The role healthcare workers play in caring for us all, and the toll it takes, became front page news during 2020, a year that placed them firmly on the frontline of a global pandemic. They were hailed as ‘superheroes’ and received public applause and accolades, and the The World Health Organisation (WHO) has declared 2021 The Year of Health and Care Workers.

However, research from Deakin University’s Institute for Health Transformation indicates that, far from feeling like infallible superheroes, healthcare workers in Australia and overseas have experienced considerable distress during the pandemic, especially nurses and midwives who had direct contact with COVID-19 patients.

“Being perceived as a superhero doesn’t always support what’s best for your mental health,” points out Dr Sara Holton, a Senior Research Fellow at the Institute’s Centre for Quality and Patient Safety Research (QPS) and co-author of ‘Psychological wellbeing of Australian hospital clinical staff during the COVID-19 pandemic’. “If you feel you’re supposed to be infallible, that could be a barrier to admitting that you’re struggling and seeking help.”

Together, nurses and midwives, doctors and allied health staff make up the largest occupational groups in a health service and have direct, sustained and intense patient contact. 

In an effort to assess the psychosocial impact of COVID-19 on clinical staff, Dr Holton and her fellow researchers from QPS undertook a survey of hospital clinical staff at Western Health, a busy health service in metropolitan Melbourne, between 15 May and 10 June 2020. At the time, Victoria was under Stage 3 restrictions and there were 1,543 cases of COVID-19 in the State. Eighteen people had died and nine were in hospital, including seven in ICU.

The researchers also surveyed staff at other Victorian health services, including Barwon Health, Eastern Health, Epworth Healthcare and Monash Health and at Odense University Hospital in Denmark.

The study was one of the first in Australia to investigate the effects of the COVID-19 pandemic on the psychological wellbeing of hospital clinical staff and the findings indicate that a considerable proportion of nurses, midwives, doctors and allied health staff experienced psychological distress while dealing with it.

“Approximately a quarter of the healthcare workers we surveyed reported symptoms of psychological distress,” Dr Holton says.

“More than half were concerned about infecting their family members and more than 80% said they had avoided interacting with their friends and extended family, even though this was permitted at the time of the survey. More than a third were concerned about caring for patient who had been diagnosed with or had suspected COVID-19.”

Respondents who had less clinical experience, poorer general health and more COVID-19-related concerns reported higher levels of depression, anxiety and stress than those who had more clinical experience, were in better health and had fewer concerns. Those who had had contact with confirmed COVID-19 cases were significantly more anxious than those who had no COVID-19 contact.

Nurses and midwives reported more severe symptoms of anxiety than doctors and allied health staff, perhaps not surprisingly as they have closer and more sustained contact with patients, making them particularly vulnerable to infection. Their mental health scores were also significantly worse than the general Australian population norm.

Many found the requirements for extra personal protection equipment (PPE) made it harder to care for patients. “My role involves talking to patients about sensitive subjects and PPE can reduce the quality of communication and be a barrier to developing therapeutic rapport,” one respondent said, while others commented on the difficulties of showering patients while wearing full PPE and side-effects such as headaches and dehydration.

Others were concerned about taking the infection home to vulnerable family members, and pregnant staff members worried about the potential effect on their unborn child.

“Healthcare workers put their physical and mental health, as well as the health of their families, at risk to care for patients during the pandemic,” Dr Holton says. “Without adequate support, they may leave their jobs, be absent from work, become unwell, or be unable to provide high quality care for their patients. We need further research to inform appropriate health service responses, interventions and support for health service staff, which address their particular psychosocial needs and concerns during the current and any future outbreaks of infectious disease.

“One of the findings of the study was that perceptions that the health service had responded appropriately to the pandemic and provided sufficient staff support were associated with better mental health. This indicates that continued provision of ‘wellbeing’ initiatives, including targeted discipline specific support interventions is crucial.”

Read the full study here:

Read more about Dr Holton’s research:

Dr Sara Holton Deakin

The immediate impact of the COVID-19 pandemic on the work and personal lives of Australian hospital clinical staff 

Responding to COVID-19: Deakin University research reveals impact on healthcare workers 

Who cares for the carers? 

Psychosocial impact of COVID-19 on nurses and midwives 

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