Department of Community Health & Family Medicine, Bangalore Baptist Hospital, Bangalore, Karnataka, India
Department of Community Health & Family Medicine, Bangalore Baptist Hospital, Bangalore, Karnataka, India.
BMJ Open. 2020 Nov 18;10(11):e042171. doi: 10.1136/bmjopen-2020-042171.
To describe the initial dilemmas, mental stress, adaptive measures implemented and how the healthcare team collectively coped while providing healthcare services in a large slum in India, during the COVID-19 pandemic.
Community Health Division, Bangalore Baptist Hospital, Bangalore.
We used mixed methods research with a quantitative (QUAN) paradigm nested in the primary qualitative (QUAL) design. QUAL methods included ethnography research methods, in-depth interviews and focus group discussions.
A healthcare team of doctors, nurses, paramedical and support staff. Out of 87 staff, 42 participated in the QUAL methods and 64 participated in the QUAN survey.
Being cognizant of the extreme vulnerability of the slums, the health team struggled with conflicting thoughts of self-preservation and their moral obligation to the marginalised section of society. Majority (75%) of the staff experienced fear at some point in time. Distracting themselves with hobbies (20.3%) and spending more time with family (39.1%) were cited as a means of emotional regulation by the participants in the QUAN survey. In the QUAL interviews, fear of death, the guilt of disease transmission to their loved ones, anxiety about probable violence and stigma in the slums and exhaustion emerged as the major themes causing stress among healthcare professionals. With positive cognitive reappraisal, the health team collectively designed and implemented adaptive interventions to ensure continuity of care. They dealt with the new demands by positive reframing, peer support, distancing, information seeking, response efficacy, self-efficacy, existential goal pursuit, value adherence and religious coping.
The novel threat of the COVID-19 pandemic threw insurmountable challenges potentiating disastrous consequences; slums becoming a threat to themselves, threat to the health providers and a threat for all. Perhaps, a lesson we could learn from this pandemic is to incorporate 'slum health' within universal healthcare.
描述在 COVID-19 大流行期间，在印度一个大型贫民窟提供医疗服务时，医疗团队所面临的初始困境、精神压力、采取的适应措施以及如何共同应对。
班加罗尔浸信会医院社区卫生司，班加罗尔。
我们使用混合方法研究，其中包括定量（QUAN）范式嵌套在主要定性（QUAL）设计中。QUAL 方法包括民族志研究方法、深入访谈和焦点小组讨论。
一个由医生、护士、辅助医疗人员和支持人员组成的医疗团队。在 87 名员工中，有 42 名参与了 QUAL 方法，64 名参与了 QUAN 调查。
意识到贫民窟的极度脆弱性，医疗团队在自我保护和对社会边缘阶层的道德义务之间挣扎。大多数（75%）员工在某个时候都感到恐惧。QUAN 调查中的参与者提到，通过业余爱好（20.3%）和与家人共度更多时间（39.1%）来分散注意力是情绪调节的一种方式。在 QUAL 访谈中，对死亡的恐惧、将疾病传播给亲人的内疚、对可能发生的暴力和污名的焦虑以及在贫民窟的疲惫感成为导致医疗保健专业人员压力的主要主题。通过积极的认知重评，医疗团队共同设计并实施了适应性干预措施，以确保护理的连续性。他们通过积极重新构建、同伴支持、保持距离、寻求信息、反应效能、自我效能、存在目标追求、价值观坚持和宗教应对来应对新的需求。
COVID-19 大流行带来的新威胁带来了巨大的挑战，可能会产生灾难性的后果；贫民窟对自己、对卫生提供者以及对所有人都是一种威胁。也许，我们可以从这场大流行中吸取的一个教训是，将“贫民窟健康”纳入全民健康覆盖范围。
