One-week longitudinal daily description of moral distress, coping, and general health in healthcare workers during the first wave of the COVID-19 outbreak in Italy: A quantitative diary study COVID-19, moral distress, coping, and general health in healthcare workers

Main Article Content

Duilio F. Manara
Giulia Villa
Lisa Korelic
Cristina Arrigoni
Federica Dellafiore
Valentina Milani
Greta Ghizzardi
Arianna Magon
Noemi Giannetta
Rosario Caruso


Coping; COVID-19; Diary; Pandemic; Mental health; Moral Distress; Health; Healthcare workers; Wellbeing.


Background and aim of the work .The fluctuation from day to day within a working week of moral distress, coping, and general health of frontline healthcare workers (HCWs) in facing the challenges of the COVID-19 pandemic has been poorly studied. This study described the weekly fluctuation from day to day of moral distress, coping, and general health in frontline HCWs who worked during the first epidemic wave (May-June 2020) of the COVID-19 pandemic in Italy.

Methods. This study has an intensive longitudinal design, and a convenience sampling procedure was employed to enroll physicians, nurses, allied health professions, and healthcare assistants. Data collection was performed using diary encompassed four sections: a socio-demographic form (required only at the baseline data collection) and three scales to assess moral distress, coping, and general health.

Results. Results confirmed poor perceived health and mild moral distress in frontline HCWs, especially in HCWs with offspring, during the initial phases of the COVID-19 pandemic and the stability of their daily perception over a working week regarding moral distress, general health, and avoidant coping strategy, while approach coping strategy reported a slight fluctuation over time.

Conclusions. Accordingly, on the one hand, these results confirm that outcomes regarding mental health and moral distress are pretty stable and provide insights, on the other hand, regarding the possible organizational interventions to support approach coping strategy as it seems more susceptible to variation over time.



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1. Chakraborty I, Maity P. COVID-19 outbreak: Migration, effects on society, global environment and prevention. Sci Total Environ 2020;728:138882. doi:10.1016/J.SCITOTENV.2020.138882
2. Preti E, Di Mattei V, Perego G, et al. The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence. Curr Psychiatry Rep 2020;22(8). doi:10.1007/s11920-020-01166-z
3. Rolandi S, Villa G, D’Aloia P, Gengo V, Negro A, Manara D. COVID-19: An Italian Hospital Response From the Nursing Perspective. Nurs Adm Q 2021;45(2):94-101. doi:10.1097/NAQ.0000000000000467
4. Manara DF, Giannetta N, Villa G. Violence versus gratitude: Courses of recognition in caring situations. Nurs Philos 2020;21(3). doi:10.1111/nup.12312
5. Nowicki GJ, Ślusarska B, Tucholska K, Naylor K, Chrzan-Rodak A, Niedorys B. The severity of traumatic stress associated with covid-19 pandemic, perception of support, sense of security, and sense of meaning in life among nurses: Research protocol and preliminary results from poland. Int J Environ Res Public Health 2020;17(18):1-18. doi:10.3390/ijerph17186491
6. Nania T, Dellafiore F, Caruso R, Barello S. Risk and protective factors for psychological distress among Italian university students during the COVID-19 pandemic: The beneficial role of health engagement. Int J Soc Psychiatry 2020;2076402094. doi:10.1177/0020764020945729
7. Lázaro-Pérez C, Martínez-López JÁ, Gómez-Galán J, López-Meneses E. Anxiety About the Risk of Death of Their Patients in Health Professionals in Spain: Analysis at the Peak of the COVID-19 Pandemic. Int J Environ Res Public Health 2020;17(16). doi:10.3390/ijerph17165938
8. Barello S, Falcó-Pegueroles A, Rosa D, Tolotti A, Graffigna G, Bonetti L. The psychosocial impact of flu influenza pandemics on healthcare workers and lessons learnt for the COVID-19 emergency: a rapid review. Int J Public Health 2020;65(7):1205-1216. doi:10.1007/s00038-020-01463-7
9. Chen R, Sun C, Chen J, et al. A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic. Int J Ment Health Nurs Published online 2020. doi:10.1111/inm.12796
10. Berlin D, Gulick R, Martinez F. Severe Covid-19. N Engl J Med 2020;383(25):2451-2460. doi:10.1056/NEJMCP2009575
11. Norman SB, Feingold JH, Kaye-Kauderer H, et al. Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depress Anxiety Published online July 2021. doi:10.1002/DA.23205
12. Hines SE, Chin KH, Levine AR, Wickwire EM. Initiation of a survey of healthcare worker distress and moral injury at the onset of the COVID-19 surge. Am J Ind Med 2020;63(9):830-833. doi:10.1002/AJIM.23157
13. Latimer A. Hospital Nurses’ Moral Distress and Coping during COVID-19: A Pilot Study. Theses Diss Work Published online January 2021:1-174. doi:
14. Arrigoni C, Caruso R, Campanella F, Berzolari FG, Miazza D, Pelissero G. Investigating burnout situations, nurses’ stress perception and effect of a post-graduate education program in health care organizations of northern Italy: a multicenter study. G Ital Med Lav Ergon 2015;37(1):39-45.
15. Barello S, Caruso R, Palamenghi L, et al. Factors associated with emotional exhaustion in healthcare professionals involved in the COVID-19 pandemic: an application of the job demands-resources model. Int Arch Occup Environ Health Published online March 3, 2021. doi:10.1007/s00420-021-01669-z
16. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:907. doi:10.1016/J.BBI.2020.05.026
17. Phiri P, Ramakrishnan R, Rathod S, et al. An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis. EClinicalMedicine 2021;34:100806. doi:10.1016/J.ECLINM.2021.100806
18. Ohly S, Sonnentag S, Niessen C, Zapf D. Diary Studies in Organizational Research: An Introduction and Some Practical Recommendations. J Pers Psychol 2010;9(2):79-93. doi:10.1027/1866-5888/A000009
19. Wilson Vanvoorhis CR, Morgan BL. Understanding Power and Rules of Thumb for Determining Sample Sizes. Tutor Quant Methods Psychol 2007;3(2):43-50. doi:10.20982/TQMP.03.2.P043
20. Signorelli C, Scognamiglio T, Odone A. COVID-19 in Italy: impact of containment measures and prevalence estimates of infection in the general population. Acta Bio Medica Atenei Parm 2020;91(Suppl 3):175-179. doi:10.23750/ABM.V91I3-S.9511
21. Sica C, Magni C, Ghisi M, et al. Coping Orientation to Problems Experienced-Nuova Versione Italiana (COPE-NVI): uno strumento per la misura degli stili di coping. Psicoter Cogn e Comport 2008;14:27-53.
22. Eisenberg S, Shen B, Schwarz E, Mallon S. Avoidant coping moderates the association between anxiety and patient-rated physical functioning in heart failure patients. J Behav Med 2012;35(3):253-261. doi:10.1007/S10865-011-9358-0
23. Piccinelli M, Bisoffi G, Bon M, Cunico L, Tansella M. Validity and test-retest reliability of the Italian version of the 12-item General Health Questionnaire in general practice: a comparison between three scoring methods. Compr Psychiatry 1993;34(3):198-205. doi:10.1016/0010-440X(93)90048-9
24. Muller AE, Hafstad EV, Himmels JPW, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Res 2020;293:113441. doi:10.1016/J.PSYCHRES.2020.113441
25. Shao Y, Fang Y, Wang M, Chang C-H (Daisy), Wang L. Making daily decisions to work from home or to work in the office: The impacts of daily work- and COVID-related stressors on next-day work location. J Appl Psychol 2021;106(6):825-838. doi:10.1037/APL0000929
26. Dellafiore F, Caruso R, Conte G, Grugnetti AM, Bellani S, Arrigoni C. Individual-level determinants of interprofessional team collaboration in healthcare. J Interprof Care 2019;33(6):762-767. doi:10.1080/13561820.2019.1594732
27. Farnese ML, Zaghini F, Caruso R, Fida R, Romagnoli M, Sili A. Managing care errors in the wards: The contribution of authentic leadership and error management culture. Leadersh & Organ Dev J 2018;40(1):17-30. doi:10.1108/LODJ-04-2018-0152
28. Charles S. Strength and vulnerability integration: a model of emotional well-being across adulthood. Psychol Bull 2010;136(6):1068-1091. doi:10.1037/A0021232
29. Kunzmann U, Little TD, Smith J. Is age-related stability of subjective well-being a paradox? Cross-sectional and longitudinal evidence from the Berlin aging study. Psychol Aging 2000;15(3):511-526. doi:10.1037/0882-7974.15.3.511
30. Souadka A, Essangri H, Benkabbou A, Amrani L, Majbar MA. COVID-19 and Healthcare worker’s families: behind the scenes of frontline response. EClinicalMedicine 2020;23:100373. doi:10.1016/J.ECLINM.2020.100373
31. Cluver L, Lachman JM, Sherr L, et al. Parenting in a time of COVID-19. Lancet 2020;395(10231):e64. doi:10.1016/S0140-6736(20)30736-4
32. Labrague LJ, De los Santos JAA. COVID-19 anxiety among front-line nurses: Predictive role of organisational support, personal resilience and social support. J Nurs Manag 2020;28(7) doi:1653-1661. doi:10.1111/jonm.13121
33. Lasalvia A, Bonetto C, Porru S, et al. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2021;30. doi:10.1017/S2045796020001158
34. Smith MJ. What constitutes success in the roll-out of COVID-19 vaccines? Lancet 2021;398(10295):115-116. doi:10.1016/S0140-6736(21)01244-7

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