problem solving during covid 19

Americans coped with pandemic using problem solving, emotional support

Alessandro Biascioli / iStock

A survey of 1,000 Americans assessing positive and negative coping skills during the pandemic shows that people fared better when focused on problem solving and planning during times of uncertainty.

As part of the study, published yesterday in PLOS One , participants engaged in an online survey to assess how they dealt with stressful life events (SLEs), coping strategies, and the physical and psychological health domains of quality of life (QOL) during COVID-19. The 25- to 30-minute survey was conducted in August 2021 on Prolific, a web-based survey recruitment platform.

Survey respondents were mostly White (73%), equally divided among men and women, with a mean age of 44. Half were married or cohabitating.

More stressors led to more avoidance behaviors

Using 16 questions, the authors identified three patterns for coping with SLEs: problem-focused coping, emotional-focused coping, and avoidant coping.

Problem-focused coping included four items relating to the use of informational support. Emotion-focused coping included six items using emotional support, humor, and religion. And avoidant coping had six items relating to self-distraction, substance use, and behavioral disengagement.

Respondents answered the coping questions using a 5-point Likert scale, noting how they had coped with particular stressors over the last year.

The mean number of SLEs reported by respondents was 1.6, with a range of 0 to 18. The three most common SLEs reported in the sample were a decrease in financial status, followed by personal injury or illness, and a change in living conditions.

Problem- and emotional-focused coping helped

For all respondents, problem-focused coping and emotion-focused coping were significantly related to higher levels of QOL, whereas avoidant coping was associated with lower QOL, the authors said. More life stressors correlated to using more avoidant coping skills.

As the pandemic instigated or exacerbated a wide range of unexpected and unpredictable stressors, such as personal illness, illness and deaths of loved ones, and unemployment, we posit that the use of emotion-focused coping was likely helpful in navigating these situations.

"Previous research, most of which was conducted pre-pandemic, has demonstrated inconsistent findings regarding the relationship between emotion-focused coping and QOL, with many studies pointing to a negative association between these two constructs," the authors said. They hypothesize that emotional coping served people well during the pandemic because it helped them handle uncertainty.

"As the pandemic instigated or exacerbated a wide range of unexpected and unpredictable stressors, such as personal illness, illness and deaths of loved ones, and unemployment, we posit that the use of emotion-focused coping was likely helpful in navigating these situations," the authors said.

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• COVID-19 and your mental health

Worries and anxiety about COVID-19 can be overwhelming. Learn ways to cope as COVID-19 spreads.

At the start of the COVID-19 pandemic, life for many people changed very quickly. Worry and concern were natural partners of all that change — getting used to new routines, loneliness and financial pressure, among other issues. Information overload, rumor and misinformation didn't help.

Worldwide surveys done in 2020 and 2021 found higher than typical levels of stress, insomnia, anxiety and depression. By 2022, levels had lowered but were still higher than before 2020.

Though feelings of distress about COVID-19 may come and go, they are still an issue for many people. You aren't alone if you feel distress due to COVID-19. And you're not alone if you've coped with the stress in less than healthy ways, such as substance use.

But healthier self-care choices can help you cope with COVID-19 or any other challenge you may face.

And knowing when to get help can be the most essential self-care action of all.

Recognize what's typical and what's not

Stress and worry are common during a crisis. But something like the COVID-19 pandemic can push people beyond their ability to cope.

In surveys, the most common symptoms reported were trouble sleeping and feeling anxiety or nervous. The number of people noting those symptoms went up and down in surveys given over time. Depression and loneliness were less common than nervousness or sleep problems, but more consistent across surveys given over time. Among adults, use of drugs, alcohol and other intoxicating substances has increased over time as well.

The first step is to notice how often you feel helpless, sad, angry, irritable, hopeless, anxious or afraid. Some people may feel numb.

Keep track of how often you have trouble focusing on daily tasks or doing routine chores. Are there things that you used to enjoy doing that you stopped doing because of how you feel? Note any big changes in appetite, any substance use, body aches and pains, and problems with sleep.

These feelings may come and go over time. But if these feelings don't go away or make it hard to do your daily tasks, it's time to ask for help.

Get help when you need it

If you're feeling suicidal or thinking of hurting yourself, seek help.

• Contact your healthcare professional or a mental health professional.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

If you are worried about yourself or someone else, contact your healthcare professional or mental health professional. Some may be able to see you in person or talk over the phone or online.

You also can reach out to a friend or loved one. Someone in your faith community also could help.

And you may be able to get counseling or a mental health appointment through an employer's employee assistance program.

Another option is information and treatment options from groups such as:

• National Alliance on Mental Illness (NAMI).
• Substance Abuse and Mental Health Services Administration (SAMHSA).
• Anxiety and Depression Association of America.

Self-care tips

Some people may use unhealthy ways to cope with anxiety around COVID-19. These unhealthy choices may include things such as misuse of medicines or legal drugs and use of illegal drugs. Unhealthy coping choices also can be things such as sleeping too much or too little, or overeating. It also can include avoiding other people and focusing on only one soothing thing, such as work, television or gaming.

Unhealthy coping methods can worsen mental and physical health. And that is particularly true if you're trying to manage or recover from COVID-19.

Self-care actions can help you restore a healthy balance in your life. They can lessen everyday stress or significant anxiety linked to events such as the COVID-19 pandemic. Self-care actions give your body and mind a chance to heal from the problems long-term stress can cause.

Take care of your body

Healthy self-care tips start with the basics. Give your body what it needs and avoid what it doesn't need. Some tips are:

• Get the right amount of sleep for you. A regular sleep schedule, when you go to bed and get up at similar times each day, can help avoid sleep problems.
• Move your body. Regular physical activity and exercise can help reduce anxiety and improve mood. Any activity you can do regularly is a good choice. That may be a scheduled workout, a walk or even dancing to your favorite music.
• Choose healthy food and drinks. Foods that are high in nutrients, such as protein, vitamins and minerals are healthy choices. Avoid food or drink with added sugar, fat or salt.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to manage how you feel can make matters worse and reduce your coping skills. Avoid taking illegal drugs or misusing prescriptions to manage your feelings.

Take care of your mind

Healthy coping actions for your brain start with deciding how much news and social media is right for you. Staying informed, especially during a pandemic, helps you make the best choices but do it carefully.

Set aside a specific amount of time to find information in the news or on social media, stay limited to that time, and choose reliable sources. For example, give yourself up to 20 or 30 minutes a day of news and social media. That amount keeps people informed but not overwhelmed.

For COVID-19, consider reliable health sources. Examples are the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Other healthy self-care tips are:

• Relax and recharge. Many people benefit from relaxation exercises such as mindfulness, deep breathing, meditation and yoga. Find an activity that helps you relax and try to do it every day at least for a short time. Fitting time in for hobbies or activities you enjoy can help manage feelings of stress too.
• Stick to your health routine. If you see a healthcare professional for mental health services, keep up with your appointments. And stay up to date with all your wellness tests and screenings.
• Stay in touch and connect with others. Family, friends and your community are part of a healthy mental outlook. Together, you form a healthy support network for concerns or challenges. Social interactions, over time, are linked to a healthier and longer life.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel sad, hurt and angry when people in their community avoid them for fear of getting COVID-19. People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers and people with COVID-19.

Treating people differently because of their medical condition, called medical discrimination, isn't new to the COVID-19 pandemic. Stigma has long been a problem for people with various conditions such as Hansen's disease (leprosy), HIV, diabetes and many mental illnesses.

People who experience stigma may be left out or shunned, treated differently, or denied job and school options. They also may be targets of verbal, emotional and physical abuse.

Communication can help end stigma or discrimination. You can address stigma when you:

• Get to know people as more than just an illness. Using respectful language can go a long way toward making people comfortable talking about a health issue.
• Get the facts about COVID-19 or other medical issues from reputable sources such as the CDC and WHO.
• Speak up if you hear or see myths about an illness or people with an illness.

COVID-19 and health

The virus that causes COVID-19 is still a concern for many people. By recognizing when to get help and taking time for your health, life challenges such as COVID-19 can be managed.

• Mental health during the COVID-19 pandemic. National Institutes of Health. https://covid19.nih.gov/covid-19-topics/mental-health. Accessed March 12, 2024.
• Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1. Accessed March 12, 2024.
• Mental health and the pandemic: What U.S. surveys have found. Pew Research Center. https://www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed March 12, 2024.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed March 12, 2024.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed March 12, 2024.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed March 12, 2024.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
• COVID-19 and substance abuse. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/covid-19-substance-use#health-outcomes. Accessed March 12, 2024.
• COVID-19 resource and information guide. National Alliance on Mental Illness. https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Resource-and-Information-Guide. Accessed March 15, 2024.
• Negative coping and PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/gethelp/negative_coping.asp. Accessed March 15, 2024.
• Health effects of cigarette smoking. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#respiratory. Accessed March 15, 2024.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed March 15, 2024.
• Your healthiest self: Emotional wellness toolkit. National Institutes of Health. https://www.nih.gov/health-information/emotional-wellness-toolkit. Accessed March 15, 2024.
• World leprosy day: Bust the myths, learn the facts. Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/world-leprosy-day/. Accessed March 15, 2024.
• HIV stigma and discrimination. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/hiv-stigma/. Accessed March 15, 2024.
• Diabetes stigma: Learn about it, recognize it, reduce it. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes_stigma.html. Accessed March 15, 2024.
• Phelan SM, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: Barriers and recommendations. Annals of Family Medicine. 2023; doi:10.1370/afm.2924.
• Stigma reduction. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/od2a/case-studies/stigma-reduction.html. Accessed March 15, 2024.
• Nyblade L, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Medicine. 2019; doi:10.1186/s12916-019-1256-2.
• Combating bias and stigma related to COVID-19. American Psychological Association. https://www.apa.org/topics/covid-19-bias. Accessed March 15, 2024.
• Yashadhana A, et al. Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: A systematic review. Health Promotion International. 2021; doi:10.1093/heapro/daab144.
• Sawchuk CN (expert opinion). Mayo Clinic. March 25, 2024.

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Solving both the short- and long-term COVID-19 crises

Subscribe to global connection, mahmoud mohieldin and mahmoud mohieldin professor, department of economics - cairo university, egypt, executive director - international monetary fund, special envoy on financing the 2030 agenda for sustainable development - united nations michael kelleher michael kelleher director of external affairs - 2blades foundation, former advisor - world bank group, former special assistant to president barack obama - united states government.

April 14, 2020

The global COVID-19 health and economic crisis compels us to act in the short-term—in the here and now. We can’t look away from the human health consequences without giving our best efforts to lessen the suffering of those infected.

On the economic side, there is also great pain that must be assuaged. Some people are even using the “ D-Word ” to describe our unique predicament, with no widely agreed-upon solutions, and central bankers feeling the need to reassure markets that they are not running low on ammunition .

Multilateral organizations such as the World Bank and IMF have abruptly retooled and turned their focus completely toward this new global challenge, making sweeping changes in their agenda, engineering relief from debt service , and making substantial new investments in disaster response . The IMF estimates the total fiscal crisis relief is now at $8 trillion . The United Nations is also urging debt relief , while organizing a coordinated response and sending technical and material assistance to dozens of countries . The EU is stepping up with a large stimulus bill . Even a divided U.S. Congress agreed to spend $2 trillion for its crisis response.

However, poor nations, including those not yet experiencing high infection rates, will find it much more difficult to find the resources to climb out of this predicament. Low- and middle-income nations will benefit from multilateral assistance, but as infection rates rise, these nations may be disproportionately affected since 93 percent of the world’s informal employment is in emerging and developing countries . Helping these workers may require novel approaches, such as cash transfers , which have been used with success in other crisis situations, while some nations are offering tax relief to spur business activity, and others recommend wage subsidies and adjustments to credit guarantees and loan terms.

Of course, we have no choice but to act. Yet what happens when the crisis is over? There will likely be another Cassandra-like report which foreshadows the next crisis, begging our future selves to act in our own self-interest and to invest in solutions to problems that will confront us soon enough. Yet we rarely act to forestall or lessen the next crisis.

It’s not like we haven’t seen (a milder version of) this movie before: 15 years ago after SARS; and five years ago after the Ebola outbreak. Both times we diverted our attention just long enough to deal with the immediate needs, and then ignored the careful high-level post-mortem reports that laid out key decisionmaking and investments that would help us respond to future, perhaps much bigger challenges in the future like COVID-19.

Yet, buried in those not quite dusty post-mortem reports is a guidebook that shows us the way to serve both our short-term and long-term needs: to invest in the Sustainable Development Goals (SDGs).

The 17 SDGs provide a pathway for us to “ build back better ” after the COVID-19 crisis, according to U.N. Secretary-General António Guterres. These global goals urge us to address challenges in poverty, health, inequality, and many other areas, while vowing to leave no one behind, with a deadline of 2030.

Many of the SDGs both address the current crisis as well as longer-term needs, including:

• Good health and well-being (SDG3). Right now the World Health Organization and other partners are supporting government COVID-19 responses , including testing, isolating, and caring for confirmed cases, while also tracing and quarantining people who have come in close contact with the infected. Over the long term, each country needs a health system that can deliver quality, essential health care and preventative services to everyone . They also need the capacity to perform future disease surveillance and diagnosis to rapidly identify, treat, and contain outbreaks, so that the human and economic costs are lessened.
• Water and sanitation (SDG6). To slow down the transmission of COVID-19 people need to wash or sanitize their hands . Yet today 3 billion people do not have access to even basic handwashing facilities at home , largely because they lack access to clean water, which increases their vulnerability to disease and ill health. Longer term, we must achieve universal access to safe and affordable drinking water and adequate sanitation for all in order to slow down the spread of infection and improve the health of all people.
• Ending hunger (SDG2). In many parts of the developing world, school closures mean the loss of children’s meals. In addition, global supply chains and trade have been disrupted , not just for food, but for agriculture inputs that support food production, exacerbated by the substantial number of workers idled due to COVID-19. Now is the time to act for long-term food security by making investments in technology that can improve agriculture productivity and the incomes of small-scale farmers.
• Decent work and economic growth (SDG8). According to the International Labour Organization (ILO), the  COVID-19 crisis  is expected to wipe out 6.7 percent of working hours globally in the second quarter of 2020— equivalent to 195 million full-time workers . The ILO and others are urging that countries offer at least a basic level of social protection to as many people as possible, as soon as possible. Longer term, countries need to make investments to sustain per capita economic growth, productivity, and entrepreneurship, to support formalization and growth of micro-, small- and medium-sized enterprises, including through access to financial services.
• Quality education (SDG4). According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), COVID-19 has forced an estimated 1.5 billion learners to stay at home . UNESCO is supporting governments for distance learning, scientific cooperation, and information support. Longer-term support means that we need to make sure all children—especially girls—are in school and reaching literacy and numeracy targets, and are given greater access to secondary and tertiary education, as well as vocational training, while all should be served by well-trained teachers.

These are just a handful of examples of a comprehensive and applicable framework to enable us to achieve these goals while fighting poverty in an inclusive and sustainable way. Yet these COVID-related SDGs require adequate financing to respond to the crisis and also to make investments that can help us to become resilient to the ever-present threats.

This crisis has shown us the enormous economic and human costs of ignoring our own best advice to stave off the next crisis. This time, let’s do the right thing and deliver.

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Students use active learning to solve COVID-19 problems

By dave winterstein.

The pervasive effects of the COVID-19 pandemic can leave us all feeling powerless at times. Students in the course Engineering Processes for Environmental Sustainability (BEE 2510) took back some power during the fall semester by addressing critical problems related to pandemic.

Instructors Jillian Goldfarb , assistant professor of biological and environmental engineering in the College of Agriculture and Life Sciences (CALS), and Alex Maag, postdoctoral associate with Cornell’s Active Learning Initiative , assigned students to solve problems related to COVID-19, from the logistics of vaccine storage and transportation, to the disinfection of public spaces, and the sanitation and reuse of personal protective equipment (PPE).

Using the pandemic as the context for a student project was not without challenges, and the instructors hesitated to ask students to focus on an issue that might be a source of pain or uncertainty for some.

“We were nervous about assigning a COVID-19-related project,” Goldfarb said, “but the way we approached it empowered students to feel like there were solutions to these problems.”

Their approach hinged on the critical step of building a sense of community, Maag added.

First Goldfarb and Maag had the class work on group problem-solving by assigning various smaller tasks during class discussions. As students became comfortable working with each other in teams, they eventually were ready to work in groups on the final project.

The community-building exercises paid off. The students produced technical reports that proposed creative, efficient and technically sound solutions to PPE shortages and vaccine distribution.

Both instructors were impressed with the degree to which the class of primarily second-year students applied a broad range of concepts covered in the course.

“Students did a lot of outside-the-box thinking on the projects,” Maag said. “As a gateway course, the class is very broad in scope so we can’t go very deep into any one topic, but they took nearly all the concepts from class and connected them in their reports.”

“We were nervous about assigning a COVID-19-related project, but the way we approached it empowered students to feel like there were solutions to these problems.” Jillian Goldfarb

One group used geomapping to optimize vaccine distribution across the country. Another contacted their hometown hospitals to ask about PPE shortages as they developed requirements for designing sanitizing equipment.

Goldfarb also noted that the project inspired students’ passion for thinking about possible solutions and applying what they learned in class to areas about which many of them knew very little.

“The students were surprised by how much the introductory engineering knowledge they gained in this class could be so widely used to solve these problems,” she said, “and that will give them confidence as they go forward.”

Goldfarb and Maag developed their assignment with support from a 2019 grant from the Active Learning Initiative, through which the Department of Biological and Environmental Engineering is helping undergraduates apply their knowledge to complex current issues.

The project was funded by CALS and a gift from Alex ’87 and Laura Hanson ’87. The Active Learning Initiative, developed within the College of Arts and Sciences with help from the Hansons, is supported by Cornell’s Office of the Vice Provost for Academic Innovation and the Center for Teaching Innovation (CTI).

For more information on the initiative, contact CTI .

Dave Winterstein is a communication specialist in the Center for Teaching Innovation.

Media Contact

Abby butler.

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Stay up to date:.

• The COVID-19 crisis forced startups to rethink everything from their management to their business models.
• Pivoting taught these 10 startups key lessons on leveraging capabilities, moving quickly, and maximizing teams.

COVID has transformed how businesses run and how leaders lead. The World Economic Forum’s Global Innovators Community, a group of innovative start-ups and scale-ups, explained recently how they used their technologies and expertise to fight the pandemic – and what they learned in the process that they’ll apply to future crises.

The Innovator Communities are an invitation-only group of the world’s most promising start-ups and scale-ups that are at the forefront of technological and business model innovation.

Companies who are invited to become Innovators will engage with one or more of the Forum’s Centres , as relevant, to help define the global agenda on key issues.

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1. Move fast and fix things MachineMetrics , an industrial IoT platform for machines, doubled down on remote technology monitoring during COVID-19 to help manufacturers monitor their factory productivity and supply chains from afar. Additionally, the company developed a program to provide free access to its technology to any manufacturer involved in the production of COVID-19-related manufacturing, such as ventilator components or testing and protective equipment or any COVID-19 related manufacturing.

Pivoting meant developing educational programs and delivery mechanisms for its new programs in about one week. The experience helped the company lean on strengths such agility and organizational trust, which were essential to both the company and its manufacturing customers’ success. Through this experience MachineMetrics learned how to balance the needs of the company with the needs of the industry its serves. When these needs are in alignment, you can move quickly to achieve remarkable things, said Graham Immerman, the Vice President of Marketing.

Have you read?

17 ways technology could change the world by 2025, 10 technology trends to watch in the covid-19 pandemic.

2. Learn first, act later KONUX , a technology company that uses artificial intelligence to support predictive maintenance of industrial plants, didn’t pretend to know what to do next or how the company should react. In the moment of great flux, Founder and CEO Andreas Kunze asked himself: “What is really the core of what we do? And in a scenario where our market collapsed, what assumptions would I still not challenge?” Such questions helped him focus on his core beliefs and the company’s strengths and values.

Said Kunze, in times of great change, “The role of the CEO needs to transform to Chief Learning Officer.” He said, “We need to learn about the market, customer, product, and people impact as fast and as much as we can. That is where innovation truly happens.”

3. Find new problems to solve Orbs , a public blockchain stack that helps businesses and governments develop blockchain applications, saw an opportunity to adapt its technology to the new challenges that COVID introduced to daily lives. A key challenge? How countries could safely open up their borders to both residents and visitors, and how individuals could prove authenticity of their health condition while maximizing privacy. “From the very first days of the COVID outbreak, we set our minds to figuring out how blockchain can be the technological foundation for current challenges,” said Netta Korin, co-founder at Orbs.

As a result, the company designed a blockchain-based health passport in which test results can be signed cryptographically. This allows holders to prove when, where and by whom they were tested for COVID or potentially any other diseases. Based on this data, countries can determine the terms under which an individual may or may not enter. Furthermore, it allows authentication of results wherever travellers go in order to track and monitor people’s paths in case of an outbreak, all the while minimizing privacy infringement. This experience taught Orbs that the real challenge is identifying the opportunity within a crisis. Thanks to these efforts, the company is currently in discussion with a government looking to adopt Orbs’ solution as part of the country’s public health platform.

4. Know your “why” Avellino shifted its business model during the crisis, pivoting from genetic data and diagnostics, to filling a gap in the testing market for the COVID-19 crisis. The change came about after just 3 weeks of brainstorming sessions. The company credits its agility to the team’s alignment on purpose and priorities, said Eric Bernabei, the Chief Sales and Marketing Officer.

There was "never a debate" about whether or not Avellino should make the pivot, explained Bernabei. The only discussion was about how to do it successfully, identifying potential risks and collaborating to ensure that it could identify trigger points for decisions and actions.

5. Find ways to foster community The pandemic brought unprecedented challenges with no established roadmaps or best practices for guidance. In that space, many companies saw the power and support networks that could provide. For instance, agtech company Mooofarm realized the value of community among its members. The company supports marginalized dairy farmers in underserved markets around the world and the pandemic underscored how the farmers that used its platform shared and learned from each other regarding cattle health and nutrition management, government schemes, subsidies and cattle trading. Progressive farmers shared dos and don'ts with each other and responded to queries about dairy farm management. To support this effort, the company is currently in the process of developing an online community to help this community better interact and strengthen its existing bonds.

6. Rethink business as usual Early in the crisis, 3D printing company 3YOURMIND Inc. , saw a way its technology could help generate PPE and respirator connectors. In only a few days, it leveraged its software technology to create a virtual factory of more than 40 professional 3D Printing suppliers and a digital inventory of more than 60 validated designs. This made it possible to deliver thousands of pieces of printed equipment, on-demand, with the highest degree of IP and data security.

The move has helped the company future-proof its business, as it saw the need for digitizing stocks and relocating production for key products and components. “Over the next 10 years, more than 8% of stock units will be virtualized and produced with on-demand 3D printing,” said Aleksander Ciszek, Chief Executive Officer at 3YOURMIND Inc. As a result, the company is helping firms to collect and assess parts data and create their own digital warehouses. “This is a tremendous task ahead of us,” said Ciszek.

7. Strengthen relationships Thanks to lockdowns and the need to communicate virtually, financial services and blockchain company Diginex went remote. It switched from running in-person consultations to a new approach that accommodated remote technology implementation. This meant standardizing its product offering to enable rapid scale-up of its technology solutions. This approach allowed Diginex to focus on its strength, the technology infrastructure, while engaging local partners to handle effective implementations. Said Miles Pelham, Diginex Chairman, the company has always valued its long-term partnerships, but this period has shown the importance of those relationships in helping the company adapt and scale.

8. Get creative The pandemic provided a special opportunity to contribute for Livinguard , a maker of innovative face masks and other PPE. Still, when work went remote, it needed to scale up while ensuring staff could work safely and transport goods after COVID halted air travel and other transport.

While most staff worked from home, the company found a locality not in full lockdown where it could run some key operations and where flights were still available. “We had to really switch gears and stretch our limbs,” said Livinguard’s EVP of Business Development Jonathan Pantanowitz.

9. Leverage your capabilities AI-powered insights company Contextere found the current pandemic created a transformational opportunity to advance productivity initiatives it couldn’t have imagined before the pandemic. The company, one that uses machine learning and industrial data to help employees execute their jobs more efficiently, saw the opportunity to apply its technology to its own company. This approach helped the team eliminate rework at Contextere and even identify new opportunities to contribute to the COVID-19 fight. Subsequent COVID-19 AI research the company conducted for its own staff led to the deployment of AI to support frontline workers, eliminating productivity barriers to overburdened workers during a critical time.

In times of great change, the role of the CEO needs to transform to Chief Learning Officer.

10. Embrace new challenges and new opportunities COVID exposed existing weaknesses and vulnerabilities – and made them more complex. Venture debt, for instance has become increasingly constrained due to regulatory restriction and conventional lending practices by financiers that demand physical collateral. For partner banks and VCs, “It is an even tougher environment, then it used to be, in relation to financing,” said Mohamed Wefati, the Founder and CEO of MIZA , a fintech company that helps support small and medium enterprises in the MENA region. “Access to finance is an issue for small enterprises.”

However, there are multiple initiatives launched by central banks and banks across the MENA region, for example, to stimulate credit for SMEs. MIZA’s main learning was that with the inevitable digital adoption sparked by COVID, small enterprises stand to benefit from increased access to finance due to their increased digital footprint. This new paradigm opens up increased opportunities for driving financial inclusion across the MENA region.

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ORIGINAL RESEARCH article

The impact of attitude toward peer interaction on middle school students' problem-solving self-efficacy during the covid-19 pandemic.

• 1 School of Educational Technology, Beijing Normal University, Beijing, China
• 2 Department of Industrial Education, Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan

The outbreak of the COVID-19 epidemic has promoted the popularity of online learning, but has also exposed some problems, such as a lack of interaction, resulting in loneliness. Against this background, students' attitudes toward peer interaction may have become even more important. In order to explore the impact of attitude toward peer interaction on students' mindset including online learning motivation and critical thinking practice that could affect their problem-solving self-efficacy during the COVID-19 pandemic, we developed and administered a questionnaire, receiving 1,596 valid responses. The reliability and validity of the questionnaire were re-tested, and structural equation modeling was applied. It was found that attitude toward peer interaction could positively predict middle school students' online learning motivation and critical thinking. Learning motivation and critical thinking also positively supported problem-solving self-efficacy. It is expected that the results of this study can be a reference for teachers to adopt student-centered online learning in problem solving courses.

Introduction

The outbreak of COVID-19 has led to the widespread practice of online learning in schools ( Zhao et al., 2021 ). Teachers and students in middle schools continue to integrate online learning into classrooms, which is further promoting the process of online and offline blended learning development ( Lee et al., 2021 ). A conceptual ecology of learning is necessary to embrace a series of learning environment “across boundaries traditionally separating institutions of education, popular culture, home, and community” ( Kumpulainen and Mikkola, 2014 , p. 51). However, the coevolution of people and their environments is an ongoing process ( Hilty and Aebischer, 2015 ). That is, online learning is intertwined with sociocultural environments ( Allen et al., 2015 ), and when people are not able to meet physically during the COVID-19 pandemic, they need more social interactions ( Kalmar et al., 2022 ). Peer interaction has been proved to benefit learning progression and contribute to deep learning ( Chadha, 2019 ). Online peer interaction embedded in learning design is useful for promoting students' learning outcomes, but previous research has mainly focused on the higher education group ( Lin et al., 2017 ; Martin et al., 2020 ). While online learning during the COVID-19 pandemic could have been a new experience for middle school students to interact with peers and their teachers ( Clark et al., 2021 ), attention to K-12 education in the literature is rare, and online learning had hardly been adopted by Chinese middle schools before the COVID-19 pandemic. As the pandemic came suddenly, most teachers in Chinese K-12 schools only conducted online one-way live-streamed lectures, and did not pay attention to interactive activities, leading to surface learning and polarization of students ( Yu and Wang, 2020 ). Thus, the present study aimed to explore the role of peer interaction in online learning based on Chinese K-12 students.

In fact, the pandemic promoted the universalization and ubiquity of online learning; thus, there is a need for more and deeper attention to online learning outcomes ( Ngo and Ngadiman, 2021 ). Learning outcomes consist of affective outcomes, cognitive outcomes, and skill-based outcomes ( Kraiger et al., 1993 ), of which motivation (as an affective outcome), critical thinking (as a cognitive outcome) and problem solving (as a skill-based outcome) have been the factors of most concern in the online learning research ( Zhou et al., 2021 ). These learning outcomes are important for not only higher education students, but also K-12 students. To explore the role of peer interaction in online learning for K-12 students during the pandemic, it is necessary to study the relationship among peer interaction, motivation, critical thinking, and problem solving.

Attitude is defined as a favorable or unfavorable evaluative reaction toward something or someone, exhibited in one's beliefs, motivation, or intended behavior ( Ajzen, 2005 ). Attitudes provide meaningful approaches to seek some degree of order, clarity, and stability in our personal motivation of reference ( Harmon-Jones and Harmon-Jones, 2021 ). As the measurement of the real interactive behavior is difficult, students' attitude toward peer interaction is used to explore the role of peer interaction in online learning. Attitudes include affective and cognitive components to predict motivation and behavior ( Ajzen, 2005 ). In contrast, mindsets consist of a collection of attitude judgments and cognitive processes and procedures to facilitate problem solving and completion of a particular task ( Gollwitzer et al., 1990 ). Moreover, mindsets drive cognitive processing, and capture the critical thinking that is an important behavioral outcome judgement ( Nolder and Kadous, 2018 ). Students' attitude toward peer interaction could have an impact on their mindsets ( Zulkifli et al., 2020 ; Thanasi-Boce, 2021 ), leading to different learning performance ( Kwon et al., 2019 ). To date, few researchers have investigated online learner profiles based on the mindset shared among students ( Zamecnik et al., 2022 ). Online learning profiles, problem solving, critical thinking, teamwork, and motivation are different in different areas and backgrounds ( Lawter and Garnjost, 2021 ). In particular, the profiles of middle school students who were born and grew up in the digital age, and so are known as “digital natives” ( Becker and Birdi, 2018 ) have not been studied. In line with this, the correlates between middle school students' attitude toward peer interaction, motivation, critical thinking, and problem solving were explored in this study.

Theoretical background

Attitude toward peer interaction in online learning.

Peer interaction is usually considered to be at the heart of the development of constructivist learning theory research ( Tenenbaum et al., 2020 ). In peer interaction, students can question others as free and active participants in social discourse, argument, and learning ( Castellaro and Roselli, 2015 ). The comparison of perspective will produce social cognitive conflict, and then generate consensus through interaction ( Tenenbaum et al., 2020 ). It has been shown that peer interaction can benefit learning progression and make students learn more deeply ( Chadha, 2019 ). Learner-learner interaction refers to the two-way communication among learners, such as exchanging ideas with classmates, discussing with each other, and getting feedback from other learners ( Wang et al., 2022 ). Moreover, middle school students had hardly ever experienced complete online learning before the COVID-19 pandemic. When the pandemic suddenly broke out, some students could have had difficulty adapting to online learning, leading to learning anxiety, loneliness, and even depression ( An et al., 2020 ; Perkins et al., 2021 ; Ying et al., 2021 ). Peer interaction might be the key to solving these affective and psychological problems ( Yao and Zheng, 2017 ; An et al., 2020 ). Especially, social and peer influence is of great importance for adolescents ( Tsai et al., 2015 ), so peer interaction could be an extremely important factor for middle school students' online learning. In brief, peer interaction is beneficial for students' development of knowledge and ability ( Chadha, 2019 ), and could also help improve students' attitudes toward online learning during the COVID-19 pandemic ( Ala et al., 2021 ; Chu et al., 2021 ; Ngo and Ngadiman, 2021 ). However, it is difficult to measure the real peer interactive behaviors of students, as the peer interactions occur naturally in social media, but are not limited to a specific learning platform. Students' attitude could show their preference for a certain behavior ( Ajzen, 2005 ). Thus, students' attitude toward peer interaction in middle high school was explored in this study.

Motivation as emotional mindset

The concept of mindsets is based on Dweck (1999) framework in which it was proposed that mindsets determine one's goals, motivation, and beliefs about effort. As a result, mindsets can organize associated constructs into a coherent motivational framework or “meaning system” ( Yu and McLellan, 2020 ). An important motivational factor that might influence individuals' willingness to engage with a task is their emotional mindset ( Wols et al., 2020 ). Students' motivation plays a fundamental role in academic achievement. In fact, Yu and McLellan (2020) applied person-centered motivation to study some key elements of the mindset-based meaning system. Although there are different ways to induce students' growth mindset, most of the studies endorsed that the growth mindset can indeed modify the learning processes ( Kania et al., 2017 ). Learning motivation is an important factor leading to success in online learning, especially for K-12 students ( Zuo et al., 2021 ). The COVID-19 pandemic has brought about great changes to students' learning, such as the disruption of social networks and teachers being less focused on the individual. Students in middle school have lost their traditional learning motivation sources, but have attained new motivation sources ( Uka and Uka, 2020 ). Learning motivation can improve academic outcomes by catering to learners' needs in online learning platforms ( Baker et al., 2016 ). Although it has been studied in much of the online learning research ( Zhou et al., 2021 ), little research has covered learning motivation in emotional mindset under the threat of COVID-19; thus, in this research, learning motivation was studied as an emotional mindset of online learning.

Critical thinking as cognitive mindset

Critical thinking is a kind of ability acquisition of online learning ( Zhou et al., 2021 ), which usually refers to skills of reasoning, evaluation, analysis, judgment, conceptualization, understanding, and reflection ( Guiller et al., 2008 ; van Laar et al., 2017 ). Individuals with a deliberative mindset are also more likely than those with an implemental cognitive mindset to take longer to reach a judgment ( Henderson et al., 2008 ), indicating their openness to information and suspension of judgment. The deliberative mindset captures the mechanics behind a “questioning mind,” a “critical evaluation of evidence,” and the responsibility to “be alert” to evidence ( Nolder and Kadous, 2018 ). In this research, critical thinking was studied as a mindset to question and to be alert for knowledge acquisition during online learning.

The Internet provides a good way for students to develop their critical thinking, as students could gain much information to help them think critically. Critical thinking is thought to be one of the most important outcomes of online learning, and previous researchers have tried to design online courses and tools to promote students' development of their critical thinking ( Goodsett, 2020 ; Varenina et al., 2021 ). This study focused on self-reporting by middle school students to evaluate their cognitive mindset related to online learning.

Problem-solving self-efficacy

Problem solving is an important ability acquisition of online learning ( Zhou et al., 2021 ), and refers to the skills of using information and communication technology to cognitively process and understand a problem situation in combination with the active use of knowledge to find a solution to a problem ( van Laar et al., 2017 ). Problem solving involves different skills, such as finding the nature of the problem, choosing problem-solving steps and strategies, selecting appropriate information, allocating appropriate sources, and monitoring the problem-solving process ( Sternberg, 1988 ). Problem solving is a key competency in online learning ( Aslan, 2021 ), and the Internet provides convenient support for learners to solve problems ( Jordan and McDaniel, 2014 ). For learners, problem solving is the key to learning success in a future-oriented society ( OECD, 2017 ). As little research has considered how students' peer interaction supports their problem solving, the present study would explore the relationship between peer interaction and problem solving.

In studies using self-reported scales, self-efficacy of performance or ability has been used widely in problem solving ( Calaguas and Consunji, 2022 ). Self-Efficacy refers to individuals' beliefs about their abilities to perform expected behaviors ( Bandura, 1994 ). According to Bandura (1997) , the problem-solving self-efficacy could be defined as the students' perceptions of their problem-solving success. In previous researches, problem-solving self-efficacy (PSSE) have been used widely to represented learners' perceptions of their problem-solving abilities ( Bandura, 2006 ; Kyung-hee, 2016 ; Salazar and Hayward, 2018 ). In this research, student' PSSE would be measured to reflect the perception of problem-solving process.

Previous studies found that online learning is useful for students, particularly in terms of learning outcomes during the COVID-19 pandemic ( Jung and An, 2021 ; Choi-Sung, 2022 ). On the contrary, Hong et al. (2021a , 2022) found learning ineffectiveness through online learning, particularly in practical skill development ( Hong et al., 2021b ). Koehler et al. (2022) found that while students collaboratively interacted in the problem-solving process, individuals with a strong problem-solving presence valued peer interaction as an important part of the learning process, were willing to invest time engaging in the discussion, and maintained a consistent presence. Peer interaction could help to improve the motivation of students in online learning. For example, Yang and Chang (2012) found that peer interaction via blogs could improve students' learning motivation. Researchers found that for students in higher education, online peer interaction could improve their level of motivation during the COVID-19 pandemic ( Thanasi-Boce, 2021 ; Kang and Zhang, 2022 ), but there has been a lack of focus on K-12. From this, we could speculate that for middle school students, the attitude toward online peer interaction during the epidemic could positively affect their online learning motivation. Hence, the following hypothesis was formulated in this study:

H1: The attitude toward online peer interaction could positively predict the online learning motivation of middle school students.

The mindset reflects the idea that individuals' cognitive processing determines both the content and strength of their resulting attitudes ( Yu and McLellan, 2020 ). Critical thinking was thought to need a cognitive process, referring to the exchange and discussion of ideas with peers involved in the collaborative process of knowledge construction ( Kuhn, 1991 ). Therefore, we could speculate that peer interaction could positively help to develop students' critical thinking. In fact, this has been proved for primary school students ( Chou et al., 2015 ) and for undergraduate students ( Oh et al., 2018 ; Zulkifli et al., 2020 ). What is more, previous researchers found that online peer discussion helped to develop university students' critical thinking better than face-to face discussion, as they would provide more well thought-out and reasonable evidence ( Guiller et al., 2008 ). We could speculate that this might also be applicable to junior middle school students. Hence, the hypothesis formulated in this study was as follows:

H2: Attitude toward online peer interaction could positively predict the critical thinking of middle school students.

Students collaborate in groups to solve a problem, and analyze the formation of the problem to identify facts about the problem situation so that they can establish their representation of the problem and have a deeper understanding of the causes of problems. Then, they propose possible solutions, where they evaluate the gap between the current state and the desired state and address the solutions to the problem ( Wu and Nian, 2021 ). These processes sometimes provide both an autonomy-controlling and an autonomy-supportive need to learn knowledge that may be maintained and enhanced by students' motivation ( Wu et al., 2020 ). Moreover, individuals with a fixed emotion mindset believe that emotions are not changeable and cannot be controlled. Individuals with a growth emotion mindset believe that emotions are malleable and can be changed with effort and experience ( Wols et al., 2020 ). For example, learning motivation is one of the major predictors of problem solving that is key in the nursing training field ( Yardimci et al., 2017 ). To understand the correlates between middle school students' learning motivation and PSSE in online learning, the following hypothesis was proposed:

H3: Learning motivation could positively predict the PSSE of middle school students.

A problem is generally viewed as a discrepancy between desired goals and an existing state ( Chi and Glaser, 1985 ), and problem solving is the process of taking actions to resolve this discrepancy ( Shermerhorn, 2013 ). Researchers have suggested specific frameworks to capture effective problem solving; together, all frameworks provide insight into the critical reasoning processes learners engage in as they resolve ill-structured problems ( Tawfik et al., 2020 ). While variation exists across focus and articulated problem-solving in online learning phases, these frameworks involve two main areas: problem finding with critical thinking (e.g., articulating a problem, constraints, clarifying diverse perspectives) and generating solutions with critical thinking (e.g., suggesting and evaluating solutions addressing identified problems) ( Koehler et al., 2022 ). Researchers found that critical thinking had positive effects on problem solving ( Kanbay and Okanli, 2017 ). Thus, the following hypothesis was proposed:

H4: Critical thinking could positively predict the PSSE of middle school students.

Peer interaction has an influence on problem solving because students rely on supportive social responses to enact most of their strategies to solve problems ( Jordan and McDaniel, 2014 ). Students need to clarify or reorganize their views and plans when solving problems in peer groups, so it could be considered that the social interaction in groups is an important aspect of production power ( Jordan and McDaniel, 2014 ). In online learning, peer interaction is also important for problem solving, but the outcome depends on the peers' competency levels and their motivation ( Kwon et al., 2019 ). Cheng and Chau (2016) revealed that peer interaction in online learning was not at the desired level, and there was a need for studies to promote attitude toward peer interaction in online learning to enhance problem solving. However, peer interaction is one of the limitations of distance education which is widely used throughout the pandemic ( Aslan, 2021 ). To understand how attitude toward peer interaction is related to online problem solving, in this research, the following hypothesis was proposed:

H5: For middle school students, attitude toward online peer interaction could positively predict PSSE mediated by learning motivation and critical thinking.

The current study adopted a person-centered approach to examine the ways in which mindsets and associated attitude toward peer interaction constructs cohered with emotional motivation and functioned together with critical thinking as a meaningful system related to PSSE. Specifically, drawing on attitude theory and mindset theory, this study addressed the research model as explained in Figure 1 .

Figure 1 . The hypothesis model.

Participants

From July 15 to July 21, 2020, questionnaires were distributed to students in eight middle schools for the prior study, and a total of 352 sample data were collected for the EFA of the scale. The prior study samples were mainly from Beijing, Liaoning, Shandong, and Henan provinces. Invalid samples were deleted according to polygraph items, and a total of 301 valid samples were retained of which 155 (51.5%) were from boys and 146 (48.5%) from girls. There were 90 (29.9%) seventh graders, 164 (54.5%) eighth graders, and 47 (15.6%) ninth graders.

From October 20 to November 1, 2020, questionnaires were randomly distributed to junior high school students in 34 provinces or districts of China. A total of 61,419 responses were received, of which 25,805 were retained after polygraph screening. We randomly selected a similar number of different types of people in the large sample to approximate stratified sampling. A total of 1,596 valid samples were randomly selected. The demographic information of the samples is shown in Table 1 . There were 803 (50.3%) boys and 793 (49.7%) girls. The proportion of students from different districts was similar, as well as that of different grades.

Table 1 . Demographic information of participants ( N = 1,596).

In this study, the questionnaire items were adapted from the relevant literature. The original measurement of peer interaction was adapted from six items of Active and Collaborative Learning in the National Survey of Student Engagement ( Kuh, 2001 ), the measurement of learning motivation was adapted from five items of Deep Motivation in R-SPQ-2F of Biggs et al. (2001) , the measurement of critical thinking was adapted from five items of the California Critical Thinking Disposition Inventory ( Facione, 1990 ), and the measurement of PSSE was adapted from five items of Han (2020) combined with Bandura (2006) Self-Efficacy scale.

Content validity was then examined by two educational technology experts and three middle school students. Some items with unclear meaning were revised. The questionnaire used a 5-point Likert scale, with options “ strongly disagree ,” “ disagree ,” “ neutral ,” “ agree ,” and “ strongly agree .” The higher the score, the higher the degree of agreement. After data collection, we tested the reliability and validity of the questionnaire items and constructs for subsequent structural equation modeling. The remaining items are listed in the Appendix .

Data analysis

To further test the content validity of the scale, nine experts were invited to judge and score the relevance between each item of the scale and the construct it belongs to. A 5-point scale was used in this study, with options “ uncorrelated ,” “ weakly correlated ,” “ moderately correlated ,” “ strongly correlated ,” and “ very correlated .” For each item, the proportion of experts who agreed that this item was strongly related to the construct (score 4 or 5) to the total number is called the Item Content Validity Index (I-CVI); it needs to reach 0.78 ( Lynn, 1986 ).

Before data analyses were performed, normality was tested. All the measured items had appropriate skewness (ranging from −0.893 to −0.295) and kurtosis (ranging from −0.216 to 0.954), smaller than the requisite maximum values of |1| and |2|, respectively, indicating that the data of all items were close to the normal distribution ( Noar, 2003 ).

Data analysis consisted of four stages: Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), reliability analysis, and Structural Equation Modeling (SEM). EFA and reliability analysis of the scale were conducted with SPSS20.0, and CFA and SEM were conducted with Mplus 8.3. In the prior study, 301 samples were used for EFA and reliability analysis to test the scale. In the formal study, a randomly selected subsample 1 ( n = 799) was used for EFA, and subsample 2 ( n = 797) was used for CFA and SEM. In the reliability analysis, all 1,596 samples were used. Bootstrapping was used 1,000 times in the indirect effect test in SEM.

In EFA, principal component analysis and the maximum variance rotation method were used to extract the factors, and components were extracted with eigenvalues > 1. If the explained variance of the first factor before rotation is <50%, it can be considered that there is no serious significant common method bias ( Hair et al., 2014 ). Items with cross factor loadings or low loadings (<0.5) were deleted ( Deng et al., 2017 ).

In CFA and SEM, the standards recommended by Hair et al. (2014) were adopted. Accordingly, indices of χ 2 / df (<5), Root Mean Square Error of Approximation (RMSEA) (<0.10), Standardized Root Mean Square Residual (SRMR) (< 0.05), Comparative Fit Index (CFI) (>0.90), and the Tucker-Lewis Index (TLI) (>0.90) were used to check the model fit degree. Then Average Variance Extracted (AVE) (>0.5) and Construct Reliability (CR) (>0.7) were calculated using factor loadings (λ) to check the convergent validity of the scale. The square root values of AVEs of components were compared with the correlations between components to check the discriminant validity of the scale. The correlations between all factors were tested for significance before SEM.

In the reliability analysis of the scale, the internal consistency coefficients' Cronbach's α values were calculated, where the whole scale and all constructs needed to be higher than 0.7 ( Fornell and Larcker, 1981 ).

Measurement model

In the content validity test stage, according to the nine experts' evaluation, four items were deleted as their I-CVI did not reach 0.78. A total of 21 items with good content validity were saved in the scale.

In the prior study, we conducted EFA using the 301 valid samples to explore the structural validity of the scale. Three items were deleted in three rounds of principal component analysis, as they have cross factor loadings (FL > 0.5 on two factors). The deleted items and retained items are shown in the Appendix . After that, the EFA result showed good validity. The internal consistency coefficient test showed good reliability of the scale. The Cronbach's α of the whole scale was 0.954, and the values of the subscales were between 0.850 and 0.945. All the construct reliabilities were higher than 0.7, indicating good reliability of the scale in the prior study.

In the formal study stage, the EFA results showed good validity of the scale. The Kaiser-Meyer-Olkin measure value was 0.917 ( p < 0.001), indicating that it was suitable for factor analysis. The explained variance of the first factor before rotation was 43.520%, indicating no serious significant common method bias. A total of four main factors were obtained, and the total explained variance was 67.013%. The loadings of each item on the factor were between 0.580 and 0.823 (see Table 2 ).

Table 2 . Means, standard deviations, factor loadings (λ), AVEs, and construct reliability.

In the formal study stage, CFA was carried out to verify the structural validity of the scale. The model fit index of χ 2 was 608.769, df was 129, χ 2 / df was 4.719 (<5), RMSEA was 0.068 (<0.08), CFI was 0.942 (>0.90), TLI was 0.931 (>0.90), and SRMR was 0.041(< 0.05), indicating that the fit for the items of the scale was acceptable. All standardized factor loadings were in a good range of 0.631–0.876. The values of AVE were all higher than 0.5, and CR was higher than 0.7, indicating good convergent validity. All the square root values of AVE of each component were higher than the correlations between it and other components (see Table 3 ), indicating good discriminant validity. All the correlations between every two factors were significant.

Table 3 . Correlations between components and AVE of the components.

In the formal study stage, the internal consistency coefficient test showed good reliability of the scale. The Cronbach's α of the whole scale was 0.920, and the values of the subscales are shown in Table 2 . All the construct reliabilities were higher than 0.7, indicating good reliability. Means of components were all above the midpoint 3, as shown in Table 2 .

Structural model

The model fit indices of the structural equation model (SEM) were good using the 797 samples for verification. The value of χ 2 was 632.437, df was 130, χ 2 / df was 4.865 (<5), RMSEA was 0.070 (<0.08), CFI was 0.939 (>0.90), TLI was 0.929 (>0.90), and SRMR was 0.048 (< 0.05), indicating a good fit of the structural equation model. The verification of the research model is shown in Figure 2 .

Figure 2 . The verification of the structural model. The figure shows the SEM results of bootstrap 1,000 times. PI, Attitude toward Peer Interaction; LM, Learning Motivation; CT, Critical Thinking; PS, PSSE.

For middle school students, the attitude toward peer interaction could significantly positively predict their online learning motivation, of which the effect was 0.638 ( p < 0.001), indicating that H1 was supported. Attitude toward peer interaction could significantly positively predict critical thinking, of which the effect was 0.648 ( p < 0.001), indicating that H2 was supported. Learning motivation could positively predict PSSE, of which the effect was 0.200 ( p < 0.001), indicating that H3 was supported. Critical thinking could positively predict PSSE, of which the effect was 0.659 ( p < 0.001), indicating that H4 was supported.

In the path analysis, the attitude toward peer interaction did not have a significant direct effect on PSSE, of which the path effect was 0.063 ( p = 0.331). To test the indirect effect, the bootstrap method was used. The 95% Confidence Interval (CI) was used to test whether there was an indirect effect. If the 95% CI does not include 0, an indirect effect exists ( Guo et al., 2018 ). As shown in Table 4 , the indirect effect from the attitude toward peer interaction to PSSE through learning motivation was 0.128 ( p < 0.001), and the 95% CI did not include 0. The indirect effect from attitude toward peer interaction to PSSE through critical thinking was 0.427 ( p < 0.001), and the 95% CI did not include 0. This indicated that attitude toward peer interaction could indirectly predict PSSE through learning motivation and critical thinking, respectively. This suggested that learning motivation and critical thinking played a full mediating role in how attitude toward peer interaction predicted PSSE. H5 was supported.

Table 4 . Indirect effect between peer interaction and PSSE.

The values of explanatory power (R 2 ) of learning motivation, critical thinking, and PSSE were, respectively, 0.407, 0.420, and 0.658. This showed that the variables of each facet had effective explanatory power of the model, as they were above the threshold of 0.3 ( Cohen, 1977 ).

A previous study indicated that participation in the peer online learning program had a positive impact on the development of communication and collaboration skills related competencies—interaction and sharing with technologies ( Carvalho and Santos, 2022 ). Peer interaction could enhance students' engagement in online learning and increase their academic emotions ( Wang et al., 2022 ). During the COVID-19 pandemic, it seems that online learning has greatly promoted teaching and learning reforms in the Internet environment, but problems have been exposed such as the lack of a collective atmosphere of study and social communication ( Xu, 2021 ). Against this background, this study measured the online peer interaction of middle school students, and measured their online learning outcomes from the perspectives of psychology, knowledge, and ability. The scale used in this study had good reliability and validity. On this basis, this study explored the predictive effect of the attitude toward online peer interaction on the online learning motivation, knowledge construction, critical thinking, and PSSE of middle school students.

From the results, the attitude toward peer interaction could significantly predict the online learning motivation of junior middle school students, and the path coefficient was high at 0.645. This showed that when students in middle school had positive attitudes toward online peer interaction, they would more likely be interested in online learning and be eager to learn online. This provides support to the view of the growth emotion mindset, which posits that emotions are malleable and can be changed with effort and experience ( Wols et al., 2020 ). The result was similar to previous studies in higher education ( Yang and Chang, 2012 ; Thanasi-Boce, 2021 ), but the prediction effect of junior middle school students during the COVID-19 pandemic was much stronger. For teenagers, peer socializing is an important source of motivation for them to participate in many activities ( Tsai et al., 2015 ). Especially during the COVID-19 pandemic, most students felt lonely and anxious during online learning ( Alshammari et al., 2021 ). Improving students' attitude toward peer interaction could help them improve their online learning motivation.

The attitude toward online peer interaction also had a strong predictive effect on the critical thinking of middle school students, with a path coefficient of 0.670. This is consistent with previous research about university students ( Guiller et al., 2008 ). With active attitudes toward online peer interaction, middle school students could exchange different views, question others, debate, and negotiate ( Goodsett, 2020 ; Varenina et al., 2021 ). In this way, they could learn to evaluate the views of others, instead of blindly listening to authority. They would also think more from different perspectives and multiple angles, so as to develop their critical thinking. Previous research found that middle school students usually gave surface and rapid responses instead of engaging in critical thinking during online learning, even though the instructor guided them to think critically ( Zhang, 2013 ). Improving peer interactions among students might be a useful solution to the problem.

Online learning motivation could positively predict PSSE. This is consistent with the nursing training field ( Yardimci et al., 2017 ). The autonomy-controlling and autonomy-supportive needs to learn knowledge might arise from the problem-solving process, and be maintained and enhanced by students' motivation ( Wu et al., 2020 ). During the COVID-19 pandemic, the level of learning motivation of middle school students might be lower than that of traditional learning, as there was a lack of peer pressure, classroom experience, and teachers' attention ( Uka and Uka, 2020 ). To improve students' performance of problem-solving, some measures should be taken to help students maintain and enhance their learning motivation.

Critical thinking could positively predict PSSE during the COVID-19 pandemic, of which the explanation rate was the highest for predicting PSSE. When students have better critical thinking, they are more likely to find the problem and evaluate the solution to the problem reasonably ( Koehler et al., 2022 ), which can lead to better PSSE. This is consistent with the finding of Kanbay and Okanli (2017) . For middle school students, it is sometimes difficult to guide them to develop critical thinking online ( Zhang, 2013 ), which may negatively lead to PSSE. More useful measures should be taken to improve students' critical thinking, which is the key to promoting good performance in problem solving.

Developing problem-solving ability through peer collaboration has become a focus of learning in recent years ( OECD, 2017 ), in which motivation as emotional mindset and critical thinking as cognitive mindset should be considered. As the results of this study showed, the direct prediction of attitude toward peer interaction on the PSSE of middle school students was not significant, but the indirect effects analysis showed that learning motivation and critical thinking were two total mediating factors of the effects from attitude toward peer interaction to PSSE. This is further exploration and a complement to previous research findings ( Jordan and McDaniel, 2014 ; Setyowidodo et al., 2020 ). Previous research found that peer interaction could have an impact on PSSE ( Jordan and McDaniel, 2014 ), but did not consider the role of mindset in this process. This research explores the role of two important mindsets in this process, and showed that attitude toward peer interaction could have an effect on PSSE through learning motivation and critical thinking. This showed that the peer interaction of middle school students during the epidemic mainly played a direct role in promoting their mindsets of motivation and critical thinking, but it was difficult to directly help students solve problems. This might be due to the fact that online peer interactions among middle school students during the pandemic were mostly spontaneous interactions, with less involving online collaborative problem-solving learning activities designed and organized by teachers in China ( Yu and Wang, 2020 ); thus, the direct prediction effect was not obvious. To explore this possibility in depth, more elaborate experimental designs are needed in the future.

Drawing on learning ecology, this study provides evidence for the importance of attitude toward peer interaction for the online learning of middle school students during the COVID-19 pandemic. The findings of this study reflect the importance of online peer interaction for middle school students during the pandemic. The results demonstrated the positive predictive effect of peer interaction on motivation and critical thinking, and reflected that the two mindsets can positively predict students' PSSE. Lacking an online collaborative problem-based activity design provided by teachers during the pandemic, online peer interaction did not directly support PSSE, but indirectly predicted it through promoting mindsets. Briefly, this study explored the relationship among attitude toward peer interaction, motivation, critical thinking, and PSSE from a new perspective in a special period. The structural model is innovative and reflects the particularity of middle school students. In the post-epidemic era, online learning has become an important learning method for junior high school students, for which peer interaction is of great significance.

Implications

This study used structural equation modeling to demonstrate the positive effect of attitude toward peer interaction on middle school students' learning outcomes during the pandemic. On the one hand, this fills the gap of previous research, that is, the lack of attention to the development of higher-order thinking in online learning in K-12 education. On the other hand, the study proposes a new model, which has a theoretically innovative role for studying peer interaction, mindsets, and PSSE in online learning.

This study provides a reference for organizing middle school students to carry out online learning. The study found that attitude toward peer interaction had a very positive predictive effect on learning mindsets and PSSE. Based on this finding, educators can guide learners to interact more with peers based on social networking sites when organizing middle school students' online learning. In practice, the scale developed in this study can be used to measure students' online learning outcomes and to adjust the design and organization of online learning in a timely manner.

Future research suggestions

The peer interaction studied in this research was general interaction without a specific classification. In previous studies, some researchers studied peer interaction more specifically and deeply, such as whether there were task instructions for peer interaction and how many people interacted in groups ( Tenenbaum et al., 2020 ). What is more, different kinds of interaction platforms, such as formal learning forums (MOOC forum) and social media (Facebook, Wechat) may also lead to different results. In previous research, digital natives preferred to interact with each other through the social networks that they were familiar with rather than the forum embedded in a learning platform ( Butrime et al., 2015 ). This preference could be further studied in the future.

In addition, some researchers have studied students' competencies in more specific online learning courses, such as online nursing courses ( Song et al., 2022 ) or person-centered online courses ( Li and Tsai, 2017 ; Koenka, 2020 ). However, this study did not specify what kind of online course affects participants' cognitive and emotional factors. Future studies may explore what kinds of online courses trigger learners' emotional and cognitive mindsets in online peer interaction.

Due to the limitations of the self-report scale, the data obtained in this study may lack a certain degree of objectivity. In future research, the results of this study can be validated through learning analysis based on data collected from the learning platform.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.

Author contributions

XA contributed to the conception of the study, performed instrument development, data analysis, and wrote the manuscript. J-CH contributed to the theoretical framework of the study and wrote the manuscript. YL contributed the instrument development, data collection, and manuscript preparation. YZ contributed to the instrument development and manuscript revision. All authors contributed to the article and approved the submitted version.

This work described in this paper was supported by a grant from the National Social Science Fund of China (Grant Number: 21&ZD238). This work was financially supported by the Institute for Research Excellence in Learning Sciences of National Taiwan Normal University (NTNU) from the Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan and BNU Interdisciplinary Research Foundation for First-year Doctoral Candidates BNUXKJC2102.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: attitude, peer interaction, motivation, critical thinking, problem-solving, middle school, online learning, COVID-19

Citation: An X, Hong J-C, Li Y and Zhou Y (2022) The impact of attitude toward peer interaction on middle school students' problem-solving self-efficacy during the COVID-19 pandemic. Front. Psychol. 13:978144. doi: 10.3389/fpsyg.2022.978144

Received: 25 June 2022; Accepted: 08 August 2022; Published: 25 August 2022.

Reviewed by:

Copyright © 2022 An, Hong, Li and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Yushun Li, lyshun@bnu.edu.cn

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Math Now: Problem-Solving in a Pandemic

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Human Resource Management Research

p-ISSN: 2169-9607    e-ISSN: 2169-9666

2020;  10(2): 33-39

doi:10.5923/j.hrmr.20201002.02

Characteristics of ‘Problem-Based Learning’ in Post-COVID-19 Workplace

Mohamed Buheji 1 , Aisha Buheji 2

1 International Inspiration Economy Project, Bahrain

2 Researcher, Bahrain

Copyright © 2020 The Author(s). Published by Scientific & Academic Publishing.

The COVID-19 pandemic forced many workplaces to adapt to drastic changes in the work environment around the world. Despite the changes in the previous years in relevance to new technologies and digitisation, the abrupt changes of the pandemic require steep-learning. As the world emerges from the lockdown, more collaborative approaches to solving complex problems are needed. Therefore, this paper investigates the requirements of Problem-based Learning (PBL) in the new normal; an era expected in the post-COVID-19 pandemic. This research uses the dimensions of both the new normal demands and the competency to be learned through the analysis of a questionnaire that investigates the need for PBL. The authors illustrate how the utilisation of PBL helps in the selective approach of the types of possible problems to be solved. The implication of this paper is that it shed light into the rising need for PBL as an attitude after COVID-19 and establish early tools to encourage further more in-depth research on the subject.

Keywords: COVID-19, New Normal, Problem-based Learning, Workplace, Problem-Solving

Cite this paper: Mohamed Buheji, Aisha Buheji, Characteristics of ‘Problem-Based Learning’ in Post-COVID-19 Workplace, Human Resource Management Research , Vol. 10 No. 2, 2020, pp. 33-39. doi: 10.5923/j.hrmr.20201002.02.

Article Outline

1. introduction, 2. literature review, 2.1. definition of problem based learning (pbl), 2.2. describing the new normal, 2.3. understanding the challenges of the new normal, 2.4. requirements of problem solving in post-covid-19 & new normal, 2.5. type of problems that would enhance the learning capacity, 2.6. new normal attitudes and pbl, 2.7. importance of mentors during problem solving journeys, 2.8. untapped covid-19 pandemic problems that await solutions, 2.9. role of pbl in covid-19 problems containment, 2.10. coming technology role in spreading pbl in the new normal, 2.11. role of pbl to validate permanent solutions, 3. methodology, 3.1. dimensions of pbl, 3.1.1. dimension of new normal demands (5rs), 3.1.2. dimension of competency to be learned (5ps), 3.2. analysis of questionnaire approach, 3.3. analysis of iiep research conducted based on pbl approach, 4. data analysis, 4.1. the need of pbl after covid-19, 4.2. the pbl influence on selecting research of the covid-19 pandemic, 5. discussion and conclusions, 5.1. the value of pbl to life and livelihood, 5.2. limitation and implications of this research.

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• Published: 30 June 2021

The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?

• Federica Angeli   ORCID: orcid.org/0000-0003-4010-3103 1 ,
• Silvia Camporesi   ORCID: orcid.org/0000-0003-4135-1723 2 &
• Giorgia Dal Fabbro 3  

Humanities and Social Sciences Communications volume  8 , Article number:  161 ( 2021 ) Cite this article

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While the world was facing a rapidly progressing COVID-19 second wave, a policy paradox emerged. On the one side, much more was known by Autumn 2020 about the mechanisms underpinning the spread and lethality of Sars-CoV-2. On the other side, how such knowledge should be translated by policymakers into containment measures appeared to be much more controversial and debated than during the first wave in Spring. Value-laden, conflicting views in the scientific community emerged about both problem definition and subsequent solutions surrounding the epidemiological emergency, which underlined that the COVID-19 global crisis had evolved towards a full-fledged policy “ wicked problem ”. With the aim to make sense of the seemingly paradoxical scientific disagreement around COVID-19 public health policies, we offer an ethical analysis of the scientific views encapsulated in the Great Barrington Declaration and of the John Snow Memorandum, two scientific petitions that appeared in October 2020. We show that how evidence is interpreted and translated into polar opposite advice with respect to COVID-19 containment policies depends on a different ethical compass that leads to different prioritization decisions of ethical values and societal goals. We then highlight the need for a situated approach to public health policy, which recognizes that policies are necessarily value-laden, and need to be sensitive to context-specific and historic socio-cultural and socio-economic nuances.

Competing goals and conflicting values in the COVID-19 wicked problem

At the time of writing (November 2020), while the world is facing a rapidly progressing COVID-19 second wave, and governments are rushing towards the reintroduction of restrictive measures, the consensus that almost monolithically surrounded the lockdown decisions—or slight variations of the same formula—in Spring 2020, is visibly breaking apart. Roughly 6 months into the pandemic, a paradox emerges. On the one hand, we have more evidence about the mechanisms underpinning the transmission, morbidity and mortality related to Sars-CoV-2. On the other hand, how such knowledge should be translated into containment policies is subject of fierce debates. In particular, a polarization of views started to emerge within the scientific community, vividly illustrated by the Great Barrington Declaration (Kulldorff et al., 2020 ; Lenzer, 2020 ) on the one side and the John Snow Memorandum (Alwan et al., 2020 ; John Snow Memorandum, 2020 ) on the other side. The Great Barrington Declaration was authored by Dr. Sunetra Gupta (University of Oxford), Dr. Jay Bhattacharya (Stanford University), and Dr. Martin Kulldorff (Harvard University), and was written and signed at the American Institute for Economic Research in Great Barrington, Massachusetts, on October 4th 2020. The document is co-signed by a further 44 medical and public health scientists and medical practitioners working in the US, Canada, Israel, Germany, India, New Zealand, and Sweden. The declaration advocates against lockdown measures to favor a containment approach based on a focused protection of the vulnerable, whilst allowing the segments of the population nominally at lower risk of COVID-related complications to resume normal life, thus favouring population-level natural immunity. The John Snow Memorandum was published in the Lancet on October 15th, 2020 as a reaction to the Great Barrington declaration, and was authored by a team of 31 scientists from the UK, Switzerland, US, Canada, Germany, France, Australia. The memorandum’s aim was to lay out empirical evidence to justify restrictive lockdown-like measures to prevent the uncontrolled spread of the virus and the subsequent collapse of healthcare systems.

Such value-laden, conflicting views about both problem definition and problem solution are typical of policy “ wicked problems ” (Alford and Head, 2017 ), a construct that increasingly applies to the COVID-19 global crisis. The pandemic has created a context in which multiple urgent, interdependent societal goals simultaneously exist, which generates a fundamental problem of prioritization of one aspect over another (Camporesi and Mori, 2020 ). Such goals can be identified in the short-term reduction of COVID-19 morbidity and mortality, the mitigation of long-term social repercussions of containment policies (rising social inequalities, mental health issues due to social isolation, intergenerational conflicts) and financial adverse consequences, in the form of severe economic recessions, and subsequent rise in unemployment, poverty levels, and social tensions (Angeli and Montefusco, 2020 ; Camporesi, 2020 ). We are currently witnessing how such prioritization choices generate conflicting stakeholder views about what the problem is (e.g., catastrophic death toll vs potential economic meltdown) and the related solutions (e.g., lockdown measures vs softer mechanisms of virus control). A full-fledged wicked problem has now arisen. However, while wicked problems are normally associated with policy choices, the polarization of views has now permeated the scientific community and the very process of translation of evidence into policy advice, therefore illustrating—perhaps more than ever before—the evolution from value-free to value-laden science.

The prioritization of the shorter-term goals of reduction of COVID-19-related morbidity and mortality in the Spring of 2020 first wave resulted in a multiplicity of policy interventions’ bundles in different countries. These interventions shared similarities in the way they restricted individual freedoms (Camporesi, 2020 ) and varied in their combination of school closures, limitations on pubs’ and restaurants’ opening times, use of face coverings, restrictions of socialization opportunities or individual mobility (Angeli and Montefusco, 2020 ). Now, as evidence about modes of contagion and manifestations of the disease accumulates, the debate about how to use the scientific evidence to inform policy has reached the stage of a polarized conflict. The shift away in narrative from the “we are all in this together” (United Nations, 2020 ), to the “focused protection” (Kulldorff et al., 2020 ) shows that the COVID -19 wicked policy problem requires more in-depth ethical considerations. In this piece, we offer an ethics-driven view of scientific advice for COVID-19 policy formulation, to illustrate how specific ethical prisms can lead to different—even polar opposite—views on containment policies. In this sense, we highlight the importance of ethics in decision-making and in the process of translating evidence into policy design (Oliver and Boaz, 2019 ). Our analysis also aims to provide an interdisciplinary interpretative lens, as it addresses the problem of how decision-makers attend to multiple objectives in space and time—a well-known area of research in management studies (Cyert and March, 1963 ; Ocasio, 1997 ; Rerup, 2009 ), by theoretically drawing on the field of public health ethics (Abbasi et al., 2018 ), and public policy formulation in the context of wicked problems (Head, 2008 ; Waddell, 2016 ).

Conflicting policy viewpoints: different priorities to different values

Conflicting values are commonplace in the context of managerial decision-making (e.g., Levinthal and Marengo, 2020 ) and in public health, especially in relation to the management of infectious diseases (Ortmann et al., 2016 ). Compulsory vaccination represents one emblematic example, in which individual freedom is restricted to favor the public good, by way of boosting heard immunity towards specific pathogens (Dawson et al., 2007 ). Public health policies revolve, although often implicitly, around a compass of three key values, namely utility, liberty, and equity/equality. The principle of utility aims at maximizing a certain value “X” for the greatest number of people. Public health policies aim at maximizing population health. In the context of measures aimed at the containment of disease outbreak, ensuring population health translates into reducing the disease transmission, morbidity and mortality, whether through vaccination, natural herd immunity, or restrictive measures aimed at reducing/modifying citizens’ socialization and interaction patterns, mobility and hygiene practices. Liberty is generally understood as the freedom to live one’s own life free from interference from others. Although there are two main understandings of liberty, a negative (liberty to act free from interference), and a positive one (liberty to shape one’s own life according to one’s own values, and to have the opportunity to do so beyond and above the lack of others’ interference) (Berlin, 1969 ) in the context of public health, liberty is generally conceptualized as negative liberty. Equity/equality is a value that is recognized as salient for public health policies, but also of difficult operationalization and implementation. Egalitarianism is the theory that aims at ensuring a fair distribution of benefits and harms across a given population, and hence to maintain distributive justice. Equity and equality are often used as synonyms in public health ethics, however, they point to different—even opposite—concepts. Equity is a normative concept, grounded in distributive justice, while that is not necessarily the case for equality (i.e. not all health inequalities are unfair) (Braveman and Gruskin, 2003 ). In the context of public health policies, equity means equal opportunity and implies that resources should be distributed in ways most likely to produce a fair distribution of harms and benefits across all segments of the population. This often implies that societal groups should not be offered the same services (as it would be in the case of equal treatment) but rather should receive differential care according to their differential needs. We will focus in this piece on equity rather than equality.

Even if not explicitly acknowledged, the values of utility, liberty and equity underpin any public (health) policy decision, including those aimed at containing the COVID-19 emergency. According to a pluralistic approach to public health policy (Selgelid, 2009b , 2009a ) these three values should all be considered as independent, socially legitimate public goals. Effective public health policies are then tasked to find creative ways to pursue all of them at the same time, through trade-offs that are socially and culturally acceptable. This is naturally easier said, than done. What creates a broad spectrum of public policy approaches in response to the COVID-19 pandemic is the different weight associated by different decision-makers—and also by scientists—to the three value dimensions of the ethical compass, resulting in different trade-off points. The recently published Great Barrington Declaration and John Snow Memorandum exemplify two situations in which, provided the same available scientific evidence, this is interpreted and translated by scientists into polar opposite advice with respect to COVID-19 containment policies. We argue that such views can be best understood in light of a different ethical compass that leads to different prioritization decisions. We can assume that signatories to both memoranda obviously want to reduce COVID-19 morbidity and mortality, want to mitigate its socio-economic repercussions, are concerned about restrictions of personal freedom and increasing surveillance, appreciate the differential impact of the policies across the population. However, the signatories assign a different weight to each of the three values of utility, liberty and equity, hence appraising the available scientific evidence with a different, value-laden ethical prism. The fact that the process of normative weighting assigned to empirical data remains implicit creates a polarization that is only apparently based on disagreements about empirical evidence.

The Great Barrington declaration takes a stance against restrictive measures aimed at controlling the community spread of the virus and instead proposes to focus policies and societal resources towards “focused protection” of the older demographics—notably those who are several times more likely to die from COVID-19 or to suffer from long-lasting complications. According to the signatories, this approach would also favor the development of herd immunity, hence further shielding the older people from the possibility of contracting the disease. This position has sparked a strong reaction from the signatories of the John Snow Memorandum, which highlights instead that the herd immunity arguments based on the assumption that natural infection from the virus will boost lasting protective immunity are flawed and lack supporting evidence. Moreover, the uncontrolled spread of Sars-CoV-2 within communities would lead to an excessive burden on healthcare systems and workers, and compromise the diagnosis and treatment of several acute and chronic conditions, with long-lasting-negative repercussions. As a consequence, the John Snow Memorandum argues that it is important to extend social distancing, targeted restrictions of mobility and socialization, face coverings and strengthened hygiene practices to the whole population.

With its emphasis on “focused protection” the Great Barrington declaration prioritizes values of liberty and equity, as it views the wide imposition of restrictive measures as violating individual freedom in a way that is unfair to the less vulnerable individuals, such as the young generations. The herd immunity argument—widely decried by the scientific community (Aschwanden, 2020 ) and public opinion alike (The Guardian, 2020 )—is highly controversial, and mostly for an ethical rather than a scientific reason. The technical possibility that a population develops natural protection from the infection exists, however, for Sars-CoV-2 it is unclear what the threshold is as this depends on the transmission rate and how long the immunity could last (Fontanet and Cauchemez, 2020 ). Although from a technical point of view the pursuit of (short-term) herd immunity is not, in theory, an unattainable policy goal, there is widespread societal consensus that it would be an unacceptable policy goal from an ethical point of view, in the absence of improved patient management and in the absence of optimal shielding of individuals at risk of severe complications. In the absence of these two key factors, current modeling of transmission dynamics predict that letting Sars-CoV-2 epidemic run its course without non-pharmaceutical interventions (i.e., social distancing, facemasks, heightened hygiene measures) would lead to catastrophic consequences in terms of death toll, both direct from COVID-19, and indirect, due to the overwhelming burden on the healthcare systems (hospital capacity) (Brett and Rohani, 2020 ).

The signatories of the John Snow Memorandum are in fact more concerned with utility, namely the short-term reduction of COVID-19-induced mortality and morbidity and the long-term health outcomes of delayed treatments. Interestingly, by problematizing the definition of “vulnerable” individuals, John Snow supporters implicitly defend the egalitarianism of their position, as evidence is still scant around the reasons underpinning the wide individual variation in COVID-19 adverse outcomes—with some developing grave complications until death and other showing only mild symptoms or remaining completely asymptomatic. Concluding that everyone is equally at risk, the John Snow Memorandum implicitly assumes that it is fair for restrictive measures to be applied to everyone, therefore leaning towards a solution geared towards equality rather than equity. Instead, the Great Barrington Declaration implicitly proffers that vulnerability to the virus is only one aspect that should be taken into account. Vulnerabilities within the population instead should be specified taking into account vulnerability towards negative repercussion of the economic recessions—such as BAME minorities in the UK (Institute for Fiscal Studies, 2020 ), as well vulnerability towards the negative effects of lockdown-induced isolation and alienation, as in adolescents (Lee, 2020 ). The prioritization of short-term gains in terms of physical health with respect to impeding longer term socio-economic disadvantage and mental health consequences therefore becomes less straightforward.

Contextualizing values and policies in time and space

In dealing with a highly complex situation—a wicked problem—such as the COVID-19 pandemic, it is important to understand how values—hence societal goals—are formulated and understood, and the influence of temporality. The value of utility can be specified short-term, as the reduction in the number of COVID-19-related deaths at a given time. However, a more encompassing, forward-looking view will also consider the total number of COVID-19-induced deaths in the medium-long run. The need to prioritize COVID patients in the hospital will necessarily lead to other collateral deaths because of missed appointments and delayed surveillance or surgeries (Maringe et al., 2020 ). Economic recession is widening inequalities and increasing poverty levels (Kirby, 2020 ; Van Lancker and Parolin, 2020 ), while the mental health repercussions induced by isolation especially in young people might lead to forms of addiction and depression (Lee, 2020 ). While deaths from the infectious disease are short-term, indirect casualties that will occur down the line need to be taken into account. Public health policies cannot afford the myopic mistake of discounting the future, a well-known individual cognitive bias (Trout, 2007 ). The public health ethics framework also demands that the management of infectious diseases outbreaks follows the key principle of proportionality in restricting individual freedoms to promote the public good (World Health Organization, 2020 ). This means that, as epidemiological and clinical evidence becomes more conclusive on the disease’s transmission, prevention and diagnosis patterns (Manigandan et al., 2020 ), on the variability of health outcomes (Chen et al., 2020 ), on the effect of non-pharmaceutical interventions to reduce community spread (Li et al., 2020 ), and on the long-term consequences of lockdown measures such as school closures (Bayham and Fenichel, 2020 ; Viner et al., 2020 ), the same restrictive policies might not be as suitable, justified or acceptable as they were in the early stage of the pandemic. This principle is implicit in the Great Barrington declaration.

What degree of personal infringement of liberty is justified? This is where ethics comes in. Expert groups will offer a range of possible ethically justified policies, but, we argue, it is the policymakers’ task to do the normative weighting and to decide which policy approach is best suited to the local socio-economic, socio-cultural and socio-political context (Angeli and Montefusco, 2020 ). While in some national settings the Great Barrington Declaration proposal could be more attuned to the existing social dynamics, individual mindsets, healthcare infrastructure and economic development, in other contexts the prescription of the very same proposal would not be applicable nor recommended, while the solutions proposed by the polar opposite John Snow Memorandum could be more suitable. For example, a policy of focused protection is not practical in settings—such as Italy—where intergenerational exchange is very high, grandparents often babysit grandchildren and even share living space with younger generations. A focused protection approach, which also aims at achieving high levels of community spread of the disease in less vulnerable societal segments, will likely lead to higher burden on the healthcare system, which is only sustainable in settings where healthcare infrastructures are strong and widely accessible, and focused protection of vulnerable segments of the population (i.e shielding) is feasible. In a similar way, restrictions to individual freedom are more difficult to implement in countries where personal liberty is culturally highly valued, and where utility—intended as the public good—comes second. A case in point is the use of face coverings, which, despite mounting evidence related to the importance of the measure to prevent COVID-19 transmission (Cheng et al., 2020 ; Lyu and Wehby, 2020 ), remains highly debated (Martin et al., 2020 ). It is not by chance that more individualistic cultures such as the United States, the United Kingdom or the Netherlands (Hofstede, 1983 ), have seen a more patchy and less widespread imposition of such measures (Royal Society, 2020 ; Statista, 2020 ), combined with higher societal resistance and rising social tensions (CNN, 2020 ).

Finally, questions of equity and justice. Public health measures aimed at containing an infectious disease outbreak should take into account to what degree the measures are disproportionately affecting certain groups of the population. This is where the concept of vulnerability comes in and where it can be used to operationalize the equity principle. Defining who qualifies as vulnerable is difficult, but by no means impossible, as research ethics literature demonstrates. One approach that we think could be well suited here is the layered approach to vulnerability (Luna, 2019 , 2014), which is context dependent, and dynamic. One could identify, for example, the following three layers of COVID-19 related vulnerability:

A biological axis: likelihood of developing severe/critical symptoms after contracting COVID-19. Evidence widely supports that older people and people with pre-existing co-morbidities are at higher risk of COVID complications;

Socio-economic axis: likelihood of being severely affected by restrictive measures. Studies have highlighted how disadvantaged groups and communities (such as BAME minorities in the UK) are disproportionally more severely hit by the economic crisis ensuing from lockdown measures;

Mental health axis: likelihood of developing severe mental health repercussions related to containment policies. School closures and extended lockdown periods have increased mental health issues in the population, with children and adolescents at particularly high risk.

Age, gender and race remain transversal axes here, as the approach rejects applying the label of vulnerability to specific groups. That does not mean that is impossible to define who is vulnerable, contrary to the John Snow memorandum positions. However, who counts as vulnerable to COVID-19 will change depending on the context, over time and through what layers one decides to look at this question. While in the first COVID-19 wave the priority has been given to the biological axis, the attention is, in the second COVID-19 wave, importantly shifting towards socio-economic and mental health aspects.

With the purpose of illustrating the longitudinal evolution over time of value prioritization, and its cross-sectional, cross-country variation, we have selected a number of containment measures that can reflect how the values of liberty, equality and utility are incorporated into scientific advice and then translated into policy. Restrictions to individual freedom can be appreciated for example through the presence of restrictions to jogging activities; the presence of a ban on amatorial sports activities; the extent of face coverings obligations, the restrictions on household mixing, and whether a social bubble is allowed. The value of equity can be operationalized into whether the measures have been prescribed to the whole population indistinctively or whether there has been a differential application to more or less vulnerable sub-groups, or taking into account the different morbidity and mortality levels across regions. This aspect can be appreciated by considering whether restrictions have been imposed nationally or following a regionalization rationale; whether face coverings have been prescribed also to children under 11, notably less amenable to infect, get infected and develop severe symptoms from COVID-19; whether specific measures have been adopted to strengthen protection of older demographics; whether youth sport activities have been allowed; whether business closures have been imposed indistinctively or have instead followed an occupational health risk assessment. Finally, utility can reflect into governments’ advocacy practices, namely the presence of a stay-at-home advice, the emphasis of COVID-19 as a burden for healthcare workers and systems, the clear and frequent communication of COVID-19 epidemic progression, the level of surveillance and sanctioning of non-compliant individual behaviors. We have considered the presence/absence as well as the strength of the above aspects at the highest point of first and second wave of COVID-19, in Italy and in the United Kingdom. As restriction levels, timing and the combination varied across England, Scotland, Wales and Northern Italy, we focused on England.

Table 1 represents the comparison of measures between COVID-19 first and second wave in the two countries, as derived from the original policy documents. Based on the nature of the containment measures, and the effect to which they reflected values of equity, utility and liberty, we computed scores on each dimension, for each country across the two waves, on a total of 20 points for each value dimension.

We then plotted the results in Fig. 1 . The graphs highlight how values are differentially embedded into containment policies trough context- and time-specific trade-offs. The figure highlights how two countries started from very different positions, with measures in Italy in the first wave almost entirely guided by utility (public health) considerations, with strong restrictions of individual freedoms and little appreciation of differences in vulnerability levels across populations and regions. In the second wave, we notice the evolution of Italian policies towards more consideration for liberty and equity value dimensions. England has experienced a similar evolution, albeit starting from a much more libertarian stance. Its policies show an evolution towards liberty and equity considerations against a slight reduction of utility-focused measures.

Evolution of the value trade-off embedded in the COVID-19 containment policies promulgated in Italy and in England, during the first and the second pandemic wave (until December 2020).

Conclusions

Public health policies—and particularly those aimed at the containment of a highly infectious disease such as COVID-19—revolve around a compass of moral values, which are often implicitly given different weights by both policymakers and scientific advisors. Both the understanding of these values, and the normative weighing of the values will always necessarily be context dependent, and dynamic. Public health policies should aim to consider to what degree the proposed measures aimed to preserve the public good are socio-culturally acceptable in restricting individual freedom, in what way they disproportionately affect certain groups of the population, according to what aspect of vulnerability is most relevant. An approach of situated policy is therefore most salient, which promotes policymaking that is attuned with idiosyncrasies that are both spatial (the socio-cultural and socio-economic local context) and temporal (given the rapid evolution of COVID-related scientific evidence). A situated approach to policymaking in the context of wicked problems reflects that there cannot be a one-size-fits-all approach to COVID-19 public health policies.

Our analysis has aimed to propose an ethics-driven perspective to better comprehend how evidence is used to inform policymaking and how disagreement on policy can emerge within scientific communities. In doing so, we have offered an interdisciplinary view at the intersection between management studies, public policy and bioethics disciplinary boundaries. Whilst the debate around evidence-based policymaking has been a core focus of science and technology studies (Frickel and Moore, 2006 ), this commentary offers an alternative perspective that is less concerned with the politics of science—hence the influence on knowledge production of socio-political factors and power dynamics (Hoppe, 2005 )—and is instead more focused on how evidence is filtered through a situated ethical prism to inform policymakers’ prioritization decisions. The recognition that policymaking is shaped by socio-contextual factors and that policymakers engage into processes of interpretation of evidence in light of their knowledge, norms and values and towards their economic and political goals is not new (Sohn, 2018 ). This commentary suggests, however, that an ethical perspective is salient to understand such processes, that interestingly affect not only policymakers but also prominent representatives of the scientific community. Our analysis thus highlighted how evidence-based public health containment measures to address the pandemic can be ethically justifiable and understood through a clear and transparent understanding of the values underpinning policy decisions, and the evolution of acceptable trade-offs over time.

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Angeli, F., Camporesi, S. & Dal Fabbro, G. The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?. Humanit Soc Sci Commun 8 , 161 (2021). https://doi.org/10.1057/s41599-021-00839-1

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Early childhood education and care (ECEC) had sustained benefits for young children’s vocabulary, communication, problem solving, and personal-social development during COVID-19, particularly for those from socioeconomically disadvantaged backgrounds.

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Preprint from PsyArXiv , 16 Dec 2022 https://doi.org/10.31234/osf.io/ytws5   PPR: PPR586102 

Abstract 

Early childhood education and care (ECEC) settings faced significant disruption during the COVID-19 pandemic, compromising the continuity, stability, and quality of provision. Two and half years on from the first UK lockdown as pandemic-era preschoolers enter formal schooling, families, practitioners, and policymakers are concerned about the impact of the disruption on children’s cognitive and socioemotional development, especially those from socioeconomically disadvantaged backgrounds. Using parent-report data from 171 children aged between 5 and 23 months in Spring 2020 (M=15 months) living in the UK, we investigate whether previously attested positive associations between ECEC attendance and the development of language and executive functions was maintained as early years settings navigated operational challenges over the first full year of the pandemic. In response to concerns about school readiness, we analyse the relationship between ECEC attendance and children’s communication, problem-solving, and personal-social development. ECEC was associated with greater growth in receptive vocabulary over the 12-month period, regardless of children’s socioeconomic background. ECEC was also associated with greater growth in expressive vocabulary, but only in children from less advantaged backgrounds. Our data suggest a similarly positive association between ECEC attendance and the communication and problem-solving skills of children from lower socioeconomic (SES) backgrounds, and between ECEC and the personal-social development of all children. We found no effect of SES or ECEC attendance on growth of either of our measures of executive function. Overall, results suggest that ECEC had sustained learning benefits for young children growing up during the pandemic despite ongoing disruption to settings, and also had specific benefits for children from less affluent home environments. As children progress to primary school, we discuss the importance of adjusting the expectations placed on pandemic-era children, and adapting curricula and learning conditions to enable schools and families to make the most of learning opportunities.

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PPRID: PPR586102 EMSID: EMS181284 PsyArXiv preprint, version 1, posted 2022 December 16 https://doi.org/10.31234/osf.io/ytws5

Early childhood education and care (ECEC) had sustained benefits for young children’s vocabulary, communication, problem solving, and personal-social development during COVID-19, particularly for those from socioeconomically disadvantaged backgrounds

• 1. School of Languages, Cultures and Societies, University of Leeds
• 2. Centre for Psychological Research, Oxford Brookes University
• 3. Department of Experimental Psychology, University of Oxford
• 4. Carnegie School of Education, Leeds Beckett University
• 5. Department of Psychology, University of Warwick

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Keywords: childcare, cognitive development, COVID-19, executive functions, language development, socioeconomic status, school readiness

Introduction

High-quality, centre-based childcare during the first three years of life benefits children’s cognitive, language, and social development at school entry and beyond ( Becker, 2011 ; Côté et al., 2013 ; Melhuish & Gardiner, 2020 ; Melhuish et al., 2015 ; Sylva et al., 2004 ; van Huizen & Plantenga, 2018 ). Research also highlights that the benefits of early childhood education and care (ECEC) are greater for children from disadvantaged backgrounds ( Connell & Prinz, 2002 ; Felfe et al., 2015 ; Geoffroy et al., 2007 , 2010 ; Larose et al., 2020 ; Melhuish, 2004 ; Melhuish et al., 2015 ; Sylva et al., 2004 ).

What is not yet known is to what extent the benefits of ECEC were maintained during the disruption to education caused by the COVID-19 lockdowns. Following an increase in the number of COVID-19 cases, ECEC settings and schools were asked to close from 20 March 2020 ‘until further notice’ as part of the UK government’s Coronavirus action plan. Between March and June 2020, much of the ECEC sector closed to all but vulnerable children and those of key workers, meaning that only 5–10% of children who usually attended ECEC in England did so ( Hunnikin & Blackburn, 2020 ). Attendance increased from early July 2020 when approximately half the average number of 3-and 4-year-old children expected in a typical week attended their early years setting. For the remainder of 2020 and into 2021, a period of quarantine measures was imposed leading to intermittent closures of ECEC settings, reduced attendance, and other types of disruption ( Bowyer-Crane et al., 2020 ). Although attendance increased incrementally over the first year of the pandemic, the number of children accessing ECEC in formal settings remained substantially below the norm at around 63% in July 2021 ( Department for Education [DfE], 2021a ).

Two and half years on from the first UK lockdown, as pandemic-era preschoolers enter primary school, we are starting to see the impact of the lockdowns and limited access to ECEC on children from diverse backgrounds. Mounting evidence from practitioner and parental observations (e.g., DfE, 2022 ; Early Years Alliance, 2021 ; Hogg & Mayes, 2022 ; La Valle et al., 2022 ; Nicholls et al., 2020 ; Ofsted, 2020 ; Tracey et al., 2022 ), as well as from quantitative measures from children, their families, and early years settings (BLINDED FOR REVIEW; González et al., 2022 ; Green et al., 2021 ), suggests that the lockdowns led to delays in key developmental skills, potentially affecting children’s experience of starting school, also known as school readiness.

School readiness is a term used to describe the compatibility between the school environment and the child’s stage of development, ensuring a smooth transition into primary school for children and their families. It has been conceptualised in a variety of ways, broadly encompassing children’s skills at the start of formal education that are critical for later academic success ( Aiona, 2005 ; Snow, 2006 ). English education policy states that school readiness gives children the broad range of knowledge and skills that provide the right foundation for good future progress through school and life ( DfE, 2021b ), and defines children who are school ready as those who have achieved the ‘good level of development’ in a range of abilities including communication and language, physical development, personal, social and emotional development, and maths and literacy, as measured using the Early Years Foundation Stage Profile (EYFSP) at the end of the Reception year (aged 4-5 years). Educators also use the term ‘school ready’ more holistically to refer to the full range of academic, socioemotional, and motor developmental measures including turn-taking, communication, concentration, and physical coordination, which enable children to access learning as they start school ( Davies et al., 2016 ; Head Start, 2020 ). In policy and practice, responsibility for school readiness is often characterised as belonging to the child or their family, rather than as a joint venture between home and educational settings.

Practitioner and parental observations reveal widespread concern about preschoolers’ development during COVID-19. The English education regulator Ofsted undertook interim research interviews with 208 registered ECEC providers in Autumn 2020, revealing particular concerns about young children’s communication and language, and their personal, social, emotional, and physical development. Almost all providers said that the pandemic had significantly impacted the learning and development of children who had left settings and subsequently returned. They also reported that children who continued to attend settings or who were well supported at home had made good progress in their learning ( Ofsted, 2020 ). Two years later, Hogg and Mayes (2022) conducted an online survey of 555 professionals and volunteers working with babies, young children, and their families in health visiting, mental health, maternity, early education, and other services. Based on this data, Hogg and Mayes (2022 , p. 4) report that the lack of opportunity for babies and young children to engage in normal activities at home and at formal ECEC settings is “likely to have pervasive impacts on health, cognitive, and physical development”. Nearly half of survey respondents reported that “many” babies they work with are impacted by more sedentary behaviour and less stimulation and play. Ninety-five per cent of respondents said that the pandemic had an ongoing negative or very negative impact on the personal and social skills of young children growing up during the pandemic, and 92% said the same for communication, speech and language skills, and emotional development.

Similar concerns emerge from parental and practitioner observations of children starting their reception year during this period. Some of the challenges commonly reported by Nicholls et al. (2020) include a lack of basic number skills, school starters struggling to follow simple instructions, holding a pencil, and playing/sharing with others. In a study of 3253 children in reception in 2020-2021 (of whom 95% attended ECEC before the pandemic, dropping to 17% during the first national lockdown with less than half returning afterwards), the proportion reaching the expected levels of development in all areas – communication and language, physical development, literacy, maths, and personal, social and emotional development – was 59% in 2021, compared to 72% for the 2019 cohort. Their parents also perceived this disadvantage ( Tracey et al., 2022 ). In a comprehensive review of qualitative and qualitative data from 2020-21, La Valle et al. (2022) report that the greatest concern among both parents and practitioners was that children who have started school since COVID-19 were ‘behind’ compared with pre-pandemic cohorts. For example, that they were not hitting milestones in their communicative development because they had not been able to access the stimulation that ECEC settings can offer. At the end of their reception year, recent national data ( DfE, 2022 ) show that 65% of children reach a good level of development, though due to EYFS reforms and associated changes to the measure, this figure can not be compared to pre-pandemic data.

A range of reports evidence a disproportionate impact of the pandemic on ECEC access and efficacy by socioeconomically disadvantaged children. They missed more formal early learning than their more advantaged peers and had longer or more frequent absences from ECEC ( La Valle et al., 2022 ), leading to concerns among early years educators about a widening development gap. Practitioners reported challenges in supporting vulnerable children during the pandemic, compounded by the low take-up of places by 2-year-olds in receipt of funded places ( Wilson & Wadell, 2020 ). The Early Years Alliance (2021) surveyed 1,300 early educators and found that 47% of respondents considered the attainment gap between the least and most advantaged under-5s had widened since the beginning of the pandemic. In addition to concerns about the learning and development of children living in poverty, ECEC providers were worried about the disproportionate challenge to children with special educational needs and disabilities (SEND) and those with English as an additional language ( Ofsted, 2022 ). These children were observed to be more deeply affected by a lack of support for the transition from nursery to school ( Bakopoulou, 2022 ).

Quantitative measures corroborate practitioner and parental concerns about restricted ECEC attendance and associated levels of cognitive development and school readiness. The positive impact of attending ECEC on aspects of cognitive development during COVID-19 for some groups of children was highlighted in an exploratory study with 189 UK families. [BLINDED FOR REVIEW] reported associations between time spent in ECEC by 8-to-36-month-olds during the pandemic, family socioeconomic status (SES), and their growth in language and executive functions during the first 6 months of the pandemic. ECEC attendance boosted receptive vocabulary growth such that children who accessed one day per week of ECEC understood 24 more new words than their peers during Spring to Winter 2020. ECEC also boosted the growth of children’s cognitive executive functions during the period. Notably, children from lower-SES families demonstrated enhanced language benefits when they continued to access ECEC provision, suggesting that when access to ECEC was disrupted during the pandemic, this disproportionately affected disadvantaged children. In a large cohort study of Uruguayan 4-to-6-year-olds, preschoolers living through the pandemic made less progress than their pre-pandemic peers in standardised, teacher-administered measures of school readiness pertaining to cognitive and motor development, attitudes to learning, and internalising behaviours. Losses were more pronounced in children attending low-SES schools ( González et al., 2022 ). Using observational data from the UK Millennium Cohort Study ( Centre for Longitudinal Studies, 2014 ), Green et al. (2021) estimated that compared to parental care only between the ages of 26–31 months, centre and non-centre-based childcare was associated with improvements in school readiness and vocabulary, respectively. Using simulation methods to approximate lockdown restrictions, Green et al. (2021) revealed the power of ECEC to reduce inequalities during COVID-19, suggesting that children from disadvantaged backgrounds (indexed by lower parental education) may benefit more from centre-based care than their more advantaged peers.

Current study

This study investigates the ongoing impacts of ECEC disruption. Our first aim is to investigate whether the attested positive association between ECEC attendance and cognitive development was maintained as early years settings continued to provide education and care alongside extensive disruption to staff, routine, and facilities, and broader operational pressures including workforce health and protection ( Hardy et al., 2022 ), workforce stability and recruitment ( Bonetti & Cottell, 2021 ; Haux et al., 2022 ), the financial sustainability of settings ( Early Years Alliance, 2020 ), and reduced access due to the temporary, partial, and in some cases permanent closures of settings ( National Day Nurseries Association, 2021 ).

Our second aim is to track children’s developmental milestones as they mature through the pandemic towards the time they will prepare to start primary school. In response to concerns about school readiness (holistically defined), we test the relationship between ECEC attendance and children’s communication, problem-solving, and personal-social development. As data converges to show that children from disadvantaged backgrounds were more negatively impacted in this regard ( Bakopoulou, 2022 ; González et al., 2022 ; La Valle et al., 2022 ), we also analyse the role of SES.

Participants

Families with 8-to-36-month-old children in the UK were recruited in Spring 2020 through Babylab databases and online advertisements via social media to take part in the Social Distancing and Development Study (SDDS). The data reported in this study were collected in Spring 2020 (03/03/20-28/06/20), Winter 2020 (27/11/20-18/12/20) and Spring 2021 (27/04/21-02/06/21) using online questionnaires. Only infants under 37 months (M days = 847.70, SD = 133.78) at the Spring 2021 data collection point, from monolingual English-speaking families, with a gestational age of at least 37 weeks, and no known genetic conditions were included; N = 171 (100 female; 71 male). As the current study extends some of our previous work, the Spring 2020 and Winter 2021 vocabulary scores, EF measures, and similar Early Childhood Education and Care (henceforth ECEC) measures are also reported in [BLINDED FOR REVIEW]. Vocabulary scores and a similar measure of ECEC attendance at the Spring 2020 data collection point for most of the sample (N = 113) are also reported in Kartushina et al. (2022) , which investigates separate questions on the impact of the home environment on language development. The online questionnaires also included other factors relevant to the wider project, such as parental mental health and access to social support systems and informal childcare, which are not reported in this study.

This study received ethical approval from the [BLINDED FOR REVIEW] University Research Ethics Committee (ref 20023). All procedures reported in this manuscript are in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participating caregivers provided informed consent at each timepoint for themselves and their child. On completion of each questionnaire, families received £30 (Spring 2020), £5 (Winter 2020) and £10 (Spring 2021) Amazon vouchers.

Socioeconomic status

Four indices of socioeconomic status (SES) were used in this study, as described below and summarised in Table 1 .

• Household Income: Caregivers reported their household income from the following categories: 1) £0-20k, 2) £21-30k, 3) £31-40k, 4) £41-50k, 5) £51-60k, 6) £61-70k, 7) £71k or over.
• Caregiver education: Caregivers reported their highest level of education from the following categories: 1) Primary school, 2) Secondary school, 3) Sixth form or college, 4) Vocational college, 5) Undergraduate, 6) Postgraduate, 7) MBA, 8) Doctoral degree. For single/widowed caregivers, only their scores were used; otherwise, mean scores were computed based on both caregivers.
• Caregivers’ occupational prestige: Caregivers reported their occupation. This was converted into scores based on Hollingshead (1975) ranging from 1 to 9; for example, 1 is for cleaners and farm labourers, 5 is for clerical and sales workers, 7 is for owners of small businesses and managers, and 9 is for engineers or large business owners. For single/widowed caregivers, only their scores were used; otherwise, mean scores were computed based on both caregivers. If one caregiver was a full-time homemaker, the occupation score was based on the other working caregiver/s.
• Index of Multiple Deprivation (IMD): Postcode data was used to compute an IMD decile group where 1 is for most deprived and 10 is for least deprived using the English ( Noble et al., 2019 ), Northern Irish (Power & Green, 2019), Scottish ( Scottish Government, 2020 ) or Welsh ( Welsh Government, 2019 ) databases as appropriate.

As described in [BLINDED FOR REVIEW], Principal Components Analysis was used to extract a single SES factor score from these four indices using the full SDDS sample.

Language ability

The Oxford Communicative Development Inventory (O-CDI; Hamilton, Plunkett & Schafer, 2000) was used to assess children’s vocabulary development at each timepoint. This UK-based parent-report measure assesses comprehension and production of 416 early English words across 19 categories (e.g. animals, vehicles, food and drink). Parents of children aged 18 to 36 months completed the extended version of the O-CDI which includes 133 additional items (i.e. a total 549 English words) and four additional categories (i.e. online, adventures, parts of things, and parts of animals). Caregivers were instructed to report on whether their child “understood” (receptive vocabulary) or “understood and said” (expressive vocabulary) each word, which was used to produce receptive and expressive vocabulary scores for each timepoint.

Executive functions

The Early Executive Functions Questionnaire (EEFQ; Hendry & Holmboe, 2020) was used to assess emergent executive functions at each timepoint (see https://osf.io/fa5eq for details). Caregivers reported on a 7-item Likert scale (“Never” to “Always”) how often their child exhibited a particular behaviour during the preceding fortnight (28 items) and for uncommon or highly context-dependent behaviours, caregivers were asked to play a short game with their child designed to elicit a particular skill in a semi-standardised way and then report on their performance (3 items). In line with Hendry and Holmboe (2020), composite Cognitive Executive Function (CEF) and Regulation scores were computed using the mean of the corresponding items.

Communication, problem-solving, and personal-social skills

The Ages and Stages Questionnaire (ASQ-3; Squires et al., 2009 ) was used to assess whether children were reaching age-appropriate developmental milestones in three domains: Communication, Problem-Solving, and Personal-Social. For example, for caregivers of 23-to-25-month-old children, items included “Does your child correctly use at least two words like “me”, “I”, “mine”, and “you”?” for Communication; “After a crumb or Cheerio is dropped into a small, clear bottle, does your child turn the bottle upside down to dump out the crumb or Cheerio?” for Problem-Solving; and “Does your child drink from a cup or glass, putting it down again with little spilling?” for Personal-Social. Caregivers reported whether their child exhibited six behaviours from the age-appropriate ASQ version for each domain on a three-point scale (10 = “yes”, 5= “sometimes”, 0= “not yet”) at the Spring 2021 data collection point. Raw scores were calculated by summing the six items for each domain (range: 0-60). As the cut-off point for developmental targets varies across the age versions, scaled scores were produced using the following formulae:

• - for positive scores: (([domain_total]-[domain_cutoff])/(60-[domain_cutoff]))*100
• - for negative scores: (([domain_total]-[domain_cutoff])/(0-[domain_cutoff]))*100.

These scaled scores adjusted the range for all age groups to -100 to 100 with 0 representing the cut-off point, such that children with a positive score are performing at or above their expected developmental targets.

Early childhood education and care

Caregivers reported whether their child received non-parental childcare from a nursery or childcare setting (henceforth ECEC) before the Spring 2020 lockdown, during all three lockdowns (Spring 2020, Winter 2020, Spring 2021), and between these lockdowns. If they attended such settings, caregivers reported the duration (full or half days), frequency (days per week), date resumed (if disrupted due to the Spring 2020 lockdown), and degree of disruption since resuming (weeks prevented from accessing ECEC due to for example, staff shortages or quarantining of close contacts). From this information, we computed the total number of days that the child accessed ECEC since the start of the Spring 2020 lockdown and then subtracted the number of disrupted days to compute a total days score. This was then divided by the number of weeks since the start of the Spring 2020 lockdown to compute an ECEC score (mean number of days per week).

Statistical analysis

Multiple linear regression analyses were conducted using vocabulary and EF difference scores as dependent variables. To compute the difference scores, the raw Receptive Vocabulary, Expressive Vocabulary, CEF, and Regulation scores at Spring 2020 were subtracted from the raw scores of the same measure at Spring 2021. Multiple linear regression analyses were also conducted using the ASQ scaled scores for Communication, Problem-Solving, and Personal-Social as dependent variables. Difference scores could not be computed for the ASQ measure as this was only collected in Spring 2021.

In each multiple linear regression, the predictor variables were ECEC, SES, and age at the Spring 2021 data collection point, and interaction terms for ECEC and age, and ECEC and SES. ECEC and age were centred to prevent issues of multicollinearity due to the inclusion of interaction terms.

To aid interpretation, we present plots showing the regression of language and EF difference scores on ECEC with the data grouped into higher and lower SES using a median split.

Summary descriptive data for predictor and dependent variables are presented in table 2 .

Abbreviations: CEF, Cognitive Executive Function; ECEC, Early Childhood Education and Care.

Effects of age, ECEC, and SES on language growth

As shown in Table 3 , increases in receptive vocabulary between Spring 2020 and Spring 2021 were negatively associated with age, meaning that vocabulary growth was more pronounced for younger children compared to older children. Increases in receptive vocabulary were also positively associated with ECEC ( Figure 1a ), such that for each day spent in ECEC, children could be estimated to understand 16 more new words over this period, compared to their peers who did not attend ECEC. For expressive vocabulary, there was a positive association with age, such that vocabulary growth was more pronounced for older children compared to younger children. There was also a significant interaction between ECEC and SES in predicting expressive vocabulary growth, meaning that the benefits of ECEC on expressive vocabulary growth were more pronounced for children from lower-SES backgrounds ( Figure 1b )

Note: *** p <.001, ** p <.01, * p <.05

Effects of age, ECEC and SES on EF growth

As shown in Table 4 , increases in CEF between Spring 2020 and Spring 2021 were negatively associated with age, meaning that growth in CEF skills were more pronounced for younger children compared with older children. Meanwhile, increases in Regulation were positively associated with age, meaning that Regulation skill growth was more pronounced for older children compared with younger children. There was no association found between CEF or Regulation difference scores with either SES, ECEC or interaction terms ( Figures 2a and 2b ).

Note: ***p <.001, ** p <.01, *p <.05

Effects of age, ECEC and SES on communication, problem-solving and personal-social skills

As shown in Table 5 , communication scores were positively associated with SES, such that children from higher-SES demonstrated higher communication scores compared to their peers. There was also a significant interaction between SES and ECEC for communication and problem-solving skills, meaning that the benefits of ECEC for communication and problem-solving were more pronounced for children from lower-SES backgrounds (see Figures 3a and 3b ). Personal-social scores were positively associated with ECEC, such that children who attended more ECEC demonstrated higher personal-social scores ( Figure 3c ). However, there was evidence of a ceiling effect for all the ASQ measures, and the data was not normally distributed for communication (Kolmogorov-Smirnov, p <.001) or personal-social ( p = .019). Subsequently, the results should be taken with caution.

Note: ***p <.001. ** p <.01, *p <.05

This study analyses associations between the amount of time that young children spent in ECEC during the first year of COVID-19, their socioeconomic background, and their cognitive development, i.e. expressive and receptive vocabulary, cognitive executive function (CEF), regulation, and their communication, problem-solving, and personal-social skills (as measures of school readiness). Our first aim was to investigate whether the previously attested positive association between ECEC attendance and cognitive development was maintained during the extended disruption. We found that children who attended ECEC for a greater part of the week showed enhanced growth in their receptive vocabulary over the 12-month period, regardless of their socioeconomic background. We also saw enhanced growth in expressive vocabulary in those who spent more time at ECEC, but only amongst children from less advantaged backgrounds. Together, these results suggest that ECEC has sustained language benefits for young children growing up during the pandemic despite ongoing disruption to settings, and also has specific benefits for the language of children from less affluent environments. There was no effect of SES or ECEC attendance on growth of either of our measures of executive function. Our second aim was to track children’s developmental milestones as they matured through the pandemic and prepared to start formal schooling. Our data suggest a similarly positive association between ECEC attendance and the communication and problem-solving skills of children from lower-SES backgrounds, and between ECEC and the personal-social development of all children.

The finding that ECEC attendance boosted language growth during the entire first year of the COVID-19 outbreak in the UK extends our earlier work focusing on the first 6 months of the pandemic for this sample [BLINDED FOR REVIEW]. Over the year-long period, ECEC was found to benefit the receptive vocabulary growth of all children (this was the case only for lower-SES children during the previous 6-month analysis). The longer period revealed for the first time an interaction between ECEC and SES on expressive vocabulary growth, which aligns with our findings on communication scores in the ASQ (suggesting that the questionnaire leans heavily on expressive language). Our findings add to the evidence base that ECEC can enrich the language development of children growing up without socioeconomic advantage ( Berry et al., 2016 ; Drange & Havnes, 2019 ; Geoffroy et al., 2007 , 2010 ; Larose et al., 2020 ; Vernon-Feagans et al., 2013 ). Such inequalities have broadened and deepened during the pandemic ( Blundell et al., 2022 ), increasing the importance of buffering factors such as ECEC. The fact that ECEC settings were grappling with disruption into 2021 yet still maintained these protective effects highlights the robustness of its influence on children’s development.

Our 12-month dataset shows no effect of ECEC attendance on growth of executive function. This is somewhat surprising since common features of ECEC (e.g. provision of developmentally appropriate learning materials and high-quality adult-child interactions) have been shown to scaffold learning and promote child EFs ( Amso, et al., 2019 ; Clark et al., 2013 ; DeJoseph et al., 2021 ; Rosen et al., 2020 ). These examples of process quality – the proximal interactions that children have with ECEC staff and equipment – may be particularly important in whether ECEC benefits EF development ( Melhuish and Gardiner, 2018 ; Pianta et al. 2005 ; Sylva et al, 2020). Crucially, process quality is likely to have been particularly impacted by the pandemic. Settings were required to keep children in small groups or bubbles, with implications for interactions with key workers. Staff absence disrupted consistency of care, and some materials were removed from settings due to concerns about viral spread. The null result for EF also contrasts with the positive link we previously found between ECEC and growth in CEF skills during the first 6 months of the pandemic. Speculatively, this contrast may be linked to social changes as the pandemic wore on. During the first summer of the pandemic, access to ECEC may have lessened family strain (see BLINDED FOR REVIEW showing the association between parental mental health and child EF) and/or provided a nurturing environment for children, boosting EF. Over the extended period, these effects may have been washed out by more pervasive factors like setting quality, parental mental health rebounding, or increased social support as restrictions were loosened.

Our data tentatively suggest that ECEC boosted the communication and problem-solving skills of disadvantaged children and the personal-social skills of all children regardless of background. These skills enable children to more easily access both the academic and social aspects of school, with knock-on effects for later attainment ( Davies et al., 2016 ; Li-Grining et al., 2010 ; McClelland et al., 2006 ). Based on our data it is not possible to attribute increased concern about school readiness exclusively to a lack of ECEC during the pandemic, among a variety of other factors such as access to services, loss of social support, and increased family stress, illness, and bereavement. Nevertheless, we suggest that increasing access to ECEC is a way of providing post-pandemic opportunities for socialisation, emotional wellbeing, physical development, and foundational academic skills, rather than compensating for ‘missing skills’. Increasing these opportunities and nurturing children via responsive support should address concerns about school readiness and help to mitigate socioeconomic attainment gaps ( Wilcock & Bazalgette, 2022 ).

It will also be important for schools to be ready for the specific needs of pandemic-era starters, rather than measuring them against pre-pandemic expectations. In Tracey et al.’s (2022) sample, the proportion of children who achieved a ‘good level of development’ (GLD) was 13% smaller than a comparable pre-pandemic cohort (59% reaching a GLD in 2020/21 compared with 72% in 2018/2019). This was coupled with 76% of schools reporting that this cohort would benefit from adjusted curricula to support their learning and development compared to pre-pandemic cohorts. Thus, the benchmarks for school readiness (especially regarding constructs such as literacy, mathematics, personal-social development, and language) should be responsively reviewed to meet children where they are when they enter and progress through school, with special focus on those children who were most disadvantaged during the pandemic (aligning with data and recommendations from Nash et al., 2022 ). A flexible, collaborative approach between schools, families, and children themselves will help all parties to maximise learning opportunities.

All children are ready to learn. However, the cohort of children starting their early education during the pandemic appear to be facing barriers to learning in schools as they currently stand. These barriers may be best addressed through enrichments to boost development, e.g. small group work and greater access to 1-to-1 adult-child interactions, and importantly, adaptations to curricula as well as school settings themselves, e.g., more outdoor/free play, more movement breaks, etc.

To summarise, our study has evidenced the enduring benefits of ECEC for children’s developing vocabulary and aspects of school readiness, and the specific support it confers to children from disadvantaged backgrounds, even when the standard provision is disrupted. Accessing centre-based education and care before the beginning of formal education provides many opportunities, including for communication, socioemotional development, and problem-solving. This provides an important foundation for learning and play, and is likely to have broader effects across curriculum areas as children mature through school.

Our findings yield several policy recommendations. First, sustainable investment in early years education will pay cost-effective dividends for society, as shown by its positive effects even when services were disrupted. Second, support for eligible families to take up their funded entitlement will ensure that the benefits of ECEC are accessible to those who stand to benefit most, mitigating achievement gaps in the early years and beyond. Third, within the Early Years Foundation Stage, a holistic and flexible approach to school readiness will help to support children to achieve a good level of development at school entry. Overall, supporting universal access to early years education, in a form that meets the needs of pandemic children will address the United Nations (2021) Sustainable Development Goal 4 to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

Our study has several limitations. Regarding measurement, our use of parent-report (compulsory during social distancing) may have increased the likelihood of error and recall bias, and our measure of school readiness was somewhat limited in its range. Because our ECEC measure did not probe aspects such as activities, facilities, or practitioner qualifications, we can not make claims about exactly how ECEC confers developmental advantages. Regarding our sample, we used a self-selecting convenience sample of UK parents, presenting limits on generalisability. We also had relatively low representation from families with extremely low SES, skewing the sample towards more highly educated parents (who were more likely to use ECEC).

Our next steps are to continue to follow this cohort as our ‘pandemic babies’ start school and advance through their education. It is important to track the enduring effects of the initial deep lockdowns of 2020, and the associated changes to key environmental predictors of development. Although follow-on effects are likely to be highly variable, some evidence points to a degree of catch-up as children mature. Although 56% of parents from a survey of 1,105 families had concerns about the socioemotional wellbeing of children starting school in September 2020, 93% felt that their children had settled in well once they had started, and by the end of the Reception year 80% of parents had no concerns about their children coping in school ( Tracey et al., 2022 ). Large-scale data from the National Foundation for Educational Research (NFER) in the UK shows that on average, children who were in Reception in March 2020 are still behind expectations in reading two years on, whereas those who were in Year 1 are faring better with regard to pre-pandemic expectations. For the former cohort, the proportion of very low attainers in reading more than tripled to 9.1 percent in spring 2022, and for pupils who were in Year 1, this proportion more than doubled to 6.5 per cent. The NFER also reports a widening SES attainment gap ( Wheater et al., 2022 ). Continuing to track these children, taking into account the effects of early educational experiences will inform an optimal support system for families.

Acknowledgements

We would like to thank all the families who have contributed to this study, and gratefully acknowledge Cecilia Zuniga-Montanez for editorial support. This research is funded by the Economic and Social Research Council (ESRC) as part of the UK Research and Innovation’s rapid response to COVID-19 (ES/V004085/1). A. Hendry is supported by the Scott Family Junior Research Fellowship at University College, University of Oxford and by a NIHR and Castang Foundation Advanced Fellowship.

Author Information

Address for correspondence Catherine Davies, School of Languages, Cultures and Societies, University of Leeds, LS2 9JT, UK. [email protected]

Competing interests

The author(s) declare none

CRediT author statement

Catherine Davies : Conceptualisation, Writing – Original Draft, Writing – Review & Editing

Shannon P. Kong: Investigation, Data curation, Methodology, Formal analysis, Visualization, Writing – Original Draft, Writing – Review & Editing

Alexandra Hendry: Conceptualisation, Methodology, Formal analysis, Writing – Review & Editing

Nathan Archer: Writing – Original Draft, Writing – Review & Editing

Michelle McGillion: Writing – Review & Editing

Nayeli Gonzalez-Gomez: Conceptualisation, Methodology, Writing – Review & Editing, Supervision, Project administration, Funding acquisition.

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• Posted December 16, 2022.

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Teamworking in Healthcare during the COVID-19 Pandemic: A Mixed-Method Study

Associated data.

The data presented in this study are available on request from the corresponding author.

The widespread impact of COVID-19 on healthcare has demanded new ways of working across many organisation types and many forms of healthcare delivery while at the same time endeavouring to place minimal, or no, additional burden on already strained healthcare teams. This is a cross-sectional mixed-method study which captured the experiences of teamwork during the COVID-19 pandemic contributing to successful collaboration. We hypothesised that work engagement and psychological safety separately contribute to collective leadership and organisational citizenship behaviours. Participants were healthcare staff on active duty during the COVID-19 pandemic in Ireland ( n = 152) who responded to our social media (Twitter) invitation to participate in this study. Survey and free-text responses were collected through an online platform. Structural equation modelling examined the relationships between work engagement and psychological safety, and collective leadership and OCBs. Open text responses relating to experiences of teamworking during the pandemic were analysed for latent themes. From the survey data, the structural model demonstrated excellent statistical fit indicating that psychological safety, but not work engagement, was predictive of collective leadership and OCBs. From the qualitative data, two key themes were generated: (1) Contrasting experiences of working in a team during the pandemic; and (2) The pandemic response: a tipping point for burnout. This study offers a valuable starting point to explore the factors driving change and the shift to more collective ways of working observed in response to COVID-19. Future studies should use longitudinal data to capture the temporal relationship of these variables which could be moderated by prolonged pressure to healthcare staff during the pandemic.

1. Introduction

The COVID-19 pandemic elicited an extraordinary response from healthcare teams. To reduce the transmission of the virus and to ensure the safe continuity of services, changes were rapidly implemented across all levels of health systems globally [ 1 ]. Despite the typically slow pace of change in healthcare pre-pandemic [ 2 , 3 ], new initiatives have been rapidly approved and implemented. The widespread impact of COVID-19 on healthcare has demanded quicker designing, implementing, and learning about innovations across many organisation types and many forms of healthcare delivery while at the same time endeavouring to place minimal, or no, additional burden on already strained healthcare staff [ 4 ]. Whilst there is considerable variety of new initiatives introduced during the pandemic, such as the use of tablets to allow the family of patients in critical care to see their loved ones, common characteristics can be identified including the emergence of enhanced interprofessional collaboration and trust within healthcare teams and empowerment and autonomy to cultivate change [ 5 ]. Against the backdrop of intense pressure to maintain quality standards while keeping themselves safe, how did healthcare staff experience teamwork during the pandemic response? What were the factors that supported healthcare teams to deliver rapid changes in service delivery? This cross-sectional study explored the association between collective leadership, psychological safety, work engagement, and organisational citizenship behaviours during this time of exceptional transformation in healthcare.

1.1. Theoretical Approaches

During the pandemic, researchers have reported softer hierarchies and greater staff autonomy within multidisciplinary teams MDTs; [ 6 , 7 ]. This approach to patient care aligns with a shift away from traditional ‘command and control’ leadership styles to a more collaborative and collective leadership approach. While there have been many studies on traditional, formal leadership roles and how they influence the team environment, there is a paucity of research looking into collective leadership. Collective leadership is characterised by all team members jointly participating in decision-making processes and fulfilling tasks traditionally reserved for a hierarchical leader [ 8 ]. In the understanding of collective leadership, even those without formal leadership roles could contribute to the team’s decision-making processes. This differs from teamwork, which is generally understood as the activity of working together in a group with other people. One can have teamwork despite being in a team controlled by an authoritative leader.

Approaches such as collective leadership (e.g., shared or distributed leadership) emphasise the relational aspects of leadership, conceptualising leadership as a dynamic, interactive group-level phenomenon rather than the responsibility of one formal ‘heroic’ leader [ 9 ]. A recent meta-analysis by Wu et al. [ 8 ] has shown the positive relationship between shared leadership and group behaviour processes (e.g., problem solving), attitudinal outcomes (e.g., team satisfaction), team cognition (e.g., team creativity), and team performance (e.g., team productivity). Although research in other fields has begun to investigate the antecedents that support the emergence of collective leadership [ 10 , 11 , 12 ], our understanding of the factors that positively influence and enable collective leadership in healthcare teams is still developing. A recent systematic review of the literature found that internal team environment (i.e., shared purpose, voice and social support) and team heterogeneity are antecedents that are positively related to the emergence of shared approaches to leadership [ 8 ] Building on Carson et al.’s [ 10 ] work, we predicted that the internal team environment will support the emergence of collective leadership in healthcare teams.

One of the key characteristics of a positive team environment is one that promotes psychological safety [ 10 ]. To actively participate in patient care decision-making, staff must perceive that their work setting accepts and encourages collaboration and feedback [ 13 ]. Psychological safety refers to the shared belief that a work setting is a safe place to take interpersonal risks such as speaking up, asking questions, and sharing ideas and opinions [ 14 ]. The importance of psychological safety in healthcare teams is emphasised by the ongoing, global response to COVID-19; the continuous adaptation and redesign of services has required enhanced collaboration, engagement, creativity, innovation, and knowledge sharing across teams and across organisations. Newman et al. [ 15 ] identify these factors as key outcomes observed when working within psychologically safe environments. Previous research suggests that psychological safety enhances the adoption of leadership roles within MDTs by enabling involvement and voice in decision-making [ 16 ]. We acknowledge that it is also plausible that collective leadership would contribute to psychological safety within the team.

For healthcare staff to adopt leadership roles, they must be engaged and motivated to do so. Researchers conceptualise work engagement as a cognitive state in which individuals invest their personal resources and energies into their work roles and tasks [ 17 , 18 ]. Schaufeli et al. [ 19 ] consider vigour (e.g., high levels of energy and mental resilience while working), dedication (e.g., sense of enthusiasm or pride in one’s work), and absorption (e.g., being deeply engrossed in one’s work) as key characteristics of work engagement. The extant literature suggests that engagement is essential for overcoming the complex barriers associated with healthcare provision, for instance excessive workloads and inadequate staffing levels, and enables employees to feel attachment and engagement to their work roles [ 13 , 17 , 20 ]. When a psychologically safe environment exists, employees perceive greater self-determination and interest in their work, leading to improved innovation and shared learning [ 21 ]. Bakker and Albrecht [ 22 ] also suggest that because engaged employees are open to new experiences, staff are more inclined to help their colleagues. Similarly, Kahn [ 17 ] suggests that engaged individuals are more likely to step outside the formal boundaries of their role to assist their colleagues and support the goals of their team or organisation. Although research has examined the association between transformational leadership (which focuses on the behaviour of a designated leader) and work engagement [ 23 , 24 ], the relationship between work engagement, collective leadership and extra-role behaviours remains unclear, requiring further investigation.

Organisational citizenship behaviour (OCB) is a term used to describe these extra-role behaviours which include helping colleagues, encouraging others, and volunteering to take on additional responsibilities [ 25 , 26 ]. In addition to work engagement and collective leadership, psychological safety has also been positively associated with OCBs [ 20 ]. When healthcare staff feel comfortable taking interpersonal risks, they actively engage as part of the MDT and therefore we propose that staff may subsequently participate in extra-role behaviours to support their colleagues.

1.2. Hypotheses

This study aims to capture the experiences of teamwork during the COVID-19 pandemic, exploring factors which contribute to successful collaboration. We hypothesise that psychological safety is a pre-requisite conditions that promote collective leadership and OCBs in healthcare teams. Acknowledging that psychological safety can also contribute to work engagement [ 21 ], we additionally hypothesise that work engagement (even in the absence of psychological safety) promotes collective leadership and OCBs in healthcare teams during the pandemic, given the needs of the health service. As of the writing of this paper, no peer-reviewed studies have examined the four constructs together in the context of healthcare, especially with the lens of teamworking during the COVID-19 pandemic.

2. Materials and Methods

2.1. design, participants and recruitment strategy.

This is a cross-sectional mixed-method study. Given the growing complexity of healthcare, we hoped to capture the richness of contextual perspectives and relationships that exist between the four constructs (psychological safety, work engagement, collective leadership, OCBs) beyond numerical data. To capture the corresponding circumstances of collaboration, we added open-ended questions to the survey. To ensure neutrality and provide a safe space for participants, we recruited through social media rather than healthcare institutions.

Participants ( n = 152) in this study consisted of healthcare professionals who were working during the COVID-19 pandemic (from March 2020) in Ireland. They included clinical, administrative, and support staff. Participants were recruited using an online survey, completed via Qualtrics.com. The survey link was published on Twitter once a week during the study period, starting on 7 September 2020, and re-tweeted 230 times by Twitter users. Participants accessed the online survey using their own personal computer (desktop/laptop/tablet) or smartphone. Those clicking on the link were taken to an information and consent page. The survey was conducted entirely online with a median completion time of 15 min. This study received an exemption from full ethical review due to the low-risk nature of the work, from the research ethics committee at University College Dublin, Ireland.

2.2. Materials

This research employed four standardised scales and a series of open text questions relating to participants’ experiences of teamworking in healthcare during COVID-19. In addition, there was an optional section on demographic information. As Ireland has a relatively small population size and considering the self-reporting of racial data, to protect the anonymity of participants, age was reported in bands.

2.2.1. Collective Leadership

Collective leadership was assessed using the Collective Leadership Scale [ 27 ]. This is a 25-item instrument which assesses four domains of collective leadership: planning and organizing (six items); problem solving (seven items); support and consideration (six items); and development and mentoring (six items). However, given the considerable time pressures on healthcare staff and to reduce participant response burden, only the first three domains were retained, totalling 19 items. The development and mentoring subscale had items pertaining to skills acquisition and exchanging career-related advice, which the researchers were aware would be difficult to do as non-essential in-person interactions were severely limited in the early stages of pandemic response. To avoid contaminating the integrity of the responses, we omitted this subscale. Items prompted participants to consider how often their team shared in tasks including ‘Planning how the work gets done’ and ‘Finding solutions to problems affecting team performance’. All items were rated using a seven-point Likert scale (‘rarely’ = 0, ‘always’ = 7), with higher scores reflecting higher levels of collective leadership. The psychometric properties of this measure have previously been supported [ 27 ]. Similarly, the internal consistency (Cronbach’s alpha) for the full scale (α = 0.98) and each individual subscale (planning and organising = 0.95; problem solving = 0.95; support and consideration = 0.95) in the current sample demonstrated high levels of consistency.

2.2.2. Utrecht Work Engagement

Work engagement was measured using the Utrecht Work Engagement Scale UWES [ 19 ]. The UWES is comprised of 17 items that measure three dimensions of work engagement: vigour (six items), dedication (five items), and absorption (six items). Sample items include ‘When I get up in the morning, I feel like going to work’ and ‘At my job, I always persevere, even when things do not go well’. All items were rated using a seven-point Likert scale (‘rarely’ = 0, ‘always’ = 7), with higher scores reflecting increased work engagement. The psychometric properties of this measure have previously been supported [ 28 ]. Moreover, the internal consistency of the full scale (α = 0.95) and individual subscales (vigour = 0.90; dedication = 0.90; absorption = 0.83) were excellent in the current sample.

2.2.3. Organisational Citizenship Behaviour

OCB was measured using the Organisational Citizenship Behaviour Scale [ 29 ]. This is a 24-item scale which assesses five domains of organisational citizenship behaviour: altruism; conscientiousness; sportsmanship; courtesy; and civic virtue. However, to minimise participant response burden and avoid overlap with UWES, only three domains were retained, namely altruism (five items), courtesy (five items), and civic virtue (four items), totalling 14 items. Items were rated using a seven-point Likert scale (‘strongly disagree’ = 0, ‘strongly agree’ = 7), with higher scores reflecting higher levels of OCB. Sample items on this scale prompted participants to consider whether team members ‘are mindful of how their behaviour affects other people’s jobs’ and ‘keep abreast of changes in the organisation’. The psychometric properties of this measure have previously been supported [ 29 ]. Moreover, the internal consistency of the full scale (α = 0.96) and individual subscales (altruism = 0.83; courtesy = 0.95; civic virtue = 0.95) were satisfactory in the current sample.

2.2.4. Psychological Safety

Psychological safety was assessed using the 19-item Psychological Safety Scale [ 30 ]. This recently developed measure is designed to target psychological safety among healthcare professionals in relation to their team leader (nine items), fellow team members (seven items), and the whole team (three items). All items were rated using a seven-point Likert scale (‘strongly disagree’ = 0, ‘strongly agree’ = 7), with higher scores being indicative of higher psychological safety. Sample items included ‘I can speak up with recommendations/ideas for new projects or changes in procedures to my peers’ and ‘If I made a mistake on this team, I would feel safe speaking up to my peers’. The internal consistency of the full scale (α = 0.97) and individual subscales (team leader = 0.97; team members = 0.94; whole team = 0.95) were satisfactory in the current sample.

2.2.5. Open-Ended Questions

A series of eight open-ended questions ( Appendix A ) were embedded between the above standardised scales to capture the nuances of participants’ experiences working as part of a healthcare team during the COVID-19 pandemic. These questions were designed to elicit perceived changes in how teams worked together during the pandemic, and how the participant felt about these changes.

2.2.6. Covariates

A number of covariates were assessed including age (18–29, 30–39, 40–49, 50–59, 60+), sex (0 = male, 1 = female), self-reported ethnicity (0 = ethnicity other than White Irish, 1 = White Irish), length of time employed in healthcare, and whether or not the participant was redeployed due to the COVID-19 pandemic. Non-white Irish participants were grouped together for our data analysis due to the small sample size. In addition, due to small sample sizes in the 18–29 and 60+ age groups, the 18–29 and 30–39 groups were collapsed together, and the 50–59, and 60+ groups were collapsed together. This resulted in three age groups: 18–39, 40–49, 50+. These covariates were selected, following the guidelines set forth by VanderWeele [ 31 ], to ensure that the observed effects were not the result of differences among sociodemographic variables or additional work-related factors. For example, time employed in healthcare and/or being redeployed during the COVID-19 pandemic might impact an individual’s level of work engagement and/or psychological safety.

2.3. Data Analysis

2.3.1. quantitative data.

Structural equation modelling (SEM) was used to examine the relationships between work engagement and psychological safety, and collective leadership and organisation citizenship behaviours, while adjusting for several exogenous covariates (age, sex, self-reported ethnicity, length of time working in healthcare, and redeployment status). SEM is advantageous as it parses out measurement error, thus leading to more accurate parameter estimates [ 32 ]. It was necessary to first evaluate the fit of the measurement model (i.e., a model consisting of just the latent variables), prior to fitting the structural model [ 33 ]. Model fit was assessed using several goodness-of-fit indices [ 34 ]: Non-significant χ 2 , Comparative Fit Index CFI; [ 35 ] and Tucker–Lewis Index TLI; [ 36 ] values ≥ 0.90; Root Mean Square Error of Approximation RMSEA; [ 37 ] and Standardised Root-Mean-Square Residual SRMR; [ 38 ] values < 0.08 suggest adequate model fit.

Data were analysed using Mplus 8.2 [ 39 ] and the models were estimated using the robust maximum likelihood (MLR) estimator. There was a substantial proportion of missing data on certain variables of the survey. Although 100% ( n = 152) completed the Collective Leadership Scale, 68.4% ( n = 104) completed the UWES, 65.8% ( n = 100) completed the Organisational Citizenship Behaviour Scale, 60.5% ( n = 92) completed the Psychological Safety Scale, and 43.4–50% ( n = 66–76) completed the remaining demographic questions. However, the missing data were found to be missing completely at random (MCAR), as indicated by Little’s MCAR test ( χ 2 [30, n = 152] = 18.39, p = 0.952).

Missing data were handled using the robust full information maximum likelihood procedure, which allows parameters to be estimated using all information available. To reduce model complexity, the latent variables (i.e., work engagement, psychological safety, collective leadership, and OCBs) were created using parcels consisting of the summed scores of each subscale within the latent variable’s respective scale. Moreover, the default procedure for using maximum likelihood estimation removes exogenous covariates using listwise deletion before the model is estimated. As such, we brought all variables, including the exogeneous covariates, into the model [ 39 ] to use all information available and thus model covariate missingness. This process makes distributional assumptions (i.e., multivariate normality) about the nature of the covariates. However, the MLR estimator was used as this estimator is robust to non-normally distributed data and can account for concerns of such multivariate non-normality.

2.3.2. Qualitative Data

The eight open-ended questions included in this survey generated text responses. The qualitative data were analysed using Braun and Clarke’s [ 40 ] 6-step thematic analysis framework. This process involved repeatedly reading the data, generating initial codes and developing, refining and naming broader themes. Rather than applying a prescriptive list of codes, a bottom-up inductive approach to coding was applied which ensured themes strongly reflected the data collected. Using NVivo11 software, an experienced qualitative researcher trained in advanced qualitative design and analysis conducted line-by-line thematic coding. As themes emerged, they were deliberated and refined through discussions with the research team who were familiar with the data set. The dependability of the findings was further enhanced through deviant case analysis. By recognizing alternative viewpoints and contradicting data, a more holistic understanding of the data was achieved. Through this process, we identified patterns in the data, interpreted them, and explained their latent ideas. In total, 96 survey participants provided responses to the open-ended questions. These data provided greater insight into the experiences of teamwork during COVID-19 enhancing our understanding of the relationship between psychological safety, work engagement, collective leadership, and OCBs.

3.1. Descriptive Statistics

Table 1 summarises the sample characteristics for the current study. The majority of participants who responded to the demographic questions are female (84%). Three quarters identified as White Irish (75%). We also note that approximately a third of our participants who responded to the demographic questions experienced redeployment to a different healthcare team during the pandemic (31.6%).

Sample characteristics and descriptive statistics of the current study.

3.2. Measurement Model

The measurement model consisting of four latent variables (work engagement, psychological safety, collective leadership, and OCBs) demonstrated excellent statistical fit ( χ 2 (48) = 70.46, p = 0.019; CFI = 0.983; TLI = 0.976; RMSEA = 0.055 [90% CI 0.023, 0.082]), SRMR = 0.035. Although a significant χ 2 indicates poor model fit, this fit statistic can often reject the postulated model for trivial misspecifications [ 41 , 42 ]. As such, it is generally recommended to consult additional fit statistics. As the CFI, TLI, and RMSEA indicated satisfactory statistical fit, it is likely that the proposed model provided adequate fit to the data. All factor loadings were positive and significant ( p < 0.001) ranging from 0.78–0.97 and inter-factor correlation ranged from 0.68–0.94. For individual factor loadings and inter-factor correlations see Appendix B , Table A2 and Table A3 ).

Structural Model

The SEM model (see Figure 1 ) demonstrated satisfactory fit to the data ( χ 2 (96) = 129.30, p = 0.001; CFI = 0.978; TLI = 0.969; RMSEA = 0.048 [90% CI 0.023, 0.068]), SRMR = 0.041 and explained 80.7% of the variance in collective leadership scores and 94.1% of the variance in OCBs.

Structural model illustrating the relationship (standardised estimates) between work engagement and psychological safety, and collective leadership and organisational citizenship behaviours. Note: Individual exogenous covariate pathways are omitted for visual clarity. Statistical significance: *** p < 0.001.

While adjusting for the exogenous covariates (see Table 2 for all parameter estimates), increased psychological safety (β = 0.90, p < 0.001) and self-reported ethnicity (ethnicity other than White Irish) (β = −0.31, p < 0.001) were associated with increased collective leadership. Similarly, psychological safety (β = 1.13, p < 0.001) and self-reported ethnicity (ethnicity other than White Irish) (β = −0.25, p < 0.001) were associated with increased OCBs. Although this standardised regression coefficient (OCBs regressed on psychological safety) may appear quite large, it is important to note that standardised coefficients can exceed a value of one if there are multiple, correlated, predictors [ 43 , 44 ]. It is also argued that one should not modify a model for the purpose of reducing large coefficients as this can lead to biased estimates [ 43 ]. Moreover, the model converged without any indicators of improper solutions, such as negative residual variances. There was no association between work engagement and either collective leadership (β = −0.01, p = 0.918) or OCBs (β = −0.24, p = 0.055).

SEM model of work engagement, psychological safety, collective leadership, and organisational citizenship behaviours.

Note: B = unstandardised estimates; β = standardised estimates; SE = standard error; a = sex coded as 0 = male, 1 = female; b = self-reported ethnicity coded as 0 = ethnicity other than White Irish, 1 = White Irish. Statistical significance: *** p < 0.001.

3.3. Qualitative Findings

Two key themes were generated from the inductive qualitative analysis of open-ended responses: (1) Contrasting experiences of working in a team during the pandemic; and (2) The pandemic response: a tipping point for burnout.

3.3.1. Contrasting Experiences of Working in a Team during the Pandemic

Participants described greater collaboration as one of the most significant changes to occur as a result of COVID-19. Staff discussed the removal of organisational barriers and “red tape” (COV217) which commonly hindered the implementation of change. This greater autonomy resulted in enhanced innovation and implementation: “less bureaucracy and more action” (COV148). In addition to more bottom-up decision-making, participants also reported enhanced interdisciplinary teamworking characterised by improved communication and the development of “supportive networks” (COV103). Some participants described “working together as one team” rather than within discipline specific silos (e.g., medicine, nursing, allied health) (COV021), which is consistent with a shift towards a collective approach to leadership. The shared goal and challenge of responding to COVID-19 encouraged staff to “pull together” (COV 209), which increased compassion and the sense of “solidarity” (COV027) in teams. Informal ‘check-ins’ were a common support mechanism identified by participants. Many staff emphasised their desire to sustain the interprofessional teamworking that emerged during the pandemic response. Some suggested that by experiencing the benefits of collective decision-making (e.g., in service redesign), greater collaboration among team members may be sustainable. However, others questioned whether “going the extra mile” for colleagues would continue (COV104), with one participant noting that the “sense of being in this together has gone” as the pandemic continued (COV015).

Other respondents, however, described a very different experience of working in healthcare during the pandemic response. In some instances, the strictures of the traditional hierarchy and power dynamics were not only evident, but reinforced, and this was universally reported as a negative, even damaging experience for staff. Some participants outlined experiences of hierarchical decision-making in which decisions were imposed and frontline staff were expected to “follow them unquestionably like school children” (COV010). One participant emphasised the fear associated with this model of leadership: “they were working in situations of fear of the management as well as fear of the virus” (COV097). While another stressed their “frustration” at the “command and control pressures on the team” (COV094). Many staff described how this sense of powerlessness made them feel “taken for granted, not important” (COV118) and simply “just a number” (COV029). Although some participants provided examples of formal wellbeing services, others felt organisational support for frontline staff was limited or “superficial” (COV130). Some staff also described poor interpersonal relationships within their frontline team. Some explained how a “blame culture” exists (COV030), while others simply mentioned feeling “let down” (COV029). These participants suggested that COVID-19 restrictions may have strengthened the hierarchical culture that exists within their workplace. Due to social distancing precautions, some staff described how there are “less people having [a] voice at the table” (COV026). Frontline staff also recognised that personal protective equipment has impacted the informal relationships within their teams as there are “few opportunities to have chats and coffee” (COV070). For others, redeployment exacerbated the fragmented nature of teamworking: “you did what you were told without question” (COV016).

3.3.2. The Pandemic Response: A Tipping Point for Burnout

Although some staff accredited greater commitment, pride and meaning to their work following their initial involvement in the pandemic response, as the pandemic continued many participants emphasised increasing levels of burnout. Burnout was illustrated in the evocative language used by participants. Staff described working on the frontline as “hell” (COV190), “unrelenting” (COV27), “exhausting, draining, and upsetting” (COV22). Some staff described feeling “shattered, shellshocked, and traumatised” (COV97) as they had “passed the novelty of being heroes” (COV143). Despite public recognition for their work, many participants felt underappreciated by their health system:

“I am working in an industry that has a small heart and little respect” (COV143).

Many participants associated burnout to their growing workloads and diminishing resources; “extra work piled on without any support” (COV005). Some described how a “get on with it” attitude exists within their organisation (COV022). However, due to the ongoing demands one participant questioned “how am I going to do this for another 20 years” (COV156). Due to their negative experiences, some staff suggested a “massive increase in anxiety related illnesses” (COV19) for healthcare staff. Others implied possibly leaving the health service because of feeling unappreciated by their organisation and the wider health system: “I’m looking for other opportunities where I’m valued more” (COV118). Despite the increased risk associated with their role (in which many contracted COVID-19), some staff felt unprotected by their health service, explaining how “no one could care less about [their] experience” (COV016). Some participants suggested that insufficiencies in organisational and wider health service leadership have left staff feeling “forgotten” on the frontline (COV019).

4. Discussion

This study, conducted in 2020 during the COVID-19 pandemic, aimed to capture the experiences of teamwork during the pandemic response. While previous research harnessing media and social media narratives has demonstrated that the health system can transform rapidly when presented with a single focus or threat [ 5 ], our research has used social media (Twitter) to recruit participants to a study exploring factors driving this shift towards collaborative and collective approaches to teamworking and leadership. Specifically, we hypothesised that work engagement and psychological safety would be associated with collective leadership and OCBs. Our results partially supported these hypotheses, with psychological safety, but not work engagement, predictive of collective leadership and OCBs. Qualitative analysis of text responses offered valuable contextual insight to help explain these findings.

As predicted, we found that psychological safety was associated with collective leadership behaviours. Previous research has found that the key drivers of psychological safety and its outcomes include the level of interaction between, and familiarity among, team members [ 45 ] and the quality of social relationships between team members, indicated by trust and collective thinking [ 46 ]. Where it exists, the interprofessional collaboration reported during the COVID-19 response enabled an atmosphere of psychological safety and creativity, where ideas and innovations were actively sought and developed collectively. Previous work has similarly found that inclusive approaches are associated with enhanced psychological safety and creativity [ 47 , 48 ]. As a result, team members were empowered to adopt leadership roles and responsibilities, effectively leveraging and contributing their expertise to support the operation and functioning of the team. Consistent with previous research [ 10 ], the qualitative findings demonstrate that the levels of peer support and the positive internal environment reported by participants promoted through this collaborative approach to change facilitated the emergence of collective leadership. This collaborative approach to change suggests a more collective mindset and coalescing around a shared goal, promoting a sense of team and collective identity [ 49 ].

In this study, psychological safety also predicted organisational citizenship behaviours. When staff feel psychologically safe in taking interpersonal risks, such as adopting a new role or responsibility, they are more willing to venture outside their own professional domain or comfort zone to support colleagues, engaging in extra-role behaviours including helping colleagues, encouraging others, and volunteering to take on additional responsibilities. However, our qualitative findings highlight the potential risk of burnout from engagement in extra-role behaviours. Organ and Ryan [ 50 ] found that individuals who engaged in high levels of OCB might feel overloaded and be at higher risk of role fatigue. Indeed, excessive levels of engagement in OCBs, such as those that were observed during the pandemic response, may contribute to burnout and ultimately disengagement in work.

Contrary to our prediction, work engagement did not predict collective leadership or OCB. Work engagement is often considered the opposite of burnout. In contrast to those who suffer from burnout, engaged employees are those who experience a sense of energetic and effective connection with their work and perceive themselves as capable of managing the demands of their role [ 19 ]. Given work engagement is defined as a positive, fulfilling work-related outlook, this experience may not be generally representative of healthcare workers perceptions during this time of unprecedented pressure on health services. Our qualitative findings offer some potential explanations into why a relationship between work engagement and collective leadership, or OCB was not observed. Firstly, this study took place several months into the onset of the global pandemic and participants in our qualitative analysis conveyed either a largely positive or a very negative experience of their work. The latter group reported higher levels of stress, burnout, and fatigue. Those who perceived more hierarchical working environments tended to report greater levels of burnout. These polarised experiences may explain why no relationship between work engagement and collective leadership and OCBs was observed. Future research should investigate this further. Secondly, whilst psychological safety and work engagement both represent positive, motivational states toward one’s work, work engagement tends to reflect cognitive appraisal of the job, whereas psychological safety is more reflective of the perceptions one holds of the work environment. This disparity may explain the current findings. Furthermore, employees tend to report high levels of work engagement when they perceive higher levels of control over their work environment [ 51 ]. In the context of an unpredictable, rapidly evolving, high-stress pandemic, it is not surprising that healthcare staff may not have the same personal resources and perceptions of control that are associated with higher levels of work engagement.

Finally, our model found that self-reported ethnicity predicted both collective leadership and OCBs. It is well-established in the literature that cross-cultural differences exist in both the meaning and perceptions of leadership and in the degree of individualism or collectivism [ 52 ]. As Friedrich et al. highlight [ 53 ], research on teams often assumes homogeneity in teams and fails to attend to this diversity. A recent meta-analysis found a positive relationship between team heterogeneity and shared leadership, suggesting the importance of diversity among team members as an antecedent condition to support collective leadership [ 8 ]. Team diversity warrants further exploration, specifically the impact of culturally diverse teams and the emergence of collective leadership and OCBs.

4.1. Theoretical and Practical Implications

This research delivered snapshots of healthcare workers’ experiences of teamworking during the COVID-19 pandemic to explore factors contributing to collaboration and successful initiatives during a crisis. At the point this manuscript was submitted, no peer-reviewed studies have examined the psychological safety, work engagement, collective leadership, and OCBs together in the context of healthcare, especially with the lens of teamworking during the COVID-19 pandemic. The majority of existing research in this field have examined the outcome variables separately through either a quantitative or qualitative approach, but seldom both. This study offers the evidence to support psychological safety as a precondition for collective leadership and OCBs even during a national crisis—that ‘necessity’ alone cannot force collaboration and force an environment of innovation to take place. There is considerable scope for learning how teams are adapting to the COVID-19 crisis and the factors that are promoting effective teamworking and outcomes. To date, a relatively narrow range of outcomes have been measured and there is opportunity to understand other antecedents and outcomes related to collective leadership, including aspects of workplace culture and the impact on burnout. The latter is attracting more attention recently due to the impact of the on-going COVID-19 pandemic on healthcare staff. These avenues for future research will prove fruitful in informing how we can train and develop teams to ensure the appropriate interventions to enable collective ways of working to harness intelligence and leverage skills and knowledge from the whole team to ensure optimal care delivery.

Practically, this study shows that recruitment of research participants through social media is possible, although not without its limitations. For healthcare teams, this study’s findings further underline the need to deliberately establish a psychologically safe environment, where individuals will not be humiliated for speaking up with ideas, questions, concerns, or observations. Risk-taking attitudes which are traditionally associated with innovation, requires an environment that is open to experimentation and welcoming of ideas even from the lowest ranks. Our study further shows that without such an environment, healthcare professionals are unlikely to go the extra mile. Several strategies have been identified to support healthcare teams foster psychological safety in daily practice [ 48 , 54 ]. Firstly, encouraging all team members to engage in more inclusive behaviours by establishing a daily multidisciplinary huddle will likely improve staff perceptions relating to the value of their role, promoting voice behaviours and staff contributions. Rather than only focusing on operational issues, protecting time monthly to reflect together as a team on more personal experiences may enhance familiarity and trust within teams. In addition to enabling team reflections, one-on-one interactions between staff have been shown to facilitate discussions on more difficult subjects [ 54 ]. Therefore, adopting an approach such as a buddy system in practice where staff are paired with a peer or more senior colleague may further strengthen interpersonal relationships promoting greater openness and ultimately psychological safety within healthcare teams.

4.2. Limitations

Whilst the research offers valuable insights to help us understand these rapid changes, the limitations of the work must also be acknowledged. In our attempt to be neutral, recruitment was through an academic social media channel. Even though the recruitment links were replicated over 200 times, we acknowledge that many healthcare workers without a Twitter account might not have been exposed to our study. As in all studies of this nature, we are aware that there is potentially a self-selection bias of healthcare workers who chose to participate. Those who are engaged in their work, have very positive or very negative stories to share, or feel they have the agency to make a difference are more likely to participate in this type of study.

Given the considerable burden already on healthcare staff, we deliberately adopted a design approach to minimise response burden. We designed the demographics section optional, and right at the end of the survey. Age was reported in bands, to minimise the possibility of identifying respondents from their demographics, as Ireland has a relatively small population. This resulted in participants only completing the substantive part of the survey and dropping out when they reach demographics section. The missing data observed in responses suggests the use of shortened scales through administration of only the most relevant sub-scales was warranted. Procedures to account for missing data using all information available, together with the analytical approach adopted, enabled robust analyses and inferences based on this data set and helped to ensure that this limitation was mitigated. Finally, causality cannot be inferred in cross-sectional research of this nature and the focus on staff in one national healthcare system may limit the generalisability of the findings. Future studies should use longitudinal data to capture the temporal relationship of these variables which could be moderated by prolonged pressure to healthcare staff during the COVID-19 pandemic.

5. Conclusions

This study explored experiences of teamworking during the COVID-19 pandemic. Structural equation modelling indicated that psychological safety, but not work engagement, was predictive of collective leadership and OCBs. Further qualitative analysis found contrasting experiences of working as part of a healthcare team during the pandemic; and initial evidence of the pandemic representing a tipping point for burnout. These findings require further investigation to clarify how the pandemic has impacted individuals and teams in the long term. Meanwhile, this research offers a valuable starting point to explore the factors driving change and the shift to more collective ways of working observed in response to demands presented as a result of the COVID-19 pandemic.

Open-Ended Questions. The following questions intend to capture attitudes towards, and motivations driving, new ways of working during COVID-19.

Standardised factor loadings of all latent variables.

Note: β = standardised estimates; SE = standard error. Statistical significance: All p < 0.001.

Inter-factor correlations of all latent variables.

Note: Statistical significance: *** p < 0.001.

Author Contributions

Conceptualization, S.A., A.D.B. and E.M.; methodology, S.A., A.D.B., L.R., R.F. and E.M.; formal analysis, S.A, R.F., L.R.; writing—original draft preparation, S.A., A.D.B., L.R., R.F; writing—review and editing, S.A., A.D.B., L.R., R.F. and E.M.; funding acquisition, E.M. All authors have read and agreed to the published version of the manuscript.

This work is funded by the Irish Health Research Board (RL-2015-1588) and the Health Service Executive.

Institutional Review Board Statement

This study received an exemption from full ethical review due to the low-risk nature of the work, from the research ethics committee at University College Dublin, Ireland.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Virtual Skills Teaching of Nursing Students during COVID-19: A Problem-Solving Approach

Affiliations.

• 1 Department of Nursing, Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
• 2 Department of Nursing, University College of Nursing, Islamia University, Bahawalpur, Pakistan.
• PMID: 35330537
• DOI: 10.29271/jcpsp.2022.04.548

The COVID-19 pandemic radically affected the whole education system including nursing education. Nursing is a practice-based profession; therefore, it is necessary to transform acquired knowledge into practice. However, in the current situation of the pandemic, the nursing students were unable to learn and practise nursing skills in the skills lab on manikins or simulation. This paper aims to give an overview and practical application of alternative solutions to overcome this situation. Alternatives like virtual skills teaching along with sign-off were sought by using problem-solving approaches to facilitate students' learning and help them to acquire necessary skills timely. Key Words: Virtual skills teaching, Nursing students, Problem-solving approach, COVID-19.

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• Education, Nursing*
• Students, Nursing*

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Solar eclipse 2024: Follow the path of totality

Thinking of taking a last-minute drive to see the eclipse here's what to know.

Geoff Brumfiel

RV traffic sits at a standstill along a two-lane road near Madras, Ore., a few days before the 2017 total solar eclipse. Experts say traffic could be heavy, but eclipse watchers shouldn't necessarily be deterred. AFP Contributor/AFP via Getty Images hide caption

RV traffic sits at a standstill along a two-lane road near Madras, Ore., a few days before the 2017 total solar eclipse. Experts say traffic could be heavy, but eclipse watchers shouldn't necessarily be deterred.

NASA says that roughly 31.6 million people live in the path of this year's total solar eclipse, and a little under half of the U.S. population lives within 200 miles driving distance of the path of totality .

That could mean many millions of Americans will hit the road to get a better view on April 8. If you're still pondering whether or not you want to make the journey, here's what to consider.

Have some destinations in mind, and check the weather and cloud cover forecasts in advance

It's a good idea to scout out one or more locations within driving distance, so that you have some flexibility if traffic or weather is threatening your plans, says Jonathan Upchurch, a professor emeritus of civil engineering at Arizona State University who has studied travel around solar eclipses.

There are several interactive tools that show the path of totality, including Eclipse2024.org and the National Solar Observatory . You can use them to figure out what sites might work best for you.

In terms of weather, check not just the weather forecast, but also the cloud cover forecast. Some websites, such as Windy.com will predict cloud cover ahead of time, giving you a sense of whether you'll actually be able to see the eclipse in all its glory.

Everything you need to know about solar eclipse glasses before April 8

During the total solar eclipse in 2017, Upchurch says he chose to go to Idaho "because there were some great chances of having sunny skies, and I had the opportunity to be nimble and relocate if I wanted to."

Before driving into the path of totality, make sure your gas tank is full and that you've got everything you need

During the last total solar eclipse in 2017, it's estimated some 5 million people took to the roads, and those numbers will potentially be much higher this year.

Given all that, Upchurch says it's important to make sure you're taking what you need into the path of totality. You should make sure your car is gassed or charged up, and that you have plenty of snacks and water with you in case you get stranded for a while, especially when trying to leave.

Solar Eclipse 2024: Totality stretches from Texas to Maine

Simple tips to safely photograph the eclipse with your cellphone.

Also don't forget to bring eclipse glasses, which must be worn anytime you're looking at the sun, except for the few minutes when it is completely blocked by the moon.

Some state emergency planners also recommend bringing a paper map or road atlas in case cellular networks become overloaded with visitors seeking directions from their phones.

Don't forget your eclipse glasses everyone! Erika Goldring/FilmMagic hide caption

Don't forget your eclipse glasses everyone!

Arrive early and stay late

Once you figure out where you're going to watch the eclipse, and you've got your supplies, try to get there early. Although traffic is likely to be heavier than normal on the morning of eclipse day, it still should be possible to reach many destinations without too much hassle, says Upchurch.

"Leaving is definitely going to be more of a problem," he says. As the eclipse concludes, people will take to the roads all at once to try and get home as fast as they can. In 2017, that led to traffic jams that lasted many hours in some areas. If possible, Upchurch says, people should stay put for a while to try and avoid the worst of the post-eclipse rush, which in 2017 stretched even into the following day in some parts of the country.

Here's what time the eclipse will be visible in your region

And one more thing: If you do find yourself on the move near the time of the eclipse, state officials stress that you should not simply pull over to the side of the road or highway you're driving on. It's important to be parked legally and safely at the moment of totality.

If you're already in the path of totality: Relax and enjoy!

Several major metropolitan areas including Dallas, Indianapolis, Cleveland and Buffalo are already inside the path of totality, so there's no need to seek a better view, Upchurch says. You'll probably have the most fun simply staying where you are.

Shots - Health News

Watching a solar eclipse without the right filters can cause eye damage. here's why.

If you're on the edge of the path of totality, however, you might consider making a short trip to get closer to the center of the eclipse's path.

"If you're within about 40 miles of the center line, you'll have two-and-a-half minutes or more" of complete totality, Upchurch says. It's up to you to decide whether it's worth making the trip to a more central location.

Despite studying the potential hassles of traveling extensively, Upchurch says he's still looking forward to seeing the 2024 eclipse, which he plans to watch from Texas.

"Totality is absolutely spectacular," he says. "If you have a chance to witness it, I would do it."

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Removal of DC’s Cherry Blossoms Reflects Troubling Future For Coastal Forests

More than 1.5 million people flock to Washington, D.C. each spring to enjoy the sight of thousands of Japanese cherry trees blossoming around the Tidal Basin, a reservoir located between the National Mall and the Potomac River. 

The trees, which were given to the United States in 1912 by the mayor of Tokyo as a symbol of international friendship, blossom with pink and white flowers in mid- to late March every year. They are among the world’s most popular natural attractions. 

But the trees also serve as a prime example of the wide-reaching effects of climate change on forest health, according to Marcelo Ardón , an associate professor of forestry and environmental resources at NC State. 

Nearly 160 of the 3,700 cherry trees around the Tidal Basin and West Potomac Park will be chopped down starting in May 2024 in preparation for a $113 million, three-year project to rebuild and raise the seawall around the Jefferson Memorial. 

“It’s a great example of where people can see the effects of sea level rise and what’s happening all over the East Coast,” said Ardón, who studies the effects of sea level rise on coastal ecosystems.

Twice a day at high tide, water from the Potomac River flows over portions of the seawall — in part because of sea level rise. Sea levels in the Washington, D.C. area have risen by more than a foot over the last century. 

Some of the cherry trees around the Tidal Basin experience regular flooding during high tide, leaving them vulnerable to the effects of saltwater intrusion. Cherry trees are meant to grow on dry land and require fresh water.

One of the cherry trees, affectionately nicknamed “Stumpy” by local residents, is nearly hollow and has lost many of its branches due to flooding. Though it continues to blossom, it will be removed this summer as part of the seawall renovation project.

“Even small changes in sea level can have devastating effects on trees,” Ardón said. 

Rising sea levels can cause extreme flooding in coastal areas, especially when a hurricane or tropical storm occurs during high tide. The strong winds can increase tidal levels, pushing saltwater inland through ditches and tidal creeks. 

When the saltwater reaches forested wetlands and other coastal ecosystems, it can damage and even kill trees, according to Ardón. The salt can accumulate in the surrounding soil and trigger microbes to produce a toxic compound that in high concentrations can inhibit root growth. It can also draw water away from the roots and out of the tissues. 

Unfortunately, the rate of sea level rise is accelerating thanks to the thermal expansion of the ocean and the increased melting of glaciers and ice sheets. The sea level along the U.S. coastline is projected to rise by as much as 12 inches in the next 30 years. By the end of the century, it could rise by as much as 6.6 feet. 

Sea level rise is raising salt levels in coastal areas along the entire Atlantic Coast, not just Washington, D.C. As a result, forested wetlands and upland forests are being transformed into large patches of dead trees known as “ghost forests.” 

“As these ecosystems turn into marshes, the trees lose their leaves, lose their bark, and can remain standing for up to a decade. The standing dead trees are eerie looking from a distance, and thus that is where the term ‘ghost forest’ comes from,” Ardón said.  

For more than 15 years, Ardón has tracked the formation of ghost forests throughout the Albemarle-Pamlico Peninsula of North Carolina. Sea levels in this area are rising faster than the global average and could rise by up to 5 feet by the end of this century. At least 11% of the area’s tree cover has already been taken over by ghost forests . 

Many of the area’s ghost forests are products of the approximately four inches of sea level rise that have occurred since the 1990s, according to Ardón and colleagues. It usually takes 10 to 20 years for forested wetlands and upland forests to transition into ghost forests and then eventually marshes, though it can sometimes occur as quickly as five years.

The formation of a ghost forest doesn’t necessarily have harmful effects on coastal ecosystems in the short term, according to Ardón. While he and other researchers know that mass tree mortality can certainly have negative effects, including a loss of carbon storage and biodiversity, they’ve also observed positive outcomes along the North Carolina coast. 

A study conducted by Ardón found that dead pine and bald cypress snags in five ghost forests on the Albemarle-Pamlico Peninsula facilitated the movement of greenhouse gases like carbon dioxide and nitrous oxide, but they retained methane — which is responsible for about 30% of the current rise in global temperature. 

NC State researchers have also discovered that trees in coastal forests on the Albemarle-Pamlico Peninsula are replaced by more salt-tolerant shrubs and grasses as they transition into marshes, producing a habitat that’s advantageous for some birds and potentially devastating for others.

Ultimately, the impact of ghost forest formation might differ from state to state. For example, while Ardón has found that forested wetlands sequester more carbon than marshes in North Carolina, other researchers have found that marshes actually perform carbon sequestration better than forested wetlands in Georgia and South Carolina. 

Ardón said there’s very little that land managers can do to stop coastal ecosystems from transitioning into ghost forests and marshes. While using water control structures and raising soil elevation might protect some of these areas for the next 20 to 30 years, these strategies aren’t likely to maintain low-lying areas in the long term. 

Some landowners in coastal areas might choose to cut their trees down to avoid losing out on profits — a strategy that’s certainly feasible if the land is due to inevitably transform into marsh. However, it could also accelerate the transition. Trees, even those that are dying, still keep the water level down by performing evapotranspiration. If the trees are cut down, the water level could rise. 

In his studies with students, Ardón has examined the saltwater threshold of different plants . He’s found that bald cypress, a common species in the coastal regions of the southeastern U.S., has a high tolerance for salt. Other species such as oak and loblolly pine, which is commonly grown for paper products on forestry plantations, are more sensitive. 

As for cherry trees, it depends on the variety. Those located around the Tidal Basin in Washington, D.C. are Yoshino cherry trees, which have some tolerance to salt but can’t endure prolonged exposure without sustaining damage . 

The National Park Service plans to replant more than 200 cherry trees around the Tidal Basin once it renovates the seawall, which according to officials, will be able to withstand about 100 years of future sea level rise.

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