Frontline Healthcare Workers Research Articles

Addressing Mental Health Symptoms Among COVID-19 Healthcare Workers: A Heart Rate Variability Biofeedback Pilot Study.

Psychological stress among frontline healthcare workers (HCWs) increased during the COVID-19 pandemic, elevating mental health risks. Heart rate variability biofeedback (HRV-BF) is an evidence-based intervention with potential to reduce psychological burden on frontline HCWs; however, no studies have examined its use among this population since the pandemic began. We designed a trial to assess the effects of a brief HRV-BF intervention delivered via telemedicine on measures of anxiety, depression and stress, and heart rate variability, compared to an in-person intervention. We hypothesised that the telemedicine intervention would be non-inferior to the in-person intervention. Using a randomized comparison trial design, we tested a 10-day brief heart rate variability biofeedback intervention among frontline HCWs during the COVID-19 pandemic. They received remote, 30-min guided sessions every other day and were taught methods of heart rate variability biofeedback. Depression, anxiety and stress were assessed at baseline, 10days, and 40days with additional measures of anxiety measured before and after each session. HRV scores were collected at baseline, as well as during the course of the 10days. Multilevel modelling was used to examine the change in depression, anxiety, stress and HRV scores across multiple time points and session types (telemedicine vs. in-person). There was no significant differences between telemedicine (n=32) and in-person (n=15) interventions on the main outcomes. Both session types showed a significant decrease in depression, anxiety and stress scores across the entire intervention, and HRV scores significantly increased across both groups. Anxiety levels also significantly decreased after each session. The non-inferiority of the telemedicine intervention to a comparable in-person intervention affirms its promise for decreasing anxiety, depression and stress among frontline HCWs and may offer a cost-effective and feasible tool to use in crises situations.

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.

COVID-19 Vaccine-induced antibody response to BNT162b2 mRNA in frontline healthcare workers

The emergence of SARS-CoV-2, the virus causing COVID-19, has resulted in a pandemic that has disrupted all sectors of society. Less than a year after the sequencing of the virus’s genome, emergency use authorization for the BNT162b2 vaccine was requested. The aim of this study was to evaluate the response to the BNT162b2-mRNA COVID-19 vaccine in frontline workers from two hospitals in Colombia. Nasopharyngeal swabs were collected for the molecular detection of SARS-CoV-2 using real-time PCR, and blood samples were taken to assess seroconversion using qualitative and quantitative IgA, IgG, and IgM test kits. The study was conducted at a high-complexity healthcare institution in Bucaramanga, Colombia. 245 people were included in the first round and 129 in the second. SARS-CoV-2 molecular tests were conducted by RT-qPCR, and peripheral blood samples were collected to measure IgG, IgM, and IgA. The main outcome was to establish natural infection and the antibody response induced by the vaccine. The entire population was tested at two fixed times with RT-PCR tests and antibody level measurements approximately 4 and 8 months after receiving the second vaccine dose. 62 (25.3%) and 35 (14.3%) participants had a history of positive PCR in the first and second rounds, respectively. All positive cases showed elevated levels of all immunoglobulins, especially IgG. The average concentrations of IgA, IgM, and IgG at 90 days were 1149.5 U/mL (95% CI 828.2-1470.9); 320.3 U/mL (95% CI 218.4-422.3); and 9277.3 U/mL (95% CI 8989.2-9565.3). Frontline healthcare workers showed an adequate response to the BNT162b2 mRNA vaccine.

Awareness and preparedness of healthcare workers for the initial wave of COVID-19 in Aotearoa New Zealand.

The TMGH-Global COVID-19 Collaborative was a multinational, multicentre, cross-sectional survey assessing the awareness and preparedness of healthcare workers (HCWs) during the first wave of the pandemic across 57 countries. Here, we report the results from Aotearoa New Zealand. This cross-sectional survey was conducted at Christchurch Hospital between February and May 2020. Data were collected from a convenience sample of HCWs and analysed using descriptive and multivariate regression to determine awareness (out of 40) and preparedness (out of 15) scores and influencing factors. Of the 158 participants (response rate 20.8%), most were women (73%) and doctors (58%) with a median age of 38 years (interquartile range [IQR] 29-49). The median awareness and preparedness scores were 33.6 (IQR 31.1-35.1) and 8 (IQR 6-8), respectively. Mainstream media was the primary source of information on COVID-19 among HCWs. The awareness score was significantly affected by gender and profession, whereas the preparedness score was influenced by age, profession, clinical experience duration and COVID-19 training. Although frontline HCWs had high awareness levels, preparedness was low. Variables influenced awareness and preparedness differently. These findings identified gaps in pandemic readiness and factors that can be leveraged to enhance future pandemic preparedness and response in New Zealand.

Knowledge, attitude, and practices toward oral health among frontline healthcare workers in India

Knowledge, attitude, and practices toward oral health among frontline healthcare workers in India

Dealing with Mental Health Problems and Work Performance Among Frontline Healthcare Workers Through the Influence of Digital Platform in Malaysian Private Hospitals: A conceptual analysis

The purpose of this study to examine mental health problems of frontline healthcare workers and their impact on work performance through exploring the influence of digital platforms in Malaysian private hospitals. This research is essential in addressing previous knowledge and theoretical gaps on the antecedents that denote to mental health problems and how digital platforms are used to improve mental health wellbeing. Basically, this study discusses the impact of four independent variables which are categorized as depression, anxiety, insomnia and distress factors whereas dependent variable is work performance. This study also will discuss problems concerning work performance of frontline healthcare workers (doctors, nurses, medical assistance, pharmacists and HR Management), specifically on poor service quality, turnover intention, work-related burnout, and exhaustion in Malaysian private hospitals. Hence, this study explores new solutions on the employees’ work performance related issues to create awareness for the Malaysian private hospitals in improving mental health issues among front-line healthcare workers to enhance their work performance through the influence of digital platforms. Private hospitals in Malaysia are experiencing critical situations related to poor employees’ performance which indirectly influence the overall productivity. Thus, private hospitals need to provide serious attention towards these related issues. A conceptual framework was formulated based on identified research gaps through the literature review. It is expected that this study will enhance the awareness for the management in Malaysian private hospitals on dealing with mental health problems which impacts work performance by exploring digital platforms as a solution.

Exploring willingness to use adverse drug reaction reporting systems: a multicentre qualitative study in China based on the technology acceptance model and task-technology fit integration approach

BackgroundAdverse drug reaction (ADR) reporting systems are critical for monitoring and managing drug safety. However, various factors influence the willingness to use these systems. This study aimed to investigate the...

Job Satisfaction and Psychosocial Well-Being of COVID-19 Frontline Health Workers in Uganda

The COVID-19 pandemic exposed frontline healthcare workers (HCWs) to mental health problems and various challenges that impacted their job satisfaction. We explored the job satisfaction and psychosocial/mental well-being of COVID-19 frontline HCWs in Uganda. This was a mixed-methods study conducted at Mulago National Referral Hospital (MNRH), Entebbe Regional Referral Hospital (ERRH), and Uganda Virus Research Institute (UVRI). A pre-tested self-administered questionnaire and Four Focus Group Discussions (FGDs) were used for data collection. A five-point Likert scale was used for the quantitative data to measure mental well-being and job satisfaction. Bloom’s cut-off was used to categorize participants’ job satisfaction and mental well-being into good (≥80%), moderate (60% - <80%), and poor (<60%). FGDs were audio-recorded, transcribed, and analyzed thematically using NVivo version 12 software. 218 participants participated in the quantitative survey and 24 of them further participated in the FGDs. 51.4% ( n = 112) were males, aged 18 to 39 years (77.5%, n = 169) and 50.9% ( n = 111) were at MNRH. Overall, 54%, 28%, and 18% of the participants reported moderate, good, and poor job satisfaction respectively. Satisfaction with salary (2.6 ± 1.2) and compensation (risk) allowances (2.4 ± 1.3) was particularly low. Furthermore, 35%, 33%, and 32% of the participants reported moderate, good, and poor mental well-being respectively. Anxiety, burnout, stigma, and discrimination contributed to poor psychosocial/mental well-being. Less than half of the frontline HCWs reported good job satisfaction and psychosocial/mental well-being. There is a need for prioritization of the psychosocial well-being of frontline HCWs, in addition to improvement of remuneration systems.

The psychological impact of COVID-19 pandemic on Iraqi health workers.

To explore the psychological impact of coronavirus disease-2019 on frontline healthcare workers in Iraq. The cross-sectional study was conducted from November 2020 to September 2021 after approval from the ethics review committee of the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised doctors and nurses from 4 teaching hospitals and 8 primary healthcare centres in Baghdad. Psychological sequels, like anxiety, depression, fear and insomnia, were assessed along with exposure to coronavirus disease-2019. The study questionnaire was based on the Patient Health Questionnaire Anxiety and Depression Scale. Data was analysed using SPSS 26. Of the 400 participants, 288(72%) were doctors and 112(28%) were nurses. Overall, 215(53.7%) subjects had had a coronavirus disease-2019 infection, 192(48%) reported having anxiety, 148(37%) fear, 100(25%) depressive symptoms, and 51(12.8%) complained of insomnia. Doctors were more likely to have anxiety than nurses (p<0.05), but the difference in terms of depression was not significant (p>0.05). The mental health of the frontline healthcare workers was found to have been affected by the coronavirus disease-2019 pandemic, with anxiety and fear being the main symptoms.

Views of emergency care providers in providing healthcare for asylum seekers and refugees

BackgroundThe number of asylum seekers awaiting decisions on their claims in the UK has more than tripled since 2014. How we meet international obligations to provide appropriate healthcare to asylum...

Prevalence of Anxiety and Depression in COVID-19 Patients and Frontline Healthcare Workers

Prevalence of Anxiety and Depression in COVID-19 Patients and Frontline Healthcare Workers

A guided single session intervention to reduce intrusive memories of work-related trauma: a randomised controlled trial with healthcare workers in the COVID-19 pandemic

Abstract Background Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic. Methods Participants with at least two intrusive memories of work-related trauma in the week before recruitment were randomised 1:1 to an imagery-competing task intervention (n = 73) or attention-based control task (n = 71). The number of intrusive memories was assessed at baseline and 5 weeks after the guided session (primary endpoint). Results The intervention significantly reduced intrusive memory frequency compared with control [intervention Mdn = 1.0 (IQR = 0–3), control Mdn = 5.0 (IQR = 1–17); p &lt; 0.0001, IRR = 0.30; 95% CI = 0.17–0.53] and led to fewer post-traumatic stress-related symptoms at 1, 3 and 6 month follow-ups (secondary endpoints). Participants and statisticians were blinded to allocation. Adverse events data were acquired throughout the trial, demonstrating safety. There was high adherence and low attrition. Conclusions This brief, single-symptom, repeatable digital intervention for subclinical-to-clinical samples after trauma allows scalability, taking a preventing-to-treating approach after trauma. Trial registration 2020–07-06, ClinicalTrials.gov identifier: NCT04460014.

A comparison of the mental health impacts and resilience of healthcare workers in rural Manitoba during the COVID-19 pandemic

Drawing on resilience research in rural studies, this study examined the mental health experiences of frontline healthcare workers during two stages of the COVID-19 pandemic in rural Manitoba, Canada. Data were collected using online surveys from May to June 2020 (n = 137) and from May to June 2021 (n = 219). The surveys assessed symptoms of anxiety and identified strategies and barriers to addressing mental health concerns. Most respondents exhibited clinical symptoms of anxiety as measured by the GAD-7 scale. Respondents mostly accessed informal supports, such as family and friends, in the first survey in 2020, and a broader mix of informal and formal supports in the 2021 survey. In both surveys, numerous barriers to accessing formal mental health support were identified. Our findings suggest that although some degree of resilience in the face of the pandemic was prevalent in rural areas, there is a need for accessible professional and peer mental health support for frontline healthcare workers. The research also highlights the importance of context and resources in sustaining the healthcare workforce in rural areas as part of the pandemic response.

Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies.

Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. The median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user.

Perceptions of lived in experiences of healthcare workers during COVID-19 Pandemic in a tertiary Care hospital: A perspective from Pakistan.

This study aimed to explore the perceptions of frontline Healthcare Workers (HCWs) towards managing COVID-19 in Tertiary care hospital in Pakistan. This qualitative exploratory study was conducted from January to May 2021 at a Tertiary care hospital designated for COVID-19 patients in Rawalpindi Pakistan. Semi-structured in-depth interviews were conducted from twenty six HCWs. To acquire a sample that was diverse in terms of professional capacity, degree of experience and exposure, purposive sampling technique was used. After thematic analysis, themes were generated by identifying patterns among codes. Five themes emerged. All HCWs experienced significant amount of negative emotions including fear, uncertainty, imposing social distancing and workload. There were also positive experiences such as rewarding, call of duty and professional growth. HCWs experiences related to personal protective equipment (PPE) were communication issues, physical and dermatological issues, reuse and working confidently while wearing PPE. HCWs were buoyed by cooperation and facilitation, trainings and health education from administration. Coping mechanisms were used such as seeking team support, adjusting cognition to deal with reality and resorting to religion. Negative emotions predominated in the beginning and positive emotions emerged gradually. PPE and administrative support played significant role. HCWs' mental health was maintained in part by their self-coping styles. The findings of this study can be employed to inform and enhance future pandemic response initiatives.

Financial incentives and work commitment among Ghanaian COVID-19 frontline healthcare workers

The influence of financial incentives on work commitment is widely studied, yet the effects of financial incentives on healthcare workers ‘commitment in a pandemic situation remains underexplored. Drawing on Ghana government’s financial incentives policy as part of its COVID-19 response, we examined the relationship between Financial Incentives (GFI) and work commitment [Adherence to Work Ethics (ATWE), Task Involvement (TI) and Organisational Citizenship Behaviours (OCB)] among COVID-19 Frontline Healthcare Workers (FHWs), and the mediating effect of Job Satisfaction (JS). Of the 187 COVID-19 FHWs in two sampled hospitals in the Ashanti region, purposive and stratified sampling techniques were used to select 126 respondents from whom data were gathered using structured questionnaires. SPSS and Smart PLS Structural Equation Modelling (SEM) were used to analyse the data. Baron and Kenny's (1986) causal-effect model of mediation analysis was used to determine the mediating role of Job Satisfaction (JS). GFI predicted ATWE positively but insignificantly. However, GFI had a significant positive effect on TI, OCB and JS. JS had no significant mediating effect on the relationship between GFI and ATWE. However, JS partially mediated the relationship between GFI, TI, and OCB. These findings offer critical insights for effectively managing the healthcare workforce during pandemics.

Reliability and Safety Testing of a Ventilator Remote Control System Against Communication Failures and Network Disruptions.

The need for remote ventilator control has been highlighted by the COVID-19 Public Health Emergency. Remote ventilator control from outside a patient's room can improve response time to patient needs, protect health care workers, and reduce personal protective equipment (PPE) consumption. Extending remote control to distant locations can expand the capabilities of frontline health care workers by delivering specialized clinical expertise to the point of care, which is much needed in diverse health care settings, such as tele-critical care and military medicine. However, the safety and effectiveness of remote ventilator control can be affected by many risk factors, including communication failures and network disruptions. Consensus safety requirements and test methods are needed to assess the resilience and safety of remote ventilator control under communication failures and network disruptions. We designed two test methods to assess the robustness, usability, and safety of a remote ventilator control prototype system jointly developed by Nihon Kohden OrangeMed, Inc. and DocBox, Inc. ("the NK-DocBox system") to control the operation of an NKV-550 critical care ventilator under communication failures and network disruptions. First, the robustness of the NKV-550 ventilator was tested using a remote-control application developed on OpenICE - an open-source medical device interoperability platform - to transmit customized high-frequency and erroneous remote-control commands that could be caused by communication failures in a real-world environment. The second method utilized a network emulator to create different types and severity of network quality of service (QoS) degradation, including bandwidth throttling, network delay and jitter, packet drop and reordering, and bit errors, in the NKV-DocBox system to quantitatively assess the impact on system usability and safety. The NKV-550 ventilator operated as expected when remote-control commands arrived as fast as once per second. It ignored erroneous commands attempting to adjust invalid ventilation parameters. When facing commands that set the ventilation mode and parameters to invalid values, it reset the ventilation mode or parameters to default values, the safety implication of which may merit further evaluation. When any network QoS attribute (except for packet reordering) started to degrade, the NK-DocBox System experienced interference to its remote-control function, such as delays in the transmission of ventilator data and remote-control commands within the system. When the network QoS was worse than 500 ms network delay, 100 ms network jitter, 1% data drop rate, 12Mbps minimal bandwidth, or 1e-6 bit error rate, the system became unsafe to use. For example, ventilator waveforms visualized on the remote-control application demonstrated freezes, out-of-synchronization, and moving backwards; and the connection between the ventilator and the remote-control application became unstable. The presented test methods confirmed the robustness of the NKV-550 ventilator against high-frequency and erroneous remote control, quantified the impact of network disruptions on the usability, reliability, and safety of the NK-DocBox system and identified the minimum network QoS requirements for it to function safely. These generalizable test methods can be customized to evaluate other remote ventilator control technologies and remote control of other types of medical devices against communication failures and network disruptions.

Supporting care providers through a holistic telehealth intervention: a mixed methods evaluation of the Integrative Touch TeleWellness program

ABSTRACT To address the needs of frontline healthcare workers and family-based caregivers during the coronavirus pandemic, Integrative Touch developed a holistic TeleWellness Program consisting of a variety of mind-body techniques over 10 weekly sessions. This mixed methods study evaluates the feasibility, outcomes, and client experience of the TeleWellness Program during the first 2 years of the pandemic. The study found preliminary evidence of positive changes during the intervention and meta-inferences regarding care providers becoming better able to provide care by addressing their own well-being first. These findings have meaningful implications for future research on accessible, holistic interventions to support care providers.

Safety first, but how? Examining the impact of safety leadership in frontline healthcare workers' safety performance during health crisis

AbstractWith the high rates of health workers' mortality and morbidity during health crises such as the COVID‐19 pandemic, this study examined how safety leadership style could improve health workers safety performance with a mediating role of safety consciousness (SCC), and a moderating role of communication transparency (CT). Survey data from 582 health workers in Ghana's Greater Accra and Ashanti regions were gathered and analysed using structural equation modelling in SMART PLS 4. The findings show that safety leadership positively impacts safety performance. Additionally, safety leadership had a positive impact on affected consciousness. Again, SCC had a positive effect on performance. Furthermore, SCC mediated the positive relationship between safety leadership and safety performance. Finally, the SCC‐safety compliance was negatively moderated by CT, though it did not moderate the SCC‐safety participation relationship. This paper holds significance as it offers strategies to enhance the safety performance of frontline healthcare workers during health emergencies such as pandemics. The measures provided in the study potentially mitigate the risks of virus contraction and health workers during health emergencies.

Healthcare workers' experiences protecting themselves and their families during the COVID-19 pandemic in 2020-2021.

We characterized experiences and strategies used by frontline healthcare workers to prevent severe-acute-respiratory-syndrome-related coronavirus transmission at work and to household members during the coronavirus disease pandemic. Alongside an online questionnaire (n = 234), remote semi-structured interviews (n = 23: 15 clinicians, 8 non-clinicians) were conducted in 2021. Mitigation challenges and facilitators were identified from data to represent experiences as a process considering the before, during, and after work shifts. Journey mapping was utilized to visually describe how healthcare workers experienced the stages of the work environment, leaving work, commuting home, and the home environment, and strategies implemented to stay safe. Major facilitators included the uptake of coronavirus disease vaccines and testing, information regarding virus transmission, and adequate personal protective equipment. The most critical challenges identified included a lack of designated areas for end-of-day disinfection, changing rooms, showers, and lockers in the leaving work stage. Psychosocial and environmental factors must be considered in future hospital pandemic preparations.