by addressing the gap of exploration in challenging conditions. The importance of emotional management on nurses' mental well-being has been overlooked but focusing on this in the next crisis could improve nurse's well-being. No patient or public contribution. GRAMMS.

Fibrotic outcomes from SARS-CoV-2 virus interstitial pneumonia.

Following the onset of the new COVID-19 pandemic, particular attention is paid to the long-term outcomes, especially concerning patients affected by the SARS-CoV-2 virus leading to interstitial pneumonia. The aim of this research is to evaluate the possible evolution over time of interstitial pneumonia into post-inflammatory fibrosing interstitial disease. This research included 42 patients admitted to the COVID ward for SARS-CoV-2 interstitial pneumonia, 10 patients with mild pneumonia and respiratory failure who were treated with O2 only, 32 patients with severe pneumonia in which O2 and non-invasive ventilation were used for respiratory assistance, and 4 patients treated with invasive mechanical ventilation. At 70±30 days, 6, 12, 24, and 36 months after discharge, the cohort of patients carried out the evaluation of inflammation indices, high-resolution computed tomography (CT) chest scans, and functional respiratory tests. The comparative analysis showed that 83.3% of patients had residual parenchymal lung disease at 36-month follow-up, with a significantly higher rate in those with severe pneumonia and more extensive disease on initial CT. Regarding the pulmonary involvement model, patients presented ground-glass opacity or peripheral parenchymal bands, or a combination of them, peri- and intralobular interstitial thickening, which may be representative of fibrotic interstitial lung disease. There is a correlation between the severity of pneumonia, the inflammatory state, the need to increase respiratory support, and the quantity and persistence of CT-related lesions. Reductions in respiratory functions and exercise capacity were observed, the latter more pronounced in patients (24%) who had contracted severe pneumonia and required ventilatory support.Pulmonary outcomes from SARS-CoV-2 respiratory infections show a wide range of radiological findings, from complete recovery to stable outcomes of thickening and distortion of the interstitial architecture. From a functional point of view, there is an impairment of the alveolar-capillary diffusion capacity and, in cases who had contracted severe pneumonia, desaturation and reduced exercise tolerance in 24% of cases at a 36-month follow-up.

Risk of Hepatitis B Virus Reactivation in COVID-19 Patients Receiving Immunosuppressive Treatment: A Prospective Study.

Objectives: This study aimed to evaluate the risk of hepatitis B virus reactivation (HBVr) in COVID-19 patients receiving immunosuppressive treatment, which has been insufficiently studied to date. Secondarily, we aimed to evaluate the seroprevalence of HBV infection in COVID-19 patients. Methods: We performed HBV screening on all Romanian adults hospitalized in four COVID-19 wards between October 2021 and September 2022. We enrolled patients with positive hepatitis B core antibody (anti-HBc) without protective hepatitis B surface antibody (anti-HBs), HBV treatment, or baseline immunosuppressive conditions, and we conducted a virological follow-up on these patients at 3 months. Results: We identified 333/835 (39.9%) anti-HBc-positive patients. Follow-up was performed for 13 patients with positive hepatitis B surface antigen (HBsAg) and 19 HBsAg-negative/anti-HBc-positive patients. Among those who received immunosuppressants, 4/23 (17.4%) patients experienced HBVr: 1 out of 8 (12.5%) HBsAg-positive patients (with 1.99 log increase in HBV DNA level) and 3 out of 15 (20%) HBsAg-negative/anti-HBc-positive patients (with a de novo detectable HBV DNA level). Conclusions: Administration of COVID-19 immunosuppressants may result in a significant risk of HBVr in co-infected patients. We recommend performing an HBV triple screen panel (HBsAg, anti-HBs, anti-HBc) for all COVID-19 patients receiving immunosuppressive treatment. HBV prophylaxis may be indicated in certain patients. Larger studies are needed in order to establish appropriate and cost-effective management for these patients.

Investigating the relationship between moral courage and caregiving behaviours among nurses working in COVID-19 wards in Iran.

To examine the correlation between moral courage and caregiving behaviour among nurses who are employed in the COVID-19 ward in Iran. This study is a descriptive-correlational and cross-sectional research conducted in 2021 in the city of Tehran, Iran. A total of 270 nurses employed in COVID-19 wards, who had been working in these wards for at least 1 month, were recruited from XXX hospitals and XXX Hospital. Data collection was conducted from September to November 2021. The data collection tools included a demographic information form, the Caring Dimension Inventory (CDI-25), and the Professional Moral Courage Scale (PMC). The designed questionnaire links were provided to the participants virtually through the Persian platform 'Pars Line' and via WhatsApp. Descriptive statistics and inferential statistics were used to examine the relationship between moral courage and care behaviour. There was a significant difference in the mean of caring behaviour between the age groups (<30 and >40 years old), and the work experience groups (<5 years and >15 years) (p < 0.05). Ethical values also varied significantly between certain age and experience groups (p < 0.05), but no significant differences were found in ethical behaviour across most ages (30-40 years) and work experience categories (>10 years) (p > 0.05). The level of moral courage among the nurses was higher than the median score of the instrument (87.31 ± 10.37). Among the dimensions of moral courage, the highest score was related to the dimension of ethical factors (17.64 ± 2.64), and the lowest score was related to the dimension of multiple values (17.26 ± 2.78). The level of caring behaviours among the nurses was lower than the median score of the instrument (46.11 ± 10.84). Among the dimensions of caring behaviours, the highest score was related to physical-technical behaviours (19.22 ± 5.27), and the lowest score was related to professional behaviours (1.35 ± 0.67). Based on the analysis, moral courage had a weak and inverse correlation with caring behaviours among nurses. The higher moral courage does not necessarily result in improved caregiving behaviours, emphasizing the need for further research to explore and address this relationship. No Patient or Public Contribution.

Predictors of Poor Mental Health Outcomes in Healthcare Workers during COVID-19: A Two Waves Study.

Objective: This cross-sectional study aimed to identify potential predictors of poor mental health outcomes among healthcare workers in two different waves of the COVID-19 emergency in Italy. Methods: An online survey collected data from N = 557 healthcare workers (21-77 years). The study predictors were sociodemographic characteristics, occupational status, factors related to the work environment, COVID-19-related adverse events, and lifetime traumatic events. The poor mental health outcomes that were considered were depersonalization/derealization, anxiety, depression, and somatization symptoms. Results: The main predictors of poor mental health outcomes were sleeping less than six hours per night, inadequate protective equipment measures, female gender, personal and familiar infection, living alone, working as a nurse, and working in a COVID-19 ward. Healthcare workers in 2021 reported experiencing more serious accidents and stressful events than those of the first wave. Depressive symptoms and COVID-19-related adverse events were higher in the second pandemic outbreak than in the first. Conclusions: Preventive strategies against poor mental health outcomes should be particularly focused on female nurses who live alone, work in areas with high infection rates, and have experienced the COVID-19 infection personally or who are close to people that have experienced the infection.

Clinical characteristics, treatment, and outcomes for elderly patients in a dedicated Covid-19 ward at a primary health care facility in western Norway: a retrospective observational study

BackgroundThe coronavirus pandemic has hit the oldest and frailest individuals hard, particularly patients and residents in nursing homes. In March 2020, we established a Covid-19 ward at a nursing home in Bergen, western Norway for elderly patients with Sars-CoV-2 infection and in the need of treatment and care in a primary health care facility. The aims of this study were to describe the organization of the ward, the clinical outcomes of infection, treatment, mortality rates in the population, the level of advanced care planning, and end-of-life care for those who died.MethodsWe present patient characteristics, outcomes, vaccination status, treatment, decisions regarding treatment intensity upon clinical deterioration, and mortality for the patients in the ward. Clinical factors possibly related to a fatal outcome were analysed with chi square test (categorical variables) or t-test (continuous variables).Results257 patients were included from March 2020 to April 2022. Fifty-nine patients (23.0%) developed respiratory failure. Ten patients (3.9%) were admitted to hospital. Advance care planning was undertaken for 245 (95.3%) of the patients. 30-day mortality rate decreased from 42 to 4% during the study period. Of the 29 (11.3%) patients who died, all were well alleviated in the terminal phase, and 26 (89.7%) of them had a Clinical Frailty Scale (CFS) value ≥ 7. A high score for CFS, respiratory failure and respiratory co-infection were significantly associated with Covid-19 related death within 30 days.ConclusionsCovid-19-related mortality markedly decreased during the study period, and a high score for CFS was related to a fatal outcome. Thorough planning of treatment intensity upon deterioration, low hospitalization rates, and good relief for those who died suggest that dedicated Covid-19 wards in nursing homes can provide good treatment for the patients and relieve other nursing homes and specialist health care services.

Work Motivation: A Wall That Not Even the COVID-19 Pandemic Could Knock Down: Research Article.

The emergence of the coronavirus pandemic in 2020 posed a new challenge, imposing extraordinary physical and psychological burdens on healthcare workers, clearly exacerbating and intensifying career abandonment. Objectives: The aim of our study was to explore the motivating factors among nurses serving during the coronavirus pandemic that they considered important in their profession despite the mental and physical stress brought about by the pandemic. Methods: A descriptive, cross-sectional study was conducted at the University of Pécs-Clinical Center-Regional Coronavirus Care Center between September 2022 and December 2022. We used non-random, expert, purposive sampling, recruiting healthcare workers who had spent at least 3 months working in a COVID ward (n = 196). Data collection was conducted by using an online, anonymous questionnaire, which included sociodemographic questions, the "Motivation at Work Scale", and a self-edited six-item questionnaire. Results: Regarding the 5-year probability of remaining in the healthcare field, nine participants (4.5%) will definitely leave the healthcare sector, twenty-seven participants (13.7%) are undecided, and seventy-eight participants (39.7%) will definitely stay in the healthcare field over the next 5 years. There is a positive, weak, but significant correlation between intrinsic motivation and the probability of leaving the profession within 5 years (r = 0.281; p < 0.05). We identified a significant, negative, and weak correlation between the number of revisited waves of the coronavirus and the fear of redeployment to the COVID ward (r = -0.273; p < 0.05). Conclusions: Despite the challenges posed by the coronavirus pandemic, only a small percentage of nurses consider leaving the healthcare profession. Joy and enjoyment in their work were dominant factors even during the pandemic.

A qualitative analysis of health service problems and the strategies used to manage them in the COVID-19 pandemic: exploiting generic and context-specific approaches

BackgroundThe COVID-19 pandemic disrupted health systems around the globe. Lessons from health systems responses to these challenges may help design effective and sustainable health system responses for future challenges. This study aimed to 1/ identify the broad types of health system challenges faced during the pandemic and 2/ develop a typology of health system response to these challenges.MethodsSemi-structured one-on-one online interviews explored the experience of 19 health professionals during COVID-19 in a large state health system in Australia. Data were analysed using constant comparative analysis utilising a sociotechnical system lens.ResultsParticipants described four overarching challenges: 1/ System overload, 2/ Barriers to decision-making, 3/ Education or training gaps, and 4/ Limitations of existing services. The limited time often available to respond meant that specific and well-designed strategies were often not possible, and more generic strategies that relied on the workforce to modify solutions and repair unexpected gaps were common. For example, generic responses to system overload included working longer hours, whilst specific strategies utilised pre-existing technical resources (e.g. converting non-emergency wards into COVID-19 wards).ConclusionDuring the pandemic, it was often not possible to rely on mature strategies to frame responses, and more generic, emergent approaches were commonly required when urgent responses were needed. The degree to which specific strategies were ready-to-hand appeared to dictate how much a strategy relied on such generic approaches. The workforce played a pivotal role in enabling emergent responses that required dealing with uncertainties.

Is there a correlation between increasing hospital falls and Covid-19 infection? Retrospective study on the entire hospital population.

Risk Management Unit at Mauriziano hospital analyzed in the present observational study possible correlation with Covid Pandemic and falls risk factors, through comparison of patients falls occurred during year 2021 in Covid and no-Covid wards. The primary outcome of the study is the evaluation of relationship between falls and Covid infection. The secondary outcome is identification of falls risk factors. No direct correlation between falls and Covid-19 infection was found. Among falls risk factors, the most interesting emerged is the fall itself that enhances the risk of relapse. Increasing in patients falls since 2020 could be affected indirectly by strong hospital organization modifications during Covid pandemic.

The Caring Process in Patients with Covid-19: A Grounded Theory Study.

The care process involves essential tasks of assisting, supporting, and facilitating nursing activities to meet the comprehensive needs of patients. Coronavirus disease 2019 (COVID-19) is a global infectious disease that has caused a pandemic. Nurses play a crucial role in caring for and treating patients with COVID-19. This study aims to explain the care process in patients with COVID-19. A qualitative study using the grounded theory method was conducted from 2021 to 2022. Eleven nurses providing care to hospitalized patients with COVID-19 were purposively selected from the COVID wards of Shariati Hospital in Tehran, Iran. Data were collected through in-depth semistructured interviews and observation. Data analysis was conducted using the approach developed by Corbin and Strauss (2008). The data analysis phase identified a main theme of "protection and support in the shadow of uncertainty" along with five main categories and ten subcategories. The main categories included "encountering life-threatening crisis", "maintaining safety", "improving the patient's physical health", "encouraging", and "feeling satisfied despite the burden of care". Nurses aimed to improve the physical and psychological conditions of patients with COVID-19 by implementing a comprehensive care plan. The five main categories identified can be considered the primary approach to nursing care in the COVID-19 crisis. Additionally, the nurses' experiences can help establish the necessary infrastructure for care and education during other potential health crises.

Mental Health Disorders of Bulgarian Healthcare Professionals during a Recurring Wave of the COVID-19 Pandemic

Introduction: During the COVID-19 pandemic, health hazards for medical professionals are associated not only with the high risk of infection, but also with poor working conditions, a stressful psychosocial environment and several socio-demographic factors. Objectives: The study aims to gain insight into possible mental health disorders among healthcare professionals working in the Bulgarian healthcare system and to determine which professional and socio-demographic categories are most significantly affected. Methods: This cross-sectional study was conducted in October 2022 in healthcare facilities from seven regions in Southern Bulgaria. A total of 665 workers from hospitals, emergency centers, general and specialized medical practices, and medical laboratories filled out the self-assessment mental health questionnaire DASS-21 (Depression, Anxiety and Stress Scale), as well as a survey about their occupational and socio-demographic characteristics. Suitable statistical methods were used to assess the scientific hypothesis. Results: 40% of all surveyed healthcare workers had some type of self-reported mental health disorder, with 27% having more than one. 13% had simultaneous signs of depression, anxiety and stress. The rates of depression, anxiety and stress were highest among those working in COVID wards and emergency care centers, among young workers under 26 years of age, and among workers with disabilities and frequently ill workers. Conclusions: Protecting healthcare workers’ physical and mental health and work ability is a matter of primary importance, particularly under challenging working conditions such as the COVID-19 epidemic.

Association of Human Leukocyte Antigen Alleles with COVID-19 Severity and Mortality in a Spanish Population.

Background and Objectives: The aim of the following cross-sectional study is to determine the association between human leukocyte antigen (HLA) alleles and outcomes in patients presenting to the emergency department (ED) with SARS-CoV-2 infection. Methods and Materials: Genotyping was made using the Axiom Human Genotyping SARS-CoV-2 Research Array. Statistical analysis was made with Fisher's exact test and multivariable logistic regression, adjusted for sex, age and clinical variables. Results: Of 190 patients, 11.1% were discharged from the ED; 57.9% were admitted to the COVID-19 ward, without intensive care unit (ICU) admission; 15.3% survived an ICU admission; and 15.8% died. After multivariable analysis, two HLA alleles protected against hospital admission (HLA-C*05:01, adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.055-0.731; and HLA-DQB1*02:02, aOR 0.046, CI 0.002-0.871) and one was associated with higher risk for ICU admission or death (HLA-DQA1*05:01, aOR 2.517, CI 1.086-5.833). Conclusions: In this population, HLA-C*05:01 and HLA-DQB1*02:02 are associated with a protective effect against hospital admission and HLA-DQA1*05:01 is associated with higher risk of ICU admission or death in the multivariable analysis. This may help stratify risk in COVID-19 patients.

The mediating effect of resilience between work fatigue and psychological distress among healthcare workers in Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia.

To test the hypothesis that resilience has a mediating effect on the association between work fatigue and psychological distress. A cross-sectional survey was conducted online in eight countries in 2021: Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia. A total of 1094 healthcare professionals specialized in medicine, pharmacy, and nurse practitioners that were exposed to/worked with COVID-19 patients were included (age: 33.89 ± 10.79 years; 59.6% females). After adjusting for potential confounders (i.e., country, gender, primary work in emergency department, primary work in infectious disease, primary work in intensive care unit, working in a COVID-19 ward, and working voluntary hours), the results of the mediation analysis showed that resilience fully mediated the association between physical work fatigue and psychological distress and partially mediated the associations between mental and emotional work fatigue and psychological distress. Higher work fatigue was significantly associated with less resilience; higher resilience was significantly associated with less psychological distress. Finally, higher mental and emotional, but not physical, work fatigue, were directly and significantly associated with more psychological distress. Identifying resilience as an important mediator in the path from fatigue to distress helps elucidate underlying mechanisms and pathways leading to the mental health-alteration process among healthcare workers during COVID-19. New strategies targeting resilience may be developed to further improve mental health outcomes among healthcare workers.

The present situation of the nursing practice environment and its influence on nursing quality in a post-epidemic era: a cross-sectional study

BackgroundNursing Practice Environment is an important index to improve nursing quality and patient outcome. To explore the nursing practice environment in the COVID-19 ward during the period of COVID-19 and its impact on nursing quality to provide reference for setting up supporting nursing team in epidemic area in the future.MethodsA cross-sectional survey was conducted among 251 nurses working in COVID-19 ward in Shanghai, Hainan and Hunan in December 2022 through stratified proportional sampling. Structured questionnaires, including general information questionnaire, professional practice environment scale and nursing quality questionnaire, were used to investigate the patients. Pearson correlation was used to analyze the correlation between nursing practice environment and nursing quality, and multiple linear regression analysis was used to analyze the influencing factors of nursing quality in the COVID-19 ward.ResultsThe professional practice environment scale score was (3.34 ± 0.40), the nursing quality questionnaire score was (9.47 ± 0.81), both at a high level. Single factor analysis showed that nursing quality was related to educational background, physical condition, professional title, grade of the original hospital and composition of nursing staff in supported departments. Nursing quality were positively correlated with each nursing practice environment dimensions (in addition to teamwork). The results of regression analysis showed that the nursing practice environment in the COVID-19 ward had a positive impact on nursing quality.ConclusionsThe nursing practice environment and nursing quality of nurses in the COVID-19ward is generally very high. The education, working hospital level and nursing practice environment of nurses are the important factors influencing nursing quality. The relationship between nursing practice environment (include leadership and autonomy in clinical practice, staff relationships with physicians, control over practice, communication about patients, handling disagreement and conflict, internal work motivation and cultural sensitivity) and nursing quality is positive. It is suggested that the hospital should pay special attention to and improve nursing practice environment in order to improve nursing quality when setting up temporary ward in the future epidemic period of infectious diseases, ensure patient safety.Impact on clinical practiceResearch shows that an active nursing practice environment can improve the quality of care, and nursing managers create and maintain an active practice environment to improve the quality of care and ensure patient safety.

Assessing Depression, Anxiety, Perceived Stress, and Job Burnout in Hospital Medical Staff During COVID-19: A Cross-sectional Study in Hamedan, Iran, 2019

Background: The medical staff who fought on the front line against the COVID- 19 pandemic were more affected by its physical and psychological dangers than others. Objective: This study aimed to investigate the level of depression, stress, anxiety, and job burnout of the medical staff in the COVID-19 wards of Hamedan Hospitals. Methods: In this cross-sectional study, the study population consisted of all medical staff working in educational and treatment centers affiliated with Hamedan University of Medical Sciences in 2019, of which 173 were medical staff in COVID-19 wards, and 173 were medical staff included by systematic random sampling from other wards. Data were collected using a demographic information checklist, Beck Depression Inventory, Beck Anxiety Inventory, perceived stress scale, and Maslach Burnout Inventory. The data were analyzed with chi-square coefficient tests and one-way analysis of variance (ANOVA) with SPSS-22 software. Results: About 26.9% of medical staff in COVID-19 wards had high job burnout, significantly different from those in non-COVID-19 wards (p &lt; 0.05). The incidence of depression was 67.5% among the medical staff in COVID-19 wards, including twenty-nine people (18.5%) with mild depression, forty-two (26.7%) with moderate depression, and thirtyfive (22.3%) with severe depression. Thirty people (19.1%) had mild anxiety, forty-three (27.4%) had moderate anxiety, and three (3.3%) had severe anxiety. In addition, the prevalence of perceived stress was 94.3%. A statistically significant difference was observed between depression, anxiety, perceived stress, and job burnout in the medical staff of COVID-19 wards and other wards (p &lt; 0.05). Conclusions: Stress, anxiety, depression, and job burnout among staff working in COVID- 19 wards differ significantly from other hospital wards employees. In similar circumstances to this pandemic, paying extra attention to medical staff is essential due to their role and the effect of their health on society’s health.