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Abaatyo J, Rukundo GZ, Twine M, Lutasingwa D, Favina A, Nyemara N, Ricciardelli R. Psychological distress among healthcare professionals in Mbarara, following the 2022 Ebola Virus Disease outbreak in Uganda: a mixed methods study. BMC Psychiatry 2024; 24:469. [PMID: 38918760 PMCID: PMC11201341 DOI: 10.1186/s12888-024-05922-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The 2022 Ebola Virus Disease (EVD) outbreak occurred at a time when Uganda was still battling the social and psychological challenges of the COVID-19 pandemic; placing health care professionals (HCPs) at a much higher risk of developing psychological distress. Psychological distress among HCPs can cause decreased workplace productivity and ineffective management of their patients. The current study aimed to investigate and understand psychological distress among HCPS in Mbarara city in Southwestern Uganda following the 2022 EVD outbreak. METHOD We enrolled 200 HCPs through convenient sampling from one private and one public health facility in Mbarara city in Southwestern Uganda, in a cross-sectional convergent parallel mixed method approach where qualitative and quantitative data were collected concurrently. Quantitative data, utilizing the Kessler Psychological Distress (K10) Scale, provided us with a quantitative measure of the prevalence of psychological distress among HCPs, and were analyzed using STATA version 16. Qualitative data, on the other hand, offered deeper insights into the nature, perceptions, and contextual factors influencing this distress, and were analyzed using emergent theme analysis. RESULTS The prevalence of psychological distress was 59.5% and it was higher among females (63.9%) compared to males (36.1%). HCPs vividly expressed distress and anxiety, with heightened suspicion that every patient might be an EVD carrier, creating a pervasive sense of unsafety in the workplace. However, the outbreak had an educational affect where concerns about the announcement of another EVD outbreak were diverse, with HCPs expressing anxiety, despair, and dissatisfaction with the country's management of potential outbreaks. CONCLUSION High levels of psychological distress were experienced by HCPs in Southwestern Uganda as a result of the 2022 EVD pandemic. HCPs express a wide range of feelings, such as dread, anxiety, despair, pessimism, and discontent with the way the outbreaks are handled throughout the nation. We recommend implementation of comprehensive psychosocial support programs tailored to the unique needs of HCPs, including counseling services, stress management workshops, and peer support networks.
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Affiliation(s)
- Joan Abaatyo
- Department of Psychiatry, Faculty of Medicine, Uganda Christian University, Kampala, Uganda.
- King Ceasor University, Kampala, Uganda.
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Margaret Twine
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Alain Favina
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Novatus Nyemara
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rosemary Ricciardelli
- Fisheries and Marine Institute, Memorial University of Newfoundland, St. John's, Canada
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Rahman MA, Islam MR, Chowdhury M, Asaduzzaman M, Barua P, Haque MA. Impact of COVID-19 on celebration of death, mortuary, and funerary customs in Bangladesh: A qualitative study. Heliyon 2024; 10:e30369. [PMID: 38720756 PMCID: PMC11076953 DOI: 10.1016/j.heliyon.2024.e30369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction During the COVID-19 pandemic, restrictions significantly impacted religious activities related to death celebrations, mortuary practices, and funerary rituals in Bangladesh. Bereaved families faced a harsh reality, unable to perform the full rituals for their loved ones due to the pandemic outbreak. This study explores the adjustments and modifications made in cultural rituals and how they affected bereaved families and close relatives. Objective This study aims to explore how the COVID-19 pandemic impacted the observance of death rituals in Bangladesh and the effects on bereaved families and close relatives. Methods This study employed a qualitative approach and gathered data through 3 key informant interviews (KIIs) and 58 in-depth interviews (IDIs) conducted between December 2020 and January 2021. Purposive sampling was employed to recruit participants from three distinct groups: (1) individuals who had experienced the death of a relative during the pandemic, (2) caregivers who provided support to those experiencing loss, and (3) volunteers actively involved with funeral and burial services. This selection strategy ensured a diverse range of perspectives on the impact of the pandemic on death rituals. Results The pandemic forced people to observe funerals or make significant sacrifices to traditional practices reluctantly. Disruptions to long-standing traditions and widespread emotional toll were as various segments of society struggled to find closure in saying goodbye to loved ones. Due to the severity of the pandemic, people became heavily reliant on priests, crematorium workers, and funeral volunteers for mortuary services. Both Hindu and Muslim religions discouraged family gatherings during post-burial rituals. The fear of contracting the virus further limited bereaved families' ability to bid farewell to their deceased loved ones properly. Conclusion This research highlights the profound impact of the pandemic on death rituals and the resulting emotional distress for bereaved families in Bangladesh. The findings are pivotal in guiding the development of concrete policies for future pandemic preparedness and response. Such policies might encompass guidelines for safe and culturally sensitive mortuary practices, psychosocial support and grief counseling initiatives for affected communities, and strategies to mitigate religious anxieties during public health emergencies.
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Affiliation(s)
- Md Abdur Rahman
- Department of Anthropology, Comilla University, Cumilla, 3500, Bangladesh
| | - Md Redwanul Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Monidipa Chowdhury
- Department of Anthropology, Comilla University, Cumilla, 3500, Bangladesh
| | - Md. Asaduzzaman
- Department of Anthropology, Comilla University, Cumilla, 3500, Bangladesh
| | - Proloy Barua
- BRAC Institute of Governance and Development (BIGD), BRAC University, Dhaka, 1212, Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
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Carnesten H, von Heideken Wågert P, Gustin LW, Toivanen S, Skoglund K, Jaarsma T, Andreae C. Struggling in the dehumanized world of COVID-An exploratory mixed-methods study of frontline healthcare workers' experiences. J Adv Nurs 2024. [PMID: 38305070 DOI: 10.1111/jan.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
AIM To explore healthcare workers' experiences of the changed caring reality during the COVID-19 pandemic in Sweden. DESIGN An online fully mixed-methods design. METHODS A web-based self-reported questionnaire with fixed and open-ended answers collected data from March to April 2021, analysed in three steps. First, free-text questions were analysed by qualitative content analysis. Then quantitative linear regression analyses using models covering stress and coping mechanisms were conducted. Finally, a meta-inference of qualitative and quantitative data emerged a new comprehensive understanding. The COREQ guidelines were used for reporting. RESULTS Meta-inferenced results of quantitative and qualitative findings show the pandemic was a traumatic experience for healthcare workers. Main theme; When work became a frightening experience in a dehumanized reality, comprised four themes: Entering unprepared into a frightful, incomprehensible world; Sacrificing moral values and harbouring dilemmas in isolation; Lack of clear management; and Reorient in togetherness and find meaning in a changed reality. Qualitative results comprised four categories; Working in a dehumanized world; Living in betrayal of ones' own conscience; Lack of structure in a chaotic time and Regaining vitality together. Subdimensions comprehensibility and meaningfulness were associated significantly with post-traumatic stress disorder in multiple regression analysis. In multiple regression analysis, sense of coherence was the most prominent coping strategy. CONCLUSIONS Forcing oneself to perform beyond one's limit, sacrificing moral values and lacking management was a traumatic experience to healthcare workers during the pandemic. Reorienting as a way of coping was possible in togetherness with colleagues. There is an urgency of interventions to meet the needs among healthcare workers who took on a frontline role during the COVID-19 pandemic and to prevent mental health illness in future crisis. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. SUMMARY The pandemic outbreak exposed frontline healthcare workers to unparallelled stress shown as negative for their mental health in several meta-analyses and systematic reviews. In-depth understanding on experiences and how symptoms of post-traumatic stress disorder relate to coping mechanisms have been scarcely explored. This study contributes to understanding on healthcare workers' experiences and the relation between lower sense of coherence and increased risk of developing symptoms of post-traumatic stress disorder. IMPLICATIONS FOR PRACTICE/POLICY This study might guide how to prepare for resilience in future emergencies.
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Affiliation(s)
- Hillewi Carnesten
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | | | - Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
- Department of Health and Care Sciences, UiT/The Arctic University of Norway, Narvik, Norway
| | - Susanna Toivanen
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | - Karin Skoglund
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Julius Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Christina Andreae
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Orhierhor M, Pringle W, Halperin D, Parsons J, Halperin SA, Bettinger JA. Lessons learned from the experiences and perspectives of frontline healthcare workers on the COVID-19 response: a qualitative descriptive study. BMC Health Serv Res 2023; 23:1074. [PMID: 37805603 PMCID: PMC10559616 DOI: 10.1186/s12913-023-10062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, healthcare systems and healthcare workers (HCWs) faced significant demands and unique challenges. In this qualitative study, we explore the effects of the COVID-19 public health policies on British Columbia's frontline HCWs, describe what worked in the management of the pandemic, and elucidate the lessons learned that could be applied to future pandemic preparedness, recovery and response. METHODS This qualitative descriptive study is part of a larger, national multi-case study on pandemic policy communication and uptake. Semi-structured interviews were conducted from November 2020- June 2021 with fourteen HCWs working in long-term care (LTC), acute care and public health settings. Data were inductively coded, and analyzed following a resilience framework for public health emergency preparedness, which emphasizes the essential elements of a public health system, vital to all phases of health emergency management, readiness, response and recovery. RESULTS HCWs experienced confusion, frustration, uncertainty, anxiety, fatigue and stress, during the pandemic and detailed challenges that affected policy implementation. This included communication and coordination inconsistencies between the province and regional health authorities; lack of involvement of frontline staff in pandemic planning; inadequate training and support; inadequate personal protective equipment resource capacity and mobilization; and staffing shortages. HCWs recommended increased collaboration between frontline staff and policy makers, investment in preparing and practicing pandemic plans, and the need for training in emergency management and infection prevention and control. CONCLUSIONS Pandemic planning, response and recovery should include inputs from actors/key stakeholders at the provincial, regional and local levels, to facilitate better coordination, communication and outcomes. Also, given the critical roles of frontline HCWs in policy implementation, they should be adequately supported and consideration must be given to how they interpret and act on policies. Bi-directional communication channels should be incorporated between policymakers and frontline HCWs to verify the appropriate adoption of policies, reflective learning, and to ensure policy limitations are being communicated and acted upon by policy makers.
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Affiliation(s)
- Marian Orhierhor
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Wendy Pringle
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Donna Halperin
- Rankin School of Nursing, St. Francis Xavier University, 4130 University Ave, Antigonish, Nova Scotia, B2G 2W5, Canada
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Janet Parsons
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
- Department of Occupational Science & Occupational Therapy, Department of Physical Therapy, and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Nova Scotia, B3K 6R8, Canada
- Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada.
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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Rivera-Cuadrado W. Healthcare practitioners' construction of occupational risk during the COVID-19 pandemic. Soc Sci Med 2023; 331:116096. [PMID: 37478661 DOI: 10.1016/j.socscimed.2023.116096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
RATIONALE AND OBJECTIVE In the pandemic's first year, frontline healthcare practitioners (HCPs) experienced a disproportionate burden of COVID-19's negative effects, including infection, death, trauma and burnout. Qualitative research is needed to understand practitioners' experiences to address the unique challenges they face. To this end, this article investigates occupational factors identified by practitioners as relevant to their risk perceptions. By positioning HCPs as a distinctive risk group in the hierarchical space of risk group prioritization, this analysis extends thinking about such classifications within medicine. METHODS Remote interviews were conducted between 2020 and 2022 with 45 U.S. practitioners, including physicians, nurse practitioners, physician associates, registered nurses and technicians. Interviews were audio recorded, transcribed, and coded using NVivo to analyze how practitioners understood their occupational risk. RESULTS Participants' risk perceptions focused on three concerns. First, working within spatial concentrations of COVID-19 required adapting procedures and reimagining their bodies as potentially hazardous. Second, the limitations of protective measures elevated concerns about healthcare work, and were perceived as pitting practitioners' health against patient care and administrative needs. Third, managing the many uncertainties about COVID-19 meant HCPs risked both its known and unknown effects. CONCLUSION This study examines frontline practitioners' perceptions of occupational risk during the pandemic. It argues two tensions underlie practitioners' risk perceptions. First, like other essential workers, HCPs constituted a unique risk group that distinguished them from other vulnerable populations - due to risks arising from occupational rather than biomedical factors. Second, unlike other essential workers, practitioners were directly exposed to infectious patients that posed risks to their health. These elements each highlight a perceived gap between practitioners' and administrators' risk perceptions that facilitated HCP cynicism about guidelines. Future research may fruitfully investigate if these themes persist outside the U.S. and across healthcare systems.
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Affiliation(s)
- Wayne Rivera-Cuadrado
- Northwestern University, Department of Sociology, 1810 Chicago Avenue, Evanston, IL, 60208, USA.
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Carola V, Vincenzo C, Morale C, Cecchi V, Rocco M, Nicolais G. Psychological Health in Intensive Care Unit Health Care Workers after the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:2201. [PMID: 36360545 PMCID: PMC9690339 DOI: 10.3390/healthcare10112201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Although the COVID-19 pandemic had an impact on the general population, health care workers (HCWs) constituted one of the groups that were most adversely affected by the associated risks, owing to the significant consequences on their mental health. This study examined these psychological effects on HCWs who cared for COVID-19 patients who were admitted to the intensive care unit in an Italian hospital. METHODS Subjects were administered several self-reported questionnaires: Kessler 10 Psychological Distress Scale (K10), Perceived Stress Scale-10 (PSS), Impact of Event Scale Revised (IES-R), and Post-traumatic Growth Inventory (PTGI), as well as two open-ended questions oriented toward understanding their positive and negative emotional experience and differentiating between two phases of the emergency. RESULTS Overall, 45% of HCWs showed medium-to-high anxiety/depressive symptoms, whereas 60% presented with medium-to-high levels of perceived stress. In addition, 37% of subjects developed symptoms of PTSD and 50% showed post-traumatic growth in the "appreciation of life" and "new possibilities" dimensions. With regard to the open-ended questions, three themes were identified: quality of workplace relationships, sense of emotional-relational competence, and sense of clinical-technical competence. In addition, two macrocategories of responses were identified in the answers: growth and block. CONCLUSIONS The mental health of HCWs who are involved in the front line of COVID-19 was significantly impacted by this experience, showing high levels of post-traumatic stress and anxiety and depressive symptoms more than 1 year after the emergency began. A qualitative analysis of staff experiences can be a useful guide for structuring interventions and prevention.
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Affiliation(s)
- Valeria Carola
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Cristina Vincenzo
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Chiara Morale
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Valentina Cecchi
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Monica Rocco
- Department of Clinical and Surgical Translational Medicine, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
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