Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms

The experience of working on the frontlines of the COVID-19 healthcare crisis has presented a cumulative traumatic experience that affects healthcare professionals’ well-being. Psychological resources such as resilience and adaptive defense mechanisms are essential in protecting individuals from severe stress and burnout. During September 2020, 233 healthcare workers responded to an online survey to test the impact of demographic variables, COVID-19 exposure, and psychological resources in determining stress and burnout during the COVID-19 emergency. Frontline workers reported higher scores for stress, emotional exhaustion, and depersonalization (p < 0.001) as compared to colleagues working in units not directly serving patients with COVID-19. Mature defensive functioning was associated with resilience and personal accomplishment (r = 0.320; p < 0.001), while neurotic and immature defenses were related to perceived stress and burnout. Stress and burnout were predicted by lower age, female gender, greater exposure to COVID-19, lower resilience, and immature defensive functioning among healthcare professionals (R2 = 463; p < 0.001). Working on the frontlines of the COVID-19 pandemic appears to provoke greater stress and burnout. On the other hand, resilience and adaptive defense mechanisms predicted better adjustment. Future reaction plans should promote effective programs offering support for healthcare workers who provide direct care to patients with COVID-19.

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Knowledge, Attitude and Practice of Personal Safety Measures Adopted by Medical Practioners during the Covid-19 Pandemic

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/190 ◽

2021 ◽

Vol 10 (12) ◽

pp. 883-887

Author(s):

Hemapriya L ◽

Maureen Prativa Tigga ◽

Anil Kumar M.R ◽

Prathap T ◽

Neha Wali ◽

...

Keyword(s):

Personal Protective Equipment ◽

Urban Areas ◽

Healthcare Workers ◽

Online Survey ◽

Healthcare Professionals ◽

Well Being ◽

World Health ◽

Protective Equipment ◽

Personal Safety ◽

Safety Measures

BACKGROUND A novel coronavirus (now termed as SARS-CoV-2) was detected as the causative agent of severe pneumonia in Wuhan, Hubei Province, China, in December 2019. Declared by the World Health Organization (WHO) as a global pandemic in March 2020, it has created profound changes in global economy and healthcare systems. This study evaluates the knowledge and practice with regard to various personal safety measures used by the healthcare professionals. METHODS We conducted a questionnaire study after obtaining approval, from the Institutional ethical committee. An online survey was conducted using a preformatted questionnaire consisting of multiple-choice questions which assessed the knowledge and practices adopted by various healthcare professionals. The survey was done between 1st and 30th of June 2020 and a total of 536 responses was analysed. RESULTS 58.4 % of the participants were females, 66 % of the healthcare workers worked at a private hospital / private medical college with 82.1 % being located in urban areas. Of the 536 respondents, 90.1 % practiced bathing immediately after returning home and 86.8 % sanitized their accessories. 86.9 % of the professionals used frequent sanitization with use of mask and gloves whereas only 12.3 % used full personal protective equipment. 58 % of females had used hydroxychloroquine as prophylaxis whereas only 41 % of males used it (statistically significant, P = 0.005). Healthcare workers in younger age group (23 - 40 years) were more likely to maintain distance with family members, and government doctors were significantly more likely to do so (P < 0.001) as compared to private practitioners. CONCLUSIONS With the medical professionals being at high risk for contracting the infection, the need to provide the healthcare professionals with adequate personal protective equipment is of utmost importance. There is also a need to maintain the well-being of the healthcare professionals as they are the weakest link in the chain. KEY WORDS Medical Practitioners, Personal Protective Equipment, Safety Measures

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The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.119 ◽

2020 ◽

pp. 1-6

Author(s):

N. Al Mahyijari ◽

A. Badahdah ◽

F. Khamis

Keyword(s):

Perceived Stress ◽

Healthcare Workers ◽

Online Survey ◽

Healthcare Professionals ◽

Arab World ◽

Close Contact ◽

Well Being ◽

Sultanate Of Oman ◽

Stress Scale ◽

Harmful Effects

Objectives: The COVID-19 (SARS-CoV2) pandemic is wreaking havoc on healthcare systems and causing serious economic, social, and psychological anguish around the globe. Healthcare workers (HCWs) who diagnose and care for COVID-19 patients have been shown to suffer burnout, stress, and anxiety. Methods: In this study, we collected data from 150 frontline HCWs who had close contact with COVID-19 patients at several health facilities in the Sultanate of Oman. The participants completed an online survey that included the Perceived Stress Scale, the Generalized Anxiety Disorder Scale, and the WHO-5 Well-Being Index. Results: The study found that a substantial number of healthcare professionals experienced relatively high levels of stress and anxiety, as well as suboptimal levels of well-being. Perceived stress and anxiety were significant predictors of HCWs’ well-being. Conclusions: This study adds to the increasing literature indicating harmful effects of COVID-19 on the mental health of HCWs.

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Impact of enhanced personal protective equipment on the physical and mental well-being of healthcare workers during COVID-19

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139150 ◽

2020 ◽

pp. postgradmedj-2020-139150 ◽

Cited By ~ 1

Author(s):

Ramanathan Swaminathan ◽

Bimantha Perera Mukundadura ◽

Shashi Prasad

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Healthcare Professionals ◽

Negative Impact ◽

Well Being ◽

Cross Sectional Study ◽

Protective Equipment ◽

Cross Sectional ◽

The Impact ◽

Mental Well Being

BackgroundThe COVID-19 pandemic has necessitated the use of enhanced personal protective equipment (PPE) in healthcare workers in patient-facing roles. We describe the impact on the physical and mental well-being of healthcare professionals who use enhanced PPE consistently.MethodsWe conducted a single-centre, cross-sectional study among healthcare professionals who use enhanced PPE. A web-based questionnaire was disseminated to evaluate the effects on individuals’ physical and mental well-being. Physical and mental impact was assessed through a visual analogue scale.ResultsProspective analysis of the views of 72 respondents is reported. 63.9% were women and 36.1% were men. Physical impact included exhaustion, headache, skin changes, breathlessness and a negative impact on vision. Communication difficulties, somnolence, negative impact on overall performance and difficulties in using surgical instrumentation were reported.ConclusionOur study demonstrates the undeniable negative impact on the front-line healthcare workers using enhanced PPE and lays the ground for larger multicentric assessments given for it to potentially be the norm for the foreseeable future.

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Burnout among healthcare professionals during COVID-19 pandemic: a cross-sectional study

10.1101/2020.06.12.20129650 ◽

2020 ◽

Cited By ~ 3

Author(s):

Mohammad Jalili ◽

Mahtab Niroomand ◽

Fahimeh Hadavand ◽

Kataun Zeinali ◽

Akbar Fotouhi

Keyword(s):

Healthcare Workers ◽

Healthcare Professionals ◽

Well Being ◽

Personal Accomplishment ◽

Capital City ◽

Average Score ◽

Control Group ◽

Related Factors ◽

Cross Sectional ◽

Job Category

AbstractBackgroundThe unpredictable nature of the new COVID-19 pandemic and the already alarming incidence of healthcare workers being affected can have a significant impact on the psychological well-being of the staff.ObjectiveTo describe the prevalence of burnout among healthcare professionals and the associated factors.DesignCross-sectional survey.SettingEight university affiliated hospitals in the capital city of Tehran, Iran.ParticipantsAll healthcare workers at the study sites who had been taking care of COVID-19 patients.MeasurementsAge, gender, marital status, having children, hospital, job category, experience, and work load, as well as the level of burnout in each subscale.Results326 persons (53.0%) experienced high levels of burnout. The average score in emotional exhaustion, depersonalization and lack of personal accomplishment was 26.6, 10.2, and 27.3, respectively. The level of burnout in the three subscales varied based on the personal as well as work related factors and gender was the only variable that was associated with high levels of all three domains.LimitationsThere was no control group and thus we cannot claim a causal relationship between COVID-19 and the observed level of burnout. Not all confounding factors might have been accounted for.ConclusionsBurnout is prevalent among healthcare workers caring for COVID-19 patients. Age, gender, job category, and site of practice contribute to the level of burnout that the staff experience.Funding sourceNone

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Psychological impact of repeated epidemic exposure on healthcare workers: findings from an online survey of a healthcare workforce exposed to both SARS (severe acute respiratory syndrome) and COVID-19

BMJ Open ◽

10.1136/bmjopen-2021-051895 ◽

2021 ◽

Vol 11 (11) ◽

pp. e051895

Author(s):

Lai Gwen Chan ◽

Pei Lin Lynnette Tan ◽

Kang Sim ◽

Ming Yee Tan ◽

Kah Hong Goh ◽

...

Keyword(s):

Work Experience ◽

Healthcare Workers ◽

Online Survey ◽

Minority Groups ◽

Prior Experience ◽

Tertiary Care ◽

Well Being ◽

Racial Minority ◽

Foreign Born ◽

The Impact

ObjectiveTo measure the psychological well-being of healthcare workers (HCWs) during this COVID-19 pandemic and examine the experiences of the subgroup of participants who were also HCWs during the 2003 SARS epidemic.DesignAnonymous online survey adapted from a similar study conducted during the SARS epidemic, disseminated from July 2020 to August 2020.SettingNine healthcare institutions across Singapore ranging from primary care, community care, tertiary care and specialised referral centres.ParticipantsEmployees working in the participating healthcare institutions.ResultsOf 3828 survey returns, 3616 had at least one completed item on the questionnaire. Majority were female (74.7%), nurses (51.7%), foreign-born (53.2%) and not working in the tertiary care setting (52.1%). The median score on the Impact of Events Scale (IES) was 15 (IQR 23) and 28.2% of the sample scored in the moderate/severe range. 22.7% of the participants were also HCWs during SARS and more than half of them felt safer and better equipped in the current pandemic. 25.2% of SARS HCWs and 25.9% of non-SARS HCWs had moderate/severe IES scores (p=0.904). After adjusting for age, marital status, parity and length of work experience, racial minority groups and living apart from family were independent predictors of high IES regardless of prior SARS epidemic experience. Daily exposure to confirmed or suspect COVID-19 cases increased the odds of high IES for non-SARS HCWs only.Conclusions and relevanceOverall, while 28% of HCWs in our study suffered from significant trauma-related psychological symptoms regardless of prior experience with the SARS epidemic, those with prior experience reported feeling safer and better equipped, finding the workload easier to manage, as well as having more confidence in their healthcare leaders. We recommend for more trauma-informed support strategies for our HCWs especially those from racial minority groups, who are foreign-born and isolated from their families.

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The Psychological Impact of the COVID-19 Pandemic on Jordanian Healthcare Workers

International Journal of Reliable and Quality E-Healthcare ◽

10.4018/ijrqeh.289635 ◽

2022 ◽

Vol 11 (3) ◽

pp. 0-0

Keyword(s):

Healthcare Workers ◽

Online Survey ◽

Early Stage ◽

Psychological Impact ◽

Well Being ◽

Anxiety And Depression ◽

Cross Sectional ◽

Care Workers ◽

Cross Sectional Design ◽

The Impact

Introduction: Healthcare workers face incomparable work and psychological demands that are amplified throughout the COVID-19 pandemic. Aim: This study aimed to investigate the psychological impact of the COVID-19 pandemic on health care workers in Jordan. Method: A cross-sectional design was used. Data was collected using an online survey during the outbreak of COVID-19. Results: Overall, of the 312 healthcare workers, almost 38% and 36% presented with moderate to severe anxiety and depression consecutively. Nurses reported more severe symptoms than other healthcare workers. And both anxiety and depression were negatively correlated with well-being. Getting infected was not an immediate worry among healthcare workers; however, they were worried about carrying the virus to their families. Implications for Practice: Stakeholders must understand the impact of COVID-19 on healthcare workers and plan to provide them with the required psychological support and interventions at an early stage.

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How COVID-19 Affected Burnout and Job Satisfaction Levels Among the Healthcare Workers in Jordanian Hospitals

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol06-i10/1240 ◽

2021 ◽

Vol 6 (10) ◽

pp. 664-667

Author(s):

Bani Ahmad Amer, RN, MHA, Ph.D.

Keyword(s):

Job Satisfaction ◽

Healthcare Workers ◽

Online Survey ◽

Healthcare Professionals ◽

Healthcare Providers ◽

Well Being ◽

World Health ◽

Background Information ◽

Work Related ◽

Health Organization

Aim: To establish how COVID-19 affected the burnout and job satisfaction levels among the health care provider in Jordan hospitals. Methodology: The online survey questionnaire was distributed to 160 nurses, doctors, and specialists and 152 responses were captured in the Google form feedback from healthcare workers from Jordan hospitals. The survey questions wanted responses related to establishment of job satisfaction and burnout levels during the COVID-19 pandemic. The questionnaire contained questions investigating the nurses' and doctors' demographic factors, work-related variables, and personal experiences. Additionally, the provision of basic needs at the workplace were investigated, and the world Health Organization-5 well-being index was established through the questionnaires (Hamdam et al., 2020). Different statistics measurements were used. Descriptive statistics were used to summarize both the background information about the healthcare providers and burnout levels. Results: From the 152 healthcare professionals filed their responses, 32.6% were males, and the rest were females. Approximately 48%.13% and 16% were nurses, doctors, and pharmacists. Burnout was caused by exhaustion, depression, anxiety, and overtime working time. 7% of the nurses were satisfied with the work, while 72.5% were not satisfied. Approximately 24% of the male healthcare providers demonstrated resilience in employment, while 5% of the female healthcare professionals demonstrated burnout and total withdrawal due to the scourging effects of COVID-19 (Abujilban et al., 2021). The healthcare providers that received psychological support from their families seemed strong and suffered lower burnout levels. The fear of infection created anxiety that led to stress, and high burnout levels. Conclusions: COVID -19 led to increased levels of burnout and lack of job satisfaction. The hospitals in Jordan were not prepared, and the fear of nurses and doctors getting infected created more anxiety. The healthcare motivation and energy to work reduced to a bare minimum.

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To burn-out or not to burn-out: a cross-sectional study in healthcare professionals in Spain during COVID-19 pandemic

BMJ Open ◽

10.1136/bmjopen-2020-044945 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044945

Author(s):

Maria Torrente ◽

Pedro AC Sousa ◽

Ana Sánchez-Ramos ◽

Joao Pimentao ◽

Ana Royuela ◽

...

Keyword(s):

Healthcare Workers ◽

Online Survey ◽

Healthcare Professionals ◽

Demographic Data ◽

Maslach Burnout Inventory ◽

Well Being ◽

Survey Study ◽

Multivariable Logistic Regression Analysis ◽

Cross Sectional ◽

Burn Out

ObjectiveTo assess the prevalence of burn-out syndrome in healthcare workers working on the front line (FL) in Spain during COVID-19.DesignCross-sectional, online survey-based study.SettingsSampling was performed between 21st April and 3rd May 2020. The survey collected demographic data and questions regarding participants’ working position since pandemic outbreak.ParticipantsSpanish healthcare workers working on the FL or usual ward were eligible. A total of 674 healthcare professionals answered the survey.Main outcomes and measuresBurn-out syndrome was assessed by the Maslach Burnout Inventory-Medical Personnel.ResultsOf the 643 eligible responding participants, 408 (63.5%) were physicians, 172 (26.8%) were nurses and 63 (9.8%) other technical occupations. 377 (58.6%) worked on the FL. Most participants were women (472 (73.4%)), aged 31–40 years (163 (25.3%)) and worked in tertiary hospitals (>600 beds) (260 (40.4%)). Prevalence of burn-out syndrome was 43.4% (95% CI 39.5% to 47.2%), higher in COVID-19 FL workers (49.6%, p<0.001) than in non- COVID-19 FL workers (34.6%, p<0.001). Women felt more burn-out (60.8%, p=0.016), were more afraid of self-infection (61.9%, p=0.021) and of their performance and quality of care provided to the patients (75.8%, p=0.015) than men. More burn-out were those between 20 and 30 years old (65.2%, p=0.026) and those with more than 15 years of experience (53.7%, p=0.035).Multivariable logistic regression analysis revealed that, working on COVID-19 FL (OR 1.93; 95% CI 1.37 to 2.71, p<0.001), being a woman (OR 1.56; 95% CI 1.06 to 2.29, p=0.022), being under 30 years old (OR 1.75; 95% CI 1.06 to 2.89, p=0.028) and being a physician (OR 1.64; 95% CI 1.11 to 2.41, p=0.011) were associated with high risk of burn-out syndrome.ConclusionsThis survey study of healthcare professionals reported high rates of burn-out syndrome. Interventions to promote mental well-being in healthcare workers exposed to COVID-19 need to be immediately implemented.

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Kidney Care during COVID-19 in the UK: Perspectives of Healthcare Professionals on Impacts on Care Quality and Staff Well-Being

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010188 ◽

2021 ◽

Vol 19 (1) ◽

pp. 188

Author(s):

Archontissa Maria Kanavaki ◽

Courtney Jane Lightfoot ◽

Jared Palmer ◽

Thomas James Wilkinson ◽

Alice Caroline Smith ◽

...

Keyword(s):

Online Survey ◽

Healthcare Professionals ◽

Healthcare Access ◽

Healthcare Delivery ◽

Well Being ◽

Care Quality ◽

Free Text ◽

Structured Interviews ◽

The Uk ◽

The Impact

In light of the rapid changes in healthcare delivery due to COVID-19, this study explored kidney healthcare professionals’ (HCPs) perspectives on the impact of these changes on care quality and staff well-being. Fifty-nine HCPs from eight NHS Trusts across England completed an online survey and eight took part in complementary semi-structured interviews between August 2020 and January 2021. Free-text survey responses and interviews were analysed using inductive thematic analysis. Themes described the rapid adaptations, concerns about care quality, benefits from innovations, high work pressure, anxiety and mental exhaustion in staff and the team as a well-being resource. Long-term retention and integration of changes and innovations can improve healthcare access and efficiency, but specification of conditions for its use is warranted. The impact of prolonged stress on renal HCPs also needs to be accounted for in quality planning. Results are further interpreted into a theoretical socio-technical framework.

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The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort

Frontiers in Psychology ◽

10.3389/fpsyg.2021.718440 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mariagrazia Di Giuseppe ◽

J. Christopher Perry

Keyword(s):

Psychological Functioning ◽

Defense Mechanisms ◽

Rating Scales ◽

Full Range ◽

Well Being ◽

Research Fields ◽

Defensive Functioning ◽

And Function ◽

The Impact ◽

Q Sort

The psychodynamic concept of defense mechanisms is nowadays considered by professionals with various theoretical orientations of great importance in the understanding of human development and psychological functioning. More than half century of empirical research has demonstrated the impact of defensive functioning in psychological well-being, personality organization and treatment process-outcome. Despite the availability of a large number of measures for their evaluation, only a few instruments assess the whole hierarchy of defenses, based on the Defense Mechanisms Rating Scales (DMRS), which arguably offers an observer-rated gold standard of assessment. The present article illustrates the theoretical and methodological background of the DMRS-Q, the Q-sort version of the DMRS for clinical use. Starting from the definition and function of the 30 defense mechanisms included in the hierarchy, we extracted 150 items that captured a full range of defensive manifestations according to the DMRS theory. The DMRS-Q set is described in this paper with reference to the DMRS manual. Directions are also provided for using the DMRS-Q online software for the free and unlimited coding of defense mechanisms. After each coding, the DMRS-Q software provides a report including qualitative and quantitative scores reflecting the individual’s defensive functioning. Qualitative scores are displayed as the Defensive Profile Narratives (DPN), while quantitative scores are reported as Overall Defensive Functioning (ODF), defensive categories, defense levels, and individual defense mechanisms. Syntax for the scoring is displayed in the results and a clinical vignette of a psychotherapy session coded with the DMRS-Q is provided. The DMRS-Q is an easy-to-use, free, computerized measure that can help clinicians in monitoring changes in defense mechanisms, addressing therapeutic intervention, fostering symptoms decreasing and therapeutic alliance. Moreover, the DMRS-Q might be a valid tool for teaching the hierarchy of defense mechanisms and increase the observer-rated assessment of this construct in several research fields.

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