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Introduction: The COVID-19 pandemic generated a significant burden on the German health care system, affecting the mental health of health care workers (HCW) in particular. Resilience may serve as an essential protective factor for individuals' well-being. Objective: Our objective was to identify demographic and work-related correlates of individual resilience and to investigate the association between pandemic-related stress, resilience and mental health using different resilience models. Methods: Our sample comprised 1034 German HCW in different medical professions who completed an online survey from 20 April to 1 July 2020. Resilience was assessed using the Resilience Scale-5 (RS-5). The pandemic-related self-reported stress burden was captured by a single item, while depression and anxiety symptoms were measured with the PHQ-2 and GAD-2, respectively. Additionally, various sociodemographic and work-related factors were assessed. Results: Overall, we found high levels of resilience in the sample compared to a German sample before the pandemic, which were significantly associated only with the older age of participants and having children in both univariate and multivariate analyses. Regarding mechanisms of resilience, moderation analysis revealed that low individual resilience and high pandemic-related stress burden independently contributed to both anxiety and depression symptoms while resilience additionally moderated the relationship between stress burden and anxiety symptoms. The link between self-reported stress burden and mental health symptoms was also partially mediated by individual resilience. Conclusion: Taken together, the findings based on the present sample during the COVID-19 pandemic suggest that resilience plays a central role in the mental health of healthcare workers and that resilience-building interventions should be expanded, especially with a focus on younger employees.
Subject(s)
COVID-19 , Resilience, Psychological , Anxiety/diagnosis , Anxiety/epidemiology , COVID-19/epidemiology , Child , Depression/diagnosis , Depression/epidemiology , Health Personnel/psychology , Humans , Mental Health , Pandemics , SARS-CoV-2ABSTRACT
Die Palliativversorgung kann in der „severe acute respiratory syndrome coronavirus type 2“(SARS-CoV-2)-Pandemie mit ihrem Fachwissen, ihren Fähigkeiten und Haltungen sowohl zur Therapiezielfindung als auch zur Entscheidungsfindung bei knappen Ressourcen beitragen. Sie liefert Empfehlungen zur Kontrolle der Symptome Luftnot, Unruhe und Angst und bietet Konzepte, wie die Kommunikation mit Patienten und Angehörigen trotz der pandemiebedingten Einschränkungen gelingen kann. In dem Projekt „Nationale Strategie für Palliativversorgung in Pandemiezeiten“ (PallPan) wurden auf der Grundlage von 16 Teilstudien insgesamt 32 Handlungsempfehlungen für Patienten, Angehörige/Pflegende, Mitarbeitende und Entscheidungsträger im Gesundheitswesen vorgelegt. Dazu gehören auch Hilfestellungen zur „Trauer in besonderen Zeiten“.
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Objective: The present study aimed to investigate the correlation between moral distress and mental health symptoms, socio-demographic, occupational, and COVID-19-related variables, and to determine differences in healthcare workers' (HCW) moral distress during the first wave of the COVID-19 pandemic. Method: Data from 3,293 HCW from a web-based survey conducted between the 20th of April and the 5th of July 2020 were analyzed. We focused on moral distress (Moral Distress Thermometer, MDT), depressive symptoms (Patient Health Questionnaire-2, PHQ-2), anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), and increased general distress of nurses, physicians, medical-technical assistants (MTA), psychologists/psychotherapists, and pastoral counselors working in German hospitals. Results: The strongest correlations for moral distress were found with depressive symptoms, anxiety symptoms, occupancy rate at current work section, and contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nurses and MTA experienced significantly higher moral distress than physicians, psychologists/psychotherapists, and pastoral counselors. The average level of moral distress reported by nurses from all work areas was similar to levels which before the pandemic were only experienced by nurses in intensive or critical care units. Conclusion: Results indicate that moral distress is a relevant phenomenon among HCW in hospitals during the COVID-19 pandemic, regardless of whether they work at the frontline or not and requires urgent attention.
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Hintergrund Obwohl Opioide wirksam Schmerzen und Dyspnoe lindern, findet dies in Leitlinien zur Symptomkontrolle unterschiedliche Gewichtung. Dies kann zu Unsicherheiten bezüglich Indikationen und ethischer Implikationen im Umgang mit Opioiden auch bei COVID-19 führen. Ziel der Arbeit Wir untersuchten bei Mitgliedern der Deutschen Gesellschaft für Palliativmedizin (DGP) die persönliche Wahrnehmung des Umgangs mit Morphin/Opioiden (M/O) zur Symptomkontrolle innerhalb und außerhalb der Palliativmedizin (PM), auch bei der Betreuung COVID-19-Erkrankter. Material und Methoden Mittels Survey Monkey® wurden DGP-Mitglieder anonymisiert nach ihrer eigenen Wahrnehmung des Umgangs mit M/O zur Symptomkontrolle befragt. Ergebnisse und Diskussion Von den 6192 DGP-Mitgliedern nahmen N = 506 teil. Den Umgang mit M/O innerhalb der PM beschrieben 98 % der befragten Ärzt:innen und Pflegekräfte als „sicher und vertraut“ bzw. 95 % als „klar geregelt“, während dies für die Bereiche außerhalb der PM von weniger als der Hälfte angegeben wurde (48 %/38 %). Bei der Betreuung COVID-19-Erkrankter wurde der Umgang mit M/O außerhalb der PM noch seltener als „sicher und vertraut“ (26 %) oder „klar geregelt“ (23 %) wahrgenommen. Dyspnoe (99 %/52 %), Erleichterung des Sterbeprozesses (62 %/37 %), Unruhe (30 %/15 %) und Angst/Panik (27 %/13 %) wurden häufiger innerhalb als außerhalb der PM als allgemeine Indikationen genannt. 89 % der Befragten wünschten sich die Einbindung eines PM-Konsilteams. Schlussfolgerung Mitglieder der DGP nahmen deutliche Unsicherheiten im Umgang mit M/O außerhalb der PM wahr. Einheitliche interdisziplinäre Leitlinien zur Symptomkontrolle etwa bei Dyspnoe, mehr Lehre und die Einbindung eines PM-Konsilteams sollten zukünftig mehr bedacht werden.
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OBJECTIVES: The COVID-19 pandemic and the measures taken to mitigate spread have affected countries in different ways. Healthcare workers, in particular, have been impacted by the pandemic and by these measures. This study aims to explore how COVID-19 has impacted on palliative care (PC) workers around the world. MATERIALS AND METHODS: Online survey to members of the International Association for Hospice and PC during the initial months of the COVID-19 pandemic. Convenience sampling was used. Statistical descriptive and contingency analyses and Chi-square tests with P < 0.05 were conducted. RESULTS: Seventy-nine participants (RR = 16%) from 41 countries responded. Over 93% of those who provide direct patient care reported feeling very or somewhat competent in PC provision for patients with COVID-19. Eighty-four felt unsafe or somewhat safe when caring for patients with COVID-19. Level of safety was associated with competence (P ≤ 0.000). Over 80% reported being highly or somewhat affected in their ability to continue working in their PC job, providing care to non-COVID patients and in staff availability in their workplace. About 37% reported that availability and access to essential medicines for PC were highly or somewhat affected, more so in low-income countries (P = 0.003). CONCLUSION: The results from this study highlight the impact of COVID-19 on the provision of PC. It is incumbent on government officials, academia, providers and affected populations, to develop and implement strategies to integrate PC in pandemic response, and preparedness for any similar future events, by providing appropriate and comprehensive education, uninterrupted access to essential medicines and personal protective equipment and ensure access to treatment and care, working together with all levels of society that is invested in care of individuals and populations at large. The long-term effects of the pandemic are still unknown and future research is needed to monitor and report on the appropriateness of measures.
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CONTEXT: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. OBJECTIVES: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. METHODS: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. RESULTS: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. CONCLUSION: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.
Subject(s)
COVID-19 , Hospice and Palliative Care Nursing , Humans , Palliative Care , Pandemics , SARS-CoV-2 , WorkforceABSTRACT
INTRODUCTION: The COVID-19 pandemic resulted in severe detrimental effects on the mental well-being of health care workers (HCW). Consequently, there has been a need to identify health-promoting resources in order to mitigate the psychological impact of the pandemic on HCW. OBJECTIVE: Our objective was to investigate the association of sense of coherence (SOC), social support and religiosity with self-reported mental symptoms and increase of subjective burden during the COVID-19 pandemic in HCW. METHODS: Our sample comprised 4324 HCW of four professions (physicians, nurses, medical technical assistants (MTA) and pastoral workers) who completed an online survey from 20 April to 5 July 2020. Health-promoting resources were assessed using the Sense of Coherence Scale Short Form (SOC-3), the ENRICHD Social Support Inventory (ESSI) and one item on religiosity derived from the Scale of Transpersonal Trust (TPV). Anxiety and depression symptoms were measured with the PHQ-2 and GAD-2. The increase of subjective burden due to the pandemic was assessed as the retrospective difference between burden during the pandemic and before the pandemic. RESULTS: In multiple regressions, higher SOC was strongly associated with fewer anxiety and depression symptoms. Higher social support was also related to less severe mental symptoms, but with a smaller effect size, while religiosity showed minimal to no correlation with anxiety or depression. In professional group analysis, SOC was negatively associated with mental symptoms in all groups, while social support only correlated significantly with mental health outcomes in physicians and MTA. In the total sample and among subgroups, an increase of subjective burden was meaningfully associated only with a weaker SOC. CONCLUSION: Perceived social support and especially higher SOC appeared to be beneficial for mental health of HCW during the COVID-19 pandemic. However, the different importance of the resources in the respective occupations requires further research to identify possible reasons.
Subject(s)
Anxiety/psychology , COVID-19/psychology , Depression/psychology , Pandemics , Sense of Coherence , Social Support , Stress, Psychological/epidemiology , Adolescent , Adult , Anxiety/epidemiology , COVID-19/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Female , Germany/epidemiology , Health Personnel , Health Promotion/statistics & numerical data , Humans , Logistic Models , Male , Mental Health , Middle Aged , Religion , SARS-CoV-2/pathogenicity , Stress, Psychological/physiopathology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: With over two million deaths and almost 100 million confirmed cases, the COVID-19 pandemic has caused a "tsunami of suffering." Health care workers, including palliative care workers, have been severely impacted. This study explores how the COVID-19 pandemic has impacted palliative care workers around the world and describes the coping strategies they have adopted to face their specific situation. METHOD: We conducted a qualitative analysis of written, unstructured comments provided by respondents to a survey of IAHPC members between May and June 2020. Free text was exported to MAX QDA, and a thematic analysis was performed by reading the comments and developing a coding frame. RESULTS: Seventy-seven palliative care workers from 41 countries submitted at least one written comment, resulting in a data corpus of 10,694 words and a total of 374 coded comments. Eight main themes are emerged from the analysis: palliative care development, workforce impact, work reorganization, palliative care reconceptualization, economic and financial impacts, increased risk, emotional impact, and coping strategies. SIGNIFICANCE OF RESULTS: The pandemic has had a huge impact on palliative care workers including their ability to work and their financial status. It has generated increased workloads and placed them in vulnerable positions that affect their emotional well-being, resulting in distress and burnout. Counseling and support networks provide important resilience-building buffers. Coping strategies such as team and family support are important factors in workers' capacity to adapt and respond. The pandemic is changing the concept and praxis of palliative care. Government officials, academia, providers, and affected populations need to work together to develop, and implement steps to ensure palliative care integration into response preparedness plans so as not to leave anyone behind, including health workers.
Subject(s)
COVID-19 , Pandemics , Health Personnel , Humans , Palliative Care , SARS-CoV-2Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Patient Isolation , Pneumonia, Viral , Social Isolation , COVID-19 , Humans , SARS-CoV-2ABSTRACT
The corona pandemic has led to a number of restrictions and prohibitions, which in turn place large psychosocial or spiritual burdens on patients with COVID-19, their families and relatives and the treating personnel in the healthcare system. Patients with COVID-19 are not allowed to receive visitors and many hospitals and nursing homes have completely banned visitors. Many support services have been reduced or stopped completely. Necessary treatment interventions for other patients with critical and life-limiting diseases have been delayed or suspended in order to free resources for the expected COVID-19 patients; however, these people need to feel social connectedness with their relatives. Palliative care patients should be exempted from any ban on visitors. Families should be able to visit dying patients even on intensive care units or isolation wards, using adequate protective equipment. Alternative options, such as video telephone calls or via social media should be explored for patients in isolation. Families should also be enabled to say goodbye to the deceased with adequate protective equipment or should be offered alternative real or virtual options for remembrance and commemoration. Health care professionals coping with the exceptional stress should be continuously supported. This requires clear communication and leadership structures, communication training, psychosocial support, but most of all optimal framework conditions for the clinical work.
Subject(s)
Coronavirus Infections/psychology , Grief , Palliative Care , Pneumonia, Viral/psychology , Betacoronavirus , COVID-19 , Counseling , Emergency Medicine , Family Therapy , Germany , Humans , Neoplasms , Occupational Stress , Palliative Medicine , Pandemics , Psycho-Oncology , SARS-CoV-2 , Social Work , Visitors to PatientsABSTRACT
Section 2 of the 2019 World Health Organization Model List of Essential Medicines includes opioid analgesics formulations commonly used for the control of pain and respiratory distress, as well as sedative and anxiolytic substances such as midazolam and diazepam. These medicines, essential to palliative care, are regulated under the international drug control conventions overseen by United Nations specialized agencies and treaty bodies and under national drug control laws. Those national laws and regulations directly affect bedside availability of Internationally Controlled Essential Medicines (ICEMs). The complex interaction between national regulatory systems and global supply chains (now impacted by COVID-19 pandemic) directly affects bedside availability of ICEMs and patient care. Despite decades of global civil society advocacy in the United Nations system, ICEMs have remained chronically unavailable, inaccessible, and unaffordable in low- and-middle-income countries, and there are recent reports of shortages in high-income countries as well. The most prevalent symptoms in COVID-19 are breathlessness, cough, drowsiness, anxiety, agitation, and delirium. Frequently used medicines include opioids such as morphine or fentanyl and midazolam, all of them listed as ICEMs. This paper describes the issues related to the lack of availability and limited access to ICEMs during the COVID-19 pandemic in both intensive and palliative care patients in countries of all income levels and makes recommendations for improving access.
Subject(s)
Coronavirus Infections , Health Services Accessibility , Pandemics , Pneumonia, Viral , Analgesics/therapeutic use , COVID-19 , Coronavirus Infections/therapy , Critical Care/legislation & jurisprudence , Health Services Accessibility/legislation & jurisprudence , Humans , Internationality , Legislation, Drug , Palliative Care/legislation & jurisprudence , Pneumonia, Viral/therapy , United NationsSubject(s)
Civil Defense , Continuity of Patient Care , Coronavirus Infections , Health Services Accessibility , Palliative Care , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Capacity Building , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Developing Countries , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2 , Stress, Psychological , TelemedicineABSTRACT
Die Krankheitsverlaufe einer COVID-19-Infektion sind sehr variabel und reichen von leichten Erkaltungssymptomen bis zu schweren beatmungspflichtigen Pneumonien, Organversagen und einer hyperinflammatorischen Immunantwort mit moglichem Versterben. Die Begleitung der schwer kranken und sterbenden PatientInnen erfordert neben akutmedizinischer Betreuung auch palliativmedizinische Expertise.