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
- Ho, C.S.; Chee, C.; Ho, R. Mental health strategies to combat the psychological impact of coronavirus disease 2019 (COVID-19) beyond paranoia and panic. Ann. Acad. Med. Singap. 2020, 49, 1–6. [Google Scholar]
- Tam, C.W.; Pang, E.P.; Lam, L.C.; Chiu, H.F. Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: Stress and psychological impact among frontline healthcare workers. Psychol. Med. 2004, 34, 1197–1204. [Google Scholar] [CrossRef]
- Mohammed, A.; Sheikh, T.L.; Poggensee, G.; Nguku, P.; Olayinka, A.; Ohuabunwo, C.; Eaton, J. Mental health in emergency response: Lessons from Ebola. Lancet Psychiatry 2015, 2, 955–957. [Google Scholar] [CrossRef]
- Krystal, J.H.; McNeil, R.L. Responding to the hidden pandemic for healthcare workers: Stress. Nat. Med. 2020, 26, 639. [Google Scholar] [CrossRef]
- Maunder, R.G.; Leszcz, M.; Savage, D.; Adam, M.A.; Peladeau, N.; Romano, N.; Rose, M.; Schulman, R.B. Applying the Lessons of SARS to Pandemic Influenza. Can. J. Public Health 2008, 99, 486–488. [Google Scholar] [CrossRef] [PubMed]
- Maunder, R.G.; Lancee, W.J.; Balderson, K.E.; Bennett, J.P.; Borgundvaag, B.; Evans, S.; Fernandes, C.M.; Goldbloom, D.S.; Gupta, M.; Hunter, J.J.; et al. Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak. Emerg. Infect. Dis. 2006, 12, 1924–1932. [Google Scholar] [CrossRef] [PubMed]
- Mak, I.W.C.; Chu, C.M.; Pan, P.C.; Yiu, M.G.C.; Ho, S.C.; Chan, V.L. Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors. Gen. Hosp. Psychiatry 2010, 32, 590–598. [Google Scholar] [CrossRef] [PubMed]
- Ho, S.M.; Kwong-Lo, R.S.; Mak, C.W.; Wong, J.S. Fear of Severe Acute Respiratory Syndrome (SARS) Among Health Care Workers. J. Consult. Clin. Psychol. 2005, 73, 344–349. [Google Scholar] [CrossRef] [PubMed]
- Da Silva, J.V.; Carvalho, I. Physicians Experiencing Intense Emotions While Seeing Their Patients: What Happens? Perm. J. 2016, 20, 15–229. [Google Scholar] [CrossRef]
- Du Plooy, L.; Harms, L.; Muir, K.; Martin, B.; Ingliss, S. “Black Saturday” and its Aftermath: Reflecting on Postdisaster Social Work Interventions in an Australian Trauma Hospital. Aust. Soc. Work. 2014, 67, 274–284. [Google Scholar] [CrossRef]
- Joubert, L.; Hocking, A.; Hampson, R. Social Work in Oncology—Managing Vicarious Trauma—The Positive Impact of Professional Supervision. Soc. Work. Health Care 2013, 52, 296–310. [Google Scholar] [CrossRef] [PubMed]
- Daphna-Tekoah, S. On the front lines: Narratives of social workers in hospitals. Qual. Psychol. 2020. in preparation. [Google Scholar]
- Maslach, C. Burnout: The Cost of Caring; Malor Books: Cambridge, MA, USA, 2003. [Google Scholar]
- Daphna-Tekoah, S.; Halevi-Sheriki, E. Symptoms of Distress and Growth among Social Workers in Hospitals in Israel; Social Work in Health Care in Israel: Tel Aviv-Yafo, Israel, 2019.
- Liu, N.; Zhang, F.; Wei, C.; Jia, Y.; Shang, Z.; Sun, L.; Wu, L.; Sun, Z.; Zhou, Y.; Wang, Y.; et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. Neuroimaging 2020, 287, 112921. [Google Scholar] [CrossRef] [PubMed]
- Kang, L.; Li, Y.; Hu, S.; Chen, M.; Yang, C.; Yang, B.X.; Wang, Y.; Hu, J.; Lai, J.; Ma, X.; et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020, 7, e14. [Google Scholar] [CrossRef]
- Greenberg, N.; Docherty, M.; Gnanapragasam, S.; Wessely, S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020, 368, m1211. [Google Scholar] [CrossRef]
- Maxwell, D.N.; Perl, T.M.; Cutrell, J.B. “The Art of War” in the Era of Coronavirus Disease 2019 (COVID-19). Clin. Infect. Dis. 2020. [Google Scholar] [CrossRef]
- Naqvi, S.H.R.; Fatima, M.; Tun, H.N. Short Message to All Healthcare Providers about Coronavirus Infectious Disease-2019 (COVID 19). Acta Sci. Microbiol. 2020, 3, 119–122. [Google Scholar] [CrossRef]
- Chen, Q.; Liang, M.; Li, Y.; Guo, J.; Fei, D.; Wang, L.; He, L.; Sheng, C.; Cai, Y.; Li, X.; et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry 2020, 7, e15–e16. [Google Scholar] [CrossRef]
- Adams, J.G.; Walls, R.M. Supporting the Health Care Workforce During the COVID-19 Global Epidemic. JAMA 2020, 323, 1439–1440. [Google Scholar] [CrossRef]
- Lai, J.; Ma, S.; Wang, Y.; Cai, Z.; Hu, J.; Wei, N.; Wu, J.; Du, H.; Chen, T.; Li, R.; et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease. JAMA Netw. Open 2020, 3, e203976. [Google Scholar] [CrossRef]
- Marchand-Senécal, X.; Kozak, R.; Mubareka, S.; Salt, N.; Gubbay, J.B.; Eshaghi, A.; Allen, V.; Li, Y.; Bastien, N.; Gilmour, M.; et al. Diagnosis and Management of First Case of COVID-19 in Canada: Lessons applied from SARS. Clin. Infect. Dis. 2020. [Google Scholar] [CrossRef] [PubMed]
- McAlonan, G.M.; Lee, A.M.; Cheung, V.; Cheung, C.; Tsang, K.W.T.; Sham, P.C.; Chua, S.E.; Wong, J.G.W.S. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can. J. Psychiatry 2007, 52, 241–247. [Google Scholar] [CrossRef] [PubMed]
- Naushad, V.A.; Bierens, J.J.; Nishan, K.P.; Firjeeth, C.P.; Mohammad, O.H.; Maliyakkal, A.M.; Chalihadan, S.; Schreiber, M.D. A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders. Prehosp. Disaster Med. 2019, 34, 632–643. [Google Scholar] [CrossRef]
- Hodges, C. Basing Action and Structures on Values in a Post-Corona World. SSRN Electron. J. 2020, 3589690. [Google Scholar] [CrossRef]
- Maslow, A.H. A Theory of Human Motivation. Psychol. Rev. 1943, 20, 20–35. [Google Scholar] [CrossRef]
- Hale, A.J.; Ricotta, D.N.; Freed, J.; Smith, C.C.; Huang, G.C. Adapting Maslow’s Hierarchy of Needs as a Framework for Resident Wellness. Teach. Learn. Med. 2019, 31, 109–118. [Google Scholar] [CrossRef]
- Thielke, S.; Harniss, M.; Thompson, H.; Patel, S.; Demiris, G.; Johnson, K. Maslow’s Hierarchy of Human Needs and the Adoption of Health-Related Technologies for Older Adults. Ageing Int. 2012, 37, 470–488. [Google Scholar] [CrossRef]
- Maslow, A.H. Toward a Psychology of Being, 2nd ed.; Van Nostr and Company: New York, NY, USA, 1968. [Google Scholar]
- Mahalakshmy, T.; Kalaiselvy, A.; Saya, G.K. Strategies to promote psycho-social wellbeing among health care workers during COVID-19 pandemic. Int. J. Health Syst. Implement. Res. 2020, 4, 11–16. [Google Scholar]
- Woodcock, C. The Listening Guide: A how-to approach on ways to promote educational democracy. Int. J. Qual. Methods 2016, 15, 1609406916677594. [Google Scholar] [CrossRef]
- Gilligan, C. The Listening Guide method of psychological inquiry. Qual. Psychol. 2015, 2, 69–77. [Google Scholar] [CrossRef]
- Woodcock, C. The silenced voice in literacy: Listening beyond words to a “struggling” adolescent girl. J. Authentic Learn. 2005, 2, 1. [Google Scholar]
- Hutton, M.; Lystor, C. The listening guide: Voice-centred-relational analysis of private subjectivities. Qual. Mark. Res. Int. J. 2020. [Google Scholar] [CrossRef]
- Petrovic, S.; Lordly, D.; Brigham, S.; Delaney, M. Learning to listen: An analysis of applying the listening guide to reflection papers. Int. J. Qual. Methods 2015, 14, 1609406915621402. [Google Scholar] [CrossRef]
- Mauthner, N.S.; Doucet, A. Reflexive Accounts and Accounts of Reflexivity in Qualitative Data Analysis. Sociology 2003, 37, 413–431. [Google Scholar] [CrossRef]
- Brown, L.M.; Gilligan, C. Listening for voice in narratives of relationship. New Dir. Child Adolesc. Dev. 1991, 1991, 43–62. [Google Scholar] [CrossRef]
- Tekoah, S.D.; Harel-Shalev, A. “Living in a movie”—Israeli women combatants in conflict zones. Women’s Stud. Int. Forum 2014, 44, 26–34. [Google Scholar] [CrossRef]
- Shanafelt, T.; Ripp, J.; Trockel, M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA 2020, 323, 2133. [Google Scholar] [CrossRef]
- Senot, C.; Chandrasekaran, A.; Ward, P.T. Role of Bottom-Up Decision Processes in Improving the Quality of Health Care Delivery: A Contingency Perspective. Prod. Oper. Manag. 2015, 25, 458–476. [Google Scholar] [CrossRef]
- Gilligan, C.; Eddy, J. Listening as a path to psychological discovery: An introduction to the Listening Guide. Perspect. Med. Educ. 2017, 6, 76–81. [Google Scholar] [CrossRef]
- Gilligan, C.; Spencer, R.; Weinberg, M.K.; Bertsch, T. On the Listening Guide: A voice-centered relational method. In Qualitative Research in Psychology: Expanding Perspectives in Methodology and Design; Camic, P.M., Rhodes, J.E., Yardley, L., Eds.; American Psychological Association (APA): Washington, DC, USA, 2003; pp. 157–172. [Google Scholar]
- Serrat, O. Managing by Walking Around. In Knowledge Solutions; Springer: Singapore, 2017; pp. 321–324. [Google Scholar]
- Harel-Shalev, A.; Daphna-Tekoah, S. Bringing Women’s Voices Back In: Conducting Narrative Analysis in IR. Int. Stud. Rev. 2016, 18, 171–194. [Google Scholar] [CrossRef]
- Daphna-Tekoah, S.; Harel-Shalev, A. Beyond binaries: Analysing violent state actors in Critical Studies. Crit. Stud. Terror. 2017, 10, 253–273. [Google Scholar] [CrossRef]
- Kook, R.; Harel-Shalev, A.; Yuval, F. Focus groups and the collective construction of meaning: Listening to minority women. Women’s Stud. Int. Forum 2019, 72, 87–94. [Google Scholar] [CrossRef]
- Horesh, D.; Brown, A.D. Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychol. Trauma Theory Res. Pr. Policy 2020, 12, 331–335. [Google Scholar] [CrossRef]
- Harel-Shalev, A.; Daphna-Tekoah, S. Breaking the Binaries in Security Studies; Oxford University Press (OUP): Oxford, UK, 2019. [Google Scholar]
- Bowlby, J.A. A Secure Base. Parent-Child Attachment and Healthy Human Development; Basic Books: New York, NY, USA, 1988. [Google Scholar]
- Santarone, K.; McKenney, M.; Elkbuli, A. Preserving mental health and resilience in frontline healthcare workers during COVID-19. Am. J. Emerg. Med. 2020, 38, 1530–1531. [Google Scholar] [CrossRef]
|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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