The COVID-19 pandemic has impacted healthcare workers physically and psychologically.[1] Healthcare workers are more vulnerable to COVID-19 infection than the general population due to frequent contact with positive COVID-19 patients.[2] Healthcare workers have been required to work under stressful conditions without proper protective equipment, and make difficult decisions involving ethical implications. Health and social systems across the globe are struggling to cope. The situation is especially challenging in humanitarian, fragile and low-income country contexts, where health and social systems are already weak. Services to provide sexual and reproductive health care risk being sidelined, which will lead to higher maternal mortality and morbidity.[3][4]
Challenges
editInfection
editThe World Health Organization reported that one in ten health workers is infected with coronavirus in some countries.[1] In March 2020, 9% of those affected with COVID-19 in Italy were health workers.[5] In May 2020, the International Council of Nurses reported that at least 90,000 healthcare workers have been infected and more than 260 nurses had died due to the COVID-19 pandemic.[6] In March 2020, one in four doctors in the UK were off sick, in isolation or caring for a family member with COVID-19.[7]
The UK government announced that retired healthcare professionals would be brought out of retirement to help during the COVID-19 crisis. This led to concerns that they could be at a higher risk for severe COVID-19 illness.[8]
Shortage of PPEs
editShortcomings of personal protective equipment have been reported from several countries.[9][8] In China, inadequate staff training, shortage of PPEs, reduced understanding of PPE use and confused PPE guidance have resulted in infections and deaths among healthcare workers.[10]
In the United States, many hospitals have reported a shortage of PPE for hospital staff.[11] As COVID-19 cases increase, it is suggested that the United States will need far more surgical masks than they currently have.[11]
One unique study used a qualitative style of research by conducting interviews to record nurses’ feedback on staff shortages, long hours, and uncooperative patients. One profound participant responded, “I am not able to sleep at all and even if I do then by that time it is already time to wake up”.[12] The nurses have been overworked by having to fill in for staff shortages on top of the more demanding working conditions. Another response read, “wearing PPE was the most troublesome. No food or water for 12 h”.[12] PPE accessibility varied in many countries, but all countries faced similar shortages of the proper supplies to protect them when working in a highly infectious environment every day.
The shortage of PPE has put many healthcare workers at risks for getting infected with COVID-19. Healthcare workers have created unconventional solutions to make up for the lack of PPE by using the resources they do have in stock. Healthcare workers have definitely had to get creative when it comes to PPE! They have used plastic bags as gowns and plastic water bottle cutouts for eye protection.[13] The shortage of PPE is even worse for hospitals in low income communities. Items such as PPE have always been scare commodities in low income countries.[14] Low income countries also are receiving the vaccine at a slower rate due to unequal distribution. Developing countries can not properly store and produce the vaccine to be able to vaccinate the population as quick as other developed countries. UICEF reported that the organization was only able to acquire one tenth of the 240 million masks requested by these communities.[14] While PPE becomes less effective at protecting against illness as it is reused, prolonged wear also causes skin damage for 97% of healthcare workers.[15] Skin damage is most commonly occurring on the bridge of the nose, caused by irritation from face masks.
Deaths
editNurse and doctor deaths due to COVID-19 have been reported from several countries.[5][16] In May 2020, they added that at least 260 nurses have died due to COVID-19. In March 2020, at least 50 doctors were reported to have died in Italy due to COVID-19.[17] The number of deaths in Italy continued to go up. By April 2020, the estimated number of medical doctor deaths was about 119 and for nurses about 34.[18] Two of the deaths within those who were nurses were suicides due to unsustainable pressure at work.[18]
On 8 August 2020, the Indian Medical Association announced that 198 doctors have died in India due to COVID-19.[19] By February 2021, the Indian Medical Association said the number of deaths of doctor in India due to COVID-19 had increased to 734;[20][21] however the government of India said that only 162 doctors had died due to COVID-19.[20]
Understaffing
editAt this point in time, it seems like everyone is struggling with understaffing, this is also true for the healthcare field. Even before the pandemic understaffing in the medical field was not uncommon throughout history. However, through the Covid fight, the impact of understaffing has been amplified. In an observational research study, Lasater and other researchers, showed that nurses' workloads were very high and that half of the nursing staff was experiencing burnout.[22] It was also discovered that “Unfavorable patient and nurse outcomes are strongly associated with poorer nurse staffing”.[22] Without the proper staffing to handle the influx of Covid patients nurses can not provide patients with the best care. They simply do not have the employees to account for all the patients
Rising to the challenge
editCOVID-19 has affected everyone and, “The nursing literature and social media are awash with stories of nurses exhausted, frightened, sometimes discriminated against, feeling burnt out, overworked, demoralized by ineffectual leadership of governments and health systems, or frustrated with the indifference of the public to adhere to public health regulations''.[23] These challenges are impacting the nursing community so much that it is affecting them mentally and physically. Burnout in nurses is very serious and without intervention, it leads to diminished patient care[24]. Not only do these nurses have to deal with the added stress of being overworked, but they are also falling victim to the virus as well. “ICN's believes that about 10% of COVID-19 cases globally are among healthcare workers”.[23] Nurses are the publics’ defense in the pandemic, but because of the lacking resources, the nurses cannot totally protect themselves or provide the best patient care. Learning from and adapting from problems is exactly how they are solved. Solutions are not instantaneous and they are not always apparent, but as they say “where there's a will there's a way”. In another research study its brought to light that during the pandemic perceived stress was lowered, because of the national support.[25] This study shows that nurses are resilient and are rising to the new challenges with the support of others.
Psychological impact
editHigher levels of depression and burnout have been seen in healthcare workers as a direct result of COVID-19. In one experiment scientists reported that “more than 28% of the sample reported high levels of emotional exhaustion, except for other non-COVID healthcare workers”[28] In addition more than 50% of the sample reported low levels of depersonalization, except for COVID nurses and physicians, who reported high levels of depersonalization in 36.73% of the cases.[28] Depersonalization can be defined as a sense of detachment from oneself and one's identity. Taking this into consideration, it is easy to conclude that as a result of COVID-19 the mental health of health care workers has degraded. In addition, when evaluating the results of another study led by Dr. Woon et al., the prevalence rates of depression as a result of COVID-19 were as high as 21.8% and participants with extremely severe depression made up 13.3% of the sample.[29]
Healthcare workers are at risk for developing trauma or other stress-related disorders due to fears of falling ill and not knowing what will happen in the future.[30] Post-traumatic stress was common among health workers, with nurses demonstrating a higher likelihood of developing or having anxiety among others in the medical field.[31]
The severity of these psychological impacts on healthcare workers in the United States has even resulted in stress-related illnesses which could cause serious health related issues.[32] Some of these stress-related illnesses include cardiovascular disease, gastrointestinal symptoms, and musculoskeletal disorders.[33]
Due to the stress from the Coronavirus many nurses are facing compassion fatigue and burnout. Part of burnout is due to a nursing shortage, there are more patients than nurses are used to taking care of at once. Increasing workload has made longer shifts for most nurses, lack of enthusiasm, and many have become emotionally drained.[34]
As the COVID-19 pandemic escalated, widespread anxiety grew and culminated in decreased desire and interest to pursue hospital-based care.[35] Consider the intense fear of a patient adamantly refusing to visit a health facility and resorting to recuperate from the comfort of their homes to avoid the COVID-19 anguish. The anxiety was far-reaching as the COVID-19 scare deepened. Patients, especially those with underlying or chronic conditions chose to stay at home or seek alternative interventions just to avoid interacting with medical personnel or appearing in public spaces. Albeit being driven by formed opinion, their hesitation and self-preservation offer clear lenses through which to view the existing gaps within the public health discourse.[35] It was the hallmark of public health breakdown as unchecked and un-intervened health conditions aggravated. It also subjected public health to scrutiny as patients skipped or delayed routine screenings while emergent ailments remained undressed. The COVID-19 pandemic scare yielded profound implications for populations, questioning the overall posture and prospect of public health interventions.
Literature highlights that avoidance and deferral behaviors and trends can trigger debilitating health outcomes[36]. These behaviors create enabling conditions for diseases to flare up and become less manageable. The trend is typical of delayed diagnoses, which enable the progression of chronic conditions leading to increased casualties. The psychological impact culminating in avoidance and deferral presents scholars with new lenses for analyzing these trends.
The COVID-19 pandemic created extensive anxiety across diverse healthcare settings. These anxieties resulted in systematic avoidance and deferrals as populations resorted to the behaviors in response to the COVID-19 scare[37]. These trends affected populations across diverse demographics, leading to debilitating care outcomes. Future efforts should foster innovative strategies such as telehealth, public education, and patient-centered interventions to expand healthcare scope and reduce the overall impact related to public health scare.
There are so many burdens that healthcare workers face due to working on the front line of the pandemic. The results showed that work burnout can be a major factor for the healthcare workers on top of other emotional challenges. [38]
It is possible that these statistics may be so significant due to self-isolating or being in quarantine. Wu et al. explain that after conducting their research they had found that those who have participated in these activities reported more symptoms of depression.[39] In contrast, researchers suspect that the depression and/ or burnout that healthcare workers are experiencing may not be from COVID-19 directly, but as a result of the situation it has put their families in and/or themselves in. It is said that as a result of COVID-19 the workload of healthcare providers has increased tremendously, possibly leaving the worker feeling drained and unable to catch up.
Global impacts
editA study from Singapore showed that healthcare workers caring for patients with COVID-19 reported anxiety, depression and stress.[40] Increasing work demands on healthcare professionals conflict with their duties to family and friends, which causes psychological stress.[8] Healthcare professionals reported being anxious about having to self-isolate, quarantine or becoming ill.[41] For healthcare workers, being quarantined was positively associated with minimizing direct contact with patients and not reporting to work.[42]
An Italian nurse committed suicide after being traumatized trying to save the lives of those with COVID-19.[43]
In Mexico, healthcare professional have also reported high levels of anxiety, because of the fear of being an asymptomatic patient, which could potentially lead to the unknowingly spread of the disease amongst their patients and their families.[44]
Healthcare workers like nurses, doctors and other medical staff that worked on the front-lines in China experienced symptoms of anxiety, depression and difficulty sleeping.[45] More specifically, about 46.04% had anxiety, 44.37% had depression, and 28.75% experienced insomnia.[45] In Wuhan, China, over 70% of healthcare workers reported psychological distress.[46]
In India, during the peak of the second wave of COVID-19, a before-after image of an Indian doctor named Dr. Sohil Makwana wearing a PPE kit and drenched in sweat after removing the PPE kit went viral internationally.[47] That image represented the condition of all doctors and frontline workers, and it created awareness about how cumbersome for doctors to work for unrealistically long hours inside PPE kits amid the rapid second wave of the coronavirus pandemic.The image clearly resonated with many, as it was retweeted nearly 17,000 times and received more than 132,000 likes.[48]
Violence against healthcare workers
editHealthcare workers have been subjected to violent crimes, such as assault. Hospitals and governments have taken stricter measures to ensure the safety of their staff; however, many healthcare workers still face significant risk of physical injury.[47]
Because of COVID-19, healthcare personnel have experienced over 600 instances of negativity directed towards them in different forms. In Pakistan, doctors were attacked by family members of a deceased patient who succumbed to COVID-19. Residents of a community in Bangladesh forced a doctor who was COVID-19 positive and his family to leave his home and the area by throwing bricks at their home.[49]
Research has shown that Egyptian healthcare workers reported high rates of verbal assault in the midst of the COVID-19 pandemic. With 93% of participants who reported violence having experienced verbal violence, and a 65.4% of reporting healthcare workings identifying as female. [50]
Ethical decisions
editThe Conversation reports that healthcare workers will have to face 'moral injury' for making difficult decisions such as moving a patient off the ventilator or refusing an ICU bed due to limited resources.[8] COVID-19 has forced healthcare workers to make many difficult ethical decisions. These include concerns for the safety of spreading COVID-19 to their families since the risk is higher when they work and care for COVID-19 patients, deciding how to distribute limited resources such as ventilators among many patients who all need it, and deciding at what point healthcare workers should stay home instead of continue to go to work if they suspect they might have been exposed to COVID-19.[51]
Two studies have shown that nurses during the pandemic are facing extreme stress. Nurses are experiencing one of the highest rates of occupational stress compared to other professions. COVID-19 has changed the way nurses care for patients, many patients needed to have virtual appointments rather than face to face care because of nurses caring for patients with COVID-19. This also has been shown in several studies that isolation meant that nurses could not go home to their loved ones, making that a virtual experience too.[52] They feared that they would infect their loved ones at home, so many did not see their families for extended periods of time.[53] Many nurses stated that they feel unsafe in their work environment, risking their own health, and a lack of support by their organization.
Impact on staff
editFemale staff
editGlobally, women make up 70 percent of workers in the health and social sector. Women are playing a disproportionate role in responding to the disease, whether that be as front line healthcare workers, careers at home or community leaders and mobilisers. In some countries, COVID-19 infections among female health workers are twice that of their male counterparts.[54][55][56] Women are still paid much less than their male counterparts in almost all countries and hold fewer leadership positions in the health sector. Masks and other protective equipment designed and sized for men leave women at greater risk of exposure.[54][55][56][57]
During the COVID-19 pandemic, rates of burnout are higher in female healthcare workers than male workers. The percentage of females enduring anxiety while working in healthcare if over twice as much as males.[58][59] Female healthcare workers were 55% more likely to report burnout compared to their male coworkers.
All staff
editThe pandemic caused the nursing community a lot of stress. A national cross-sectional survey found that “71.4% of doctors and 74.4% of nurses experienced moderate-to-severe perceived stress”.[60] In another Covid based study, the nurses all share common themes that include, working over hours, fear of contraction, limited supplies, endless patients, and self-sacrifice.[61] Similarly in a cross-sectional survey, the researchers concluded that a high percentage of the resilient nurses surveyed report high-stress levels and/or PTSD symptoms.[62] The survey also identifies eight major themes, “revealed from nurses' free-text responses: (a) working in an isolated environment, (b) PPE shortage and the discomfort of pronged usage, (c) sleep problems, (d) intensity of workload, (e) cultural and language barriers, (f) lack of family support, (g) fear of being infected, and (h) insufficient work experiences with COVID-19”[62] A lot of these concerns are a direct result or exacerbated by the COVID-19 pandemic. The recent shortage of nurses has caused a nursing burnout which is affecting individuals and their workloads. Nurses are having an increase level of stress and mental disorders due to the increase in workload and number of patients they are getting.[63]
Health care workers have experienced physical and mental health side effects because of the COVID-19 pandemic. Common mental health conditions include PTSD (post traumatic stress disorder), depression, anxiety disorders, and stress disorders. [64] These mental side effects caused difficulties amongst health care workers not only during the pandemic, but also after the pandemic was considered over. Healthcare workers experienced tremendous amounts of stress during the pandemic which had effects on mental and physical health.
Recommendations
editWorld Health Organization
editThe World Health Organization has given the following key recommendations to decrease the spread of COVID-19 among healthcare workers:[1]
- Training healthcare workers to identify respiratory diseases
- Providing increased access to personal protective equipment
- Providing psychological support to health workers
- Routinely conducting hospital surveillance
- Recognizing that every healthcare system can have gaps
Centers for Disease Control and Prevention
editThe Centers for Disease Control and Prevention has issued guidance on preventing transmission and reducing job stress in response to the COVID-19 pandemic for healthcare workers:
Infection prevention
edit- Implement telehealth protocols where possible[65][66]
- Screen ever one entering a healthcare facility for COVID-19 symptoms
- Use appropriate face coverings dependent upon the procedure (i.e. N95s for aerosol-generating procedures)
- Establish a plan to identify and track suspected and confirmed cases to promptly impose quarantine measures
- Re-arrange waiting areas and install barriers to encourage physical distancing
- Practice hand hygiene and frequent disinfection of surfaces
Managing job stress
editA 2020 Cochrane review found that among healthcare workers there is low certainty evidence that resilience training may lead to greater levels of individual resilience for healthcare workers.[67] Due to limitations in the reviewed studies (44 RCTs), the authors advise caution in drawing definitive conclusions and recommend more studies with improved designs.[67]
Other recommendations:
- Stay in communication with coworkers and supervisors about job stress[68]
- Maintain a consistent sleep and meal schedule
- Eat healthy foods
- Develop healthy coping mechanisms[69]
- Get exercise and make time for hobbies outside of work
- Take breaks from watching, reading, and listening to the news
- Practice mindfulness techniques, such as breathing exercises and meditation
- Talk to a mental health professional if needed
- Technology (online counseling) can provide physiological support in order to reduce the risk of insomnia, anxiety, and depression/burnout.[29]
UNFPA
editUNFPA recommends that all women and girls must have access to a continuum of sexual and reproductive health services[70]. In accordance to national guidelines and standards, some services for women and girls include antenatal, perinatal and postnatal care, and screening tests.[3][4]
Karolinska Institute
editThe Karolinska Institute recommends health workers to take care of oneself, avoid unhelpful strategies, stay in touch with loved ones, not blame oneself and reach out if physical or psychological help is required.[71]
Sources
editThis article incorporates text from a free content work. Licensed under CC BY-SA 3.0 IGO (license statement/permission). Text taken from Explainer: How COVID-19 impacts women and girls, UN Women.
References
edit- ^ a b c "How to protect health workers now: WHO Hay COVID-19 briefing". World Economic Forum. 10 April 2020. Retrieved 13 May 2020.
- ^ Trivedi, Ashish; Fontelera, Maria; Ishak, Norzawani; Lai, Alice; Win, Kyaw N; Ismail, Khalifah; Koh, David (May 2022). "Healthcare workers' preparedness and response during COVID-19 pandemic". Proceedings of Singapore Healthcare. 31. doi:10.1177/20101058211050752. ISSN 2010-1058. PMC 9720055.
- ^ a b Continuing essential Sexual, Reproductive, Maternal, Neonatal, Child and Adolescent Health services during COVID-19 pandemic (PDF). World Health Organization, UNFPA, UNICEF. 2020.
- ^ a b Coronavirus Disease (COVID-19) Pandemic UNFPA Global Response Plan (PDF). UNFPA. 2020.
- ^ a b Mitchell G (20 March 2020). "Nurses among confirmed deaths from Covid-19 around the world". Nursing Times. Retrieved 13 May 2020.
- ^ "90,000 healthcare workers infected with COVID-19: ICN". www.aa.com.tr. Retrieved 13 May 2020.
- ^ "Covid-19: One in four doctors off sick or in isolation". ITV News. Retrieved 13 May 2020.
- ^ a b c d Taegtmeyer M, Wingfield T. "Healthcare workers and coronavirus: behind the stiff upper lip we are highly vulnerable". The Conversation. Retrieved 13 May 2020.
- ^ "Begging for Thermometers, Body Bags, and Gowns: U.S. Health Care Workers Are Dangerously Ill-Equipped to Fight COVID-19". Time. Retrieved 13 May 2020.
- ^ Wang J, Zhou M, Liu F (May 2020). "Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China". The Journal of Hospital Infection. 105 (1): 100–101. doi:10.1016/j.jhin.2020.03.002. PMC 7134479. PMID 32147406.
- ^ a b Ranney ML, Griffeth V, Jha AK (April 2020). "Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic". The New England Journal of Medicine. 382 (18): e41. doi:10.1056/NEJMp2006141. PMID 32212516. S2CID 214643757.
- ^ a b Chahal S, Govil N, Gupta N, Nadda A, Srivastava P, Gupta S, Dang P (2020-07-30). "COVID Related Original Research: Stress, coping and attitudinal change towards medical profession during COVID-19 Pandemic among health care professionals in India: a cross sectional study" (PDF). Indian Journal of Mental Health. 7 (3): 255. doi:10.30877/IJMH.7.3.2020.255-262. ISSN 2394-6652. S2CID 226377479.
- ^ Livingston E, Desai A, Berkwits M (May 2020). "Sourcing Personal Protective Equipment During the COVID-19 Pandemic". JAMA. 323 (19): 1912–1914. doi:10.1001/jama.2020.5317. PMID 32221579. S2CID 214694823.
- ^ a b McMahon DE, Peters GA, Ivers LC, Freeman EE (July 2020). "Global resource shortages during COVID-19: Bad news for low-income countries". PLOS Neglected Tropical Diseases. 14 (7): e0008412. doi:10.1371/journal.pntd.0008412. PMC 7337278. PMID 32628664.
- ^ Shaukat N, Ali DM, Razzak J (July 2020). "Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review". International Journal of Emergency Medicine. 13 (1): 40. doi:10.1186/s12245-020-00299-5. PMC 7370263. PMID 32689925.
- ^ "A striving school nurse, a devoted pharmacist: the US health workers who died from Covid-19". The Guardian. 12 May 2020. Retrieved 13 May 2020.
- ^ "50 doctors have now died in Italy as health system struggles amid coronavirus epidemic". The Independent. 28 March 2020. Retrieved 13 May 2020.
- ^ a b Lapolla P, Mingoli A, Lee R (March 2021). "Deaths from COVID-19 in healthcare workers in Italy-What can we learn?". Infection Control and Hospital Epidemiology. 42 (3): 364–365. doi:10.1017/ice.2020.241. PMC 7256220. PMID 32408922.
- ^ "IMA says nearly 200 doctors in India have succumbed to COVID-19 so far; requests PM's attention". Economic Times. 8 August 2020. Retrieved 9 August 2020.
- ^ a b "IMA refutes govts data, says 734 doctors died due to Covid-19, condemns Centres apathy". Hindustan Times. 2021-02-03. Retrieved 2021-02-13.
- ^ "IMA publishes list of 382 doctors who died due to Covid-19, demands they be treated as martyrs". Hindustan Times. 2020-09-16. Archived from the original on 2021-03-10. Retrieved 2021-02-13.
- ^ a b Lasater KB, Aiken LH, Sloane DM, French R, Martin B, Reneau K, et al. (August 2021). "Chronic hospital nurse understaffing meets COVID-19: an observational study". BMJ Quality & Safety. 30 (8): 639–647. doi:10.1136/bmjqs-2020-011512. PMC 7443196. PMID 32817399.
- ^ a b Turale S (June 2021). "COVID-19: Looking to the future of nursing: innovations & policy recommendations". International Nursing Review. 68 (2): 139–140. doi:10.1111/inr.12687. ISSN 0020-8132. PMC 8207033. PMID 34053075.
- ^ Ghahramani, Sulmaz; Lankarani, Kamran Bagheri; Yousefi, Mohammad; Heydari, Keyvan; Shahabi, Saeed; Azmand, Sajjad (2021-11-10). "A Systematic Review and Meta-Analysis of Burnout Among Healthcare Workers During COVID-19". Frontiers in Psychiatry. 12. doi:10.3389/fpsyt.2021.758849. ISSN 1664-0640. PMC 8631719. PMID 34858231.
- ^ Zhang M, Zhang P, Liu Y, Wang H, Hu K, Du M (June 2021). "Influence of perceived stress and workload on work engagement in front-line nurses during COVID-19 pandemic". Journal of Clinical Nursing. 30 (11–12): 1584–1595. doi:10.1111/jocn.15707. PMC 8014711. PMID 33590524.
- ^ Brown, Natalie (2021-05-01). "Viral picture reveals India's nightmare". news.com.au. Retrieved 2022-02-12.
- ^ "Exhausted doc in India goes viral with post urging vaccinations". New York Post. 2021-05-01. Retrieved 2022-02-12.
- ^ a b Di Mattei VE, Perego G, Milano F, Mazzetti M, Taranto P, Di Pierro R, et al. (May 2021). "The "Healthcare Workers' Wellbeing (Benessere Operatori)" Project: A Picture of the Mental Health Conditions of Italian Healthcare Workers during the First Wave of the COVID-19 Pandemic". International Journal of Environmental Research and Public Health. 18 (10): 5267. doi:10.3390/ijerph18105267. PMC 8156728. PMID 34063421.
- ^ a b Woon LS, Sidi H, Nik Jaafar NR, Leong Bin Abdullah MF (December 2020). "Mental Health Status of University Healthcare Workers during the COVID-19 Pandemic: A Post-Movement Lockdown Assessment". International Journal of Environmental Research and Public Health. 17 (24): 9155. doi:10.3390/ijerph17249155. PMC 7762588. PMID 33302410.
- ^ Cabarkapa S, Nadjidai SE, Murgier J, Ng CH (October 2020). "The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review". Brain, Behavior, & Immunity - Health. 8: 100144. doi:10.1016/j.bbih.2020.100144. PMC 7494453. PMID 32959031.
- ^ Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, et al. (August 2020). "Psychological impact of COVID-19 on medical care workers in China". Infectious Diseases of Poverty. 9 (1): 113. doi:10.1186/s40249-020-00724-0. PMC 7422468. PMID 32787929.
- ^ Kim SC, Sloan C, Montejano A, Quiban C (March 2021). "Impacts of Coping Mechanisms on Nursing Students' Mental Health during COVID-19 Lockdown: A Cross-Sectional Survey". Nursing Reports. 11 (1): 36–44. doi:10.3390/nursrep11010004. PMC 8608075. PMID 34968310.
- ^ Melnyk BM, Tan A, Hsieh AP, Gawlik K, Arslanian-Engoren C, Braun LT, et al. (May 2021). "Critical Care Nurses' Physical and Mental Health, Worksite Wellness Support, and Medical Errors". American Journal of Critical Care. 30 (3): 176–184. doi:10.4037/ajcc2021301. PMID 34161980. S2CID 235584247.
- ^ Nwanya M, Rowberry D (May 2021). "The importance of understanding burnout: an oncology nurse perspective". British Journal of Nursing. 30 (10): S8–S14. doi:10.12968/bjon.2021.30.10.s8. PMID 34037439. S2CID 235202457.
- ^ a b Arias-Ulloa, Cristian Arturo; Gómez-Salgado, Juan; Escobar-Segovia, Kenny; García-Iglesias, Juan Jesús; Fagundo-Rivera, Javier; Ruiz-Frutos, Carlos (December 2023). "Psychological distress in healthcare workers during COVID-19 pandemic: A systematic review". Journal of Safety Research. 87: 297–312. doi:10.1016/j.jsr.2023.07.016. hdl:10272/23225. PMID 38081703.
- ^ Koontalay, Apinya; Suksatan, Wanich; Prabsangob, Kantapong; Sadang, Jonaid M (October 2021). "Healthcare Workers' Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review". Journal of Multidisciplinary Healthcare. 14: 3015–3025. doi:10.2147/JMDH.S330041. ISSN 1178-2390. PMC 8558429. PMID 34737573.
- ^ Tong, Jie; Zhang, Jie; Zhu, Na; Pei, Yu; Liu, Weiqing; Yu, Wei; Hu, Chengping; Sun, Xirong (2023-01-27). "Effects of COVID-19 pandemic on mental health among frontline healthcare workers: A systematic review and meta-analysis". Frontiers in Psychology. 13. doi:10.3389/fpsyg.2022.1096857. ISSN 1664-1078. PMC 9912473. PMID 36778177.
- ^ Koontalay, Apinya; Suksatan, Wanich; Prabsangob, Kantapong; Sadang, Jonaid M (October 2021). "Healthcare Workers' Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review". Journal of Multidisciplinary Healthcare. 14: 3015–3025. doi:10.2147/JMDH.S330041. ISSN 1178-2390. PMC 8558429. PMID 34737573.
- ^ Blake H, Bermingham F, Johnson G, Tabner A (April 2020). "Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital Learning Package". International Journal of Environmental Research and Public Health. 17 (9): E459–E460. doi:10.3390/ijerph17092997. PMC 7246821. PMID 32357424.
- ^ Tan BY, Chew NW, Lee GK, Jing M, Goh Y, Yeo LL, et al. (August 2020). "Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore". Annals of Internal Medicine. 173 (4): 317–320. doi:10.7326/M20-1083. PMC 7143149. PMID 32251513.
- ^ Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ (March 2020). "The psychological impact of quarantine and how to reduce it: rapid review of the evidence". Lancet. 395 (10227): 912–920. doi:10.1016/S0140-6736(20)30460-8. PMC 7158942. PMID 32112714.
- ^ Marjanovic Z, Greenglass ER, Coffey S (August 2007). "The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey". International Journal of Nursing Studies. 44 (6): 991–8. doi:10.1016/j.ijnurstu.2006.02.012. PMC 7094220. PMID 16618485.
- ^ Squires N (25 March 2020). "Italian nurse commits suicide as another 683 people die from coronavirus". The Telegraph. Archived from the original on 2022-01-12. Retrieved 13 May 2020.
- ^ Delgado-Gallegos JL, Montemayor-Garza RJ, Padilla-Rivas GR, Franco-Villareal H, Islas JF (October 2020). "Prevalence of Stress in Healthcare Professionals during the COVID-19 Pandemic in Northeast Mexico: A Remote, Fast Survey Evaluation, Using an Adapted COVID-19 Stress Scales". International Journal of Environmental Research and Public Health. 17 (20): 7624. doi:10.3390/ijerph17207624. PMC 7593933. PMID 33086744.
- ^ a b Que J, Shi L, Deng J, Liu J, Zhang L, Wu S, et al. (2020-06-14). "Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China". General Psychiatry. 33 (3): e100259. doi:10.1136/gpsych-2020-100259. PMC 7299004. PMID 32596640.
- ^ Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. (March 2020). "Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019". JAMA Network Open. 3 (3): e203976. doi:10.1001/jamanetworkopen.2020.3976. PMC 7090843. PMID 32202646.
- ^ a b "Health workers become unexpected targets during covid-19". The Economist. Retrieved 13 May 2020.
- ^ "Indian doctor shares harrowing photo showing him drenched in sweat". www.msn.com. Retrieved 2022-02-12.
- ^ Devi S (September 2020). "COVID-19 exacerbates violence against health workers". Lancet. 396 (10252): 658. doi:10.1016/S0140-6736(20)31858-4. PMC 7470723. PMID 32891198.
- ^ Seddik, Salma Abdelrehim; Abdelhai, Rehab; Aboushady, Ahmed Taha; Nawwar, Ahmed Essam; El Essawy, Rania Assem; Hegazy, Amira Aly (2023-11-16). "Violence against healthcare workers during the COVID-19 pandemic: a cross-sectional survey at Cairo University Hospital". Frontiers in Public Health. 11. doi:10.3389/fpubh.2023.1277056. ISSN 2296-2565. PMC 10693415. PMID 38045967.
- ^ Menon V, Padhy SK (June 2020). "Ethical dilemmas faced by health care workers during COVID-19 pandemic: Issues, implications and suggestions". Asian Journal of Psychiatry. 51: 102116. doi:10.1016/j.ajp.2020.102116. PMC 7187815. PMID 32371227.
- ^ Maben J, Bridges J (August 2020). "Covid-19: Supporting nurses' psychological and mental health". Journal of Clinical Nursing. 29 (15–16): 2742–2750. doi:10.1111/jocn.15307. PMC 7264545. PMID 32320509.
- ^ Arcadi P, Simonetti V, Ambrosca R, Cicolini G, Simeone S, Pucciarelli G, et al. (July 2021). "Nursing during the COVID-19 outbreak: A phenomenological study". Journal of Nursing Management. 29 (5): 1111–1119. doi:10.1111/jonm.13249. PMC 8014333. PMID 33421209.
- ^ a b "UN Secretary-General's policy brief: The impact of COVID-19 on women | Digital library: Publications". UN Women. Retrieved 2020-06-12.
- ^ a b "Gender equality matters in COVID-19 response". UN Women. Retrieved 2020-06-12.
- ^ a b "COVID-19: Emerging gender data and why it matters | UN Women Data Hub". data.unwomen.org. Retrieved 2020-06-12.
- ^ Rimmer MP, Al Wattar BH (August 2020). "Provision of obstetrics and gynaecology services during the COVID-19 pandemic: a survey of junior doctors in the UK National Health Service". BJOG. 127 (9): 1123–1128. doi:10.1111/1471-0528.16313. PMC 7283977. PMID 32460422.
- ^ Shaukat N, Ali DM, Razzak J (July 2020). "Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review". International Journal of Emergency Medicine. 13 (1): 40. doi:10.1186/s12245-020-00299-5. PMC 7370263. PMID 32689925.
- ^ Cheristanidis S, Kavvadas D, Moustaklis D, Kyriakidou E, Batzou D, Sidiropoulos E, Papazisis G, Papamitsou T. Psychological Distress in Primary Healthcare Workers during the COVID-19 Pandemic in Greece. Acta Med Acad. 2021 Aug;50(2):252-263. doi: 10.5644/ama2006-124.341. PMID 34847678.
- ^ Kader N, Elhusein B, Chandrappa NS, Nashwan AJ, Chandra P, Khan AW, Alabdulla M (August 2021). "Perceived stress and post-traumatic stress disorder symptoms among intensive care unit staff caring for severely ill coronavirus disease 2019 patients during the pandemic: a national study". Annals of General Psychiatry. 20 (1): 38. doi:10.1186/s12991-021-00363-1. PMC 8379565. PMID 34419094.
- ^ Sadang JM (2021). "The Lived Experience of Filipino Nurses' Work in COVID-19 Quarantine Facilities: A Descriptive Phenomenological Study". Pacific Rim International Journal of Nursing Research. 25 (1): 154–164.
- ^ a b Leng M, Wei L, Shi X, Cao G, Wei Y, Xu H, et al. (March 2021). "Mental distress and influencing factors in nurses caring for patients with COVID-19". Nursing in Critical Care. 26 (2): 94–101. doi:10.1111/nicc.12528. ISSN 1362-1017. PMID 33448567. S2CID 225407069.
- ^ Pines AM (May 2000). "Treating career burnout: a psychodynamic existential perspective". Journal of Clinical Psychology. 56 (5): 633–42. doi:10.1002/(sici)1097-4679(200005)56:5<633::aid-jclp5>3.0.co;2-#. PMID 10852150.
- ^ Hill, James Edward; Harris, Catherine; Danielle L., Christian; Boland, Paul; Doherty, Alison J.; Benedetto, Valerio; Gita, Bhutani E.; Clegg, Andrew J. (June 2022). "The prevalence of mental health conditions in healthcare workers during and after a pandemic: Systematic review and meta-analysis". Journal of Advanced Nursing. 78 (6): 1551–1573. doi:10.1111/jan.15175. ISSN 0309-2402. PMC 9111784. PMID 35150151.
- ^ "Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic". Centers for Disease Control and Prevention. 2020-02-11. Retrieved 2020-07-14.
- ^ Chidiebere Okechukwu E, Tibaldi L, La Torre G (2020). "The impact of COVID-19 pandemic on mental health of Nurses". La Clinica Terapeutica. 171 (5): e399–e400. doi:10.7417/CT.2020.2247. PMID 32901781. S2CID 221569645.
- ^ a b Kunzler AM, Helmreich I, Chmitorz A, König J, Binder H, Wessa M, Lieb K (July 2020). "Psychological interventions to foster resilience in healthcare professionals". The Cochrane Database of Systematic Reviews. 2020 (7): CD012527. doi:10.1002/14651858.CD012527.pub2. PMC 8121081. PMID 32627860.
- ^ "Healthcare Personnel and First Responders: How to Cope with Stress and Build Resilience During the COVID-19 Pandemic". Centers for Disease Control and Prevention. 2020-02-11. Retrieved 2020-07-14.
- ^ Hertel, R. A. (2020). The Use of Psychological PPE in the Face of COVID-19. MEDSURG Nursing, 29(5), 293–296.
- ^ Vizheh, Maryam; Qorbani, Mostafa; Arzaghi, Seyed Masoud; Muhidin, Salut; Javanmard, Zohreh; Esmaeili, Marzieh (December 2020). "The mental health of healthcare workers in the COVID-19 pandemic: A systematic review". Journal of Diabetes & Metabolic Disorders. 19 (2): 1967–1978. doi:10.1007/s40200-020-00643-9. ISSN 2251-6581. PMC 7586202. PMID 33134211.
- ^ "Covid-19: Recommendations and resources for healthcare workers Karolinska Institutet". ki.se.