Headache and Associated Psychological Variables in Intensive Care Unit Nurses during the COVID-19 Pandemic: A Prospective Study.

(1) Background: Headaches in health professionals have been studied over the years. This has become even more relevant during the COVID-19 pandemic, due to their link with the use of masks, being female or working in highly complex units. However, their association with different personality traits has not been studied in healthcare workers (HCWs). The aim of this study was to assess the prevalence and evolution of headaches throughout the pandemic in Intensive Care Unit (ICU) nurses and to analyze their association with sociodemographic, occupational and personality variables as well as with other symptoms. (2) Methods: This was an observational, descriptive, longitudinal, prospective study with two periods of data collection (at the end of the containment phase and six months thereafter). A non-probabilistic convenience sampling was performed (n = 131). (3) Results: A high percentage of ICU nurses reported headaches during the first (71%) or second (79.4%) time point; more than half of the sample (58.8%) reported headaches over time (chronic headache). Although a higher prevalence of headaches was observed in women at both assessment points, no significant gender-related relationships were observed for headaches maintained across the two time points. Regarding the symptoms and personality variables, positive relationships were found between headaches and anxiety (p = 0.005), insomnia (p = 0.030) and emotional exhaustion (p = 0.022), and a negative relationship was found between headaches and hardiness (p = 0.031). (4) Conclusions: Our study highlights the importance of assessing occupational, psychological and emotional aspects in order to decrease the prevalence of headaches and thus improve the quality of the work life of nurses in such demanding environments as the ICU.

Post-Pandemic Insomnia in Healthcare Workers: A Prospective Study including Sociodemographic, Occupational and Psychosocial Variables.

Background/Objectives: Previous research points to the prevalence of insomnia during the COVID-19 pandemic among healthcare workers (HCWs). However, longitudinal studies on its evolution, including the post-pandemic stage, are less abundant, with a special lack of research about possible psychosocial risk factors. The aim of the current study is to analyze the evolution of insomnia in Spanish HCWs from the beginning of the pandemic until two years later, examining the influence of sociodemographic, occupational and psychosocial variables. Methods: This was a prospective longitudinal design with three data collection periods in which insomnia was assessed using the Insomnia Severity Index (ISI), in addition to sociodemographic, occupational and psychosocial (i.e., social support, self-efficacy, resilience and cognitive fusion) variables in HCWs (n = 216) who were in direct contact with COVID-19 patients. Results: High scores were observed for insomnia, with a clear decrease throughout the periods studied (F = 30.198, p < 0.001). An association was observed between insomnia and certain sociodemographic and occupational variables (i.e., work category, p = 0.001; availability of Personal Protective Equipment (PPE), p < 0.001; workload, p < 0.001; worry about self or family contagion, p = 0.002, p = 0.003, respectively). Insomnia had negative relationships with social support (p = 0.014), self-efficacy (p < 0.001) and resilience (p < 0.001) and positive relationships with cognitive fusion (p < 0.001). Interaction effects between the evolution of insomnia and social support from friends (p = 0.024, ƞ2 = 0.34) and between the evolution of insomnia and cognitive fusion (p = 0.047; ƞ2 = 0.25) were found. Conclusions: Social support, self-efficacy and resilience act as buffers for insomnia. Cognitive fusion acts as a clear precipitator of insomnia as well as directly influencing its evolution. Social support from friends also affects the evolution of insomnia. Within the specific circumstances of the COVID-19 pandemic, a long-term effect of social support from friends and a short-term effect of cognitive fusion on the evolution of insomnia was observed. The findings emphasize the need to implement specific interventions to promote the mental well-being of HCWs, particularly in crisis contexts that involve an increase in occupational stress, emphasizing the role of certain psychosocial variables as protective factors.

A study on optimism as a psychological strength in nurses through a prospective study from the outbreak of the COVID-19 pandemic to two years later.

Aims and objectives: This study analyzes, in nurses, the influence of openness to experience and hardiness (assessed at baseline and one year after the COVID-19 pandemic respectively) on the development of optimism (assessed two years after the COVID-19 pandemic). Concerns about self-contagion were included as a moderating variable, given their relevance as a risk factor. Background: Nurses have been among the healthcare professionals most affected by the COVID-19 pandemic. Most previous studies have focused on the variables contributing to psychological symptoms, whilst the attention given to the variables adding to the well-being of these professionals has been much scarcer. Design: A prospective study was carried out. Methods: This study was carried out using three data collection periods: Period 1 (From May to June 2020), Period 2 (From January 2021 to April 2021), and Period 3 (From April 2022 to July 2022), with the participation of 151 Spanish nurses, using online self-reporting questionnaires. The study followed the STROBE statement. Results: The results showed that the proposed model was statistically significant. There was a positive effect of openness to experience (year 2020) on hardiness assessed one year later (year 2021). Similarly, hardiness had a positive effect on optimism assessed another year on (year 2022). Conclusions: Concerns about self-contagion behaved as a moderator in the relationship between openness to experience and hardiness (the relationship between openness and hardiness was statistically significant when contagion concern was higher). Relevance to clinical practice: In-depth understanding of the psychological processes that trigger psychological strengths (i.e. optimism) as a result of adverse situations (i.e. COVID-19 pandemic) is essential in promoting the mental health of healthcare professionals. Interventions targeting resilient personality traits and cognitive flexibility are key to this goal. No Patient or Public Contribution: The participants contributed exclusively to the collection of the sample.

From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic.

Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within "positive psychology" have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January-March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = -0.275 (0.100); LLCI = -0.487, ULCI = -0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = -0.053 (0.215), t = 0.248, p = 0.804, LLCI = -0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy.

Concern about contagion and distress in intensive care unit (ICU) nurses during the COVID-19 pandemic. Motherhood as moderator.

The aim of this research is to analyze the role that children play between fear of contagion and distress in intensive care unit (ICU) nurses during the COVID-19 pandemic, taking into account possible work stressors. Cross-sectional study using an online survey. The selection of the sample was carried out by means of a non-probabilistic sampling for convenience, sending the link to professionals of the Spanish healthcare system who had been in contact with COVID-19 patients. Social networks were also used. Data was collected from May to July 2020. Mothers were selected from among the female nurses for participation in this study. The sample was composed of 283 female nurses working in critical care during the COVID-19 pandemic. Distress levels were significantly lower (F = 2.372, p = .048) in women with children over the age of 16 (M = 8.26, SD = 4.44) than in those without them (M = 10.30;DT = 3.75) (cohabitants). No differences were observed in worries about contagion between nurses with children (either under or over 16 years of age) and without children at home. The regression analysis found significant direct positive contributions of worries about contagion (p = .025) and the presence of children living at home (p = .033) on distress levels. We found a moderating effect of having children over 16 years old living at home in this relationship (ß = 2.198, t = 2.422, p = .016, 95 percentCI = .406-3.992). Our results suggest higher levels of distress in ICU nurses who are working-mothers during COVID-19 pandemic. Living at home with children over 16 years of age has a moderating effect. Our study results point to the need to create action protocols that prepare the health system for outbreaks including early care actions with special emphasis on higher risk groups.

Predisposición del personal sanitario a la vacunación frente a la COVID-19 / Disposition among healthcare staff to be vaccinated against COVID-19

Objetivo: conocer la predisposición del personal sanitario a la vacunación contra el SARS-CoV-2 y sus razones para ello. Método: estudio transversal mediante encuesta online realizada entre diciembre de 2020 y febrero de 2021. Profesionales del sistema sanitario español pertenecientes a cualquier categoría que hubieran trabajado atendiendo a pacientes con COVID-19 desde marzo de 2020, tanto en el ámbito hospitalario como extrahospitalario, incluyendo Atención Primaria. Muestreo no probabilístico. Cuestionario ad hoc: características de la muestra, preocupación por el contagio y predisposición a la vacunación frente al COVID-19. Análisis descriptivo. Resultados: participaron 834 profesionales sanitarios. La predisposición para la vacunación frente al SARS-CoV-2 fue elevada (92% de los encuestados se administrarían la vacuna). Las principales razones fueron la preocupación por el contagio de familiares y por el contagio propio, seguido por la necesidad de finalizar con la pandemia actual lo antes posible. La decisión de administrarse o no la vacuna solo se ve estadísticamente influenciada por la categoría profesional y el sexo, siendo enfermeras y médicos los porcentajes más altos que han afirmado que sí se administrarían la vacuna, así como los hombres. Conclusiones: a través de este estudio se evidencia la predisposición positiva del personal sanitario hacia las vacunas actuales frente al SARS-CoV-2. Además, casi la totalidad de los profesionales sanitarios encuestados tienen una elevada preocupación por la posibilidad de contagiar la enfermedad a un familiar, o ante la probabilidad del contagio propio. No influye en la decisión de administrarse la vacuna si en el momento actual dichos profesionales estaban trabajando con pacientes COVID-19 positivos.(AU)

Objective: to understand the disposition among healthcare staff to be vaccinated against SARS-CoV-2 and their reasons for it. Method: a cross-sectional study through online survey conducted between December 2020 and February 2021. The study included professionals from the Spanish Health System belonging to any category who had managed COVID-19 patients from March 2020, both in the hospital and the community settings, including Primary Care. Non-probabilistic sampling, and ad hoc questionnaire: sample characteristics, concern about contagion, and willingness to be vaccinated against COVID-19. Descriptive analysis. Results: the study included 834 healthcare professionals. There was a high disposition to be vaccinated against SARS-CoV-2 (92% of the participants would receive the vaccine). The main reasons were concern about getting infected and infecting their relatives, followed by the need to end up the current pandemics as soon as possible. The decision of receiving the vaccine or not was only statistically influenced by professional category and gender, with nurses and doctors as well as men presenting the highest rates claiming that they would receive the vaccine. Conclusions: this study showed the positive disposition of the healthcare staff towards current vaccines against SARS-CoV-2. Moreover, almost all healthcare professionals involved showed high concern for the possibility to infect a relative with the disease, or the possibility of becoming infected. The fact that said professionals were working with patients positive for COVID-19 at that time had no impact on their decision to receive the vaccine.(AU)

Intensive care unit professionals during the COVID-19 pandemic in Spain: social and work-related variables, COVID-19 symptoms, worries, and generalized anxiety levels.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 outbreak has been identified as a pandemic and global health emergency. It presents as a severe acute respiratory disease. The rapid dissemination of the disease created challenges for healthcare systems and forced healthcare workers (HCWs) to deal with many clinical and nonclinical stresses. The aim of our research is to describe work conditions, symptoms experienced by HCWs, worries about contagion, and generalized anxiety symptoms and compare those findings across regions in Spain. METHODS: This cross-sectional study was conducted using an online survey. Critical care units throughout Spain were included. The sample comprised HCWs working in intensive care units from March to May 2020. We assessed work variables, physical symptoms, worries about contagion, and anxiety (generalized anxiety disorder-7 questionnaire). RESULTS: The final sample comprised 448 surveys. Among the respondents, 86.9% (n=389) were nursing professionals, and 84.8% (n=380) were women. All participants cared for coronavirus disease 2019 (COVID-19) patients during the study period. Workload during the pandemic in Madrid was judged to be higher than in other regions (P<0.01). The availability of personal protective equipment was found to be higher in Cataluña. The most frequently experienced symptom was headaches (78.1%). Worries about self-infection and the possibility of infecting others received mean scores of 3.11 and 3.75, respectively. Mean scores for generalized anxiety levels were 11.02, with 58.7% of the professionals presenting with generalized anxiety syndrome during the assessment. CONCLUSIONS: In this study, we found high levels of anxiety among HCWs caring directly for COVID-19 patients, which could produce long-term psychological alterations that still need to be assessed.

Stress and quality of life of intensive care nurses during the COVID-19 pandemic: Self-efficacy and resilience as resources.

BACKGROUND: Health care workers employed in the COVID-19 emergency are at a high risk of stress. AIMS AND OBJECTIVES: To explore the mediating roles of self-efficacy and resilience between stress and both physical and mental quality-of-life components in intensive care nurses during the COVID-19 pandemic. DESIGN: Cross-sectional survey design. METHODS: The stress subscale (depression, anxiety, and stress scale in Spanish Scale, DASS-21), the summary components (physical and mental) of health-related quality of life (SF-36), the general self-efficacy scale (GSES), and the resilience scale (RS-14) were administered in 308 intensive care nurses. Serial multiple mediator models were used. RESULTS: There was a significant indirect effect of levels of perceived stress on both physical and mental health components through self-efficacy and resilience. Specifically, greater perception of self-efficacy was associated with a lower perception of stress and greater resilience, while higher resilience was associated with greater physical and mental health (B = -0.03; SE = 0.02; 95% confidence interval [CI] = [-0.07, -0.01]; B = -0.03, SE = 0.01, 95% CI = [-0.07, -0.01], respectively). It was observed that self-efficacy alone also mediates the relationship of the perception of stress on the components of physical and mental health (B = -0.07; SE = 0.05; 95% CI = [-0.18, -0.03]; B = -0.09; SE = 0.04; 95% CI = [-0.17, -0.24], respectively). However, resilience alone was not a significant mediator of these associations. CONCLUSIONS: It can be concluded that stress is linked to the physical and mental health components related to quality of life through self-efficacy and resilience. RELEVANCE TO CLINICAL PRACTICE: These psychological resources would allow the nursing staff to maintain a good quality of life despite high levels of stress. These findings have implications for future research in terms of both model testing and clinical application.

Resilience and anxiety among intensive care unit professionals during the COVID-19 pandemic.

BACKGROUND: The situation of the COVID-19 global pandemic has generated an unprecedented state of emergency worldwide that has had a psychological impact on health care workers working in the ICU and this has created the need to implement different psychological strategies. AIM: This study explores (a) the prevalence of symptoms associated with generalized anxiety disorder (GAD), (b) the relationship between GAD symptoms and resilience skills, and (c) which of the resilience skills were associated with a probable GAD among the ICU professionals during the COVID-19 pandemic. STUDY DESIGN: Cross-sectional survey design. METHODS: We explored anxiety and resilience in 448 ICU health care workers using an online survey. RESULTS: The participants showed high resilience levels and more than half of them presented symptoms consistent with a possible diagnosis of GAD. The GAD symptoms were more prevalent among women, nursing assistants, interns, staff who worked on rotation and health care workers who had to attend to more than 20 COVID patients. Significant negative correlations between resilience skills and GAD symptoms were found. The multiple regression analysis showed that resilience skills contribute to 14.4% of the variance for GAD symptoms. The binary logistic regression showed that the only skill that had a significant and negative predictive effect was "I usually take things in my stride" (OR = 0.774, 95% CI 0.67, 0.88; P = .000). This ability was the differentiating skill between professionals who equal or exceed the cut-off point established for the diagnosis of a probable GAD regarding those who do not. CONCLUSION: ICU professionals developed symptoms consistent with a possible diagnosis of GAD due to their exposure to extremely stressful circumstances. However, resilience skills acted as a protective factor. RELEVANCE TO CLINICAL PRACTICE: The importance of incorporating programmes that mitigate these psychological effects and to promote adaptive coping styles during pandemics has become a need after what ICU professionals have gone through.

Oesophageal bezoar as a complication of enteral nutrition in critically ill patients. Two case studies.

Enteral nutrition has a relatively low incidence of major complications. The most common complications are mechanical problems, bronchoaspiration and diarrhoea. A rare complication associated with the use of enteral nutrition is oesophageal bezoar. A bezoar is a body of undigested and partially digested matter in the gastrointestinal tract. The main risks factors are gastric motility dysfunction and the use of opiates or sucralfate. The aim of this paper was to present two cases of oesophageal obstruction resulting from the formation of bezoars due to enteral nutrition. Both patients experienced prolonged stays in the intensive care unit and were receiving enteral nutrition, and both cases involved an obstruction of the nasogastric tube and the regurgitation of solid chunks of enteral nutrition through the mouth and the nose. Impactions of solidified enteral nutrition in the distal parts of the oesophagus were confirmed with gastroscopies. Enzymatic complexes containing papain, cellulose, pancreatin, pepsin and diastase were used to successfully dissolve the bezoars in both cases.