The novel Coronavirus Disease 2019 (COVID-19) outbreak, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), originated in Wuhan, China, and rapidly advanced into a global pandemic . As an international public health crisis, the COVID-19 pandemic has challenged health care, economic, and social systems worldwide; the severity of COVID-19 infection has overwhelmed hospital capacities, exhausting resources, and placing extraordinary demands on health care workers (HCWs) to provide care for a population with which they had no experience [2, 3]. Furthermore, the burden of COVID-19 has led to a rise in other infectious diseases in many countries, due to the diversion of resources to control the pandemic. This is especially challenging in low- and middle-income countries where healthcare systems are already fragile [4–7]. These factors combined have shown that adequacy of resources and staff competencies on the management of the novel disease are extremely important.
Organizational preparedness is vital when there is sudden emergence of a new infectious disease. Fundamental to organizational preparedness are skills and knowledge of the novel threat, and the management of infected patients [8, 9]. Preparedness of the hospitals includes the development and implementation of strategies for prevention, detection, and containment of the infectious disease, programs for management and support of the workforce, and procedures for response and mollification of issues that evolve from the spread of pandemics, such as shortages of personal protective equipment, restricted hospital capacity, and acquisition of vaccines [10, 11]. Additionally, training and education of HCWs on preparedness for a pandemic is essential to improve the experience, knowledge, skills, and mental wellbeing of staff during a pandemic .
While the preparation of handling a surge of patients in hospitals is central, evidence suggests monitoring the emotional and psychological burden on staff is equally essential [13–15]. Overall, HCWs exhibit higher rates of anxiety, depression, burnout, and suicidal ideation when compared to the general population [16–18]. During infectious outbreaks, there are significant psychological impacts across all population groups, with HCWs bearing a disproportionate burden [19–21]. HCWs experience multiple sources of stress during outbreak related surges, including coping with increased volume of patients, risk of nosocomial infections, fear of secondary transmission to family members, resource scarcity, stigmatisation, understaffing, and uncertainty [13, 22–24]. Additional challenges are faced by HCWs with no infectious disease expertise as they adapt to new working environments under considerable different conditions than they are accustomed with, and often with insufficient skills and training .
During previous infectious outbreaks, such as the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) epidemics, HCWs experienced fear, anxiety, emotional distress, panic attacks, depression, psychotic symptoms, insomnia, and post-traumatic stress disorder (PTSD) [11, 13, 14, 19, 25–27]. These adverse psychological outcomes have been reported to be long lasting, persisting six months to three years post-outbreak [14, 21, 27]. Widespread anxiety, depression, stress and insomnia among HCWs was described during the early stages of the COVID-19 outbreak . Further reports of the psychological impact on HCWs, including symptoms of fear, insomnia, psychological distress, burnout, and anxiety, have persistently appeared in the literature as this current global health crisis continues [15, 23, 28–32]. Like previous infectious outbreaks, the mental impact and stress induced by COVID-19 has the potential to develop into PTSD [33, 34]. Combined evidence of psychological impact on HCWs reported during SARS and MERS, and now also during COVID-19, highlights the need for continuing monitoring and support of HCWs mental health and wellbeing in infectious outbreak situations [18, 35].
Given the above, it is necessary to have a validated tool to evaluate the perception of HCWs on the effectiveness of organizational preparedness strategies from which they derive confidence to deal with the pandemic. Building confidence among HCWs is critical to combat the experience of fear and anxiety that are related to the potential of being infected during a novel pandemic . These feelings of fear and anxiety are not unwarranted. During the SARS outbreak, the total number of HCW infections accounted for 21% of all confirmed cases worldwide , whereas in highly affected countries such as Vietnam, Canada, Philippines, France, and Singapore, HCW infections made up an even larger proportion; 28–57% of SARS cases . Furthermore, 72% and 55% of all SARS cases were healthcare related in Toronto and Taiwan, respectively . MERS infections among HCWs have accounted for an estimated 18% of the global total of cases . In South Korea, 21% of hospital-acquired infections occurred in HCWs , while analyses of MERS infections in Saudi Arabia between 2016–2019 demonstrated that 26% of cases were in HCWs . Therefore, understanding the perception of HCWs on organizational preparedness is imperative to evaluating the confidence of the workforce in dealing with the pandemic.
Given the importance of understanding how personnel may make decisions when facing competing duties, it is evident there is a paucity of adequate tools for assessing the perception of HCWs to organizational preparedness during an infectious outbreak. This is pertinent because making assumptions without adequate evidence may have serious consequences during disaster planning and management. Plans, policies, and organizational decisions should be based on the best available evidence which in turn would contribute to supporting hospital managers clinically, as well as fine tuning disaster plans for healthcare organizations. Therefore, the impetus to close the gap in literature is to have validated tools for HCWs in the preparation of a pandemic. This study provides a step towards the development of a comprehensive tool that can be used to explore aspects of preparedness, such as knowledge, skills, and mental wellbeing from the perspectives of HCWs themselves.