Modifiable work stress factors and psychological health risk among nurses working within 13 countries.

INTRODUCTION: Nurses are identified as having higher work stress and poor mental health risk among health care workforce globally. It remains unclear which modifiable stress factors pose the greatest risk for poor psychological health among nursing workforce and needed to inform targeted practice and policy change. To determine which occupation-related or personal stress factors precipitate higher risk for burnout, depression, anxiety, job satisfaction or intention to leave one's position among nurses globally. DESIGN: A cross-sectional anonymous survey was administered via email using a snowball recruitment strategy. METHODS: Academic researchers and clinical industry leaders across 3 global regions collaborated to generate an email listserv of professional nursing contacts for survey distribution. The survey included valid and reliable measures to scale stress factors (Work Stress Questionnaire), and screen for burnout (single item), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2), resilience (Brief Resilience Scale) and intention to leave one's job (single item). We used logistic regression, first unadjusted and then adjusted for personal and professional characteristics, to determine associations between stress factors and psychological health risk. RESULTS: The final sample consisted of responses from 2864 nurses working across 13 countries. Most respondents reported working as a clinical nurse in the Philippines (n = 2275), United States (n = 424) and Saudi Arabia (n = 104). One third of nursing respondents endorsed high burnout and intention to leave their job. Those reporting work conflict had significantly higher odds of burnout (odds ratio 3.18; 95% CI 2.22-4.54) and three times more likely to screen positive for depression (odds ratio 3.02; 95% CI 1.36-6.72) and anxiety (odds ratio 2.92; 95% CI 1.57-5.43). Those endorsing difficulty sleeping were 15 times more likely to screen positive for depression (odds ratio 15.63; 95% CI 2.09-117.06). Lack of social support was significantly associated to higher risk for burnout, job dissatisfaction, depression, anxiety, and intention to leave one's position. CONCLUSIONS: Nurses remain at risk for burnout and poor psychological health stemming from work stress. Factors such as clear workplace goals and assignments, increased engagement, good sleep health and social support may serve as protective factors against suboptimal psychological health, and in-turn poor workforce retention. CLINICAL RELEVANCE: Nurses reporting conflict in the workplace are three times more likely to screen positive for burnout, depression, and anxiety. Nurses reporting difficulty sleeping are 15 times more likely to screen positive for depression. Several modifiable factors can be targeted to reduce poor psychological health and high workforce turnover among nurses across countries.

Foreign-born nurses as COVID-19 survivors in the Nordic region: A descriptive phenomenological study.

OBJECTIVE: In 2020, amid limited COVID-19 vaccination access, many nurses from Black, Asian and Minority Ethnic (BAME) groups in the United States of America and United Kingdom succumbed to the virus. No fatalities among Filipino foreign-born nurses (FBNs) in the BAME groups were recorded in the Nordic region. This study explored the experiences of Filipino FBNs in the Nordic region who, during the initial 2020 pandemic wave, cared for COVID-19 patients, contracted the virus and subsequently recovered. METHODS: The research employed a descriptive phenomenological methodology to explore the experiences of six Filipino FBNs who had recovered from COVID-19 in various regions of the Nordic countries, including Finland (n = 1), Sweden (n = 1), Denmark (n = 2), Norway (n = 1) and Iceland (n = 1). Data collection occurred through online videoconferencing between September 2020 and February 2021, utilising a semi-structured approach. The data analysis was conducted following Sundler and colleagues' qualitative thematic analysis, which is grounded in descriptive phenomenology. RESULTS: The data analysis yielded three primary themes and twelve sub-themes, which explored the experiences of Filipino FBNs with COVID-19 infection. The study demonstrated that unclear national guidelines impacted nurses' preparedness in caring for COVID-19 patients, contributing to their susceptibility to contracting the virus. The lack of occupational healthcare services for nurses during and after the pandemic affected their work morale in an unfamiliar setting. CONCLUSION: The study provided valuable insights into the experiences of Filipino FBNs during the COVID-19 pandemic, emphasising the need for clearer guidelines, enhanced training and improved support for healthcare workers. It highlighted the psychological impact of COVID-19, emphasising the importance of mental health support and stigma reduction efforts. The study also emphasised the significance of improving occupational health services to support the well-being and recovery of healthcare workers during and after the pandemic, with implications for developing comprehensive strategies to protect frontline healthcare workers in health crises.

Factors associated with weight gain during COVID-19 pandemic: A global study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in changes in lifestyle habits and experiences of mental health outcomes, some of which were possibly related to weight gain, leading to an increase in the prevalence of obesity, which is associated with the development of several severe diseases. Concerns regarding weight gain and its impact on health outcomes are prevalent worldwide, with obesity being one of the highest causes of mortality in current society. METHODS: A self-reported questionnaire collected data from participants aged 18 years of age and above from 26 countries and regions worldwide. Post-hoc multiple logistic regression analyses have been done to evaluate the association between demographic and socioeconomic factors, and the perspectives that were identified to be associated with weight gain. RESULTS: Participants belonging to a younger age group; with a higher level of education; living in an urban area; living with family members; employed full-time; and had obesity were found to be more vulnerable to weight gain. After adjusting for socio-demographic factors, participants who were quarantined; exercised less prior to the pandemic; consumed unhealthy foods; and reported negative thoughts such as helplessness and the perceived risk of COVID-19, were more likely to experience weight gain; while negative thoughts such as having no means of control over the COVID-19 pandemic and the consequences of the COVID-19 pandemic will have great personal effect were associated with females, students, and people living in the rural area. CONCLUSIONS: Weight gain risk during the pandemic was significantly associated with certain socio-demographic and COVID-19 related factors. To improve public health outcomes, future research should conduct a longitudinal evaluation on the effects of COVID-19 experiences upon health choices. Streamlined mental support should also be provided to the vulnerable groups which were prone to negative thoughts that were associated with weight gain.

Resilience level and its association with maladaptive coping behaviours in the COVID-19 pandemic: a global survey of the general populations.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has induced a significant global concern on mental health. However few studies have measured the ability of individuals to "withstand setbacks, adapt positively, and bounce back from adversity" on a global scale. We aimed to examine the level of resilience, its determinants, and its association with maladaptive coping behaviours during the pandemic. METHODS: The Association of Pacific Rim Universities (APRU) conducted a global survey involving 26 countries by online, self-administered questionnaire (October 2020-December 2021). It was piloted-tested and validated by an expert panel of epidemiologists and primary care professionals. We collected data on socio-demographics, socioeconomic status, clinical information, lifestyle habits, and resilience levels measured by the Brief Resilience Scale (BRS) among adults aged ≥ 18 years. We examined factors associated with low resilience level, and evaluated whether low resilience was correlated with engagement of maladaptive coping behaviours. RESULTS: From 1,762 surveys, the prevalence of low resilience level (BRS score 1.00-2.99) was 36.4% (America/Europe) and 24.1% (Asia Pacific). Young age (18-29 years; adjusted odds ratio [aOR] = 0.31-0.58 in older age groups), female gender (aOR = 1.72, 95% C.I. = 1.34-2.20), poorer financial situation in the past 6 months (aOR = 2.32, 95% C.I. = 1.62-3.34), the presence of one (aOR = 1.56, 95% C.I. = 1.19-2.04) and more than two (aOR = 2.32, 95% C.I. = 1.59-3.39) medical conditions were associated with low resilience level. Individuals with low resilience were significantly more likely to consume substantially more alcohol than usual (aOR = 3.84, 95% C.I. = 1.62-9.08), take considerably more drugs (aOR = 12.1, 95% C.I. = 2.72-54.3), buy supplements believed to be good for treating COVID-19 (aOR = 3.34, 95% C.I. = 1.56-7.16), exercise less than before the pandemic (aOR = 1.76, 95% C.I. = 1.09-2.85), consume more unhealthy food than before the pandemic (aOR = 2.84, 95% C.I. = 1.72-4.67), self-isolate to stay away from others to avoid infection (aOR = 1.83, 95% C.I. = 1.09-3.08), have an excessive urge to disinfect hands for avoidance of disease (aOR = 3.08, 95% C.I. = 1.90-4.99) and transmission (aOR = 2.54, 95% C.I. = 1.57-4.10). CONCLUSIONS: We found an association between low resilience and maladaptive coping behaviours in the COVID-19 pandemic. The risk factors identified for low resilience in this study were also conditions known to be related to globalization-related economic and social inequalities. Our findings could inform design of population-based, resilience-enhancing intervention programmes.

Factors Associated with Vaccination Intention against the COVID-19 Pandemic: A Global Population-Based Study.

Several vaccines have been developed for COVID-19 since the pandemic began. This study aimed to evaluate the factors associated with COVID-19 vaccination intention. A global survey was conducted across 26 countries from October, 2020 to December, 2021 using an online self-administered questionnaire. Demographic information, socio-economic status, and clinical information were collected. A logistic regression examined the associations between vaccine intention and factors such as perceptions and the presence of chronic physical and mental conditions. The sample included 2459 participants, with 384 participants (15.7%) expressing lower COVID-19 vaccination intent. Individuals who identified as female; belonged to an older age group; had a higher level of education; were students; had full health insurance coverage; or had a previous history of influenza vaccination were more willing to receive vaccination. Conversely, those who were working part-time, were self-employed, or were receiving social welfare were less likely to report an intention to get vaccinated. Participants with mental or physical health conditions were more unwilling to receive vaccination, especially those with sickle cell disease, cancer history within the past five years, or mental illness. Stronger vaccination intent was associated with recommendations from the government or family doctors. The presence of chronic conditions was associated with lower vaccine intention. Individuals with health conditions are especially vulnerable to health complications and may experience an increased severity of COVID-19 symptoms. Future research should evaluate the effectiveness of interventions targeting the vaccine perceptions and behaviours of at-risk groups. As such, public awareness campaigns conducted by the government and proactive endorsement from health physicians may help improve COVID-19 vaccination intention.

Randomized controlled trial on the effectiveness of web-based Genomics Nursing Education Intervention for undergraduate nursing students: a study protocol.

AIM: To describe a randomized controlled trial protocol that will evaluate the effectiveness of two web-based genomic nursing education interventions. BACKGROUND: Preparing future nurses to be competent in genetic and genomic concepts is fundamental to ensure appropriate clinical application. However, genetics-genomics concepts are still new in the field of nursing. Little is known about what type and kind of web-based nursing education is effective in improving the knowledge of nursing students. To address these knowledge gaps, a web-based 'Genomic Nursing Education Intervention' will be developed and compared with an existing online education programme. DESIGN: A randomized controlled trial of two groups with pre-test and repeated posttesting. METHODS: The Genomic Nursing Concept Inventory, a validated tool, will be used to assess the genetics-genomics knowledge of nursing students. Participants will be randomly allocated to either a control or an intervention group. The control group will receive the standard web-based nursing education, while the intervention group will receive a newly developed web-based education intervention. Outcome measures include the students' knowledge level of nursing genetics-genomics concepts. Participants will be retested at 3 and 6 months. CONCLUSION: Current evidence shows that ensuring nurses have adequate education in genetic-genomic concepts is challenging. This study will demonstrate which of two web-based nursing education methods is more effective in teaching genetic-genomic concepts. This research project will better prepare the nursing profession in their careers for the emerging advance technologies in genetics-genomics and personalized health care. IMPACT: Current evidence shows major challenges in ensuring that nurses have adequate education in genetics-genomics concepts. Less is known about what approaches to web-based education are effective to improve the knowledge gaps of nursing students in genetics-genomics concepts. This study will determine which type of web-based nursing education is effective in improving the genetics-genomics knowledge of nursing students. This research project will help better prepare nurses in dealing with advances in genetics-genomics in their careers. TRIAL REGISTRATION:  This study is registered in ClinicalTrials.gov (ID number NCT03963687) https://clinicaltrials.gov/show/NCT03963687.

Tobacco use and E-cigarette regulation: Perspectives of University Students in the Asia-Pacific.

INTRODUCTION: The Asia-Pacific is home to 30% of the world's smokers. Additional efforts are needed to reduce negative health impacts of tobacco, including e-cigarettes. The study objectives were to 1. Investigate Asian-Pacific students' knowledge, attitudes, and use of tobacco products; 2. Determine the level of student support for tobacco control policies; and 3. Examine differences in students' attitudes by the strength of national tobacco control policies based on implementation of WHO's MPOWER package, and e-cigarette regulation in their countries. METHODS: A total of 1953 students from members of the Association of Pacific Rim Universities in 13 countries completed the online survey. We compared the results by the Fisher-Freeman-Halton test. RESULTS: While about 83% of students had heard of e-cigarettes; only 14.1% had tried them. Students in countries with e-cigarette bans were the least likely to report having experimented with e-cigarettes (8.1%). While the vast majority of students (87.9%) reported having seen health campaigns targeting combustible cigarettes, far fewer (42.5%) had seen any health campaigns targeting e-cigarettes. About 80% of students supported smoke-free campuses, with the most support coming from those in countries with the weakest adoption of MPOWER policies (88.7%) and no e-cigarette regulations (80.4%). Students in countries with the weakest MPOWER policies were also the most likely to support campus bans and government regulation of e-cigarettes. CONCLUSIONS: The adoption of tobacco control polices by government may have an impact on e-cigarette smoking behavior among students, and student support for tobacco control, including noncombustible products, is high. Universities should take action by adopting comprehensive tobacco control measures that include e-cigarette regulations.

An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study.

BACKGROUND: Dramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses. METHODS: This mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers' migration of relevant policy documents and academic literature on health workers' migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists. RESULTS: Filipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement. The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as on brain drain, gain, and circulation, and on opportunities for knowledge and technology transfer. Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered, especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources. At the same time, migration is, however, seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility. CONCLUSIONS: Unless socioeconomic conditions are improved and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for outmigration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.