Fear of making a mistake-Largest cause of stress for staff in COVID-19 ICU's

Background: Work stress among healthcare staff has been identified as an extensive problem already before the pandemic. To be able to treat the surge of COVID-19 patients in need of intensive care COVID-19 ICUs were swiftly set up and staffed. The aim of this study was to investigate what staff perceived as most stressful. Material(s) and Method(s): During spring 2020 up to 270 COVID-19 patients were simultaneously treated in ICU's in the greater Stockholm and Sormland regions, upholding 100 ICU beds pre-pandemic.1 Staff reactions to work in a COVID-19 ICU was collected in a survey. Nine causes for stress were scored on a five graded likert like scale from does not agree to fully agrees. 612 nurses and physicians, both regular ICU staff and newcomers, working in ICU's in 2 larger and 3 smaller hospitals responded, (response rate approx. 35%). Data was analyzed using structural equation modeling to calculate loading of each factor. Result(s): The highest scoring cause of stress was "making a mistake". "Getting infected" got the lowest score among the 9 predefined causes. Conclusion(s): Clinicians working in COVID-19 ICUs were generally confident not to get infected at work. Commitment to maintain patient safety and frustration not to live up to standards of care in this strained situation was reflected in "making a mistake" and "relatives cannot visit" scoring as the number one and three out of the nine causes of stress. Increased knowledge about work-related stressors is crucial, in order to prevent detrimental impacts of such stressors.

Stress factors and safety climate in the Intensive Care Unit (ICU) during the COVID-19 pandemic

Background: The outbreak of the COVID-19 pandemic had, besides the huge impact on private lives for the individual, also a big impact on health care systems worldwide. [1,2] An association between healthcare workers' stress as a main component of wellbeing and patient safety has been shown in different studies. [3] Aim/objective: The presented study is part of a project on "Sustainable PRofessional life under a pandEMic" (SUPREM) which includes standardized, validated instruments and has the aim to investigate stress factor perception and safety climate among coworkers in ICUs while caring for COVID-19 positive patients. This study was conducted at five Swedish hospitals and one German hospital during the pandemic. This refers to the German data. Method(s): All participants (physicians, nurses, physiotherapists;n = 120) gave their written informed consent. A nine-item questionnaire was used to collect the self-reported perception of stress factors in which each proposal was rated on a five-point Likert-type scale from 'I strongly disagree' (1) to 'I strongly agree' (5). Data is presented in percent of participants answering, "strongly agree". Additionally, free text questions were used to provide the participants with the opportunity to add stress factors. Result(s): The fear of infecting someone else was rated as a main stress factor in the German survey (45,0%). The fact that relatives were not allowed to visit the patients was also rated high (35,0%) together with the concern of making mistakes (29,2%). Discussion/conclusions: The fear of infecting someone else as the main stress factor in this study might mirror the mix of a pandemic where so much knowledge was lacking in the beginning together with a potential lack of protection gear. Other top stress factors show a commitment to involve relatives and keep up patient safety. This study might contribute to improve conditions regarding times of exceeded workload, like in a pandemic and to maintain staff wellbeing by highlighting factors that contribute to perceived stress.