Listening to Hospital Personnel’s Narratives during the COVID-19 Outbreak
1.1. The Setting—COVID-19 in Hospitals
The moment that I was informed that we had become a COVID-19 department, I was devastated. This coronavirus is so frightening, and I knew that I could die from it. I am a person who needs to be in control, and I had lost control, I was so frightened. This entire new situation was scary—a situation of life or death. Moreover, I was in it. At the level of the team, we did not know what to expect, personally and collectively, as a department. I did not know what was expected from me as a social worker and what were the guidelines; everything was new. We created everything from the beginning, and I was scared.Emma, a social worker in the hospital’s Corona Department
1.2. Theoretical Framework
2. Materials and Methods
- In the first stage, “Listening to the Plot,” attention is paid to the whole story of the interviewee. The researchers’ goal in this stage is to analyze the story in its context, similar to the analysis of an unfolding plot of a novel. The researchers identify recurring images and words, key metaphors, and dominant themes. The Guide also requires that the researchers document their own reflexive emotional and intellectual responses, thoughts, and feelings, as a means to better recognizing how their responses to the interviewee might affect their understanding of the narrative and the subsequent analysis. This stage is similar to the analysis modes in several of the qualitative thematic methods described in the literature .
- The second stage, “I Poems,” is unique to the Listening Guide method. The second-stage listening and transcript analysis follows the use of the first-person pronoun “I.” Within a passage in the transcript, scholars underline every use of “I” together with the attendant verb and any seemingly important accompanying words and then paste these “I Voice” phrases together to compose an “I Poem.” This composite traces how the interviewee views herself/himself and the most prominent themes that preoccupy her/him.
- The third step, “Listening for Contrapuntal Voices,” concentrates on how the interviewee talks about her/his or relationships with others. In this phase, scholars identify the multiple aspects of the story being told, often in multiple voices, with each voice (e.g., “You Voice,” “The Voice of Trauma and Stress”; see below) being underlined in a different color. The transcript thus provides a visual way of examining how the different voices change in relation to one another.
- In the fourth and final step, “Composing an Analysis,” an interpretation of the interviews is developed that synthesizes what has been learned during the entire process by assembling the evidence drawn from the different instances of listening as the basis for composing the analysis. A summary analysis is then constructed [42,43].
3.1. The First Step: “Listening to the Plot”
3.2. The Second Step: The “I Poem”
3.3. The Contrapuntal Voices of Healthcare Workers
3.3.1. The Voice of Trauma and Stress
A deceased is a deceased but the separation from the family is extremely difficult, the wrapping process is a different from what you normally do in the internal ward. In addition to the regular wrap we put them in a nylon wrap and that is horrifying. A really unpleasant sight. It is like you put your patients in a plastic bag and you close it with a zipper. And then you cover with another bag but from the opposite side. An unpleasant wrapping of a patient since it is supposed to be isolated.
Look, the coronavirus is something completely new. A whole new disease that we do not have a clue how to treat, how to behave with it … and the craziest thing [is] that no-one in the world has the knowledge how to treat this disease, no knowledge-based expertise, no medical literature. So, you are constantly calling your colleagues in the country and around the world. Then, you are planning how you will cope with your first coronavirus patient. And then you are planning your second patient and the third. The decisions [as the head of the ICU] are just on your shoulders. They said to me: you are crazy … you are crazy; what are you doing? But I had to listen to myself, my instincts, and I said I have to go with my feelings and intuition. The decision is all yours. And what is most crazy is that you do not know what will happen next. Now it [the patient’s condition] is fine and five minutes later the patient can die and there is no-one to consult with because no-one knows [anything] about COVID-19.
3.3.2. The Voices of Security and Knowledge
At the beginning of the corona outbreak, there was a lack of food, protective gear, and clothes and shielding eyeglasses to protect ourselves. We had to shower between the shifts, and there was a shortage of showers in the hospital, and we had to fight for the basic needs to be protected, especially during the weekends. It was horrible. Everyone was terrified. There was a lack of food in the Corona Department. At the beginning, I did not have what to eat during the day. I felt broken and choked …. There were shifts that I did not eat for almost 12 h.
I did not have a life except the work at the hospital these past few weeks. I did not have a private life at all. I did not meet my family. I am tired all the time, I just want to sleep like a human being, to eat, to be away from the hospital and from the Corona that is all over; these 12-h shifts killed me. I am a single mother and I have a daughter. My daughter was all by herself at our house. It is unbearable; she was all by herself for all those days of the corona, and I was here taking care of other people.
There was constant anxiety and fear that we would infect others; we [at the Corona Department] felt like lepers … and then the isolation from my family since I was so afraid that I would infect them. I was isolated like a leper. My children could not go out to play with other children because I was terrified that I would infect my children and that they would infect their friends with coronavirus. At the beginning of the coronavirus, my daughter was so stressed out from this crazy situation.
3.3.3. The Voice of Attachment
We were all a big family helping each other. I felt so close to all my peers; working together in such a tough time was different from what I had known in the last 26 years that I have been working in the hospital. As a team, we have become closer to each other, and I have discovered additional angels in my team …. In our department there is a sense of “togetherness” and comradery. Professionally, there will be changes; there are thoughts about modifying procedures in light of the current pandemic …. Relating to each other, currently feeling that we are a united and cohesive group.
This period is a mixture of emotions. The reality is that everything is so new and unfamiliar. Nevertheless, the staff are so devoted to each other and struggling to do their best to help each other and changing shifts due to the lack of nurses. Sometimes they asked about treatment and I did not have an adequate answer. How I will say it? This is the period that we are re-inventing the protocols and rules of treatment. I am telling them that I am so sorry but there are no guidelines yet.
3.3.4. The Voice of Meaningfulness
- Ad-hoc meetings aimed at strengthening and supporting staff in transition (in that their departments had changed location and/or function to corona-related locations/functions) were arranged. COVID-19-dedicated teams were approached immediately before or after transition, and a focused, short intervention was conducted with all available staff members.
- Telephone support for teams put in isolation after exposure to the coronavirus was established. 140 calls were made to support employees who were in isolation following exposure to patients infected with coronavirus.
- Targeted short interventions were initiated for HCWs experiencing anxiety symptoms, and various relaxation techniques, such as eye movement desensitization and reprocessing (EMDR) treatment, were offered for trauma treatment.
- Basic information was made available to employees exposed to patients hospitalized for COVID-19. Using the current research results, we created a brochure, in question and answer format, designed to provide information on employee health and rights, workplace guidelines, and the procedure that should be followed after an unwitting exposure to a patient with COVID-19.
- A 24/7 hotline was opened for consultations and questions concerning mental or emotional distress.
Conflicts of Interest
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|Sector N = 433||Medicine 72 (16.6%)||Nursing 169 (39%)||Admin 41 (9.5%)||Paramed * 26 (6%)||Other * 125 (28.9%)|
N = 381
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Daphna-Tekoah, S.; Megadasi Brikman, T.; Scheier, E.; Balla, U. Listening to Hospital Personnel’s Narratives during the COVID-19 Outbreak. Int. J. Environ. Res. Public Health 2020, 17, 6413. https://doi.org/10.3390/ijerph17176413
Daphna-Tekoah S, Megadasi Brikman T, Scheier E, Balla U. Listening to Hospital Personnel’s Narratives during the COVID-19 Outbreak. International Journal of Environmental Research and Public Health. 2020; 17(17):6413. https://doi.org/10.3390/ijerph17176413Chicago/Turabian Style
Daphna-Tekoah, Shir, Talia Megadasi Brikman, Eric Scheier, and Uri Balla. 2020. "Listening to Hospital Personnel’s Narratives during the COVID-19 Outbreak" International Journal of Environmental Research and Public Health 17, no. 17: 6413. https://doi.org/10.3390/ijerph17176413