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. 2022 Aug 11;13(2):2107810.
doi: 10.1080/20008066.2022.2107810. eCollection 2022.

Shared sources and mechanisms of healthcare worker distress in COVID-19: a comparative qualitative study in Canada and the UK

Suze G Berkhout  1   2 , Jo Billings  3 , Nada Abou Seif  3 , David Singleton  3 , Hilarie Stein  1 , Siobhan Hegarty  3 , Tamara Ondruskova  3 , Emilia Soulios  3 , Michael A P Bloomfield  3 , Talya Greene  3   4 , Alison Seto  2 , Susan Abbey  1   2 , Kathleen Sheehan  1   2
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Shared sources and mechanisms of healthcare worker distress in COVID-19: a comparative qualitative study in Canada and the UK

Suze G Berkhout et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: COVID-19 has had a significant impact on the wellbeing of healthcare workers, with quantitative studies identifying increased stress, anxiety, depression, insomnia, and PTSD in a wide range of settings. Limited qualitative data so far has offered in-depth details concerning what underlies these challenges, but none provide comprehensive comparison across different healthcare systems. Objective: To explore qualitative findings relating to healthcare worker distress from two different countries to understand the nuanced similarities and differences with respect to the sources and impact of distress relating to COVID-19. Method: A comparative interpretive thematic analysis was carried out between two qualitative data sets examining healthcare workers' experiences of distress during the COVID-19 pandemic. Data from Canada and the UK were collected in parallel and analyzed in an iterative, collaborative process. Results: A number of sources of distress cut across both study settings including concerns about safety and patient care, challenges at home or in one's personal life, communication issues, work environment, media and public perception, and government responses to the pandemic. These sit on a spectrum from individual to institutional sources and were mutually reinforcing. Our analysis also suggested that common mechanisms such as exacerbations in uncertainty, hypervigilance, and moral injury underpinned these sources, which contributed to how they were experienced as distressing. Conclusion: This is the first international collaboration utilising qualitative data to examine this pressing issue. Despite differences in the political, social, health service, and pandemic-related context, the sources and mechanisms of distress experienced by healthcare workers in Canada and the UK were remarkably similar. HIGHLIGHTS This international comparative qualitative study explores how mechanisms that lead to distress are shared across different geographies and cultures, even as the local context shapes the sources of distress themselves.

Antecedentes: La COVID-19 ha tenido un impacto significativo en el bienestar de los trabajadores de la salud, con estudios cuantitativos que identifican un aumento del estrés, la ansiedad, la depresión, el insomnio, y el TEPT en una amplia variedad de entornos. Hasta ahora, los datos cualitativos son limitados y han ofrecido un profundo detalle sobre lo que subyace a estos desafíos, pero ninguno proporciona una comparación exhaustiva entre los diferentes sistemas de atención de salud.Objetivo: Explorar los hallazgos cualitativos relacionados con la angustia de los trabajadores de la salud de dos países diferentes para comprender las sutiles similitudes y diferencias con respecto a las fuentes y el impacto de la angustia relacionada con la COVID-19.Método: Se llevó a cabo un análisis temático interpretativo comparativo entre dos conjuntos de datos cualitativos que examinaron las experiencias de angustia de los trabajadores de la salud durante la pandemia de la COVID-19. Los datos de Canadá y el Reino Unido se recopilaron en paralelo y se analizaron en un proceso colaborativo iterativo.Resultados: Una serie de fuentes de angustia atraviesan ambos entornos de estudio, incluidas las preocupaciones sobre la seguridad y el cuidado del paciente, los desafíos en el hogar o en la vida personal, los problemas de comunicación, el entorno laboral, la percepción pública y de los medios de comunicación, y las respuestas gubernamentales a la pandemia. Estos se ubican en un espectro desde fuentes individuales hasta institucionales y se reforzaron mutuamente. Nuestro análisis también sugirió que mecanismos comunes como las exacerbaciones de la incertidumbre, la hipervigilancia, y el daño moral sustentaban estas fuentes, lo que contribuyó a que se experimentaran como angustiosas.Conclusión: Esta es la primera colaboración internacional que utiliza datos cualitativos para examinar este apremiante problema. A pesar de las diferencias en el contexto político, social, de servicios de salud y relacionado con la pandemia, las fuentes y los mecanismos de angustia experimentados por los trabajadores de la salud en Canadá y el Reino Unido fueron notablemente similares.

背景：COVID-19 对医护人员的福祉产生了重大影响，定量研究发现在广泛的环境中应激、焦虑、抑郁、失眠和 PTSD 增加。迄今为止，有限的定性数据提供了有关这些挑战背后的详细信息，但没有提供跨不同医疗保健系统的综合比较。目的：探究来自两个不同国家的与医护人员痛苦相关的定性研究结果，以了解 COVID-19 相关痛苦的来源和影响方面的细微相似性和差异。方法：在两个考查COVID-19 疫情期间医护人员痛苦经历的定性数据集之间进行了比较解释性主题分析。来自加拿大和英国的数据并行收集，并在一个迭代、协作的过程中进行分析。结果：两个研究环境中都有许多困扰的来源，包括对安全和患者护理的担忧、家庭或个人生活中的挑战、沟通问题、工作环境、媒体和公众认知，以及政府对疫情的反应。这些遍布从个人到机构的来源谱系，并且相互增强。我们的分析还表明，不确定性加剧、高警觉和道德伤害等导致人们感到痛苦的常见机制是这些来源的基础。结论：这是第一次利用定性数据来研究这一紧迫问题的国际合作。尽管在政治、社会、卫生服务和疫情相关的背景下存在差异，加拿大和英国的医护人员所经历的痛苦来源和机制非常相似。.

Keywords: COVID-19; distress; healthcare workers; mental health; trauma.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Formulation of the relationship between sources, mechanisms, and modifiers of HCW distress in COVID-19.
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