The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Quantitative Design
2.2. Qualitative Design
- What was your experience in providing healthcare during the COVID-19 crisis?
- Were there any problems or conflicts arising from that situation? Could you give some examples? Do you remember any particularly difficult moments? In what sense?
- How has this affected you personally and professionally? What have you been most concerned about, and do you think it will have future implications?
3. Results
3.1. Quantitative Results
3.1.1. Characteristics of the Participants
3.1.2. Description of Psychological and Moral Status
3.1.3. Relation between Socio-Demographics and Psychological and Moral Status
3.1.4. Relation between COVID-19 Related Variables and Psychological and Moral Status
3.2. Qualitative Results
3.2.1. First Wave in Spain (March–June 2020)
Clinical Impact
Professional Impact
Personal and Family Impact
3.2.2. Second Wave in Spain (August–November 2020)
Clinical Impact
Professional Impact
Personal and Family Impact
4. Discussion
5. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Percentage | M (SD) |
---|---|---|
Age (years) | 39/(9) | |
Sex | ||
Female | 81.1% | |
Male | 18.9% | |
Occupation | ||
Physicians | 10% | |
Nurses | 65% | |
Nursing assistants | 25% | |
Hospitals Hospital in Mallorca Hospital in Ibiza Hospital in Menorca | 85% 11% 12% | |
Type of contract | ||
Permanent | 33% | |
Locum | 23% | |
Temporary | 44% | |
Professional experience (years) | 38/(13) | |
Family circumstances | ||
(1) Living alone | 18% | |
(2) Living with a partner | 27% | |
(1) or (2) with dependents | 46% | |
Have you had COVID-19? | ||
No | 86% | |
Yes | 4% | |
Has anyone in your family had COVID-19? | ||
No | 87% | |
Yes | 13% | |
Have you had to self-isolate? | ||
No | 75% | |
Yes | 24% | |
Has anyone in your department been infected with COVID-19? | ||
No | 14% | |
Yes | 86% | |
Has your unit provided you with protective equipment? | ||
No | 25% | |
Yes | 74% | |
Has your workload increased? | ||
It has decreased considerably | 3% | |
It has decreased slightly | 1% | |
It has remained the same | 7% | |
It has increased slightly | 11% | |
It has increased considerably | 78% | |
Have any of your COVID-19 patients passed away? | ||
No | 8% | |
Yes | 92% | |
Were any family members present when your patient/s were dying? | ||
No | 71% | |
Yes | 29% |
Scales | M (SD) |
---|---|
The Moral Distress Scale | |
Moral distress | 2.5 (1.19) |
The Professional Quality of Life Scale | |
Compassion satisfaction | 40.4 (5.5) |
Burnout | 27.5 (5.1) |
Compassion fatigue | 26.5 (6.2) |
The Professional Self-Care Scale | |
Physical self-care | 3.79 (1) |
Psychological self-care | 2.81 (1.1) |
Social self-care | 3.97 (1) |
Compassion Satisfaction | Burnout | Compassion Fatigue | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
F | df | Df Error | p | η2 | F | df | Df Eror | p | η2 | F | df | Df Error | p | η2 | |
Sex | 4.571 | 1 | 109 | 0.035 | 0.040 | 0.042 | 1 | 109 | 0.838 | 0.000 | 0.130 | 1 | 109 | 0.719 | 0.001 |
Occupation | 0.276 | 2 | 107 | 0.759 | 0.005 | 0.636 | 2 | 107 | 0.531 | 0.012 | 3.021 | 2 | 107 | 0.053 | 0.053 |
Protective equipment against COVID-19 | 6.930 | 1 | 107 | 0.010 | 0.061 | 7.915 | 1 | 107 | 0.006 | 0.069 | 2.950 | 1 | 107 | 0.089 | 0.027 |
Providing patient support | 6.856 | 1 | 100 | 0.010 | 0.064 | 1.612 | 1 | 100 | 0.207 | 0.016 | 2.744 | 1 | 100 | 0.101 | 0.027 |
Factors and Categories | Moral Stress | Compassion Satisfaction | Burnout | Compassion Fatigue | ||||
---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
Sex | ||||||||
Male | 2.39 | 0.54 | 43.06 | 6.23 | 27.56 | 5.48 | 26.11 | 7.47 |
Female | 2.54 | 0.75 | 40.15 | 5.08 | 27.29 | 4.95 | 26.70 | 6.09 |
Occupation | ||||||||
Intensive care doctor | 2.36 | 0.46 | 39.83 | 6.30 | 28.83 | 4.98 | 27.00 | 6.39 |
Nurse | 2.55 | 0.67 | 40.55 | 5.24 | 27.12 | 4.74 | 25.68 | 5.87 |
Nursing Assistant | 2.56 | 0.92 | 41.19 | 5.49 | 27.61 | 5.47 | 29.15 | 6.94 |
Protective equipment against COVID-19 | ||||||||
No | 2.94 | 0.76 | 38.08 | 7.20 | 29.83 | 5.12 | 28.62 | 6.68 |
Yes | 2.40 | 0.66 | 41.28 | 4.58 | 26.64 | 4.83 | 26.14 | 6.13 |
Providing patient support | ||||||||
No | 2.58 | 0.67 | 39.68 | 5.68 | 28.09 | 5.05 | 27.47 | 6.59 |
Yes | 2.46 | 0.86 | 42.70 | 4.23 | 26.76 | 4.19 | 25.16 | 5.91 |
Participant | Occupation | Sex | Age | Years of Professional Experience | Years of Experience in ICU | Length of Time Providing COVID-19 Patient Care Prior to Interview |
---|---|---|---|---|---|---|
P1 | Intensive care doctor | Male | 53 | 28 | 19 | 3 months |
P2 | Intensive care doctor | Female | 42 | 12 | 7 | 4 months |
P3 | Intensive care doctor | Male | 54 | 21 | 20 | 4 months |
P4 | Intensive care doctor | Female | 32 | 8 | 1.5 | 8 months |
N1 | Intensive care nurse | Male | 44 | 23 | 20 | 4 months |
N2 | Intensive care nurse | Male | 47 | 25 | 18 | 3 months |
N3 | Intensive care nurse | Female | 46 | 25 | 20 | 3 months |
N4 | Intensive care nurse | Female | 52 | 29 | 24 | 1 month |
NA1 | Nursing assistant | Male | 30 | 8 | 18 months | 7 months |
NA2 | Nursing assistant | Female | 49 | 18 | 13 | 4 months |
NA3 | Nursing assistant | Female | 43 | 20 | 20 | 8 months |
Themes and Subthemes | First Wave | Second Wave |
---|---|---|
Clinical impact: Changes in clinical practice or in the hospital, such as workload, rearrangement of spaces, protective equipment, dehumanisation of care. | You never think you’ll experience something like this. At first, I couldn’t believe it (P2) My first impression is that this has been a very intense, unforeseen, unexpected experience (N1) A flood of patients came in, all of them critically ill, one after another. We worked shifts under a lot of pressure, wearing PPE for many hours (N1) The operating theatres were not operational. The resuscitation unit was to serve as a regular ICU for non-COVID critical patients and then a space was made available for non-critical COVID patients (P2) They were all novice professionals, but they were eager to give their all. You had [to train] two of them at a time. It was an excessive workload (N4) The most difficult part was working with the PPE on, especially for nurses. They worked longer hours, and when they were finished, you could see the marks on their faces (P1) You’d put on your goggles, and they’d start to fog up. I’m sorry, but I chose to work at ease at the expense of my personal safety. I don’t know how other people could prepare medication with those screens on (N2) PPE and masks would change from day to day. Some masks were not protecting us (P2) Those of us in the ICU are the hospital elite. It was shameful to see how others were working in other departments. We didn’t have equipment shortages (NA3) It wasn’t humane, you couldn’t even hold their hand. It was like an assembly plant (NA3) We felt that the care we provided was becoming increasingly dehumanized, but our relationship with the families was excellent, everyone understood the situation (N1) We all felt as though we had kidnapped the people we had in the ICU (P2) It was hard seeing no relatives in the ICU, the patients alone, the deaths, informing the families by phone (N4) Seeing patients alone, intubated, and only able to say goodbye to us. The desolation felt by patients was brutal (N1) They were patients with multiple conditions, and you were extremely happy when they recovered (N3) | There’s more information, more patient circuits and protocols; you’re more prepared, precautionary measures are taken (N1) Activity has never stopped inside the hospital. And people from other departments can no longer come and help (NA1) There are not enough people to hire and not enough people who are familiar with the ICU. People are working double shifts. It’s exhausting (N1) New people came during the first wave, but now more new people have come again (NA3) There were no longer so many concerns about PPE (P4) During the second wave, we were more prepared and informed about unfamiliar things. We’re now more acquainted with PPE and the disease, among other things (N1) |
Professional impact: Changes that directly affected the professional, such as burnout, compassion satisfaction, and compassion fatigue. | This is the first time I’ve seen colleagues seriously considering leaving the nursing profession (N4) It’s been very positive in allowing you to analyze and appreciate things (NA2) We all need to wear the word ‘humility’ on our foreheads [as a reminder] (N4) It was amazing how colleagues from different professions set to work together. It was terrific. Doctors, nurses, and assistants worked shoulder to shoulder. The hierarchical boundaries that still linger in our imaginations became increasingly blurred (N1) | People are more tired in this second wave. They haven’t been able to take a few days off or go on holiday (N1) Burnout undermines resilience. People are tired, physically and emotionally exhausted (NA3) So now people are tired... physically tired, emotionally tired (N1) We felt helpless and outraged during the phased reopening because we saw that measures were being lifted as if we had beaten the virus while we still had COVID patients in our units (P4) People are very tired. They won’t stop whining and complaining (NA3) They’re not giving us the psychological support we need. I myself am considering seeking professional help, which I believe our organizations should be offering us (P4) |
Personal and family impact: personal and family changes such as insomnia, emotional lability, and fear of infecting others. | I’d wake up to my heart pounding at 5:00 in the morning and I’d start looking for solutions. It started to feel unhealthy and made you wonder what was going wrong (N1) It was chaos at the beginning. All that made us extremely nervous and stressed (NA2) You couldn’t cry when you were in there. You cried when you got out. In my case, I’d cry when I got home (NA3) The first time I was putting on my PPE, all I had in my head was the image of my children. I had fear written all over my face. I wasn’t afraid for myself, but for my children and my husband (N4) My ritual was like this: when my husband came to pick me up, I’d sit on a towel in the back of the car. I’d come home and rub bleach all over me, get completely undressed, put my clothes in the washing machine, and go straight to the shower. And then you could speak to me. I was sleeping on a mattress on the floor in the dining room, away from them (N4) It has affected my private life because I self-isolated at home in a room (P1) | You reduce your personal life and your leisure time to walking around and not interacting with anyone, and then you keep seeing that people are not observing that (N1) You remember every patient, especially those who didn’t turn out well. You have very painful memories, and these are things that we’ll never forget. They are engraved on our minds. For a year now I haven’t slept well, I have nightmares, my life at home has changed dramatically (P4) |
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Moreno-Mulet, C.; Sansó, N.; Carrero-Planells, A.; López-Deflory, C.; Galiana, L.; García-Pazo, P.; Borràs-Mateu, M.M.; Miró-Bonet, M. The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study. Int. J. Environ. Res. Public Health 2021, 18, 9243. https://doi.org/10.3390/ijerph18179243
Moreno-Mulet C, Sansó N, Carrero-Planells A, López-Deflory C, Galiana L, García-Pazo P, Borràs-Mateu MM, Miró-Bonet M. The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study. International Journal of Environmental Research and Public Health. 2021; 18(17):9243. https://doi.org/10.3390/ijerph18179243
Chicago/Turabian StyleMoreno-Mulet, Cristina, Noemí Sansó, Alba Carrero-Planells, Camelia López-Deflory, Laura Galiana, Patricia García-Pazo, Maria Magdalena Borràs-Mateu, and Margalida Miró-Bonet. 2021. "The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study" International Journal of Environmental Research and Public Health 18, no. 17: 9243. https://doi.org/10.3390/ijerph18179243