Coronavirus (558) Lancet Global Health: The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study

6 May, 2020

Citation, summary, selected extracts and comment from me below.

CITATION: The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study

Qian Liu et al.

Open Access Published: April 29, 2020

DOI:https://doi.org/10.1016/S2214-109X(20)30204-7

SUMMARY

Background: In the early stages of the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China, the local health-care system was overwhelmed. Physicians and nurses who had no infectious disease expertise were recruited to provide care to patients with COVID-19. To our knowledge, no studies on their experiences of combating COVID-19 have been published. We aimed to describe the experiences of these health-care providers in the early stages of the outbreak.

Methods: We did a qualitative study using an empirical phenomenological approach. Nurses and physicians were recruited from five COVID-19-designated hospitals in Hubei province using purposive and snowball sampling. They participated in semi-structured, in-depth interviews by telephone from Feb 10 to Feb 15, 2020. Interviews were transcribed verbatim and analysed using Haase's adaptation of Colaizzi's phenomenological method.

Findings: We recruited nine nurses and four physicians. Three theme categories emerged from data analysis. The first was “being fully responsible for patients' wellbeing—‘this is my duty’”. Health-care providers volunteered and tried their best to provide care for patients. Nurses had a crucial role in providing intensive care and assisting with activities of daily living. The second category was “challenges of working on COVID-19 wards”. Health-care providers were challenged by working in a totally new context, exhaustion due to heavy workloads and protective gear, the fear of becoming infected and infecting others, feeling powerless to handle patients' conditions, and managing relationships in this stressful situation. The third category was “resilience amid challenges”. Health-care providers identified many sources of social support and used self-management strategies to cope with the situation. They also achieved transcendence from this unique experience.

Interpretation: The intensive work drained health-care providers physically and emotionally. Health-care providers showed their resilience and the spirit of professional dedication to overcome difficulties. Comprehensive support should be provided to safeguard the wellbeing of health-care providers. Regular and intensive training for all health-care providers is necessary to promote preparedness and efficacy in crisis management.

SELECTED EXTRACTS:

“We try to deeply understand the guidelines released by the country, discuss with other colleagues to know their experiences in treating patients with COVID-19, then transform the knowledge and experience to use for our patients. We keep exploring.”

'Initially, health-care providers were nervous and lacked confidence in caring for patients with this new disease. The risk, transmissibility, pathogenicity, and treatment of the disease were not well understood.'

'Continuous medical education and training is needed to assure medical teams are adequately prepared to deal with public health emergencies'.

A linked Comment concludes: 'Focusing on health-care providers' experiences, understanding the similarities and differences between the experiences of different groups of health-care providers, developing targeted measures, and giving health-care providers sustained and comprehensive support are necessary to improving their physical and mental health during the COVID-19 pandemic.'

Focusing on health-care providers' experiences in the COVID-19 crisis

Yang Xiong, Lingli Peng. DOI:https://doi.org/10.1016/S2214-109X(20)30214-X

COMMENT (Neil PW): For me, this paepr underlines the importance of having health systems that are supportive and health-worker-centred (in addition to being patient-centred). Healthcare providers who are better supported are more resilient and better able to deliver high-quality care. This contrasts with the treatment of Dr Li Wenliang, the Wuhan doctor who first raised the alarm on 30 December 2019 about a possible outbreak of an illness that resembled severe acute respiratory syndrome (SARS), later identified as COVID-19, onhly to be summoned by Wuhan police and admonished for "making false comments on the Internet" https://en.wikipedia.org/wiki/Li_Wenliang Dr Li later contracted and died from the disease.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org