Sharma Monisha, Creutzfeldt Claire J, Lewis Ariane, Patel Pratik V, Hartog Christiane, Jannotta Gemi E, Blissitt Patricia, Kross Erin K, Kassebaum Nicholas, Greer David M, Curtis J Randall, Wahlster Sarah
Department of Global Health, University of Washington, Seattle, Washington, USA.
Department of Neurology, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Clin Infect Dis. 2021 May 18;72(10):e566-e576. doi: 10.1093/cid/ciaa1311.
Assessing the impact of coronavirus disease 2019 (COVID-19) on intensive care unit (ICU) providers' perceptions of resource availability and evaluating the factors associated with emotional distress/burnout can inform interventions to promote provider well-being.
Between 23 April and 7 May 2020, we electronically administered a survey to physicians, nurses, respiratory therapists (RTs), and advanced practice providers (APPs) caring for COVID-19 patients in the United States. We conducted a multivariate regression to assess associations between concerns, a reported lack of resources, and 3 outcomes: a primary outcome of emotional distress/burnout and 2 secondary outcomes of (1) fear that the hospital is unable to keep providers safe; and (2) concern about transmitting COVID-19 to their families/communities.
We included 1651 respondents from all 50 states: 47% were nurses, 25% physicians, 17% RTs, and 11% APPs. Shortages of intensivists and ICU nurses were reported by 12% and 28% of providers, respectively. The largest supply restrictions reported were for powered air purifying respirators (56% reporting restricted availability). Provider concerns included worries about transmitting COVID-19 to their families/communities (66%), emotional distress/burnout (58%), and insufficient personal protective equipment (PPE; 40%). After adjustment, emotional distress/burnout was significantly associated with insufficient PPE access (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI], 1.32-1.55), stigma from community (aRR, 1.32; 95% CI, 1.24-1.41), and poor communication with supervisors (aRR, 1.13; 95% CI, 1.06-1.21). Insufficient PPE access was the strongest predictor of feeling that the hospital is unable to keep providers safe and worries about transmitting infection to their families/communities.
Addressing insufficient PPE access, poor communication from supervisors, and community stigma may improve provider mental well-being during the COVID-19 pandemic.
评估2019冠状病毒病（COVID-19）对重症监护病房（ICU）医护人员对资源可用性的认知的影响，并评估与情绪困扰/职业倦怠相关的因素，可为促进医护人员福祉的干预措施提供依据。
在2020年4月23日至5月7日期间，我们通过电子方式对美国照顾COVID-19患者的医生、护士、呼吸治疗师（RT）和高级实践提供者（APP）进行了一项调查。我们进行了多变量回归分析，以评估担忧、报告的资源短缺与3个结果之间的关联：一个主要结果是情绪困扰/职业倦怠，另外两个次要结果是：（1）担心医院无法保障医护人员的安全；（2）担心将COVID-19传播给家人/社区。
我们纳入了来自美国所有50个州的1651名受访者：47%是护士，25%是医生，17%是RT，11%是APP。分别有12%和28%的医护人员报告了重症监护医生和ICU护士短缺的情况。报告的最大供应限制是电动空气净化呼吸器（56%报告供应受限）。医护人员的担忧包括担心将COVID-19传播给家人/社区（66%）、情绪困扰/职业倦怠（58%）和个人防护装备（PPE）不足（40%）。调整后，情绪困扰/职业倦怠与PPE获取不足（调整后相对风险[aRR]，1.43；95%置信区间[CI]，1.32 - 1.55）、来自社区的污名（aRR，1.32；95% CI，1.24 - 1.41）以及与上级沟通不畅（aRR，1.13；95% CI，1.06 - 1.21）显著相关。PPE获取不足是感觉医院无法保障医护人员安全以及担心将感染传播给家人/社区的最强预测因素。
解决PPE获取不足、上级沟通不畅和社区污名问题，可能会改善COVID-19大流行期间医护人员的心理健康。
