"Surviving to thriving": a meta-ethnography of the experiences of healthcare staff caring for persons with COVID-19

Stress and coping in the face of COVID-19: a qualitative inquiry into early pandemic experiences and psychological well-being of health workers in Burkina Faso, Senegal and The Gambia

COVID-19 represented an unprecedented challenge for health workers around the world, resulting in strong concerns about impacts on their psychological well-being. To inform on-going support and future preparedness activities, this study documented health workers' experiences, well-being and coping throughout the first wave of the pandemic, in Burkina Faso, Senegal and The Gambia. We collected data from 68 primarily clinical staff from the COVID-19 treatment, maternity and emergency departments in 13 purposely hospitals and laboratories across the three countries. Following in-depth interviews via Zoom (mid-May to September 2020), we regularly followed up via WhatsApp until the end of 2020. We used a mixed deductive and inductive coding approach and a framework matrix to organize and analyse the material. All respondents initially assessed the situation as stressful and threatening. Major emotional reactions included fear of own infection, fear of being a risk to loved ones, guilt, compassion, and anxiety regarding the future. Many suffered from feeling left alone with the emerging crisis and feeling unvalued and unappreciated, particularly by their governments and ministries of health. Conversely, health workers drew much strength from support and valuation by direct supervisors and team members and, in part, also by patients, friends and family. We observed important heterogeneity between places of work and individual backgrounds. Respondents coped with the situation in various ways, particularly with strategies to manage adverse emotions, to minimize infection risk, to fortify health and to find meaning in the adverse circumstances. Coping strategies were primarily grounded in own resources rather than institutional support. Over time, the situation normalized and fears diminished for most respondents. With a view towards emergency preparedness, our findings underline the value of participation and transparent communication, institutional support and routine training to foster health workers' psychological preparedness, coping skill set and resilience more generally.

Midwives' experiences of providing maternity care to women and families during the COVID-19 pandemic in Northern Italy

PROBLEM

The COVID-19 pandemic has significantly challenged maternity provision internationally. Rapid and radical changes were implemented, with midwives facing anxiety and moral distress if not able to provide optimal and woman-centred care in line with professional values.

BACKGROUND

Healthcare professionals' stress and burnout are commonly reported during other global emergencies, which may eventually contribute to reduced quality of care. There is lack of evidence of the challenges faced by midwives in Italy during the COVID-19 pandemic.

AIM

To explore midwives' experiences of providing care to women and families during the COVID-19 pandemic.

METHODS

Qualitative interpretive phenomenological approach, using semi-structured interviews and thematic analysis. The sample included 15 midwives. Ethical approval was obtained.

FINDINGS

Four themes were identified: 1) adjusting to the ever-evolving organisation of care; 2) physical, psychological and relational challenges; 3) support network; 4) deferred sense of awareness.

DISCUSSION

Midwives faced professional and personal challenges during the pandemic, displaying feelings of fear, anxiety, uncertainty, discomfort, lack of support and knowledge with potential long-term effects. Adjusting to the continuous, rapid and drastic re-organisation of maternity services was particularly challenging. Factors facilitating a safe, supportive and empowering workplace included support from colleagues and managers, access to appropriate PPE, reliable guidelines, good communication and emotional support. Positive aspects of personal and professional development included communication skills, establishment of trusting relationships, sense of empowerment and teamwork.

CONCLUSION

In the context of a pandemic, optimisation of midwives' physical, emotional and psychological wellbeing should be considered. Timely and comprehensive guidelines and appropriate resources should be provided to assist midwives in facilitating family-centred respectful maternity care and preserving childbirth as a bio-psychosocial event.

“Flying over the crisis”: A study on interdisciplinary metaphors of resilience

Background/Aim: Metaphors on theoretical concepts may be congruent or divergent from their explicit definitions. We carried out a secondary qualitative analysis on metaphors of members of an interdisciplinary research group on resilience and investigated: (A) Which metaphors do experts in different disciplines use to describe people showing resilience? (B) Do these (implicit) metaphors support the (explicit) theses of the research group on resilience? (C) Do we find differences between experts from different disciplines in the use of metaphors on resilience? Method: Nine guideline-based interviews with experts from medicine, psychology, philosophy, and theology were studied using a systematic metaphor analysis, basing on inductive and deductive categorizations. Results: Eight metaphor sources were identified, for example, battle, path. Experts used similar metaphors to describe resilience that often overarched the concepts of resilience as a trait, process, and outcome. Moments of vulnerability within the resilience trajectory were found. Conclusions: The analysis revealed high concordance of metaphors across different disciplines, reflecting both the ideas of the group as well as the mainstream view of resilience. This supports that implicit concepts may be more difficult to reframe than explicit theories. Few differences between disciplines may point to the impact of an overarching Western concept of individual resilience.

Walking a tightrope: A meta-synthesis from frontline nurses during the COVID-19 pandemic

Nursing staff plays a key role in the public health response to the COVID-19 pandemic, being in the front line of care. This study sought to synthesise the qualitative literature on care experiences of frontline nurses during the COVID-19 pandemic. A search was conducted on five databases in January 2021. Fifteen qualitative studies met the inclusion criteria and were included in the research, being submitted to interpretive meta-synthesis according to the eMERGe guide. The final synthesis included a line of argument that shows the experiences of frontline nurses during the COVID-19 pandemic, divided into three major themes: 'Instability on the edge of a cliff: unpredictable and unknown context,' 'The price of walking the tightrope: the uncertainty surrounding care,' and 'Finding the balance to reach the other side: dealing with the emotional demands of care.' Although essential in the health response to the COVID-19 pandemic, nurses experienced an emotional impact arising from the hampered care provision. Our results point to need for strengthening the training of nurses and future nurses, creating and promoting measures that contribute to their psycho-emotional well-being, ensuring a safe environment for their clinical practice, and promoting their participation in decision-making processes.