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ORIGINAL ARTICLE
Ahead of print publication  

Psychological consequences and coping strategies of health-care workers in COVID section of a tertiary hospital: A qualitative study


1 Bharati Hospital and Research Centre, Pune, Maharashtra, India
2 Department of Psychiatry, Bharati Hospital and Research Centre, Pune, Maharashtra, India

Date of Submission13-Oct-2021
Date of Decision24-Nov-2021
Date of Acceptance13-May-2022
Date of Web Publication05-Sep-2022

Correspondence Address:
Kashish Thaper,
Bharati Hospital and Research Centre, Dhankawadi, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aip.aip_125_21

  Abstract 


Background: Health-care workers (HCWs) working in COVID care are vulnerable to various psychological stressors. The novel nature of infection and exponential increase in cases add to the workload and psychological distress. Hence, assessing the psychological consequences and methods of coping in these HCWs is important. The detection can help in devising appropriate psychological interventions for them. Aim: The aim of this study was to assess the psychological reactions, symptoms, and coping strategies of HCWs in COVID section of a tertiary hospital. Objectives: The objectives of this study were as follows: (1) to explore various psychological reactions, stressors, psychological symptoms, and coping skills of doctors, nurses, and support staff working in COVID section of a tertiary care hospital and (2) to correlate the psychological reactions, stressors, and psychological symptoms with sociodemographic factors. Methodology: This was a qualitative study. A total of 100 HCWs including doctors, nurses, and support staff working in COVID section of hospital were interviewed for psychological consequences and their coping strategies. Their narratives were coded into themes and analyzed. Statistical Analysis: Frequency and percentages for quantitative variables were used for statistical analysis. Chi-square test was used for correlation of qualitative variables. Results: The HCWs reported various psychological reactions of worries about their own health which was significant in HCWs in intensive care unit (χ2 = 12.35, P = 0.002) and had concern of nature of work, which was a significant concern in doctors (χ2 = 9.59, P = 0.008). The stressor of uncomfortable personal protective equipment was found to be reported more significantly by support staff (chi2 = 11.1, P = 0.03), and that of long and burdensome work reported more significantly by females (chi2 = 4.64, P = 0.03). They had prominent psychological symptoms of irritability significantly reported by doctors (χ2 = 9.91, P = 0.007), sleep disturbances significantly reported by unmarried (χ2 = 6.76, P = 0.009), and by nurses (χ2 = 9.7, P = 0.008). The most common coping strategies used were acceptance, problem-solving strategies, and communicating with family members and colleagues. Conclusion: The HCWs in COVID section had stressors with psychological reactions and symptoms and used various coping strategies to deal with them.

Keywords: Coping, COVID, health-care workers, psychological consequences



How to cite this URL:
Thaper K, Datar M, Shetty J, Bhattacharya A. Psychological consequences and coping strategies of health-care workers in COVID section of a tertiary hospital: A qualitative study. Ann Indian Psychiatry [Epub ahead of print] [cited 2022 Sep 25]. Available from: https://www.anip.co.in/preprintarticle.asp?id=355610




  Introduction Top


The coronavirus (2019-COV) is a kind of zoonotic virus that has been first proclaimed in Wuhan (China), however, the outbreak rapidly grew and spread to neighboring countries. As of April 2020, the total number of infected individuals was around 3 million, with ~200,000 deaths and more than 1 million recoveries globally.[1],[2] The rate of transmission of COVID virus is very high which leads to high infectivity and exponential rise in cases.[3] By May 18, India investigated ∼1 lakh (0.1 million) infected cases from COVID-19, and as of July 11, the cases equaled 8 lakh causing a lot of fear and panic in society.[4] Health-care workers (HCWs), working in the frontlines, were thus overburdened making them, particularly vulnerable to psychological distress.

The psychological effects related to the pandemic were driven by many factors, including uncertainty about the duration of the crises, lack of proven therapies or a vaccine, and potential shortage of health-care resources, including personal protective equipment (PPE). Lack of proper PPE had a considerable impact on the HCWs' state of mind.[5] HCWs were also distressed by the effects of social distancing balanced against the desire to be present for their families, and the possibility of personal and family illness.[6]

HCWs are at a high risk of stigmatization by society due to their vicinity to COVID patients and thus are believed to be carriers of infection.[7]

HCWs may have experienced psychological distress from providing direct care to patients with COVID-19, knowing someone who has contracted or died of the disease, or being required to undergo quarantine or isolation.[8],[9],[10]

Hospitals were also converted to triage areas as there were too many COVID-positive patients and there was a need to prioritize which of them were critically ill and needed to be addressed on a priority basis. Decision-making was also a tough part of the process as, in some cases, the doctors would have to choose between which patients needed to be chosen on a priority basis for treatment with limited resources available. There was also a shortage of beds as the number of cases was on the rise, which caused significant psychological distress to the patient's families as well as the HCWs, as they had to prioritize among the sick and explain the families of patients about the precarious situation.[11]

Not surprisingly, providers caring for patients with COVID-19 are at the greatest risk of psychological distress. Long working hours, worry of risk to self and family, concern about inadequate personal protection materials, separation from family/loved ones, preexisting mental health, and addiction issues all may constitute a risk for burnout.[12] A study reports that one-fourth of HCWs felt stigmatized by the community.[13]

A survey of 1257 nurses and physicians caring for the patients with the disease in China found that these providers (41.5% of the respondents) had significantly more depression, anxiety, insomnia, and distress than the providers who did not care directly for the patients. Another observational study of 180 HCWs providing direct care for patients with COVID-19 found substantial levels of anxiety and stress that adversely influenced sleep quality and self-efficacy.[14]

Importantly, those who reported a strong social support network had a lower degree of stress and anxiety, and a higher level of self-efficacy.

It is critical to ensure that those in need of help are identified early and offered an appropriate intervention in the form of medications and psychological support with adoption of healthy coping strategies. It is important to identify the nature of stressors experienced by the health-care providers in a practical scenario and their psychological responses with their coping strategies. A knowledge of the existing coping strategies being used by various individuals may provide a helpful information to guide others in the direction of healthy coping.[13]

Our hospital is one of the major COVID care tertiary hospitals in Pune city, India. Pune witnessed one of the highest turnovers of COVID patients in India. Since the burden of cases in our hospital was increasing, we found the need to assess the psychological burden on the HCWs. Identification of distress at a proper time and inculcating appropriate coping strategies was a major goal so that intervention is done at a proper time. Hence, the study was important to assess the psychological effects of the pandemic on HCWs and assess their coping mechanisms.


  Methodology Top


The aim of the study was to assess the psychological reactions, symptoms, and coping strategies of HCWs in a tertiary hospital. The objectives were as follows: (1) to explore various psychological reactions, stressors, psychological symptoms, and coping skills of doctors, nurses, and support staff working in COVID section of a tertiary care hospital and (2) to correlate the psychological reactions, stressors, and psychological symptoms with sociodemographic factors.

Study design

This was a qualitative study. The qualitative study design was based on phenomenology based on Polit and Beck model in which subjective experience of individuals is explored.[15]

Study setting and participants

Our hospital is a multidisciplinary tertiary care hospital in a city in India. Due to rapid surge in COVID cases, a section for dedicated COVID management was created in the hospital. Doctors, nurses, and support staff were posted for duties in this section of hospital. The HCWs (doctors, nurses, and support staff) who were currently working or had just completed COVID section duty in the outpatient, inpatient, or intensive care units (ICUs) of the hospital were selected. All HCWs who were working in the COVID section of hospital during the period of May 2020–October 2020 who consented for interviews were enrolled for the study.

Sampling

The sampling technique was convenient sampling. May 2020–October 2020 witnessed the highest COVID cases in the city. HCWs posted in COVID sections were interviewed during this period. Fifty-two doctors, 27 nurses, and 21 support staff were interviewed. The interviews were stopped on sample saturation when no additional themes in the narratives of patients were generated. The total sample size achieved was 100.

Data collection

The first author conducted the interviews of HCWs. Adequate PPE and distancing were maintained as per guidelines in the hospital. The phenomenological qualitative study design was followed.[16] In-depth interviews were conducted using a semi-structured open-ended questionnaire which was used as an interview guide. The semi-structured questions were developed by expert opinion and consensus of authors who are specialized and experienced in the field of psychological medicine.

  1. The questionnaire included patient's sociodemographic details, specialty of HCWs, and location and duration of COVID posting. They were also asked the place of their residence whether alone, with family, or with peers/friends


  2. Following semi-structured questions were asked:


    1. What were your psychological reactions during COVID duties?
    2. What were your stressors?
    3. What were your psychological symptoms during the COVID duties?
    4. How did you cope to your stressors during the course of your COVID duty?


The interviews were conducted in a quiet setting where privacy and confidentiality were ensured. It was also ensured that rapport was well established with patients and they were interviewed with empathetic and nonjudgmental approach. The interviews were conducted for an approximate period of 30–45 min. The patients were interviewed only once. All the interviews were transcribed.

Data analysis of qualitative data

The transcribed narratives of each patient were analyzed by all authors, and common themes were generated with consensus from all authors. The format of thematic analysis of the transcript was followed in which familiarizing with data, searching, and reviewing themes with data triangulation with interpretation individually and then in group by all authors till common themes were generated.[17],[18] The themes were then coded for analysis.

Trustworthiness of data

We adopted strategies of credibility, transferability, dependability, and confirmability to ensure the trustworthiness of data.[19]

Ethics

The study was approved by the institutional ethics committee prior to the initiation of the study, Ref – BVDUMC/IEC/19 dated June 24, 20. The participants were explained about the nature of the study, and informed consent was taken from all participants before initiation of data collection. They were explained that they were free to suspend or withdraw from the interview if they were uncomfortable or it was negatively affecting their emotional state.

Statistical analysis

Frequency and percentages were calculated for quantitative variables. Qualitative data were analyzed using Chi-square test for comparison of coded variables. Quantitative tool analysis of parametric data was compared using Student's t-test, and nonparametric data were compared using the Mann–Whitney U-test where appropriate. The Chi-square test was used to compare the proportion of burnout and subgroup distributions in the demographic data. The Fisher's exact test was used when n ≤ 5 for any cell.


  Results Top


Fifty-two doctors, 27 nurses, and 21 support staff were interviewed. [Table 1] depicts the sociodemographic details of the study sample.
Table 1: Sociodemographic data of health-care workers

Click here to view


Most postings in the inpatient department (IPD) and outpatient department (OPD) were of 12 h each for doctors and 8 h each for nurses and support staff. All nighttime duties were of 12 h each irrespective of the nature of work. Postings for doctors in medicine specialty used to be of 1 month each with groups alternating between day and night shifts on a weekly basis. Other specialty doctors were posted for 2 weeks with weekly alterations of shifts. For nurses and support staff also, the postings lasted for a month and a day off was given after the night shift that happened once in 3 days. ICU postings for doctors were of 12 h each with day and night shifts on alternate days and a day off work after night shift. Mostly doctors from medicine, anesthesiology, surgery, and orthopedics who were acquainted with the ICU work were recruited for the same. ICU duty hours for the nurses and support staff were the same as that for doctors.

In the first question about the “psychological reactions during COVID duty,” eight different themes were derived from the narratives of HCWs [Table 2].
Table 2: Themes for “psychological reactions during COVID duty”

Click here to view


Health-related worry

This feeling was shared by 65% of the subjects interviewed, and most of these reported that their worries came from an uncertainty about the transmission risk and mortality due to COVID19 infection and also whether they will be able to receive or afford care. The theme was found to be significant in those posted in ICUs (88.46%) as compared to those in OPD (72%) or in IPD (48.9%) (χ2 = 12.3572, P = 0.002).

A 30-year-old male doctor who was posted in the COVID ICU for 15 days reported “I was apprehensive whether I will be able to manage the work and if I get infected I will infect my friends and they might get quarantined.”

A 41-year-old female support staff who was posted in the OPD for 15 days reported “I was very worried as the pandemic was spreading so fast, and I feared I would get infected if I did the COVID duty and I won't be able to afford care.”

Nature of work

Thirty-seven percent of those posted were concerned about the nature of work that they might have to do and whether they had the expertise to do the work which was out of their routine. This was reported by various doctors from paraclinical specialties and specialties not commonly dealing with pulmonary and systemic infections. This particular concern was found to be significantly higher in doctors (50%) as compared to nurses (33.3%) and support staff (13.8%) (χ2 = 9.5921, P = 0.008).

A 24-year-old female junior doctor who was posted in COVID ward for 15 days reported “I was very worried about the type of work expected of me there as I am not acquainted with this work.”

Fear of transmitting infection to near ones

Fear of transmitting the disease was also present in 20% of the subjects which was significantly higher in those who were living with the family (31.7%) as compared to those living with colleagues (12.28%) and those living alone (0) (χ2 = 6.1350, P = 0.047).

A 29-year-old female critical care medicine doctor who was posted in COVID ICU for repeated cycles of 15 days duty reported “I live with my husband in a flat, so I was very scared that because of the duty I might get infected and spread the infection on to him.”

Eleven percent were worried about their family members being stressed due to their COVID duties.

Excitement about duty

Fourteen percent of the HCWs including doctors, nurses, and support staff reported feeling excited about the COVID duty with some of them sharing a feeling of pride of being able to serve in a situation of global crisis, some others excited about learning about management of a novel infection, and some were happy to break the monotony of their regular routine and considered it a break from the usual work. This theme was found to be more significant in males (26.9%) as compared to females (9.46%) (χ2 = 4.8736, P = 0.027).

A support staff, a former auto-rickshaw driver, was happy to have found a job and a sustained income during the period of lockdown when his routine work was at a halt.

A 38-year-old female support staff who was posted in the COVID ward for 15 days reported “I volunteered to help as I think it is my responsibility to serve in this situation of a pandemic.”

Stigmatization in society

Five percent of the subjects had this concern, and it was significantly higher in married individuals (16.67%) as compared to unmarried (1.47%) (χ2 = 5.5728, P = 0.018) and in those living with family (12.19%) as compared to those living alone or with colleagues who had no such concerns (χ2 = 7.5738, P = 0.023). A 32-year-old nurse reported “I feel awkward to go back home as my neighbours avoid talking to me and also appear anguished when I pass by.”

Concerns about missing out on academic learning

Some junior doctors from various specialties were also concerned about losing out on their training and curriculum in their respective fields (13%). This theme was found to be significantly higher in males (42.3%) as compared to females (2.7%) (χ2 = 26.6835, P = 0.000). It was also significantly more prominent in unmarried (17.65%) as compared to married (3.1%) (χ2 = 4.0574, P = 0.044) and in those posted in ICU (23.08%) as compared to those in IPD (14.28%) with none of those posted in OPD reporting the same (χ2 = 6.1416, P = 0.046).

A 25-year-old female junior doctor who was posted in COVID isolation ward for 15 days reported “I have joined training in Anaesthesia and within a few weeks I got COVID duty. I felt frustrated as I was missing out on learning Anaesthesiology.”

A 28-year-old male surgical doctor who was posted in COVID ICU for 15 days reported “I was concerned because I knew I would not get enough surgical work and there might not be much to learn in the COVID duties.”

Positive acceptance of COVID duty

Nine percent of the HCWs interviewed had acceptance when informed about duty. A 23-year-old female medical intern who was posted in OPD for 15 days reported “I felt fine as I considered it a part of my job, every one of my co interns were getting posted to COVID at least once, so I knew my turn would be there too.”

Another 22-year-old female staff nurse who was posted in the COVID ward for 2 cycles of 15 days reported “I was mentally prepared as I had the duty after my friends, and they had told me what it was going to be like.”

A 27-year-old female doctor who was posted in the COVID ward for 15 days reported “I was not very worried really, because I had tested positive for COVID myself before and I may have developed immunity now.”

The HCWs were interviewed about their stressors. The themes derived from the narratives are shown in [Table 3].
Table 3: Themes of “stressors during the COVID duty”

Click here to view


Long working hours

Forty-nine percent of the subjects reported long working hours as their stressor.

The subjects reported feeling both physically and mentally exhausted during the last few hours of duty, and due to odd working hours and a long donning and doffing procedure, their eating and sleeping patterns were disturbed.

A 24-year-old female doctor who was posted in the COVID ward for 15 days reported “I had so long working hours and I am not used to working that long. Even my family members were scared about my health.”

A 23-year-old female medical intern who was posted in the OPD for 15 days reported “My meal times got totally disturbed due to long duty hours and I was not able to eat on time because of the lengthy donning and doffing procedure.”

Uncomfortable personal protective equipment

This stressor was reported by 29% of the subjects as a factor contributing to physical exhaustion. Some reported getting headaches due to wearing masks for a long duration and many reported feeling hot and suffocated inside the PPE kit sometimes having profuse sweating and itching. Skin reaction at the site of the nose clip of mask was reported by one. This particular stressor was reported significantly by support staff (52.38%) as compared to nurses (37%) or doctors (15.4%) (χ2 = 11.1043, P = 0.004).

A 41-year-old female support staff who was posted in the OPD for 15 days reported “The PPE kit was too hot and suffocating and wearing it for long hours was troublesome.”

A 24-year-old female doctor who was posted in the COVID ICU for 15 days reported “I already have a problem of migraine and wearing the face shield for long hours gave me headache.”

Inadequate personal protective equipment

On the other hand, 20% of the subjects expressed concerns about getting inadequate protective kits.

A 30-year-old doctor posted in ward reported that “I feel the personal protective equipment is inadequate and I do not feel safe.”

Heavy workload due to inadequate staffing

Twenty-three percent reported that work load was excessive. It was significantly more often reported by females (28.38%) as compared to males (7.7%) (χ2 = 4.6488, P = 0.031).

A 24-year-old female doctor who was posted in the COVID ward for 15 days reported “I was burdened with heavy workload. I feel the patient to staff ratio is a matter of concern as we have to manage so many patients.”

Difficulty adjusting with the colleagues was another stressor reported by 9% of the HCWs. There were instances of differences among the doctors and nurses or among nurses and other supportive staff regarding management of the overwhelming workload and distribution of duties causing a feeling of exhaustion at the end of the day.

Difficulty in communicating

Those posted in covid duties had to communicate telephonically with the support staff (like billing staff, pharmacy etc.) and with other HCWs of different COVID wards, ICUS and flu OPD within hospital as well as with other COVID centers to check for the availability of beds, ventilators, O2 delivery units etc. this task was burdensome for many. Some doctors expressed that they could spare limited time for counseling relatives owing to the burden of work and it had to be done using speakerphones through mask and face shields which often led to difficulties in communication.

A 30-year-old male doctor who was posted in the COVID ICU for 15 days reported “I had to counsel the patient's relatives many times and had to explain them everything properly over the phone. The patient's relatives used to call me again and again which made me feel frustrated.”

Excessive mortality and complications

This was reported by 7% of the subjects and was significantly associated with the place of duty. Those posted in ICU reported this concern significantly more often (23.08%) as compared to those in ward (2%) or in OPD (0%) (χ2 = 14.0557, P = 0.001).

The themes derived when interviewed about the psychological symptoms are shown in [Table 4].
Table 4: Themes of “psychological symptoms during the course of duty”

Click here to view


Fear and anxiety of getting infected during the duty

This was reported by 39% of the HCWs during the course of their duty.

A 24-year-old doctor who was posted in the OPD for 15 days reported “a worry was constantly there in my mind that I might eventually get infected, I was feeling tensed about it every day.”

Irritability

This was also reported by 33% of the staff due to excessive work, multiple interruptions, communication difficulties, and uncomfortable PPE. Conflicting work priorities often led to differences among the doctors, nurses, and nonmedical HCWs as reported by some doctors and nurses.

A 30-year-old female doctor who was posted in the COVID ICU for 15 days reported “I was feeling quite irritable as the nursing staff was changing frequently and so I had to explain the work to new staff again and again.”

This was significantly more reported by unmarried subjects (39.7%) as compared to married (18.75%) (χ2 = 4.3220, P = 0.038) and also was found to be significantly higher in doctors (46.15%) as compared to nurses (25.9%) or support staff (10.52%) (χ2 = 9.9150, P = 0.007).

Sleep disturbances

Twenty-six percent of the subjects reported varying degrees of sleep disturbances. This was found to be significantly higher in unmarried subjects (33.8%) as compared to married subjects (9.8%) (χ2 = 6.7602, P = 0.009). This was also found to be significantly more common in nurses (37%) and doctors (30.77%) as compared to support staff (0%) (χ2 = 9.7026, P = 0.008). A significant association of sleep disturbance with living arrangement was also seen (χ2 = 9.7042, P = 0.008), with more of those living with colleagues (36.84%) reporting this as compared to those living with family (9.75%). One of two people living alone had reported sleep disturbances.

A 26-year-old junior doctor who was posted in the COVID ward for 15 days reported that “My entire sleep wake cycle got disturbed as I am not used to stay up all entire night for duties.”

Three ICU residents reported having disturbed sleep due to some shocking incidents that happened during duty with one reporting being reprimanded by a senior colleague and the other two sharing a feeling of panic and helplessness due to their inability to do enough to save a patient.

Overwhelmed

A feeling of being overwhelmed was reported by 10% of the subjects; this theme was found to be significantly higher in the unmarried population (17.65%) as compared to married (0%) (χ2 = 6.4171, P = 0.011). Furthermore, it was significantly more prominent in doctors (21.15%) as compared to nurses (3.7%) or support staff (0%) (χ2 = 8.7496, P = 0.013) and had a significant association with the living arrangement, with 1 out of 2 living alone reporting this as did 17.54% of those living with colleagues compared to just 2.44% of those living with family reporting this feeling (χ2 [2] = 7.9430, P = 0.019).

Lack of interest and apathy

It was found in 8% of the HCWs. A 28-year-old doctor reported “I don't feel energy and enthusiasm to do this work. Every morning I feel reluctant to go to work.” Three percent of the HCWs also reported frank sadness with occasional crying spells.

No psychological symptoms

This absence of psychological symptoms was found to be significantly associated with the subject's gender, with 32.43% females reporting this as compared to 11.54% of the males who reported having no symptoms (χ2 = 4.2615, P = 0.039).

Coping strategies

The themes derived on interviewing about the coping strategies are shown in [Table 5]:
Table 5: Themes of coping strategies

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Communication with family for emotional support

Communicating with family and support system was effectively used by 38% of the HCWs for coping emotionally. A doctor also reported that playing with his pets after going back home would generally make him calm.

Spirituality

Six percent of the HCWs reported using spirituality to manage anxiety. An HCW reported that “since the circumstances were out of control of anyone, we can just be cautious about the protective measures and if the illness still occurs then it's not in anyone's control and I leave that worry to God and would accept whatever he's decided for me.”

Distraction

Another common coping strategy used was distracting self from thinking about the troubling issue. Some of them reported watching movies over the Internet and listening to music would help distract them from thinking about work-related issues. One nurse reported having a hot water bath after work to get herself relaxed, and a doctor reported eating good food as a way to cope with a stressful day.

Sharing distress with colleagues

Sharing their distress with colleagues at work who were going through somewhat similar situations was also used as a coping mechanism by many (35%). A few HCWs reported that sharing meals and joking around with colleagues during lunchtime would often get them rejuvenated for the rest of the duty.

Problem-solving

Forty-nine percent of the subjects used problem-solving strategies such as ensuring adequate rest on off duty hours, dividing duty hours and work among colleagues, maintaining clear and effective communication with colleagues and patient relatives, and learning to communicate with empathy with the relatives over telephone. Many doctors would carry a list of jobs to be done and tackle each one at a time.

Acceptance and positive outlook

Most were aware of the need of their contribution to the global pandemic situation and how certain hurdles might have to be faced during their duties, especially those who had duties during the later months of COVID, so they had accepted the reality of the situation and tried to keep a positive outlook (61%).

Avoidance

It was used by 4% of the HCWs. They avoided telling their families about the COVID duty to prevent facing their emotional reactions. Some HCWs avoided facing their colleagues who they had interpersonal issues with to avoid conflict.


  Discussion Top


During the initial stage of the pandemic, when the HCWs were allotted duties in the COVID section of the hospital, there were multiple psychological reactions, prominent among them were being worried about their own health with fear of infection in 65%. Since the management of patients in the initial stages of this novel pandemic was intriguing, 37% of the HCWs reported concerns about the nature of work. Twenty percent had fear of passing the infection to their loved ones. This was significantly associated with subjects who were staying with their family members. A study by Suleiman et al. on 308 physicians in Jordan reported that 96.4% had fear of transmitting the disease to love ones.[20]

The prominent stressors reported by HCWs were about PPE, with 29% reporting it to be uncomfortable and 20% reporting it to be inadequate.

Zhang et al., who surveyed 304 HCWs in Iran, found that access to PPE resulted in both improved physical health and job gratification and ultimately led to less distress among HCWs.[21] Delgado et al. measured HCWs' personal safety perception in 936 workers in Latin America. Overall, HCWs lacked sufficient PPE and felt limited support from human resources and public officials. It was a fact that in the initial few months of the pandemic, globally hospitals faced with a herculean challenge of balancing the safety of their staff, patient care, and financial and logistic issues related to arranging the protective equipment.[5]

A significant number of participants in our study reported stressors of work-related problems such as long working hours, inadequate workforce, difficulties in work-related communication, and problems with nature of work. Eighteen percent of the HCWs in a study by Suleiman reported anxiety due to uncertain and fluctuating protocols in patient management.[20] In a study done by Shoja et al. on Iranian health workers, it was found that those health workers who encountered COVID-19 patients were subjected to more task load compared to those who had no contact with COVID-19 patients at the workplace.[22]

The protective effect of a committed relationship surfaced in 194 physicians surveyed in Oman. The researchers revealed that individuals who were married and older experienced less stress compared to other HCWs. Additionally, the authors found that females may be more susceptible to stress.[23]

However, in our study, no significant relation was obtained between work-related stressors and marital status, but those who were married were significantly less likely to report symptoms such as irritability, sleep disturbances, and disbelief. On the other hand, those who were married were significantly more likely to report a fear of stigmatization.

As far as the gender differences were concerned, this study had similar findings as in that by Badahdah et al.,[23] showing a significantly higher reported stressor of increased workload by females as compared to males and also absence of psychiatric symptoms being reported more often by males.[5] However, in our study, the concerns about missing out on academic learning were more commonly and significantly reported by male as compared to females and in those posted in ICUs as compared to those posted elsewhere. The stressor of disruption of academic schedule has not been tested previously. Males were also found to be more likely to report excitement about duty as compared to females.

Twenty-six percent of our participants reported sleep disturbances. Qi et al. also measured sleep in their survey of 1306 (801 frontline) HCWs in China. The authors found that frontline HCWs had advanced anxiety, depression, and prevalence of sleep disturbances compared to nonfrontline HCWs.[24]

Zhang et al. also evaluated the prevalence of insomnia and its risk factors on 1565 HCWs in China and found the prevalence to be 36.1%. Insomnia risk factors included lower levels of education, working in a unit with isolation, being a physician, lack of support, having high levels of uncertainty, and being worried about infection.[21]

The knowledge of existing coping strategies is also relevant in assessing the HCWs for psychological risks as a use of adaptive coping strategy may avoid adverse psychological consequences.[25]

The use of positive coping mechanisms such as seeking social support, positive thinking, and problem-solving was associated with lower levels of traumatic stress, psychological distress, anxiety, and depression.[26],[27]

Most of our study participants were found to use adaptive coping strategies such as communication and emotional support, sharing distress, spirituality, using problem-solving techniques, and acceptance. Thirty-three percent of the participants also used techniques of distraction to relieve their stress.


  Conclusion Top


COVID HCWs face multiple psychological stressors and symptoms. Effective coping and psychological support is essential for HCWs to deal with the COVID crisis.

Limitations

The diagnosis of psychological symptoms could not be done as this was a qualitative study. The sample was collected for a period of 4 months during COVID peak. The findings cannot be generalized to all HCWs over a period of time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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