The Impact of Covid-19 on Healthcare Workers

Wellness: The Study of Burnout (stress) and the Need

to Mitigate the situation as Oppose other Occupations
during this Pandemic.
(Qualitative Research Study).

P.I.C.O.T

Population/Problem: Impact if Covid-19 on healthcare workers.

Intervention: Burnout (stress) and need to mitigate the situation.

Comparison: As Oppose other Occupations.

Outcomes: Mitigate the situation.

Time: During this pandemic.

INTRODUCTION
Background of the Study
The covid-19 pandemic has heavily burdened, and in many cases overwhelmed,
healthcare systems (Armocida et al., 2020; Xie et al., 2020) including healthcare
workers. This pandemic has resulted in an international public health emergency and
has affected populations all across the world, including occupations/workers not
included in the health system. Previous viral outbreaks (such as the Severe Acute
Respiratory Syndrome (SARS) outbreak), have shown that frontline and non-frontline
healthcare workers are at increased risk of infection and other adverse psychological
and physical health outcomes (Xiao et al., 2020). COVID-19 has proven to be very
aggressive and attacks the respiratory system, which places patients into the hospital.
Thus, this has led to many healthcare facilities struggling to balance patient occupancy
and proper protective equipment (PPE). As such, with a high inflow of patients and
inadequate amount proper protective equipment, these circumstances may be
correlated with of high amounts of stress. Also, the World Health Organization (WHO)
has emphasized the extremely high burden on healthcare workers, and called for action
to address the immediate needs and measures needed to save lives and prevent a serious
impact on physical and mental health of healthcare workers (WHO, 2020). Again, the
fear of spreading Covid-19 virus to many others is another factor that contributes to
their stress faced by healthcare workers. More so, healthcare workers reported mental
health problems associated with healthcare worker’s occupational activities during and
up until years after epidemics, including symptoms of post-traumatic stress, burnout,
depression and anxiety (Lancee et al., 2008; Maunder et al., 2006; Park et al., 2018).

Here, burnout is also known as a stress syndrome. It refers to as a syndrome

conceptualized as resulting from chronic workplace stress that has not been successfully
managed. Experiencing burnout may have a very strong impact on a person’s
psychological and physical well-being and affects various aspects. Burnout can be
categorized as feelings of exhaustion, negative feelings towards one’s job and reduced
work productivity (WHO, 2020). Due to the fact that nurses constitute the largest part
of the healthcare workforce in an epidemic, and they undertake most of the tasks related
to infectious disease containment, a study was conducted in order to assess the
prevalence of burnout among nurses working in the largest tertiary hospital in the
Philippines. The results of the survey showed the exposure and personal factors among
246 nurses consisting most of females (78.5%) from the different wards and units in the
Philippines General Hospital (Elsevier B.V, 2017). Almost half (49.6%) of the
respondents reported being ill due to work in the past year, and 56.1% missed work
because of an illness. Correlation statistics using the Spearman's rho showed
organizational role stressors was most significant in burnout among nurses in the
Philippine's largest tertiary hospital. Organizational role stressors consisted of ten
dimensions, namely: inter-role distance (IRD), role stagnation (RS), role expectation
conflict (REC), role erosion (RE), role overload (RO), role isolation (RI), personal
inadequacy (PI), self-role distance (SRD), role ambiguity and resource inadequacy (RIn)
((Elsevier B.V, 2017). The contribution of the study is in advancing new concepts in the
already existing framework of burnout, and thus, can assist healthcare workers (nurses)
and hospital administration on how to control this problem.

Statement of the Problem

Identifying and discussing about the issue of burnout (stress) is important

because it helps to preserve healthcare worker’s optimal health. Here, identifying this
issue and providing support might enable healthcare workers to give the best possible
care to their patients, not only is it necessary to take care of those who are working in
the frontlines, it is also important to examine how it has affected those in the past and to
use that knowledge to help treat what they are currently facing now. More ever, many
healthcare works carry the fear of the uncertainty of spreading the virus to their families
back home and lack of personal protective equipment (PPE) and close contact with
COVID-19, as such, it is important to address the factors that are contributing to the
stress. Future interventions at the national levels are needed to improve frontline health
workers mental health during the pandemic by addressing its associated factors. A study
conducted on healthcare workers (nurses) on the frontlines in China, Wuhan have
reported the worker’s feeling of burnout was associated with a lack of social support
(Hu, 2020). A lack of social support was one of the important factors connected to
negative psychological outcomes. There must be proper emotional support for those
struggling to balance physiological and psychological changes, as well as addressing
other contributing work-related factors that can be modified in order to decrease
burnout levels.

Research Question:

What type of interventions can be applied to reduce the burnout faced by health workers
in this COVID-19 pandemic?

Assumption:
The prevalence of burnout (stress) is more common among healthcare workers than
workers of other occupations.

Theoretical Framework

Healthcare workers undergo a lot of stress while working in the hospitals or health
facilities. Here, the Neuman Systems Model is a theoretical framework that represents
the structure of stressors, the responses to these stressors, and the corresponding
interventions. This framework establishes a holistic approach which includes five
important factors which are; physiological, psychological, sociocultural, spiritual, and
developmental (Kerime, 2017). More so, with these factors, the goal is to organize intra,
inter, and extra-personal stressors. The intrapersonal stressors occur within the
individual, such as conditioned responses, thoughts, and sensations. The interpersonal
stressors refer to negative relationships between healthcare workers and patients. Extra-
personal stressors occur outside the individual, such as the healthcare worker economic
circumstances. As such, interventions to reduce stress should be routed in these three
directions. With organizing how these stressors affect an individual, it may then help
identify and examine the main source of where the stress may be coming from. Whether
it is internally or externally, using this model allows the individual to evaluate what the
problem is, how they perceive it and what can be done for relief. Furthermore, the goal
of primary prevention is to reduce the possibility of facing a stressor or reduce the
possibility of a reaction. In secondary prevention, intervention is made after the client
responds to the symptoms of stress. The tertiary prevention takes place after active
treatment or the secondary prevention phase and it aims to ensure that the patient
recovers the optimal stability of the system in Neuman’s model. With the use of a digital
care package and using Mindfulness-Based Stress Reduction (MBSR) techniques, this
may help healthcare worker’s identify what causes stress in the hospital. Again, this can
help measure the level of burnout they are experiencing and determine the specific
interventions to reduce their stress. This model emphasizes the importance of
incorporating the patient’s needs as well as maintaining optimal health or wellness
within ones’ self. With implementing interventions that will help healthcare workers
cope with stress related to burnout, it will lead to healthier coping mechanisms and a
reduction in reporting high levels of burnout due to the Covid-19 pandemic.

Conceptual Paradigm

Stress should be seen as the result of the interaction between the environment
and an individual. In this case of healthcare workers, the specific stressors are related to
factors of psychological outcomes and hospital practices, which are often intense,
repetitive and also exhaustive. The diagram below illustrates the interaction between
healthcare workers and stressors.

Environment

Family Healthcare Hospital practices

Worker
Stimulus
Reaction
Duration

Intensity
Social problems Social support
Coping
Personal problems

Homeostasis

Significance of the Study

The reason for conducting this study is to identify long term impacts of the
COVID-19 pandemic on healthcare workers who experience burnout as well as the
success of interventions designed to reduce the impact. The findings of this study will
benefit firstly, healthcare workers considering that they play very important role in the
health system and the society. Through this study, healthcare workers will be able to
develop coping mechanisms to alleviate the stress the face, thus providing the best care
to their patients. Moreover, this study will be beneficial to patients/clients and the entire
society. With this study, patients and the society will now be able to understand what
healthcare workers face, thus broadening their minds about certain things in the
healthcare system and making them to cooperate and respect healthcare workers, which
will help to mitigate their stress.

Scope and Limitation

This study focuses on the impact of burnout (stress) among healthcare workers
especially during this Covid-19 pandemic. The data collected for this study will be
conducted to the healthcare workers (nurses) in the Philippines. This study will not
cover other problems that are not considered as one of burnout. Other
occupations/workers that do not fall as part of the healthcare workers team are not
within the scope of this research study. This study would be done through the use of
references (citations), observation and interviews. With this, we will be able to identify
the impact of stress/burnout among healthcare workers.

Definition of Terms

1. Burnout: It is a psychological syndrome that can be described as chronic

exhaustion. This phenomenon may result from extremely stressful work conditions
where an individual’s stress is not properly managed.
2. Covid-19: Coronavirus disease (COVID-19) refers to an infectious disease caused
by the SARS-CoV-2 virus. People who fall sick with COVID-19 will experience mild
to moderate symptoms and recover without special treatment. However, some will
become seriously ill and require medical attention.
3. Wellness: It refers to the state of being in optimal (good) health.
4. Healthcare worker: Healthcare worker refers to a person who works in a
healthcare setting and provides care and services to the sick (patients), such as a
doctor or nurse.
5. Stress: It refers to a state of psychological tension (or strain) resulting very
demanding circumstances or work.
6. Hospital: It refers to a health care facility which providing patient treatment with
specialized medical and nursing staff and medical equipment.