the impact of covid 19 on healthcare workers essay

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The Impact of COVID-19 on Healthcare Worker Wellness: A Scoping Review

Affiliations.

1 University of Louisville, Department of Emergency Medicine, Louisville, Kentucky.
2 University of Louisville, Kornhauser Library, Louisville, Kentucky.
PMID: 32970555
PMCID: PMC7514392
DOI: 10.5811/westjem.2020.7.48684

At the heart of the unparalleled crisis of COVID-19, healthcare workers (HCWs) face several challenges treating patients with COVID-19: reducing the spread of infection; developing suitable short-term strategies; and formulating long-term plans. The psychological burden and overall wellness of HCWs has received heightened awareness in news and research publications. The purpose of this study was to provide a review on current publications measuring the effects of COVID-19 on wellness of healthcare providers to inform interventional strategies. Between April 6-May 17, 2020, we conducted systematic searches using combinations of these keywords and synonyms in conjunction with the controlled vocabulary of the database: "physician," "wellness, "wellbeing," "stress," "burnout," "COVID-19," and "SARS-CoV-2." We excluded articles without original data, research studies regarding the wellness of non-healthcare occupations or the general public exclusively, other outbreaks, or wellness as an epidemic. A total of 37 studies were included in this review. The review of literature revealed consistent reports of stress, anxiety, and depressive symptoms in HCWs as a result of COVID-19. We describe published data on HCW distress and burnout but urge future research on strategies to enhance HCW well-being.

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Conflict of interest statement

Conflicts of Interest : By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Process of systematic searches using combinations…

Process of systematic searches using combinations of “physician,” “wellness,” “wellbeing,” “stress,” “burnout,” “COVID-19,” and…

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Open access
Published: 17 April 2021

Impact of the COVID-19 crisis on work and private life, mental well-being and self-rated health in German and Swiss employees: a cross-sectional online survey

Martin Tušl 1 ,
Rebecca Brauchli 1 ,
Philipp Kerksieck 1 &
Georg Friedrich Bauer 1

BMC Public Health volume 21 , Article number: 741 ( 2021 ) Cite this article

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The COVID-19 crisis has radically changed the way people live and work. While most studies have focused on prevailing negative consequences, potential positive shifts in everyday life have received less attention. Thus, we examined the actual and perceived overall impact of the COVID-19 crisis on work and private life, and the consequences for mental well-being (MWB), and self-rated health (SRH) in German and Swiss employees.

Cross-sectional data were collected via an online questionnaire from 2118 German and Swiss employees recruited through an online panel service (18–65 years, working at least 20 h/week, various occupations). The sample provides a good representation of the working population in both countries. Using logistic regression, we analyzed how sociodemographic factors and self-reported changes in work and private life routines were associated with participants’ perceived overall impact of the COVID-19 crisis on work and private life. Moreover, we explored how the perceived impact and self-reported changes were associated with MWB and SRH.

About 30% of employees reported that their work and private life had worsened, whereas about 10% reported improvements in work and 13% in private life. Mandatory short-time work was strongly associated with perceived negative impact on work life, while work from home, particularly if experienced for the first time, was strongly associated with a perceived positive impact on work life. Concerning private life, younger age, living alone, reduction in leisure time, and changes in quantity of caring duties were strongly associated with perceived negative impact. In contrast, living with a partner or family, short-time work, and increases in leisure time and caring duties were associated with perceived positive impact on private life. Perceived negative impact of the crisis on work and private life and mandatory short-time work were associated with lower MWB and SRH. Moreover, perceived positive impact on private life and an increase in leisure time were associated with higher MWB.

The results of this study show the differential impact of the COVID-19 crisis on people’s work and private life as well as the consequences for MWB and SRH. This may inform target groups and situation-specific interventions to ameliorate the crisis.

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Key findings

31% of employees perceived a negative impact of the crisis on their work life. Mandatory short-time workers and those who lost their job felt the negative impact the most.

10% of employees perceived a positive impact of the crisis on their work life. Those working in home-office, particularly if experienced for the first time, felt the positive impact the most.

30% of employees perceived a negative impact of the crisis on their private life. Living in a single household, reduction in leisure time, and changes in quantity of caring duties (i.e., increase or decrease) were strongly associated with the negative impact.

13% of employees perceived a positive impact on their private life. Living with a partner or family, mandatory short-time work, increases in leisure time and caring duties were strongly associated with the positive impact.

Perceived negative impact of the crisis on work and private life and mandatory short-time work were strongly associated with lower mental well-being and self-rated health.

Perceived positive impact of the crisis on private life and an increase in leisure time were strongly associated with higher mental well-being and, for leisure time, also with higher self-rated health.

Targeted interventions for vulnerable groups should be established on a company/governmental levels such as psychological first aid accessible online or rapid financial aids for those who have lost their income partially or completely.

Companies may consider offering positive psychology trainings to employees to help them purposefully focus on and make use of the beneficial consequences of the crisis. Such trainings may also include workshops on optimal crafting of their work and leisure time during the pandemic.

On January 30, 2020, the World Health Organization (WHO) declared the outbreak of COVID-19 a Public Health Emergency of International Concern (PHEIC) [ 1 ]. In the following weeks, the virus quickly spread worldwide, forcing the governments of affected countries to implement lockdown measures to decrease transmission rates and prevent the overload of hospital emergency rooms. Switzerland entered full lockdown on March 16th, Germany followed 6 days later on March 22nd. Restrictive measures in both countries were comparable and included border controls, closing of schools, markets, restaurants, nonessential shops, bars, entertainment and leisure facilities, as well as ban on all public and private events and gatherings [ 2 , 3 ]. Such strict measures were in place until the end of April when both governments started to gradually ease the measures [ 4 , 5 ]. Consequently, much of the working population suddenly faced drastic changes to everyday life. People who commuted to work and had rich social lives outside their homes found themselves in a mandatory work from home (WFH) situation, many employees were furloughed or laid off as various businesses and industries had to shut down, and health workers in emergency rooms as well as supermarket staff and other essential employees were faced with a dramatic increase in workload and job strain [ 6 , 7 ].

Regarding the public health impact of the COVID-19 crisis, several studies suggest that working conditions have deteriorated and that employees are more likely to experience mental health problems, such as stress, depression, and anxiety [ 8 , 9 , 10 , 11 ]. In particular, women, young adults, people with chronic diseases, and those who have lost their jobs as a result of the crisis seem to be the most affected [ 11 , 12 , 13 , 14 ]. One of the common stressors that research has highlighted is the fear of losing one’s job and, consequently, one’s income [ 7 ]. Moreover, social isolation, conflicting messages from authorities, and an ongoing state of uncertainty have been described as some of the main factors contributing to emotional distress and negatively affecting mental health and well-being [ 8 , 14 , 15 , 16 , 17 , 18 ].

In the European context, Eurofound [ 12 ] released a report on research in April 2020 involving 85,000 participants across 27 EU member countries. The data indicate that the EU population experienced high levels of loneliness, low levels of optimism, insecurity regarding their jobs and financial future, as well as a decrease in well-being. Germany scored slightly below the EU27 average in well-being, and there is further evidence that it decreased significantly in the early stages of the COVID-19 pandemic, between March 2020 and May 2020 [ 19 ]. The Eurofound report does not discuss Switzerland; however, other studies suggest that there has been an increase in emotional distress in Swiss young adults [ 20 ] and that undergraduate students have experienced higher levels of stress, depression, anxiety, and loneliness compared to the time before the COVID-19 outbreak [ 14 ]. A Swiss social monitor study reports that over 40% of Swiss adults perceive a worsened quality of life compared to before the pandemic, 10% experience feelings of loneliness, 10% report fear of losing their job, and about 1% lost their job as a result of the pandemic. The report also indicates an increase in WFH by 29% compared to before the pandemic [ 21 ].

Accordingly, the data from Eurofound [ 12 ] also suggest that European employees have experienced a dramatic increase in WFH. About 37% of the EU working population transitioned to WFH as a result of the pandemic, and 24% WFH for the first time. Before the pandemic, employees had considered remote working a benefit when it followed their preferences. However, the COVID-19 lockdown changed this by forcing many employees into mandatory WFH [ 6 ]. This posed various challenges for employees without prior WFH experience, such as organizing the workspace, establishing new communication channels with colleagues, coping with work isolation, or managing boundaries between work and non-work [ 22 , 23 , 24 ]. Without proper support from the employer or insufficient resources to manage these challenges, mandatory WFH may become a burden that negatively affects employees’ well-being [ 8 ] and, in turn, their performance [ 22 ]. Furthermore, the increase in WFH has been highlighted as a potential threat to parents with small children at home, as this group is likely to experience difficulties in combining work duties with home schooling and household chores [ 12 , 23 ].

Indisputably, the COVID-19 pandemic has had a strong impact on many aspects of our lives and will continue to do so for months and years to come. However, the consequences of the crisis and societal reactions to the challenges posed by the virus are not deemed solely negative. The new situation also holds opportunities for positive shifts in our work and private lives that were impossible before the COVID-19 crisis. Many may see this crisis as an opportunity to learn how to cope with profound changes in everyday life and even to adopt new pro-active behaviors. For instance, some employees may discover that the new ways of working (e.g., WFH) facilitate more productivity and are more satisfying compared to working in an office [ 25 ]. Data collected from employees in Denmark and Germany between March and May 2020 [ 26 ] suggest that 71% of respondents felt informed and well prepared for the changing work situation and WFH. Participants also reported several advantages of working from home, such as perceived control over the workday, working more efficiently, or saving time previously spent commuting. In contrast, some reported disadvantages of WFH included social isolation, loss of the value of work, and a lack of important work equipment. Nonetheless, respondents reported overall relatively more positive experiences of WFH than negative ones. Thus, we argue that more balanced studies are needed that examine both the negative and positive impact of the COVID-19 crisis on peoples’ lives, health, and well-being, considering differential effects in diverse subgroups. Such studies have the potential to conclude how to diminish the negative and enhance the positive outcomes of the current and future pandemic-related crises in the working population.

Aim and objectives

The overall aim of the present study was to examine the actual and perceived overall impact of the COVID-19 crisis on employees’ work and private life, along with its consequences for mental well-being (MWB) and self-rated health (SRH) in the German and Swiss working populations. Specifically, we pursued the following objectives:

To investigate the perceived positive and negative impact of the COVID-19 crisis on work and private life as well as to assess the self-reported changes in work and private life routines induced by the crisis.

To examine which sociodemographic variables and which self-reported changes in work and private life routines are associated with perceived positive and negative impact of the COVID-19 crisis on work and private life.

To investigate how the self-reported changes and perceived overall impact of the COVID-19 crisis on work and private life are associated with MWB and SRH as relevant health outcomes.

Although SRH has been identified as a relevant predictor of mental distress during the COVID-19 pandemic [ 10 , 27 ], to our knowledge, it has not been studied as an outcome variable in combination with MWB indicators as in our study.

The present study used a cross-sectional online survey design. We report our study following the STROBE guidelines for cross-sectional studies [ 28 ], and the checklist for reporting results of internet e-surveys (CHERRIES) [ 29 ], see ‘Additional file 1 .pdf’ in supplementary material.

Participants were recruited through a panel data service Respondi ( respondi.com ). Cross-sectional data were collected from employees in Germany and Switzerland via an online questionnaire using a web-based survey provider SurveyGizmo. The questionnaire was tested and checked by senior researchers from the field for face validity prior to the administration. The period of data collection was from 9th to 22nd April 2020, when both countries were in full lockdown as part of the control measures relating to COVID-19. Participants received a minimal incentive for completing the survey (i.e., points which could be redeemed towards a given service after participating in several surveys). Participation was voluntary and participant anonymity and confidentiality of their data were assured and emphasized. Each participant in the online panel service database had a unique code which ensured anonymity and prevented multiple submissions from one participant. Important items in the survey were mandatory and participants were informed if they accidently skipped an item. Further, the questionnaire used a logic to avoid asking redundant or non-applicable questions (e.g., participants who indicated that they lost their job were not asked about the change in working time or home-office). Moreover, we included several disqualifying items (i.e., “Please choose number three as an answer to this item”) as a quality check to exclude participants who would give random answers. Participants were able to go back in the survey and review or change their answers.

The eligibility criteria were: being employed (not self-employed), working more than 20 h per week, and being within the age range of 18 to 65 years. The final sample included 2118 participants. Figure 1 shows a flow diagram describing how the final sample was achieved.

Sample flow diagram

Sociodemographic characteristics of the sample are shown in Table 1 : the mean age was 46.51 years ( SD = 11.28), 5% completed primary, 58% secondary, and 37% tertiary education, Footnote 1 55% were male, 77% were from Germany, and 72% were living with a partner, family, or in a shared housing.

Overall, in terms of age, education, and living situation (i.e., single households), the study sample seems to be a good representation of the target of the working population in Germany ( www.destatis.de ) and Switzerland ( www.bfs.admin.ch ). In general, males were slightly overrepresented in our sample (56%) compared to the general population (52%); however, the proportion of males in both countries did not differ significantly (56% from Germany, 52% from Switzerland), χ 2 (1) = 1.63, p = 0.201.

Perceived overall impact of COVID-19 on work and private life

Assuming that both improvements and deteriorations can simultaneously occur due to COVID-19, we designed four separate items (see ‘Additional file 2 .pdf’ in supplementary material) to assess participants’ subjective evaluation of the overall impact of the COVID-19 crisis on their work and private lives: “The Corona-crisis has (a) worsened my work life; (b) improved my work life; (c) worsened my private life; (d) improved my private life.” The response scale ranged from 1 = strongly disagree to 5 = strongly agree . As a primer to this question, we defined the Corona-crisis as follows:

“The following questions deal directly with the current COVID-19 (Corona) pandemic and the consequent regulations from the government (i.e., business closures, school closures, event bans, contact reduction in public spaces, etc.). Hereafter, we refer to this collectively as the Corona-crisis. Please compare your current situation with the situation as it was before the government regulations.”

Changes in work and private life routines

The following items examined qualitative and quantitative changes in participants’ work and private life routines resulting from the COVID-19 crisis: (a) change in employment contract ( no change ; short-time work Footnote 2 with a reduced contract ; short-time work with a contract reduced to 0 h ; job loss ); (b) proportion of WFH before and after COVID-19 ( 0 to 100% ; participants were grouped into three categories according to their answers: None , Experienced , New Footnote 3 ); (c) changes in quantity of working time,; (d) changes in quantity of leisure time; and (e) changes in quantity of caring duties. The response scale for items c, d, and e ranged from 1 = strongly decreased to 5 = strongly increased . For the statistical analysis, responses were grouped into three categories: decreased (1 + 2), unchanged (3), increased (4 + 5).

Mental well-being

MWB was assessed with the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) [ 30 ]. Specifically, we used the German translation of the 7-item short version of the WEMWBS [ 31 ]. WEMWBS is a measure of MWB capturing the positive aspects of mental health, namely, positive affect (feelings of optimism, relaxation), satisfying interpersonal relationships, and positive functioning (clear thinking, self-acceptance, competence, autonomy). The response scale ranged from 1 = never to 5 = all the time . For the statistical analysis (i.e., ordinal logistic regression model), we grouped participants into six categories according to their overall score in percentiles (10, 25, 50, 75, 90, 99%).

Self-rated health

SRH was assessed with a single item: “In general, how would you evaluate your health?” [ 32 ]. The response scale ranged from 1 = very bad to 5 = very good . The application of single-item measures for self-evaluated health is a gold standard in public health research [ 33 ].

Statistical analysis

Data analysis was carried out using R version 4.0.2. In the first step, four ordinal logistic regression models using polr from the MASS R package [ 34 ] were fitted to assess associations of the perceived overall impact of COVID-19 on work and private life as outcome variables with sociodemographic factors (gender, age, country, living situation) and factors related to changes in work and private life routines (changes in employment contract, WFH, work time, leisure time, caring duties) as independent variables. To verify that there was no multicollinearity, the variables were tested a priori using the variance inflation factor tested vif from the car R package [ 35 ] (VIF < 2). The results are presented as adjusted odds ratio (OR) with 95% confidence intervals (95% CI) interpreted as the OR of reporting a higher level of the impact compared to the reference category.

Further, two additional ordinal logistic regression models were fitted to investigate the association between the perceived overall impact of COVID-19 on work and private life Footnote 4 and the self-reported changes in work and private life routines as independent variables and MWB with SRH as outcome variables. In both models, we also controlled for possible confounders (gender, age, country, living situation). The results are presented as adjusted OR with 95% CI interpreted as the OR of reporting a higher level of MWB/SRH compared to the reference category.

Figure 2 displays the correlations between the analyzed variables. Education was not included in the regression models due to missing data (see details in the Methods section).

Correlation matrix of the analyzed variables. Note: Only correlations with p < 0.01 displayed; Gender (1 = Female, 2 = Male); Country (1 = Germany, 2 = Switzerland); Education (1 = Primary, 2 = Secondary, 3 = Tertiary); Living situation (1 = Alone, 2 = With partner/family); Contract change (1 = No change, 2 = Short-time reduced, 3 = Short-time 0, 4 = Job loss); Home-office (1 = None, 2 = Experienced, 3 = New)

Perceived overall impact of COVID-19 crisis and self-reported changes in work and private life routines

Figure 3 shows the results for the four items related to the perceived overall impact of the COVID-19 crisis on work and private life. Thirty-one percent of participants (strongly) agreed that their work life had worsened and 30% (strongly) agreed that their private life had worsened. In contrast, 10% (strongly) agreed that their work life had improved and 13% (strongly) agreed that their private life had improved as a result of the COVID-19 crisis.

Perceived impact on work and private life and self-reported changes in work time, leisure time, and caring duties. Note: Total percentage does not always equal 100% due to rounding error

Further, Fig. 3 shows self-reported changes with regard to the quantity of time actually spent in work and private life. Work time decreased for 38%, leisure time increased for 36%, while the amount of caring duties changed for 26% of participants.

Figures 4 and 5 show self-reported changes with regard to contracted working hours and home-office. Twenty-eight percent of participants experienced a change in their employment contract, while 27% were affected by mandatory short-time work, 1% lost their job as a result of the COVID-19 crisis. Fifty-one percent reported to WFH and of those, 20% reported doing so for the first time.

Self-reported changes in home-office. Note: None = 0% WFH before COVID-19, 0% after; Experienced = at least 10% WFH before and at least 10% after COVID-19; New = 0% WFH before and at least 10% after COVID-19

Self-reported changes in contracted working hours. Note: Short-time reduced = work hours temporarily partly reduced by employer; Short time 0 = work hours temporarily reduced to 0 by employer

Factors associated with perceived impact on work life

Table 2 shows OR comparisons between different subgroups concerning their evaluation of the degree to which their work life had worsened or improved due to the COVID-19 crisis, assessed by two separate dependent variables. Regarding perceived negative impact on work life, change in employment contract demonstrated the highest OR of reporting a deterioration of work life. The association was particularly strong in participants who had their contract reduced to mandatory short-time work with 0 working hours (OR = 9.72) and in those who had lost their job (OR = 35.07). Further, participants who reported a change in their work time had a significantly higher OR of reporting a deterioration of work life (OR = 2.95; 2.06). Finally, changes in leisure time and increased caring duties were significantly associated with perceived deterioration of work life. This association was particularly strong for a decrease in leisure time (OR = 1.62) and an increase in caring duties (OR = 1.58).

Regarding perceived positive impact of COVID-19 on work life, WFH had the highest OR of reporting an improvement in work life. The association was particularly strong in those who had started to WFH for the first time (OR = 2.77). Increase in leisure time was also significantly associated with a positive impact on work life. Further, older employees in the 51–60 and 61–65 age groups had significantly lower odds of reporting a positive impact of COVID-19 on work life (OR = 0.71; 0.61), as well as short-time employees, in particular those with a contract reduced to 0 working hours (OR = 0.53), and those who reported a decrease in work time (OR = 0.61).

Factors associated with perceived impact on private life

Table 2 further shows OR comparisons within different subgroups concerning their evaluation of the degree to which their private life had worsened or improved due to the COVID-19 crisis, assessed by two separate dependent variables. Regarding perceived negative impact on private life, the subgroup of participants living with a partner, family, or in a shared housing had significantly lower odds of reporting the deterioration of their private life compared to those living alone (OR = 0.41). The odds of reporting deterioration of private life were lower also for the 61–65 age group (OR = 0.58). Finally, changes in the quantity of leisure time and quantity of caring duties were associated with perceived deterioration of private life, and this association was particularly strong for a decrease in leisure time (OR = 2.62) and a decrease in caring duties (OR = 1.62).

Regarding perceived positive impact on private life, the strongest association was with an increase in leisure time (OR = 2.25), followed by living with a partner, family, or in a shared housing (OR = 1.74); WFH, particularly among those with prior WFH experience (OR = 1.72); and with an increase in caring duties (OR = 1.33). Short-time workers had significantly higher odds of reporting a positive impact on their private life compared to workers without any change, especially those with a contract reduced to 0 working hours (OR = 1.57).

Association between the perceived impact, self-reported changes, mental well-being and self-rated health

Table 3 shows the results of the associations between perceived overall impact, the self-reported changes in work and private life routines, and relevant health outcomes in terms of MWB and SRH, controlled for various sociodemographic variables. Regarding the perceived overall impact, participants who (strongly) agreed that COVID-19 had worsened their work life reported significantly lower MWB (OR = 0.61) compared to those who (strongly) disagreed. In addition, participants who neither agreed nor disagreed that their work life had worsened reported lower MWB (OR = 0.71) compared to those who (strongly) disagreed. A strong negative association could also be seen regarding perceived negative impact on private life: participants who (strongly) agreed that their private life had worsened reported lower MWB (OR = 0.62) and SRH scores (OR = 0.67) compared to those who (strongly) disagreed. Both outcomes were also negatively associated with employees who neither agreed nor disagreed that their private life had worsened (OR = 0.80; 0.66) compared to those who (strongly) disagreed. Finally, participants who (strongly) agreed that their private life had improved as a result of the COVID-19 crisis had higher odds of reporting a higher MWB score (OR = 1.39) compared to those who (strongly) disagreed.

Regarding the impact of the self-reported changes in work and private life routines, mandatory short-time workers with a contract reduced to 0 working hours reported significantly lower MWB (OR = 0.57) and SRH (OR = 0.49) compared to participants without any change in their employment contract. In contrast, an increase in leisure time was positively associated with both better MWB (OR = 1.23) and SRH (OR = 1.45).

The present study aimed to examine the impact of the COVID-19 crisis on employees’ work and private life and the consequences for MWB and SRH in German and Swiss employees. The first objective of the study was to assess the perceived impact and self-reported changes related to COVID-19. Although the research has thus far mostly emphasized the negative impact of the COVID-19 crisis [ 9 , 10 , 11 , 12 , 36 ], our data show that more than 40% of participants perceived no negative changes and over 10% even positive shifts in both life domains. This can be partly explained by the experienced changes in daily routines: 28% of participants were affected by a change in their employment contract and 49% by changes in the quantity of work time, confirming almost identical findings for Germany in the Eurofound report [ 12 ]. Also, quantity of leisure time and of caring duties changed for 58 and 26% respectively. The finding that about half WFH at least part of their working time, and 20% for the first time is also in line with Eurofound’s data where 24% reported WFH for the first time [ 12 ]. Overall, the proportion of people affected by changes in work and private life is comparable but hardly exceeds 50%, similar to the proportion of participants who reported a deterioration in their work and private life.

The second objective was to explore the factors associated with perceived impact on work and private life. A change in contracted work hours (i.e., mandatory short-time work, job loss), and changes in work time were strongly associated with reporting deterioration of work life. Those affected by short-time work experienced a significant disruption in their work routine as well as fear of losing the job, factors associated with increased level of distress and low MWB [ 7 ]. In consequence, employees whose contract had been reduced or terminated due to the lockdown measures are particularly vulnerable to developing mental health problems [ 11 , 13 ]. Further, an increase in caring duties, and, perhaps more surprisingly, increase and decrease in leisure time were strongly associated with perceived deterioration of work life. Such changes in private life routines may require efforts for readjustments that can interfere with work and work-life balance. These readjustments may be particularly difficult for older employees (i.e., age group 61–65) who were more likely to report deterioration of their work life. They may be particularly sensitive to changes in daily structure and less flexible in adapting to a new situation, such as mandatory WFH, less personal contact with colleagues, and an increase in the use of digital technology.

WFH was most strongly associated with perceived positive impact of the COVID-19 crisis on work life, particularly in those reporting WFH for the first time, supporting evidence from Ipsen and colleagues [ 26 ]. This positive impact of WFH may be explained by a reduction or absence of commute time, more job autonomy, more flexible workdays, and ultimately, extra time for leisure. In fact, increased leisure time was another important factor associated with perceived positive impact of the COVID-19 crisis on work life. More time for leisure may allow for better recovery from work and rebuilding of personal resources [ 37 , 38 ], which can then help an individual deal with work demands. In contrast, a change in contracted working hours and a decrease in work time were negatively associated with perceived positive impact on work life. A reduction in work time may not only cause financial problems, but also reduces important daily routines and social interactions at work, and may trigger fear of losing one’s job. Again, older employees may struggle more with the new situation and may be less successful in transforming it to their benefit, explaining why the oldest age groups, 54–60 and 61–65 years, were less likely to report an improvement in their work life.

Regarding the perceived impact on private life, participants living alone were more likely to report a deterioration and less likely to report an improvement of their private life compared to those living with a partner, family, or in a shared housing. The COVID-19 lockdown substantially restricted possibilities for social interactions beyond one’s own household, particularly affecting people living alone. For individuals who live alone, this may lead to feelings of loneliness [ 12 ], which in turn, threatens their MWB [ 39 ], highlighting the importance of having opportunities for direct exchange in such a crisis situation. This could also explain that an increase in caring duties, allowing for more exchange with family members, was associated with perceived positive shifts in private life. Further, an increase in WFH showed to be beneficial also to the private life, particularly to those experienced in WFH who did not need to first establish their workspace and new routines. Increase in leisure time and, more surprisingly, mandatory short-time work were also associated with positive impact on private life, as employees can engage more freely in activities they value. Interestingly, participants over 60 years old were less likely to report a deterioration of their private life. Older employees may be less dependent on the number of social contacts beyond their household, and they may have more mature emotion regulation strategies than the younger generations [ 40 ]. Indeed, mental well-being of the German elderly population (65+) remained largely unaltered during the early COVID-19 lockdown [ 41 ].

Finally, our third objective was to investigate how the perceived overall impact and self-reported changes induced by the crisis were associated with MWB and SRH. Low SRH has been associated with increased odds of depression [ 27 ], displaying the relevance of SRH for psychologically demanding situations, such as the COVID-19 pandemic. Our results suggest a strong negative association between the perceived negative impact on work and private life, MWB and SRH, indicating that this perception by itself is of relevance. It is of note that the perceived negative impact, particularly in private life, had such a strong association with SRH, which is more stable over time than MWB. In contrast, perceived positive impact on private life was associated with higher MWB. It seems that those who were able to cope with the COVID-19 crisis and translate the lockdown measures into some positive shifts in their private life, also benefited in terms of increased MWB.

Looking at the impact of the self-reported changes on MWB and SRH, mandatory short-time work with 0 contracted working hours was strongly associated with a lower MWB and SRH. Short-time work leads to significant losses of financial security and of daily structure and routines. Conversely, an increase in leisure time was positively associated with MWB, and the link was even stronger with SRH. More time for leisure gives extra opportunities for individuals to engage in meaningful activities that provide them with important resources that benefit their MWB and SRH. The overall strength of the associations indicates that MBW may be more affected by the perceived impact, as both are cognitive-emotional domains and are more dependent on the cognitive appraisal of one’s situation and emotional experience. SRH, on the other hand, may be more affected by actual changes in work and private life that increase or decrease opportunities to engage in activities that are perceived as beneficial to health.

Limitations and strengths

A major limitation is the cross-sectional design, which allowed only to infer associations between variables but did not provide evidence of the directions of the associations or potential causality. Furthermore, the online survey created timely data on the immediate impact of the COVID-19 crisis situation. However, the self-reported data may be influenced by common method biases [ 42 ], such as social desirability bias [ 43 ] or self-selection bias, posing potential threats to the validity of our findings. Thus, we hired a professional panel data service that guarantees collection of high quality data. Moreover, we implemented various strategies in the questionnaire such as using disqualifying items to prevent invalid answers. The sociodemographic characteristics of our sample indicate a good representation of the target population. Finally, we did not control for all variables that might have affected the results. For instance, coping with a crisis and MWB differ individually and may be influenced by variables such as personality traits, resilience, or coping style [ 44 , 45 , 46 , 47 ]. However, our study aimed to provide a broad picture of both the negative and positive impacts of the COVID-19 crisis on a large, diverse sample of the working population. Thus, it was beyond the scope of this study to investigate individual differences and characteristics. In addition, a more complete, lengthy survey would have likely reduced the participation rate.

A strength of the present study is the relatively large and heterogeneous sample size that allowed us to conduct a detailed analysis and explore different subgroups within the sample. Another strength is the time point of the data collection launched at the beginning of April 2020, close to the first peak of the COVID-19 outbreak in Germany and Switzerland and onset of the related lockdown measures. This enabled us to capture a valid picture of the immediate impact of the lockdown measures. Moreover, the survey assessed the present situation, adding to the validity compared to a retrospective survey design. Finally, the combination of a subjective evaluation of the impact of the crisis with relevant, standardized public health indicators of MWB and SRH increases the relevance of the results to public health research and for policymaking.

Conclusion and policy recommendations

The present study contributes to our understanding of the impact of the COVID-19 crisis on work and private life. It provides evidence on the covariates of a more negative/positive perceived impact and on the associations with MWB and SRH in the German and Swiss working populations. Employees whose employment contract was affected by the crisis seem to have felt the greatest negative impact on their work life. This highlights the crucial role of (un−/under-)employment in a crisis, as employment is associated with several health-promoting factors that cannot be substituted in any other way [ 48 ]. Moreover, the private life of employees living alone has been affected most negatively due to social isolation. Thus, psychological first aid also accessible online should be established particularly for these vulnerable groups [ 49 ]. Employers need to assure that they keep close social ties with and emotionally support employees with reduced contract or working hours. Moreover, rapid financial aids are needed to those who have lost their income partially or completely.

Nevertheless, we should also foster positive consequences of the crisis. In general, it seems that an increase in WFH was positive for work life. Learning from the beneficial effects of WFH in a crisis can inform future organizational and legislative policies to support this form of working. As employees experienced with WFH had a stronger positive impact on private life than first-timers, future WFH policies should include offering training and exchange of experience between employees on how to establish positive routines compatible with their private life. This will help employees to proactively identify their preferences and craft their work environment accordingly [ 50 ]. Further, an increase in leisure time was particularly positive for private life. More leisure time allows for dedicating extra time to activities one enjoys, and this may be beneficial also for recovery and detachment from work [ 51 ] and for mental health in general [ 52 ]. Thus, employees could also be trained in optimal crafting of their leisure time to strengthen these beneficial effects [ 53 , 54 ].

Finally, we saw that besides the reported actual changes in work and private life, also the perception of the overall positive or negative impact is related to the health outcomes. This suggests to offer positive psychology trainings to employees helping them to purposefully focus on and make use of potential positive consequences of the crisis [ 55 , 56 , 57 ]. From a longitudinal research perspective, it would be interesting to further examine how the actual and perceived impact of the ongoing crisis as well as the associated health outcomes change over time and whether some of the new routines developed during the pandemic will be maintained in the long term.

To conclude, our study adds to recent evidence [ 58 ] that the Covid-19 crisis and related lockdown measures do not have solely negative impact. Rather, it affects vulnerable groups of individuals who need targeted support, while the majority of the population remain healthy or even experience positive shifts in their daily life.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The R code used for the statistical analysis is available in the GitHub repository: https://github.com/jesuismartin/covid

Education estimates are based on data from n = 1194 participants who took part in a subsequent wave of data collection (December 2020), missing values ( n = 924) were imputed using mice R package (for details see supplementary material). Education was not included in the regression models as the imputed data could potentially threaten the validity of our conclusions.

Short-time work is defined as “public programs that allow firms experiencing economic difficulties to temporarily reduce the hours worked while providing their employees with income support from the State for the hours not worked” (European Commission, 2020, Retrieved from: https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1587138033761&uri=CELEX%3A52020PC0139 ).

None = 0% WFH before COVID-19, 0% after; Experienced = at least 10% WFH before and at least 10% after COVID-19; New = 0% WFH before and at least 10% after COVID-19.

Participants were grouped into three categories according to their answers: disagree (1 + 2), neither/nor (3), agree (4 + 5).

Abbreviations

World Health Organization

Public Health Emergency of International Concern

Work from home

European Union

Confidence interval

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Acknowledgements

The authors would like to thank to Roald Pijpker from Wageningen University for his helpful comments during the final editing of the manuscript.

MT received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 801076, through the SSPH+ Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS) of the Swiss School of Public Health. RB, PK, and GB received funding from the University of Zurich Foundation. Beyond providing the funding, these funding bodies were not involved at any stage of the study.

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MT planned and carried out data collection and analysis, interpretation of the results, writing and reviewing the manuscript in collaboration with the co-authors. RB contributed to the research concept, data collection, data analysis, and review of the manuscript. PK was involved with the conceptualization of the research, interpretation of the results, writing, and review of the manuscript. GB contributed to the conceptualization of the research, interpretation of results, writing, and review of the manuscript. All authors read and approved the final manuscript before submission.

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Informed consent was obtained from all participants, the study included adult participants (18+ years) only. Participants voluntarily completed the questionnaires, guaranteeing their anonymity. For anonymous surveys on working/living conditions and self-reported mental well-being and health no ethical review was necessary under national, university, or departmental rules (Department of Data Protection at the University of Zurich, www.dsd.uzh.ch/en/ ). The study was conducted under strict observation of ethical and professional guidelines. The study was not registered prior to the start of the data collection as this is not common in the field of occupational health psychology where this study originated. The study is part of a larger longitudinal data collection on occupational health and individual strategies employee use to craft their work, started already before the Covid-19 pandemic. When the pandemic started, we decided to add the study aim to explore the immediate impact of the Covid-19 crisis on Swiss and German working population presented in this paper. The manuscript is an accurate and transparent account of the study, and no important aspects of the study or any analyses conducted have been omitted.

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Tušl, M., Brauchli, R., Kerksieck, P. et al. Impact of the COVID-19 crisis on work and private life, mental well-being and self-rated health in German and Swiss employees: a cross-sectional online survey. BMC Public Health 21 , 741 (2021). https://doi.org/10.1186/s12889-021-10788-8

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the impact of covid 19 on healthcare workers essay

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Published: 24 March 2022

Health care workers’ experiences during the COVID-19 pandemic: a scoping review

Souaad Chemali 1 ,
Almudena Mari-Sáez 1 ,
Charbel El Bcheraoui 2 &
Heide Weishaar ORCID: orcid.org/0000-0003-1150-0265 2

Human Resources for Health volume 20 , Article number: 27 ( 2022 ) Cite this article

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COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers’ (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs’ experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included.

161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs’ well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs’ personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs’ experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs’ experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries.

This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs’ experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs’ circumstances.

Conclusions

Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.

Peer Review reports

Introduction

The COVID-19 pandemic has put health systems worldwide under pressure and tested their resilience. The World Health Organization (WHO) acknowledges health workforce as one of the six building blocks of health systems [ 1 ]. Health care workers (HCWs) are key to a health system’s ability to respond to external shocks such as outbreaks and as first responders are often the hardest hit by these shocks [ 2 ]. Therefore, interventions supporting HCWs are key to strengthening health systems resilience (ibid). To develop effective interventions to support this group, a detailed understanding of how pandemics affect HCWs is needed.

Several recent reviews [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] focus on HCWs’ experiences during COVID-19 and the impact of the pandemic on HCWs’ well-being, including their mental health [ 3 , 7 , 8 , 11 , 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Most of these reviews refer to psychological scales measurements to provide quantifiable information on HCWs’ well-being and mental health [ 8 , 13 , 14 , 19 , 21 , 22 , 23 , 24 , 25 , 28 ]. While useful in assessing the scale of the problem, such quantitative measures are insufficient in capturing the breadth of HCWs’ experiences and the factors that impact such experiences. The added value of qualitative studies is in understanding the complex experiences of HCWs during COVID-19 and the contextual factors that influence them [ 29 ].

This paper reviews qualitative studies published during the first year of the pandemic to investigate what is known about HCWs’ experiences during COVID-19 and the factors and support needs associated with those experiences. By presenting HCWs’ perspectives on the pandemic, the scoping review provides the much-needed evidence base for interventions that can help strengthen HCWs and alleviate the pressures they experience during pandemics.

The review follows the Joanna Briggs Institute (JBI) process and guideline on conducting scoping reviews [ 30 ]. JBI updated guidelines identify scoping reviews as the most suitable choice to explore the breadth of literature on a topic, by mapping and summarizing available evidence [ 30 ]. Scoping reviews are also suitable to address knowledge gaps and provide insightful input for decision-making [ 30 ]. The review also applies the PRISMA checklist guidance on reporting literature reviews [ 31 ].

Information sources

A systematic search was conducted on PubMed database between the 9th and 28th of March 2021.

Search strategy

Drawing on Shaw et al. [ 32 ] and WHO [ 33 ], the search strategy used a controlled vocabulary of index terms including Medical Subject Headings (Mesh) of the keywords and synonyms “COVID-19”, “HCWs”, and “qualitative”. Keywords were combined using the Boolean operator “AND” (see Additional file 1 ).

Eligibility criteria

The population of interest included all types of HCWs, independent of geography and settings. Only original studies were included in the review. Papers further had to (1) report primary qualitative data, (2) report on HCWs’ experiences and perceptions during COVID-19, and (3) be available as full texts in English, German, French, Spanish or Arabic, i.e., in a language that could be reviewed by one or several of the authors. Studies focusing solely on HCWs’ assessment of newly introduced modes of telemedicine during COVID-19 were excluded from the review as their clear emphasis on coping with technical challenges deviated from the review’s focus on HCWs’ personal and professional experiences during the pandemic.

Selection process

The initial search yielded 3976 papers. All papers were screened and assessed against the eligibility criteria by one researcher (SC) to identify relevant studies. A random 25% sample of all papers was additionally screened by a second researcher (HW). Any uncertainty or inconsistency regarding inclusion were resolved by discussing the respective articles ( n = 76) among the authors.

Data collection process

Based on the research question, an initial data extraction form was developed, independently piloted on ten papers by SC and HW and finalised to include information on: (1) author(s), (2) year of publication, (3) type of HCW, (5) study design, (6) sample size, (7) topic of investigation, (8) data collection tool(s), (9) analytical approach, (10) period of data collection, (11) country, (12) income level according to World Bank [ 34 ], (13) context, and (14) main findings related to experiences, factors and support needs. Using the final extraction form, all articles were extracted by SC, with the exception of four German articles (which were extracted by HW), one Spanish and one French article (which were extracted by AMS). As far as applicable, the quality of the included articles was appraised using the JBI critical appraisal tool for qualitative research [ 35 ].

Synthesis methods

The socio-ecological model originally developed by Brofenbrenner was adapted as a framework to analyze and present the findings [ 36 , 37 , 38 ]. The model aims to understand the interconnectedness and dynamics between personal and contextual factors in shaping human development and experiences [ 36 , 38 ]. The model was chosen, because it accounts for the multifaceted interactions between individuals and their environment and is thus suited to capture the different dimensions of HCWs’ experiences, the factors associated with those experiences as well as the sources of support identified. The five socio-ecological levels (individual, interpersonal, institutional, community and policy) of the model served as a framework for analysis and were used to categorise the main themes that were identified in the scoping review as relevant to HCWs’ experiences. The process of identifying the sub-themes was conducted by SC using an excel extraction sheet, in which the main findings were captured and mapped against the socio-ecological framework.

Study selection

The selection process and the number of papers found, screened and included are illustrated in a PRISMA flow diagram (Fig. 1 ). A total of 161 papers were included in the review (see Additional file 2 ). Table 1 lists the included studies based on study characteristics, including type of HCW, healthcare setting, income level of countries studied and data collection tools.

PRISMA flow diagram

Study characteristics

Included papers investigated various types of HCWs. The most investigated type were nurses, followed by doctors/physicians. Medical and nursing students were also studied frequently, while only a small number of studies focused on other professions, e.g., community health workers, therapists and managerial staff. A third of all studies studied multiple HCWs, rather than targeting single professions. The majority of papers investigated so-called “frontline staff”, i.e., HCWs who engaged directly with patients who were suspected or confirmed to be infected with COVID-19. Fewer studies focused on non-frontline staff, and some explored both frontline and non-frontline staff.

Around two-thirds of all papers studied HCWs’ experiences in high-income countries, notably the USA, followed by the UK. Many papers also focused on HCWs in upper-middle income countries, with almost half of them conducted in China. Few papers investigated HCWs in lower-middle income countries, including India, Zimbabwe, Pakistan, Nigeria, and Senegal. Finally, one paper focused on HCWs in Ethiopia, a low-income country. A couple of studies presented data from multiple countries of different income levels, and one study investigating HCWs in Palestine could not be categorised. Overall, the USA was the most studied and China the second most studied geographical location (see Additional file 3 ). Hospitals were by far the most investigated healthcare settings, whereas outpatient settings, including primary care, pharmacies, homes care, nursing homes, healthcare facilities in prisons and schools as well as clinics, were investigated to a considerably lesser extent. Several studies covered more than one setting.

All studies applied a cross-sectional study design, with 54% published in 2020, and the remainder in 2021. A range of qualitative data collection methods were applied, with interviews being by far the most prominent one, followed by open-ended questionnaires. Focus groups and a few other methods including social media, online platforms or recording systems submissions, observations and open reflections were used with rare frequencies. The sample size in studies using interviews ranged between 6 and 450 interviewees. The sample size in studies using Focus Group Discussions (FGDs) ranged between 7 and 40 participants. Further information on the composition and context of the FGDs can be found in additional file 4 . Several studies used multiple data collection tools. The majority of studies applied common analysis methods, including thematic and content analysis, with few using other specific approaches.

Results of syntheses

An overview of the findings based on the socio-ecological framework is summarised in Table 2 , which lists the main sub-themes identified under each socio-ecological level.

Individual level

At the individual level, HCWs’ experiences related to their well-being, professional and personal identity as well as daily work–life routine. In terms of well-being, HCWs reported negative impacts on their physical health (e.g., tiredness, discomfort, skin damage, sleep disorders) [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] and compromised mental health. The reported negative impact on mental health included increased levels of self-reported stress, depression, anxiety, fear, grief, guilt, anger, isolation, uncertainty and helplessness [ 39 , 41 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 ]. The reported reasons for HCWs’ reduced well-being included work-related factors, such as having to adhere to new requirements in the workplace, the lack and/or burden of using Personal Protective Equipment (PPE) [ 41 , 44 , 52 , 63 , 64 , 78 , 93 , 124 , 125 ], increased workload, lack of specialised knowledge and experience, concerns over delivering low quality of care [ 42 , 44 , 49 , 52 , 53 , 63 , 69 , 70 , 73 , 74 , 76 , 78 , 79 , 83 , 84 , 85 , 86 , 89 , 90 , 93 , 94 , 101 , 103 , 109 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ] and being confronted with ethical dilemmas [ 43 , 72 , 76 , 78 , 136 , 141 , 142 , 143 , 144 , 145 ]. HCWs’ compromised psychological well-being was also triggered by extensive exposure to concerning information via the media and by the pressure that was experienced due to society and the media assigning HCWs hero status [ 53 , 72 , 81 , 92 , 97 , 107 , 139 , 146 ]. Factors that were reported by HCWs as helping them cope with pressure comprised diverse self-care practices and personal activities, including but not limited to psychological techniques and lifestyle adjustments [ 47 , 56 , 64 , 71 , 72 , 78 , 90 , 139 , 147 , 148 ] as well as religious practices [ 81 , 112 , 149 ].

Self-reported well-being differed across occupations, roles in the pandemic response and work settings. One study reported that HCWs working in respiratory, infection and emergency departments expressed more worries compared to HCWs who worked in other hospital wards [ 64 ]. Similarly, frontline HCWs seemed more likely to experience feelings of helplessness and guilt as they witnessed the worsening situation of COVID-19 patients, whereas non-frontline HCWs seemed to experience feelings of guilt due to not supporting their frontline colleagues [ 98 ]. HCWs with managerial responsibility reported heightened concern for their staff’s health [ 75 , 110 , 150 ]. HCWs working in nursing homes and home care reported feelings of being abandoned and not sufficiently recognised [ 75 , 123 , 144 ], while one study investigating HCWs responding to the pandemic in a slums-setting reported fear of violence [ 56 ].

HCWs reported that the pandemic impacted both positively and negatively on their professional and personal identity. While negative emotions were more dominant at the beginning of the pandemic, positive effects were reported to gradually develop after the initial pandemic phase and included an increased sense of motivation, purpose, meaningfulness, pride, resilience, problem-solving attitude, as well as professional and personal growth [ 43 , 44 , 47 , 49 , 50 , 51 , 63 , 67 , 68 , 69 , 71 , 73 , 74 , 75 , 76 , 78 , 79 , 87 , 90 , 91 , 92 , 93 , 98 , 102 , 104 , 112 , 114 , 117 , 118 , 119 , 122 , 124 , 131 , 132 , 143 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 ]. Frontline staff reported particularly strong positive effects related to feelings of making a difference [ 69 , 92 ]. On the other hand, some HCWs reported doubts with regard to their career choices and job dissatisfaction [ 40 , 46 , 59 , 130 ]. Junior staff, assistant doctors and students often reported feelings of exclusion and concerns about the negative effects of the pandemic on their training [ 40 , 162 , 163 ]. Challenges with regard to their professional identity and a sense of failing their colleagues on the frontline were particularly reported by HCWs who had acquired COVID-19 themselves and experienced long COVID-19 [ 121 , 160 , 164 ]. HCWs who reached out to well-being support services expressed concern at being stigmatised [ 97 ].

HCWs reported a work–life imbalance [ 57 , 97 ] as they had to adapt to the disruption of their usual work routine [ 59 , 62 , 131 ]. This disruption manifested in taking on different roles and responsibilities [ 39 , 49 , 67 , 73 , 83 , 89 , 94 , 97 , 110 , 137 , 139 , 144 , 151 ], increased or decreased workload pressure [ 85 , 128 , 130 , 133 ] and sometimes redeployment [ 57 , 155 , 165 ]. HCWs also reported negative financial effects [ 59 , 86 , 166 ].

Interpersonal level

The findings presented in this section relate to HCWs’ perceptions of their relationships in the private and professional environment during the pandemic and to the impact these relationships had on them. With regard to the home environment, HCWs’ concerns over being infected with COVID-19 and transmitting the virus to family members were identified in almost all studies [ 41 , 44 , 48 , 51 , 54 , 56 , 61 , 68 , 75 , 77 , 80 , 85 , 90 , 128 , 139 , 160 , 167 , 168 , 169 , 170 , 171 ]. HCWs living with children or elderly family members were particularly concerned [ 47 , 65 , 95 , 97 , 163 , 172 ]. In some cases, HCWs reported that they had introduced changes to their living situation to protect their loved ones, with some deciding to move out to ensure physical distance and minimise the risk of transmission [ 39 , 43 , 44 , 89 , 105 , 161 ]. Some HCWs reported sharing limited details about their COVID-19-related duties to decrease the anxiety and fear of their significant others [ 81 ]. While in several studies, interpersonal relationships were reported to cause concerns and worries, some study also identified interpersonal relationships and the subsequent emotional connectedness as a helpful resource [ 47 , 173 , 174 ] that could, for example, alleviate anxiety [ 64 ] or provide encouragement for working on the frontline [ 49 , 106 ]. However, interpersonal relationships did not always have a supportive function, with some HCWs reporting being shunned by family and friends [ 66 , 111 , 175 ].

With regard to the work environment, relationships with colleagues were mainly described as supportive and empowering, with various studies reporting the value of teamwork during the pandemic [ 47 , 51 , 52 , 67 , 71 , 77 , 83 , 91 , 97 , 98 , 108 , 134 , 148 , 151 , 161 ]. Challenges with regard to collegial relationships included social distancing (which hindered HCWs’ interaction in the work place) [ 176 ] and working with colleagues one had never worked with before (causing a lack of familiarity with the work environment and difficulties to adapt) [ 79 ]. HCWs who worked in prisons reported interpersonal conflicts due to perceived increased authoritarian behaviour by security personnel that was perceived to manifest in arrogance and non-compliance with hygiene practices [ 88 ].

In terms of HCWs’ relationships with patients, many studies reported challenges in communicating with patients [ 50 , 55 , 126 , 132 , 133 , 172 ]. This was attributed to the use of PPE during medical examinations and care and the reduction of face-to-face visits or a complete switch to telehealth [ 128 , 139 ]. The changes in the relationships with patients varied according to the nature of work. Frontline HCWs, for example, reported challenges in caring for isolated patients [ 41 , 43 , 52 , 148 ], whereas HCWs working in specific settings and occupational roles that required specific interpersonal skills faced other challenges. This was, for example, the case for HCWs working with people with intellectual disabilities, who found it challenging to explain COVID-19 measures to this group and also had to mitigate physical contact that was considered a significant part of their work [ 71 ]. For palliative care staff, the use of PPE and measures of social distancing were challenging to apply with regard to patients and family members [ 177 ]. Building relationships and providing appropriate emotional support was reported to be particularly challenging for mental health and palliative care professionals supporting vulnerable adults or children [ 117 ]. Challenges for health and social care professionals were associated with virtual consultations and more difficult conversations [ 117 ]. Physicians reported particular frustration with remote monitoring of chronic diseases when caring for low-income, rural, and/or elderly patients [ 169 ]. Having to adjust, and compromise on, the relationships with patients caused concerns about the quality of care, which in turn, was reported to impact negatively on HCWs’ professional identity and emotional well-being.

Institutional level

This section presents HCWs’ perceptions of decision-making processes in the work setting, organizational factors and availability of institutional support.

With regard to decision-making, a small number of studies reported HCWs’ trust in the institutions they worked in [ 143 , 172 ], while the majority of studies revealed discontent about institutional leadership and feelings of exclusion from decision-making processes [ 65 , 178 ]. More specifically, HCWs reported a lack of clear communication and coordination [ 41 , 70 , 144 , 148 , 179 ] and a wish to be provided with the rationales behind management decisions and to be included in recovery phase planning [ 48 ]. They perceived centralised decision-making processes as unfamiliar and restrictive [ 150 ]. Instead, HCWs endorsed de-centralised and participatory approaches to communication and decision-making [ 56 ]. Emergency and critical care physicians suggested to include bioethicists as part of the decision-making on triaging scarce critical resources [ 126 ]. Studies of both hospital and primary care settings reported perceived disconnectedness and poor collaboration between managerial, administrative and clinical staff, which was a contributing factor to burnout among HCWs [ 60 , 83 , 149 , 169 , 180 , 181 , 182 ]. Dissatisfaction with communication also related to constantly changing protocols, which were perceived as highly burdening and frustrating, creating ambiguity and negatively affecting HCWs’ work performance [ 44 , 55 , 59 , 78 , 112 , 183 ].

In terms of organizational factors, many HCWs reported a perceived lack of organizational preparedness and poor organization of care [ 60 , 65 , 120 , 179 ]. Changes in the organization of care were perceived as chaotic, especially at the beginning of the pandemic, and changes in roles and responsibilities and role allocation were perceived as unfair and unsatisfying [ 72 , 97 ]. Only in one study, changes in work organisation were perceived positively, with nurses reporting satisfaction with an improved nurse–patient ratio resulting from organisational changes [ 52 ]. Overall, frontline HCWs advocated for more stability in team structure to ensure familiarity and consistency at work [ 47 , 66 , 72 , 114 , 116 ]. HCWs appreciated multidisciplinary teams, despite challenges with regard to achieving rapid and efficient collaboration between members from different departments [ 41 , 143 , 152 ].

Regarding institutional support, in some instances, psychological, managerial, material and technical support was positively acknowledged, while the majority of studies reported HCWs’ dissatisfaction with the support provided by the institution they worked in [ 46 , 48 , 73 , 84 , 92 , 97 , 114 , 139 , 144 , 174 , 184 ]. Across studies, a lack of equipment, including the unavailability of suitable PPEs, was one of the most prominent critiques, especially in the initial phase the pandemic [ 41 , 46 , 54 , 55 , 61 , 69 , 70 , 72 , 73 , 81 , 84 , 85 , 96 , 97 , 111 , 118 , 144 , 147 , 168 ]. In one study of a rural nursing home, HCWs reported being illegally required to treat COVID-19 patients without adequate PPE [ 39 ]. Specialised physicians, such as radiologists, for example, reported that PPE were prioritised for COVID-19 ward workers [ 65 ]. In another instance, HCWs reported that they had taken care of their own mask supply [ 113 ]. Insufficient equipment and the subsequent lack of protection induced fear and anxiety regarding one’s personal safety [ 64 , 87 ]. HCWs also reported inadequate human resources, which had consequences on increased workload [ 44 , 46 , 54 , 69 , 75 , 85 ]. Dissatisfaction with limited infrastructure was reported overall and across settings, but specific limitations were particularly relevant in certain contexts [ 116 ]. HCWs in low resource settings, including Pakistan, Zimbabwe and India, reported worsening conditions regarding infrastructure, characterised by a lack of water supply and ventilation, poor conditions of isolation wards and lack of quality rest areas for staff [ 41 , 58 , 84 ]. Despite adaptive interventions aimed at shifting service delivery to outdoors, procedures such as patient registration and laboratory work took place in poorly ventilated rooms [ 56 ]. Technical support such as the accessibility to specialised knowledge and availability of training were identified by HCWs as an important resource that required strengthening. They advocated for better “tailor-made” trainings in emergency preparedness and response, crisis management, PPE use and infection control [ 41 , 52 , 61 , 68 , 73 , 127 , 144 ]. HCWs argued that the availability of such training would improve their sense of control in health emergencies, while a lack of training compromised their confidence in their ability to provide quality healthcare [ 47 , 134 ].

Structural factors such as power hierarchies and inequalities played a role in HCWs’ perceived sense of institutional support amidst the quick changes in their institutions. Such factors were particularly mentioned in studies investigating nurses who reported dissatisfaction over doctors’ dominance and discrimination in obtaining PPE [ 54 ] as well as unfairness in work allocation [ 72 , 184 ]. They also perceived ambiguity in roles and responsibilities between nurses and doctors [ 101 ]. A low sense of institutional support was also reported by other HCWs. Junior medical staff and administrative staff reported feeling exposed to unacceptable risks of infection and a lack of recognition by their institution [ 139 ]. Staff in non‐clinical roles, non-frontline staff, staff working from home, acute physicians and those on short time contracts felt less supported and less recognised compared to colleagues on the frontline [ 48 , 139 ].

Community level

This level entails how morale and norms, as well as public knowledge relate to HCWs’ experiences in the pandemic. On the positive side, societal morale and norms were perceived as enhancing supportive attitudes among the public toward HCWs and triggering community initiatives that supported HCWs in both emotional and material ways [ 47 , 78 , 92 , 108 , 140 , 147 ]. This supportive element was especially experienced by frontline HCWs, who felt valued, appreciated and empowered by their communities. HCWs’ reaction to the hero status that was assigned to them was ambivalent [ 146 , 185 ]. In response to this status attribution, HCWs reported a sense of pressure to be on the frontline and to work beyond their regular work schedule [ 51 ]. With community support being perceived as clearly focusing on hospital frontline staff, HCWs working from home, in nursing homes, home care and non-frontline facilities and wards perceived less public support [ 139 ] and appreciation [ 85 , 144 ]. One study highlighted that HCWs did not benefit from this form of public praise but preferred an appreciation in the form of tangible and financial resources instead [ 160 ].

A clear negative aspect of social norms manifested in the stigmatisation and negative judgment by community members [ 72 , 100 , 106 , 186 , 187 ], who avoided contact with HCWs based on the perceptions that they were virus carriers and spreaders [ 43 , 68 , 92 , 111 ]. Such discrimination had negative consequences with regard to HCWs’ personal lives, including lack of access to public transportation, supermarkets, childcare and other public services [ 65 , 80 , 107 ]. Chinese HCWs working abroad reported bullying due to others perceiving and labeling COVID-19 as the ‘Chinese virus’ [ 77 ]. Negative judgment was mainly reported in studies on nurses . In a study of a COVID-19-designated hospital, frontline nurses reported unusually strict social standards directed solely at them [ 122 ]. In a comparative study of nursing homes in four countries, geriatric nurses reported social stigma toward their profession, which the society perceive not worth of respect [ 75 ].

Beyond social norms, studies identified the level of public awareness, knowledge and compliance as important determinants of HCWs’ experiences and emotional well-being [ 147 ]. For example, a lack of compliance with social distancing and other preventive measures was reported to induce feelings of betrayal, anger and anxiety among HCWs [ 41 , 80 , 81 , 111 , 188 ]. The dissemination of false information and rumors and their negative influence on knowledge and compliance was also reported with anger by HCWs in general [ 58 ], an in particular by those who worked closely with local communities [ 129 ]. Online resources and voluntary groups facilitated information exchange and knowledge transfer, factors which were valued by HCWs as an important source of information and support [ 131 , 189 ].

Policy level

Findings presented here include HCWs’ perceptions of governmental responses, governmental support and the impact of governmental measures on their professional and private situation. In a small number of studies, HCWs expressed confidence in their government’s ability to respond to the pandemic and satisfaction with governmental compensation [ 45 , 47 ]. In most cases, however, HCWs expressed dissatisfactions with the governmental response, particularly with the lack of health system organisation, the lack of a coordinated, unified response and the failure to follow an evidence-based approach to policy making. HCWs also perceived governmental guidelines as chaotic, confusing and even contradicting [ 61 , 85 , 86 , 115 , 117 , 118 , 120 , 123 , 147 , 160 , 182 , 190 ]. In one study, inadequate staffing was directly attributed to inadequate governmental funding decisions [ 191 ]. Many studies reported that HCWs had a sense of being failed by their governments [ 60 , 100 , 191 ], with non-frontline staff, notably HCWs working with the disabled [ 71 , 181 ], the elderly [ 39 , 75 , 123 , 151 ] or in home-based care [ 58 ], being particularly likely to voice feelings of being forgotten, deprioritised, invisible, less recognised and less valued by their governments. Care home staff perceived governmental support to be unequally distributed across health facilities and as being focused solely on public institutions, which prevented them from receiving state benefits [ 149 ].

Measures and regulations imposed at the governmental level had a considerable impact on HCWs’ professional as well as personal experiences. In nursing homes, HCWs perceived governmental regulations such as visiting restrictions as particularly challenging and complained that rules had not been designed or implemented with consideration to individual cases [ 62 ]. The imposed rules burdened them with additional administrative tasks and forced them to compromise on the quality of care, resulting in moral distress [ 62 ]. In abortion clinics, HCWs expressed concerns about their services being classed as non-essential services during the early stages of the pandemic [ 190 ]. Governmental policies also had impacts on HCWs personally. For example, the closure of childcare negatively impacted HCWs’ ability to balance personal and private roles and commitments. National lockdowns which restricted travel made it harder for HCWs to get to work or to see their families, especially in places with low political stability [ 95 ]. The de-escalation of measures, notably the opening of airports, was perceived as betrayal by HCWs who felt they bore the burden of increased COVID-19 incidences resulting from de-escalation strategies [ 111 ].

HCWs identified clear and consistent governmental crisis communication [ 97 , 126 ], better employees’ rights and salaries, and tailored pandemic preparedness and crisis management policies that considered different healthcare settings and HCWs’ needs [ 43 , 64 , 81 , 101 , 124 , 160 , 167 , 169 , 188 , 192 , 193 ] as important areas for improvement. HCWs in primary care advocated for strengthened primary health care, improved public health education [ 45 , 130 ] and a multi-sectoral approach in pandemic management [ 129 ].

Our scoping review of HCWs’ experiences, support needs and factors that influence these experiences during COVID-19 shows that HCWs were affected at individual, interpersonal, institutional, community and policy levels. It also highlights that certain experiences can have disruptive effects on HCWs’ personal and professional lives, and thus identifies problems which need to be addressed and areas that could be strengthened to support HCWs during pandemics.

To the best of our knowledge, our review is the first to provide a comprehensive account of HCWs’ experiences during COVID-19 across contexts. By applying an exploratory angle and focusing on existing qualitative studies, the review does not only provide a rich description of the situation of HCWs but also develops an in-depth analysis of the contextual multilevel factors which impact on HCWs’ experiences.

Our scoping review shows that, while studies on HCWs’ experiences in low resource settings are scarce, the few studies that exist and the comparison with other studies point towards setting-specific experiences and challenges. We thus argue that understanding HCWs’ experiences requires comparative investigations, which not only take countries’ income levels into account but also other contextual differences. For example, in our analysis, we identify particular challenges experienced by HCWs working in urban slums and places with limited infrastructure and low political stability. Similarly, in a recent short communication in Social Science & Medicine, Smith [ 194 ] presents a case study on the particular challenges of midwives in resource-poor rural Indonesia at the start of the pandemic, highlighting increased risks and intra-country health system inequalities. Contextual intra-country differences in HCWs’ experiences also manifest at institutional level. For example, the review suggests that HCWs who work in non-hospital settings, such as primary care services, nursing homes, home based care or disability services, experienced particular challenges and felt less recognized in relation to hospital-based HCWs. In a similar vein, HCWs working in care homes felt that as state support was not equally distributed, those working in public institutions had better chances to benefit from state support.

The review highlights that occupational hierarchies play a crucial role in HCWs’ work-related experiences. Our analysis suggests that existing occupational hierarchies seem to increase or be exposed during pandemics and that occupation is a structural factor in shaping HCWs’ experiences. The review thus highlights the important role that institutions and employers play in pandemics and is in line with the growing body of evidence that associates HCWs’ well-being during COVID-19 with their occupational role [ 195 ] and the availability of institutional support [ 195 , 196 ]. The findings suggest that to address institutional differences and ensure the provision of needs-based support to all groups of HCWs, non-hierarchical and participative processes of decision-making are crucial.

Another contextual factor affecting HCWs’ experiences are their communities. While the majority of HCWs experience emotional and material support from their community, some also feel pressure by the expectations they are confronted with. The most prominent example of such perceived pressure is the ambivalence that was reported with regard to the assignment of a hero status to HCWs. On the one hand, this attribution meant that HCWs felt recognized and appreciated by their communities. On the other hand, it led to HCWs feeling pressured to work without respecting their own limits and taking care of themselves.

This scoping review points towards a number of research gaps, which, if addressed, could help to hone interventions to support HCWs and improve health system performance and resilience.

First, the majority of existing qualitative studies investigate nurses’ and doctors’ experiences during COVID-19. Given that other types of HCWs play an equally important role in pandemic responses, future research on HCWs’ experiences in pandemics should aim for more diversity and help to tease out the specific challenges and needs of different types of HCWs. Investigating different types of HCWs could inform and facilitate the development of tailored solutions and provide need-based support.

Second, the majority of studies on HCWs’ experiences focus on hospital settings. This is not surprising considering that the bulk of societal and political attention during COVID-19 has been on the provision of acute, hospital-based care. The review thus highlights a gap with regard to research on HCWs in settings which might be considered less affected and neglected but which might, in fact, be severely collaterally affected during pandemics, such as primary health centers, care homes and home-based care. It also indicates that research which compares HCWs’ experiences across levels of care can help to tease out differences and identify specific challenges and needs.

Third, the review highlights the predominance of cross-sectional studies. In fact, we were unable to identify any longitudinal studies of HCWs’ experiences during COVID-19. A possible reason for the lack of longitudinal research is the relatively short time that has passed since the start of the pandemic which might have made it difficult to complete longitudinal qualitative studies. Yet, given the dynamics and extended duration of the pandemic, and knowledge about the impact of persistent stress on an individual’s health and well-being [ 197 , 198 , 199 , 200 ], longitudinal studies on HCWs’ experiences during COVID-19 would provide added value and allow an analysis across different stages of the pandemic as well as post-pandemic times. In our review, three differences in HCWs’ experiences across the phases of the pandemic were observed. The first one is on the individual level, reflecting the dominance of the negative emotions at the initial phase of the pandemic, which was gradually followed by increased reporting of the positive impact on HCWs’ personal and professional identity. The two other differences were on the institutional level, referring to the dissatisfaction over the lack of equipment and organization of care, mainly observed at the initial pandemic phase. Further comparative analysis of changes in HCWs’ experiences over the course of a pandemic is an interesting and important topic for future research, which could also map HCWs’ experiences against hospital capacities, availability of vaccines and tests as well as changes in pandemic restrictions. Such comparative analysis can inform the development of suitable policy level interventions accounting for HCWs’ experiences at different pandemic stages, from preparedness to initial response and recovery.

Finally, the majority of studies included in the review were conducted in the Northern hemisphere, revealing a gap in understanding the reality of HCWs in low- and lower middle income countries. Ensuring diversity in geographies and including resource-poor settings in research on HCWs would help gain a better contextual understanding, contribute to strengthening pandemic preparedness in settings, where the need is greatest, and facilitate knowledge transfer between the global North and South. While further research can help to increase our understanding of HCWs’ experiences during pandemics, this scoping review establishes a first basis for the evaluation and improvement of interventions aimed at supporting HCWs prior to, during and after COVID-19. A key finding of our analysis to strengthen HCWs’ resilience are the interdependencies of factors across the five levels of the socio-ecological model. For example, institutional, community or policy level factors (such as dissatisfaction with decision-making processes, public non-compliance or failures in pandemic management) can have a negative impact on HCWs at interpersonal and individual levels by impacting on their professional relationships, mental health or work performance. Similarly, policy, community or institutional level factors (such as adequate policy measures, appreciation within the community and the provision of PPE and other equipment) can act as protective factors for HCWs’ well-being. In line with the social support literature [ 201 ], interpersonal relationships were identified as a key factor in shaping HCWs’ experiences. The identification of the inter-dependencies between factors affecting HCWs during pandemics further highlights that health systems are severely impacted by factors outside the health systems’ control. Previous scholars have recognized the embeddedness of health systems within, and their constant interaction with, their socio-economic and political environment [ 202 ]. Previous literature, however, also shows that interventions tackling distress of HCWs have largely focused on individual level factors, e.g., on interventions aimed at relieving psychological symptoms, rather than on contextual factors [ 16 ]. To strengthen HCWs and empower them to deal with pandemics, the contextual factors that affect their situation during pandemics need to be acknowledged and interventions need to follow a multi-component approach, taking the multitude of aspects and circumstances into account which impact on HCWs’ experiences.

Limitations and strengths

Our scoping review comes with a number of limitations. First, due to resource constraints, the search was conducted using only one database. The authors acknowledge that running the search strategy on other search engines could have resulted in additional interesting studies to be reviewed. To mitigate any weaknesses, extensive efforts were made to build a strong search string by reviewing previous peer-reviewed publications as well as available resources from recognized public health institutions. Considering the high numbers of studies identified, it can be, however, assumed that the search strategy and review led to valid conclusions. Second, the review excluded non-original publications. While other types of publications could have provided additional data and perspectives on HCWs’ experiences, we decided to limit our review to original, peer-reviewed research articles to ensure quality. Third, the review excluded studies on other pandemics, which could have provided further insights into HCWs’ experiences during health crises. Given the limited resources available to the research project, it was decided to focus only on COVID-19 to accommodate a larger target group of all types of HCWs and a variety of geographical locations and healthcare settings. Furthermore, it can be argued that previous pandemics did not reach the magnitude of COVID-19 and did not lead to similar responses. With the review looking at the burden of COVID-19 as a stressor, it can be assumed that the more important the stressor, the more interesting the results. Therefore, the burdens and the way in which HCWs dealt with these burdens would be particularly augmented with regard to COVID-19, making it a suitable focus example to investigate HCWs’ experiences in health crises. The authors acknowledge that during other pandemics HCWs’ experiences might differ and be less pronounced, yet this review has addressed stressors and ways of supporting HCWs that could also inform future health crises. In our view, a major strength of the review is that is does not apply any limitation in terms of the types of HCWs, the geographical locations or the healthcare settings included. This approach did not only allow us to review a wide range of literature on an expanding area of knowledge [ 30 ], but to appropriately investigate HCWs’ experiences during a public health emergency of international concern that affects countries across the globe. Providing detailed information about the contexts in which HCWs were studied, allowed us to shed light on the contextual factors affecting HCWs’ experiences.

Implications for policy and practice

Areas of future interventions that improve HCWs’ resilience at individual level could aim towards alleviating stress and responding to their specific needs during pandemics, in line with encouraging self-care activities that can foster personal psychological resilience. Beyond that, accounting for the context when designing and implementing interventions is crucial. This can be done by addressing the circumstances HCWs live and work in, referred to in German-speaking countries as “Verhältnisprävention”, i.e., prevention through tackling living and working conditions. Respective interventions should tackle all levels outlined in the socio-ecological model, applying a systems approach. At the interpersonal level, creating a positive work environment in times of crises that is supportive of uninterrupted and efficient communication among HCWs and between HCWs and patients is important. In addition, interpersonal support, e.g., by family and friends could be facilitated. At institutional level, organizational change should consider transparent and participatory decision making and responsible planning of resources availability and allocation. At community level, tracing rumors and misinformation during health emergencies is crucial, as well as advocating for accountable journalism and community initiatives that support HCWs in times of crisis. At policy level, pandemic regulations need to account for their consequences on HCWs’ work situations and personal lives. Governmental policies and guidelines should build on scientific evidence and take into account the situations and lived experiences of HCWs across all levels of care.

This scoping review of existing qualitative research on HCWs’ experiences during COVID-19 sheds light on the impact of a major pandemic on the health workforce, a key pillar of health systems. By identifying key drawbacks, strengths that can be built upon, and crucial entry-points for interventions, the review can inform strategies towards strengthening HCWs and improving their experiences. Following a systems approach which takes the five socio-ecological levels into account is crucial for the development of context-sensitive strategies to support HCWs prior to, during and after pandemics. This in turn can contribute to building a sustainable health workforce and to strengthening and better preparing health systems for future pandemics.

Availability of data and materials

All data generated during this study are included in this published article and its supplementary information files, except for a detailed extraction sheet for all studies included, which is available from the corresponding author upon request.

Abbreviations

Health care workers

Joanna Briggs Institute

Focus Groups Discussions

Personal Protective Equipment

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Open Access funding enabled and organized by Projekt DEAL. The study was funded by the German Federal Ministry of Health (Bundesministerium für Gesundheit, BMG).

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HW and AMS conceived and designed the scoping review. SC extracted, analyzed and conceptualized the data as well as drafted the initial version of this manuscript. HW and AMS provided quality checks for the methodology and analysis. HW, AMS and CEB substantively revised each version of the manuscript and provided substantial inputs. All authors read and approved the final manuscript.

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Additional file 1.

: Table S1. Search strategy. The document includes the search strings for the review.

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: Table S2. List of included papers. The file lists the 161 included papers, detailing the title, authors, publication year and DOI link.

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: Table S3. List of countries studied. The file includes a table listing the countries in which the included studies were conducted according to frequency.

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: Table S4. Detailed information on FGDs. This document provides information extracted from studies that used FGDs as a qualitative data collection tool. The table lists the overall number of focus group discussion’s participants in each of those studies, the number of FGDs per study, whether FGDs were conducted online or offline, the type of study participants, and any other information on the methods that could be extracted.

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Chemali, S., Mari-Sáez, A., El Bcheraoui, C. et al. Health care workers’ experiences during the COVID-19 pandemic: a scoping review. Hum Resour Health 20 , 27 (2022). https://doi.org/10.1186/s12960-022-00724-1

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Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review

Natasha Shaukat 1 , 2 ,
Daniyal Mansoor Ali 2 &
Junaid Razzak 2 , 3

International Journal of Emergency Medicine volume 13 , Article number: 40 ( 2020 ) Cite this article

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Coronavirus disease (COVID-19) pandemic has spread to 198 countries, with approximately 2.4 million confirmed cases and 150,000 deaths globally as of April 18. Frontline healthcare workers (HCWs) face a substantially higher risk of infection and death due to excessive COVID-19 exposure. This review aimed at summarizing the evidence of the physical and mental health impacts of COVID-19 pandemic on health-care workers (HCWs).

We used the Arksey O’Malley framework to conduct a scoping review. A systematic literature search was conducted using two databases: PubMed and Google Scholar. We found 154 studies, and out of which 10 met our criteria. We collected information on the date of publication, first author’s country, the title of the article, study design, study population, intervention and outcome, and key findings, and divided all research articles into two domains: physical and mental health impact.

We reviewed a total of 154 articles from PubMed (126) and Google Scholar (28), of which 58 were found to be duplicate articles and were excluded. Of the remaining 96 articles, 82 were excluded after screening for eligibility, and 4 articles did not have available full texts. Ten full-text articles were reviewed and included in this study.

Our findings identified the following risk factors for COVID-19-related health impact: working in a high-risk department, diagnosed family member, inadequate hand hygiene, suboptimal hand hygiene before and after contact with patients, improper PPE use, close contact with patients (≥ 12 times/day), long daily contact hours (≥ 15 h), and unprotected exposure. The most common symptoms identified amongst HCWs were fever (85%), cough (70%), and weakness (70%). Prolonged PPE usage led to cutaneous manifestations and skin damage (97%), with the nasal bridge (83%) most commonly affected site. HCWs experienced high levels of depression, anxiety, insomnia, and distress. Female HCWs and nurses were disproportionately affected.

The frontline healthcare workers are at risk of physical and mental consequences directly as the result of providing care to patients with COVID-19. Even though there are few intervention studies, early data suggest implementation strategies to reduce the chances of infections, shorter shift lengths, and mechanisms for mental health support could reduce the morbidity and mortality amongst HCWs.

Coronavirus disease 2019 (COVID-19) was first identified in Wuhan City in December 2019, after which, the disease spread throughout Hubei Province and other parts of China [ 1 , 2 ]. After causing significant morbidity and mortality in China, by February 2020, COVID-19 had spread to numerous other countries, including the USA, Italy, Spain, Germany, France, and Iran [ 3 , 4 , 5 ]. As of April 18, COVID-19 has spread to 198 countries, infecting 2.4 million people and causing 150,000 deaths across the world and is therefore considered a global pandemic [ 6 , 7 , 8 ].

Healthcare workers (HCWs) are amongst the high-risk group to acquire this infection [ 9 , 10 , 11 ]. China reported infection in 3387 HCWs, while 22 HCWs (0.6%) died due to the illness [ 9 , 12 ]. Similarly, Italy (20%), Spain (14%), and France (over 50 deaths amongst HCWs) reported high rates of HCW infection [ 10 , 13 , 14 ].

Given the high burden, there is a growing demand and focus on protecting HCWs across the world through provision of personal protective equipment (PPE), training, addressing fatigue, and countering the psychosocial consequences [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ].

The literature on the health consequences of HCWs providing care to COVID-19 patients is proliferating, and no review is available to guide practitioners and leaders on the efficacy of various interventions. This scoping review aims to summarize the evidence of the physical and mental health impacts of COVID-19 pandemic on healthcare workers.

Study design

We used the methodological framework by Arksey and O’Malley to conduct the scoping review [ 22 ]. The five steps followed were identifying a clear research question and objective; identifying relevant articles; selection of articles, data extraction; and charting of data, organizing, summarizing, analyzing, and reporting of data [ 22 ]. The primary research question guiding this review is “What are the physical and mental health effects of managing patients with COVID-19 on the frontline health-care workers?”

Literature search strategies

We searched PubMed or Medical Literature Analysis and Retrieval System Online (MEDLINE), and Google Scholar for relevant articles from January to March 2020. Medical subject headings (MeSH) were searched using Boolean operators “ OR/AND ”. The search terms were: (“2019-nCoV” OR “coronavirus” OR “COVID-19” OR “nCoV)” AND (“health-care workers”) AND (“health impacts” OR “physical health” OR “mental health”).

Eligibility criteria

We included studies assessing the impact of COVID-19 on the health of HCWs and were published in the English language and published from January to March 2020. Healthcare workers included all clinical staff, including doctors, nurses, paramedics, and technicians. Editorials, commentaries, and non-English articles were excluded.

Identification and selection of studies

Two researchers (NS and DMA) independently searched through the literature. The two sets of literature were then compared, and duplicate articles were removed. Figure 1 presents a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram showing the process of searching and selecting the research articles.

PRISMA flow diagram for database search of studies

Data extraction from included studies

After the selection of the articles, we extracted and recorded data in a data extraction form in an Excel spreadsheet. The domains in the data extraction form were date of publication, the title of the article, name of the journal, study design, study setting and population, intervention, and outcome reported and key findings.

Summarizing the findings

We summarized our findings into the following research domains: mental health impacts and physical health impacts.

Studies’ characteristics

A total of 154 articles were retrieved from PubMed (126 articles) and Google Scholar (28 articles). Fifty-eight duplicate articles were excluded. Out of the remaining 96 articles, 82 articles were either not related to the impact of COVID-19 on healthcare workers, were editorials or commentaries, or were written in a language other than English, and no English translation was available and therefore were excluded. Among the remaining 14 articles, 4 articles did not have available full texts. Ten full-text articles were reviewed and included in this study. Out of the ten studies included, two were written in Chinese but had English translations available.

Research domains

Among the 10 studies included in this review, 5 studies assessed mental health impacts, and 5 studies assessed the physical health impacts of COVID-19 on healthcare workers. The methodological characteristics of these studies are summarized in Table 1 . Six were cross-sectional, two were interventions, one was a retrospective cohort, and one was a case series. The study population comprised both male and female, including frontline physicians, nurses, and specialist staff. Most of the studies (90%) were from scholars in the Peoples Republic of China (PRC), while one was from scholars based in Singapore.

The findings related to mental health and physical health impact of COVID-19 on healthcare workers from the included articles are summarized in Table 2 .

Mental health impacts

Five articles discussed mental health impact on healthcare providers. In one study, out of 230 healthcare workers who responded to the mental health assessment scales, 53 (23.04%) had psychosocial problems. Among these 53 medical staff, more females (48 (90.57%)) than males (5 (9.43%)), and more nurses (43 (81.13%)) than physicians (10 (18.9%)) suffered from mental health issues due to the infectious outbreak [ 23 ]. The psychological impact on healthcare workers included the following conditions: overall anxiety (23–44%), severe anxiety (2.17%), moderate anxiety (4.78%), mild anxiety (16.09%), stress disorder (27.4–71%), depression (50.4%), and insomnia (34.0%) [ 23 , 24 ]. Anxiety in females was higher than in males (25.67% vs. 11.63%), nurses higher than doctors (26.88% vs. 14.29%) [ 23 ]. Frontline healthcare workers engaged in direct COVID-19 patient care were at higher risk of depression (OR 1.52; 95% CI 1.11–2.09), anxiety (OR,1.57; 95% CI 1.22–2.02), insomnia (OR 2.97; 95% CI 1.92–4.60), and distress (OR 1.60; 95% CI 1.25–2.04) [ 24 ].

The tools used in these studies included Self-Rating Anxiety Scale [ 23 , 25 ], Generalized Anxiety Disorder Scale [ 24 ], General Self-Efficacy Scale [ 25 ], Stanford Acute Stress Reaction Questionnaire [ 25 ], Pittsburgh Sleep Quality Index [ 25 ], Insomnia Severity Index [ 24 ], Social Support Rate Scale [ 25 ], Post-Traumatic Stress Disorder Self-Rating Scale [ 23 ], and Impact of Event Scale [ 24 ].

Physical health impacts

Covid-19 infection transmission and mortality among healthcare providers.

Early studies from the Peoples Republic of China (PRC) demonstrate that HCWs are more susceptible to COVID-19. Studies amongst HCWs in PRC showed that COVID-19 risk was linked with working in high-risk department such as infectious disease and pulmonology (RR = 2.13, 95% CI 1.45–3.95), diagnosed family member (RR = 2.76, 95% CI 2.02–3.77), inadequate hand hygiene (RR = 2.64, 95% CI 1.04–6.71), suboptimal hand hygiene before and after contact with patients (RR = 2.43, 95% CI 1.34–4.39), improper PPE (RR = 2.82, 95% CI 1.11–7.18), close contact with patients (12 times/day), long daily contact hours (≥ 15 h), and unprotected exposure. Common symptoms were fever (85%), cough (80%), weakness (70%), chest distress (7%), hemoptysis (7%), headache (7%), and diarrhea (7%) [ 17 , 26 , 27 ]. Similarly, another study showed that COVID-19 infected 30 medical staff, including 20 doctors and 8 nurses in a hospital. Of these, 26 had mild, and 4 had a severe infection, and all of them had exposure to the virus [ 27 ]. A case series from Singapore recorded outcomes of 41 HCWs who were exposed to a patient with COVID-19 pneumonia before diagnosis of COVID in this patient. None of the 41 HCWs developed COVID-19. All the HCWs were wearing surgical and N-95 masks at the time of exposure [ 28 ].

Cutaneous manifestations

Prevention against the viral illness meant that healthcare workers had to wear personal protective equipment (PPE) for a prolonged period. A cross-sectional study demonstrated skin damage in 97% of the medical staff, with the nasal bridge (83.1%), being the most commonly affected site. The most common presenting symptom was dryness or tightness and desquamation (70.3%), and these manifestations were associated with more than 6 h of continuous PPE use and more than 10 times/day hand hygiene [ 29 ].

This review collates evidence on the health impacts of COVID-19 on HCWs. Our findings suggest HCWs are susceptible to various health consequences due to the COVID-19 pandemic. For those with COVID-19 infections, the most common symptoms were fever and cough, which were similar to those seen in the community. Several risk factors were identified; long duty hours, working in the high-risk department, lack of PPE, diagnosed family member, unqualified hand-washing, and improper infection control. Furthermore, prolonged PPE usage led to skin damage, with the nasal bridge being the most common site. Battling COVID-19 on the frontline makes HCWs vulnerable to psychological distress. Finding shows high levels of depression, stress, anxiety, distress, anger, fear, insomnia, and post-traumatic stress disorder in the HCWs. Females and nurses were disproportionately affected more from mental health consequences. Frontline female nurses work in close contact with patients for longer working hours, which may result in fatigue, stress, and anxiety. However, this finding warrants for further research to better prepare for the future.

Worldwide, COVID-19 has affected large numbers of frontline HCWs. As of March 2020, COVID-19 has infected more than 3000 HCWs in China only [ 30 ]. A similar situation was witnessed in previous outbreaks of Ebola virus disease (EVD), Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) [ 31 , 32 , 33 , 34 , 35 ]. Figures from Sierra Leone, Liberia, and Guinea showed approximately 6–8% of Ebola infection amongst the HCWs [ 35 ], SARS infected approximately 1000 HCWs, and 1.4% deaths occurred in China only [ 36 ]. Early COVID-19 studies indicate a worrisome situation of morbidity and mortality [ 16 , 20 ]. The fact that healthcare workers are at increased risk of infection by COVID-19 will further exacerbate the existing shortage of skilled workforce, as most health systems and EDs are running at their full capacities [ 18 , 20 , 30 , 37 ].

During outbreaks, the HCWs experience considerable stress. In a Chinese study during the Ebola outbreak, HCWs reported extreme somatization, depression, anxiety, and obsession-compulsion [ 38 ]. During the MERS outbreak, a Saudi study reported almost two-third of HCWs felt at risk of getting infected with MERS CoV and felt unsafe at work [ 39 ]. These findings are consistent with previous SARS situations in which HCWs reported high levels of fear of contagion and infecting family members, emotional disturbance, uncertainty, and stigmatization [ 40 , 41 ]. Risk factors for mental health include overwhelming situations, social disruption of daily life, feeling vulnerable, at risk of getting infected, fear of transmitting the disease to families, and loved ones [ 11 ]. Previous outbreaks showed that HCWs suffer significant stress, and a similar outcome is expected in COVID-19.

One of the major challenges faced in controlling this pandemic is the extreme shortage of PPEs [ 18 ]. A highly infectious pandemic challenges already compromised health systems with resultant shortages in supplies and PPEs. For instance, during the Ebola outbreak, many countries faced PPE shortages [ 35 , 42 ]. In a pandemic, ensuring emergency medical supplies is pertinent to national public health emergency response systems [ 18 ]. Therefore, it is pertinent to establish an emergency reserve medical supplies program to ensure the provision of supplies based on needs, type, quality, and quantity.

Pandemics exert significant psychological impacts on HCWs, highlighting the need for appropriate psychological support, interventions, and staff support measures. COVID-19-specific psychological interventions for medical staff in China included psychological intervention support teams, psychological counselling, availability of helpline, establishment of shift systems in hospitals, online platforms for medical assistance, incentives, providing adequate breaks and time offs, providing a place to rest and sleep, leisure activities such as yoga, meditation and exercise, and motivational sessions [ 15 , 16 ]. Protecting the well-being of HCWs, through appropriate measures is a crucial tool in national emergency public health response to fighting the outbreaks. If timely measures are not taken, although the disease will subside eventually, a new surge of patients suffering from psychological morbidity will emerge.

Strengths and limitations of the study

The scoping review applied systematic and vigorous search strategy as per the study objective. The study presents a summary the recent scientific evidence and could strengthen the response for the current and future outbreaks. Given the rapidity of the pandemic, studies present here have a relatively short follow-up period. Also, our review included only studies published in the English language and may have missed findings published in other languages. The incidence of health impacts of COVID-19 on HCWs are not documented due to methodological limitations of studies, especially difficulty in finding the actual denominator data. Lastly, interventional studies are relatively scarce.

HCWs are at risk for developing physical and mental health consequences due to their role in providing care to patients with COVID-19. Implementation of the following strategies may help reduce the burden of health consequences: the adequate provision and training on the use of personal protective equipment, strict infection control practices, shorter shift length, and provision of mental health and support services.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

Corona virus disease

Healthcare workers

Personal protective equipment

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Ebola virus disease

Middle East respiratory syndrome

Severe acute respiratory syndrome

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We thank all the frontline healthcare heroes who are busy risking their lives in battling this pandemic.

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Shaukat, N., Ali, D.M. & Razzak, J. Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review. Int J Emerg Med 13 , 40 (2020). https://doi.org/10.1186/s12245-020-00299-5

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Covid-19: risks to healthcare workers and their families

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Risk of hospital admission with covid-19 in healthcare workers and their households

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Peer review
Ulf Karlsson , consultant ,
Carl-Johan Fraenkel , consultant
Department of Infectious Diseases and Infection Control, Skane University Hospital, Kioskgatan 17, 22185, Lund, Sweden
Correspondence to: U Karlsson ulf.karlsson{at}med.lu.se

Mistakes made in the first wave must not be repeated in the second

Since the beginning of the coronavirus 2019 (covid-19) pandemic, healthcare workers have shown a remarkable resilience and professional dedication despite a fear of becoming infected and infecting others. 1 In a linked paper (doi: 10.1136/bmj.m3582 ), Shah and colleagues now report robust and concerning findings regarding the risks of covid-19 among health workers and their households. 2

In a large register based cohort study, comprising the entire Scottish healthcare workforce, the authors compared the risk of covid-19 related hospital admission between patient facing and non-patient facing workers, their household members, and the general population. Absolute risks were low, but during the first three months of the pandemic patient facing healthcare workers were three times more likely to be admitted with covid-19 than non-patient facing healthcare workers. Risk was doubled among household members of front facing workers, in analyses adjusted for sex, age, ethnicity, socioeconomic status, and comorbidity.

Previous work reported similar risks for covid-19 among healthcare workers, 3 4 but the new study provides the most comprehensive estimate to date of the risk of more serious disease, and it is the first to report risk to household members. The reasons for the observed increase in risk—likely multifactorial—need to be explored to help to guide safety improvements in healthcare settings.

During lockdowns, most essential workers are unable to protect themselves by working from home. Furthermore, insufficient physical distancing is a leading contributor to any work related covid-19 outbreak. 5 Consequently, workers in sectors such as transport and social care are also at increased risk of covid-19, although healthcare workers have been shown repeatedly to be at highest risk. 5 6

During the first wave of the pandemic, overstretched healthcare systems left health workers in hard hit countries struggling with long working hours, fatigue, and extreme psychological stress. Rapidly vanishing supplies, national lockdowns, and a feeding frenzy on the open market for personal protective equipment (PPE) led to shortages. 7 Healthcare workers often had to care for patients with suspected or confirmed covid-19 infection without proper training or adequate PPE. This contributed to an increased risk to healthcare workers during the initial phase of the pandemic. 3 8 9

Superspreading events, a hallmark of previous coronavirus outbreaks, contribute substantially to community transmission of covid-19 and to work related clusters. 5 Most countries struggled with insufficient testing capacity in the first months of the pandemic, which hampered early detection of emerging outbreaks and implementation of infection control measures. Increasing experience now suggests that every suspected healthcare associated infection should trigger a bundle of immediate infection control measures, including extensive screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), quarantining of all patients on the affected ward, physical distancing between personnel, and use of reinforced PPE during all contact with patients on the affected ward, in order to prevent larger outbreaks. 10 11 12

Most, but not all, studies report increased risks for health workers caring for patients with covid-19. 3 13 14 Working in intensive care units is not associated with an increased risk of infection, possibly owing to the protection afforded by high level PPE or to the decrease in infectivity that occurs in the later stages of the illness, even among critically ill patients. 13 15 The greatest risk to healthcare workers may be their own colleagues or patients in the early stages of unsuspected infections when viral loads are high. 12

Most studies to date, including Shah and colleagues’ study, have evaluated risks to healthcare workers during the early phases of the pandemic. Advances since then may have reduced the risks, although further confirmatory studies are needed. Such advances include greater knowledge of transmission dynamics and the impact of asymptomatic and pre-symptomatic infections, 16 better access to effective PPE, improved testing capabilities, optimised triage systems, implementation of new infection control measures such as continuous mask use in hospitals, 17 18 and faster outbreak alerts and responses.

High quality prospective studies evaluating new prevention and control practices will be important to guide improvements in our approach to protecting healthcare workers and their families, 19 including those from ethnic minority communities who have the highest risks of infection and poor outcomes, widening workplace inequality. 3 The international community must support efforts by the World Health Organization to secure adequate supplies of PPE and covid-19 tests for low and middle income countries. An effective vaccine, if and when available, must be distributed fairly and healthcare workers must be prioritised globally. In accordance with United Nations Sustainable Development Goals, we must ensure the protection and security of all health workers in all settings. 20

Research, doi: 10.1136/bmj.m3582

Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none.

Provenance and peer review: Commissioned; not peer reviewed

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Nguyen LH ,
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↵ European Centre for Disease Prevention and Control. COVID-19 clusters and outbreaks in occupational settings in the EU/EEA and the UK. 2020. https://www.ecdc.europa.eu/en/publications-data/covid-19-clusters-and-outbreaks-occupational-settings-eueea-and-uk .
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↵ World Health Organization. Protocol for assessment of potential risk factors for 2019-novel coronavirus (COVID-19) infection among health care workers in a health care setting. 2020. https://www.who.int/publications/i/item/protocol-for-assessment-of-potential-risk-factors-for-2019-novel-coronavirus-(2019-ncov)-infection-among-health-care-workers-in-a-health-care-setting .
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Inside SC Johnson

COVID-19’s impact on work, workers, and the workplace of the future

Business woman of color typing on a laptop with a hologram of a globe and connections to many headshots in the foreground

What will the world of work look like, post COVID-19? A paper co-authored by Dyson School faculty member Kevin Kniffin along with 28 other researchers and scholars from around the world — “ COVID-19 and the Workplace: Implications, Issues, and Insights for Future Research and Action ” ( American Psychologist ) — includes a preview of how COVID-19 may change work practices in the long term and offers projections about the workplace of the future.

Kniffin and his co-authors took a broad view of the pandemic’s many impacts on the workplace, encapsulating existing research, predicting a few likely outcomes, and pointing to new questions worthy of study. “By organizing our experiences as researchers in a wide array of topical areas,” they wrote, “we present a review of relevant literatures along with an evidence-based preview of changes that we expect in the wake of COVID-19 for both research and practice.”

“‘Sensemaking’ was the first value generated by this extraordinary collaboration, which we undertook because of the extraordinary impacts associated with the emergence of COVID-19,” says Kniffin. “With so many dimensions of work and life changing rapidly in relation to COVID-19, a clear and succinct assessment was our first task—and a foundation for charting roadmaps for future research and action.”

A new normal: Working from home

When the pandemic hit the U.S. hard in March, millions of workers began working from home – an unprecedented and ongoing phenomenon “facilitated by the rise of connectivity and communication technologies,” Kniffin and his co-authors note in the paper.

The authors project that working from home will not only continue for many workers, but that “COVID-19 will accelerate trends towards working from home past the immediate impacts of the pandemic.” This will be driven, in part, as organizations recognize the health risks of open-plan offices. “As we now live and work in globally interdependent communities, infectious disease threats such as COVID-19 need to be recognized as part of the workscape,” write Kniffin et al. “To continue to reap the benefits from global cooperation, we must find smarter and safer ways of working together.” Organizations will also appreciate the cost-savings of replacing full-time employees with contractors who can stay connected digitally, note the authors.

In light of this anticipated shift, one goal of the paper is to guide future research to “examine whether and how the COVID-19 quarantines that required millions to work from home affected work productivity, creativity, and innovation.”

Best practices for high-functioning virtual teams

Virtual teams were already growing in number and importance pre-COVID-19, as noted in the paper. Now, many workers participate in a variety of remote teams, via synchronous and asynchronous digital communication. Since virtual teams are here to stay for many workers even post-pandemic, it’s important to recognize the challenges and adopt best practices. For example, the authors point out that “traditional teamwork problems such as conflict and coordination can escalate quickly in virtual teams” and offer recommendations based on prior research, including:

Build structural scaffolds to mitigate conflicts, align teams, and ensure safe and thorough information processing.
Formalize team processes, clarify team goals, and build-in structural solutions to foster psychologically safe discussions.
Provide opportunities for non-task interactions among employees to allow emotional connections and bonding to continue among team members.

Greater appreciation for woman leaders?

“A feminine style of leadership might become recognized as optimal for dealing with crises in the future,” write Kniffin et al. They point to high-profile woman leaders who have grappled with COVID-19 effectively, including Angela Merkel, chancellor of Germany, and Tsai Ing-wen, president of Taiwan. And they list several feminine values and traits that can be effective in crisis management (pointing to the relevant research regarding each trait), including:

a communal orientation in moral decision-making,
higher sensitivity to risk, particularly about health issues,
higher conscientiousness, and
more attentive communication styles.

Creating roadmaps for new patterns of work

In addition to the sudden shift in working from home, “COVID-19 and the Workplace” touches on many other aspects of the pandemic’s impact on workers and organizations. They point to the economic, social, and psychological challenges and risks for workers deemed “essential” as well as for furloughed and laid-off workers. They touch on fundamental changes brought about in some industries, and new opportunities in others. Regarding impacts on workers, they discuss increases in economic inequality, social distancing and loneliness, stress and burnout, and addiction. The authors also refer to factors that moderate the impacts of workplace changes brought about by the pandemic, including age, race and ethnicity, gender, family status, personality, and cultural differences.

By drawing on existing research to help make sense of the crisis and highlighting topics ripe for new research, the authors hope to clear a path to guide studies focused on building positive, productive interactions that will aid in the ongoing transition to new patterns of work. “We hope that our effort will help researchers and practitioners take steps to manage and mitigate the negative effects of COVID-19 and start designing evidence-based roadmaps for moving forward.”

“When we started this project,” Kniffin added, “it wasn’t clear how long COVID-19 would persist as a force of disruption and destruction. As the pandemic has persisted, though, it’s increasingly clear that COVID-19 should be considered for its impact in relation to almost any work-related practice. On top of that, the many ways in which COVID-19 has variably and disparately impacted people and work around the world warrants close attention, concern, and action.”

Organizational Behavior
Thought Leadership

Tim Iorio, Ph.D.

I am working on a book concerning survival in Corporate America: Lessons Learned (my memoirs), including chapters on how COVID-19 has changed the landscape. Your research is needed and invaluable, and I look forward to following it. I will more than likely do some Qualitative Research myself on the subject. Thank you.

Rachel Frampton

From my point of view, businesses must invest in workplace covid management software that will protect their employees. Well, I agree with you that they must provide smarter and safer ways of working together. We also share the same opinion about the importance of providing virtual consultations and meetings.

Comments are closed.

Open access
Published: 12 August 2024

Healthcare staff experiences on the impact of COVID-19 on emergency departments: a qualitative study

Ahmet Butun ORCID: orcid.org/0000-0002-6856-9389 1

BMC Health Services Research volume 24 , Article number: 921 ( 2024 ) Cite this article

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The COVID-19 pandemic has had a major impact on the access and delivery of healthcare services, posing unprecedented challenges to healthcare staff worldwide. Frontline healthcare staff faced unique stressors and challenges that impact their well-being and patient care. This qualitative study aimed to explore the experiences and perspectives of frontline ED healthcare staff on emergency care services during the COVID-19 pandemic, providing valuable insights into the challenges, adaptations, and lessons learned in delivering emergency care.

This study utilized a qualitative approach. In-depth semi-structured interviews were conducted with 30 ED healthcare staff from three different hospitals located in Turkey between 15/03/2022 and 30/04/2022. Convenience sampling was used to recruit participants. The duration of the interviews ranged from 28 to 37 min. Data saturation was reached as no new information was gathered. The data were analyzed using the thematic analysis method. NVivo software was used to manage the data analysis process. Member check was carried out to ensure that the generated themes conformed to the participants’ views.

15 sub-themes under three themes emerged: (1) the impact of COVID-19 on emergency care services, including sub-themes of “introducing a COVID-19 unit in the ED”, “changes in the routine functioning of EDs”, “changes in the number of ED visits”, “quality of care”, “resources”, and “increased workload”; (2) the psychological effects of COVID-19 on ED healthcare staff, including sub-themes of “staying away from family”, “fear”, “society’s perspective on healthcare professionals”, “morale-staff burnout”, “psychological and emotional effects”, and “unable to receive sufficient support”; and (3) the difficulties faced by ED healthcare staff, including sub-themes of “difficult working conditions”, “community-based effects difficulties”, and “COVID-19 is an unknown situation”.

Staff burnout threatens the quality of patient care and staff retention, and therefore this should be addressed by ED directors and leaders. This study could inform appropriate stakeholders regarding lessons learned from COVID-19 to better manage future pandemics. Learning from such lived experiences and developing appropriate interventions to minimize the difficulties faced during COVID-19 would allow better management of future pandemics. This study calls for a reform to address the challenges faced by healthcare staff, improve the overall response to public health crises, and enhance the resilience of healthcare systems for future crises.

Peer Review reports

The COVID-19 pandemic has had a major impact on the access and delivery of healthcare services, posing unprecedented challenges to healthcare staff worldwide. The COVID-19 pandemic caused a high mortality rate and disruption to healthcare and social care around the world [ 1 , 2 ]. The pandemic has required the reconfiguration of health services to ensure the maintenance of essential health services [ 3 ]. The COVID-19 pandemic also caused delays in seeking care due to the fear of infection [ 4 ]. Delaying care may increase morbidity and mortality in non-COVID-19 patients [ 2 , 5 ]. The first COVID-19 case was identified on 11 March 2020 in Turkey. Around 35 million people were tested, around 2.9 million patients were diagnosed with COVID-19, around 30.000 patients were died within 1 year of starting of the pandemic, between 11 March 2020 and 11 March 2021 [ 6 ].

Emergency Departments (EDs) healthcare staff face an enormous mental burden and physical exertion when caring for patients potentially infected with COVID-19. Frontline healthcare staff face unique stressors and challenges that impact their well-being and patient care [ 7 , 8 ]. ED healthcare staff were deeply impacted by COVID-19, and they are at a high risk of burnout due to COVID-19 [ 9 , 10 ]. However, the COVID-19 pandemic has underscored the need for qualitative research to understand the experiences and perceptions of healthcare staff, as well as the use of healthcare services during this unprecedented health emergency [ 11 , 12 , 13 ]. Therefore, exploring the experiences of ED healthcare staff throughout the COVID-19 pandemic will provide a comprehensive understanding of their unique experiences and challenges.

In addition, studies showed that EDs in low-income and middle-income countries are likely to be impacted more significantly by the effects of the COVID-19 pandemic than those in high-income countries [ 9 , 14 , 15 ]. Thus, studying how the COVID-19 pandemic affects emergency care services in the context of a middle-income country (Turkey) is needed. This study focused on the impact of the COVID-19 pandemic on the general working conditions of the emergency care system, including ED services, ED healthcare staff, and ED patients in addition to its impact on general healthcare system. This qualitative study aims to explore the experiences and perspectives of frontline ED healthcare staff on emergency care services during the COVID-19 pandemic, providing valuable insights into the challenges, adaptations, and lessons learned in delivering emergency care.

Study design

This study utilized a qualitative exploratory descriptive approach as this allows to explore, describe, and a deep understanding of ED healthcare staff experiences during the COVID-19 pandemic.

Participants and settings

Participants were ED healthcare staff including ED nurses ( n = 20), ED physicians ( n = 8), and ED consultants ( n = 2) from 3 different hospitals located in Turkey, namely, Mardin Training and Research Hospital ( n = 21), Midyat Public Hospital ( n = 6), and Kiziltepe Public Hospital ( n = 3). Six healthcare staff refused to participate in this study. Mardin Training and Research Hospital is a public and tertiary hospital with a 700-bed capacity and around 150 ED healthcare staff. Midyat Public Hospital and Kiziltepe Public Hospital are public hospitals with 150-bed and 300-bed capacity, respectively. Convenience sampling was used to recruit participants. ED healthcare staff working in three hospitals were invited to participate in an interview. Those who accept to participate were included in the study. Participants characteristics were provided in Table 1 .

Procedure for the interviews

The interview guide (provided in Table 2 ) was developed by the researcher (A.B.) and piloted with 4 healthcare staff before commencing data collection. In-depth semi-structured interviews were conducted by researcher (A.B.), who had experience in conducting interviews and qualitative research, with 30 ED healthcare staff between 15/03/2022 and 30/04/2022. A quiet and comfortable private room at each hospital was arranged for the interviews. All interviews were audio-recorded and conducted in Turkish. The duration of the interviews ranged from 28 to 37 min. Data saturation was reached as no new information was gathered.

Ethical considerations

Ethical approval was obtained from the Mardin Artuklu University Non-Interventional Clinical Research Ethics Committee (Date: 08/03/2022, REF: E-76272411-900-47908). The participants were informed about the aim of the study, and verbal consent was obtained from all participants.

Data analysis and rigor

The data were analyzed using thematic analyses. A six-step thematic analysis developed by Braun and Clarke [ 16 ] was followed: (1) familiarizing with the data, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report. NVivo software was used to manage the data analysis process. The researcher (A.B.) generates the themes and sub-themes by following a six-step thematic analysis. The developed sub-themes and themes were reviewed and checked by a second qualitative researcher (Y.Y.) using NVivo software, and consensus was reached by discussion. In addition, member check was carried out to ensure that the generated themes conformed to the participants’ views of the topic and the process, and therefore minimized researcher bias. Following the data analysis process, the researcher (A.B.) contacted five participants by email to compare how the themes generated from the analysis related to their experience (member check). They reported a high level of congruence (around 95%) between the themes descriptions and their views, thus adding credibility to the results. All of these processes add to the rigor of the results and increase their credibility and trustworthiness.

The thematic analysis was concluded with 15 sub-themes under three themes. The three themes were the impact of COVID-19 on emergency care services, the psychological effects of COVID-19 on ED healthcare staff, and the difficulties faced by ED healthcare staff.

Impact of COVID-19 on emergency care services

This theme describes how COVID-19 changed the routine functioning of EDs, how ED visits were affected, how protective measures were taken, and how it affected the quality of care, resources used, and workload. Six sub-themes emerged: “introducing a COVID-19 unit in the ED”, “changes in the routine functioning of EDs”, “changes in the number of ED visits”, “quality of care”, “resources”, and “increased workload”.

Introducing a COVID-19 unit in the ED

A separate unit was introduced beside the ED to care for those with COVID-19 or suspected of COVID-19. Extra precautions against COVID-19 were taken in these units. Introducing these services might prevent contamination between those with and without COVID-19. In addition, the COVID-19 process delayed treatment in the ED. ED staff had to take precautions for all patients, which increased the time allocated for each patient and subsequently delayed treatment.

“The COVID-19 unit was introduced in the ED. Those with suspected COVID-19 were referred to the COVID-19 unit for examination. COVID-19 tests were also conducted here.” (Participant 16). “The ED has been divided into two units , the adult ED and the COVID-19 unit. The staff working in the COVID-19 unit paid attention to the use of masks , gowns , and visors , social distance , and cleaning rules while providing care to the patients.” (Participant 19). “The COVID-19 unit was introduced. In the past , we used to quickly perform the procedures of the incoming patients without masks and gloves , but because of the pandemic , we started to perform the procedures of the patients by taking precautions. Because we did not know whether the incoming patients had COVID-19 or not , we took the same precautions for each patient.” (Participant 5).

Changes in the routine functioning of EDs

The COVID-19 pandemic has changed the routine functioning of ED services. ED healthcare staff started to perceive all ED patients as suspected COVID-19 patients. Also, the ED healthcare staff had to take more precautions while examining the patients. They had to use protective equipment such as gloves, masks, aprons, and visors. In addition, healthcare staff also had to pay attention to social distancing and hygiene rules while providing care. All these extra precautions lead to fatigue and working under difficult working conditions, which could lead to high levels of stress and burnout. Working under such circumstances overwhelmed the ED healthcare staff during the COVID-19 pandemic.

“We approached each patient as if they had COVID-19 , without knowing whether the patients had COVID-19 or not. Also , it was very difficult to change the protective equipment each time.” (Participant 16). “We started working with protective equipment. We were working more distantly with the patients. We have started to pay more attention to hygiene rules. The workload of the ED has increased enormously.” (Participant 22).

The ED healthcare staff explained that they had difficulties dealing with COVID-19 as this was a new pandemic and it was an unknown process. ED healthcare staff start to use protective equipment and explain the importance of paying attention to prevention and precautionary methods to patients. In addition, ED healthcare staff had difficulties dealing with COVID-19 because of its high contagiousness.

“Since it was the first time , we had experienced such a process , we had a lot of difficulties managing the process. The disease was new , and people were unconscious. Patients began to be treated more distantly and more carefully. We started to use protective equipment and made a lot of effort to explain the methods of protection and precaution to the patients. The contagiousness of the disease made our job even more difficult.” (Participant 25). “We started using protective equipment to protect ourselves. Disinfectants were used. We pay attention to social distancing while examining patients. We changed the gloves frequently. I washed my hands often. Hand washing is essential. The risk of infection was very high. I started to use protective equipment regularly.” (Participant 6).

Changes in the number of ED visits

ED healthcare staff stated that the number of ED visits by those whose condition was non-urgent decreased. The decrease in the number of ED visits could be a result of fear of acquiring COVID-19 infection and a desire to reduce the pressure on the ED. However, ED healthcare staff reported that patients started to visit the EDs again after a few months from the start of the pandemic. Such decrease in the number of non-urgent ED visits was temporary only at peak incidences of COVID-19.

“At the beginning of the pandemic , non-urgent ED visits decreased. Patients did not come to the ED because of fear of COVID-19. However , they come to the ED now , it has become normal for the people , they do not care about COVID-19.” (Participant 10). “In the early days of COVID-19 , when there were restrictions , the number of patients with non-urgent conditions was quite low. When the restrictions were abolished , it started to increase again. The number of patients with non-urgent conditions increases when COVID-19 cases decrease , and the number of those with non-urgent conditions decreases when COVID-19 cases increase.” (Participant 5).

Quality of care

ED healthcare staff stated that the COVID-19 pandemic decreased the quality of care in the ED because of the limited time allocated for each patient. This is an important issue for patient safety. ED healthcare staff stated that they had limited time for patient examination and this could affect the quality of care provided to patients.

“There has been a decrease in the quality of treatment and care provided to patients. There has not been enough time for patients to be examined.” (Participant 11).

ED healthcare staff stated that they experienced a lack of resources and sometimes unavailability of resources during COVID-19. ED healthcare staff stated that they sometimes had to work without protective equipment while dealing with patients with COVID-19. Working without protective equipment increases the risk of COVID-19 transmission. In addition, some medications were out of stock, and they had to use other available medications while caring for patients.

“Protective equipment such as masks and gloves have decreased over time. Equipment began to be distributed in limited quantities per staff member. There were times when we had to work without protective equipment due to a lack of resources. This increased the risk of transmission of the disease.” (Participant 12).

Increased workload

The participants stated that the workload of the ED increased during COVID-19. Increased workload decreases staff performance and efficiency. In addition, some of the staff were infected with COVID-19 and therefore unable to work during that time. This caused an increased workload for those who are not yet infected. Healthcare staff reported that they experienced irregular working hours due to an unpredicted number of staff to work, and this led to an irregular and limited social life. ED healthcare staff had to deal with COVID-19 with a limited number of staff. ED healthcare staff could not get enough rest, which caused staff burnout.

“When we were infected with COVID-19 , we were away from the hospital and from our work for a week. Therefore , there was a lack of staff and an increase in the workload. The staff had to work a 24-hour shift because employees with COVID-19 could not come to work. We had to work overtime. In the past , we worked according to a certain plan; however , there was an irregular working plan during the COVID-19 process. The high contagiousness of COVID-19 caused disruptions.” (Participant 1). “Our working conditions have become very difficult. Our workload has increased considerably.” (Participant 10). “The workload of the ED has increased with the pandemic. We could not get enough rest. There were limited number of staff. Our working life is always busy , stressful , and exhausting. I had a harder time with the disease. My work routine has changed. There was an unnecessary workload , but there was not enough healthcare staff.” (Participant 26).

Psychological effects of COVID-19 on ED healthcare staff

This theme explains how the COVID-19 pandemic affects ED healthcare staff, including their social life, fears, psychological and emotional effects, and how they were supported during COVID-19. Six sub-themes emerged: “Staying away from family”, “fear”, “society’s perspective on healthcare professionals”, “morale-staff burnout”, “psychological and emotional effects” and “unable to receive enough support”.

Staying away from family

Almost all participants reported that they had experienced difficult times because they had to stay away from their families to reduce the risk of infection and keep them safe. Staying away from their families affects ED healthcare staff psychologically and increases their anxiety and stress levels.

“During the COVID-19 pandemic , most of the staff did not go home; they stayed away from their families because of the risk of infection. Some people stayed in hotels and other types of accommodation” (Participant 10). “The time we spend with our families has decreased. The high contagiousness of the disease and our fear of infecting our loved ones increased our anxiety and stress levels. We had to be very careful not to get the disease and infect our loved ones.” (Participant 11). “Being away from my family made me psychologically depressed.” (Participant 16).

The participants stated that they experienced fear regarding COVID-19. Such fear was regarding their own health and the potential consequences of contracting COVID-19, hospitalization and transmitting the virus to others, including colleagues, patients, and family members. Participants stated that the pandemic affected their mental well-being. Many healthcare staff faced considerable stress and anxiety during COVID-19.

“At the beginning of the pandemic , we were all psychologically feared. I was worried and afraid of how the disease would progress , how I would pass it if I infected , whether I would be hospitalized , and whether it would infect others if it infected me.” (Participant 16). “Psychologically , we were in a constant state of fear.” (Participant 24). “It affected me badly. I am a person who loves to live. I was afraid of dying. The pandemic process was very difficult and worn me out.” (Participant 26). “When there are deaths or negative situations among our colleagues , we are inevitably affected emotionally. We were affected emotionally. Also , I was afraid of infecting my family or any other person” (Participant 1).

Society’s perspective on healthcare professionals

Almost all healthcare staff stated that they were excluded from the members of the society because of being a healthcare staff. Being healthcare staff during the pandemic times means that they have a higher risk of transmission of the disease, and therefore, they were not welcomed in society. Healthcare staff felt excluded by members of society during the pandemic. Such exclusion by society affects the mental health and morale of healthcare staff.

“Society ran away from us during the pandemic.” (Participant 10). “In this process , everyone treated us as if we had COVID-19 because we were healthcare professionals. I felt so excluded.” (Participant 11). “Because I was a healthcare staff member , even my neighbours were not close to me , and they did not even want to use the same lift.” (Participant 13). “Society has become afraid of us.” (Participant 14).

Morale-staff burnout

Some ED healthcare staff members were psychologically affected. ED healthcare staff struggled with COVID-19 and experienced sleeplessness, stress, and exhaustion. Participants reported a high level of burnout related to COVID-19. It was found that COVID-19 caused an increased workload in the ED, which led to staff being exhausted, getting stressed, working without getting enough sleep, and experiencing burnout.

“In addition to the serious battle we fought physically , we were also fighting a great battle spiritually. We had many friends whose psychology was disturbed by this disease. As a result , we were constantly tensed and stressed. We experienced burnout in the process.” (Participant 25). “Due to the increasing number of cases , our workload in the ED has increased a lot. This made it very difficult for us; we were sleepless for days.” (Participant 27). “I cried for nights because of the difficulty of this process. It was an exhausting process. Understanding and tolerance are always expected from us , but we are never shown these things. We are human too , so we get burnout , angry , and tired.” (Participant 30). “Healthcare staff who contracted COVID-19 had to start work after a few days without being tested again.” (Participant 24). “This process has demoralized all of us. Our staff and friends have been infected with COVID-19. Some of the healthcare staff members died. We have also experienced such incidents. We are very saddened by these events.” (Participant 4).

Psychological and emotional effects

Participants expressed that the pandemic had a significant negative impact across multiple domains of life, including family, social, and work life. Participants reported that their social life was negatively affected. They experienced feelings of isolation or disconnection from friends, extended family, or social networks. Such social isolation and working under difficult circumstances overstressed ED healthcare staff and, affected them psychologically and emotionally. ED healthcare staff stated that such conditions increased their stress levels.

“Our family life , social life , and working life have been affected in a very negative way.” (Participant 25). “It was a very difficult process , and we were affected psychologically.” (Participant 28). “It wore me out psychologically. My social life was affected too much. I could not see my loved ones outside.” (Participant 8). “We had difficult days psychologically and physically” (Participant 12). “The pandemic has affected us negatively. We lost a chief physician who was a former colleague of mine. I was affected by this loss. When we thought about the risk of our family , relatives , and those with chronic diseases getting COVID-19 , we were burned out more.” (Participant 13).

Unable to receive sufficient support

Some ED healthcare staff reported that they did not receive sufficient support during the COVID-19 pandemic. Their motivation decreased due to unable to receive the required support. They experienced violence and were affected financially and spiritually. In addition, they experienced social isolation and a lack of social life. Accumulation of all these negative conditions affects ED healthcare staff psychologically and leads them to feel alone. The ED healthcare staff described that the absence of support and motivation contributed to their ability to cope with the challenges they faced.

“This process was difficult. There was no source of motivation. During this period , I was separated from my family and friends. I had difficulties both financially and spiritually. Cases of verbal and physical violence have increased. Health policies must be changed.” (Participant 30).

Difficulties faced by the ED healthcare staff

This theme describes the difficulties faced by ED healthcare staff during the COVID-19 pandemic. Three sub-themes emerged “difficult working conditions”, “community-based effect difficulties”, and “COVID-19 was an unknown situation”.

Difficult working conditions

ED healthcare staff worked under difficult working conditions during COVID-19. They had to work by using protective equipment all the time while working. In addition, ED staff stated that the risk of infection for them was high, and this caused them to be stressed, stay away from their families, and be isolated from society.

“We had a lot of trouble. We had to work with heavy protective equipment. The risk of infection was very high. As the number of cases increased , patient circulation increased , which affected us negatively.” (Participant 1). “We tried to be more careful while working. Healthcare staff are faced with difficulties due to a lack of protective equipment. We put in more effort. We sweated while working with protective equipment. There have also been times when we have put our health at risk.” (Participant 12). “It was very difficult to work with protective equipment; standing with them all day long left us drenched in sweat. It was a very difficult process , and it affected us psychologically.” (Participant 28).

Community-based effect difficulties

The ED healthcare staff stated that they faced significant difficulties due to non-compliance with safety standards by members of the community. ED healthcare staff reported members of the community did not adhere to recommended safety measures such as wearing masks, maintaining social distance, and practising proper hygiene. This non-compliance could cause serious risks for both healthcare staff and other patients because it increases the likelihood of virus transmission within healthcare settings.

“We had serious problems because the patients did not comply with the rules of masking , social distance , and hygiene.” (Participant 10). “When patients are referred to the COVID-19 unit , they do not go there to avoid testing. We started missing real emergency cases. Patients with high blood pressure , heart failure , and diabetes started to burden the emergency department because they did not use their medications or because their controls were delayed.” (Participant 10).

COVID-19 is an unknown situation

The participants stated that the COVID-19 pandemic was an unknown situation and, therefore, they did not know how to respond to this pandemic, including the symptoms of the disease, how to approach patients, what precautions should be taken, and how to treat or alleviate the disease.

“At the beginning of the pandemic , we did not know exactly what to do because the disease was new. Information was limited. Therefore , the emergency department could not be managed.” (Participant 2). “Since we were caught unprepared at the beginning of the pandemic , we had difficulties about what to do , how to take actions , how to make the patient use the protective equipment , and how to protect ourselves.” (Participant 18). “Because we had no information about the disease , we had difficulties in controlling the process , and we did not know how to approach the patients.” (Participant 22). “Since we have experienced such a process for the first time , we have had many difficulties in managing the process. The disease was new , and people were unconscious. All patients were approached with suspicion of COVID-19. Patients began to be treated more distantly and more carefully.” (Participant 25). “We did not know what the disease was like at the beginning of the pandemic and how we should approach patients. Therefore , the care and treatment provided to patients was inadequate.” (Participant 28).

This study found that COVID-19 negatively affects emergency care services in Turkey, including changes in the functioning of EDs and ED visits, decreased quality of care, increased use of resources, and workload. In line with the existing literature [ 2 , 17 , 18 , 19 , 20 ], this study revealed that the number of ED visits decreased at the beginning of the pandemic. The existing literature showed that the number of ED visits decreased by 65% [ 20 ], by 50% [ 21 ], and by 37% [ 22 ] during the first lockdown. Such a reduction in the number of ED visits could be a result of restrictions and the fear of being infected with COVID-19. The existing literature showed that patients were concerned about visiting the ED during the COVID-19 pandemic [ 23 ]. However, ED visits enormously increased after abolishing the restrictions as patients adapted their health-seeking behaviors throughout the pandemic.

The results of this study highlighted that ED healthcare staff experienced many difficulties during the COVID-19 pandemic, such as staying away from their family, fear, negative society perspective on healthcare staff, morale and staff burnout, psychological and emotional effects, and inability to receive enough support. This study found that ED healthcare staff had to stay away from their families during the COVID-19 pandemic because of the risk of infection to their families, which concurred with the existing literature [ 24 , 25 ]. This affects ED healthcare staff psychologically and increases their anxiety and stress levels. In addition, this study found that ED healthcare staff experienced distress and a high level of burnout during the COVID-19 pandemic, which concurs with some of the existing studies [ 8 , 26 , 27 , 28 , 29 , 30 ]. In line with some studies [ 26 , 31 , 32 ], this study found that experiencing burnout could be negatively associated with patient satisfaction, quality of care, staff morale and retention, and therefore a loss of workforce for the future.

In line with the results of this study, ED healthcare staff faced challenges such as increased workload and resource constraints during the COVID-19 pandemic [ 10 , 33 , 34 , 35 ]. ED healthcare staff face mental burdens and physical exertion when caring for patients in the ED during the COVID-19 pandemic. ED healthcare staff provide care under difficult circumstances with limited resources. In line with these results, some studies suggested that stress factors in relation to providing health care for patients with COVID-19 should be addressed [ 7 , 36 ].

Strengths and limitations

One of the strengths of this study is to include a large sample of ED healthcare staff working in three different hospitals with in-depth semi-structured interviewing resulting in a rich and detailed source of qualitative data for analysis. One of the limitations of this study could be the generalizability of the results due to the nature of qualitative research, which does not attempt to generalize the results to other populations. In addition, this study was conducted around 1 year later than the starting point of time of COVID-19. Therefore, participants may not recall all their experiences during COVID-19. The results may be transferrable to policymakers, ED directors, or other key stakeholders across Turkey and other countries with similar contexts.

Conclusion and recommendations

This study could provide a better understanding of how ED services and ED staff were affected by the COVID-19 pandemic, including decreased quality of care in the ED, increased workload, resource strains, psychological effects on ED staff, and related difficulties. Learning from such lived experiences and developing appropriate interventions to minimize the difficulties faced during COVID-19 would allow better management of future pandemics.

Staff burnout threatens the quality of patient care and staff retention, and therefore this should be addressed by ED directors and leaders. Supporting staff in dealing with difficulties such as psychological problems, fears, burnout and providing a safe working environment could contribute to staff well-being, a better workforce for the future, and staff retention. This study calls for a reform to address the challenges faced by healthcare staff, improve the overall response to public health crises such as the COVID-19 pandemic, and enhance the resilience of healthcare systems despite future crises. This study could inform appropriate stakeholders regarding lessons learned from COVID-19 to better manage future pandemics. Learning from such lived experiences and developing appropriate interventions to minimize the difficulties faced during COVID-19 would allow better management of future pandemics.

Data availability

No datasets were generated or analysed during the current study.

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Ahmadidarrehsima S, et al. Exploring the experiences of nurses caring for patients with COVID-19: a qualitative study in Iran. BMC Nurs. 2022;21(1):16.

Mohammadi F, et al. Management of COVID-19-related challenges faced by EMS personnel: a qualitative study. BMC Emerg Med. 2021;21(1):95.

Patterson JE, et al. Moral distress of medical family therapists and their physician colleagues during the transition to COVID-19. Journal of Marital and Family Therapy; 2021.

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Acknowledgements

The author would like to thank Dr Yesim Yesil for her contribution to this study. The author would also like to acknowledge the participants and the hospital management teams for their help with participant recruitment.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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A.B.: Conceptualization, Resources, Data curation, Software, Visualization, Methodology, Project administration, Formal analysis, Writing – original draft, Writing – review & editing.

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Butun, A. Healthcare staff experiences on the impact of COVID-19 on emergency departments: a qualitative study. BMC Health Serv Res 24 , 921 (2024). https://doi.org/10.1186/s12913-024-11362-9

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Safety first, but how? Examining the impact of safety leadership in frontline healthcare workers' safety performance during health crisis

Francisca Arboh , Baozhen Dai , +3 authors Stephen Addai-Dansoh
Published in Journal of Contingencies and… 8 August 2024

57 References

Rethinking frontline health workers’ safety performance in times of pandemic: the role of spiritual leadership, leading for safety: a question of leadership focus, exploring the relationships between safety compliance, safety participation and safety outcomes: considering the moderating role of job burnout, the combined effect of safety specific transformational leadership and safety consciousness on psychological well-being of healthcare workers, assessing the effects of safety leadership, employee engagement, and psychological safety on safety performance., leadership styles and safety performance in high-risk industries: a systematic review, safety leadership: a meta‐analytic review of transformational and transactional leadership styles as antecedents of safety behaviours, safety management and safety performance nexus: role of safety consciousness, safety climate, and responsible leadership, a correlation among safety leadership, safety climate and safety performance, contextualizing leadership: transformational leadership and management‐by‐exception‐active in safety‐critical contexts, related papers.

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Ancillary hospital workers experience during COVID-19: systematic review and narrative synthesis

COVID-19 overwhelmed healthcare systems worldwide. Its impact on clinical staff is well documented, but little is known about the effects on ancillary staff (cleaners, porters and caterers).

To identify the evidence of the impact of COVID-19 on ancillary staff at National Health Service (NHS) hospitals in England.

Systematic review and narrative synthesis.

Data sources

Databases (MEDLINE, CINAHL Ultimate, APA PsycINFO, APA PsycArticles and Academic Search Ultimate). Reference lists were searched. Four independent reviewers screened titles and abstracts against inclusion criteria. Data were extracted from included papers and studies were critically assessed using relevant critical appraisal tools.

8/178 studies were included, of which 5 quantitative, 2 qualitative and 1 mixed methods. Ancillary staff had higher rates of past and present COVID-19 infection. Participants felt that the work of ancillary staff had been insufficiently recognised by managers and that they had little voice within the NHS. They also experienced inequity regarding available support and safe working practices due to largely digital modes of communication which they rarely, if ever, used. In an evaluation of a personal protective equipment support ‘helper’ programme, ancillary workers were more positive about it than nurses, allied health practitioners, and doctors.

Few studies included ancillary staff. As reported, ancillary staff at NHS hospitals had a higher prevalence of COVID-19 infection but felt marginalised and poorly supported. They valued training when offered. Additional research is needed to understand better the impact of COVID-19 on ancillary key workers, and how best to support them in future similar circumstances.

Read the full article ›

COVID-19: Long-term effects

Some people continue to experience health problems long after having COVID-19. Understand the possible symptoms and risk factors for post-COVID-19 syndrome.

Most people who get coronavirus disease 2019 (COVID-19) recover within a few weeks. But some people — even those who had mild versions of the disease — might have symptoms that last a long time afterward. These ongoing health problems are sometimes called post- COVID-19 syndrome, post- COVID conditions, long COVID-19 , long-haul COVID-19 , and post acute sequelae of SARS COV-2 infection (PASC).

What is post-COVID-19 syndrome and how common is it?

Post- COVID-19 syndrome involves a variety of new, returning or ongoing symptoms that people experience more than four weeks after getting COVID-19 . In some people, post- COVID-19 syndrome lasts months or years or causes disability.

Research suggests that between one month and one year after having COVID-19 , 1 in 5 people ages 18 to 64 has at least one medical condition that might be due to COVID-19 . Among people age 65 and older, 1 in 4 has at least one medical condition that might be due to COVID-19 .

What are the symptoms of post-COVID-19 syndrome?

The most commonly reported symptoms of post- COVID-19 syndrome include:

Symptoms that get worse after physical or mental effort
Lung (respiratory) symptoms, including difficulty breathing or shortness of breath and cough

Other possible symptoms include:

Neurological symptoms or mental health conditions, including difficulty thinking or concentrating, headache, sleep problems, dizziness when you stand, pins-and-needles feeling, loss of smell or taste, and depression or anxiety
Joint or muscle pain
Heart symptoms or conditions, including chest pain and fast or pounding heartbeat
Digestive symptoms, including diarrhea and stomach pain
Blood clots and blood vessel (vascular) issues, including a blood clot that travels to the lungs from deep veins in the legs and blocks blood flow to the lungs (pulmonary embolism)
Other symptoms, such as a rash and changes in the menstrual cycle

Keep in mind that it can be hard to tell if you are having symptoms due to COVID-19 or another cause, such as a preexisting medical condition.

It's also not clear if post- COVID-19 syndrome is new and unique to COVID-19 . Some symptoms are similar to those caused by chronic fatigue syndrome and other chronic illnesses that develop after infections. Chronic fatigue syndrome involves extreme fatigue that worsens with physical or mental activity, but doesn't improve with rest.

Why does COVID-19 cause ongoing health problems?

Organ damage could play a role. People who had severe illness with COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain. Inflammation and problems with the immune system can also happen. It isn't clear how long these effects might last. The effects also could lead to the development of new conditions, such as diabetes or a heart or nervous system condition.

The experience of having severe COVID-19 might be another factor. People with severe symptoms of COVID-19 often need to be treated in a hospital intensive care unit. This can result in extreme weakness and post-traumatic stress disorder, a mental health condition triggered by a terrifying event.

What are the risk factors for post-COVID-19 syndrome?

You might be more likely to have post- COVID-19 syndrome if:

You had severe illness with COVID-19 , especially if you were hospitalized or needed intensive care.
You had certain medical conditions before getting the COVID-19 virus.
You had a condition affecting your organs and tissues (multisystem inflammatory syndrome) while sick with COVID-19 or afterward.

Post- COVID-19 syndrome also appears to be more common in adults than in children and teens. However, anyone who gets COVID-19 can have long-term effects, including people with no symptoms or mild illness with COVID-19 .

What should you do if you have post-COVID-19 syndrome symptoms?

If you're having symptoms of post- COVID-19 syndrome, talk to your health care provider. To prepare for your appointment, write down:

When your symptoms started
What makes your symptoms worse
How often you experience symptoms
How your symptoms affect your activities

Your health care provider might do lab tests, such as a complete blood count or liver function test. You might have other tests or procedures, such as chest X-rays, based on your symptoms. The information you provide and any test results will help your health care provider come up with a treatment plan.

In addition, you might benefit from connecting with others in a support group and sharing resources.

Long COVID or post-COVID conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html. Accessed May 6, 2022.
Post-COVID conditions: Overview for healthcare providers. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html. Accessed May 6, 2022.
Mikkelsen ME, et al. COVID-19: Evaluation and management of adults following acute viral illness. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
Saeed S, et al. Coronavirus disease 2019 and cardiovascular complications: Focused clinical review. Journal of Hypertension. 2021; doi:10.1097/HJH.0000000000002819.
AskMayoExpert. Post-COVID-19 syndrome. Mayo Clinic; 2022.
Multisystem inflammatory syndrome (MIS). Centers for Disease Control and Prevention. https://www.cdc.gov/mis/index.html. Accessed May 24, 2022.
Patient tips: Healthcare provider appointments for post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/post-covid-appointment/index.html. Accessed May 24, 2022.
Bull-Otterson L, et al. Post-COVID conditions among adult COVID-19 survivors aged 18-64 and ≥ 65 years — United States, March 2020 — November 2021. MMWR Morbidity and Mortality Weekly Report. 2022; doi:10.15585/mmwr.mm7121e1.

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What to know about COVID symptoms, CDC guidelines if you test positive

By nbc chicago staff • published august 11, 2024 • updated on august 11, 2024 at 6:43 pm.

Though the summer of 2024 has been life back to normal in many ways throughout the world in regards to the COVID-19 pandemic, those who have tested positive for the virus recently may be wondering what has changed in regards to symptoms and CDC guidelines.

While weekly case data is no longer reported by the Illinois Department of Public Health, those who have recently attended Lollapalooza or other major events may have tested positive in recent days.

📺 24/7 Chicago news stream: Watch NBC 5 free wherever you are

If you contracted COVID in past months or years, the guidelines may be different this time around, due to significant changes initiated by the CDC earlier this year.

Here's what to know:

In March, the Centers for Disease Control and Prevention updated its COVID guidelines to mirror guidance for other respiratory infections. Those who contracted COVID-19 no longer need to stay away from others for five days, the CDC said, effectively nixing the five-day isolation recommendation.

COVID symptoms summer 2024: What to watch for as new variants rise, spread

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KP.3 COVID variant is dominant in the US: What are the symptoms?

People can return to work or regular activities if their symptoms are mild and improving and it's been a day since they've had a fever, but the CDC still recommends those with symptoms stay home.

"The recommendations suggest returning to normal activities when, for at least 24 hours, symptoms are improving overall, and if a fever was present, it has been gone without use of a fever-reducing medication," the guidance states.

Once activities are resumed, the CDC still recommends "additional prevention strategies" for an additional five days, including wearing a mask and keeping distance from others.

The agency is emphasizing that people should still try to prevent infections in the first place, by getting vaccinated, washing their hands, and taking steps to bring in more outdoor fresh air.

Feeling out of the loop? We'll catch you up on the Chicago news you need to know. Sign up for the weekly Chicago Catch-Up newsletter .

As part of the guidance, the CDC suggests:

Staying up to date with vaccination to protect people against serious illness, hospitalization, and death. This includes flu, COVID-19, and RSV if eligible.
Practicing good hygiene by covering coughs and sneezes, washing or sanitizing hands often, and cleaning frequently touched surfaces.
Taking steps for cleaner air , such as bringing in more fresh outside air, purifying indoor air, or gathering outdoors.

The change comes at a time when COVID-19 is no longer the public health menace it once was. It dropped from being the nation's third leading cause of death early in the pandemic to 10th last year.

Most people have some degree of immunity to the coronavirus from past vaccinations or from infections. And many people are not following the five-day isolation guidance anyway, some experts say.

What are the symptoms?

Sore throat
Muscle aches
Altered sense of smell
Fever or chills
Shortness of breath or difficulty breathing
Nausea or vomiting

Last year, a Chicago-area doctor said she's noticed shifts in the most common symptoms her patients reported as the JN.1 variant rose to dominance.

Dr. Chantel Tinfang, a family medicine physician with Sengstacke Health Center at Provident Hospital of Cook County, noted at the time that many of the cases she saw reported less of the fever, body aches and chills, and presented more with sore throat, fatigue and coughing.

"We still see some patients experiencing decreased appetite, a loss of taste or smell. So it kind of depends," she said. "One patient was just very, very tired. Like she couldn't really do much. And that's when you know ... it's different. It's not just coughing and shortness of breath. We still see that though."

She suggested consulting with your doctor if your symptoms don't begin to improve outside of the recommended isolation period.

As for timing, symptoms can last for several days, but in some cases, even longer.

"Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as Long COVID or Post-COVID Conditions (PCC)," according to the CDC.

Such symptoms can last for weeks and possibly even years.

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WHO offers new online course on building resilient health systems

In 2022, the World Health Organization (WHO) introduced a new online course aimed at strengthening health systems resilience in the face of public health challenges. The course – available through OpenWHO – addresses both acute shocks, such as infectious disease outbreaks and environmental disasters, and chronic stressors like non-communicable diseases and antimicrobial resistance.

Course overview

As demonstrated by the COVID-19 pandemic, health systems worldwide are under constant pressure from a range of public health threats, both acute and chronic. These challenges can severely impact the delivery of essential health services, leading to setbacks in achieving universal health coverage (UHC) and health security goals. WHO emphasizes the need for a renewed focus on building resilience by addressing critical vulnerabilities within health systems – before, during and after a shock event.

This course targets decision-makers in public health policy and health service managers at national, subnational and community levels. It promotes an integrated approach and actions to enhance health systems resilience across policymaking, planning, service delivery and monitoring and evaluation.

Course structure and certification

The course, which takes approximately five hours to complete, is divided into four modules:

Introduction to health systems resilience covers the definition, importance and key attributes of health systems resilience;
Building health system resilience before shock events focuses on governance, intersectoral coordination and continuity planning;
Health systems resilience during shock events discusses maintaining essential health services and integrating resilience into incident management systems; and
Health systems recovery and building resilience outlines steps for recovery and the importance of post-event evaluations.

Each module has short learning sessions with exercises, case scenarios, discussion points and quizzes. Participants who score at least 80% will receive a Record of Achievement certificate, while those who complete 80% of the course material will earn a Confirmation of Participation certificate. Additionally, a digital Open Badge is available for those who achieve a Record of Achievement.

Since the offline course materials were adapted for virtual learning and published on OpenWHO in 2022, there have been 6870 enrollments – a testament to the growing need for WHO’s support in this area.

This dedicated training package is part of WHO’s programme of work on health systems resilience and essential public health functions which is supported by the UHC Partnership as well as by other partners including the Korea International Cooperation Agency (KOICA), the United States Agency for International Development (USAID), the Public Health Agency of Canada (PHAC), and the Foreign, Commonwealth and Development Office (FCDO) of the United Kingdom.

Learning outcomes

By the end of the course, participants will be able to:

incorporate resilience attributes into health policies and plans
apply integrated approaches to building health systems resilience
advocate for the implementation of key resilience requirements.

For more information and to enrol in the course, visit the course webpage .

About OpenWHO

OpenWHO , launched in 2017 by the Learning and Capacity Development Unit in the WHO Health Emergencies Programme, is a free open-access online learning platform covering a wide a variety of public health topics. It offers self-paced, multilingual courses based on WHO’s guidance and designed for frontline responders, health workers, policymakers and anyone interested in public health. The platform provides low-bandwidth, adaptable and translatable resources. It also offers CPD-accredited courses for ongoing professional development.

For more information, visit the publications , newsletters and FAQ section of the website. Join OpenWHO today to access high-quality learning programs and make a difference in public health.

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Building health system resilience to public health challenges: guidance for implementation in countries

WHO Special Programme on Primary Health Care

Kids’ mental health is in crisis. Here’s what psychologists are doing to help

Research is focused on child and teen mental health, exploring why they are struggling and what can be done to help them

Vol. 54 No. 1 Print version: page 63

Mental Health

[ This article is part of the 2023 Trends Report ]

The Covid -19 pandemic era ushered in a new set of challenges for youth in the United States, leading to a mental health crisis as declared by the United States surgeon general just over a year ago. But U.S. children and teens have been suffering for far longer.

In the 10 years leading up to the pandemic, feelings of persistent sadness and hopelessness—as well as suicidal thoughts and behaviors—increased by about 40% among young people, according to the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Surveillance System .

“We’re seeing really high rates of suicide and depression, and this has been going on for a while,” said psychologist Kimberly Hoagwood, PhD, a professor of child and adolescent psychiatry at New York University’s Grossman School of Medicine. “It certainly got worse during the pandemic.”

In addition to the social isolation and academic disruption nearly all children and teens faced, many also lost caregivers to Covid -19, had a parent lose their job, or were victims of physical or emotional abuse at home.

All these difficulties, on top of growing concerns about social media, mass violence, natural disasters, climate change, and political polarization—not to mention the normal ups and downs of childhood and adolescence—can feel insurmountable for those who work with kids.

“The idea of a ‘mental health crisis’ is really broad. For providers and parents, the term can be anxiety-provoking,” said Melissa Brymer, PhD, who directs terrorism and disaster programs at the UCLA–Duke University National Center for Child Traumatic Stress. “Part of our role is to highlight specific areas that are critical in this discussion.”

Across the field, psychologists are doing just that. In addition to studying the biological, social, and structural contributors to the current situation, they are developing and disseminating solutions to families, in schools, and at the state level. They’re exploring ways to improve clinical training and capacity and working to restructure policies to support the most vulnerable children and teens.

Psychologists were also behind new mental health recommendations from the U.S. Preventive Services Task Force, a group of volunteer health professionals who evaluate evidence on various preventive health services. The task force now recommends regular anxiety screenings for youth ages 8 to 18 and regular depression screenings for adolescents ages 12 to 18.

“I see these trends in children’s mental health problems as being critical, but there are solutions,” Hoagwood said. “If we refocus our efforts toward those solutions, we could see some of these tides turn.”

Sources of stress

Across the United States, more than 200,000 children lost a parent or primary caregiver to Covid -19 (“ Covid -19 Orphanhood,” Imperial College London, 2022). In the face of those losses, families had to curtail mourning rituals and goodbye traditions because of social distancing requirements and other public health measures, Brymer said. Many children are still grieving, sometimes while facing added challenges such as moving to a different home or transferring to a new school with unfamiliar peers.

The CDC also reports that during the pandemic, 29% of U.S. high school students had a parent or caregiver who lost their job, 55% were emotionally abused by a parent or caregiver, and 11% were physically abused ( Adolescent Behaviors and Experiences Survey—United States, January–June 2021 , CDC ).

“Schools are crucial for keeping kids safe and connecting them with services, but the pandemic completely disrupted those kinds of supports,” Brymer said.

Those extreme disruptions didn’t affect all young people equally. Echoing pre- Covid -19 trends, the CDC also found that girls, LGBTQ+ youth, and those who have experienced racism were more likely to have poor mental health during the pandemic, said social psychologist Kathleen Ethier, PhD, director of the CDC’s Division of Adolescent and School Health.

Contributing factors likely include stigma, discrimination, and online bullying, Ethier said. Female students also report much higher levels of sexual violence than their male peers, which can further harm mental health.

As much hardship as Covid -19 wrought, it’s far from the only factor contributing to the current crisis. Biology also appears to play a role. The age of puberty has been dropping for decades, especially in girls, likely leading to difficulty processing complex feelings and knowing what to do about them ( Eckert-Lind, C., et al., JAMA Pediatrics , Vol. 174, No. 4, 2020 ). In early puberty, regions of the brain linked to emotions and social behavior are developing more quickly than regions responsible for the cognitive control of behavior, such as the prefrontal cortex, Ethier said.

Those developmental changes drive young people to seek attention and approval from their peers . For some, using social media fulfills that need in a healthy way, providing opportunities for connection and validation to youth who may be isolated from peers, geographically or otherwise.

For others, negative messages—including online bullying and unrealistic standards around physical appearance—appear to have a detrimental effect, but more research is needed to understand who is most at risk.

“There is clearly some aspect of young people’s online life that’s contributing [to the mental health crisis], we just don’t know exactly what that is,” said Ethier.

Finally, structural factors that affect millions of U.S. children, including poverty, food insecurity, homelessness, and lack of access to health care and educational opportunities, can lead to stress-response patterns that are known to underlie mental health challenges.

“Even in very young children, prolonged stress can trigger a cycle of emotion-regulation problems, which can in turn lead to anxiety, depression, and behavioral difficulties,” Hoagwood said. “These things are well established, but we’re not doing enough as a field to address them.”

Building capacity in schools

The biggest challenge facing mental health care providers right now, experts say, is a shortage of providers trained to meet the mounting needs of children and adolescents.

“There’s a growing recognition that mental health is just as important as physical health in young people’s development, but that’s happening just as mental health services are under extreme strain,” said clinical psychologist Robin Gurwitch, PhD, a professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center.

Schools, for example, are a key way to reach and help children—but a 2022 Pew Research Center survey found that only about half of U.S. public schools offer mental health assessments and even fewer offer treatment services. Psychologists are now ramping up efforts to better equip schools to support student well-being onsite.

Much of that work involves changing policies at the school or district level to provide more support for all students. For example, school connectedness—the degree to which young people feel that adults and peers at school care about them and are invested in their success—is a key contributor to mental health. Youth who felt connected during middle and high school have fewer problems with substance use, mental health, suicidality, and risky sexual behavior as adults ( Steiner, R. J., et al., Pediatrics , Vol. 144, No. 1, 2019 ).

Through its What Works in Schools program , the CDC funds school districts to make changes that research shows foster school connectedness. Those include improving classroom management, implementing service-learning programs for students in their communities, bringing mentors from the community into schools, and making schools safer and more supportive for LGBTQ+ students.

Psychologists are also building training programs to help teachers and other school staff create supportive classrooms and aid students who are in distress. Classroom Wise (Well-Being Information and Strategies for Educators), developed by the Mental Health Technology Transfer Center Network and the University of Maryland’s National Center for School Mental Health (NCSMH), is a free, flexible online course and resource library that draws on psychological research on social-emotional learning, behavioral regulation, mental health literacy, trauma, and more ( Evidence-Based Components of Classroom Wise (PDF, 205KB), NCSMH, 2021 ).

“We’re using evidence-based practices from child and adolescent mental health but making these strategies readily available for teachers to apply in the classroom,” said clinical psychologist Nancy Lever, PhD, codirector of NCSMH, who helped develop Classroom Wise .

The course incorporates the voices of students and educators and teaches actionable strategies such as how to create rules and routines that make classrooms feel safe and how to model emotional self-regulation. The strategies can be used by anyone who interacts with students, from teachers and administrators to school nurses, coaches, and bus drivers.

“What we need is to build capacity through all of the systems that are part of children’s lives—in families, in schools, in the education of everybody who interacts with children,” said psychologist Ann Masten, PhD, a professor of child development at the University of Minnesota.

Other training efforts focus on the students themselves. Given that preteens and teenagers tend to seek support from their peers before turning to adults, the National Child Traumatic Stress Network (NCTSN) created conversation cards to equip kids with basic skills for talking about suicide. The advice, available in English and Spanish, includes how to ask about suicidal thoughts, how to listen without judgment, and when to seek guidance from an adult ( Talking About Suicide With Friends and Peers, NCTSN, 2021 ).

While training people across the school population to spot and address mental health concerns can help reduce the strain on mental health professionals, there will always be a subset of students who need more specialized support.

Telehealth, nearly ubiquitous these days, is one of the best ways to do that. In South Carolina, psychologist Regan Stewart, PhD, and her colleagues colaunched the Telehealth Outreach Program at the Medical University of South Carolina in 2015. Today, nearly every school in the state has telehealth equipment (Wi-Fi and tablets or laptops that kids can use at school or take home) and access to providers (psychology and social work graduate students and clinicians trained in trauma-focused cognitive behavioral therapy). Students who need services, which are free thanks to grant funding or covered by Medicaid, meet one-on-one with their clinician during the school day or after hours ( American Psychologist , Vol. 75, No. 8, 2020 ).

“We learned a lot about the use of technology during the pandemic,” Ethier said. “At this point, it’s very much a matter of having sufficient resources so more school districts can access those sources of care.”

Expanding the workforce

Limited resources are leaving families low on options, with some young people making multiple trips to the emergency room for mental health-related concerns or spending more than six months on a waiting list for mental health support. That points to a need for more trained emergency responders and psychiatric beds, psychologists say, but also for better upstream screening and prevention to reduce the need for intensive care.

“Just as we need more capacity for psychiatric emergencies in kids, we also need an infusion of knowledge and ordinary strategies to support mental health on the positive side,” Masten said.

In New York, Hoagwood helped launch the state-funded Evidence Based Treatment Dissemination Center in 2006, which offers free training on evidence-based practices for trauma, behavioral and attention problems, anxiety, depression, and more to all mental health professionals who work with children in state-licensed programs, which include foster care, juvenile justice, and school settings, among others. The center provides training on a core set of tools known as PracticeWise ( Chorpita, B. F., & Daleiden E. L., Journal of Consulting and Clinical Psychology , Vol. 77, No. 3, 2009 ). It also offers tailored training based on requests from community agency leaders and clinicians who provide services to children and their families.

Hoagwood, in collaboration with a consortium of family advocates, state officials, and researchers, also helped build and test a state-approved training model and credentialing program for family and youth peer advocates. The peer advocate programs help expand the mental health workforce while giving families access to peers who have similar lived experience ( Psychiatric Services , Vol. 71, No. 5, 2020).

Youth peer advocates are young adults who have personal experience with systems such as foster care, juvenile justice, or state psychiatric care. They work within care teams to provide basic education and emotional support to other youth, such as giving advice on what questions to ask a new mental health practitioner and explaining the differences between psychologists, psychiatrists, and social workers. Youth peer advocates in New York can now receive college credit for their training in peer specialist work.

“Making community health work into a viable career can also increase diversity among mental health workers and help us address structural racism,” Hoagwood said.

Pediatricians are another group that can provide a first line of defense, drawing on their relationships with parents to destigmatize mental health care.

“Pediatricians are in many ways uniquely positioned to help address the mental health crisis in youth,” said Janine A. Rethy, MD, MPH, division chief of community pediatrics at MedStar Georgetown University Hospital and an associate professor of pediatrics at Georgetown University School of Medicine. “We have the privilege of building long-term relationships with children and their families over many years,” with at least 12 well-child checkups in just the first three years of a child’s life, followed by annual visits.

During these visits, they can watch for warning signs of social and behavioral problems and screen for maternal depression and other issues in parents, which is now recommended by the American Academy of Pediatrics (PDF, 660KB) . Several new resources provide guidance for integrating mental health care into pediatric practices, including the Behavioral Health Integration Compendium (PDF, 4.1MB) and the Healthy Steps program . But most pediatricians need more education on mental health issues in order to effectively respond, Rethy said—yet another area where psychologists may be able to help. Psychologists can provide direct consultations and training to pediatricians through the Pediatric Mental Health Care Access program.

“The more we can weave mental health knowledge, capacity, and checkpoints into places where parents feel comfortable—like the doctor’s office and at school—the better,” Masten said. “All professionals who work with young people really need the knowledge that’s being generated by psychologists.”

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Editor in Chief's Introduction to Essays on the Impact of COVID-19 on Work and Workers

On March 11, 2020, the World Health Organization declared that COVID-19 was a global pandemic, indicating significant global spread of an infectious disease ( World Health Organization, 2020 ). At that point, there were 118,000 confirmed cases of the coronavirus in 110 countries. China had been the first country with a widespread outbreak in January, and South Korea, Iran and Italy following in February with their own outbreaks. Soon, the virus was in all continents and over 177 countries, and as of this writing, the United States has the highest number of confirmed cases and, sadly, the most deaths. The virus was extremely contagious and led to death in the most vulnerable, particularly those older than 60 and those with underlying conditions. The most critical cases led to an overwhelming number being admitted into the intensive care units of hospitals, leading to a concern that the virus would overwhelm local health care systems. Today, in early May 2020, there have been nearly 250,000 deaths worldwide, with over 3,500,000 confirmed cases ( Hopkins, 2020 ). The human toll is staggering, and experts are predicting a second wave in summer or fall.

As the deaths rose from the virus that had no known treatment or vaccine countries shut their borders, banned travel to other countries and began to issue orders for their citizens to stay at home, with no gatherings of more than 10 individuals. Schools and universities closed their physical locations and moved education online. Sporting events were canceled, airlines cut flights, tourism evaporated, restaurants, movie theaters and bars closed, theater productions canceled, manufacturing facilities, services, and retail stores closed. In some businesses and industries, employees have been able to work remotely from home, but in others, workers have been laid off, furloughed, or had their hours cut. The International Labor Organization (ILO) estimates that there was a 4.5% reduction in hours in the first quarter of 2020, and 10.5% reduction is expected in the second quarter ( ILO, 2020a ). The latter is equivalent to 305 million jobs ( ILO, 2020a ).

Globally, over 430 million enterprises are at risk of disruption, with about half of those in the wholesale and retail trades ( ILO, 2020a ). Much focus in the press has been on the impact in Europe and North America, but the effect on developing countries is even more critical. An example of the latter is the Bangladeshi ready-made-garment sector ( Leitheiser et al., 2020 ), a global industry that depends on a supply chain of raw material from a few countries and produces those garments for retail stores throughout North America and Europe. But, in January 2020, raw material from China was delayed by the shutdown in China, creating delays and work stoppages in Bangladesh. By the time Bangladeshi factories had the material to make garments, in March, retailers in Europe and North American began to cancel orders or put them on hold, canceling or delaying payment. Factories shut down and workers were laid off without pay. Nearly a million people lost their jobs. Overall, since February 2020, the factories in Bangladesh have lost nearly 3 billion dollars in revenue. And, the retail stores that would have sold the garments have also closed. This demonstrates the ripple effect of the disruption of one industry that affects multiple countries and sets of workers, because consider that, in turn, there will be less raw material needed from China, and fewer workers needed there. One need only multiply this example by hundreds to consider the global impact of COVID-19 across the world of work.

The ILO (2020b) notes that it is difficult to collect employment statistics from different countries, so a total global unemployment rate is unavailable at this time. However, they predict significant increase in unemployment, and the number of individuals filing for unemployment benefits in the United States may be an indicator of the magnitude of those unemployed. In the United States, over 30 million filed for unemployment between March 11 and April 30 ( Bureau of Labor Statistics, 2020 ), effectively this is an unemployment rate of 18%. By contrast, in February 2020, the US unemployment rate was 3.5% ( Bureau of Labor Statistics, 2020 ).

Clearly, COVID-19 has had an enormous disruption on work and workers, most critically for those who have lost their employment. But, even for those continuing to work, there have been disruptions in where people work, with whom they work, what they do, and how much they earn. And, as of this writing, it is also a time of great uncertainty, as countries are slowly trying to ease restrictions to allow people to go back to work--- in a “new normal”, without the ability to predict if they can prevent further infectious “spikes”. The anxieties about not knowing what is coming, when it will end, or what work will entail led us to develop this set of essays about future research on COVID-19 and its impact on work and workers.

These essays began with an idea by Associate Editor Jos Akkermans, who noted to me that the global pandemic was creating a set of career shocks for workers. He suggested writing an essay for the Journal . The Journal of Vocational Behavior has not traditionally published essays, but these are such unusual times, and COVID-19 is so relevant to our collective research on work that I thought it was a good idea. I issued an invitation to the Associate Editors to submit a brief (3000 word) essay on the implications of COVID-19 on work and/or workers with an emphasis on research in the area. At the same time, a group of international scholars was coming together to consider the effects of COVID-19 on unemployment in several countries, and I invited that group to contribute an essay, as well ( Blustein et al., 2020 ).

The following are a set of nine thoughtful set of papers on how the COVID-19 could (and perhaps will) affect vocational behavior; they all provide suggestions for future research. Akkermans, Richardson, and Kraimer (2020) explore how the pandemic may be a career shock for many, but also how that may not necessarily be a negative experience. Blustein et al. (2020) focus on global unemployment, also acknowledging the privileged status they have as professors studying these phenomena. Cho examines the effect of the pandemic on micro-boundaries (across domains) as well as across national (macro) boundaries ( Cho, 2020 ). Guan, Deng, and Zhou (2020) drawing from cultural psychology, discuss how cultural orientations shape an individual's response to COVID-19, but also how a national cultural perspective influences collective actions. Kantamneni (2020) emphasized the effects on marginalized populations in the United States, as well as the very real effects of racism for Asians and Asian-Americans in the US. Kramer and Kramer (2020) discuss the impact of the pandemic in the perceptions of various occupations, whether perceptions of “good” and “bad” jobs will change and whether working remotely will permanently change where people will want to work. Restubog, Ocampo, and Wang (2020) also focused on individual's responses to the global crisis, concentrating on emotional regulation as a challenge, with suggestions for better managing the stress surrounding the anxiety of uncertainty. Rudolph and Zacher (2020) cautioned against using a generational lens in research, advocating for a lifespan developmental approach. Spurk and Straub (2020) also review issues related to unemployment, but focus on the impact of COVID-19 specifically on “gig” or flexible work arrangements.

I am grateful for the contributions of these groups of scholars, and proud of their ability to write these. They were able to write constructive essays in a short time frame when they were, themselves, dealing with disruptions at work. Some were home-schooling children, some were worried about an absent partner or a vulnerable loved one, some were struggling with the challenges that Restubog et al. (2020) outlined. I hope the thoughts, suggestions, and recommendations in these essays will help to stimulate productive thought on the effect of COVID-19 on work and workers. And, while, I hope this research spurs to better understand the effects of such shocks on work, I really hope we do not have to cope with such a shock again.

Akkermans J., Richardson J., Kraimer M. The Covid-19 crisis as a career shock: Implications for careers and vocational behavior. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Blustein D.L., Duffy R., Ferreira J.A., Cohen-Scali V., Cinamon R.G., Allan B.A. Unemployment in the time of COVID-19: A research agenda. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
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Cho E. Examining boundaries to understand the impact of COVID-19 on vocational behaviors. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Guan Y., Deng H., Zhou X. Understanding the impact of the COVID-19 pandemic on career development: Insights from cultural psychology. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
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International Labor Organization ILO monitor: COVID-19 and the world of work. Third edition updated estimates and analysis. 2020. https://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/briefingnote/wcms_743146.pdf Retrieved May 5, 2020 from:
International Labor Organization (2020b) COVID-19 impact on the collection of labour market statistics. Retrieved May 6, 2020 from: https://ilostat.ilo.org .
Kantamneni, N. (2020). The impact of the COVID-19 pandemic on marginalized populations in the United States: A research agenda. Journal of Vocational Behavior, 119 . [ PMC free article ] [ PubMed ]
Kramer A., Kramer K.Z. The potential impact of the Covid-19 pandemic on occupational status, work from home, and occupational mobility. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Leitheiser, E., Hossain, S.N., Shuvro, S., Tasnim, G., Moon, J., Knudsen, J.S., & Rahman, S. (2020). Early impacts of coronavirus on Bangladesh apparel supply chains. https://www.cbs.dk/files/cbs.dk/risc_report_-_impacts_of_coronavirus_on_bangladesh_rmg_1.pdf .
Restubog S.L.D., Ocampo A.C., Wang L. Taking control amidst the Chaos: Emotion regulation during the COVID-19 pandemic. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Rudolph C.W., Zacher H. COVID-19 and careers: On the futility of generational explanations. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Spurk D., Straub C. Flexible employment relationships and careers in times of the COVID-19 pandemic. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
World Health Organization (2020). World Health Organization Coronavirus Update. Retrieved May 5, 2020 from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 .

IMAGES

Mental health challenges for healthcare workers during the COVID-19
COVID-19's impact on healthcare
COVID-19 Impact on Healthcare Workers
The Mental Health of Healthcare Workers in COVID-19
COVID-19’s potential impact on healthcare
COVID-19 Risks and Impacts Among Health Care Workers by Race/Ethnicity

COMMENTS

Impact of COVID-19 pandemic on healthcare workers
The COVID-19 pandemic is a healthcare crisis, leading to unprecedented impact on healthcare services, notable morbidity and mortality of the public and healthcare workers (HCWs), economic repercussions, and significant psychological effects. To reduce the risk of viral transmission from person to person during the pandemic, the Indian ...
COVID-19: a heavy toll on health-care workers
The COVID-19 pandemic is a stark reminder of racial and socioeconomic disparities, with disproportionate infection and death rates among migrants, the poor, and racialised groups. COVID-19 has also had a disproportionate effect on women health-care workers. Women comprise 70% of the global health and social care workforce, putting them at risk ...
The Impact of COVID-19 on Healthcare Worker Wellness: A Scoping Review
INTRODUCTION. The COVID-19 pandemic has resulted in significant burdens globally. Detrimental effects include high rates of infection and death, financial hardships faced by individuals, stress related to known and particularly unknown information, and fear of the uncertainty regarding continued impact. Healthcare workers (HCWs), at the heart ...
The overall impact of COVID‐19 on healthcare during the pandemic: A
The impact of COVID‐19 on the health care system has been dramatic as it had to undergo major changes such as postponement of elective surgeries and non‐urgent medical care, and acceptance of telehealth to achieve pandemic preparedness. Patients have had difficulty reaching the hospital through ambulances and those with a chronic disease ...
Confronting Health Worker Burnout and Well-Being
Early in the Covid-19 pandemic, when much of U.S. society shut down, health workers put their own safety on the line and kept going to work to care for patients.
The impact of COVID-19 on health and care workers:
Key messages. Between January 2020 and May 2021, surveillance data reported to WHO showed 3.45 million deaths due to COVID-19. Of these only 6643 deaths were identified as being in health and care workers (HCWs), but this figure significantly under-reports the burden of mortality world-wide in this group.
The Impact of COVID-19 on Healthcare Worker Wellness: A ...
The psychological burden and overall wellness of HCWs has received heightened awareness in news and research publications. The purpose of this study was to provide a review on current publications measuring the effects of COVID-19 on wellness of healthcare providers to inform interventional strategies. Between April 6-May 17, 2020, we conducted ...
Impact of the COVID-19 crisis on work and private ...
The COVID-19 crisis has radically changed the way people live and work. While most studies have focused on prevailing negative consequences, potential positive shifts in everyday life have received less attention. Thus, we examined the actual and perceived overall impact of the COVID-19 crisis on work and private life, and the consequences for mental well-being (MWB), and self-rated health ...
Health care workers' experiences during the COVID-19 pandemic: a
The COVID-19 pandemic has put health systems worldwide under pressure and tested their resilience. The World Health Organization (WHO) acknowledges health workforce as one of the six building blocks of health systems [].Health care workers (HCWs) are key to a health system's ability to respond to external shocks such as outbreaks and as first responders are often the hardest hit by these ...
Experiences of frontline healthcare workers and their views about
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 ...
Physical and mental health impacts of COVID-19 on healthcare workers: a
Background Coronavirus disease (COVID-19) pandemic has spread to 198 countries, with approximately 2.4 million confirmed cases and 150,000 deaths globally as of April 18. Frontline healthcare workers (HCWs) face a substantially higher risk of infection and death due to excessive COVID-19 exposure. This review aimed at summarizing the evidence of the physical and mental health impacts of COVID ...
Covid-19
A Crisis in Public Health. The United States has 4% of the world's population but, as of July 16, approximately 26% of its Covid-19 cases and 24% of its Covid-19 deaths. 17 These startling ...
The Effects of COVID-19 on Healthcare Workers: An Exploration of Burnout
emotional exhaustion while 556 (27.6%) nurses marked high depersonalization while working. caring for COVID-19 patients (Hu, et al, 2020). A majority of participating nurses also disclosed. that they were experiencing moderate (28%) and high (36.2%) levels of fear when delivering.
Covid-19: risks to healthcare workers and their families
Since the beginning of the coronavirus 2019 (covid-19) pandemic, healthcare workers have shown a remarkable resilience and professional dedication despite a fear of becoming infected and infecting others. 1 In a linked paper (doi: 10.1136/bmj.m3582 ), Shah and colleagues now report robust and concerning findings regarding the risks of covid-19 ...
Keep health workers safe to keep patients safe: WHO
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Healthcare Workers' Burdens During the COVID-19 Pandemic: A Qualitative
The study results demonstrate that the COVID-19 pandemic has had an impact on all aspects of life, especially for healthcare providers, who work on the frontlines. ... and protection of healthcare workers from COVID-19. Antimicrob Resist Infect Control. 2020; 9 (1):100. doi: 10.1186/s13756-020-00763- ... The experiences of health-care ...
COVID-19's impact on work, workers, and the workplace of the future
The authors project that working from home will not only continue for many workers, but that "COVID-19 will accelerate trends towards working from home past the immediate impacts of the pandemic.". This will be driven, in part, as organizations recognize the health risks of open-plan offices. "As we now live and work in globally ...
Impact of the COVID-19 pandemic on healthcare workers
The COVID-19 pandemic has impacted healthcare workers physically and psychologically. [1] Healthcare workers are more vulnerable to COVID-19 infection than the general population due to frequent contact with infected individuals. Healthcare workers have been required to work under stressful conditions without proper protective equipment, and ...
Impact of COVID-19 on people's livelihoods, their health and our food
Reading time: 3 min (864 words) The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty ...
Testing an intervention to improve health care worker well ...
Many healthcare workers experienced burnout, fatigue, and other adverse psychological outcomes stemming from the COVID-19 pandemic. This study examined the impact of a peer-to-peer support intervention (Stress First Aid) to improve health care worker well-being during the COVID-19 pandemic. Among 28 hospitals and federally qualified health centers (FQHCs) and 2,077 health care workers, the ...
Healthcare staff experiences on the impact of COVID-19 on emergency
The COVID-19 pandemic has had a major impact on the access and delivery of healthcare services, posing unprecedented challenges to healthcare staff worldwide. Frontline healthcare staff faced unique stressors and challenges that impact their well-being and patient care. This qualitative study aimed to explore the experiences and perspectives of frontline ED healthcare staff on emergency care ...
Safety first, but how? Examining the impact of safety leadership in
The findings show that safety leadership positively impacts safety performance, and the SCC‐safety compliance was negatively moderated by CT, though it did not moderate the SCC‐safety participation relationship. With the high rates of health workers' mortality and morbidity during health crises such as the COVID‐19 pandemic, this study examined how safety leadership style could improve ...
Ancillary hospital workers experience during COVID-19: systematic
COVID-19 overwhelmed healthcare systems worldwide. Its impact on clinical staff is well documented, but little is known about the effects on ancillary staff (cleaners, porters and caterers). Aim. To identify the evidence of the impact of COVID-19 on ancillary staff at National Health Service (NHS) hospitals in England. Design
COVID-19: Long-term effects
But some people — even those who had mild versions of the disease — might have symptoms that last a long time afterward. These ongoing health problems are sometimes called post-COVID-19 syndrome, post-COVID conditions, long COVID-19, long-haul COVID-19, and post acute sequelae of SARS COV-2 infection (PASC).
The Well-Being of Healthcare Workers During the COVID-19 Pandemic: A
The coronavirus disease 2019 (COVID-19) pandemic has turned into a global healthcare challenge, causing significant morbidity and mortality.Healthcare workers (HCWs) who are on the frontline of the COVID-19 outbreak response face an increased risk of contracting the disease. Some common challenges encountered by HCWs include exposure to the ...
What to know about COVID symptoms, CDC guidelines
The change comes at a time when COVID-19 is no longer the public health menace it once was. It dropped from being the nation's third leading cause of death early in the pandemic to 10th last year.
WHO offers new online course on building resilient health systems
As demonstrated by the COVID-19 pandemic, health systems worldwide are under constant pressure from a range of public health threats, both acute and chronic. These challenges can severely impact the delivery of essential health services, leading to setbacks in achieving universal health coverage (UHC) and health security goals.
Kids' mental health is in crisis. Here's what psychologists are doing
The Covid-19 pandemic era ushered in a new set of challenges for youth in the United States, leading to a mental health crisis as declared by the United States surgeon general just over a year ago.But U.S. children and teens have been suffering for far longer. In the 10 years leading up to the pandemic, feelings of persistent sadness and hopelessness—as well as suicidal thoughts and ...
College of Social Sciences and Public Policy
$3M estate gift to FSU expresses couple's 'love for the university' In a significant show of support for their alma mater, Florida State University alumni Scott and Suzi Brock recently announced a $3 million charitable bequest that underscores the couple's enduring appreciation for FSU Athletics, gives back to the College of Business and honors Scott Brock's late father, a northwest ...
Editor in Chief's Introduction to Essays on the Impact of COVID-19 on
Editor in Chief's Introduction to Essays on the Impact of COVID-19 on Work and Workers. On March 11, 2020, the World Health Organization declared that COVID-19 was a global pandemic, indicating significant global spread of an infectious disease ( World Health Organization, 2020 ). At that point, there were 118,000 confirmed cases of the ...

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Impact of the COVID-19 crisis on work and private life, mental well-being and self-rated health in German and Swiss employees: a cross-sectional online survey

Key findings

Aim and objectives

Perceived overall impact of COVID-19 on work and private life

Changes in work and private life routines

Statistical analysis

Perceived overall impact of COVID-19 crisis and self-reported changes in work and private life routines

Factors associated with perceived impact on work life

Factors associated with perceived impact on private life

Association between the perceived impact, self-reported changes, mental well-being and self-rated health

Limitations and strengths

Conclusion and policy recommendations

Availability of data and materials

Abbreviations

Acknowledgements

Author information

Contributions

Corresponding author

Ethics declarations

Consent for publication

Competing interests

Additional information

Supplementary Information

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BMC Public Health

Health care workers’ experiences during the COVID-19 pandemic: a scoping review

Conclusions

Introduction

Information sources

Search strategy

Eligibility criteria

Selection process

Data collection process

Synthesis methods

Study selection

Study characteristics

Results of syntheses

Individual level

Interpersonal level

Institutional level

Community level

Policy level

Limitations and strengths

Implications for policy and practice

Availability of data and materials

Abbreviations

Acknowledgements

Author information

Contributions

Corresponding author

Ethics declarations

Additional information

Supplementary Information

Additional file 2

Additional file 3

Additional file 4

Rights and permissions

About this article

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Human Resources for Health

Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review

Study design

Literature search strategies

Eligibility criteria

Identification and selection of studies

Data extraction from included studies

Summarizing the findings

Studies’ characteristics

Research domains

Mental health impacts

Physical health impacts