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BMC Health Services Research

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Open Access 01-12-2021 | Ebola Virus | Research article

Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis

Authors: Jo Billings, Brian Chi Fung Ching, Vasiliki Gkofa, Talya Greene, Michael Bloomfield

Published in: BMC Health Services Research | Issue 1/2021

Abstract

Background

Healthcare workers across the world have risen to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. There has been increasing recognition of the potential mental health impact of COVID-19 on frontline workers and calls to provide psychosocial support for them. However, little attention has so far been paid to understanding the impact of working on a pandemic from healthcare workers’ own perspectives or what their views are about support.

Methods

We searched key healthcare databases (Medline, PsychINFO and PubMed) from inception to September 28, 2020. We also reviewed relevant grey literature, screened pre-print servers and hand searched reference lists of key texts for all published accounts of healthcare workers’ experiences of working on the frontline and views about support during COVID-19 and previous pandemics/epidemics. We conducted a meta-synthesis of all qualitative results to synthesise findings and develop an overarching set of themes and sub-themes which captured the experiences and views of frontline healthcare workers across the studies.

Results

This review identified 46 qualitative studies which explored healthcare workers’ experiences and views from pandemics or epidemics including and prior to COVID-19. Meta-synthesis derived eight key themes which largely transcended temporal and geographical boundaries. Participants across all the studies were deeply concerned about their own and/or others’ physical safety. This was greatest in the early phases of pandemics and exacerbated by inadequate Personal Protective Equipment (PPE), insufficient resources, and inconsistent information. Workers struggled with high workloads and long shifts and desired adequate rest and recovery. Many experienced stigma. Healthcare workers’ relationships with families, colleagues, organisations, media and the wider public were complicated and could be experienced concomitantly as sources of support but also sources of stress.

Conclusions

The experiences of healthcare workers during the COVID-19 pandemic are not unprecedented; the themes that arose from previous pandemics and epidemics were remarkably resonant with what we are hearing about the impact of COVID-19 globally today. We have an opportunity to learn from the lessons of previous crises, mitigate the negative mental health impact of COVID-19 and support the longer-term wellbeing of the healthcare workforce worldwide.

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Ghebreyesus TA. Addressing mental health needs: an integral part of COVID-19 response. World Psychiatry. 2020;19(2):129–30. https://doi.org/10.1002/wps.20768.CrossRef

Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7(6):547–60. https://doi.org/10.1016/S2215-0366(20)30168-1.CrossRefPubMedPubMedCentral

Brooks S, Amlôt R, Rubin GJ, Greenberg N. Psychological resilience and post-traumatic growth in disaster-exposed organisations: overview of the literature. BMJ Military Health. 2020;166(1):52–6. https://doi.org/10.1136/jramc-2017-000876.CrossRefPubMed

Carrieri D, Briscoe S, Jackson M, Mattick K, Papoutsi C, Pearson M, et al. ‘Care Under Pressure’: a realist review of interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care. BMJ Open. 2018;8(2):e021273.CrossRefPubMedPubMedCentral

Greene T, Harju-Seppänen J, Adeniji M, Steel C, Grey N, Brewin CR et al. Predictors of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19. medRxiv 2020. Available from: https://doi.org/10.1101/2020.10.21.20216804. [Accessed 25 Oct 2020].

Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. 2020;7(6):468–71. https://doi.org/10.1016/S2215-0366(20)30171-1.CrossRefPubMedPubMedCentral

Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976.CrossRefPubMedPubMedCentral

Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Netw Open. 2020;3(5):e2010185. https://doi.org/10.1001/jamanetworkopen.2020.10185.CrossRefPubMedPubMedCentral

National Institute for Health and Care Excellence. Post-traumatic stress disorder: Evidence reviews for psychological, psychosocial and other non-pharmacological interventions for the prevention of PTSD in adults (NICE Guideline No. 116) 2018. Retrieved from https://www.nice.org.uk/guidance/ng116/evidence/. Accessed 6 June 2020.

10.

Rose SC, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2002;2.

11.

Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e15–6. https://doi.org/10.1016/S2215-0366(20)30078-X.CrossRefPubMedPubMedCentral

12.

Moher D, Liberati A, Tetzlaff J, Altman DG. Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med. 2009;6(7):e1000097.

13.

CASP UK. Critical appraisal skills programme (CASP). Qualitative Research Checklist. 2017;31(13):449.

14.

Lachal J, Revah-Levy A, Orri M, Moro MR. Meta-synthesis: an original method to synthesize qualitative literature in psychiatry. Front Psychiatry. 2017;8:269. https://doi.org/10.3389/fpsyt.2017.00269.CrossRefPubMedPubMedCentral

15.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa.CrossRef

16.

Gershon R, Dernehl LA, Nwankwo E, Zhi Q, Qureshi K. Experiences and psychosocial impact of West Africa Ebola deployment on US health care volunteers. PLoS Currents. 2016;8. https://doi.org/10.1371/currents.outbreaks.c7afaae124e35d2da39ee7e07291b6b5.

17.

Shih FJ, Gau ML, Kao CC, Yang CY, Lin YS, Liao YC, et al. Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome. Appl Nurs Res. 2007;20(4):171–80. https://doi.org/10.1016/j.apnr.2006.08.007.CrossRefPubMedPubMedCentral

18.

Yin X, Zeng L. A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory. Int J Nurs Sci. 2020;7(2):157–60. https://doi.org/10.1016/j.ijnss.2020.04.002.CrossRefPubMedPubMedCentral

19.

Koh Y, Hegney D, Drury V. Nurses' perceptions of risk from emerging respiratory infectious diseases: a Singapore study. Int J Nurs Pract. 2012;18(2):195–204. https://doi.org/10.1111/j.1440-172X.2012.02018.x.CrossRefPubMedPubMedCentral

20.

Raven J, Baral S, Wurie H, Witter S, Samai M, Paudel P, et al. What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal. Health Res Policy Syst. 2018;16(1):6. https://doi.org/10.1186/s12961-018-0285-1.CrossRefPubMedPubMedCentral

21.

Chung BPM, Wong TKS, Suen ESB, Chung JWY. SARS: caring for patients in Hong Kong. J Clin Nurs. 2005;14(4):510–7. https://doi.org/10.1111/j.1365-2702.2004.01072.x.CrossRefPubMed

22.

Broom J, Broom A, Bowden V. Ebola outbreak preparedness planning: a qualitative study of clinicians' experiences. Public Health. 2017;143:103–8. https://doi.org/10.1016/j.puhe.2016.11.008.CrossRefPubMed

23.

Moore DM, Gilbert M, Saunders S, Bryce E, Yassi A. Occupational health and infection control practices related to severe acute respiratory syndrome: health care worker perceptions. AAOHN J. 2005;53(6):257–66. https://doi.org/10.1177/216507990505300606.CrossRefPubMed

24.

Bergeron SM, Cameron S, Armstrong-Stassen M, Pare K. Diverse implications of a national health crisis: A qualitative exploration of community nurses' SARS experiences. Can J Nurs Res Archive. 2006;38(2):42–54.

25.

Rubin GJ, Harper S, Williams PD, Öström S, Bredbere S, Amlôt R, et al. How to support staff deploying on overseas humanitarian work: a qualitative analysis of responder views about the 2014/15 west African Ebola outbreak. Eur J Psychotraumatol. 2016;7(1):30933. https://doi.org/10.3402/ejpt.v7.30933.CrossRefPubMed

26.

Im SB, Baumann SL, Ahn M, Kim H, Youn BH, Park MK, et al. The experience of Korean nurses during the Middle East respiratory syndrome outbreak. Nurs Sci Q. 2018;31(1):72–6. https://doi.org/10.1177/0894318417741119.CrossRefPubMedPubMedCentral

27.

Aghaizu A, Elam G, Ncube F, Thomson G, Szilágyi E, Eckmanns T, et al. Preventing the next 'SARS' - European healthcare workers' attitudes towards monitoring their health for the surveillance of newly emerging infections: qualitative study. BMC Public Health. 2011;11(1):541. https://doi.org/10.1186/1471-2458-11-541.CrossRefPubMedPubMedCentral

28.

Erland E, Dahl B. Midwives’ experiences of caring for pregnant women admitted to Ebola centres in Sierra Leone. Midwifery. 2017;55:23–8. https://doi.org/10.1016/j.midw.2017.08.005.CrossRefPubMed

29.

Fawaz M, Samaha A. The psychosocial effects of being quarantined following exposure to COVID-19: A qualitative study of Lebanese health care workers. Int J Soc Psychiatry. 2020;66(6);560–5. https://doi.org/10.1177/0020764020932202.

30.

Kim Y. Nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea. Am J Infect Control. 2018;46(7):781–7. https://doi.org/10.1016/j.ajic.2018.01.012.CrossRefPubMedPubMedCentral

31.

Lamb D. Factors affecting the delivery of healthcare on a humanitarian operation in West Africa: a qualitative study. Appl Nurs Res. 2018;40:129–36. https://doi.org/10.1016/j.apnr.2018.01.009.CrossRefPubMed

32.

Smith MW, Smith PW, Kratochvil CJ, Schwedhelm S. The psychosocial challenges of caring for patients with Ebola virus disease. Health Security. 2017;15(1):104–9. https://doi.org/10.1089/hs.2016.0068.CrossRefPubMed

33.

Liu H, Liehr P. Instructive messages from Chinese nurses’ stories of caring for SARS patients. J Clin Nurs. 2009;18(20):2880–7. https://doi.org/10.1111/j.1365-2702.2009.02857.x.CrossRefPubMed

34.

Lam KK, Hung SYM. Perceptions of emergency nurses during the human swine influenza outbreak: a qualitative study. Int Emerg Nurs. 2013;21(4):240–6. https://doi.org/10.1016/j.ienj.2012.08.008.CrossRefPubMedPubMedCentral

35.

Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts JI, et al. Healthcare workers' attitudes to working during pandemic influenza: a qualitative study. BMC Public Health. 2009;9(1):56. https://doi.org/10.1186/1471-2458-9-56.CrossRefPubMedPubMedCentral

36.

Andertun S, Hornsten A, Hajdarevic S. Ebola virus disease: caring for patients in Sierra Leone – a qualitative study. J Adv Nurs. 2017;73(3):643–52.

37.

Sun N, Wei L, Shi S, Jiao D, Son R et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control. 2020;1;48(6):592–8.

38.

Chiang HH, Chen MB, Sue IL. Self-state of nurses in caring for SARS survivors. Nurs Ethics. 2007;14(1):18–26. https://doi.org/10.1177/0969733007071353.CrossRefPubMed

39.

Mok E, Chung BP, Chung JW, Wong TK. An exploratory study of nurses suffering from severe acute respiratory syndrome (SARS). Int J Nurs Pract. 2005;11(4):150–60. https://doi.org/10.1111/j.1440-172X.2005.00520.x.CrossRefPubMedPubMedCentral

40.

Bensimon CM, Tracy CS, Bernstein M, Shaul RZ, Upshur RE. A qualitative study of the duty to care in communicable disease outbreaks. Soc Sci Med. 2007;65(12):2566–75. https://doi.org/10.1016/j.socscimed.2007.07.017.CrossRefPubMedPubMedCentral

41.

Guimard Y, Bwaka MA, Colebunders R, Calain P, Massamba M et al. Organization of patient care during the Ebola hemorrhagic fever epidemic in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis 1999; 179(Supplement_1), S268-73.

42.

Al Knawy BA, Al-Kadri HM, Elbarbary M, Arabi Y, Balkhy HH, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open. 2019;9(5):e017476. https://doi.org/10.1136/bmjopen-2017-017476.CrossRefPubMedPubMedCentral

43.

Shih FJ, Turale S, Lin YS, Gau ML, Kao CC, et al. Surviving a life-threatening crisis: Taiwan’s nurse leaders’ reflections and difficulties fighting the SARS epidemic. J Clin Nurs. 2008;18(24):3391–400.CrossRef

44.

von Strauss E, Paillard-Borg S, Holmgren J, Saaristo P. Global nursing in an Ebola viral haemorrhagic fever outbreak: before, during and after deployment. Glob Health Action. 2017;10(1):1371427. https://doi.org/10.1080/16549716.2017.1371427.CrossRef

45.

Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 2020;369:m1642.

46.

Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68(5):748–66. https://doi.org/10.1037/0022-006X.68.5.748.CrossRefPubMed

47.

Greenberg N, Tracy D. What healthcare leaders need to do to protect the psychological well-being of frontline staff in the COVID-19 pandemic. BMJ Leader. 2020;4:3.

48.

Gerada C. Some good must come out of covid-19. BMJ. 2020;369.

49.

Billings J, Greene T, Kember T, Grey N, El-Leithy S, et al. Supporting hospital staff during COVID-19: early interventions. Occup Med. 2020;70(5):327–9.

50.

Hewlett BL, Hewlett BS. Providing care and facing death: nursing during Ebola outbreaks in Central Africa. J Transcult Nurs. 2005;16(4):289–97. https://doi.org/10.1177/1043659605278935.CrossRefPubMed

51.

Honey M, Wang WY. New Zealand nurses perceptions of caring for patients with influenza a (H1N1). Nurs Critical Care. 2013;18(2):63–9. https://doi.org/10.1111/j.1478-5153.2012.00520.x.CrossRef

52.

Lau PY, Chan CW. SARS (severe acute respiratory syndrome): reflective practice of a nurse manager. J Clin Nurs. 2005;14(1):28–34. https://doi.org/10.1111/j.1365-2702.2004.00995.x.CrossRefPubMedPubMedCentral

53.

Lee SH, Juang YY, Su,YJ, Lee HL, Lin YH, Chao CC. Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry. 2005;27(5):352–8. https://doi.org/10.1016/j.genhosppsych.2005.04.007.

54.

Liu C, Wang H, Zhou L, Xie H, Yang H et al. Sources and symptoms of stress among nurses in the first Chinese anti-Ebola medical team during the Sierra Leone aid mission: A qualitative study. Int J Nurs Sci. 2019;10;6(2):187–91.

55.

Liu YE, Zhai ZC, Han YH, Liu YL, Liu FP, Hu DY. Experiences of front-line nurses combating coronavirus disease-2019 in China: A qualitative analysis. Public Health Nursing 2020; Published online September 2020.

56.

Locsin RC, Kongsuwan W, Nambozi G. Ugandan nurses’ experience of caring for persons dying from Ebola hemorrhagic fever. Int J Hum Caring. 2009;13(4):26–32. https://doi.org/10.20467/1091-5710.13.4.26.CrossRef

57.

McMahon SA, Ho LS, Scott K, Brown H, Miller L et al. “We and the nurses are now working with one voice”: How community leaders and health committee members describe their role in Sierra Leone’s Ebola response. BMC Health Serv Res. 2017;17(1):495.

58.

O'Boyle C, Robertson C, Secor-Turner M. Nurses' beliefs about public health emergencies: fear of abandonment. Am J Infect Control. 2006;1;34(6):351–7.

59.

O'Sullivan TL, Amaratunga C, Phillips KP, Corneil W, O'Connor E, Lemyre L, Dow D If schools are closed, who will watch our kids? Family caregiving and other sources of role conflict among nurses during large-scale outbreaks. Prehospital Disaster Med. 2009;24(4):321–5. https://doi.org/10.1017/S1049023X00007044.

60.

Pearce C, Shearer M, Phillips C, Hall S, Kljakovic M, Glasgow NJ, et al. Views of GPs and practice nurses on support needed to respond to pandemic influenza: a qualitative study. Aust Health Rev. 2011;35(1):111–5. https://doi.org/10.1071/AH09788.CrossRefPubMed

61.

Raven J, Wurie H, Witter S. Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study. BMC Health Serv Res. 2018;18(1):251. https://doi.org/10.1186/s12913-018-3072-3.CrossRefPubMedPubMedCentral

62.

Sarikaya O, Erbaydar T. Avian influenza outbreak in Turkey through health personnel's views: a qualitative study. BMC Public Health. 2007;7(1):330. https://doi.org/10.1186/1471-2458-7-330.CrossRefPubMedPubMedCentral

63.

Shaw KA, Chilcott A, Hansen E, Winzenberg T. The GP's response to pandemic influenza: a qualitative study. Fam Pract. 2006;23(3):267–72. https://doi.org/10.1093/fampra/cml014.CrossRefPubMed

64.

Taylor HA, Rutkow L, Barnett DJ. Local preparedness for infectious disease outbreaks: a qualitative exploration of willingness and ability to respond. Health Security. 2018;16(5):311–9. https://doi.org/10.1089/hs.2018.0046.CrossRefPubMedPubMedCentral

65.

Wong EL, Wong SY, Lee N, Cheung A, Griffiths S. Healthcare workers’ duty concerns of working in the isolation ward during the novel H1N1 pandemic. J Clin Nurs. 2012;21(9–10):1466–75. https://doi.org/10.1111/j.1365-2702.2011.03783.x.CrossRefPubMed

Title: Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis
Authors: Jo Billings
Brian Chi Fung Ching
Vasiliki Gkofa
Talya Greene
Michael Bloomfield
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Ebola Virus
COVID-19
Published in: BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-021-06917-z

At a glance: The STEP trials

Springer Medicine

Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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