The initial electronic search of the entire database resulted in finding a total of 226 articles, of which 23 full texts were selected and reviewed after the screening and qualitative evaluation process,
Description of Studies:
The details of the studies included in this review are presented in tables 2 and 3. (Tables are attached)
The 23 articles included in this systematic review and meta-synthesis were reviewed, and the effects of the Covid-19 disaster on the employees and the retention strategies were considered as the main themes of this study. Table 4 shows the relationships between the themes, codes, and sub codes. (The complete table4 is attached.)
1) Effects of Covid-19 on the staff
Violence and stigma against the staff, burnout and stress, and increased workload are some of the effects of the Covid-19 disaster on hospital staff, which increases the rate of quitting.
Violence and stigma against the staff
In general, hospital staff is facing a variety of problems during the disaster, including increased violence, which may lead to the rejection and isolation of health care providers from the community. On the other hand, an increase in the patient mortality rate will increase blaming the staff by the community, and in some cases, they are even subject to inappropriate behaviors and so-called bullying by the patients' families.
Burnout and stress:
Healthcare providers are battling the deadly Covid-19 virus. This unprecedented situation has created many sources of emotional distress for the staff. In other words, many health workers identify with the patients and their companions, and as the mortality rates increase or the patients' conditions deteriorate, they considered the care provided to be ineffective and suffer a lot of psychological stress. On the other hand, they are very scared and worried because they are facing with an unknown disease of which they do not have sufficient information and are at risk of getting infected at any moment due to frequent exposure to it or causing the disease to be transmitted to their families and killing them. In addition, health care providers are concerned about being isolated due to the disease and losing their credibility in providing care to others. Furthermore, the great psychological pressure on the health workers in hospitals, especially the emergency department and ICU personnel, has increased anxiety, depression, insomnia, denial, and anger, and they are all experiencing the fear of losing their colleagues at any moment.
Increased employee workloads
The Corona disaster has put a lot of work pressure on the health workers for a variety of reasons, including staff shortages, equipment shortages, and increased workloads on others. Hospital staff is at risk due to the shortage of safety equipment. The biggest misfortune is probably the shortage of personal protective equipment for the first-line health workers, and they have sometimes even reused disposable equipment. There are not enough masks, protective clothing, goggles, etc. On the other hand, the shortage of staff to work in the related departments has increased the pressure on the personnel and has increased their workload as well.
2) Retention strategies
Acquiring communication skills, paying attention to the employees' mental and physical health, focusing on the employees' safety during the disaster, mobilizing the employees to help the existing forces, expanding cyberspace infrastructures, and using motivational-health incentives are among the strategies that can be used by senior managers during the disaster in order to retain the personnel.
Acquire communication skills:
During the Covid-19 disaster, health care providers need to acquire extensive communication skills to communicate with the patients and their companions, to work in multi-specialty teams, and to gain psychological knowledge.
Employees' Mental and Physical Health:
The mental and physical health of the frontline and at-risk healthcare staff must be prioritized, and online psychological counseling classes can be provided in order to prepare them before disasters. In addition, strategies such as sending positive energy text messages, making phone calls with the staff to boost their morale, cheering up the hospital environment, having energetic head nurses and supervisors, and generally boosting the morale of the people in the workplace are various options to prepare the employees to encounter a disaster. On the other hand, the use of the floating force plan can also improve the mental health of the staff, so that any nurse who feels uncomfortable can be transferred to other sections after reporting to the head nurse and the nursing department.
Attention to employee safety:
This epidemic has encountered all health workers to a strange and unknown world, and sharing their experiences can open the doors of this unknown world to others. The experiences of the employees that are more frequently exposed to the disease can be used to aware other healthcare providers and facilitate self-care. In addition, due to the high infection caused by the virus, the health workers are at a serious risk of the disease. Protective clothing, gloves, goggles, hand sanitizers, cleaning agents, gowns, and headgears are essential items that must be adequately stocked. It is also recommended to use ice jackets to lower the staff's body temperature, to move the staff by the office car and not to use public transportation, and to monitor the arrangement of the isolation rooms and the use of the equipment in order to increase the safety of the staff. On the other hand, creating an identification system for the staff allowed to enter medical centers and preventing other staff from entering the wards, and also periodic rotation of the frontline nurses using a hybrid model in which novice and skilled employees are put together in a working group in order for the front-line nurses to have enough rest while ensuring the quality of services and safety are of great importance.
Mobilizing the staff to assist the current forces:
Using prepared forces with strengths to help the current forces during the disaster is a good solution. However, the criteria such as good physical health and proficiency in basic nursing techniques (injection, oxygen ventilation, and condition monitoring) must be considered when entering the forces. Issuing permits for healthcare providers in a short time, early graduation of medical students, re-employment of retired physicians, transfer of the staff from low-referral wards to corona sections, using the private sector personnel, employing interdisciplinary forces such as health students, and team formation are the measures that can be taken to mobilize the staff and assist the current forces.
Expanding cyberspace infrastructures:
Online medicine through the use of video conferencing and virtual meetings during the disaster will expand the cyberspace infrastructures and retain human resources by increasing the staff's awareness and reducing their stress.
Providing incentives such as paying extra as a risk payment to healthcare providers during the disaster, providing free internet services from work to home, offering childcare and food coupons to the employees, and providing supplemental life insurance to all the employee at risk, virtual and in-person appreciation of the staff with good performance during the disaster, reducing the length of service for the unemployed staff, and establishing incentive day-offs will reduce stress and increase comfort in the workplace and will ultimately increase the well-being of the individuals and the community. This in turn will affect the retention of human resources in the workplace during the disaster.
In the end, reviewing and comparing the results of the studies included in the present research on the effects of Covid-19 on the health workers and the strategies appropriate to their retention during the disaster led to the extraction of the following conceptual framework.