Post-Traumatic Stress Disorder among Frontline Nurses during the COVID-19 Pandemic and Its Relationship with Occupational Burnout.

Objective: This study aimed to determine the level of post-traumatic stress disorder (PTSD) among nurses and its relationship with occupational burnout. Method : This online cross-sectional survey was conducted from late November to early January 2020 in six hospitals in Iran. 309 frontline nurses in COVID-19 wards were selected via stratified random sampling and asked to complete a sociodemographic questionnaire, the Impact of Event Scale-revised version (IES-R), and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) in an anonymous online survey. Data management and analysis were performed in SPSS 25.0 using descriptive and inferential statistics, including Pearson's correlation coefficient, independent samples t-test, ANOVA, and linear regression. Results: The majority of the participants were women (81.6%) with a mean ± SD age of 31.56 ± 6.42 years. The mean ± SD of the total PTSD score was 39.2 ± 16.44 years, indicating severe PTSD among nurses. The mean ± SD of the total occupational burnout score was 82.77 ± 19.38, expressing moderate burnout. The findings also demonstrated a significant moderate correlation between PTSD and occupational burnout (r = 0.363, P < 0.001). Univariate analysis revealed a significant relationship of occupational burnout with PTSD, work experience, number of night shifts per month, and employment status (P < 0.05). However, in multivariate analysis, only PTSD had a positive and significant relationship with occupational burnout (P < 0.001; R2 = 160; ß = 0.339) and was a predicting factor for it. Conclusion: We found that both PTSD and burnout are common among nurses. Given the role of PTSD especially as a predictor of burnout and the significant impact of these disorders on occupational and non-occupational activities, immediate and appropriate measures are necessary to monitor and reduce their effects on the nurses who are at the forefront of fighting the pandemic.

The role of the ICU liaison nurse services on anxiety in family caregivers of patients after ICU discharge during COVID-19 pandemic: a randomized controlled trial.

BACKGROUND: With the onset of the COVID-19 pandemic and the need to maintain social distancing and changes in wards' structure, families no longer access the routine support they received during the hospitalization of their patients in the ICU. This study aimed to determine the effects of ICU liaison nurse services on the anxiety in patients' family caregivers after ICU discharge during the COVID-19 pandemic. METHODS: This randomized controlled trial was performed in western Iran from February 2020, to March 2021. Sixty subjects were selected from the family caregivers of the patients transferred from the ICU and were randomly assigned to the control (n = 30) and the intervention groups (n = 30). The control group received routine transfer care. In the intervention group, liaison nurse services were offered in 4 dimensions: patient support, family support, training, support of the ward's staff, and the evaluation of the destination ward. The participants' anxiety was measured using the Spielberger State Anxiety Inventory immediately after the patient transfer and 6 h after admission to the general ward. Data analyzed with SPSS V16, descriptive and inferential statistics, including Chi-square test, Mann-Whitney test, Wilcoxon test, and Generalized Linear Model with cumulative logit link function. Results were reported at a 0.05 significance level. RESULTS: A statistically significant difference was observed in baseline anxiety levels (P = 0.035) and age group (P < 0.001) between the intervention and control groups. After moderating baseline anxiety levels, the age group, and marital status, the impact of the intervention was significant (X2 = 10.273, df = 1, P < 0.001), meaning that the intervention could reduce the relative chances of developing higher levels of anxiety by 92.1% (OR: 0.08, 95%CI: 0.017-0.373, P < 0.001). CONCLUSIONS: This study confirmed the positive impact of nursing services on reducing anxiety in family caregivers during the COVID-19 pandemic. It is recommended to use these services, especially during the COVID-19 condition, to facilitate the patient transfer, support the patient's family, and reduce the health care gap between the ICU and the ward.

The effect of the online flipped classroom on self-directed learning readiness and metacognitive awareness in nursing students during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom's effect on nursing students' self-directed learning readiness and metacognitive awareness. METHODS: This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester's first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software. RESULTS: There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students' mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07). DISCUSSION: Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.