Faculty of Law, Université Sherbrooke, CHU Sainte-Justine Research Centre, Montreal, QC, Canada.
CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
CJEM. 2022 Aug;24(5):482-492. doi: 10.1007/s43678-022-00306-z. Epub 2022 May 11.
This study's objective was to examine emergency department (ED) workers' perspectives during the Canadian COVID-19 first wave.
This qualitative study included workers from nine Canadian EDs who participated in 3 monthly video focus groups between April and July 2020 to explore (1) personal/professional experiences, (2) patient care and ED work, (3) relationships with teams, institutions and governing bodies. Framework analysis informed data collection and analysis.
Thirty-six focus groups and 15 interviews were conducted with 53 participants (including 24 physicians, 16 nurses). Median age was 37.5 years, 51% were female, 79% had more than 5 years' experience. Three main themes emerged. (1) Early in this pandemic, participants felt a responsibility to provide care to patients and solidarity toward their ED colleagues and team, while balancing many risks with their personal protection. (2) ED teams wanted to be engaged in decision-making, based on the best available scientific knowledge. Institutional decisions and clinical guidelines needed to be adapted to the specificity of each ED environment. (3) Working during the pandemic created new sources of moral distress and fatigue, including difficult clinical practices, distance with patients and families, frequent changes in information and added sources of fatigue. Although participants quickly adapted to a "new normal", they were concerned about long-term burnout. Participants who experienced high numbers of patient deaths felt especially unprepared.
ED workers believe they have a responsibility to provide care through a pandemic. Trust in leadership is supported by managers who are present and responsive, transparent in their communication, and involve ED staff in the development and practice of policies and procedures. Such practices will help protect from burnout and ensure the workforce's long-term sustainability.
本研究旨在探讨加拿大 COVID-19 第一波期间急诊科（ED）工作人员的观点。
这项定性研究包括来自加拿大 9 家急诊科的工作人员，他们于 2020 年 4 月至 7 月期间参加了 3 次每月一次的视频焦点小组，以探讨（1）个人/专业经历，（2）患者护理和 ED 工作，（3）与团队、机构和管理机构的关系。框架分析为数据收集和分析提供了信息。
对 53 名参与者（包括 24 名医生、16 名护士）进行了 36 次焦点小组和 15 次访谈。参与者的中位数年龄为 37.5 岁，51%为女性，79%的工作经验超过 5 年。出现了三个主要主题。（1）在这场大流行的早期，参与者感到有责任为患者提供护理，并对他们的 ED 同事和团队表示团结，同时平衡个人保护与许多风险。（2）ED 团队希望根据最佳现有科学知识参与决策。机构决策和临床指南需要适应每个 ED 环境的特殊性。（3）在大流行期间工作会产生新的道德困境和疲劳源，包括困难的临床实践、与患者和家属的距离、信息频繁变化和额外的疲劳源。尽管参与者很快适应了“新常态”，但他们担心长期倦怠。经历大量患者死亡的参与者感到特别没有准备。
ED 工作人员认为他们有责任在大流行期间提供护理。领导的信任得到了支持，这些领导者要在场并做出响应，沟通要透明，并让 ED 工作人员参与政策和程序的制定和实践。这种做法将有助于防止倦怠，并确保劳动力的长期可持续性。
