Lived experiences of healthcare workers on the front line during the COVID-19 pandemic: a qualitative interview study

Experiences of U.S. frontline physicians during the COVID-19 pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic caused profound and rapid changes in patient care and healthcare system organization. There is a compelling need for insight into the challenges that confronted physicians during the early phase of the pandemic to identify successful adaptations and strategies that minimize disruption to patient care and protect clinician wellbeing. The purpose of this study was to understand physicians' lived experiences of providing patient care during the early COVID-19 pandemic.

METHODS

This qualitative, descriptive study used a thematic analysis approach. The sample included 17 physicians from five specialties with direct care experience of COVID-19 patients (infectious disease, primary care, emergency medicine, critical care, and hospitalists). Participants were identified through snowball sampling. Data were collected through focus groups and interviews in May and June 2020 and analyzed with an inductive and deductive approach using thematic analysis.

RESULTS

Three overarching themes relating to patient care delivery during the ongoing COVID-19 pandemic were identified: facilitators, barriers, and acute stressors. Facilitator subthemes included: organizational logistical and operational support, organizational support for self-care and wellness, and peer and family support/debriefing. Barrier subthemes included: lack of clear and consistent governmental guidelines and organizational support, uncertainty resulting from poor communication or lack of information, and interpersonal barriers to physician self-care and wellbeing. Stressor subthemes included: concern about exposure, feeling unprepared, and anticipating the worst.

CONCLUSIONS

Physicians reported that both patient care and their own wellbeing were greatly impacted by organizational and systems level facilitators and barriers. Findings from this study can inform the creation of best practices, tools, and strategies that can assist with future emergency preparedness and pandemic response planning efforts.

Understanding the Lived Experience of Nurses: A Mixed-Methods Study of Resilience and Burnout

BACKGROUND

During COVID-19, organizations accommodated an increase in critically ill and isolated patients. Rapid changes to workload and the environment consumed daily operations, causing an unrelenting strain on nurses.

OBJECTIVE

This study explored the lived experience of nurses during a pandemic event. Additional objectives were to determine the levels of individual resilience and burnout.

METHODS

This cross-sectional survey used a convergent mixed-methods design. Descriptive and inferential statistics were used to summarize and test differences in resiliency and burnout scores. Constant comparative analysis was used to analyze qualitative responses.

RESULTS

The Brief Resilient Coping Scale indicated medium resilient copers (mean, 15.7 [SD, 2.52]). There was no correlation between burnout and Brief Resilient Coping Scale (r = 0.186). Four themes were identified: (1) mental, physical, and emotional toll; (2) constant change; (3) perceptions of leadership; and (4) burnout.

DISCUSSION

No correlation was found between coping ability and burnout. Nursing burnout was associated with the ongoing tolls, constant change, and leadership challenges.

Burnout among South African nurses during the peak of COVID-19 pandemic: a holistic investigation

BACKGROUND

The wellbeing of health care workers (HCWs) has been an ongoing challenge, especially within low and middle-income countries (LMICs) such as South Africa. Evidence suggesting that HCWs are increasingly stressed and burned out is cause for concern. Nurses in particular have been impacted physically, mentally and psychosocially during the recent COVID-19 pandemic. This may leave a disproportionate consequence, affecting various aspects of their wellbeing, thereby justifying a need for a more holistic investigation of the wellbeing of South African nurses and their coping mechanisms during the peak of the pandemic.

METHODS

This was a cross-sectional study design. Online self-reported questionnaires were administered in six hospitals, sampled purposively and conveniently from three South African provinces. Using STATA 18.0, the Wilcoxon Ranksum test at 5% alpha compared the wellbeing and coping mechanisms of nursing staff and nursing management during COVID-19's peak. Univariable and multivariable linear regression analyses were performed to determine factors associated with burnout in nurses, at a 95% confidence interval (CI). Validated scales measuring burnout, coping, resilience, as well as mental and physical health were utilised.

RESULTS

Of 139 participants, 112(97.4%) were females, with 91(82%) and 20(18%) being nursing staff and management respectively. The median age of the participants was 43.3 years (n = 112), with a practising duration of 12 years (n = 111). There was a significant difference in the burnout score between nursing staff and nursing management (p = 0.028). In the univariable linear regression model, burnout was significantly (p < 0.05) associated with the Brief COPE Inventory (BCI), Conor-Davidson Resilience Scale (CDRS), Global Mental and Health Scale (GMHS), Global Physical and Health Scale (GPHS) and Hospital Anxiety and Depression Scale (HADS), as well as occupation. In the multivariable linear regression model, burnout was significantly associated with the CDRS [Coeff.=0.7, 95%CI 0.4; 0.9], GMHS [Coeff.=-2.4, 95%CI -3.2; -1.6], GPHS [Coeff.2.1, 95%CI 1.3; 2.9], and HADS [Coeff.=0.7, 95%CI 0.2; 1.2].

CONCLUSION

Investigating multiple aspects of wellbeing in this study, it's shown that coping and resilience may not be key factors in promoting the wellbeing of South African nurses. However, effective mental health interventions are crucial and should be prioritised to mitigate burnout during future health emergencies. Future studies examining the associations between general health, coping and resilience may help generate further evidence towards holistic interventions aimed at promoting nurses' wellbeing.

CLINICAL TRIAL NUMBER

Not applicable.

The impact of COVID-19 during the first two years: Giving voice to pediatric nurses

PURPOSE

The purpose of this study was to describe the experiences of pediatric nurses providing direct care in a variety of settings during the first two years of the COVID-19 pandemic.

DESIGN AND METHODS

This was a qualitative descriptive study. Donabedian's Quality Framework for the Evaluation of Healthcare was used to guide the design. Purposive sampling was used to recruit 24 direct care nurses from inpatient and outpatient settings within one healthcare system. Semi-structured, audio-recorded interviews were conducted in-person or via a virtual platform from November 2021 through March 2022.

RESULTS

Four major themes were determined across all settings and included: 1) adapting to continuous change, 2) needing effective communication, 3) triggering moral distress, and 4) searching for relief. Fifteen subthemes emerged from the major themes.

CONCLUSIONS

The impact of the COVID-19 pandemic on pediatric nurses has been profound. Given the opportunity, pediatric nurses clearly articulated the personal and professional challenges they faced throughout the pandemic, how they navigated them, and how they hope healthcare systems will handle crises in the future.

PRACTICE IMPLICATIONS

The future of pediatric nursing depends on the engagement and support for direct care nurses to practice their profession and meet the needs of both patients and families. Leaders and nurses working together are integral to this future. Nurses want leaders to be present and listen, to value their opinions and to engage them in decision-making that impacts their practice. They need leaders at all levels to understand their work environment and to advocate and support their mental health through readily available resources.

"It was simply disturbing" - evaluation of the stress factors of nursing staff on special COVID-19 wards during the pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic has posed enormous challenges for healthcare systems worldwide. The strain on nursing staff working in special COVID-19 wards during the pandemic increased dramatically. To support nursing staff more effectively in similar situations in the future, it is important to identify specific stress factors to design effective support measures.

OBJECTIVE

To collect the experiences and lessons learned from nursing staff who have been affected by COVID-19 pandemic on a special COVID-19 ward that were perceived as stressful. The findings should contribute to the development of specific support measures for healthcare professionals.

DESIGN

Qualitative interview study.

SETTING

We interviewed 14 members of nursing staff who worked on COVID-19 wards at two University Hospitals about their working experiences during the pandemic.

RESULTS

We were able to identify 10 key stress factors. These included an increased workload, communication deficits, a difficult personnel situation, subjective pressure, the establishment of a new ward, a shortage of material resources, inadequate hygiene conditions, a lack of opportunities to cope with the situation, the absence of relatives and decision making.

CONCLUSION

The identification of various stress factors highlights the urgent need for comprehensive support measures. These measures could include concepts for dealing with physical and psychosocial stress, the provision of resources and sufficient personnel support. It remains crucial to proactively take preventive and supportive measures to reduce the burden and moral distress of nursing staff and protect their health in the long term. Despite the pandemic, the implications of our findings remain relevant for the future.

Provision of Public Dental Services During the COVID-19 Pandemic: Experiences of Dental Staff in Greater Western Sydney, Australia

BACKGROUND AND AIM

The coronavirus (COVID-19) pandemic led to significant changes in health service delivery. Despite the risk in high-exposure environments, frontline workers such as dental staff were expected to continue delivering essential services. This study specifically sought to explore the experiences of dental staff in New South Wales and determine their perceptions of dental care delivery during a pandemic.

METHODS

Purposive sampling was used to recruit twenty-four dental staff from two local health districts. A deductive framework, as described by Braun and Clark, was used to analyse the transcripts. Four major focus areas were identified: responding to protocol changes, adapting to the impact of changes in policy and protocol, modifying dental treatment planning and recommendations for training and implementation of policies.

RESULTS

Dental staff reported that management staff were doing all they could and were most supported working in a team. Reduced contact with patients and personal protective equipment helped staff feel safe when seeing patients. Mental health and remote dentistry services could be more supported.

CONCLUSIONS

Unique challenges were experienced by dental staff and their management during the global COVID-19 pandemic. Future considerations include improved support for staff and further investigation into the effectiveness of options such as teledentistry.

Nurses Lived Experiences, Burdens and Coping Strategies During COVID-19 Pandemic

This is a qualitative phenomenological study that was designed to navigate through nurses' lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses' lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses' eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.

"Trust people you've never worked with" - A social network visualization of teamwork, cohesion, social support, and mental health in NHS Covid personnel

Background

The unprecedented rapid re-deployment of healthcare workers from different care pathways into newly created and fluid COVID-19 teams provides a unique opportunity to examine the interaction of many of the established non-technical factors for successful delivery of clinical care and teamwork in healthcare settings. This research paper therefore aims to address these gaps by qualitatively exploring the impact of COVID work throughout the pandemic on permanent and deployed personnel's experiences, their ability to effectively work together, and the effect of social dynamics (e.g., cohesion, social support) on teamwork and mental health.

Methods

Seventy-five interviews were conducted across the UK between March and December 2021 during wave 2 and 3 of COVID-19 with 75 healthcare workers who were either permanent staff on Intensive Care/High Dependency Units used as COVID wards, had been rapidly deployed to such a ward, or had managed such wards. Work Life Balance was measured using the WLB Scale. Interview transcripts were qualitatively coded and thematic codes were compared using network graph modeling.

Results

Using thematic network analysis, four overarching thematic clusters were found, (1) teamwork, (2) organizational support and management, (3) cohesion and social support, and (4) psychological strain. The study has three main findings. First, the importance of social factors for teamwork and mental health, whereby team identity may influence perceptions of preparedness, collaboration and communication, and impact on the collective appraisal of stressful events and work stressors. Secondly, it demonstrates the positive and negative impact of professional roles and skills on the development of teamwork and team identity. Lastly the study identifies the more pronounced negative impact of COVID work on deployed personnel's workload, mental health, and career intentions, exacerbated by reduced levels of social support during, and after, their deployment.

Conclusion

The thematic network analysis was able to highlight that many of the traditional factors associated with the successful delivery of patient care were impeded by pandemic constraints, markedly influencing personnel's ability to work together and cope with pandemic work stressors. In this environment teamwork, delivery of care and staff well-being appear to depend on relational and organizational context, social group membership, and psycho-social skills related to managing team identity. While results hold lessons for personnel selection, training, co-location, and organizational support during and after a pandemic, further research is needed into the differential impact of pandemic deployment on HCWs mental health and teamwork.

Experiences of Spanish out-of-hospital emergency workers with high levels of depression during the COVID-19 pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic had a major psychological impact on health care workers (HCWs). This study was embedded in a larger quantitative study on the mental health care of out-of-hospital HCWs in Spain. To better understand this, a qualitative study was conducted to explore the experiences, coping strategies, and influencing factors of out-of-hospital HCWs who scored high (> 25 points) on the Depression Anxiety Stress Scale (DASS-21) in a previous quantitative mental health study.

METHODS

A qualitative study was conducted using six in-depth interviews with individuals who scored high on the depression scale and agreed to be contacted by email between May and June 2021, using the phenomenological approach. The data were analysed using Brawn and Clare's method.

RESULTS

The main results findings related to four themes. The emotional impact of assuming a professional role with high self-demands and responsibilities; Factors influencing the development of negative emotions such as the cruelty of the pandemic, the helplessness in relation to health management and policy, the changing role of the professional and the relationship with society; Personal protection through coping strategies to manage negative emotions such as support from colleagues and family; Good practices for the future looking for different management strategies that can influence individuals and their personal, professional, and social relationships.

CONCLUSION

The strong impact of the circumstances experienced points to the need to develop psychological support programmes that can protect people's mental health from depression during a crisis and improve the relationship between workers and their managers.

Cross-sectional survey of sexual health professionals' experiences and perceptions of the 2022 mpox outbreak in the UK

OBJECTIVE

To understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK.

DESIGN

Cross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness, support, and training; safety at work; vaccination; and well-being. Qualitative descriptive analysis of open-text responses was conducted to support interpretation of the quantitative data.

PARTICIPANTS

Participants who were employed as sexual health professionals in the UK and had direct clinical experience of mpox were included in the analysis. The survey was completed between 11 August and 31 October 2022 by 139 respondents, the majority of whom were doctors (72.7%), cis-female (70.5%) and White (78.4%).

RESULTS

70.3% reported that they were required to respond to mpox in addition to their existing clinical responsibilities, with 46.8% working longer hours as a result. In the open-text data, respondents highlighted that workload pressures were exacerbated by a lack of additional funding for mpox, pre-existing pressures on sexual health services, and unrealistic expectations around capacity. 67.6% of respondents reported experiencing negative emotional impact due to their mpox work, with stress (59.0%), fatigue (43.2%) and anxiety (36.0%) being the most common symptoms. 35.8% stated that they were less likely to remain in their profession because of their experiences during the mpox outbreak. In the open-text data, these feelings were ascribed to post-COVID exhaustion, understaffing and frustration among some participants at the handling of the mpox response.

CONCLUSIONS

These findings indicate that sexual health services require increased funding and resources, along with evidence-based well-being interventions, to support sexual health professionals' outbreak preparedness and recovery.

The impact of pandemics on healthcare providers' workloads: A scoping review

AIMS

To review and synthesize available evidence exploring the impact of pandemics on direct healthcare providers' workloads in the acute care setting.

DESIGN

Scoping review.

DATA SOURCES

A review of English research articles published up to August 2022 that examined the impact of pandemics on healthcare providers' workloads was undertaken. Studies were identified by searching four electronic databases: Medline (EBSCO), CINAHL (EBSCO), Web of Science and PsychInfo (EBSCO). Fifty-five studies met the inclusion criteria.

REVIEW METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review checklist.

RESULTS

Healthcare workers experience an increase in workload pressures during a pandemic. This included patients requiring more care, undertaking non-normal work activities, increase in work content including changes to documentation, increase in demand and skills required, an increase in overtime and hours of work per week and higher patient-to-nurse ratios. The review also highlighted changes to the work environment and worsened work environments, including staffing shortages.

CONCLUSION

Focused efforts from health organizations to prioritize supportive conditions, policies focused on improved work environments, staffing adequacy and fair and reasonable workloads will enhance retention of the current workforce and future planning for pandemics.

IMPACT

Understanding workload challenges faced by frontline health professionals during the pandemic can improve planning, including policies and procedures, and resource allocation for future pandemic or emergency situations. In addition, extended periods of high workloads can impact staff retention. As many countries return to life after COVID-19, it is important that healthcare organizations examine staff pressures and identify ways to support staff moving forward. This will be vital for the future sustainability of the workforce.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic: a systematic review and meta-analysis

OBJECTIVE

The COVID-19 pandemic has had a significant impact on the burnout and mental health of medical staff. This meta-analysis aims to provide additional (and updated) evidence related to burnout and mental health problems among medical staff using a broader data pool.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, CNKI, Wanfang data and three preprint databases (SSRN, bioRxiv and medRxiv) were searched from 1 January 2020 to 17 May 2021.

ELIGIBILITY CRITERIA

We included observational studies investigating the prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic, including cross-sectional study, cohort study and case-control study.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used a self-designed form to extract the primary data. The Joanna Briggs Institute quality appraisal tool was used to assess the quality of selected studies. Heterogeneity among studies was assessed by I² statistic. A random-effects model was used to pool the prevalence. Subgroup analysis was performed to explore between-group differences.

RESULTS

250 studies were included, with a sample of 292 230 participants from 46 countries. The pooled prevalence of burnout, anxiety, depression, insomnia, stress, post-traumatic stress disorder symptoms and somatic symptoms was 43.6% (95% CI 36.3% to 51.2%), 37.1% (95% CI 34.7% to 39.7%), 37.6% (95% CI 35.0% to 40.4%), 43.7% (95% CI 39.1% to 48.5%), 41.3% (95% CI 35.1% to 47.9%), 30.6% (95% CI 23.6% to 38.5%) and 25.0% (95% CI 16.7% to 35.6%), respectively. Subgroup analysis showed a higher prevalence of anxiety, depression and insomnia in frontline workers than in non-frontline workers, and a higher prevalence of anxiety in females than males. Mild cases accounted for the most significant proportion of the outcomes except for stress.

CONCLUSIONS

This study highlights that identifying the risks of burnout and mental health problems and adopting preventive interventions are priorities for policymakers and medical staff to avoid long-term occupational, health and social impacts.

PROSPERO REGISTRATION NUMBER

CRD42021254425.

Lived-in experiences of health care professionals affected with COVID-19

Background and Objective

Healthcare providers (HCPs) were vital during the COVID-19 pandemic. The healthcare providers affected by COVID-19 underwent various life changing events while continuing their profession during the pandemic. This study is aimed to explore the lived-in experiences of HCPs affected by COVID-19 at a tertiary care Mental Health Institute in India.

Materials and Methods

The sampling method was purposive. Twenty two HCPs (eight nursing educators, seven nursing officers, five contractual cleaning workers, and two laboratory technicians) participated in the interviews conducted by the researchers to obtain the lived-in experiences of HCPs who have recovered from COVID-19. Researchers used a sociodemographic form and an interview guide to collect the data. Interviews were audio recorded and analyzed by using Atlas-ti-9 software.

Results

All the participants were female, and they revealed various physical, psychological, and social issues faced by HCPs while balancing home and workplace. Thematic data analysis resulted in the emergence of two themes and 11 subthemes related to life changing events.

Conclusion

The findings concluded that although the healthcare providers had working experience in the field of mental health, they too experienced mild psychological issues like anxiety, depression, and fear of death because of this pandemic situation.

Voice from the frontline and learning for the future: A qualitative descriptive study on wider perspectives of frontline nurses in India during the COVID 19 global pandemic

Objective

This study was conducted to explore frontline nurses' experiences of the impact of COVID 19 pandemic and suggestions for improvement in the healthcare system, policy and practice in the future.

Method

A qualitative descriptive design was used. Frontline nurses who were involved in providing care to patients affected with COVID 19 in four designated COVID units from the Eastern, Southern and Western regions of India were interviewed during January to July 2021. Interviews were audio-recorded and transcribed manually by researchers from each region and thematically analysed.

Result

Twenty-six frontline nurses aged between 22 and 37 years with a range of 1-14 years of work experience following a Diploma or Bachelor's degree in Nursing and Midwifery and working in the COVID units of selected regions in India participated in the study. Three key themes emerged: 'Physical, emotional and social health - an inevitable impact of the pandemic' described effects of the pandemic on nurses' health and wellbeing; 'Adapting to the uncertainties' narrated how nurses accommodated to the uncertainties during the pandemic; and 'An agenda for the future - suggestions for improvement' emphasised on practical strategies for the future.

Conclusion

The inevitability of the pandemic had an influence at a personal, professional, and social level with learning for the future. The findings of this study have implications for healthcare system and facilities by enhancing resources, supportive environment for staffs to cope with the challenges imposed by the crisis and ongoing training to manage life threatening emergencies in the future.

Escalation to intensive care for the older patient. An exploratory qualitative study of patients aged 65 years and older and their next of kin during the COVID-19 pandemic: the ESCALATE study

BACKGROUND

older people comprise the majority of hospital medical inpatients so decision-making regarding admission of this cohort to the intensive care unit (ICU) is important. ICU can be perceived by clinicians as overly burdensome for patients and loved ones, and long-term impact on quality of life considered unacceptable, effecting potential bias against admitting older people to ICU. The COVID-19 pandemic highlighted the challenge of selecting those who could most benefit from ICU.

OBJECTIVE

this qualitative study aimed to explore the views and recollections of escalation to ICU from older patients (aged ≥ 65 years) and next of kin (NoK) who experienced a COVID-19 ICU admission.

SETTING

the main site was a large NHS Trust in London, which experienced a high burden of COVID-19 cases.

SUBJECTS

30 participants, comprising 12 patients, 7 NoK of survivor and 11 NoK of deceased.

METHODS

semi-structured interviews with thematic analysis using a framework approach.

RESULTS

there were five major themes: inevitability, disconnect, acceptance, implications for future decision-making and unique impact of the COVID-19 pandemic. Life was highly valued and ICU perceived to be the only option. Prior understanding of ICU and admission decision-making explanations were limited. Despite benefit of hindsight, having experienced an ICU admission and its consequences, most could not conceptualise thresholds for future acceptable treatment outcomes.

CONCLUSIONS

in this study of patients ≥65 years and their NoK experiencing an acute ICU admission, survival was prioritised. Despite the ordeal of an ICU stay and its aftermath, the decision to admit and sequelae were considered acceptable.

The mental health and wellbeing of healthcare workers during COVID-19 in South Africa

Background

Little is known about the experiences and impact of coronavirus disease 2019 (COVID-19) on the mental health and wellbeing of healthcare workers (HCWs), particularly in Global South contexts.

Aim

The authors aimed to explore the experiences of HCWs at different points during the COVID-19 pandemic in South Africa.

Setting

This study's sample included 621 HCWs from various professions and health sectors who completed the survey during the pandemic peaks of waves I, II and III in South Africa.

Methods

The authors used a qualitative survey design exploring participants' general work, life, mental health and wellbeing experiences, and their support mechanisms or strategies. Data were analysed using thematic analysis.

Results

The authors identified three overarching themes in the data, namely stress, adjustment to work during COVID-19, and support experiences and needs. These themes were common across all three survey waves, with some minor differences noted across the waves.

Conclusion

An overarching thread of uncertainty seems central to HCWs' experiences of working during COVID-19, related to pressures in the South African healthcare system that have been aggravated by the pandemic.

Contribution

These findings have the potential to inform the development of contextually relevant approaches to support the mental health and wellbeing needs of HCWs during and after a pandemic. In particular, workplaces need to actively offer psychological support to all HCWs, not just to workers traditionally defined as frontline.

Experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic: A thematic meta-synthesis study

AIM

The aim of this work is to synthesize and interpret qualitative research examining the experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic in different countries.

BACKGROUND

The prevalence of disasters, including the pandemic, is increasing globally. It is important to understand nurses' experiences in depth to effectively manage extraordinary events that may occur in the future.

DESIGN

This is a thematic meta-synthesis study.

METHODS

Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus, were searched for publications from December 2019 to October 2020. The search was updated for publications to 30 May 2022. The thematic synthesis method was used to analyse and interpret the data.

FINDINGS

The experiences of the nurses giving care to patients with COVID-19 were grouped under four themes: (1) Difficulties encountered in the care of patients with COVID-19; (2) mixed emotions experienced in the care of patients with COVID-19; (3) coping strategies that nurses used in the management of the pandemic; (4) the benefits of the COVID-19 to nurses.

CONCLUSION

Nurses faced many difficulties and experienced mixed emotions while providing care for patients with coronavirus disease. Perceived social support was seen as the most important strategy for coping with these difficult situations. It is important to be aware of the difficulties and emotions experienced by nurses and support them during the COVID-19 pandemic for the management of future pandemics.

Health Experiences of Nurses during the COVID-19 Pandemic: A Mixed Methods Study

This study characterizes the impact of the COVID-19 pandemic on the mental and physical health of nurses. Qualitative data (collected using semi-structured interviews) were integrated with quantitative data (collected concurrently using the SF-12 Health Survey). Nurses (N = 30) compared their health prior to and during the first pandemic wave (March-May 2020). Interviews were analyzed thematically; descriptive statistics and t-tests compared pre-pandemic to current SF-12 scores. Qualitative findings demonstrated an impact on nurses' mental health expressed as isolation, loss, intense emotions, and feelings of being expendable. Impact on nurses' physical health included exhaustion, personal protective equipment skin breakdown, limited breaks from work, and virus exposure. Quantitative results show nurses' experienced declines in overall mental health (p < .001), and multiple physical health domains: role limitations due to physical problems (p < .0001), bodily pain (p < .0001), and general health (p < .0001). Promotion of nurses' well-being and safety, as well as education in emergency preparedness, must be given precedence to protect nurses' health.

Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia

BACKGROUND

In 2020, during the first wave of the COVID-19 pandemic in Australia, hospital intensive care units (ICUs) revised patient care practices, curtailed visiting, and augmented the use of personal protective equipment to protect patients, staff, and the community from viral transmission.

AIM

The aim was to explore ICU staff experiences and perceptions of care and communication with patients during the COVID-19 pandemic to understand how alternative ways of working have influenced work processes, relationships, and staff morale.

METHODS

This was a qualitative exploratory design study using audio-recorded and transcribed interviews with 20 ICU staff members. Data were analysed using thematic analysis.

FINDINGS

Four major themes were derived from the data: (i) Communication and connection, (ii) Psychological casualties, (iii) Caring for our patients, and (iv) Overcoming challenges. Patient care was affected by diminished numbers of critical care qualified staff, limited staff entry to isolation rooms, and needing to use alternative techniques for some practices. The importance of effective communication from the organisation and between clinicians, families, and staff members was emphasised. personal protective equipment hindered communication between patients and staff and inhibited nonverbal and verbal cues conveying empathy in therapeutic interactions. Communication with families by phone or videoconference was less satisfying than in-person encounters. Some staff members suffered psychological distress, especially those working with COVID-19 patients requiring extracorporeal membrane oxygenation. Moral injury occurred when staff members were required to deny family access to patients. Workload intensified with increased patient admissions, additional infection control requirements, and the need to communicate with families using alternative methods.

CONCLUSION

The results of this study reflect the difficulties in communication during the early stages of the COVID-19 pandemic. Communication between staff members and families may be improved using a more structured approach. Staff reported experiencing psychological stress when separating families and patients or working in isolation rooms for prolonged periods. A flexible, compassionate response to family presence in the ICU is essential to maintain patient- and family-centred care.

Psychological distress among healthcare workers during the Covid-19 in Kosovo

Epidemic outbreaks, such as Covid-19, can cause psychological distress for health workers. This research explored the psychosocial experiences of healthcare workers caring for Covid-19 patients in Kosovo. From June 21 to February 9, 2022, we enrolled 21 physicians and 52 general and head nurses (in total 73 participants) who provided care for Covid-19 patients in secondary and tertiary health care institutions around Kosovo. The interviews were conducted face-to-face. Thematic analysis was used as a method for the analysis of interview transcripts. The psychological experiences of physicians and nurses caring for Covid-19 patients can be summarised into four main themes. First, fear of being contaminated with Covid-19 in the workplace and fear of infecting family members. The second, fear due to the unknown nature of the disease. Third, emotional distress from delivering bad news to the patients and families. And fourth, the death of Covid-19 patients. The research found out that the healthcare workers in Kosovo experienced psychological distress, i.e., feeling overwhelmed, helpless, guilty, fearful, and anxious while providing care services for patients with Covid-19.

The lived experiences of emergency care personnel in the Western Cape, South Africa during the COVID-19 pandemic: A longitudinal hermeneutic phenomenological study

In March 2020, the World Health Organisation declared COVID-19 a global pandemic. Shortly after the first case of COVID-19 was reported in South Africa, the Western Cape province experienced a rapid growth in the number of cases, establishing it as the epicentre of the disease in South Africa. The aim of this study was to explore emergency care personnel's lived experiences and their perceptions thereof within the context of the COVID-19 pandemic in the Western Cape province. This study followed a longitudinal hermeneutic phenomenological approach. The convenience sample included prehospital and emergency centre medical personnel. Data were collected over a 4-month period using both one-on-one interviews and participant recorded voice recordings. Data were analysed following Ricoeur's theory of interpretation. Four themes were generated during the data analysis: 1) In the beginning, waiting for the unknown; 2) Next, change and adaptation in the workplace; 3) My COVID-19 feelings; 4) Support and connection. Participants discussed the uncertainty associated with responding to an unknown threat and a need to keep up with constant change in an overburdened work environment. Results showed high levels of uncertainty, restriction, fear, anxiety, and exhaustion. Despite these difficulties, participants demonstrated resilience and commitment to caring for patients. A need for support was also highlighted. Results indicated that change, over time, resulted in adaptation to a new way of practising and keeping safe. Healthcare workers experienced intersecting consequences as frontline healthcare workers and members of the public, all of which impacted their well-being. The importance of compassion and encouragement as forms of support was highlighted in the study. Robust and sustained support structures in a time of change, low mood, and exhaustion are essential.

Making It Work: The Experiences of Delivering a Community Mental Health Service during the COVID-19 Pandemic

The COVID-19 pandemic forced rapid innovative change to healthcare delivery. Understanding the unique challenges faced by staff may contribute to different approaches when managing future pandemics. Qualitative interviews were conducted with 21 staff from a Community Mental Health Team in the North West of England, UK, three months after the first wave of the pandemic. Thematic analysis was used to examine data reporting the challenges arising when working to deliver a service during the pandemic. Data is discussed under four headings; "senior trust managers trying to make it work", "individuals making it work", "making it work as a team", and "making it work through working at home". Clear communication was essential to ensure adherence to guidelines while providing safe care delivery. The initial response to the pandemic involved the imposition of boundaries on staff by senior leadership to ensure that vulnerable service users received a service while maintaining staff safety. The data raises questions about how boundaries were determined, the communication methods employed, and whether the same outcome could have been achieved through involving staff more in decision-making processes. Findings could be used to design interventions to support mental health staff working to deliver community services during future crises.

Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study

Objectives: Whereas early findings suggest that risk perceptions related to COVID-19 affect psychological well-being in healthcare workers (HCWs), the temporal associations between these variables need to be clarified and HCWs lived experience further explored. This study proposes a mixed evaluation of COVID-19-related risk perception and affective responses among HCWs.

Methods: A longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures of COVID-19 risk perceptions, depression, anxiety, burnout and secondary traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) participated in semi-structured interviews exploring both risk perceptions and affective responses.

Results: Main quantitative findings showed positive associations between worry to contaminate others and depression (IRR = 1.04, p < 0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes emerged from the thematic content analysis: 1) life was turned upside down; 2) skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to be found between protection and restrictions.

Conclusion: These findings emphasize the importance to develop tailored interventions, such as group discussion sessions, to optimize risk perception and help manage uncertainty.

Lived experience of Jordanian front-line healthcare workers amid the COVID-19 pandemic: a qualitative study

OBJECTIVES

This study aimed to explore the lived experience of Jordanian front-line healthcare workers (FHCWs), including their experienced challenges and adaptations amid the COVID-19 pandemic.

DESIGN

A phenomenological qualitative design was used to highlight the experiences of a sample Jordanian FHCWs during the COVID-19 pandemic. Qualitative interviews were conducted using a semistructured guide with open-ended questions, audiotaped and then transcribed verbatim. Thematic analysis of the transcribed narratives was conducted using an open coding line by line to develop themes and related subthemes.

SETTING

Mobile COVID-19 testing and contact tracing units during an active surge of cases in Jordan between May and September 2020.

PARTICIPANTS

Participants were recruited using purposive sampling method and consisted of 15 FHCWs (2 physicians, 10 nurses, 2 paramedics and 1 laboratory technician) who have worked in testing and contact tracing teams in the community and have dealt with suspected or confirmed cases of COVID-19 infection.

RESULTS

Participant narratives were classified into two main overarching themes; challenges and adaptation themes. The challenges theme was exhibited as follows: (1) an excruciating encounter with an invisible enemy, (2) distorted knowledge about COVID-19 and (3) organisational and administrative challenges. The adaptation theme was exhibited as follows: (1) seeking relevant knowledge about the disease and (2) seeking more connectedness.

CONCLUSIONS

The COVID-19 pandemic exerted many challenges for FHCWs at multiple levels; intrapersonal and interpersonal, organisational and societal levels. Nevertheless, a number of adaptation strategies within these levels have been reported. This study helps to provide the base on which healthcare officials and public health personnel can formulate preparedness plans that tackle challenges faced by front-line workers, which ultimately enhance the resilience of healthcare systems to withstand future pandemics.

A critical care outreach team under strain - Evaluation of the service provided to patients with haematological malignancy during the Covid-19 pandemic

Purpose

Critical Care Outreach Teams (CCOTs) have been associated with improved outcomes in patients with haematological malignancy (HM). This study aims to describe CCOT activation by patients with HM before and during the Covid-19 pandemic, assess amny association with worse outcomes, and examine the psychological impact on the CCOT.

Materials and methods

A retrospective, mixed-methods analysis was performed in HM patients reviewed by the CCOT over a two-year period, 01 July 2019 to 31 May 2021.

Results

The CCOT increased in size during the surge period and reviewed 238 HM patients, less than in the pre- and post-surge periods. ICU admission in the baseline, surge and the non-surge periods were 41.7%, 10.4% and 47.9% respectively. ICU mortality was 22.5%, 0% and 21.7% for the same times. Time to review was significantly decreased (p = 0.012). Semi-structured interviews revealed four themes of psychological distress: 1) time-critical work; 2) non-evidence based therapies; 3) feelings of guilt; 4) increased decision-making responsibility.

Conclusions

Despite the increase in total hospital referrals, the number of patients with HM that were reviewed during the surge periods decreased, as did their ICU admission rate and mortality. The quality of care provided was not impaired, as reflected by the number of patients receiving bedside reviews and the shorter-than-pre-pandemic response time.

University freshmen's excessive smartphone use and psychological safety during the COVID-19 pandemic

Although excessive smartphone use has been confirmed as being associated with specific representations of mental health (e. g., anxiety, depression, wellbeing, etc.) throughout the COVID-19 pandemic, the relationship between excessive smartphone use and cognitive representations of mental health (i.e., psychological safety) is not yet fully understood. This study aimed to identify the association between excessive smartphone use and psychological safety among university freshmen during the COVID-19 pandemic; in addition, we examined the mediation effects of hardiness and interpersonal distress in this relationship. In this study, 1,224 university freshmen were selected at random from several universities in Guizhou Province of China. The Psychological Safety Scale was used to evaluate the mental health of university freshmen; the Mobile Phone Dependence Scale was used to evaluate excessive smartphone use; the Hardiness Questionnaire was used to evaluate hardiness; and the Interpersonal Relation Synthetic Diagnose Test was used to evaluate interpersonal distress. The findings showed that: (1) the greater the degree of excessive smartphone use, the more serious respondents' interpersonal distress and the lower their hardiness; (2) excessive smartphone use was not only directly related to the psychological safety of university freshmen but also indirectly related to their psychological safety through the independent mediation of hardiness and interpersonal distress, as well as through the chain mediation of hardiness and interpersonal distress. In general, excessive smartphone use in university freshmen could lead to a decline in their psychological safety. Also, hardiness and interpersonal distress play a complex role in this relationship. During the COVID-19 pandemic, interventions on the mental health of college freshmen should not only provide guidance on how to use their smartphone responsibly but also to provide them with support and guidance for the enhancement of their hardiness and improvement of their interpersonal relationships.