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      A qualitative study of the perceptions and experiences of healthcare providers caring for critically ill patients during the first wave of the COVID-19 pandemic: A PsyCOVID-ICU substudy

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          Abstract

          Background

          Intensive care unit (ICU) staff have faced unprecedented levels of stress, in the context of profound upheaval of their working environment due to the COVID-19 pandemic. We explored the perceptions of frontline ICU staff about the first wave of the COVID-19 pandemic, and how this experience impacted their personal and professional lives.

          Methods

          In a qualitative study as part of the PsyCOVID-ICU project, we conducted semi-structured interviews with a random sample of nurses and nurses’ aides from 5 centres participating in the main PsyCOVID study. Interviews were recorded and fully transcribed, and analysed by thematic analysis.

          Results

          A total of 18 interviews were performed from 13 August to 6 October 2020; 13 were nurses, and 5 were nurses’ aides. Thematic analysis revealed three major themes, namely: (1) Managing the home life; (2) Conditions in the workplace; and (3) the meaning of their profession.

          Conclusion

          In this qualitative study investigating the experiences and perceptions of healthcare workers caring for critically ill patients during the first COVID-19 wave in France, the participants reported that the crisis had profound repercussions on both their personal and professional lives. The main factors affecting the participants were a fear of contamination, and the re-organisation of working conditions, against a background of a media “infodemic”.

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          Most cited references30

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          Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

          Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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            Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

            Highlights • At least one in five healthcare professionals report symptoms of depression and anxiety. • Almost four in 10 healthcare workers experience sleeping difficulties and/or insomnia. • Rates of anxiety and depression were higher for female healthcare workers and nursing staff. • Milder mood symptoms are common and screening should aim to identify mild and sub-threshold syndromes.
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              2019-nCoV epidemic: address mental health care to empower society

              A novel coronavirus (2019-nCoV) has been identified as originating in Wuhan, Hubei Province, China. It has widely and rapidly spread in China and several other countries, causing an outbreak of acute infectious pneumonia. According to the official website of the National Health Commission, 1 as of Feb 4, 2020, 24 324 people have been confirmed to have a 2019-nCoV infection and 490 deaths have resulted from 2019-nCoV in 31 provinces in mainland China. 1 16 678 confirmed cases were in Hubei province. 2 Nearly 160 cases of 2019-nCoV have been detected and confirmed in southeast Asia (Thailand, Singapore, Malaysia, Vietnam, Philippines, and Cambodia), east Asia (Japan and Korea), south Asia (India, Nepal, and Sri Lanka), western Asia (United Arab Emirates), Europe (Germany, France, Italy, UK, Russia, Finland, Spain, and Sweden), North America (USA and Canada), and Australia. 3 Approximately 13% of people with confirmed 2019-nCoV infection are reported to have severe respiratory symptoms, 2% have died, and 4% have been cured. 1 Human-to-human transmission is occurring, and WHO has recommended limiting human-to-human transmission by reducing secondary infections among close contacts and health-care workers, preventing transmission amplification events, and preventing further international spread.3, 4 The outbreak of 2019-nCoV in China has caused public panic and mental health stress. The increasing number of patients and suspected cases, and the increasing number of outbreak-affected provinces and countries have elicited public worry about becoming infected. The unpredictable future of this epidemic has been exacerbated by myths and misinformation, often driven by erroneous news reports and the public's misunderstanding of health messages, thus causing worry in the population. Further travel bans and some executive orders to quarantine travellers during the Spring Festival holiday might have generated public anxiety while trying to contain the outbreak. The medical health-care workers who are caring for individuals who are either severely ill, feel scared, or experiencing bereavement are themselves exposed to trauma. Health-care workers are also at risk of getting infected, and they carry a large burden in the clinical treatment and public prevention efforts in Chinese hospitals and community settings. The challenges and stress they experience could trigger common mental disorders, including anxiety and depressive disorders, and posttraumatic stress disorder, 5 which in turn could result in hazards that exceed the consequences of the 2019-nCoV epidemic itself. To efficiently cope with the 2019-nCoV outbreak, the Chinese Government has implemented rapid and comprehensive public health emergency interventions. To date, all of the 31 provincial-level regions in mainland China with confirmed 2019-nCoV cases have activated so-called level 1 public health emergency responses (ie, the highest level of emergency public health alerts and responses within the national public health management system). 6 The provincial governments are responsible for organising, coordinating, and handling all emergency public health treatments, disclosing information, and gathering emergency materials and facilities under the guidance of the State Council. For health-care sectors, in addition to public health interventions, dealing with public psychological barriers and performing psychological crisis intervention is included in the level 1 response. The National Health Commission has released guidelines for local authorities to promote psychological crisis intervention for patients, medical personnel, and people under medical observation during the 2019-nCoV outbreak. 7 Peking University is preparing a mental health handbook for the public that describes how to deal with stress and other psychological problems occurring due to the outbreak of 2019-nCoV. 8 The Chinese Government strives to improve the public's awareness of prevention and intervention strategies by providing daily updates about surveillance and active cases on websites and social media. Increasingly, psychologists and psychiatrists use the internet and social media (eg, WeChat, Weibo, etc) to share strategies for dealing with psychological stress. For example, experts from Peking University Sixth Hospital made six suggestions for the public to cope with mental stress. 9 These included assessing the accuracy of information disclosed, enhancing social support systems (eg, families and friends), eliminating stigma associated with the epidemic, maintaining a normal life under safe conditions, and using the psychosocial service system, particularly telephone-based and internet-based counselling for health-care staff, patients, family members, and the public. Numerous psychiatric hospitals, psychological counselling centres, and psychology departments within universities have launched specialised hotlines to provide psychological counselling services for people in need. 7 We believe that including mental health care in the national public health emergency system will empower China and the world during the campaign to contain and eradicate 2019-nCoV.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                9 September 2022
                2022
                9 September 2022
                : 17
                : 9
                : e0274326
                Affiliations
                [1 ] Department of Cardiology, University Hospital, Besançon, and EA3920, University of Burgundy-Franche-Comté, Besançon, France
                [2 ] EURL SLc, Chamesey, France
                [3 ] Unité de Recherche UR3476, Mediation Research Center, University of Lorraine, Nancy, France
                [4 ] Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
                [5 ] Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
                [6 ] Laboratoire de Psychologie, Université de Bourgogne Franche-Comté, Besançon, France
                [7 ] Service de Médecine Légale CHU Dijon, Cellule d’Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France
                [8 ] Service de Médecine Intensive-Réanimation, CH de Dieppe, France
                [9 ] Espace de Réflexion Éthique de Normandie, Université de Caen, Caen, France
                [10 ] Inserm CIC 1432, Module Épidémiologie Clinique (CIC-EC), CHU Dijon-Bourgogne, UFR des Sciences de Santé, Dijon, France
                [11 ] Inserm CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
                [12 ] DRCI, USMR, Francois Mitterrand University Hospital, Dijon, France
                [13 ] Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
                [14 ] Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
                [15 ] Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
                George Mason University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-4224-9731
                Article
                PONE-D-21-31126
                10.1371/journal.pone.0274326
                9462768
                36084004
                d1f71cfe-6771-4e16-a5fb-c2a779dae657
                © 2022 Ecarnot et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 27 September 2021
                : 25 August 2022
                Page count
                Figures: 1, Tables: 1, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100009243, Direction Générale de l’offre de Soins;
                Award ID: PHRC 2020
                The PsyCOVID-ICU study was funded by a grant (PHRC-COVID 2020) from the Programme Hospitalier de Recherche Clinique National, funded by the French Ministry of Health, to the University Hospital of Dijon, France. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Hospitals
                Intensive Care Units
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Research and Analysis Methods
                Research Design
                Qualitative Studies
                Biology and Life Sciences
                Psychology
                Emotions
                Fear
                Social Sciences
                Psychology
                Emotions
                Fear
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Custom metadata
                Data cannot be made publicly available because they contain potentially identifying information. The data can be obtained by addressing a written request to the Ethics Committee CPP Est 1, at the University Hospital of Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France.
                COVID-19

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