Search Results (274)

Racialised minority populations were disproportionately affected by COVID-19 and saw the highest rate of COVID-19 infections and mortality. Low socioeconomic status, working as frontline workers, temporary employment, precarious immigration status and pre-existing medical conditions were factors that contributed to disadvantaged experiences. This systematic review looked at the impact of COVID-19 on racialised minority populations globally, recognising their experiences, perspectives and the effects on their physical and mental health. Eight electronic databases were searched (MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Social Sciences Citation Index (SSCI), Social Policy and Practice (SPP), Applied Social Sciences Index and Abstracts (ASSIA), MedRxiv and Research Square) for English language qualitative studies. Reference lists of relevant literature reviews and reference lists of articles were hand-searched for additional potentially relevant articles. Duplicates were removed, and articles were screened for titles and abstracts, followed by full-text screening. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included studies (n = 70). Data were synthesised using thematic synthesis. Seven major and three minor themes were identified. The major themes related to (i) children and young people’s experiences of COVID-19; (ii) exacerbated pre-existing disparities relating to income, employment and housing security, health insurance and immigration status; (iii) lack of knowledge and information about COVID-19 and COVID-19 misinformation; (iv) racial history of medicine and treatment of racialised populations; (v) contemporary experiences of racism; (vi) impact on physical and mental health and wellbeing; (vii) concerns about safety at work. Minor themes related to (a) experiences of intercommunity mutual aid; (b) adherence to preventative guidance/COVID-19 restrictions; (c) the role of faith. Research needs to focus on developing and testing interventions that support transformation of social, cultural and economic systems towards equity of access to healthcare and healthcare knowledge. Research should be cognisant of interventions that have worked in shifting the equity dial in the past, implement these and use them to inform new approaches. Policy and practice should be mechanisms for enabling the implementation of interventions. Full article

Background/Objectives: We sought to determine the factors associated with Emergency Department (ED) healthcare workers (HCW) reluctance to seek, utilize, or take advantage of psychological support services during the pandemic. Methods: A 53-item survey, delivered via REDCap, was completed by ED staff in seven hospitals between 15 July 2020 and 24 August 2020. Results: 351 participants (28.7% response rate) completed the survey with 20.1% of respondents endorsing clinically significant psychiatric symptoms and 31.7% of participants endorsing burnout. 75% of those who endorsed significant emotional symptoms did not seek formal psychological support. Most of those (33/44) who did not seek support, despite anxiety and/or depression, reported experiencing practical barriers (access, cost, time, confidentiality) while emotional barriers (not wanting to acknowledge needing help; stigma; embarrassment) were endorsed by 22.7% (10/44). Conclusions: These findings offer several opportunities for intervention, including changes to workflow and culture in the ED which may address emotional barriers to self-care and pragmatic system changes that may help address practical barriers. Full article

Background: Healthcare workers (HCWs) are at occupational risk from COVID-19. Understanding the profile of infected HCWs is important to guide workplace protections. Objectives: To describe the demographic and clinical characteristics of HCWs infected with COVID-19 and to examine factors associated with vaccination status among infected HCWs. Methods: The study design was cross-sectional, using medical records from health workers working in a tertiary teaching facility in Gauteng, South Africa, from 12 May 2021 to 11 May 2022. The data were analysed using univariate and multiple logistic regression analysis. Statistical significance was set at p < 0.05. Results: A total of 1235 HCW records were included. The age ranged from 17 to 64 years. The median age was 38 years (IQR: 32–48). Nurses accounted for the largest proportion of cases, followed by healthcare assistants and physicians. Female sex, older age, and comorbidity were associated with higher odds of being vaccinated among infected HCWs. Conclusions: This study provides a descriptive profile of HCWs infected with COVID-19 during the third and fourth wave transition in South Africa. The findings highlight demographic and clinical factors linked to vaccination status among infected HCWs and underscore the continued need for infection prevention and control measures to protect frontline staff. Full article

Background/Objectives: Vaccination is a critical public health measure for older adults in residential aged care facilities (RACFs). In Australia, COVID-19, influenza, pneumococcal, and shingles vaccines are recommended and funded for this group. However, vaccination coverage remains suboptimal, with limited understanding of the underlying causes. Methods: A mixed-methods design explored the enablers and barriers to vaccination from the perspectives of frontline providers, RACF staff, residents and family members. Descriptive statistics were used to quantify the prevalence of perceived enablers and barriers within stakeholder groups. Qualitative data—collected through open-ended questions—were analysed using manual, deductive-iterative coding to identify key themes. Key quotes illustrate the findings. Results: Input was gathered from seven in-reach geriatric staff, 40 general practitioners (GPs), 90 RACF staff, 17 RACF residents, and 84 family members of residents. Results were grouped under four key themes: operational, communication, coordination, and financial. RACF staff identified limited access to vaccination histories as the most significant barrier and relied on external providers to upload data to the Australian Immunisation Register (AIR). On-site clinics were essential, but organisational policies prevented nurse-led vaccination of residents. Most RACFs stored only influenza vaccines and depended on external providers for others. Simplified, translated information was called for. Healthcare provider and RACF endorsement was valued, but RACF staff felt ill-equipped to handle conversations around vaccine hesitancy. Consent processes were burdensome, and responsibility for tracking vaccination schedules was unclear with calls for streamlined processes. Low provider remuneration was also noted, with calls for increased government support. Conclusions: This work identifies key enablers and barriers to resident vaccination in RACFs. Improving delivery requires organisational policy change, staff support, digital access, and continued advocacy. Analysis of targeted interventions and coverage will be reported separately. The approach is replicable for other vulnerable groups. Full article

The COVID-19 pandemic exposed the fragility of global health systems, as physicians faced extremely challenging conditions including excessive workloads, infection risk, and high patient mortality. We conducted a cross-sectional survey that aimed to assess the post-pandemic prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in a sample of Greek physicians who worked on the frontline during the SARS-CoV-2 (COVID-19) pandemic. An online survey was conducted between 1 March and 31 July 2023, in which 200 Greek physicians were invited via e-mail to voluntarily answer a confidential online questionnaire, and 58 of them responded. The survey included two clinically validated tools: the Patient Health Questionnaire-4 (PHQ-4) and the Impact of Event Scale—Revised (IES-R). Univariate correlations of 26 exposure variables with anxiety, depression, combined anxiety/depression, and PTSD were performed. In total, 58 eligible physicians (46.6% female) participated in this study. The rates of anxiety, depression, combined anxiety/depression, and PTSD were 27.5% (95% CI: 16.7–40.9), 31.0% (19.5–44.5), 22.4% (12.5–35.3), and 24.1% (13.9–37.2), respectively. Notably none of the physicians working in a laboratory developed any mental health symptoms. The following factors were found to be associated with the development of higher mental health symptoms: age ≤ 30, employment in healthcare ≤ 10 years, working in COVID-19 wards, working in intensive care units or COVID-19 wards, a history of mental health symptoms, a history of physical conditions, shortages of materials and equipment for diagnosing or treating patients, development of a disease other than COVID-19, and the development of a new mental health condition during the pandemic (p < 0.05 for all associations). Our findings highlight the need to better prepare physicians with adequate materials, infrastructure, and psychological support such that, in a potential future health crisis, they will not be at such high risk of mental health problems. Full article

Simulation is widely used in healthcare, with VR simulation replacing physical scenarios with virtual ones. Participants observe based on predefined learning objectives and reflect on them during debriefing sessions. De-escalation is recommended as the first-line response to potential aggression in mental healthcare. Staff in secure mental health units frequently face aggression, and training may enhance de-escalation skills. The study aimed to explore staff experiences with VR simulation as a supplement to physical simulation for de-escalation and examine differences between those with and without prior physical simulation experience. The study involved 58 frontline staff in a Norwegian high security secure mental health department. Twelve simulations were conducted, followed by a post-simulation questionnaire. Data was analyzed using thematic analysis and appropriate statistical analyses. Departmental and data protection approvals were obtained, and participation was based on informed consent. Two themes emerged: (1) enhances situational understanding, and (2) lack of training for action readiness. Participants rated the simulation highly on most questions and perceived VR simulation as a valuable supplement to physical simulation. Those without prior simulation experience were more satisfied with the VR scenario (mean difference = 0.421, 2-sided 95%CI = 0.036–0.807, t = 2.188, p = 0.033), learned more from the VR simulation (mean difference = 0.725, 2-sided 95%CI = 0.045–1.406, t = 2.136, p = 0.037), experienced VR scenario which was more applicable to clinical work (mean difference = 0.645, 2-sided 95% CI = 0.161–1.128, t = 2.674, p = 0.010), and reflected that the VR simulation increased their experienced safety (mean difference = 1.133. 95%CI = 0.478–1.788, t = 3.468, p = 0.001). Greater benefits were yielded from the VR simulation for those without prior simulation experience than those with previous experience. Further studies are recommended. Full article

Background: AMR causes a large global health burden, with approximately 4.95 million deaths linked to bacterial AMR in 2019, 1.27 million due to AMR directly. Although Brazil mandated prescriptions for systemic antibiotics in 2010/2011, self-medication and access without prescriptions continue, with community pharmacists playing a vital part in antimicrobial stewardship (AMS). This study examined antibiotic misuse and AMR in Brazil through community pharmacists’ perspectives, emphasising their dual role as professional actors and frontline observers of public behaviour. Methods: We conducted 20 semi-structured interviews with community pharmacists and performed reflexive thematic analysis of their accounts, repeating five independent analytic cycles to confirm thematic robustness. Results: Six themes were consistently identified as recounted by pharmacists in their practice contexts: Access and Self-Medication; Relationships with Healthcare Professionals; Knowledge and Beliefs about Antibiotics; Use and Adherence; Healthcare System Barriers; and Regulation and Enforcement. Pharmacists mentioned regular requests for antibiotics without prescriptions, drug reuse, and significant impact from community, i.e., from relatives, and peers. The common misunderstanding was that antibiotics treat viral illnesses. Structural issues, for instance GP appointment costs and long waits, made patients seek help from pharmacies. Due to regulation being applied inconsistently, pharmacies struggled to refuse unsuitable requests. Conclusions: Framed through pharmacists’ dual vantage as professionals and frontline observers, the findings highlight intertwined factors underpinning inappropriate antibiotic use in Brazil and support a multi-pronged intervention spanning health system strengthening, professional education, economic considerations, and community engagement. Full article

Background: Burnout is a widespread concern across frontline professions, with healthcare, education, and emergency services workers experiencing particularly high rates of stress and emotional exhaustion. Passive artificial intelligence (AI) technologies may provide novel means to monitor and predict burnout risk using data collected continuously and non-invasively. Objective: This review aims to synthesize recent evidence on passive AI approaches for detecting stress and burnout among frontline workers, identify key physiological and behavioral biomarkers, and highlight current limitations in implementation, validation, and generalizability. Methods: A narrative review of peer-reviewed literature was conducted across multiple databases and digital libraries, including PubMed, IEEE Xplore, Scopus, ACM Digital Library, and Web of Science. Eligible studies applied passive AI methods to infer stress or burnout in individuals in frontline roles. Only studies using passive data (e.g., wearables, Electronic Health Record (EHR) logs) and involving healthcare, education, emergency response, or retail workers were included. Studies focusing exclusively on self-reported or active measures were excluded. Results: Recent evidence indicates that biometric data (e.g., heart rate variability, skin conductance, sleep) from wearables are most frequently used and moderately predictive of stress, with reported accuracies often ranging from 75 to 95%. Workflow interaction logs (e.g., EHR usage patterns) and communication metrics (e.g., email timing and sentiment) show promise but remain underexplored. Organizational network analysis and ambient computing remain largely conceptual in nature. Few studies have examined cross-sector or long-term data, and limited work addresses the generalizability of demographic or cultural findings. Challenges persist in data standardization, privacy, ethical oversight, and integration with clinical or operational workflows. Conclusions: Passive AI systems offer significant promise for proactive burnout detection among frontline workers. However, current studies are limited by small sample sizes, short durations, and sector-specific focus. Future work should prioritize longitudinal, multi-sector validation, address inclusivity and bias, and establish ethical frameworks to support deployment in real-world settings. Full article

Objectives: We aimed to investigate whether AI assistance could improve the performance of pneumothorax detection on chest radiographs (CXR) by readers with varying experience from radiologists to the frontline healthcare providers, and whether AI assistance could diminish the potential confounders for readers’ detecting pneumothorax. Methods: In this retrospective, single-center, blinded, multi-reader diagnostic accuracy study, 125 CXRs were prepared from radiological information system (March 2024 to August 2024) for test. The 18 readers were composed of six groups, each had 3 persons: board-certified radiologists (Group-1), senior radiology residents (Group-2), junior radiology residents (Group-3), postgraduate year residents (Group-4), senior radiographers (Group-5), and junior radiographers (Group-6). They read the CXR independently twice, without and with AI assistance, at an interval of one month. We used receiver operating characteristic curve for performance analysis and generalized estimating equation (GEE) model for confounding factor analysis. Results: AI software alone achieved a high area under curve of 0.965 (95% CI: 0.926, 0.995). With AI assistance, the performance in all groups significantly improved (p < 0.01) especially the junior readers (the frontline healthcare providers, Group-3, 4, 6) and diminished the difference among all groups except some related to Group-1. GEE model showed that AI assistance, reader’s experience, and projection type interfere with the readers’ performance (all p < 0.05). Conclusions: AI assistance could improve the performance of pneumothorax detection by varying experience of readers, especially the frontline healthcare providers. The influence of confounders, such as reader’s experience, also be diminished by AI assistance. Full article

Background: Swallowing difficulties (dysphagia) are highly prevalent among older adults and significantly contribute to malnutrition, dehydration, and poor health outcomes. Healthcare aides (HCAs), as frontline caregivers in long-term care, play a pivotal role in supporting residents’ nutritional intake. However, validated tools to evaluate their competencies in nutrition-related eating support are lacking. Methods: A cross-sectional study was conducted to develop and validate a competency-based questionnaire assessing healthcare aides’ knowledge, attitudes, and behaviors toward nutrition-focused eating support. Core domains, including oral function care, safe feeding practices, food texture modification, and nutrition safety, were identified through a systematic literature review and refined using a two-round modified Delphi process involving 26 experts. A 47-item questionnaire was then administered to 202 HCAs in Taiwan. Psychometric testing included item analysis, KR-20, Cronbach’s α, confirmatory factor analysis (CFA), composite reliability (CR), and average variance extracted (AVE). Results: The final instrument demonstrated strong content validity. The knowledge domain achieved acceptable reliability (KR-20 = 0.61), while the attitude and behavior domains showed excellent internal consistency (Cronbach’s α = 0.98). CFA confirmed good structural validity (χ²/df = 3.86, CFI = 0.93). CR and AVE values further supported construct validity. Conclusions: This nutrition-centered questionnaire is a valid and reliable tool to assess HCAs’ competencies in providing eating support. It offers a foundation for identifying training needs and designing educational programs aimed at preventing malnutrition and enhancing person-centered mealtime care in long-term care facilities. Full article

The COVID-19 pandemic represents an unprecedented event in contemporary history, with far-reaching repercussions for the global economy and society. This article examines the economic challenges and consequences of this pandemic for women. It further explores the pandemic effects on women’s health and well-being, exacerbated by the limited access to basic healthcare and mental health resources, and it points out the challenges facing women in frontline occupations (namely, healthcare). This article also highlights the alarming surge in domestic violence and abuse against women during the pandemic, aggravated by lockdown measures and isolation from support networks. In addition, this article discusses various social and political implications of this pandemic for women, and it reveals how women demonstrated significant resilience over the pandemic-related struggles. The implications of the COVID-19 pandemic are likely to persist in the post-pandemic era as they intersect with ongoing social and economic transformations and new events/crises. At this point, it remains to be determined to what extent this pandemic has decelerated (or even reversed) the progress that was made over the past few decades in terms of reducing gender inequality and enhancing women’s social status, and to what degree women’s resilience in the face of this pandemic has mitigated its adverse effects on their economic opportunities and social positions. Nevertheless, this article aims to provide a reference for governments, women’s organizations, and policymakers in assessing the implications of this pandemic for women and in designing sustained and targeted measures to support women vis-à-vis future crises. Full article

Background: The COVID-19 pandemic significantly affected the mental health of frontline healthcare workers. This study investigated the mental health and occupational stressors faced by frontline workers in Selangor during the pandemic. Methods: A cross-sectional study was conducted using secondary data from the Mental Health and Psychosocial Support Services team, collected from March to August 2020. A total of 4593 frontline workers participated in the Depression, Anxiety, and Stress Scale screening. Results: Mental health symptoms were common among frontline workers during the COVID-19 pandemic, with 14.8% reporting stress, 30.7% anxiety, and 20.4% depression. Female workers had significantly higher odds of all three conditions, with adjusted odds ratios (aOR) of 1.35 (95% CI: 1.10–1.66) for stress, 1.25 (95% CI: 1.07–1.47) for anxiety, and 1.23 (95% CI: 1.03–1.47) for depression. Workers aged 18–30 had higher odds of stress (aOR 1.88; 95% CI: 1.42–2.47), anxiety (aOR 1.74; 95% CI: 1.43–2.12), and depression (aOR 1.80; 95% CI: 1.43–2.27) compared with those over 40. Employment in hospitals was associated with increased odds of all three conditions, with aORs ranging from 1.71 to 2.05. Among 711 respondents who reported occupational stressors, lack of mental health support was the strongest predictor (aORs 4.91–5.20), followed by poor work rotation and conflict with supervisors. Conclusions: Women, younger staff, and hospital workers were more vulnerable to mental health symptoms during the pandemic. Organizational factors, especially limited support and poor work arrangements, played a major role. Targeted mental health services and improved working conditions are needed to support healthcare workers in future emergencies. Full article

In parallel with technical training on knowledge and skills of task-specific medical or surgical procedures, wide arrays of soft skills training would contribute to obstetric safety in the contemporary healthcare setting. This article, as a service evaluation, explored the effect of a specialty-based Crew Resource Management (CRM) training series that transforms the concept of human factors into sustainable measures in fostering clinical safety culture of the Department of Obstetrics and Gynaecology (O&G) in the Queen Elizabeth Hospital. Within the last decade, a tri-phasic programme has been implemented by an inter-professional workgroup which consists of a consultant anaesthesiologist, medical specialists and departmental operations manager from O&G, a nurse simulation specialist, hospital administrators, and a research psychologist. (1) Phase I identified different patterns of attitudinal changes (in assertiveness, communication, leadership, and situational awareness, also known as “ACLS”) between doctors and nurses and between generic and specialty-based sessions for curriculum planning. (2) Phase II evaluated how these specific behaviours changed over 3 months following CRM training tailored for frontline professionals in O&G. (3) Phase III examined the coping style in conflict management and the level of sustainability in self-efficacy over 3 months following specialty-based CRM training. The findings showed the positive impacts of O&G CRM training on healthcare professionals’ increased attitude and behaviour in “ACLS” by 22.7% at a p < 0.05 level, character strengths in conflict management, and non-inferior or sustained level of self-efficacy under tough conditions in the clinical setting up to 3 months after training. As a way forward, incorporating a scenario-based O&G CRM programme into existing skills-based training is expected to change service framework with an innovative approach. In addition, exploring actual clinical outcomes representing a higher level of organisational impacts can be a strategic direction for further studies on the effect of this practical and educational approach on obstetric safety culture. Full article

Background/Objectives: Home healthcare assistants (HHCAs) play a vital role in supporting older adults to remain in their homes. Yet, this work is often performed under conditions of emotional strain, limited resources, and systemic undervaluation. This study answers the question, how do HHCAs cope with work-related stress? Methods: Undertaken during the COVID-19 pandemic, a period of heightened stress and mandated social distancing, online interviews were conducted with HHCAs (n = 10). Data were inductively analyzed and themes were identified. Results: It was found that amid experiences of fear, caregiver stress, grief, and exhaustion, HHCAs coped with resource, communication, and care challenges by relying on informal peer-managed communication systems with colleagues. Leveraging existing peer-support coping strategies, HHCAs negotiated caring for others while taking care of themselves alongside a care ecosystem under unprecedented strain. Conclusions: HHCAs are increasingly vital to front-line home health care amid global aging and a shift toward community-based services. Urgent organizational reform is needed to support their well-being, prevent stress, and avoid burnout. Research-informed sector-wide planning must ensure adequate resources to maintain high-quality home care in the face of rising demand and anticipated future health crises. Full article

Background: During the global outbreak of coronavirus disease 2019 (COVID-19), the Kingdom of Saudi Arabia (KSA) ranked second in terms of the highest rate of confirmed cases among the Arab Gulf countries. This situation significantly impacted its population, economy, and healthcare system, especially the psychological well-being of frontline healthcare workers, including frontline nurses. However, there is lack of studies on this topic, particularly on the experiences of frontline expatriate nurses in the KSA, necessitating the utilization of descriptive phenomenological design. Objective: This study aimed to explore the experiences of frontline expatriate nurses and their influence on psychological well-being while delivering care to patients with COVID-19. Methods: The study employed a qualitative, descriptive phenomenological design that adhered to the key features of Husserl’s phenomenological approach and purposive sampling to select 17 frontline expatriate nurses. They participated in face-to-face semi-structured interviews. Prior to the 17 semi-structured interviews, written consent was obtained from each of the frontline expatriate nurses. The qualitative data collected were analyzed through thematic analysis and rigor was ensured in this qualitative investigation. Results: Two primary themes were identified from the interviews: (1) psychological effects due to fear of contracting the corona virus, which included two sub-themes pertaining to organizational stressors resulting in having anxiety, depression, fear, mental stress, and stigmatization; and (2) resilience to cope with the challenges brought by the pandemic, which was characterized by three sub-themes focusing on the importance of accurate information, presence of family and social support, and maintaining good health. The expatriate status of frontline nurses is a key factor influencing in their psychological well-being and resilience. Conclusions: Findings indicated that the psychological well-being of frontline expatriate nurses was adversely affected during the pandemic while caring for COVID-19 patients. Consequently, targeted interventions aimed at alleviating the negative psychological impacts of the pandemic are urgently needed to bolster the resilience of frontline expatriate nurses in emergency situations such as the COVID-19 crisis to cope with the associated psychological challenges during the peak of the pandemic, particularly among expatriate nurses. Full article