Division of Hospital Medicine, Denver Health, Denver, Colorado, USA
Division of Hospital Medicine, Denver Health, Denver, Colorado, USA.
BMJ Open. 2021 May 4;11(5):e048712. doi: 10.1136/bmjopen-2021-048712.
To describe the drivers of distress and motivations faced by interdisciplinary clinicians who were on the frontline caring for patients with COVID-19.
50 semistructured interviews. Transcripts were analysed using qualitative thematic analysis.
A safety-net hospital in Denver, Colorado.
Interdisciplinary frontline clinicians including physicians, advance practice providers, nurses, respiratory therapists and paramedics providing inpatient hospital care to patients hospitalised for COVID-19.
Fifty clinicians (32 women and 18 men) participated. Five themes with respective subthemes (in parentheses) were identified: depersonalisation and barriers to care (impeding rapport and compassion, focusing on infection risk at the expense of high-quality care, grief from witnessing patients suffer in isolation), powerless in uncertainty (inescapable awareness of personal risk, therapeutic doubt in a void of evidence, confronting ethical dilemmas, struggling with dynamic and unfamiliar challenges), overwhelmed and exhausted (burden of personal protective equipment (PPE), information overload and confusion, overstretched by additional responsibilities at work, compounded by personal life stressors, feeling vulnerable and dispensable, compassion fatigue, distress from the disproportionate impact on socially oppressed communities), bolstering morale and confidence (motivated by community and family support, equipped with data), and driven by moral duty (responsibility to patient care and community, collegial solidarity and collaboration, contributing to the greater good).
Frontline clinicians reported distress due to the challenges of PPE, uncertainty and powerlessness, new responsibilities at work and home, losing control of their schedules, grief from witnessing patients suffer in isolation and witnessing healthcare disparities exacerbated by this pandemic. Clinicians feel supported by their colleagues, families, and community and were driven by a sense of moral duty. Healthcare system should adopt strategies to minimise distress faced by interdisciplinary clinicians on the frontline of COVID-19.
描述在照顾 COVID-19 患者一线工作的跨学科临床医生所面临的困境和动机。
50 次半结构式访谈。使用定性主题分析对转录本进行分析。
科罗拉多州丹佛市的一家安全网医院。
跨学科一线临床医生，包括为 COVID-19 住院患者提供住院治疗的医生、高级执业护士、护士、呼吸治疗师和护理人员。
50 名临床医生（32 名女性和 18 名男性）参与了研究。确定了五个主题和各自的子主题（括号内）：去人性化和护理障碍（阻碍融洽关系和同情心，关注感染风险而不是高质量护理，目睹患者在隔离中受苦而感到悲伤）、不确定性中的无能为力（不可避免地意识到个人风险，在缺乏证据的情况下对治疗产生怀疑，面对伦理困境，努力应对动态和陌生的挑战）、不知所措和疲惫不堪（个人防护设备（PPE）的负担，信息过载和混乱，工作负担增加，个人生活压力源加剧，感到脆弱和可有可无，同情心疲劳，社会受压迫社区不成比例受到影响的痛苦）、增强士气和信心（社区和家庭支持的动力，配备数据）和道德责任驱动（对患者护理和社区的责任，同事间的团结与合作，为更大的利益做出贡献）。
一线临床医生报告称，由于 PPE、不确定性和无力感、工作和家庭新责任、失去对日程的控制、目睹患者在隔离中受苦和目睹医疗保健差距因这场大流行而加剧等挑战而感到痛苦。临床医生感到同事、家人和社区的支持，并受到道德责任的驱使。医疗保健系统应采取策略，尽量减少 COVID-19 一线跨学科临床医生所面临的困境。
