Emotions in the Time of COVID-19: Affections and Impacts among the Spanish Primary Care Workforce

Background: The literature review shows that most studies on the psychological impact of COVID-19 on healthcare professionals have focused on hospital staff, with few specifically addressing the primary care workforce. This study aims to explore primary care workers’ verbal accounts of the emotions they experienced. Methods: This is a qualitative study carried out between July and December 2020 in Spain. Semi-structured interviews and focus groups were conducted with primary care workers. Data were analysed through thematic content analysis. Participants were selected using purposive sampling. Results: A total of 53 primary care workers participated in the study, of whom 38 were individually interviewed, and 15 participated in three focus groups. Our analysis revealed themes in two categories: (1) from infection to affection; and (2) affected, but not patients—a discourse based on the acceptance of their experience as part of their work in primary care, creating an ideological construct or “shield” based on emotional self-management. Conclusions: Self-reflection on the emotional impact of COVID-19 is scarce. Examples of emotional affections include an obsessive focus on hygiene, the inability to establish clear boundaries between the personal and the professional spheres, and experiencing—and having to self-manage—emotional strain.

Prolonged Mechanical Ventilation At Home Versus Long Term Care: Caregiver Characteristics And Strain

Although the number of Prolonged Mechanical Ventilation (PMV) patients and their informal caregivers (CGs) is rising both at Home or Long Term Care (LTC), little is known concerning CG characteristics or strain. We enrolled 120 patients and 106 informal CGs: 34/46 and 72CGs/74 PMV patients from Home Hospital and LTC respectively. CGs were married (82%), female (60.4%), mean age 59 ±14 years; spouses (29%) or children (40%) of the PMV patient. The 13-item Modified Caregiver Strain Index (MCSI) (Maximum severity=26) was 13.6± 6.5, similar at Home vs. LTC (14.3±7.5 vs. 13.3±6.0, p=0.9). Most frequent complaints were distress concerning patient’s changes (93%) or upsetting behaviours (82%), feeling overwhelmed (82%), sleep disturbance (69%) and emotional adjustments (67%). Home CGs reported significantly more physical and financial burden, confinement, and need for work adjustment, while LTC CGs reported greater emotional disturbance and upsetting patient behaviours. Hierarchical clustering identified three clusters of CG strain: burden (physical/time/financial), emotional (upsetting adjustment/ behaviours/overwhelmed) and disturbance (work/plans/confinement). Emotional strain was most frequent, irrespective of site of care; however CGs at Home vs. LTC experienced significantly higher burden and disturbance vs. higher emotional strain respectively. In multivariate models, after adjusting for numerous patient and CG variables, increasing CG strain was consistently associated with rising patient symptomatology. This relationship was pronounced among CGs of Home PMV patients, with a significant interaction variable of Home*Patient symptomatology. Our findings identify specific patterns of strain among caregivers of PMV patients whether at home or LTC, and highlight the importance of addressing their unique needs.

Psychometric Testing of the BRI Unmet Need Instrument: A Comprehensive Measure of Dementia Caregivers' Needs

Compared to non-dementia caregivers, family/friend caregivers of individuals with dementia experience more negative caregiving consequences. One reason is the myriad of negatively impacted life domains including: managing symptoms; family communication; financial and legal matters; and finding and coordinating services. Few psychometrically tested measures exist for assessing the range of potential unmet needs of dementia caregivers. Such a measure would describe the frequency and correlates of unmet needs and provide a key outcome for intervention research. This study tested the psychometric properties of a comprehensive measure of unmet needs, the BRI Unmet Need Instrument. Data from 192 family/friend dementia caregivers was used to test reliability and four validity types. Results showed total unmet needs, as well as its nine subscales, had good reliability (Cronbach’s alpha .70 - .95). Discriminant validity was confirmed through factor analyses of the 45 unmet needs and items in measures of depression and care-related strain. Unmet need items loaded on separate factors that were deemed acceptable (.72-.38). Predictive validity was assessed by the association with depression, which was significant and an acceptable range (r = .22, p < .01). Convergent validity was confirmed by significant associations with three caregiver strain measures, mastery (r = .40, p <.01), emotional strain (r = .19, p < .01), and relationship strain (r = .15, p <.05). Good structural validity for nine predetermined unmet needs subscales was found using principal component analysis (loadings = .82-.39). Results suggest the BRI Unmet Needs Instrument is a ready-to-use, reliable and valid comprehensive measure.

Ethnic Differences in Context: Does Emotional Conflict Mediate the Effects of Both Team- and Individual-Level Ethnic Diversity on Emotional Strain?

Work teams are becoming increasingly heterogeneous with respect to their team members’ ethnic backgrounds. Two lines of research examine ethnic diversity in work teams: The compositional approach views team-level ethnic heterogeneity as a team characteristic, and relational demography views individual-level ethnic dissimilarity as an individual member’s relation to their team. This study compares and contrasts team-level ethnic heterogeneity and individual-level ethnic dissimilarity regarding their effects on impaired well-being (i.e., emotional strain) via team- and individual-level emotional conflict. Fifty teams of retail chain salespeople (n = 602) participated in our survey at two points of measurement. Based on the ethnic background of team members, we calculated team-level ethnic heterogeneity that applied to all members, and individual-level ethnic dissimilarity within the team that varied according to each member’s ethnic background. Multilevel path modeling showed that high levels of team-level ethnic heterogeneity were related to high levels of emotional strain via team-level emotional conflict. However, the opposite was found for individual-level ethnic dissimilarity. We discussed this difference by contextualizing individual-level ethnic dissimilarity in the team-level heterogeneity and social status of ethnic groups in society at large. Our findings suggest that the social status of the ethnic group to which team members belong may impact how ethnic diversity relates to team processes and well-being.

Managing role expectations and emotions in encounters with extremism: Norwegian social workers’ experiences

To prevent radicalisation and violent extremism, many European countries have adopted a multiagency approach, consisting of both police, teachers and social workers. Such strategies have caused concern for a securitization of social policy and stigmatization of vulnerable groups. This study aims at gaining insight into how Norwegian social workers involved in prevention work against violent extremism experience and manage role conflicts and emotions during interaction with their clients. This article presents findings from 17 individual and two focus group interviews which indicate that social workers experience emotional strain caused by role conflicts and emotional dissonance within a securitized field of social work. To handle these challenges, social workers apply a dynamic combination of surface and deep acting strategies, at both the reactive and proactive level, such as ‘Keeping a brave face’, ‘Character acting’ and ‘Adopting the client’s perspective’. Our findings contribute to expanding both the empirical and conceptual understanding of emotion management at work, and provides a novel insight into how prevention work against violent extremism is perceived by social workers. Also, in a field influenced by security rhetoric, our study gives encouraging new knowledge about how social workers can resist falling into oppressive and controlling practices by seeking to engage with and understand their clients’ human side, and relate this to their own lives.

Fears, Reassurance, and Milestones: A Twitter Analysis around World Prematurity Day during the COVID-19 Pandemic

Preterm birth (birth <37 completed weeks’ gestation) is common, affecting 10.6% of live births globally (nearly 15 million babies per year). Having a new baby admitted to a neonatal unit often triggers stress and anxiety for parents. This paper seeks to explore experiences of preterm birth via Twitter. The intermingling of COVID-19 restrictions and World Prematurity Day allows for an understanding of both the additional stresses incurred as a consequence of the pandemic and the more “everyday” experiences in the NICU and beyond. The content analysis of the data included 3161 tweets. Three themes were identified: 1. COVID-19 was not the only trauma; 2. Raising awareness, especially World Prematurity Day; and, 3. Baby milestones. These themes highlight the multi-level challenges faced by parents of premature babies and the healthcare professionals involved in their care. The COVID-19 pandemic and the consequent restrictions imposed on parents’ contact with their babies have resulted in immense emotional strain for families. The reported COVID-19 pandemic “baby blind spot” appears to particularly impact this group of babies. Improved understanding of the lived experiences of preterm babies and their families should inform greater awareness and improved support.

Workplace Cognitive Failure among Nurses during the COVID-19 Pandemic

Numerous studies provide evidence of the physical and emotional strain experienced by nurses during the COVID-19 pandemic. However, little is known regarding the impact of this occupational strain on nurses’ cognitive function at work. The aim of this study was to identify factors associated with workplace cognitive failure in a sample of U.S. nurses during the COVID-19 pandemic. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). Path analysis was conducted to test the parallel effects of frequency of contact with COVID patients and personal protective equipment (PPE) supply on workplace cognitive failure scores. Mediation effects of stress, sleep quality, secondary trauma, and work-related exhaustion were examined for each exposure. Results revealed significant indirect effects of all mediators except sleep quality of contact with COVID patients (cumulative indirect effect = 1.30, z = 6.33, p < 0.001) and PPE (cumulative indirect effect = −2.10, z = −5.22, p < 0.001) on cognitive failure. However, 58% of the PPE effect was direct. To reduce the risk of cognitive failure, healthcare organizations need to provide nurses with protective equipment and work environments that allow nurses to strengthen their resilience to extreme working conditions.

Nurses’ view of the nature of the support given to parents in the neonatal intensive care unit

Background: Most parents of Neonatal intensive care unit (NICU) babies often expressed dissatisfaction with the nursing care in NICU because of their unaddressed needs, resulting in emotional strain. This raises an essential question of how NICU nurses provide support for the parents. However, this can be relatively challenging in the NICU setting. Objective: To explore nurses’ views on the nature of parental support provided in NICU settings in Brunei Darussalam. Methods: This study employed a qualitative research approach conducted in 2020. Ten nurses were individually interviewed in semi-structured interviews. The data were analysed using thematic analysis. Results: Three broad themes were identified, namely: (1) Emotional and informational support (2) Keeping the support going (3) Seeking help from others. The data provide insights into how nurses provide emotional and informational support to parents in the NICU setting. Challenges were encountered in providing support and were addressed through the involvement of the doctors and emotional support continuity by nursing colleagues. Conclusion: This paper describes two critical supports given to the parents in the NICU setting and the challenges that underline these supports and proposes strategies used by nurses to help the parents. The balance needed between work demand and parental support is highlighted. In order to give more robust parental support, ongoing interactions with doctors and nursing colleagues are required.