Understanding the mental health impact and needs of public healthcare professionals during COVID-19 in Pakistan : a qualitative study

Abstract

ObjectivesA dearth of qualitative studies constrains in-depth understanding of health service providers’ perspectives and experiences regarding the impact of COVID-19 on their mental health. This study explored the mental health impact and needs of of public sector healthcare workers during COVID-19 who working in secondary-level and tertiary-level healthcare settings of Pakistan.DesignAn exploratory qualitative study.SettingTwenty-five secondary-level and eight tertiary-level public hospitals of Sindh and Punjab provinces of Pakistan.ParticipantsIn-depth interviews were conducted with 16 health service providers and 40 administrative personnel. Study data were analysed on NVivo V.11 using the conventional content analysis technique.ResultsThe study identified three overarching themes: (1) mental health impact of COVID-19 on health service providers that included the fear of acquiring the infection and transmitting it to their family members, fear of social isolation and stigma, anxiety related to the uncertainty of COVID-19, nervousness due to media exaggeration and stress associated with excessive workload; (2) mental health needs of health service providers involved in the COVID-19 crisis and available support from the healthcare system, including the expression of the need for counselling services and safe working conditions, the need for paid rest periods, and the need for appreciation and motivation to work in the pandemic; and (3) suggestions to address mental health needs of healthcare workers, including provision of specialised mental healthcare/services, formal training of health managers on managing mental health needs of health facility staff, and assessment and addressing of these needs of the health workforce.ConclusionThe study emphasises the need to strengthen health system preparedness for recognising and addressing the needs of healthcare professionals. At the system level, there is a need for a specialised unit to provide mental health services and better communication strategies. At the staff level, continuous motivation and appreciation should be given to healthcare professionals either through monetary incentives or formal acknowledgement of their performance.

Mapping the needs of healthcare workers caring for COVID-19 patients using the socio-ecological framework: a rapid scoping review

“…Organizational-level needs were reported by 10 studies (47.6%) conducted in India ( n = 3, 30.0%), Africa ( n = 1, 10.0%), China ( n = 1, 10.0%), Pakistan ( n = 1, 10.0%), Spain ( n = 1, 10.0%), Turkey ( n = 1, 10.0%), UK ( n = 1, 10.0%), and USA ( n = 1, 10.0%). Specifically, needs reported by HCWs included feeling appreciated at work, support by superiors through listening to their fears and concerns and co-workers such as sharing experiences, flexible working hours, safe and secure working conditions such as administrative measures for better protection from COVID-19, improvement of protective equipment, paid night shifts, rest periods and holidays, and clear communication of policies related to risk, workload and sick leave [ 34 , 36 , 38 , 39 , 42 – 45 , 68 , 71 ].…”

“…Individual-level challenges were reported by 18 studies conducted in India (n = 4, 22.2%), Africa (n = 3, 16.6%), Ireland (n = 2, 11.0%), USA (n = 2, 11.0%), Bangladesh (n = 1, 5.6%), China (n = 1, 5.6%), Indonesia (n = 1, 5.6%), Pakistan (n = 1, 5.6%), South Korea (n = 1, 5.6%), Turkey (n = 1, 5.6%), and UK (n = 1, 5.6%). Challenges included mainly fear (78%) and reduced mental health (78%) due to the COVID-19 pandemic [33][34][35][36][37][38][39][40][41][42]. Specifically, HCWs faced mostly the fear of contracting COVID-19 and transmitting it to their family members, and the uncertainty that comes with the disease (i.e., they were unaware of the nature and the consequences of the disease due to lack of knowledge about the novel virus), fear of alienation from society, and fear of death due to COVID-19, and experiencing loss and of experiencing loneliness [33,35,36,[38][39][40][41][42].…”

“…Challenges included mainly fear (78%) and reduced mental health (78%) due to the COVID-19 pandemic [33][34][35][36][37][38][39][40][41][42]. Specifically, HCWs faced mostly the fear of contracting COVID-19 and transmitting it to their family members, and the uncertainty that comes with the disease (i.e., they were unaware of the nature and the consequences of the disease due to lack of knowledge about the novel virus), fear of alienation from society, and fear of death due to COVID-19, and experiencing loss and of experiencing loneliness [33,35,36,[38][39][40][41][42]. They also reported increased stress, burnout, emotional exhaustion, psychological and physical fatigue, sense of guilt due to the inability to save patients, and isolation due to the COVID-19 protective measures [33,34,[36][37][38][39]42].…”

Human resource management (HRM) strategies of medical staff during the COVID-19 pandemic

“…A comprehensive look at the motivational factors of frontline employees, the possibility of rotating employees and not forcing employees to provide services, screening employees' mental health, using clergy and experienced employees to maintain mental health, and teaching the principles of self-care for emotional, relational, and spiritual/religious health, providing financial rewards to employees working in the COVID-19 department for the use of new methods in providing medical services, are collectively effective in improving the motivation and resilience of the medical staff during the epidemic ( Table 5 ). Establishing a specialized mental health unit and providing continuous financial, family and emotional support to health professionals is a suggestion mentioned in the study of Hameed et al [ 34 ]. Effective management of the psychological capital of treatment staff will improve the quality of medical services, increase patient satisfaction, and bring a competitive advantage to healthcare organizations [ 50 ].…”

“…Accordingly, lack of motivation and dissatisfaction among the healthcare workers may lead to the provision of low-quality services and poor outcomes [ 33 ]. Therefore, it is recommended to create a specialized unit to provide mental health services and to give continuous financial, family and emotional support to health care professionals [ 34 ]. It has been acknowledged in a study that paying attention to internal motivational factors such as spirituality and awareness is more effective than external motivational factors such as salaries and job satisfaction of health workers [ 35 ].…”