Stressors and lessons for future support for healthcare staff facing adverse challenges: A systematic review of qualitative research conducted in the UK during the COVID-19 pandemic

Abstract

Background Extreme events (e.g., floods, hurricanes) can overwhelm healthcare workers and systems. Similarly, healthcare workers were particularly affected during the COVID-19 pandemic, and high levels of distress and mental ill health have been reported. Aim To examine and synthesise qualitative research findings regarding the stressors, and their psychosocial impacts, that healthcare staff faced in the UK during the COVID-19 pandemic, and to provide lessons for future support. Method A systematic review, pre-registered on PROSPERO (CRD42022304235), was carried out on papers reporting qualitative research published between January 2021 and January 2022 that focused on the impact of COVID-19 on UK healthcare workers. Findings from 27 qualitative papers were integrated using thematic synthesis. Results Several types of stressors were identified including the SARS-CoV-2 virus, problems related to personal protective equipment, leadership, and communication processes, high workloads, and issues stemming from uncertainty and a lack of knowledge. These stressors were related to a range of adverse psychosocial outcomes including worrying about oneself and others, fatigue, lack of confidence in oneself and in senior managers, impacts on teamwork, and feeling unappreciated or that one's needs are not recognised. Conclusions Apart from COVID-19 itself (the primary stressor), healthcare staff experienced distress due to ineffective policies, practices and administrative arrangements that were in place before the pandemic, or from insufficient or ineffective responses to the pandemic (secondary stressors). However, secondary stressors can be modified to mitigate their negative effects, thus workforce planning should shift from focusing on individuals towards amending healthcare staff's psychosocial working environments.