Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Background A wide range of evidence has shown that healthcare workers, currently on the frontlines in the fight against COVID-19, are not spared from the psychological and mental health-related consequences of the pandemic. Studies synthesizing the role of coping behaviours, psychological resilience, and social support in safeguarding the mental health of HCWs during the pandemic is largely unknown. Aim (s) To appraise and synthesize studies examining psychological resilience, coping behaviours, and social support among healthcare workers (HWCs) during the coronavirus pandemic. Design This is a systematic review with a narrative synthesis. Method Using articles from PubMed, CINAHL, SCOPUS, MEDLINE and PsychINFO, a total of 31 articles were included in the review. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta□Analyses statement guidelines. Results Healthcare workers were found to have moderate to high levels of psychological resilience and utilized both problem-centred coping (e.g., use of social support, praying) and emotion-centred coping (e.g., use of diversionary activities) to manage the stress-associated with the coronavirus pandemic. Coping behaviours, psychological resilience, and social support were associated with positive mental and psychological health outcomes. Conclusion Substantial evidence supports the effectiveness of coping behaviours, psychological resilience, and social support to preserve psychological and mental health among HCWs during the COVID-19 pandemic. Relevance to Practice In order to safeguard the mental health and well-being of HCWs during the pandemic, hospital and nursing administrators should focus on building coping skills, psychological resilience, and social support in HWCs through innovative and theory-based interventions, supportive leadership, and fostering a resilient work environment.

https://medrxiv.org/content/10.1101/2020.11.05.20226415v1.full.pdf

Psychological resilience, coping behaviours, and social support among healthcare workers during the COVID-19 pandemic: a systematic review of quantitative studies

AIM: To appraise and synthesize studies examining resilience, coping behaviours and social support among health care workers during the coronavirus pandemic. BACKGROUND: A wide range of evidence has shown that health care workers, currently on the frontlines in the fight against COVID-19, are not spared from the psychological and mental health-related consequences of the pandemic. Studies synthesizing the role of coping behaviours, resilience and social support in safeguarding the mental health of health care workers during the pandemic are largely unknown. EVALUATION: This is a systematic review with a narrative synthesis. A total of 31 articles were included in the review. KEY ISSUES: Health care workers utilized both problem-centred and emotion-centred coping to manage the stress associated with the coronavirus pandemic. Coping behaviours, resilience and social support were associated with positive mental and psychological health outcomes. CONCLUSION: Substantial evidence supports the effectiveness of coping behaviours, resilience and social support to preserve psychological and mental health among health care workers during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: In order to safeguard the mental health of health care workers during the pandemic, hospital and nursing administrators should implement proactive measures to sustain resilience in HCWs, build coping skills and implement creative ways to foster social support in health care workers through theory-based interventions, supportive leadership and fostering a resilient work environment.

Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies.

BACKGROUND: Pandemic fatigue is an emerging health concern among frontline clinical nurses as a consequence of the ongoing coronavirus pandemic and the various measures implemented to slow the spread of infection. As yet, no studies have investigated the link between pandemic fatigue and resilience, mental health, sleep quality and job contentment in frontline clinical nurses. AIM: This study examined the influence of pandemic fatigue on clinical nurses' mental health, sleep quality and job contentment, with resilience as a mediator. METHODS: This was a descriptive, cross-sectional study involving 255 frontline clinical nurses in the Philippines. The Pandemic Fatigue Questionnaire, Brief Resilience Scale, Job Contentment Scale, and the Sleep Quality Scale were used to collect data through an online survey. RESULTS: The mean pandemic fatigue score was 3.086 (out of 5). Being vaccinated (s = 0.231, p < 0.001) and increased staffing levels (s = -0.488, p < 0.01) were associated with decreased pandemic fatigue in clinical nurses. Resilience partially mediated the relationships between (a) pandemic fatigue and mental health (s = -0.488, p < 0.001), (b) pandemic fatigue and sleep quality (s = -0.326, p < 0.001) and (c) pandemic fatigue and job contentment (s = -0.395, p < 0.001). CONCLUSION: Clinical nurses who received a COVID-19 vaccine and those who perceived sufficient staffing in their units reported lower levels of pandemic fatigue. Resilience reduces the effects of pandemic fatigue on clinical nurses' mental health, sleep quality and job contentment. IMPLICATIONS FOR NURSING MANAGEMENT: By providing frontline nurses with access to COVID-19 vaccines and ensuring a sufficient staffing levels, nurse managers could effectively reduce or prevent pandemic fatigue and improve their mental health. Implementing resilience-promoting measures are essential to support nurses' mental health, promote their sleep quality and foster job satisfaction.

Pandemic Fatigue And Clinical Nurses' Mental Health, Sleep Quality And Job Contentment During The COVID-19 Pandemic: The Mediating Role Of Resilience.

Resilience as a mediator between compassion fatigue, nurses’ work outcomes, and quality of care during the covid-19 pandemic

The COVID-19 pandemic has instigated significant changes for health care systems. With clinician burnout rising, efforts to promote clinician resilience are essential. Within this quality improvement project, an interprofessional debriefing program (Brigham Resilience in COVID-19-pandemic Emergency Forum-BRIEF) was developed within two emergency departments (EDs). An interprofessional group of ED providers led optional, nightly debriefings using a web-based portal to connect with ED clinicians for six weeks. In total, 81 interprofessional staff participated in nightly debriefings with a 47% attendance rate. On average, three participants attended the BRIEF nightly (range = 2-8) to discuss the challenges of social distancing, scarce resources, high acuity, clinician burnout and mental health. Participation increased as rates of COVID-19 positive patients rose. Debriefing leaders provided ED leadership with summaries of clinician experiences and suggestions for improvements. Feedback supported quality improvement initiatives within the ED and greater mental health support for staff. Clinicians and administrators provided positive feedback regarding the program's impact on clinician morale, and clinical processes that promoted the safety and quality of patient care. Optional debriefing with receptive departmental leadership may be a successful tool to support clinicians and hospitals during critical events.

Bolstering clinician resilience through an interprofessional, web-based nightly debriefing program for emergency departments during the COVID-19 pandemic.

A Pivot to Palliative: An Interdisciplinary Program Development in Preparation for a Coronavirus Patient Surge in the Emergency Department.

Background: Most older adults visit the emergency department (ED) near the end of life without advance care planning (ACP) and thus are at risk of receiving care that does not align with their wishes and values. ED GOAL is a behavioral intervention administered by ED clinicians, which is designed to engage seriously ill older adults in serious illness conversations in the ED. Seriously ill older adults found it acceptable in the ED. However, its potential to be used by nurses remains unclear. Objective: The aim of this study is to identify refinements to adapt an ED-based ACP intervention by eliciting the perspectives of nurses. Design: This is a qualitative study using semistructured interviews. Data were analyzed using axial coding methods. Setting/Subjects: We recruited a purposeful sample of ED nurses in one urban academic ED and one urban community ED in the northeastern region of the United States. Results: Twenty-five nurses were interviewed (mean age 46 years, 84% female, and mean clinical experience of 16 years). Emerging themes were identified within six domains: (1) nurses' prior experience with serious illness conversations, (2) overall impression of ED GOAL, (3) refinements to ED GOAL, (4) implementation of ED GOAL by ED nurses, (5) specially trained nursing model, and (6) use of telehealth with ED GOAL. Conclusions: ED nurses were generally supportive of using ED GOAL and provided insight into how to best adapt and implement it in their clinical practice. Empirical evidence for adapting ED GOAL to the nursing practice remains to be seen.

Andrew Dundin

Papers

Bolstering clinician resilience through an interprofessional, web-based nightly debriefing program for emergency departments during the COVID-19 pandemic.

A Pivot to Palliative: An Interdisciplinary Program Development in Preparation for a Coronavirus Patient Surge in the Emergency Department.

Refinement of an Emergency Department-Based, Advance Care Planning Intervention for Nurses.