Discussion
The COVID-19 pandemic is globally the most serious and prolonged medical
crisis, with Singapore bearing the early brunt of the pandemic. Our
study indicated that study participants had a normal mean BRS score.
This was similar to the resilience of primary healthcare professionals
from a systematic review done in New York8. The median
BRS score was 3.6 and 11.3% of respondents reported low resilience.
Nurses had significantly lower BRS score compared to doctors in our
study (3.8 vs 3.4, p=0.003). This may be in part related to their
graduate educational background. A cross-sectional study conducted among
nurses in Singapore in 2018 found that there was a positive correlation
between highest educational qualification and resilience level; nurses
with a bachelor’s or postgraduate degree were about three times more
likely to be of moderate or high resilience compared to nurses with only
a general nursing certificate9.
Male HCW had higher resilience scores than female HCW in this study.
While this may be confounded by the lack of males amongst nurses in this
study, previous studies analysing factors affecting resilience did not
demonstrate association between gender and resilience
scores8,10-12. There was no association between age of
HCW and years of working experience with resilience score. This was
unlike that suggested in Balmer et al 2014 that resilience among police
officers was negatively affected by increased rank, age and length of
service. However, the difference in the nature of the work may explain
the difference in factors affecting resilience10.
In this study, respondents were generally more concerned regarding their
family’s health and safety compared to their own. This was similar to
studies done in Taiwan and China during the SARS outbreak on HCW caring
for SARS patients. Their main worries included fears of contracting SARs
and transmitting SARS to their families, being negligent and endangering
co-workers and patients13,14. In addition to the
heightened fear during work, the long working hours affected most HCW
mentally. The social isolation from colleagues and self-imposed
isolation from family members affected their social wellbeing and
increased mental stress.
Three main factors were identified in this study that made our staff
happy during their isolation duties: 1) Good teamwork with reliable and
efficient colleagues; 2) Time away from routine clinical work and 3)
Appreciation from the department, community and patients. These factors
were similarly being identified in Saudi Arabia during the MERS-CoV
outbreak15 and in Taiwan during the SARS
outbreak13. At our hospital, we are fortunate to have
sufficient provision of personal protective equipment (PPE) for all
staff, right from the start of the outbreak, triaged according to task
and exposure with clear clinical guidelines available on our hospital
intranet and round-the-clock Infectious Disease (ID) specialists
available over telephone, who were helpful and supportive. Concerns
regarding sufficient PPE and equipment were unfortunately reported in
other centres. This was found to be associated with higher HCW
infections16. In our centre, we recognised that there
would be concern regarding safety and hence staffs who are allocated
isolation duties were prioritised for completion of PPE and PAPR
training prior to commencing their isolation duties. This ethos
continues till today where vaccination is offered to the HCWs over other
population.
A study by Jens Klein et al conducted in Germany implied that
interventions aimed at reducing psychosocial stress at work among
clinicians could improve quality of healthcare17.
Promotion of autonomy, provision of adequate support services, a
cooperative work environment, and promotion of work-life balance, were
possible interventions to reduce psychosocial stress at the organization
level. At the same time, working overtime, inadequate rewards,
high-perceived demands, and inefficiency at work should be reduced. At
the individual level, the reduction of stressful workplace experience
like over-commitment by stress prevention programs or other stress
management interventions could be an option to increase personal
well-being and stress coping methods. Studies suggested that social
support at work, satisfying work relationships, and organizational trust
were able to reduce symptoms of work stress and error frequency. Further
possible interventions at the interpersonal level could address the
improvement of leadership or provision of esteem reward and supervisory
capacity. A reduction of formal hierarchies could promote social support
as well. At the structural level, innovations in work organization,
compensatory wage systems, or models of gain sharing could be
implemented. Interventions on psychosocial work factors, addressing
psychological demands, decision latitude, social support, and
effort-reward-imbalance, for the different levels were effective in
preventing mental health problems and improving working conditions in a
hospital setting.