{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:07:05Z","timestamp":1787015225377,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate midwives' level of stress and burnout during the COVID\u201019 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A mixed\u2010methods study was undertaken from July to December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected using a national online observational survey. Descriptive and inferential analyses were performed to evaluate stress, burnout and the impact of the pandemic on personal and professional dimensions. A deductive qualitative approach was used to analyse open\u2010ended responses, that were merged with quantitative data following a convergent mixed\u2010methods approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1944 midwives participated in the survey. The stress summary score mean was 10.34, and 562 midwives (28.91%) experienced burnout. The intention to reduce working hours was reported by 202 midwives (10.39%), with 60.40% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009122) of them experiencing burnout. The intention to leave clinical practice within the following 2\u2009years was reported by 239 (12.29%), with 68.20% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009163) of them experiencing burnout. All the personal dimensions and professional activities considered were defined by more than half of midwives as being impacted \u2018Moderately\u2019 or \u2018To a great extent\u2019 by pandemic. Stress and burnout frequencies increased when the midwives' perception of the pandemic effects was higher. Potential supporting strategies described by midwives as the most important in increasing their ability to cope with the pandemic were \u2018Women's awareness of the midwives' role\u2019 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091072; 55.14%) and \u2018Family and friends' emotional support\u2019 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009746; 38.38%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggested strategies to support a positive and safe working environment for midwives during a pandemic emergency, with potential transferability to similar contexts when human resources are lacking. It is recommended that maternity services provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Studies conducted during the first COVID\u201019 pandemic wave showed an increased level of stress, anxiety, burnout, post\u2010traumatic stress disorder and depression experienced by healthcare professionals; moreover, midwives experienced drastic changes in care pathways and policies with struggles identified when providing high\u2010quality woman\u2010centred care following pandemic restrictions. Although it is recommended, there is lack of knowledge about long\u2010term psychological effects of COVID\u201019 for midwives. Our study highlights that during the Omicron wave midwives experienced a high level of stress and burnout with an impact on individual dimensions and professional activities. Their stress and burnout were influenced by several factors, including restrictions in place, lack of organizational acknowledgement, work overload and need for extra childcare cover. Maternity services should provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Recommendations on how to facilitate this are suggested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>During the writing process, we referred to \u2018The Strengthening the Reporting of Observational Studies Epidemiology Statement\u2019, the guidelines for reporting observational studies from the Equator network.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patient or public contribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What does this paper contribute to the wider global clinical community?<\/jats:title>\n                    <jats:p>Work overload conditions negatively impacted on the quality of maternity services. Improving organizational aspects, reducing working hours, promoting family and friends' emotional support and improving women's awareness of midwife's role were the main strategies reported by midwives. These suggestions for ensuring a positive and safe working environment for midwives during a pandemic emergency could potentially be applied to similar situations where human resources are lacking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jan.16065","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T03:45:25Z","timestamp":1705635925000},"page":"4510-4522","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Midwives' stress and burnout during the Omicron wave in Italy: An observational survey"],"prefix":"10.1111","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0156-8429","authenticated-orcid":false,"given":"Simona","family":"Fumagalli","sequence":"first","affiliation":[{"name":"School of Medicine and Surgery University of Milano Bicocca  Monza Italy"},{"name":"Department of Obstetrics and Gynecology Foundation IRCCS San Gerardo dei Tintori  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0140-7069","authenticated-orcid":false,"given":"Maria","family":"Panzeri","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery University of Milano Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0826-5516","authenticated-orcid":false,"given":"Sara","family":"Borrelli","sequence":"additional","affiliation":[{"name":"Division of Midwifery, School of Health Sciences The University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Ornaghi","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery University of Milano Bicocca  Monza Italy"},{"name":"Department of Obstetrics and Gynecology Foundation IRCCS San Gerardo dei Tintori  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Antolini","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Prevention and Biotechnology, Center for Biostatistics University of Milano Bicoca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5450-5317","authenticated-orcid":false,"given":"Gaia Giulia Angela","family":"Sacco","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery University of Milano Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5378-3026","authenticated-orcid":false,"given":"Martina","family":"Formenti","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery University of Milano Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Sala","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery University of Milano Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Nespoli","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery University of Milano Bicocca  Monza Italy"},{"name":"Department of Obstetrics and Gynecology Foundation IRCCS San Gerardo dei Tintori  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,19]]},"reference":[{"key":"e_1_2_13_1_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/8608732"},{"key":"e_1_2_13_1_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/00469580221079684"},{"key":"e_1_2_13_1_4_1","unstructured":"American Medical Association. 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