Page 13 - GHES-2-4

Global Health Economics and
Sustainability
COVID-19 and the burden on healthcare workers

wellbeing drop-in sessions providing additional avenues emergency department has expanded non-clinical areas to
for vulnerable staff to seek support (Poonian et al., 2020). provide these safe places for rest, mindfulness, yoga, and
sustaining social connectedness (Poonian et al., 2020).
3.2.2. Leadership and effective communication In addition, safe areas provide easy access to water and

Anticipatory anxiety, fear, misinformation, and a lack educational materials for frontline HCWs to support their
of confidence in PPE have been linked to significant psychological well-being (Presti et al., 2020).
psychological distress in frontline HCWs (Gupta &
Sahoo, 2020). However, with clear, identifiable leadership 4. Discussion
and effective communication, anxiety can be minimized This study highlights the enormous impact of the early
(Poonian et al., 2020). Moreover, through ensuring regular stages of the COVID-19 pandemic on the psychological
updates, providing opportunities to ask questions, and health of frontline HCWs globally, as well as the likely
extending support beyond just hospital issues to areas impact of a future pandemic or major event. Over 50%
such as family needs or finances, feelings of helplessness of frontline HCWs reported symptoms of psychological
experienced by frontline HCWs can be reduced, thereby distress, such as anxiety, depression, insomnia, burnout,
alleviating their stress and improving their mental or acute stress reactions (Que et al., 2020). Thus, this
wellbeing (Gupta & Sahoo, 2020, Poonian et al., 2020). pandemic had the potential to derail career paths, decrease

3.2.3. Rostering job satisfaction, accelerate compassion fatigue, and cause
significant detriment to patient outcomes. In addition,
COVID-19 posed a unique set of challenges to rostering in those who work in emergency departments, who work
emergency departments. To ensure they remained staffed directly with COVID-19 patients, or who are forced to
with appropriately skilled clinicians despite the possibility quarantine are at a significantly higher risk of distress,
of staff being furloughed or isolated, many hospitals making the volume of affected frontline HCWs potentially
adapted their rosters. The pandemic strategy in Singapore’s huge (Master et al., 2020; Gupta & Sahoo, 2020; An, 2020;
largest tertiary teaching hospital involved dividing staff Que et al., 2020; Firew et al., 2020), reducing a health-care
into five equally balanced teams. They worked 12-h shifts service’s ability to function and placing their non-COVID
with handovers, and staff overlaps were kept as brief patients at risk. Furthermore, psychological distress has
as possible (Chua et al., 2020). The longer shifts had a been linked to medical errors, delayed recoveries, and
built-in buffer capacity that provided additional rest days poor patient satisfaction (Spinelli et al., 2019). Therefore,
if no teams required quarantine, meaning that the average the implementation of evidence-based strategies to
hours worked would only increase slightly if as many as reduce psychological distress, not just in the context of
three teams were required to isolate (Chua et al., 2020). In COVID-19 but also for future psychologically distressing
a large Melbourne metropolitan hospital, a roster was also events, is crucial to ensure the health of frontline HCWs
implemented where full-time staff worked no more than and improve patient care. In addition, these interventions
four consecutive shifts followed by 3 days off, with staff will improve HCWs’ work satisfaction and productivity;
rotating between areas of high and low stress (Poonian reduce absenteeism and employee turnover; and assist in
et al., 2020). This ensured an optimal recovery time for the formation and maintenance of a supportive, safe, and
staff, protecting against chronic stress, and maintaining effective work culture (Spinelli et al., 2019).
staff capacity to fulfill their roles (Poonian et al., 2020).
Moreover, 4 hourly breaks were taken as encouraged by The establishment of evidence-based, preventive, and
the Australian College of Emergency Medicine (ACEM), supportive measures to improve the mental health of
and the final 30 min of shifts were reserved for debriefing frontline HCWs should be a priority for all health-care
and reflective self-care (Poonian et al., 2020). Finally, some services in the early stages of a pandemic or psychologically
hospitals redeployed nurse practitioners and physician distressing event. Many have already met this challenge
assistants to areas of critical need, providing support by putting in place measures they believe will reduce the
with low acuity diagnoses, discharging patients, and burden. While this is a positive step for frontline HCWs,
collaborating with telehealth physicians to reduce the the effectiveness of these programs has, unfortunately, only
burden on frontline HCWs (Proulx et al., 2020). been demonstrated during non-pandemic times and has
not yet been rigorously explored during a pandemic.
3.2.4. Safe rest areas Resilience is defined as the maintenance or quick
Research from China indicates the need for a “COVID-safe” recovery of mental health during or after periods of stressful
rest area for frontline HCWs working in high-risk areas exposure (Kunzler et al., 2020). A Cochrane review of
(Presti et al., 2020). At the Royal Melbourne Hospital, the resilience training in health-care professionals highlighted

Volume 2 Issue 4 (2024) 5 https://doi.org/10.36922/ghes.2530