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Sustaining Health Care Professionals during Pandemic Influenza: A Pre-incident Pilot Project
RS2005-OD06
Final Report Date: September 2007
| Principal Investigator: | David R. Kuhl (Providence Health Care and University of British Columbia) |
| Co-Investigators: | Denys J. Carrier, Linda MacNutt, Paul R. Whitehead, Raymond Barnard (Providence Health Care) |
| Workplace partners: | Dr. Dan Kalla, Ms. Kit Schindell, Ms. Stephanie Hennessy, Ms. Wendy Scott, Ms. Bonita Elliott |
For more information about this project, please contact Dr. David Kuhl.
Issue
Health care authorities around the world have been advised to prepare for the outbreak of a new strain of influenza that is likely to occur in the future. Such a pandemic would be a stressful event for health care practitioners, who already face stressful working conditions and high rates of absenteeism, low morale and burnout. In this study, researchers conducted several focus groups to explore health care practitioners’ needs, concerns and stress levels relating to future pandemics.
Key findings
- A large increase in anxiety was experienced by focus group participants after receiving a presentation and detailed information package on pandemics.
- Six themes emerged in focus group discussions: the relationship between work and home; the emotional impact, psychosocial support; leadership authority and difficult decisions; communication; and supplies.
- The findings highlight the need to prepare health care practitioners ahead of time by providing detailed information and training concerning the expected nature and impact of a pandemic, and will inform the development of future pandemic-related programs and materials.
- The researchers made several recommendations for pandemic related policy development based on the findings (see Conclusions).
Objectives
- To understand the needs of health care practitioners.
- To explore how health care practitioners react to information about pandemics.
- To examine health care practitioners views’ on two stress management tools and whether these tools could be useful in addressing pandemic related stress.
- To gather information that will improve the development of pandemic preparedness materials and programs for health care practitioners, and strategies for providing psychosocial support during such events.
Method
Eight focus groups were conducted over seven months with a total of 52 individuals. Participants completed a questionnaire called the State Trait Anxiety Inventory before and after the pandemic information was presented. This gathered the data needed to observe any changes in anxiety occurring after the presentation of the pandemic information.
Focus group discussions were conducted using an interview and process guide developed for this purpose. The discussions were recorded, transcribed, and analyzed to identify themes. The themes were validated by comparing three independent analyses by researchers, by obtaining comments from a subset (21) of participants, and by obtaining comments from three health care leaders.Results
- A large increase in anxiety was experienced by focus group participants after receiving a presentation and detailed information package on pandemics.
- Six themes emerged in focus group discussions: the relationship between work and home; the emotional impact, psychosocial support; leadership authority and difficult decisions; communication; and supplies.
- The relationship between work and home theme highlighted how health care practitioners anticipate a conflict arising during a pandemic between going to work and being certain that their families are cared for. This theme identified the importance of acknowledging this conflict in the workplace and working with health care practitioners to resolve it rather than mandating them to work.
- The emotional impact theme included feelings of fear, overwhelm, moral distress, grief, guilt and anger; as well as the differences in emotional impacts depending on the stage or wave of the pandemic. This theme points to the benefit of emphasizing the safety of staff and their families during pandemics and communicating how safety will be promoted in the workplace during these events.
- The psychosocial support theme identified types of support that participants felt would be beneficial. This included: support from leadership, organization support, interpersonal or team support, and support that is tailored to the stage the pandemic.
- The leadership/authority and difficult decisions theme included comments about the need for leadership in planning for a pandemic, particularly in developing protocols for dealing with the ethical issues that will arise, as well as in developing and communicating protocols ahead of time, and in implementing the plan during the pandemic.
- The communication theme also highlighted the need for preparation and communication before a pandemic influenza outbreak. There is a need for timely, clear and current information both before and during an outbreak. Key audiences (e.g., general public, health care practitioners) and topics were identified.
- Supplies, the final theme, identified some of the supply related difficulties that would likely occur during a pandemic, such as breakdowns of supply channels and infrastructure, and the need to anticipate and prepare for such challenges.
Conclusions
The findings point to the need to exercise care in providing pandemic information and training to health care practitioners, and provide specific insights about issues that can inform the design of related programs, policies and materials. The researchers made the following recommendations for pandemic related policy development based on the findings:
- Develop “report to work” guidelines for disease outbreaks that take into account global discussions of ethical issues.
- Include staff input when developing policies for preparing for pandemic influenza outbreaks, both as a means of enhancing policy development and a way of fostering staff trust, commitment and support.
- Incorporate a psychosocial support plan into all pandemic influenza emergency preparedness plans.
- Include a coordinated and collaborative plan among primary care physicians, community health centres and health care institutions, in order to provide a streamlined and effective response to patient care.
Future directions
A number of directions were identified for future research:
- Different formats for pandemic preparedness training, that go beyond online formats to include experiential and group processes.
- Best practice psychosocial interventions that take into account the prolonged duration and different stages of pandemic influenza outbreaks.
- Models to improve collaboration and interaction between the health care community, hospitals and local communities.
- Additional lessons learned from at the St. Vincent’s SARS clinic.
- An examination of health care staff sick leave and related health problems arising during disease outbreaks such as SARS, Norwalk and Pneumococcal disease.