Healthcare professionals’ perceptions and experiences of the influence of the COVID-19 pandemic on their personal and work performance

2.3.1Experiences of healthcare workers about adapting to their worker roles during the pandemic

Research conducted by Rose, Hartnett and Pillai [17] revealed that HCWs in the United States of America, felt anxious about contracting the COVID-19 virus and that they had to develop adaptative strategies to continue working in high risk environments. Individuals felt that the use of PPE, having financial resources and having empathetic workplace managers would enable them to work in the second wave of the pandemic. Similarly, in a study conducted in the United Kingdom, HCWs reported that limited or poor fitting PPE, a lack of routine testing, poorly trained deployed HCW were deemed as barriers to engaging in work related task [19]. In addition, HCWs from Africa emphasize a need to utilize HIV health counsellors, community rehabilitation workers as key resources in communities to support the work of HCWs working hospital environments by means of encouraging social distancing, supporting COVID-19 testing and dispelling myths related to COVID-19. HCWs also supported the use of risk allowances and compensation for HCWs working in high risks areas [20]. The above information highlights the challenges that HCW experienced while working during the pandemic.

8.1.1Category: Feeling stressed and fearful

The first category explains the different stressors the HCWs experienced due to the pandemic. The majority of the participants have fears surrounding the available personal protective equipment (PPE) and important hospital equipment needed for their patients. Many hospitals in SA are already under resourced for general treatments. One participant stated that they only have one ventilator at their hospital, equipment that will become a necessity once the number of sick patients increase. They feel they also don’t have enough PPE and that once they run out, they will most likely contract the virus.

“Our PPE is definitely not sufficient, so when the day comes where our infection rate increases healthcare workers will not be protected.”-(Participant 3)

Eight of the participants feared for the lives of their families, patients and colleagues rather than themselves. Since the HCWs will work with COVID-19 patients directly, often with minimal PPE, they are at a high risk of contracting the virus. They therefore stated that they are worried about contracting the virus but more fearful that they won’t know they have the virus and will then pass it on to others who are vulnerable and who they care about.

“The stressors are more linked to the lives of others than to my own. I think the biggest concern would be if I were to bring COVID to my family or pass it along to other patients.”- (Participant 4)

8.1.2Category: Feeling frustrated

This category discusses the various frustrations that the HCWs are experiencing during this time. Some expressed frustration with the current lockdown rules as they felt that the rules were impeding their ability to cope. Those HCWs who still had access to alcohol or cigarettes explained how it helped them relax after work. One participant recognized that his frustration was linked directly to his mental health.

“If I could just smoke my cigarettes my mental health would be fine.”(Participant 8)

A few of the participants stated that they were frustrated by other professionals not implementing the public health protocols or expecting higher pay to work during this time even though it is what is required of their job. One participant mentioned how the policies and plans created are often not well executed. Due to the workers increased risk of contracting the virus, some believe that they should receive danger pay and refuse to do the necessary work tasks if they don’t receive this extra pay. However, others get frustrated by this as they believe that this is just part of the duties they signed up for when deciding to become a HCW.

“It irritates me when other health professionals expect to be paid more for working during this time or refuse to do their duties because of the risks involved (not specifically happening at my hospital).”(Participant 7)

8.1.3Category: Feeling grateful

Despite the HCWs feeling stressed and frustrated, this category explains their feelings of gratefulness. Four of the participants’ stated that they were grateful to be able to work and earn a salary as they realize many other South Africans currently aren’t able to.

“I am also pleased that I am able to bring home a salary every month as I am currently the only breadwinner.”- Participant 1

Keeping a working routine has given the HCWs a sense of normality. COVID-19 has also taken over the topic of conversations and, according to the HCWs, everyone expects them to know more about the virus and so is constantly asking them for advice. Therefore, going into work, gives them a break from constantly speaking and hearing about the virus.

“I suppose I’m grateful my routine and life has changed but there is still some level of “normal”.”- (Participant 5)

“Working in a hospital is great because people don’t always talk about COVID (surprise, surprise) and it’s really nice not to hear about Corona all the time”- (Participant 4)

8.2.1Category: Staff shortages

In this category the lack of support from government is elicited. Participants described the long history of South Africa’s healthcare worker staff shortages and how those few who are employed have had to carry the encumbrances of a system that cannot meet the demands of the country. In addition, participants expressed the importance of hiring more staff to avoid the healthcare system from crashing due to the loss of an already compromised working force.

“Uhm, people are complaining about numbers, we’ve always been short of numbers. We’re working hours that are not humane, because we don’t have people, it’s not something that’s new. It’s my first year’s working, and I’ve been doing this for five years, and it’s, it’s now, just the way it is, you know?” (Participant 1)

“So, we’re actually short of staff there at the clinic also. So, it is a lot of work that we have to do. Sometimes people stay home also because they get sick or their children get sick, stuff like that, and we just have to carry on with the work load.” (Participant 5)

8.2.2Category: Personal protective equipment and social distancing

This category was formulated as all of the participants noted that the main precaution taken to protect them from the virus included the use of (PPE) and the implementation of social distancing. All of the participants noted that it was very important to make use of PPE and to implement social distancing to protect themselves and others from the virus. Below are quotes from participants 1, 2 and 3 about the precautions taken at work to ensure protection from COVID-19:

“Masks have become an important part of daily life.” (Participant 1)

“Socially distancing, wearing masks, sanitizing and washing hands.” (Participant 2)

“People are advised to adhere to the 1.5 m social distancing rule inside and outside the building. All people are wearing masks and using hand sanitizers.” (Participant 3)

All the companies involved in this research study have taken measures to protect their staff as best as possible and below are quotes from participants 2, 3 and 4 explaining what their company has put in place:

“All employees are screened on entry to the buildings for symptoms related to COVID-19. Everyone’s temperature is taken twice a day. If they do show symptoms, we do a risk assessment on them in our designated sick room and make recommendations about getting tested and self-isolating.” (Participant 2)

8.3.1Category: Job modifications

This category looks at all the changes and adaptations that have had to be made within the participants’ work environments. The HCWs state that there are less trauma patients and that they have moved follow-up appointments if possible. This has led to a quieter hospital.

“Our outpatient clinic has become quieter. We have tried to reduce the numbers of people following up by extending their follow-up dates if they are stable.”(Participant 7)

All the HCWs are having to follow new protocols, guidelines and safety procedures. A few of them have had to go through training sessions and the majority have had to take on new duties/roles in the hospital. Putting on all of the PPE, also takes a while. As a result, even though there are less patients in the hospital, the HCWs are constantly busy with paperwork and new protocols.

“Almost all patients coming in to casualty are suspects and get swabbed. Filling in the forms take extremely long; it is a lot of admin.”- Participant 3

8.3.2Category: Leisure time and social participation has been negatively affected

This category looks at the changes made within the participants’ other daily routines. According to the HCWs, it has been really difficult for them not to be able to go out with friends after work or have social gatherings on the weekends due to the lockdown rules, as this is their method of debriefing. A few participants stated that they still socialize with friends; however, it is always in a phone call or over video chat. One participant said:

“And social participation is nonexistent.”- Participant 8

Even though they miss going out with friends, some HCWs have mentioned how they are glad they get to go into work as see their colleagues.

“Most of my friends here are also doctors at the hospital so I see them daily. It is at work, however, and we miss socializing after work and on weekends.”- Participant 7

8.3.3Category: Steps needed to enhance one’s mental health

This category explains new coping mechanisms the HCWs have included into their daily routines in order to maintain their mental health. According to the HCWs, phoning and speaking to family have helped them cope during this time. One participant said:

“I phone my family and hear how they are.”- Participant 5

Exercising at home or in the mornings, as well as eating healthily seem to be common daily activities that the HCWs have added to their routines. One participant stated that she does exercise classes online with other individuals which helps her feel less alone. The participants stated that keeping active and healthy helps them remain positive during this time.

8.3.4Category: Additional roles and tasks obtained

As a result of less clients being referred to OT especially in the hospital/clinic setting, participants working in these settings have noted that the work pace has slowed down, leaving time during the day to engage in tasks that are related or unrelated to their roles as OTs. One individual reported:

“The other responsibilities that we now have as the Allied team is assisting with the screening of COVID-19 patients which is a three-hour slot and this can range from screening staff or screening patients coming in to the hospital from the outside or from other hospitals that is the one major change that we have seen in our department.” (Participant 4)

Another participant reported that she had to take on the additional tasks of other staff members because they were not able to attend work during this time. She reported:

“I now have more work to do as some of the clinical staff cannot work due to the lockdown regulations affecting family responsibilities, as such the OT has to cover for any gaps created due to that.” (Participant 3)

9.1.1A feeling of ambivalence

The participants in this study mentioned several barriers related to participation in their personal and professional roles. South African HCWs are considered an essential service through all the levels of lockdown and therefore have a responsibility to work even when the majority of the rest of the population can stay at home [10]. The participants in this study mentioned in theme 1 category 1, how they were experiencing fear and frustration during the initial period of the lock down regulation in South Africa, they were uncertain about engaging in work tasks while fearing the possibility of contracting COVID-19. One fear mentioned in this category was not having enough PPE or hospital equipment. Research conducted on the willingness of HCWs to work during a pandemic, indicates that a lack of PPE is a common barrier to work participation for these workers [24]. HCWs will be in direct contact with COVID-19 positive patients with minimal PPE and so their risk of being infected is high. The virus is most contagious in the first week of infection before symptoms are present [25]. This is also worrying for the HCWs as they fear they will be infected without knowing and then take it home to their family. Concern regarding family was a large finding within this research study and has been backed up by research conducted globally during various health pandemics [26]. The participants also mentioned a fear for the community that they are working in. SA is a highly unequal society and even though the COVID-19 virus infects all races and socioeconomic backgrounds, it could pose a high risk to lower income communities [27]. Lastly, participants mentioned feeling frustrated as other HCWs expect to be paid more for upholding their obligations to work during this time. Hazard or danger allowance is an incentive for essential workers working in dangerous working conditions [28]. This has been a common request during the pandemic by essential workers, specifically HCWs, from various part of the world [16]. Furthermore, HCWs working in healthcare environments in the United States of America, United Kingdom and other countries in Africa has also highlighted the need to be compensated financially by employers [17, 19, 20].

9.1.2Staff shortages and the use of personal protective equipment

While hundreds of health professionals are left unemployed, the few that remain employed are forced to work under stressful conditions with minimum relief between shifts, therefore compounding feelings of a lack of job satisfaction [13]. Behrens [14] said that the disproportionate ratio of healthcare professionals to healthcare users will continue to put pressure on the healthcare workers as more people become infected with COVID-19, further affecting their health and well-being and job dissatisfaction. It could therefore be argued that a lack of PPEs provided to healthcare workers is a cause of concern as it contributed to work-related stress and a depleting workforce as more healthcare workers lose their lives [28]. The latter authors are supported by Swartz et al. [11] by noting that healthcare workers are experiencing an overwhelming amount of anxiety due to lack of support and PPEs. Furthermore, they supported the finding that some healthcare workers were opting not to go to work as they fear losing their lives and infecting their family members. This endorses the research finding that some healthcare workers are reluctant to engage with their patients due to the lack of protection provided to them by the government as more people become infected and seek medical support.

9.2.1HCWs perceptions on adaptations made within their work environments

The South African constitution states that citizens have the right to an environment that is not harmful to their health and well-being [29]. Working conditions and design can have an impact on an individual’s mental health and can cause burnout, stress and even depression amongst HCWs [30]. The risk of exposure to hazards is evident and is exacerbated by working conditions such as overcrowding, bad ventilation, inadequate supply and use of personal protective equipment (PPE) and staff shortages. The participants in this study commented on some changes that were made to the physical work environments of the HCWs in this study.

9.2.2Social participation

Participation in social activities has been associated with better mental health [31]. Being able to socially connect has shown to be important for physical, psychological and emotional well-being [30]. Not being able to engage in meaningful socialization results in occupational alienation, which may cause prolonged isolation, disconnectedness and a sense of meaningless that increases the risk of mental illness [1, 32]. Some participants, however, did mention that they are still able to socialize with colleagues at work, maintaining some form of social participation. The latter was seen as an facilitatory mechanism that aided participants in adapting to their worker roles during the pandemic.

9.2.3Coping mechanisms

Coping strategies refer to the thoughts and behaviors used in order to manage the internal and external demands of stressful situations. Active coping strategies are behavioral or psychological responses designed to change the nature of the stressor itself or how one thinks about it and are said to be good ways of dealing with stress [33]. The majority of participants in this study mentioned that they incorporated healthy coping mechanisms into their routines in order to maintain their mental health during the pandemic, which acted as an enabler to their mental health. This was mainly discussed in theme 3 under the category ‘Steps needed to enhance one’s mental health’. The participants discussed phoning and speaking to their family during this time as well as receiving support from family and friends. Social support is considered a factor that reduces psychological distress and provides psychological advantages to those facing stressful situations [33]. It could therefore be argued that the latter simple strategies enhanced the mental health of HCW.

9.2.4Workload and work duties

In the category ‘Job modifications’ under theme 3, participants mention how their workload has actually decreased during this time and hospitals have been a bit quieter. However, a few participants mentioned that they will most probably have an increase in workload and work hours as the coronavirus cases increase. Many countries around the world have warned of ‘the calm before the storm’ meaning although it is quiet now, the influx of patients is on its way [34]. As previously stated, burnout is a syndrome resulting from chronic work stress and it can have lifelong effects on an individual’s wellbeing [35]. The increase in workload as well as the unique circumstances surrounding the pandemic may result in increased stress possibly leading to burnout or increased risk of developing depression and anxiety [36]. Psychologists state that having a routine, both in the work place and at home, helps individuals cope with change by creating healthy habits to reduce stress levels [37]. A sudden change in routine therefore may cause some individuals to experience increased stress. The participants have stated various ways in which their work demands have changed during this time, commonly mentioning precautions. Chersich et al. [20] mention that by having managers or employers simply show empathy and support to HCWs also contributed to HCWs adapting to their worker roles. These precautions varied between hospitals but the common ones included wearing PPE and increased hand sanitizing. Most of these participants stated that even though the precautions were annoying at times they were happy with these changes as they protected themselves and their colleagues. No increased stress levels due to the changing of work demands were recorded.