Frontline Health Research Articles

Inpatient Physician and Nurse Experience During the COVID-19 Crisis at a Public Safety Net Hospital

Background: The COVID-19 pandemic has been associated with front line health care provider burnout, depression, and post-traumatic stress disorder. We sought to better understand how nurses and physicians of differing genders may have been affected differently by the COVID-19 crisis. Methods: Between July 17, 2020, and October 31, 2020, we surveyed nurses and physicians caring for COVID-19 patients at a large, academic, public safety net hospital in the southern United States. Survey questions were adapted from validated questionnaires used to determine quality of life, assess levels of anxiety, and determine how COVID-19 may have affected our nurses’ and physicians’ work, home and social lives. Results: Overall, 120 (41.7%) providers responded, including 39 (50%) physicians and 81 (38.6%) nurses. 69.3% reported disruption to their home/family, 76.3% to their social lives, and 29.8% worried about financial strain. More nurses than physicians worried about being excluded from social gatherings (59.7% v 35.1%, p=0.01). Similarly, 70.1% of nurses and 46.0% of physicians expressed concern of exposing others to COVID-19 (p=0.01). Nurses also expressed greater concern about being treated differently by others when compared to physicians (64.5% v 37.8%, p= 0.01). Female physicians reported greater difficulty separating their personal lives from their professional lives than male physicians and either male or female nurses (84.6%% vs 35% vs 33.3% vs 35.9%, p <0.05). Most physicians (89.7%) and nurses (93.8%) reported some level of anxiety, with 31.5% of respondents experiencing moderate or severe anxiety. Conclusion: Healthcare workers on the frontline of COVID-19 pandemic, regardless of profession, reported increased anxiety that extended beyond the hospital into their homes and social lives. Physicians and nurses, as well as men and women, reported different sources and degrees of stress and disruption to their work, home and social lives.

Patient- and community-centered approaches as the cornerstone of health services evaluation in the 21st century.

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Information System as part of epidemic management in Burkina Faso: from plan to reality (Field Findings)

BackgroundHealth information systems (HIS) in most developing countries face many challenges. In view of the recurrent weaknesses in preparedness and response during the management of epidemics, we have examined the organization and functioning of the health information system in Burkina Faso.MethodsWe conducted a cross-sectional study from January 1, 2020 to March 31, 2020 including a review of HIS documents, key informant interviews and direct observations. The study was conducted at the public primary health care (PHC) and community level of Bama and Soumagou, in the rural health districts of Dandé and Tenkodogo. Study participants included community-based health workers (CBHWs) and health workers in the PHC areas, community-based organization animators (CBOAs), CBO monitoring-evaluation officers and members of the District management team (DMT).ResultsWhile reporting forms used in all health facilities are standardized, they are not necessarily well understood at community level and at the health centers. Reports prepared by CBHWs are often delayed by the head nurse at the primary health care service. Case definitions of epidemic diseases are not always well understood by community-based health workers and front-line health workers.ConclusionThe health information system in Burkina Faso can be improved using simple strategies. There is a need to hold regular training/refresher sessions for agents involved in surveillance and to ensure the development of simplified case definitions for emerging diseases and/or diseases of public health interest for community use. Furthermore, existing epidemic management committees need to be revitalized.

Evidence of Interventions and Strategies to Bridge the Quality Improvement Gap Led by HCW at the Frontline in SSA: A Scoping Review

Abstract Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when there was no new information. All evidence was scored based on the 6 criteria described by Backhouse et al., which clearly distinguish quality improvement from clinical audit and research. Inclusion criteria were studies that involved frontline health care workers to test “change ideas” and used data systems to measure improvement in service delivery. Results A total of 75 records were identified and including 52 from the peer review search and 23 records from the grey literature search. Only 15 of 47 countries had publications (peer-review or grey literature) describing QI initiatives. Most quality improvement (QI) initiatives were multicomponent and included knowledge transfer, skills building, mentorship and learning visits. Most publications reported QI initiatives aimed at reproductive, maternal, neonatal and child health (n=23) and HIV (n=14) service delivery. Only 6 had experimental designs. No publications were identified prior to 2012 and a rapid escalation of published quality improvement initiatives from 2012 to 2020 was seen. Conclusion QI is in the very nascent stage in SSA. Most large-scale public health QI initiatives are sector specific, siloed, and donor driven. QI initiatives within sector specific programs have not moved horizontally and have had limited ability to change the broader system. Energy must be exerted to change the status quo. Making health care safer and more effective is not spontaneous.

Ms. Noemi Monika Szeifert

IntroductionWorking in COVID – 19 Health Care Units – Psychological impacts (PTSD, Depression, Anxiety Disorders) Working in the frontline during COVID-19 has put under extreme psychological and physical pressure the health care workers. The severe psychological symptomps can emerge on short, mid and long term as well. Our research is focusing on the psychological impacts of front line health care workers.Objectives In our lecture, we summarize our reserach made in the National Traumatology Center, Budapest, Hungary among health care workers who worked in the front and in the second line during the most severe period of the pandemic in Hungary, and discuss probable risk factors for PTSD and chronic psychological distress related to COVID-19. Furthermore we make an overview on the most frequently used coping skills for dealing with the psychological stress caused by the pandemic among the health care workers. The sample taking was processed in July 2021, after 3 month the 3rd COVID – 19 wave officially ended in Hungary.Methods 123 health care workers completed the online survey anonimously, included Beck Depression Inventory, Spielberger Anxiety State Inventory, PTSD Checklist, Lazarus Coping Scale.Results23% of HCW reported symptomps of depression, nearly 25% dealing with sleeping disorders and 38% with chronic fatigue, 42,50 % HCW suffering from anxiety disorders, 22% HCW experiencing symptomps of PTSD.ConclusionsWith our results we would like to raise awareness of the challenges and severe psychological consequences that these colleagues, our national heroes we can say, are facing after working in COVID-19 Health Care Units.DisclosureNo significant relationships.

Assessment of the effectiveness of a course in major chemical incidents for front line health care providers: a pilot study from Saudi Arabia

BackgroundMass chemical exposure emergencies are infrequent but can cause injury, illness, or loss of life for large numbers of victims. These emergencies can stretch and challenge the available resources of healthcare systems within the community. Political unrest in the Middle East, including chemical terrorist attacks against civilians in Syria and increasing chemical industry accidents, have highlighted the lack of hospital preparedness for chemical incidents in the region. This study aimed to evaluate the effectiveness of a course designed to empower frontline healthcare providers involved in mass casualty incidents with the basic knowledge and essential operational skills for mass chemical exposure incidents in Saudi Arabia.MethodsA mixed-methods approach was used to develop a blended learning, simulation enhanced, competency-based course for major chemical incidents for front line healthcare providers. The course was designed by experts from different disciplines (disaster medicine, poisoning / toxicology, and Hazard Material Threat - HAZMAT team) in four stages. The course was piloted over five days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia). The 41 participants were from different government health discipline sectors in the country. Pre- and post-tests were used to assess learner knowledge while debriefing sessions after the decontamination triage session and simulation-enhanced exercises were used for team performance assessment.ResultsThe overall knowledge scores were significantly higher in the post-test (69.47%) than the pre-test (46.3%). All four knowledge domains also had significant differences between pre- and post-test results. There were no differences in the pre and post-test scores for healthcare providers from the different health disciplines. A one-year post-event survey demonstrated that participants were satisfied with their knowledge retention. Interestingly, 38.3% had the opportunity to put this knowledge into practice in relation to mass chemical exposure incidents.ConclusionDelivering a foundation level competency-based blended learning course with enhanced simulation training in major chemical incidents for front line healthcare providers may improve their knowledge and skills in response to such incidents. This in turn can improve the level of national preparedness and staff availability and make a crucial difference in reducing the health impacts among victims.

Zika Virus: Knowledge, Attitude and Preventive Practices of Medical Doctors in a Tertiary Health Institution in Northern Nigeria

Zika virus, is an emerging arbovirus transmitted to humans through infected female Aedes species mosquitoes such as A albopictus and A aegypti via blood transfusion, sexual activities and from mother to fetus. This study aimed at assessing the knowledge, attitude and preventive practices of medical doctors at the Usmanu Danfodiyo University Teaching Hospital Sokoto.
 This was a cross-sectional descriptive study carried out amongst medical doctors at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. A set of semi structured, self- administered questionnaire was used to obtain information on knowledge, attitude and preventive practices against ZIKV using a two stage sampling method. Data collected was entered into and analyzed using SPSS statistical software version 23. The data was analyzed and summarized using frequencies, percentages, mean and standard deviation (SD) and presented as tables and charts. The Fisher’s exact test was used to establish the association between socio-demographic variables and attitude and knowledge of Zika virus infection with p- value set at p < 0.05.
 The research was approved by the Health Research Ethics committee of the teaching hospital.
 Most of respondents in this study had good knowledge (87.5%), positive attitude (82.1%) and good practices of prevention of ZIKV (87.5%) respectively. There was a statistically significant association between attitude and knowledge of ZIKV as the respondents with positive attitude had good knowledge of the virus (p=0.002).
 Our respondents who are physicians displayed a very good knowledge, attitude and practices towards the ZIKV infection. Physicians as front line health workers are at a greater risk of being infected with ZIKV, and this underscores the need for them to always adhere to laid down standard operating procedures and universal precautionary measures. These will go a long way in reducing the morbidity and mortality associated with this infection.

Psychological Impact on the NHS staff at a Teaching Hospital in UK during the First Wave of the COVID-19 Pandemic

Aims: To know the Psychological impact of Covid-19 Pandemic on Hospital staff. Methods: The survey was conducted during the first wave of COVID-19 between 4thJune 2020 to 5th July 2020 at St. Helens & Knowsley Teaching Hospitals NHS Trust. Permission was obtained from the Audit & Information Governance Department of St. Helens & Knowsley Teaching Hospitals NHS Trust. Survey was done through Survey Monkey web site and used staff hospital e mail addressess to communicate with the hospital staff. Results: COVID-19 Pandemic has significant effects on the mental health and wellbeing of Front Line Health Workers in UK as shown in this study. Our study showed that major depressive symptoms were more common in non-doctors and doctors were more non-depressed. [Figure 3] There was a slightly higher sub-threshold depression among doctors over other staff members. Altogether among both groups of the front the line health workers 57.79% were non-depressed, 25.32% had sub-threshold depressive symptoms, and 16.88% had major depressive symptoms. [Figure 3] Conclusions: It is noted from our study that Front Line Health Workers do not give priority to their mental health wellbeing, hence there should be a system to regularly assess mental health of Front Line Health Workers and they should be encouraged to seek advice which appeared lacking in the respondents. It is important to mention that during the first wave, behavior, pathology and treatment of COVID-19 was not understood, and NHS staff at St. Helens & Knowsley Teaching Hospitals NHS Trust, like many other health care workers risked their own lives as Front Line Health Workers. It is not surprising that there was an impact on psychological wellbeing in such challenging circumstances.

Prevalence of Adverse Childhood Experiences Among Frontline Homeless Services Workers in Texas

A personal history of trauma can be a risk factor for job-based secondary traumatic stress and burnout. Experts have pointed to the need to understand the prevalence of adverse childhood experiences (ACEs) among people on the frontlines of health and human services to ensure adequate supports. A small body of literature has examined the prevalence of ACEs among direct service providers, including child welfare workers and social workers. This study adds to that research by assessing the prevalence of ACEs in a sample of frontline homeless service workers. Findings suggest an ACE prevalence higher than the general population but similar to that found in other studies of direct service professionals. Implications for organizational support and trauma-informed supervision are discussed.

Mental stress in health care professionals during COVID-19 outbreak.

BackgroundIn December 2019, an outbreak of novel corona virus pneumonia occurred in Wuhan City, China, and spread throughout the whole of country in a short period. Figures from China’s National Health Commission show that more than 3300 health care workers have been infected as of early March. In Italy, 20% of responding health care professionals was infected, and some have died. Health care professionals are exposed to different types of stress both physical and psychological in response to this serious infectious public health event.Research aimsThe aim of this study is to measure the degree of mental stress among front line health care workers dealing with COVID-19 patients.MethodsWe conducted the study through online survey questionnaire after obtaining the ethics approval from the Research Ethics Committee of Galway University Hospital in Ireland (Ref: C.A. 2355). All personal information of the medical staff involved in the survey has been kept confidential.ResultsThree hundred nine health care members (209 male and 97 female) have agreed to participate in our survey from different hospitals and different specialties all over the world. Overall PSS Score: mean 19.42 (Standard Deviation ± 5.876, range 1–33). Frontline health care workers working in University Hospitals and tertiary referral centres had lower levels of stress compared to those working in peripheral hospitals (P = 0.007, Kruskal Wallis).ConclusionThe COVID-19 pandemic is one of the most stressful events that a health care worker may face during his life time. Most of the participants in the survey developed a moderate degree of stress.

Knowledge, Attitudes, and Preparedness for Managing Pregnant and Postpartum Women with COVID-19 Among Nurse-Midwives in Kenya.

IntroductionGlobally, maternal morbidity and mortality have increased during the COVID-19 pandemic. Given the high burden of maternal and neonatal mortality in Kenya prior to COVID-19, front line health workers, including nurse-midwives, must be competent to ensure continued quality maternal services. Knowledge and awareness of COVID-19 transmission influence nurse-midwives risk perception and ability to implement prevention strategies.ObjectiveWe examined nurse-midwives’ knowledge, attitudes, and preparedness in managing pregnant and postpartum women with COVID-19 in Kenya.MethodsA cross-sectional online survey was conducted among 118 nurse-midwives between July 2020 and November 2020. A 31-item survey comprising 15 knowledge, 11 attitude, and five preparedness questions was administered using SurveyMonkey. A link to the survey was distributed among nurse-midwives via email. Multiple logistic regression analysis was used to assess associations between the variables. A p-value <.05 was considered statistically significant.ResultsEighty-five participants were included in the final analysis (response rate 72%). Most participants were female (n = 69, 81.2%), 52.9% (n = 45) worked in labor wards, and 57.6% (n = 49) worked in rural hospitals. Overall, 71% (n = 57) of participants had sufficient knowledge about managing COVID-19 in pregnant and postpartum women. However, only 63% were willing to receive COVID-19 vaccination. Nurse-midwives working in urban areas were 3.7 times more likely to have positive attitudes than those in rural areas (odds ratio 3.724, 95% confidence interval 1.042–13.31; p = .043).ConclusionNurse-midwives’ responses to the Kenyan government's COVID-19 guidelines for managing and caring for pregnant women were inconsistent. Continued professional development for nurse-midwives is important to ensure they stay abreast of evolving COVID-19 guidelines for maternal health. Our findings also suggest vaccine hesitancy may be a hurdle for ongoing COVID-19 vaccination.

Impact of COVID-19 on Health Care Workers - Burnout Scenario in This Pandemic

Coronavirus epidemic 2019 (COVID-19) has become a global pandemic and has already ceased millions of peoples lives all over the world, Till today while we are entering 2022 but still struggling with new strains, people who don’t want to follow guidelines and/or get vaccination, this situation become extreme out of control for healthcare workers in every country. Because the situation that its uncontrollable prevalence leads to exceed the capacity of healthcare systems and causes an extra burden on healthcare workers. Thus, this study aimed to find the impact of COVID-19 on the front line health care workers in Malaysia and to measure the burnout ratio among them using Maslach Burnout Inventory. 532 healthcare workers including physicians, nurses and other nonspecialists attended an online survey answering questionnaires on the Maslach Burnout Inventory, previous job demands and a checklist on the frequency of psychosomatic symptoms. Results indicated that the level of burnout and frequency of experienced psychosomatic symptoms are correlated to growing demand during COVID 19 pandemic situation. And, finding meaning in one’s own work is correlated to personal enjoyment. According to the findings of this study, urgent actions should be taken to minimize the burden on healthcare workers during this pandemic situation to ensure the well being and safety of their lives as well.

Estimation of Prevalence and Comparing the Levels of Stress, Anxiety, Depression, and Psychological Impact Before and After COVID-19 Lockdown Among Front Line Health Care Workers.

The main objective of the study is to estimate the prevalence and compare the levels of psychological impact, anxiety, depression, and stress experienced by the frontline health care workers (HCWs) during the lockdown and post lockdown periods at Apollo Institute of Medical Sciences and Research, Hyderabad, India. All participants involved in the study were evaluated by using depression, anxiety and stress scale 21, the impact of event scale revised scale for post-traumatic stress disorder (PTSD), and a standardized questionnaire. During the lockdown period, the score for depression was observed mean scores to be more in front desk people (2.70) followed by pharmacists and technicians (2.60) and security (2.28) in the lockdown period. During the lockdown, the highest levels of anxiety were seen in security staff (4.72) and housekeeping (4.8), with a considerable increase after the lockdown situation. During the lockdown period, the mean score of pharmacists and technicians (10.33) were more stressed than other HCWs, and the second-highest levels of stress were observed in security (10.11) and front desk workers (10.09), respectively. Our results show that there was a worsening of the psychological impact of the pandemic and an increase in PTSD, stress, anxiety, and depression among HCWs. Female gender, pharmacists, and technicians were the most vulnerable group to develop psychiatric comorbidities.

Preparedness, Identification and Care of COVID-19 Cases by Front Line Health Workers in Selected Health Facilities in Mbale District Uganda: A Cross-Sectional Study.

Introduction:The nature of work of Health care professionals exposes them to high risks of contracting COVID-19 and spreading it among themselves, to their patients and subsequently to the general community. Thus, it is essential that frontline health workers are equipped with both material and knowledge to enable them accurately suspect, detect, isolate, and manage COVID-19 cases. Findings have indicated a high prevalence of COVID-19 infections among front-line health workers. The Current Study assessed preparedness, identification, and care of COVID-19 Cases by frontline health workers in selected health facilities in Mbale District.Methodology:Across sectional survey was used to collect quantitative data using Google forms, An online platform for data collection. Data was collected from 189 frontline health workers in both government and private Health facilities in Mbale District between April and August 2020. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.Findings:The study found that a good proportion of frontline health workers can identify cases by symptom and case definitions as probable case 113/189(59.8%), suspected case 60/189(36%) and confirmed case 22/189 (11.6%). There were generally low levels of preparedness in terms of initial service care being offered with the highest being 53/189(28.2%) and 50/189(26.4%) for facilities that had places for isolation and those with intravenous fluids respectively and the least was being able to offer oxygen and Intensive Care Services at 43/189(22.0%) and 20/189(10.3%) respectively.Conclusion and recommendations:There's a need to ensure a continuous supply of PPEs and IPC materials to health facilities. CPD programs are essential in equipping Health workers with up-to-date information on COVID-19 Case Management. Facilities should be supported to setup isolation facilities at all levels, both permanent and temporary. Provision of Face masks to health workers should be prioritised and hand washing facilities should be installed at every serving point.

Detecting Symptom Errors in Neural Machine Translation of Patient Health Information on Depressive Disorders: Developing Interpretable Bayesian Machine Learning Classifiers.

Background: Due to its convenience, wide availability, low usage cost, neural machine translation (NMT) has increasing applications in diverse clinical settings and web-based self-diagnosis of diseases. Given the developing nature of NMT tools, this can pose safety risks to multicultural communities with limited bilingual skills, low education, and low health literacy. Research is needed to scrutinise the reliability, credibility, usability of automatically translated patient health information.Objective: We aimed to develop high-performing Bayesian machine learning classifiers to assist clinical professionals and healthcare workers in assessing the quality and usability of NMT on depressive disorders. The tool did not require any prior knowledge from frontline health and medical professionals of the target language used by patients.Methods: We used Relevance Vector Machine (RVM) to increase generalisability and clinical interpretability of classifiers. It is a typical sparse Bayesian classifier less prone to overfitting with small training datasets. We optimised RVM by leveraging automatic recursive feature elimination and expert feature refinement from the perspective of health linguistics. We evaluated the diagnostic utility of the Bayesian classifier under different probability cut-offs in terms of sensitivity, specificity, positive and negative likelihood ratios against clinical thresholds for diagnostic tests. Finally, we illustrated interpretation of RVM tool in clinic using Bayes' nomogram.Results: After automatic and expert-based feature optimisation, the best-performing RVM classifier (RVM_DUFS12) gained the highest AUC (0.8872) among 52 competing models with distinct optimised, normalised features sets. It also had statistically higher sensitivity and specificity compared to other models. We evaluated the diagnostic utility of the best-performing model using Bayes' nomogram: it had a positive likelihood ratio (LR+) of 4.62 (95% C.I.: 2.53, 8.43), and the associated posterior probability (odds) was 83% (5.0) (95% C.I.: 73%, 90%), meaning that approximately 10 in 12 English texts with positive test are likely to contain information that would cause clinically significant conceptual errors if translated by Google; it had a negative likelihood ratio (LR-) of 0.18 (95% C.I.: 0.10,0.35) and associated posterior probability (odds) was 16% (0.2) (95% C.I: 10%, 27%), meaning that about 10 in 12 English texts with negative test can be safely translated using Google.

Factors affecting dementia care practitioners' decision-making on moves to a care home for persons living with dementia: A factorial survey.

Deciding if and when might be the 'optimal' time for a person living with dementia to move to a care home is often difficult for the individual, family and practitioners. In this study, we describe the outcome of a factorial survey conducted with 100 dementia care practitioners (a frontline health or social care worker who works with people living with dementia) in England, which investigated factors used in deciding when a person living with dementia moves to a care home. Using findings from qualitative interviews with older people living with dementia, family carers, care home managers and social workers, we identified four factors that appeared to influence the decision to move to a care home: (1) Family carers' ability to support the person with daily activities, (2) amount of support provided by home care workers, (3) level of risk of harm and (4) the person living with dementia's wishes. These factors were then randomised within skeleton vignettes that told the story of a fictitious woman (Jane) living with dementia at home with her husband. Fifty-four variations of the vignettes were produced and randomly assigned to 100 surveys. A total of 100 volunteer dementia care practitioners (78% female, 54% over 50years of age) received their own personalised online survey link via email and were asked to read each vignette and decide whether to suggest Jane (a) move to a care home or (b) continue living at home. Results indicated that Jane's wishes principally drove most dementia care practitioners' decision on whether to suggest a move to a care home or stay living at home (odds ratio=6.5-19.5). Findings will inform a better understanding of the factors that contribute toward a decision to move to a care home and be of relevance to policy, practice, training and support.

Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays

Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. The authors have no conflicts of interest to declare.

Psychological distress, fear and coping among Malaysians during the COVID-19 pandemic.

The COVID-19 pandemic has enormously affected the psychological well-being, social and working life of millions of people across the world. This study aimed to investigate the psychological distress, fear and coping strategies as a result of the COVID-19 pandemic and its associated factors among Malaysian residents. Participants were invited to an online cross-sectional survey from Aug-Sep 2020. The study assessed psychological distress using the Kessler Psychological Distress Scale, level of fear using the Fear of COVID-19 Scale, and coping strategies using the Brief Resilient Coping Scale. Univariate and multivariate logistic regression analyses were conducted to adjust for potential confounders. The mean age (±SD) of the participants (N = 720) was 31.7 (±11.5) years, and most of them were females (67.1%). Half of the participants had an income source, while 216 (30%) identified themselves as frontline health or essential service workers. People whose financial situation was impacted due to COVID-19 (AOR 2.16, 95% CIs 1.54-3.03), people who drank alcohol in the last four weeks (3.43, 1.45-8.10), people who were a patient (2.02, 1.39-2.93), and had higher levels of fear of COVID-19 (2.55, 1.70-3.80) were more likely to have higher levels of psychological distress. Participants who self-isolated due to exposure to COVID-19 (3.12, 1.04-9.32) and who had moderate to very high levels of psychological distress (2.56, 1.71-3.83) had higher levels of fear. Participants who provided care to a family member/patient with a suspected case of COVID-19 were more likely to be moderately to highly resilient compared to those who did not. Vulnerable groups of individuals such as patients and those impacted financially during COVID-19 should be supported for their mental wellbeing. Behavioural interventions should be targeted to reduce the impact of alcohol drinking during such crisis period.

Leadership, professional quality of life and moral distress during COVID‐19: A mixed‐methods approach

AimTo understand the impact of professional stressors on nurses' and other health care providers' professional quality of life and moral distress as they cared for patients during the COVID‐19 pandemic.BackgroundHealth care providers caring for patients during the COVID‐19 pandemic are at increased risk of decreased professional quality of life and increased moral distress.MethodsA convergent mixed‐methods design and snowball sampling was used to collect survey data (n = 171) and semi‐structured interviews (n = 23) among health care providers working in the inpatient setting.ResultsPerceived lack of support from executive leadership, access to personal protective equipment and constantly changing guidelines led to decreased professional quality of life and increased moral distress among health care providers.ConclusionFindings from this study indicate that shared governance, disaster management training and enhanced communication may assist executive leadership to reduce the likelihood of decreased professional quality of life and increased moral distress in front line health care providers.Implications for Nursing ManagementFollowing the principles of shared governance may assist executive leadership to promote and acknowledge the significance of the role of health care providers at the bedside. Additionally, disaster management training and open communication are crucial to ensure that health care providers are adequately informed and supported at the bedside.

SP-0370 ESTRO RTTC guidance on COVID-19

Radiotherapy (RT) plays a key role in cancer management, and ideally, a course of RT should not be interrupted. Unforeseen interruptions to RT, leading to an increase in overall treatment time, can result in a higher risk of recurrences and poorer outcome. So with COVID-19 being classed as a pandemic in March 2020, it was important that RT services should be maintained and provided in a safe environment for both RTTs and patients. To this end, the European Society for Radiotherapy and Oncology, Radiation TherapisT Committee (ESTRO RTTC) published a guidance document and infographics at an early stage to aid RTTs in working safely as front line workers and keeping patients safe. Both these publications covered 4 domains: Patient care, RTT workflow, Remote working and RT practice and were translated into many European languages so that all RTTs in Europe would have access to them. Subsequently, a survey, initiated by ESTRO Radiation Oncology Safety and Quality Committee (ROSQC), was performed in May 2020 within the RTT community in Europe and America. The aim was to investigate the changes in RT practice in the 4 domains mentioned above, in the COVID-19 era and to recommend proactive measures to protect RT practice in future pandemics: 229 respondents from 27 countries completed the survey. The survey showed that within these 4 domains different countries had different approaches in dealing with COVID and RTTs were not always seen as front line workers despite their crucial role in the treatment of cancer patients. The survey also showed that in the early months lack of resources either personal protection, or financial issues dictated government guidelines. Most RTT departments followed government guidelines, but this was not always in line with acknowledging RTTs as front line workers. Systems and protocols needed to be put in place in a relatively short time to avoid spreading disease to staff and patients and the possible closure of a department because of no staff. The problems and issues encountered and lessons learnt during this pandemic will help us prepare for future pandemics . This presentation will focus on the RTT committee guidelines and the results of the survey and how we can use these in the future. RTTs are front line health care workers and should be recognized as such in all countries.