Frontline interdisciplinary clinician perspectives on caring for patients with COVID-19: a qualitative study

Abstract

ObjectiveTo describe the drivers of distress and motivations faced by interdisciplinary clinicians who were on the frontline caring for patients with COVID-19.Design50 semistructured interviews. Transcripts were analysed using qualitative thematic analysis.SettingA safety-net hospital in Denver, Colorado.ParticipantsInterdisciplinary frontline clinicians including physicians, advance practice providers, nurses, respiratory therapists and paramedics providing inpatient hospital care to patients hospitalised for COVID-19.ResultsFifty clinicians (32 women and 18 men) participated. Five themes with respective subthemes (in parentheses) were identified: depersonalisation and barriers to care (impeding rapport and compassion, focusing on infection risk at the expense of high-quality care, grief from witnessing patients suffer in isolation), powerless in uncertainty (inescapable awareness of personal risk, therapeutic doubt in a void of evidence, confronting ethical dilemmas, struggling with dynamic and unfamiliar challenges), overwhelmed and exhausted (burden of personal protective equipment (PPE), information overload and confusion, overstretched by additional responsibilities at work, compounded by personal life stressors, feeling vulnerable and dispensable, compassion fatigue, distress from the disproportionate impact on socially oppressed communities), bolstering morale and confidence (motivated by community and family support, equipped with data), and driven by moral duty (responsibility to patient care and community, collegial solidarity and collaboration, contributing to the greater good).ConclusionFrontline clinicians reported distress due to the challenges of PPE, uncertainty and powerlessness, new responsibilities at work and home, losing control of their schedules, grief from witnessing patients suffer in isolation and witnessing healthcare disparities exacerbated by this pandemic. Clinicians feel supported by their colleagues, families, and community and were driven by a sense of moral duty. Healthcare system should adopt strategies to minimise distress faced by interdisciplinary clinicians on the frontline of COVID-19.

The COVID-19 Clinician Cohort (CoCCo) Study: Empirically Grounded Recommendations for Forward-Facing Psychological Care of Frontline Doctors

“…In relation to previous studies, findings from this study reflect similar themes drawn out elsewhere during the pandemic [15][16][17][18][19][20][21][22] suggesting 'commonality' in experiences of frontline workers [40]. This extends across specialties, gender and ethnicity within our sample-few discrepancies were identified between groups, despite recent quantitative studies reporting significant differences in psychological distress related to age, gender…”

“…Analyses generated six key themes: 'accounts of challenging frontline situations', 'impact on staff', 'coping strategies', 'sources of support', 'organisational influences on wellbeing', and 'improving engagement with support'. The first two themes mirror findings reported extensively elsewhere [15][16][17][18][19][20][21][22], making no novel contribution to knowledge in the field. In this paper, we report only the latter four themes (Table 3), which are aligned with our study aims, and underpin development of recommendations and a model of care to support clinicians' wellbeing.…”

“…A recent qualitative study reported that preferences, experiences, and coping styles of COVID-19 HCW should be considered when developing "programs developed to mitigate stress" [13] (p. 1) with a recent meta-analysis indicating that more "high-quality qualitative research is urgently needed" particularly with frontline HCW whose "voices have not yet been adequately represented" [14] (p. 25). Billings et al [14] indicate qualitative research should underpin clinical guidance, and while subsequent qualitative studies have explored frontline HCW experience of working and caring for patients during the COVID-19 pandemic [15][16][17][18][19][20][21][22] drawing out similar themes to those reported in other pandemics [14], few qualitative studies have specifically sought to develop or directly inform guidance [23]. The initial COVID-19 mental health response has recently been criticised for underutilising qualitative enquiry, overlooking lived experience, and focusing on general populations such as HCW [24].…”

Analyzing the Impact of COVID-19 Trauma on Developing Post-Traumatic Stress Disorder among Emergency Medical Workers in Spain

“…A study conducted in Denver, Colorado shows that, during the pandemic, frontline physicians suffered from a lack of confidence in their actions, as with the health professionals in our research, as well as a sense of helplessness and a feeling of uselessness in saving patients' lives [46].…”

EMJ COVID-19 monthly top five (June 2021)

“…How to support frontline workers remains a topic of focus. 13 This study aimed to evaluate factors contributing to clinician distress and motivation during the COVID-19 pandemic. Semistructured interviews were conducted with 50 (32 women and 18 men) frontline healthcare workers and thematically analysed.…”