Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Level 09-03J, Singapore, S117549, Singapore.
Department of Psychiatry, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, S308433, Singapore.
Hum Resour Health. 2022 Jul 15;20(1):60. doi: 10.1186/s12960-022-00756-7.
Uncertainties related to COVID-19 have strained the mental health of healthcare workers (HCWs) worldwide. Gaining the ability to adapt and thrive under pressure will be key to addressing this. We explore what characterises risk, vulnerability and resilient responses of HCWs during the early stages of the outbreak in Singapore.
We undertook qualitative theory-guided thematic analysis of e-diary entries from HCWs who navigated the outbreak from June-August 2020. Data were extracted from a subset of an online survey of n = 3616 participants collected across 9 institutions, including restructured hospitals, hospices and affiliated primary care partners.
N = 663 or 18% submitted qualitative journal entries included for analyses. All professional cadres, local as well as foreign HCWs participated. Themes are reported according to the Loads-Levers-Lifts model of resilience and highlighted in italics. The model assumes that resilience is a dynamic process. Key factors threatening mental health (loading) risk included a notable rise in anxiety, the effects of being separated from loved ones, and experiencing heightened emotions and emotional overload. Bad situations were made worse, prompting vulnerable outcomes when HCWs experienced stigma in the community and effects of "public paranoia"; or under conditions where HCWs ended up feeling like a prisoner with little control or choice when either confined to staff accommodation or placed on quarantine/Stay Home Notices. Those with strife in their place of residence also described already difficult situations at work being aggravated by home life. Protection (lifts) came from being able to muster a sense of optimism about the future or feeling grateful for the pace of life slowing down and having the space to reprioritise. In contrast, when risk factors were present, balancing these in the direction of resilient outcomes was achieved by choosing to re-direct stress into positive narratives, drawing on inner agency, uptake of therapeutic activities, social support as well as faith and prayer and drawing comfort from religious community among other factors.
The Loads-Levers-Lifts model is used to guide analysis to inform intervention designs. Levers promoting resilience through targeting therapies, workplace policies and awareness campaigns accounting for identified loads are proposed.
与 COVID-19 相关的不确定性给全球医护人员的心理健康带来了压力。能够在压力下适应和茁壮成长将是解决这一问题的关键。我们探讨了在新加坡疫情早期，医护人员面临的风险、脆弱性和弹性反应的特征。
我们对 2020 年 6 月至 8 月期间参与疫情应对的医护人员的电子日记条目进行了定性理论指导的主题分析。数据来自对 9 家机构的 3616 名参与者进行的在线调查的一个子集，包括重组医院、临终关怀机构和附属初级保健合作伙伴。
共有 663 名（占 18%）提交了定性日记条目进行分析。所有专业人员、本地和外国医护人员都参与了研究。根据弹性的“负荷-杠杆-提升”模型报告主题，并以斜体突出显示。该模型假设弹性是一个动态的过程。威胁心理健康的关键因素（负荷）包括焦虑的显著增加、与亲人分离的影响、以及情绪和情绪过载的加剧。当医护人员在社区中受到污名化和“公众偏执”的影响，或者当他们感到自己像一个被限制在员工宿舍或被隔离/居家通知中的囚犯，几乎没有控制或选择时，糟糕的情况会变得更糟，导致脆弱的结果。那些在居住地有困难的人还描述说，工作中的困难情况因家庭生活而加剧。（提升）来自对未来的乐观感，或者对生活节奏放缓和有空间重新优先考虑的感激之情。相比之下，当风险因素存在时，通过将压力重新导向积极的叙述、利用内在能动性、接受治疗活动、社会支持以及信仰和祈祷，并从宗教社区中获得安慰等因素，来平衡这些因素以实现有弹性的结果。
使用“负荷-杠杆-提升”模型来指导分析，为干预设计提供信息。提出了通过针对治疗、工作场所政策和意识运动来提升弹性的杠杆，以应对已确定的负荷。
