Viral Heroism: What the Rhetoric of Heroes in the COVID-19 Pandemic Tells Us About Medicine and Professional Identity

Family support, anger and aggression in health workers during the first wave of the pandemic

Introduction

Anger is considered as one of the basic human emotions, constituting the affective component of aggression. In the first year of the pandemic, the intense pressure on healthcare workers resulted in the deterioration of their psychosocial problems.

Objective

The aim of this study is to investigate the relationship between family support, anger, and aggression.

Methods

The present study included physicians and nurses who completed an online survey of Dimensions of Anger Reactions-5 (DAR-5), a Brief Aggression Questionnaire (BAQ) and a Family Support Scale (FSS). Before completing the questionnaires, participants were asked to state their gender, years of work, age, and profession.

Results

Fifty-three men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale. Male participants displayed lower DAR-5 scores compared to women. Female participants displayed lower FSS scores compared to men, but higher scores when compared with earlier measures. Regression showed that 15.2% of the variance in BAQ scores can be explained by DAR-5 scores, with an additional 3.8% explained by FSS scores, while an additional 2.3% is explained by years of working experience. Mediation analysis highlighted the role of family support as a negative mediator in the DAR-5 and BAQ relationship.

Conclusion

During the first year of the pandemic, there was an increase in the sense of family support among female health workers. One-third of the participants displayed increased anger scores. Family support acts as a mediator by preventing anger derailing into aggression. In healthcare worker support programs, it seems necessary to entail a specific section on anger management.

Shifting Professional Identity Among Indonesian Medical Practitioners During the COVID-19 Pandemic

The COVID-19 pandemic has had a significant impact on medical practitioners' professional identities due to its novelty and intensity. Using constructivist grounded theory, we investigated how the COVID-19 pandemic shifted individuals' identities as medical practitioners in Indonesia, where the pandemic caused high death rates among healthcare workers, particularly medical practitioners. By interviewing 24 medical practitioners and analyzing relevant documents and reports, we developed a grounded theory of professional identity shifts. We found two patterns: (1) identity growth, in which the medical practitioners thrive and claimed stronger professional identities, and (2) psychological and moral distress leading to attrition, facilitated adaptation, or professional identity collapse. We also found several primary protective factors including religious beliefs, good leadership, team cohesion, healthy work boundaries, connection to significant others, and public acknowledgment. Without adequate protective factors, medical practitioners experienced difficulties redefining their professional identities. To cope with the situation, they focused on different identities, took some time off, or sought mental health support, resulting in facilitated adaptation. Others resorted to attrition or experienced professional identity collapse. Our findings suggest that medical practitioners' experience of professional identity shifts can be improved by providing medical practitioners with opportunities for knowledge updates, better organizational leadership and work boundaries, strategies to enhance team cohesion, and other improvements to medical systems.

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research

OBJECTIVES

We aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice.

HYPOTHESIS/RESEARCH QUESTION

What does published literature tell us about heroism and paramedic practice?

SETTING

Paramedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes.

PARTICIPANTS

We conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied.

RESULTS

151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice.

CONCLUSION

Paramedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice.

STUDY REGISTRATION

PROSPERO: CRD42021234851.

Impacts of COVID-19 pandemic on professional identity development of intern nursing students in China: A scoping review

PURPOSE

Clinical experience plays a vital role in the development of the professional identity (PI) of nursing students. China has applied a strict zero- COVID health policy in combating the COVID-19 pandemic since December 2019 and studies have been conducted in different places of China to explore PI development of nursing students during the pandemic time among the intern nursing students who are on clinical practices. This review study aims to synthesize the previous studies and provide a comprehensive picture of the impacts of the pandemic on the PI development of intern nursing students.

METHODS

Arksey and O'Malley's five-stage scoping review framework was used. Combinations of keywords were used to search relevant articles in both Chinese and English databases published from inception of the articles until the final search date (10 March 2022). The initially included articles were also appraised for their quality, and those that passed the appraisal were left for data analysis. The analytic results were cross-checked among the reviewers.

RESULT

Three themes emerged from the included studies: 1) the PI levels, 2) the impacts of personal and social factors of PL, and 3) the specific impact of the COVID-19 pandemic. The levels of students' PI ranged from 66%-80% of the total scores in PI instruments, almost the same levels as in pre-pandemic time, despite the elevated social image of nurses after the COVID-19 pandemic. There is no consensus about the impacts of most personal and social factors on students' PI across the studies. The impacts of COVID-19 on PI were both positive and negative.

CONCLUSIONS

COVID-19 epidemic exerted complicated impacts on the PI of intern nursing students. While it is necessary to address the fear of the COVID-19 pandemic among intern nursing students, the pandemic may not be an opportunistic time to enhance the students' PI.

Evolution of the Public-Health Response to COVID-19 Pandemic in Spain: A Descriptive Qualitative Study

The capacity of hospitals and primary care centres has, rightfully, been at the centre of public and political debate on resource availability and control measures during the outbreak of COVID-19 and lockdown. Thus, the aim of this study is to describe the public and professional perceptions towards the evolution of the COVID-19 public-health response, in order to analyse and learn lessons for future health policies in similar situations in the future. A descriptive qualitative study was conducted through 41 in-depth interviews between January and June 2021. Twenty-one healthcare professionals and twenty service users participated in our study. The participants were recruited using purposive sampling. After our data analysis, three main themes emerged: (i) experiences during an unprecedented public health threat: the impact and challenges of early control measures, and outcomes for the public image of nursing; (ii) overcoming the impact of the outbreak on the healthcare system: professional coping strategies in the context of the pandemic, and institutional considerations in hospitals and primary care; and (iii) the efficiency of resource management during the outbreak: perceptions of professionals and healthcare users. Health providers and service users demand structural and organisational changes, as well as resource-optimisation strategies for front-line workers. Nurses need to be involved in decision making in order to provide evidence-based guidelines and ensure well-resourced and supported care practice.

"We have to be the link between everyone": A discursive psychology approach to defining registered nurses' professional identity

Background

The occupational health and safety of registered nurses is unsatisfactory, often including high work demands in combination with insufficient acknowledgement. Implicit expectations influence their working conditions, many of which are set by the nurses themselves. Therefore, we aimed to explore how professional identity was discursively constructed by Swedish registered nurses in research interviews about night shift work.

Design and Methods

Ten semi‐structured interviews with registered nurses were analysed using a discursive psychology approach. The Standards for reporting qualitative research guided the reporting.

Results

The professional identity of registered nurses included a theoretical professional aspect as well as a unique experience‐based competence. With their overview and breadth of competence, registered nurses constitute the hub of healthcare activities, also mastering tasks in the fields of other health professions. This opacity of professional boundaries is associated with boundless expectations of the registered nurse. Additionally, the professional identity stipulates always putting the patient's best interests first, and one's own needs second.

'A picture is worth a thousand words'-A photovoice study exploring health professionals' experiences during the COVID-19 pandemic

Aim

To elicit the experiences and perspectives of health professionals working on the frontline in the COVID‐19 pandemic.

Background

Although some qualitative studies have been carried out in health professionals during COVID‐19 pandemic, to our knowledge, no study has used the Photovoice method.

Design

A qualitative descriptive study using Photovoice was carried out between March and June 2020.

Methods

A total of 20 health professionals were recruited from public and private healthcare services. The participants were invited to share photographs about their experiences while working during COVID‐19 pandemic. Following the Photovoice method, audio‐recorded interviews were conducted. The data were analysed using the ‘SHOWED’ mnemonic, with five questions answered about each photograph. The EQUATOR checklist has been used.

Results/Findings

Three themes emerged: (1) Personal attitudes of health professionals; (2) Support from the community; and (3) Management of institutional resources. Despite the fact that health professionals in this study were exposed to major risks while caring for patients with COVID‐19’ they felt a strong sense of responsibility towards the community. In order to handle these stressful situations, they used coping mechanisms, good humour and leisure, but also received support from the population, who saw them as highly skilled health professionals.

Conclusion

These findings highlight the essential role of health professionals in the COVID‐19 pandemic and the tireless work they are carrying out to provided highly skilled care.

Relevance to clinical practice

These findings could contribute to raise awareness on the needs of health professionals during the pandemic, allowing managers to plan strategies to ensure the safety, and well‐being of these professionals, as well as adopting similar strategies in their practice to create a space for critical reflection through participatory approaches.

A Journal of the COVID-19 (Plague) Year

The essays in this special issue of HEC Forum provide reflections that make explicit the implicit anthropology that our current pandemic has brought but which in the medical ethics literature around COVID-19 has to a great extent ignored. Three of the essays are clearly “journalistic” as a literary genre: one by a hospital chaplain, one by a medical student in her pre-clinical years, and one by a fourth-year medical student who reports her experience as she completed her undergraduate clerkships and applied for positions in graduate medical education. Other essays explore the pandemic from historical, sociological, and economic perspectives, particularly how triage policies have been found to be largely blind to structural healthcare disparities, while simultaneously unable to appropriately address those disparities. Central issues that need to be addressed in triage are not just whether a utilitarian response is the most just response, but what exactly is the greatest good for the greatest number? Together, the essays in this special issue of HEC Forum create a call for a more anthropological approach to understanding health and healthcare. The narrow approach of viewing health as resulting primarily from healthcare will continue to hinder advances and perpetuate disparities. Health outcomes result from a complex interaction of various social, economic, cultural, historical, and political factors. Advancing healthcare requires contextualizing the health of populations amongst these factors. The COVID-19 pandemic has made us keenly aware of how interdependent our health as a society can be.