Table 2

Impacts of COVID-19 pandemic on healthcare providers

SubthemeLevelIllustrative quote
Risk of infection1,3,4…the kind of thing that would really be unexpected and really upsetting is having evaluated a patient, for instance, this week who was negative and then they [tested positive), and for all of us to hear about that and then have to worry about that.—debriefing interview
Negative impacts
Anxiety1,3,4I mean there’s a fair bit of anxiety, for sure. I think with regards to, you know exposure, family, sort of uncertainty. And just like trying to do the best you can in a different sort of world, if you want to call it that, with the COVID-19 sort of being the primary thing that comes up every step of the way. Like sometimes you’re standing there and you’re like oh my God this patient is bleeding to death, can we stop talking about the COVID-19? You know but it’s something that we’re just having, having to talk about. I think, I think that the anxiety part.—debriefing interview
Depression3,4It’s been sad, just the effect that this has had on these 2 patients in particular. One because I feel like that for months and months and months, we’ve been working together to get out more and to spend more time doing things, but, you know, give them a sense of purpose or satisfaction. It almost hurts them that much more, you know they’ve been working towards it, both of them had achieved the task of getting out more, so just as they were starting to get it together and like “oh this like really does work and this is really helping” and seeing some improvement and symptoms, and then it being taken away from them is pretty earth shattering.—debriefing interview
Stress4There are providers that are stressed. I mean, it’s the COVID-19 stress, it’s the daycare stress, unemployment stress, kids not getting jobs. It’s a whole morass, as you probably already know. things that are happening to people.—debriefing interview
Guilt4Yeah, and I think people feel conflicted that you get to go to work and see your friends and so you get to have those at work and you get to have a conversation with adult friends in person and a lot of people don't get to do that anymore. And that sounds fun… I think there’s also this is little bit of guilt in I know I told you that [the hospital] is not seeing this deluge of patients and you know, the community, the restaurants are giving out free lunch and local celebrities… have dropped off some food or some free thing to healthcare workers… and you're sort of like well actually we aren’t seeing that many patients right now with COVID-19.—debriefing interview
Ethical conflicts3,4I think one of the early discussions we had…we have a program here where we use ECMO for respiratory failure. And one of the early discussions we had here with not just the hospital…, but also with other ECMO centers throughout the Pacific Northwest was what are we going to do in the anticipation of this surge of patients? Does it make sense to utilize a very high resource, you know procedure, for a very, very small number of patients, where a lot of PPE is going to be used and a lot of dedication, a lot of dedicated staff. And at that time, we kind of made the decision that we, that we wouldn’t…that did not make sense. That we wouldn’t offer that service. As it started to unfold, that, you know the surge that we were anticipating didn’t develop quite in the way that we thought it would or we feared that it would, we then kind of, as a group, reinstituted the procedure and recognizing that, well it seems like we do have the capacity both in terms of staff and space and with PPE and equipment to provide that service.—debriefing interview
Social tension4My colleague that’s been here for 15 years, she’s great. At the end [of our shift] as we were saying goodbye to her, she asks me to tell her everything you've learned [from this study). She’s pushing me; she said “okay [name removed), so why do you get to do research? That’s a pretty privileged thing to do and then why don't you come here [to treat patients), I'm doing this yes you know, and you know it’s also like we need people.”—debriefing interview
Coping strategies and resources
Procedural innovations3,4We want to make sure that our outpatients clinic and providers are safe and patients with COVID-19 go to outpatient units and so it’s an important workaround but for patients that will have trouble with Telemedicine and Telehealth, it does feel like the emergency department is now not only a safety net but it’s sort of the end of the road for a lot of people—debriefing interview
Prevention1,3,4I think most people including myself are going home and just showering and then you know washing the clothes that they were wearing to and from the hospital. And everyone at the hospital has moved to where its just wearing scrubs as soon as they come in.—debriefing interview
Social support3,4The community very much wanted to contribute whatever they could to recognize the work that healthcare is providing for the communities, which has been wonderful. But we want to make sure that information makes it to staff as well.—debriefing interview
Mental health services3,4The university had this drop-in session of talk about your concerns and one of my colleagues dropped in and he said that he is saw every healthcare worker has sort of their own piece of the thing that’s making their life harder and what he would be most helpful emergency medicine doctors talking about what makes emergency medicine. So, we kind of developed our own faculty we just had like drop-ins in zoom meetings where you could go in and it was free from judgement and you could talk about whatever you needed to talk about. I think a lot of people found those to be helpful and I dropped in a couple times especially kind of early on.—debriefing interview
Information3,4I think knowledge has helped already a lot. In the beginning, again there was so little known about, even the, how the disease was transmitted was very, very little was known in the beginning. There’s still some question in that, you know what is considered safe what’s not considered safe. What procedures can we perform using this type of PPE vs that type of PPE. I think when staff understand everything that there is to know about a given, you know disease transmission and process, then that makes them a little more comfortable.—debriefing interview
Self-care1,3,4I think, I think for me what made the difference is being very purposeful with what I’ve been doing with my time, and I think for the vast majority of humans and providers, we create a system of coping for ourselves and when those traditional means are getting thwarted or changed, we have to find a good replacement for that. And I think that yeah being purposeful that how you’re spending your time and customizing it to your needs and what gets you through is important, but I also think that means having the boundaries between work and personal life so that you have the time to, one, think about what you need to do to get yourself through, and two, actually do those things—debriefing interview