Pride and adversity among nurses and physicians during the pandemic in two US healthcare systems: a mixed methods analysis
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Abstract
Background
Our aims were to examine themes of the most difficult or distressing events reported by healthcare workers during the first wave of COVID-19 pandemic in two US health care systems in order to identify common themes and then to relate them to both behavioral theory and measures of anxiety and depression.
Methods
We conducted a cross-sectional survey of nurses and physicians during the early phases of the COVID-19 pandemic in the US. An emailed recruitment letter was sent, with about half choosing to supply open-ended responses relevant to thematic analysis. We measured symptoms of anxiety and depression separately, captured demographics, and asked two open-ended questions regarding events that were the most difficult or stressful, and reinforced pride. We reported descriptive statistics and coded thematic categories for their continuum “pride” and “distress” the factors related to fostering well-being according to the Self-Determination Theory.
Results
Themes that emerged from these narratives were congruent with prediction of Self-Determination theory that autonomy-supportive experiences will foster pride, while autonomy-thwarting experiences will cause distress. Those who reported distressful events were more anxious and depressed compared to those who did not. Among those who reported incidences that reinforced pride in the profession, depression was rarer compared to those who did not. These trends were evident after allowing for medical history and other covariates in logistic regressions.
Conclusion
Causal claims from our analysis should be made with caution due to the cross-sectional research design. Understanding perceptions of the pandemic by nurses and physicians may help identify and manage sources of distress, and suggest means of mitigating the risk of mental health distress through autonomy-supportive policies.
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SciScore for 10.1101/2022.03.16.22272485: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Our project received ethics approval from the Institutional Review Boards of the respective institutions (Drexel University and University of Nevada, Las Vegas). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our work suffers from numerous limitations arising from cross-sectional design, even though we did …
SciScore for 10.1101/2022.03.16.22272485: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Our project received ethics approval from the Institutional Review Boards of the respective institutions (Drexel University and University of Nevada, Las Vegas). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our work suffers from numerous limitations arising from cross-sectional design, even though we did control for health history and demographics. Notably, principal component analysis shows that both difficult and pride-full experiences are not exclusively clustered among persons with history of mood disorders. However, all data is self-reported, thus being subject to biases from social desirability and correlated errors. Lack of responses in shared narratives cannot be interpreted as absence of relevant events and our conclusions are thus tempted by bias due to willingness to share experiences. Some of the experiences, such as those arising from management environment and economic situation must have been shared by all respondents within healthcare systems and professions, but only reported by some. Therefore, our conclusions are limited to perception of events and willingness to share them; we mitigated bias from shared working conditions by controlling for healthcare system and profession in statistical models. We lacked some of the information that would have been helpful in interpreting data, such as availability and utilization of mental health supports. We only studied two healthcare systems and struggled with (typically) low participation rates, undermining generalizability of the findings. Despite limitations, we believe that our work offers some valuable insights and can help manage mental health challenges experienced by nurses and physicians during response to epide...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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