Longitudinal analysis of Israeli nurses’ perceptions, trust & emotions during the COVID-19 pandemic

Abstract Background The nursing sector is the largest human resource in the healthcare system providing direct patient care. The Covid-19 pandemic has forced nursing teams into a sustained state of emergency, and with it, much uncertainty and risk taking. Aims Examining the emotions, risk and threat perceptions, trust in the healthcare system and compliance with Ministry of Health (MOH) regulations among nurses at two points in time during the COVID-19 pandemic in Israel. Methods Research questionnaires were distributed to nurses at the height of the pandemic’s first wave (March-May 2020). Among the respondents, 140 agreed to continue with the follow-up study. During the pandemic’s third wave (January 2021), the research questionnaire was re-sent to these respondents. Of these, 80 filled-in the second questionnaire. Findings Naturally, there was a higher level of experience among the nursing staffs in dealing with the virus in the second as compared to the first period in time. During the first wave, approximately a fifth of the participants (21%) reported that they had cared for patients who had been confirmed as having COVID-19, while during the third wave, most of the participants (66%) reported caring for people who had been confirmed as having contracted the virus. The findings demonstrate significantly lower levels of compliance with regulations and risk perception, and a significantly higher level of emotions in the third wave as compared to the first. However, there was no change in the level of trust in the healthcare system or in the pandemic-related threat perception. Conclusions The findings provide us with some information regarding the process the nursing staffs have undergone (and are still undergoing) in dealing with the pandemic, and may point at a ‘pandemic fatigue’ amongst them. This concept relates to progressively lower regulation compliance levels appearing over time, affected by the target population’s emotions, experiences and perceptions. Key messages • It is important to assist the nurses’ emotional regulation with the help of professionals in the organization, form colleagues’ support groups and ensure management recognition of the situation. • Resilience-raising steps should be taken, for example by ensuring rest times and sufficient medical and protective equipment.


Background:
Health and social service centers are developed for the first contact points in Finland. Long waiting times, shortage of staff and lack of coordination have been major problems in primary care. As a solution, multiprofessional teams and better collaboration between professionals have been built. This study explores, how the teams work and what challenges they have.

Methods:
The study is based on 16 interviews (25 managers) in 5 health and social services centers. County provided specialized care in the whole area as well as primary services in two centers, one center was provided by a municipality, and two by a private firm. The managers were asked about work organization, their experiences of the team model and about well-being of employees. The interviews were analyzed using content analysis.

Results:
The managers saw the team work as functioning rather well. They also highlighted effective digital services and task shifting. Easy consultation of GP' was important as nurses were the first contact for clients in phone. In this call, the client' case was tried to be handled as far as possible. The competences of new professionals, such as social workers or psychiatric nurses had high value for the team. But the service processes and teambuilding were in progress. Working in mutual facilities and easy consultation of professionals was seen important. In most organizations clients were separated to different teams based on their service needs (acute or chronic conditions), or earlier clientele. As a result, some teams gained a more burdensome clientele, which increased stress.

Conclusions:
Multiprofessional work can streamline and improve the treatment process, but this requires more information which ways to collaborate work best for the clients and professionals. Key messages: Multiprofessional team work, task shifting and digital services may increase efficiency and well-being of workers at health and social centers. Easy consultation of GP's is required for task shifting.

Background:
The nursing sector is the largest human resource in the healthcare system providing direct patient care. The Covid-19 pandemic has forced nursing teams into a sustained state of emergency, and with it, much uncertainty and risk taking.

Aims:
Examining the emotions, risk and threat perceptions, trust in the healthcare system and compliance with Ministry of Health (MOH) regulations among nurses at two points in time during the COVID-19 pandemic in Israel.

Methods:
Research questionnaires were distributed to nurses at the height of the pandemic's first wave (March-May 2020). Among the respondents, 140 agreed to continue with the follow-up study. During the pandemic's third wave (January 2021), the research questionnaire was re-sent to these respondents. Of these, 80 filled-in the second questionnaire. Findings: Naturally, there was a higher level of experience among the nursing staffs in dealing with the virus in the second as compared to the first period in time. During the first wave, approximately a fifth of the participants (21%) reported that they had cared for patients who had been confirmed as having COVID-19, while during the third wave, most of the participants (66%) reported caring for people who had been confirmed as having contracted the virus. The findings demonstrate significantly lower levels of compliance with regulations and risk perception, and a significantly higher level of emotions in the third wave as compared to the first. However, there was no change in the level of trust in the healthcare system or in the pandemic-related threat perception.

Conclusions:
The findings provide us with some information regarding the process the nursing staffs have undergone (and are still undergoing) in dealing with the pandemic, and may point at a 'pandemic fatigue' amongst them. This concept relates to progressively lower regulation compliance levels appearing over time, affected by the target population's emotions, experiences and perceptions. Key messages: It is important to assist the nurses' emotional regulation with the help of professionals in the organization, form colleagues' support groups and ensure management recognition of the situation. iii563 Resilience-raising steps should be taken, for example by ensuring rest times and sufficient medical and protective equipment. Issue/problem: Modelling and forecasting the number of health professionals in Slovenia, in particular medical doctors, and nurses, has been a serious challenge for health policy for decades. No serious methodology has ever been implemented to support this process.

Description of the problem:
Methodology was developed with the support of the EU SRSS (Structural Reform Support Service) mechanism and further adapted according to the specifics of the Slovenian health system and of the needs of the MoH. The project took two years and was developed jointly with the relevant stakeholders -MoH, National Health Insurance, Medical and Nursing Chambers, Association of Public providers of health care. It was building on the experiences of Austria and Germany. Methodology included the supply and demand side of retrospective data and forecasting data on the population demographic structure as well as the current numbers of doctors and nurses in training.

Results:
We have developed a model for forecasting the needs for medical specialists and we tested it on the example of paediatrics, gynaecology, orthopaedics, general surgery, neurology, infectious diseases, and urology. We calculated the forecasted needed numbers for the year 2035 for each of the specialties, where we also indicated the increases and decreases in demand expected based on the demographic, epidemiological and service use projections.

Lessons:
Most importantly, the report was endorsed by all the participating stakeholders in the process. The MoH adopted the methodology as a part of the planning mechanism for prospective and current needs for medical specialists in training. Some flaws in the processes identified together with the inadequacies in the updating of data on health professionals led to the MoH's recommendations to providers on regularly updating their data in the national health providers' registry.

Introduction:
Due to a shortage of health professionals and economic pressure, many German hospitals are required to transform the clinical work environment to increase job satisfaction, but also to attract and retain health professionals. Leadership is a key factor for the successful implementation of organization-wide change. The aim of this study was to identify the attributes and competencies among leaders that are beneficial for implementing and managing hospital-wide transformations.

Methods:
A qualitative study design. In 2020, 18 face-to-face, semistructured interviews were conducted with chief nursing officers, ward managers, nurses and physicians in five German hospitals which have started implementing a hospital-wide transformation (e.g. Magnet Õ or Pathway Õ ). Interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using the content analysis method according to Mayring.

Results:
Results show five beneficial leadership elements to instigate and steer hospital-wide transformation: (1) Charismatic leaders are role models and idealists with well-communicated visions that are grounded in clinical practice and reflect the clinical practitioners.
(3) Empowering leaders are highly supportive and increase the intrinsic motivation of employees.
(4) Imparting interprofessional appreciation refers to leaders who cultivate a respectful relationship with persons from other professional groups and recognize their daily performance.
(5) Agile leaders are well and quickly accessible for employees and respond situationally to changing demands in everyday work.

Conclusions:
Interviewees described characteristics of hospital leaders as success factors for establishing and maintaining continuous change processes. Charismatic and supportive leaders are critical to transform the hospitals' culture and values. In addition, equitable interprofessional collaboration is of utmost importance. Key messages: Charismatic, agile, empowering leaders can have a positive impact on system-wide change processes. The successful transformation of hospitals' work environment needs interprofessional appreciation and the mutual acknowledgement of competences.

Introduction:
The estimated shortage of more than 15 million health and social care professionals, including over 6 million nurses, together with the significant phenomenon of international migration of such professionals, emerged, during COVID-19, with even more evidence. During the pandemic the danger of a collapse of health systems in many areas due to a shortage of staff was manifest. This leads, among other reasons for several professionals to migrate from South America to Italy and Europe.

Results:
Several initiatives have been developed to establish international and/or bilateral obligations among countries in terms; however, this showed to be insufficient. There is confusion in terms of the necessity of harmonizing rules, nursing curricula,