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      Burnout symptoms among physicians and nurses before, during and after COVID-19 care Translated title: Síntomas de Burnout entre médicos y enfermeros antes, durante y después de atender pacientes con COVID-19 Translated title: Sintomas de burnout entre médicos e enfermeiros antes, durante e depois do cuidado de pacientes com COVID-19

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          Abstract

          Objective:

          this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care.

          Method:

          a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used.

          Results:

          280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff.

          Conclusion:

          the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.

          Translated abstract

          Objetivo:

          este estudio evaluó síntomas de Burnout entre médicos y enfermeros antes, durante y después de la atención provista a pacientes con la enfermedad COVID-19.

          Método:

          estudio comparativo y transversal realizado en la unidad de Atención Respiratoria de un hospital público de nivel terciario. Se empleó el Inventario de Burnout Maslach.

          Resultados:

          se distribuyeron 280 encuestas entre los tres períodos: antes (n=80), durante (n=105) y después (n=95) de la atención a pacientes con COVID-19; se obtuvieron 172 encuestas respondidas. Las tasas de respuesta fueron 57,5%, 64,8% y 61,1%, respectivamente. Los valores de prevalencia de Burnout grave fueron 30,4%, 63,2% y 34,5% antes, durante y después de la atención a pacientes por la enfermedad del coronavirus 2019 (p<0,001). Los síntomas de agotamiento emocional (p<0,001) y despersonalización (p=0,002) fueron más prevalentes entre los enfermeros que entre los médicos. El Síndrome de Burnout grave fue más prevalente en las mujeres, los enfermeros y el personal del turno noche.

          Conclusión:

          la elevada prevalencia de Burnout se duplicó en el primer pico de internaciones y regresó a niveles previos a la pandemia un mes después de finalizada la atención a pacientes por la enfermedad del coronavirus 2019. El Síndrome de Burnout varió por sexo, turno de trabajo y ocupación, y los enfermeros representaron los grupos más vulnerables. Es necesario enfocarse en estrategias de evaluación y mitigación tempranas para asistir a los enfermeros, no solo durante la crisis sino permanentemente.

          Translated abstract

          Objetivo:

          este estudo avaliou os sintomas de burnout entre médicos e enfermeiros antes, durante e após o cuidado dos pacientes contaminados com o COVID-19.

          Método:

          estudo transversal comparativo realizado na unidade de Atenção Pulmonar de um hospital público de nível terciário. Foi utilizado o Inventário de Burnout de Maslach.

          Resultados:

          280 formulários de pesquisa foram distribuídos em três períodos: antes (n=80), durante (n=105) e após (n=95) os cuidados dos pacientes contaminados com COVID-19; 172 formulários foram respondidos. As taxas de resposta foram de 57,5%, 64,8% e 61,1%, respectivamente. A prevalência de burnout grave foi de 30,4%, 63,2% e 34,5% antes, durante e após o atendimento dos pacientes (p<0,001). Os sintomas de exaustão emocional (p<0,001) e despersonalização (p=0,002) foram mais prevalentes entre os enfermeiros do que entre os médicos. O burnout grave foi mais prevalente em mulheres, enfermeiros e funcionários do turno da noite.

          Conclusão:

          a alta prevalência de burnout dobrou no primeiro pico de internações hospitalares e voltou aos níveis pré-pandemia um mês após o término dos cuidados dos pacientes contaminados com COVID-19. O burnout variou de acordo com o sexo, turno e profissão, encontrando-se os enfermeiros entre os grupos mais vulneráveis. O foco na avaliação precoce e nas estratégias de mitigação é necessário para apoiar os enfermeiros não apenas durante a crise, mas de forma permanente.

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          Psychological stress of ICU nurses in the time of COVID-19

          As the coronavirus disease 2019 (COVID-19) pandemic accelerates, global health care systems have become overwhelmed [1], leading to great psychological pressure on nurses in the care of critically ill patients with COVID-19. Moreover, extreme incidents have occurred, such as suicide of nurses caring for critically ill patients, in Italy. In fact, the psychological problems are also common among nurses in Wuhan City, China. The Department of Critical Care Medicine, Wuhan Pulmonary Hospital, is the designated hospital for the treatment of severe patients with COVID-19. It has a total of 20 intensive care unit (ICU) beds and 102 nurses from the local hospital and other hospitals in the provinces and cities outside of Wuhan City. The critically ill patients receive mechanical ventilation. Most of them also need advanced life support, such as extracorporeal membrane oxygenation, continuous renal replacement therapy, and ventilation in the prone position. Front-line nurses experience huge workload, long-term fatigue, infection threat, and frustration with the death of patients whom they care. They also face anxiety or even misunderstanding among patients and their family members. In the early stage, nurses from other regions outside of Wuhan City did not communicate with each other and usually felt lonely. Additionally, they worried about their families and vice versa. All these factors have resulted in high psychological pressure among ICU nurses in Wuhan. We surveyed 85 ICU nurses in our ward and found that the main manifestations were decreased appetite or indigestion (59%), fatigue (55%), difficulty sleeping (45%), nervousness (28%), frequent crying (26%), and even suicidal thoughts (2%). Especially, young nurses with no experience of caring for critically ill patients face a greater psychological crisis. If these psychological problems are not solved effectively, they may not only lead to a decline in their immunity and increase the chances of COVID-19 infection but also have an adverse impact on the quality and safety of the medical care system [2–4]. Therefore, early measures were actively taken, and the following improvements were made (Table 1): Each medical team included a psychologist, and early psychological assessments and interventions were conducted. Nurses were guided to develop a reasonable understanding of the pandemic and avoid excessive panic and anxiety. They were recommended to seek professional help from the psychologist if they felt psychological stress that was difficult to relieve. Nurses were advised to get familiar with the working environment and working procedures as soon as possible. Working together with colleagues in a harmonious working environment can help relieve psychological stress. They were asked to express emotions by talking, drawing, singing, and exercising. Some easy-to-learn methods, such as taking a deep breath, were encouraged to be used to relieve tension and anxiety. Relaxation exercise was recommended during work shifts under the guidance of mental health professionals. They were advised to communicate with colleagues who had the same experience or similar feelings and then understand and heal each other. They were asked not to force herself or himself to forget unpleasant experiences. It was normal for them to not forget such experiences; they might even remember it for a lifetime. Nurses were divided into 11 groups, and each group had a team leader to establish a WeChat online communication platform, enhance teamwork atmosphere and cohesion, and spread positive information, such as epidemic control and patient rehabilitation. Nurses were encouraged as more patients were effectively treated and the mortality rate declined. Regular meetings were organized to find the sources of nurses’ psychological problems and targeted solutions. Most nurses from other provinces had no work experience in infectious diseases and were worried about getting infected at work. Education and training were strengthened accordingly, including the use of personal protective equipment, hand hygiene, ward disinfection, medical waste management, and occupational exposure management. If unsuccessful cure and poor prognosis of critically ill patients caused depression among nursing staffs, professional knowledge training was strengthened to deepen the understanding of the disease. More knowledge of the expert consensus for COVID-19 diagnosis and treatment was provided, and successful therapy cases were shared. If a nurse’s professional skills were not sufficient to take care of critically ill patients, he/she was allocated appropriate patients according to his/her actual nursing ability and provided special training as per the requirements. If it was a psychological problem caused by a physical overdraft at work, the shift working system was adjusted to ensure that nurses took rest as much as possible, such as shift rotation reduced from 6 to 4 h. A professional consultation team was set up, mainly including mental health professionals. Regular remote mental health training and guidance, individualized psychotherapy, or appropriate medical intervention was provided to nurses through lectures, group counseling, individual counseling, online platforms, and psychological hotlines. The social support system was improved. The original working unit established a care and support group to strengthen humanitarian care. Their leaders, colleagues, and volunteers regularly visited the family members of the nursing staffs to find and resolve their worries in a timely manner. Regular chat and exchange with family and former colleagues were organized through WeChat videos. Table 1 Psychological stress of ICU nurses in the time of COVID-19 Problems Solutions 1 Anxiety regarding unfamiliar working environment and processes. Establish a communication mechanism with local medical staff to get familiar with the working environment and working procedures as soon as possible. 2 Lack of work experience in infectious diseases. Allocate appropriate patients according to the actual nursing ability and provide necessary special training. 3 Worry about getting infected. Enhance education and training, including personal protective, hand hygiene, ward disinfection, medical waste management, and occupational exposure management. 4 Huge workload and long-term fatigue. Adjust work shift to ensure nurses to have plenty of rest. 5 Depression due to unsuccessful cure of critically ill patients. 1) Equip each medical team with a psychologist for early psychological assessments and interventions. 2) Strengthen professional training to deepen the understanding of the disease. 3) Share successful therapy cases. 4) Actively express emotions to relieve tension and anxiety. 5) Perform relaxation exercise under the guidance of the mental health professionals. 6 Worry about their families, and vice versa. 1) Communicate with colleagues who have the same experience or similar feelings. 2) Regularly chat and exchange with family through WeChat videos. 3) Establish a social care and support group to find and resolve worries accordingly. 4) Set up a professional team to provide remote mental health training and guidance, individualized psychotherapy, or appropriate medical intervention to nurses in multiple ways. In summary, through the early assessment and active resolution of psychological stress, nurses experienced no adverse events during the fight against COVID-19. Of course, the long-term psychological changes in nurses needed a regular follow-up. Hence, it is recommended to address the psychological problems of ICU nurses who care for patients with COVID-19 and take action as soon as possible to relieve the psychological pressure on these nurses. Our experience may serve as a valuable reference while designing psychological health interventions for nurses in future large-scale public health emergencies.
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            Stress, Burnout, and Coping Strategies of Frontline Nurses During the COVID-19 Epidemic in Wuhan and Shanghai, China

            Background: Nurses at the frontline of caring for COVID-19 patients might experience mental health challenges and supportive coping strategies are needed to reduce their stress and burnout. The aim of this study was to identify stressors and burnout among frontline nurses caring for COVID-19 patients in Wuhan and Shanghai and to explore perceived effective morale support strategies. Method: A cross-sectional survey was conducted in March 2020 among 110 nurses from Zhongshan Hospital, Shanghai, who were deployed at COVID-19 units in Wuhan and Shanghai. A COVID-19 questionnaire was adapted from the previous developed “psychological impacts of SARS” questionnaire and included stressors (31 items), coping strategies (17 items), and effective support measures (16 items). Burnout was measured with the Maslach Burnout Inventory. Results: Totally, 107 (97%) nurses responded. Participants mean age was 30.28 years and 90.7% were females. Homesickness was most frequently reported as a stressor (96.3%). Seven of the 17 items related to coping strategies were undertaken by all participants. Burnout was observed in the emotional exhaustion and depersonalization subscales, with 78.5 and 92.5% of participants presenting mild levels of burnout, respectively. However, 52 (48.6%) participants experienced a severe lack of personal accomplishment. Participants with longer working hours in COVID-19 quarantine units presented higher emotional exhaustion (OR = 2.72, 95% CI 0.02–5.42; p = 0.049) and depersonalization (OR = 1.14, 95% CI 0.10–2.19; p = 0.033). Participants with younger age experienced higher emotional exhaustion (OR = 2.96, 95% CI 0.11–5.82; p = 0.042) and less personal accomplishment (OR = 3.80, 95% CI 0.47–7.13; p = 0.033). Conclusions: Nurses in this study experienced considerable stress and the most frequently reported stressors were related to families. Nurses who were younger and those working longer shift-time tended to present higher burnout levels. Psychological support strategies need to be organized and implemented to improve mental health among nurses during the COVID-19 pandemic.
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              Mental Health Outcomes in Healthcare Workers in COVID-19 and Non-COVID-19 Care Units: A Cross-Sectional Survey in Belgium

              Background The literature shows the negative psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on frontline healthcare workers. However, few are known about the mental health of physicians and nurses working in general hospitals during the outbreak, caring for patients with COVID-19 or not. Objectives This survey assessed differences in mental health in physicians and nurses working in COVID-19 or non-COVID-19 medical care units. Design A cross-sectional mixed-mode survey was used to assess burnout, insomnia, depression, anxiety, and stress. Setting A total of 1,244 physicians and nurses from five general hospitals in Belgium, working in COVID-19 care units (CCU), non-COVID-19 care units (NCCU), or both (CCU + NCCU) were informed of the study. Participants Six hundred forty-seven healthcare workers participated in the survey (response rate = 52%). Measurements Validated instruments were used to assess the outcomes: the PFI (burnout/professional fulfillment), the ISI (insomnia), and the DASS-21 (depression, anxiety, and stress). Results Results showed high prevalence of burnout, insomnia, depression, and anxiety among participants. After adjusting for confounders, multivariate analysis of variance showed no differences between CCU, NCCU, and CCU + NCCU workers. Univariate general linear models showed higher level of burnout, insomnia, and anxiety among nurses in comparison to physicians. Being a nurse, young, isolated, with an increased workload were risk factors for worse mental health outcomes. Limitations The mental health of the tested sample, before the outbreak, is unknown. Moreover, this cross-sectional design provides no information on the evolution of the mental health outcomes over time. Conclusion Directly caring for patients with COVID-19 is not associated with worse mental health outcomes among healthcare workers in general hospitals. High prevalence of burnout, insomnia, depression, and anxiety among physicians and nurses requires special attention, and specific interventions need to be implemented. Protocol Registration ClinicalTrials.gov, identifier NCT04344145.
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                Author and article information

                Contributors
                Role: Concepción y dibujo de la pesquisaRole: Obtención de datosRole: Análisis e interpretación de los datosRole: Análisis e interpretación de los datosRole: Análisis estadísticoRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Concepción y dibujo de la pesquisaRole: Obtención de datosRole: Análisis e interpretación de los datosRole: Análisis estadísticoRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Concepción y dibujo de la pesquisaRole: Obtención de datosRole: Análisis e interpretación de los datosRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Obtención de datosRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importanteRole: Otros (Supervisión)
                Role: Análisis e interpretación de los datosRole: Análisis estadísticoRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Obtención de datosRole: Análisis e interpretación de los datosRole: Análisis estadísticoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Journal
                Rev Lat Am Enfermagem
                Rev Lat Am Enfermagem
                rlae
                Revista Latino-Americana de Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
                0104-1169
                1518-8345
                03 November 2023
                Jan-Dec 2023
                : 31
                : e4046
                Affiliations
                [ 1 ]Hospital General de México, Servicio de Neumología, Ciudad de México, México.
                [2 ]Becario del Sistema Nacional de Investigadores, CONACYT, México.
                Author notes
                [Autor de correspondencia: ] Pablo Álvarez-Maldonado E-mail: pamyacs@ 123456yahoo.com https://orcid.org/0000-0001-6809-1082

                Conflicto de intereses: los autores han declarado que no existe ningún conflicto de intereses.

                Editor Asociado: Juan Manuel Carmona-Torres

                Author information
                http://orcid.org/0009-0007-0677-9325
                http://orcid.org/0000-0001-6809-1082
                http://orcid.org/0000-0002-0199-1163
                http://orcid.org/0009-0007-0749-0443
                http://orcid.org/0000-0003-4318-181X
                http://orcid.org/0000-0002-9314-3515
                Article
                00365
                10.1590/1518-8345.6820.4046
                10631294
                37937599
                0c45e213-c091-4de1-8049-78a4970fec6c
                Esta licencia permite a otros distribuir, mezclar, ajustar y construir a partir de su obra, incluso con fines comerciales, siempre que le sea reconocida la autoría de la creación original. Esta es la licencia más servicial de las ofrecidas. Recomendada para una máxima difusión y utilización de los materiales sujetos a la licencia.

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                History
                : 25 April 2023
                : 13 August 2023
                Page count
                Figures: 6, Tables: 6, References: 28
                Categories
                Artículo Original

                burnout,covid-19,physicians,nurses,pandemics,sars-cov-2,médicos,enfermeras,pandemias,covid 19,enfermeiros

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