Mental health challenges faced by health workers who cared for patients infected with COVID-19 in Windhoek, Namibia

doi:10.21203/rs.3.rs-4850449/v1

Download PDF

Research Article

Mental health challenges faced by health workers who cared for patients infected with COVID-19 in Windhoek, Namibia

https://doi.org/10.21203/rs.3.rs-4850449/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

No sector was spared from the devastations of the global COVID-19 pandemic, which subjected health workers to unrivalled distressing experiences owing to strained health systems. Despite documented evidence that COVID-19 exacerbated health workers’ mental health challenges in many parts of the world, there are limited qualitative data on how mental health of health workers in Windhoek, were affected. This study explored how the direct care of patients infected with COVID-19 affected the mental wellness of health workers in Windhoek.

Methods

This was a qualitative study using a grounded theory design to purposively recruit and interview health workers until data saturation, which was reached at 21 interviews. The interviews were conducted in English face-to-face, digitally recorded (with participants’ consent), transcribed word-for-word and manually analysed using inductive thematic analysis.

Results

Participants included three medical doctors, nine nurses, three physiotherapists, and six caregivers. Our analysis produced five main themes and twelve subthemes: (i) nature of participants’ COVID-19 experiences (negative experiences and positive experiences); (ii) triggers of mental health challenges (psychological distress, work-related psychosocial factors, posttraumatic stress disorder (PTSD) symptoms and moral distress); (iii) stress responses (iv) coping strategies (building and nurturing resilience, fulfilment of career obligation and maladaptive coping response); and (v) deterrents to mental health-seeking (stigma and fear of breach of confidentiality, prioritising patient-care over self-care and ignorance, participants’ unawareness of mental health services)

Conclusion

This study provides important insights into the mental health challenges faced by health workers while caring for patients infected with COVID-19 in Windhoek, Namibia. These lessons should be considered when developing psychosocial programmes for staff working in similar contexts.

health workers

pandemic

psychological impacts of COVID-19

SARS

mental health

Namibia

qualitative

First discovered in Wuhan, China, in December 2019, a novel coronavirus (COVID-19) pandemic caused global shockwaves in the health system and threatened humanity in a manner not seen in recent years (1). Coronavirus, a highly contagious virus, is transmitted through respiratory droplets from coughing or sneezing of an infected person (2). As of early March 2020, the mortality rate in China had rapidly increased by 3.6%, compared to 1.5% in settings outside of China (3). Fever, dry cough, myalgia, fatigue and dyspnoea were identified as the most common symptoms of COVID-19, with an incubation period of 2–14 days (4,5). The rapid spread of COVID-19 resulted in the World Health Organisation (WHO) declaring COVID-19 a pandemic on March 11, 2020 (6). Since then, COVID-19-related morbidity and mortality have increased exponentially, and Namibia was no exception, as the first case was reported on March 13, 2020 (7). On May 4, 2023, the WHO declared that COVID-19 was no longer a public health emergency of international concern (PHEIC) (8). However, as of January 7, 2024, Namibia had recorded 172,221 confirmed cases and 4,103 deaths out of the global share of 773,448,535 and 6,991,829 confirmed cases and deaths, respectively (9).

Studies by Serdarevic et al. (10) and Kang et al. (11) have shown that the COVID-19 pandemic has had dire psychological consequences on health workers (10,11). This phenomenon has been reported in previous infectious diseases, such as Ebola disease, Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) (12,13). Similar to elsewhere in the world, health workers who were at the forefront of the COVID-19 pandemic may have endured stress (14), thereby putting them at risk of mental health challenges(15).

The WHO defines mental health as a state of well-being in which the individual realises his or her ability to cope with everyday challenges to work productively and fruitfully in serving his or her community (16). Mental disorders are becoming serious problems of public health concern in the modern society (17), especially for healthcare workers during pandemic periods. This phenomenon would likely exacerbate psychological stress levels arising from prolonged tiring working hours, separation from loved ones, fear of being infected, and being stigmatised by society (18,19).

Other studies have shown that health workers’ mental health were challenged during the COVID-19 pandemic (20–22), thereby manifesting in anxiety and depression (23,24). Unprecedentedly high disease transmission and mortality worsened by inadequate resources, including personal protective equipment (PPE), were key risk factors for mental health problems (25–27). Health workers in high-transmission settings were more likely to experience fatigue, inadequate sleep, posttraumatic stress disorder (PTSD), and social contact anxiety than their counterparts in low-transmission settings(28,29).

While stigmatisation of carers for COVID-19-infected patients and reduced family support distressed health workers (30,31), social support minimised mental health problems (32). Health workers’ experiences of mental health problems varied widely across settings, with some developing obsessive-compulsive disorder (OCD) traits, especially pertaining to excessive hand washing and PPE wearing (33). Others resorted to substance abuse, self-medication, and withdrawals from society and family (34). Despite the plethora of evidence on health workers’ mental challenges relating to the COVID-19 pandemic, globally, this is not the case in Namibia (35). Therefore, this study provides important insights into how COVID-19 affected the mental health of health workers who directly cared for patients diagnosed with COVID-19 in Windhoek.

Study setting

The study was conducted at state and private health facilities in Windhoek, the capital city of Namibia. Windhoek is in the Khomas region, where the first COVID-19 cases were reported, but also experienced the highest morbidity and mortality in the country. The selected hospitals provided tertiary health care, one clinic designated as a provisional national COVID-19 centre, and private physiotherapy care for patients infected with COVID-19. Some sections/wards in these hospitals and clinics accommodated patients infected with COVID-19. Emergency and isolation wards were made available for the same purpose within these facilities.

Study design

This study used the grounded theory design to explore the mental health challenges experienced by health workers who care for patients infected with COVID-19 in Windhoek, Namibia.

Characteristics of the participants

The participants were health workers (doctors, nurses, physiotherapists, and caregivers) who directly cared for patients with COVID-19 for a minimum of 6 months. After the study was explained, all participants voluntarily signed informed consent forms before being interviewed. There was no relationship between the participants and the researcher.

The selection of participants

The participants were purposively selected using heterogeneous sampling strategies. These individuals were all recruited based on their job description, duty station, and availability. Due to changes in the job relocation and duty status after the pandemic subsided, six facilities, namely: Robert Mugabe Clinic, Paramount Medical Health Centre, Catholic Private Hospital, Circle Private Hospital, Roland Physiotherapy and Katutura Intermediate Hospital, were used to trace and recruit eligible health workers. The in-depth interviews were conducted at the participants’ preferred place (workplace), and only the researcher and participant were present during the interviews.

Data generation and analysis

The data were generated between February and March 2023 through semi-structured face-to-face interviews, using an interview guide. The interview guide comprised of three types of questions: the main questions, follow-up questions, and probes questions. The interviews were conducted in English and lasted for approximately 20 to 45 minutes. No repeat interviews were carried out.

All interviews were audio-recorded (with the participant’s permission), with socio-demographic information collected at the end of each interview. The lead researcher transcribed the audio-materials in verbatim, and these were supported with hand-written field notes.

Grounded theory guided iterative data analysis, which followed the inductive reasoning technique to interpret and construct data-derived meaning (36). The grounded theory approach allows in-depth exploration of emerging themes in participants’ narrative responses as the research progresses through repeated reading of interview transcripts, discussion of emerging ideas, and coding several times until theories are developed (36). This process included constant comparative analysis, which began with the initial data collection and continued throughout the study by reading the transcripts several times to understand and familiarise with the data. Data saturation was reached at 21 interviews. Memoing was performed to help the researcher make conceptual leaps from the raw data to describe the study phenomenon (37). A codebook was developed to code and analyse concept patterns to identify relevant statements, determine their meaning, and organise them into categories, subthemes, and themes. Manual analysis was possible with twenty-one interviews.

Ethical consideration

Ethics approvals

were granted by the Biomedical Research Ethics Committee (reference number: BREC/00004991/2022) of the University of Kwazulu-Natal and Namibia’s Ministry of Health and Social Service (MOHSS), Biomedical Research Ethics Committee and Research Management Committee (reference number: 22/3/11). All participants voluntarily signed written informed consent forms and data were anonymised to ensure confidentiality.

The study participants included doctors (3), nurses (9), physiotherapists (3), and caregivers (6) who cared for patients diagnosed with COVID-19 during the pandemic. The participants’ ages ranged from 23 to 59 years, with 76% being female, and 57%, 38% and 5% were single, married, and divorced, respectively (Table 1). More than half of the participants (52%) reported contracting COVID-19 while caring for infected patients, but only 10% of the participants sought professional mental health help (Table 1).

Table 1

Participants’ demographic profile
#	Gender	Age in years	Occupation	Marital status	Contracted COVID while caring	Sought professional mental health help	Years of working experiences
1	female	24	caregiver	single	yes	no	3
2	female	35	caregiver	single	yes	no	5
3	female	40	caregiver	married	yes	no	10
4	female	36	caregiver	married	no	no	5
5	female	39	caregiver	single	yes	no	7
6	female	59	enrolled nurse	married	no	no	35
7	female	56	registered nurse	married	yes	no	30
8	female	23	caregiver	single	no	no	3
9	female	54	registered nurse	single	yes	no	31
10	female	45	registered nurse	married	yes	no	17
11	female	28	enrolled nurse	single	yes	no	3
12	male	29	registered nurse	single	yes	yes	4
13	male	48	doctor	married	no	no	20
14	female	36	doctor	married	yes	yes	8
15	female	26	registered nurse	single	no	no	2
16	male	36	physiotherapist	married	no	no	8
17	male	26	physiotherapist	single	no	no	3
18	female	38	physiotherapist	divorce	no	no	15
19	female	27	registered nurse	single	no	no	4
20	female	26	registered nurse	single	no	no	3
21	male	35	doctor	single	yes	no	7

The data analysis produced five main themes and twelve subthemes (Table 2).

Table 2

Themes and subthemes from the data analysis
Themes	Sub-themes
Nature of participants’ COVID-19 experiences	Negative experiences
Nature of participants’ COVID-19 experiences	Positive experiences
Triggers of Mental health challenges	Psychological distress
	Work-related psychosocial factors
	Posttraumatic Stress Disorder (PSTD) symptoms
	Moral distress
Stress responses
Coping strategies	Building and nurturing resilience
	Fulfilment of career obligation
	Maladaptive coping response
Deterrents to mental health-seeking	Stigma and fear of breach of confidentiality
	Prioritising patient-care over self-care and ignorance
	Participants’ unawareness of mental health services

Nature of Participants’ COVID-19 experiences

There were mixed views on how participants experienced the COVID-19 pandemic, some experiences were negative, but others were positive.

Negative experiences

Participants described their experiences as unusual and new. The newness of their experiences created a sense of uncertainty about what to expect, with widespread conflicting information and conspiracies worsening the situation. Misinformation particularly pushed health workers to a state of helplessness, hopelessness, and sadness.

“It [the COVID-19 pandemic] was new, and we were overwhelmed, uncertain whether the medication would work…you will do everything you need to do according to the published guidelines, but the patient will still pass away.”Participant #14

“The misinformation created fear, panic, a wrong mindset, and negativity. There was no encouragement.” Participant #2

Nevertheless, despite all the devastations, some positive experiences came out of the deadly COVID-19 pandemic.

Positive experiences

Despite the pandemic’s hardship, participants highlighted a sense of fulfilment that came with saving lives, which they viewed as a reward for their effort and commitment.

“There was a reward we were getting from helping patients, seeing the patient recover and seeing the role we were doing. Physiotherapists played an active role in this COVID-19 outbreak, …and feeling you were making a difference.” Participant #17

It was during the pandemic that health workers found meaning in their work and were imbued with professional confidence and competency for professional growth. They also gained new knowledge and skills, thereby encouraging them to pursue career development for future pandemics.

“Nursing is my calling, so if you went through what was going on, you would want to do more, you would want to know more, you would like to save more lives; so, this was also the reason I applied for nursing, I am currently studying, so I can provide more service.” Participant #8

Apart from these experiences, COVID-19 also triggered a number of mental health problems among health workers.

Triggers of Mental health challenges

Health workers reported a number of triggers of mental health challenges arising from caring for patients with COVID-19.

Psychological distress

The sharp increase in the number of COVID-19 related deaths triggered psychological distress, which induced fear and anxiety among COVID-19 designated health workers. This was exacerbated by the fact that more than half of the participants were infected with COVID-19 while caring for the patients.

“I got it [COVID-19] from the patient. I was caring for a COVID-19 patient. I could not even talk; I was having shortness of breath. So, the COVID-19 among the staff started with me, then other staff started to get sick from there.” Participant #3

“I was anxious when I knew I was going to the COVID ward, so I did not look forward to it. I can’t say I lost sleep, but there was that anxiety I carried within my mind.” Participant #16

During the delta wave, high mortality resulted in dead bodies being kept inwards for longer than usual, and this adversely affected health workers psychologically.

“Even though I have seen people dying, I have never seen people dying in a number the way people were dying from COVID-19. It was not only the patients we cared for dying but also family members. Aaah! It is sad.” Participant #10

“Lifeless body we kept from the morning till evening, the mortuary was full, there was no space. It was a trauma for me to see those lifeless bodies there. You feel like the value of life was useless, and some patients could not say bye to their loved ones.” Participant #4

All participants agreed that PPE discomfort, supply and inadequate resources also increased the risk of psychological distress. Strangely, the shortage of PPEs equally caused psychological distress. Participants perceived PPE as stressful to use, with some stresses coming from the logistical and physical steps required. For example, PPEs were hot, and doubling masks made them suffocate. Donning and doffing for full PPE was also time-consuming. Participants also reported shortages of other supplies, including oxygen and ventilator machines, leading to health workers making difficult decisions on whose life to prioritise and save. All these issues were psychologically distressing.

“We worked long shifts, and you are wearing this PPE; it is hot there. You are sweating the whole day and holding your urine. Imagine! You are even struggling to breathe yourself.” Participant #17

“There were times when there was no PPE, and then we had to use the minimal amount we could use. There are days you have full PPE, and there are days you don’t have all that. You have the face mask and apron. Then, you ask yourself, ‘Am I exposing myself?’. Thank God, I did not get infected.” Participant #21

The unpreparedness of the health system to handle the COVID-19 pandemic was also distressing for health workers. Participants asserted that even the training they received hardly matched the reality on the ground.

“The unpreparedness was a challenge but is what is expected in any outbreak. It created total stress for everyone and the uncertainty of not knowing if you will be the next patient. Facilities were not totally prepared; there was a time we ran out of oxygen in the hospitals.” Participant #9

Participants also reported that they were dissatisfied with daily COVID-19 screening tests, citing that uncomfortable and painful mandatory nasopharyngeal swabbing was psychologically traumatising.

“Had to be tested every day at work. That was a trauma for me. It comes to the point of asking God to test positive so I do not have to be swabbed every day. We were understaffed. Most of our colleagues tested positive, so we had to work seven days a week.” Participant #4

Work-related psychosocial factors

Designation to the COVID-19 ward also induced other psychosocial distresses. This distress arose from stigma, loneliness, and discrimination. However, stigma did not only come from other people, this workforce also experienced self-stigma, as they anticipated other people to keep a distance once they learned that they worked in COVID-19 wards.

“At functions, you have to keep your distance because you were not sure should anything happen; it will be pointed at you that work at the hospital in the COVID ward because people understand was like,’ I am getting this from the hospital.” Participant #6

Others actually reported experiences of stigma from their own family members.

“I had challenges where you came home, and from the gate, people felt like you brought all the germs from the hospital. This made me feel angry and rejected because people were scared of me. I was staying behind the house, which made me feel more isolated.” Participant #3

Participants also felt that their hard work was not properly recognised and rewarded by employers, and this affected them psychosocially. Participants felt that they could have been appreciated for their hard work and effort in battling the pandemic.

“Most of the health workers felt like they were doing their best, but the management did not appreciate health workers. There is a point when you test positive; you have seven days to return to work. I understand there is a shortage, but there was also a lack of appreciation. We were pushed to do things, and we put effort, but they never appreciated.” Participant #21

The ministry or the government was supposed to acknowledge what health workers did, even a simple certificate to say thank you. It was never done.” Participant #13

COVID-19 destabilised work-life balance due to high work demands and working for longer hours than usual.

“It was very physically demanding. I had to put my master on hold because there was no time for it. Morning to evening, you are busy at work the whole day in the PPE; you cannot even scratch your nose. It was exhausting seeing COVID patients all day, every day, and having no time for something else, no time to exercise, no time to do other things. You are just seeing COVID patients every day, all day, that is it. For me, it was physically exhausting.” Participant #18

Posttraumatic stress disorder (PTSD) symptoms

Apart from the physical exhaustion, COVID-19 exposed the health workers’ neglect of their psychological wellness, which ultimately culminated into the manifestation of posttraumatic stress disorder symptoms. Some participants reported experiences of flashback memories of those rooms where those patients and some even relatives died under their care.

“We were too busy, but after a year, I feel like that’s where I sort of started to process most of the impacts of the experience. Most of the time, you were just busy. However, afterwards, I experienced posttraumatic stress with inductive thoughts and definitely some sort of depression, and I was on medication for it as well and had to see a therapist to do some active work to process it.” Participant #14

“Talking about it now, it always brings back tears in my eyes, and it brings back the memories. It will take time for us to heal.” Participant #7

COVID-19 has had long-term effects on the health workers who care for infected patients, as eloquently illustrated by one participant (Medical Doctor).

“I love my job and medicine, but I must admit, after COVID-19, I hesitate to accept treating palliative or more seriously ill patients. I think I was traumatised.” Participant #14

Moral distress

Health workers in COVID-19 wards had to contend with constantly making morally difficult decisions, including making judgements on who to let go and who to save, given limited resources. Regrettably, these decisions led to feelings of guilt, shame, hopelessness, and self-blaming for patients’ deaths.

“I feel like I was failing the patients; my goal as a doctor was to save lives, and I was not achieving this goal.” Participant #13

Stress responses

There was a convergence of views among participants on how they responded to and adjusted to stressful work environments, while caring for patients with COVID-19. Their sleep patterns and eating habits changed, and so did emotions and physical adaptations to stressful pandemic situations.

“I had a problem sleeping. Every time I leave the hospital, I take the patients with me. Especially if I work the day shift, so at night when am sleeping I hear the sound of the machine, I am giving medication in my sleep, I cannot cut off from work.” Participant #10

“It was just terrible. It created fear in me, a lot of fear, and sleepless nights. I could not sleep at night and had thought of how patients died in my hand. I dream of seeing corpses lying around, and I could hear machine sounds in my sleep.” Participant #2

“Could not eat. I did not trust any shop food if it was not warm food from my pots. Even if it was my lunch pack that I had prepared at home, I could not eat at work. I feel it had COVID.” Participant #4

The pressure exerted by COVID-19 robbed health workers of the opportunity to process their emotional and mental trauma, let alone the neglect of their own sick family members and mourning for those who had demised.

“As health workers, we did not have time to grieve. We did not have time to heal mentally, physically, or emotionally. Yes, we were given days off for isolation when we tested positive, but when those days are over, you must come back to work. We never had time to process and heal. Your relatives were also dying, and people at work were dying. As a health worker, if I am COVID-19 positive, I must heal quickly and get back to work.” Participant #5

“We are spending the whole day in the COVID ward; when I get home, I am so tired, I keep thinking about my patients, I slept, I dream I am in the COVID ward’. Now I am like 24 − 7 hours in the COVID ward.” Participant #17

Coping strategies

The difficulties that health workers endured during COVID-19 also meant that they developed their own coping strategies for their survival.

Building and nurturing resilience

Participants found prayer to be an important instrument for building resilience. Other helpful tools were physical activities, self-care, and simply accepting that the pandemic was beyond their control.

“It [death by COVID-19] was everywhere. People were dying of COVID-19 everywhere, all of us. Therefore, I realised that I can only do what I can. You deal with the situation as it comes.” Participant #10

“For me, what helped me was to work out, do some exercise and stay fit.” Participant #17

“I steam, morning and night. I was also taking the booster and drinking lemon water.” Participant #15

With over half (52%) of the participants acquiring COVID-19 infection, social and emotional support in some instances coping abilities by the health workers stemmed from the support received from their families, patients’ families, the facility, some NGOs, and colleagues.

“I had support from family members. Some of our nannies went all the way and even made us fruit baskets. From the community in the morning, they will come to drop some soup. The support from outside was actually well.”Participant #9

“there were some NGOs and companies that supported us with food, chairs, and different devices. We appreciate that.” Participant #13

“The facility arranged for health workers to talk to someone to help them cope. This truly helped me a lot.” Participant #11

Apart from only 10% of the participants seeking professional mental health help, they all viewed mental health interventions as a priority during the pandemic.

Fulfilment of career obligation

Noting that saving lives was part of health workers’ responsibilities helped participants embrace and reframe a positive attitude about their work and COVID-19 conditions.

“We are health workers and took an oath for that. We are nurses, and we are supposed to care for these patients; we can die for these people. It was just a matter of doing the job required to do as ordered. Psychologically, you must be strong yourself.” Participant #15

Maladaptive coping responses

Some participants reported using alcohol and sleeping pills to induce sleep, as they found it difficult to stop thinking about work, even when they were at home.

“I started drinking beer to help me sleep. I will hear people crying, hospital machine sounds, and the phone ringing, so I kind of become an alcoholic. If I knock off, I will go drink one beer just to sleep.” Participant #1

Deterrents to mental health-seeking

Seeking mental health help is not easy, with the stigmatisation of these services being the main deterrent. Over-focus on patient care, and neglecting their own wellness were other important factors that affected the utilisation of mental health services by health workers. In some instances, health workers were not aware of the existence of mental health services in their facilities/ settings.

Stigma and fear of breach of confidentiality

The stigmatisation of mental health services by associating them with craziness remains an important barrier to their uptake.

“I think we shy away from it [mental health] and fear being labelled because of the stigma that is attached to mental health. When people hear you are going to see a psychologist, people will not think maybe it is just for counselling; they will be like, “Are you okay? What is going on? Are you mad? Such sort of things.” Participant #12

Participants also shared experiences of breach of confidentiality when seeking mental health help within their facilities. This deterred them from seeking mental health help.

“There is no confidentiality; you will hear your stories around or be told who was also here. I am talking about something that happened.” Participant #21

Prioritising patient-care over self-care and ignorance

Participants asserted that health workers did not only prioritise patient-care over self-care, but in some instances, they were ignorant.

“Someone must take care of the patients. If I am not doing it, who is going to do it? I know there is a shortage, and a job must be done.” Participant #21

“I think health workers are the most difficult ones to seek help because you are in the system; we do not think you are vulnerable to psychological issues or mental conditions. We don’t think we can be affected like other people.” Participant #13

Participants’ unawareness of mental health services

Participants asserted that they were unaware of the availability of mental health services in their facilities.

“Who do I call? Where do I go, too? I think mental service for health workers is also needed; we also go through things. I will go if I know where I can easily access a psychologist, not just for COVID-19….” Participant #5.

Despite the reported poor health workers’ awareness of mental health services, one participant had a different view.

“They [health facilities] were supported to have a support system for mental health care. So, we can talk, like how we are talking now, how I felt and how I feel now.” Participant #7

This study revealed that the COVID-19 pandemic adversely affected the mental wellness of the health workers who were deployed to work in COVID-19 wards.

The ambiguity and uncertainty regarding the prevention and treatment protocols, fuelled by conflicting information in the media, made things difficult for health workers.

Participants generally saw the COVID-19 pandemic as traumatising and deadly, thereby increasing their fears of acquiring infections. Sadly, more than half of the participants (52%) could not evade their fears as they still acquired infections while caring for patients with COVID-19, which made their fears real. Seeing people dying in numbers compounded with their own infections further deteriorated their state of psychological wellness. In a nutshell, COVID-19 created a state of paranoia among health workers working in COVID-19 wards. For example, while the shortage of protective equipment, such as PPE, had psychological effects on health workers, they were equally affected by the logistics and inconvenience of using these PPE.

The in-depth interviews with health workers revealed that high patient care demands were potentially at the cost of their health and well-being due to unpreparedness, lack of proper guidelines and overburdened infrastructures. Work-related stressors created a severe toll on health workers, and this was consistent with the findings of a previous study by Simms et al. (38), who reported that inadequate resources within a demanding environment are significantly associated with mental disorders. We found that facilities struggled with medical oxygen shortages, inadequate ventilator machines and PPE, and a lack of isolation wards and beds where patients ended up in corridors, thereby creating a stressful working environment for health workers. Similar results have been reported in Peru and China, where shortages of regular personal protective equipment (PPE) have created uncertainty about health workers’ safety(39,40). Even in instances where PPEs were available, participants described their use as stressful, cumbersome, suffocating, and extremely exhausting. Donning and doffing was particularly time-consuming (41). Participants also raised concerns about daily nasopharyngeal COVID-19 screening tests being traumatic, uncomfortable and painful. However, in contrast to our results, a study conducted in London revealed that the health worker screening test was feasible, improved understaffing and reduced the risk of asymptomatic spread of SARS-CoV-2 (42).

The fact that COVID-19 protocols prohibited usual burial send-offs resulted in psychological symptoms of depression, anger, and anxiety (43). Like many people during the COVID-19 pandemic, our participants shared the same experiences, which led to being emotionally overwhelmed and missed grieving opportunities for their departed loved ones. It was also noted that prolonged working hours and high patient volume increased burnout. A study conducted by Ashipala & Nghole in Namibia reported that burnout can negatively impact health workers, both physically and emotionally, thereby compromising patient care quality (44).

However, behavioural changes in response to stress, such as changes in sleeping patterns and sleep quality, self-reported experiences of insomnia and nightmares, as well as sleep terrors, characterised by working in stressful environments, were reported by our participants. Our findings compare well with those of Jansson & Linton (45), which revealed an association between stress and insomnia. A study by Vu et al. also found evidence that digital healthy diet literacy (DDL) and healthy eating behaviours (HESs) are independent predictors of COVID-19 fear and changes in mental health status in health workers (46). This phenomenon is supported by our findings, as there were changes in our participants’ eating habits.

Lack of social support is the single most important factor for developing adverse mental health outcomes across all types of disasters (47). Therefore, poor social support increases anxiety, depressive symptoms and stress among health workers(48,49). Health workers caring for patients infected with COVID-19 felt that they were ostracised by society and family for fear of being infected (50), even though, at times, stigmatisation was more of a perception than reality (self-stigma). Self-stigma also led to loneliness, separation and depression. Furthermore, recognition and empowerment play essential roles in enhancing employee motivation towards achieving tasks, as well as providing employees with intrinsic satisfaction with their job and environment (51). In contrast to these findings, in our study, participants reported that they received low support and recognition from management to boost their motivation.

Although the nature of health workers’ work exposes them to traumatic situations, COVID-19 still does not spare them from developing moral distress (52). The feelings of guilt, shame, hopelessness, and self-blame for patients’ deaths were pervasive among the study participants. Moral dilemmas were also reported, whereby participants grappled with deciding whom to prioritise and whom to let go, given limited resources, and these were in direct conflict with their beliefs and morals (53). They also reported experiencing PSTD symptoms, such as avoidance and intrusive memories with flashbacks of rooms where patients died. A study conducted in China found that 40.2% of health workers screened positive for posttraumatic syndrome disorder symptoms (54).

Despite many challenges, health workers demonstrated some degree of resilience, professional dedication, and a sense of responsibility to society to overcome the psychological challenges imposed by the pandemic (55). While some participants used prayer to cope with the situation, others simply accepted the situation. Consistent with prior studies (32,56), our findings showed that social support decreases stress, anxiety and feelings of isolation. In instances where loved ones, patients’ families, facilities and NGOs provided social support, this proved useful. Health workers also reframe a positive attitude toward difficult pandemic circumstances to focus on saving lives (57). The professional oath made by participants when entering the profession resonated with them during the difficult pandemic period, at times to a point of ignoring their own health needs. Unfortunately, some adopt maladaptive coping practices, such as alcohol consumption, self-medication, and sleeping pills, crept in (34).

Health workers’ psychological needs were inadvertently ignored during the COVID-19 pandemic, as the main focus was on infection control and patient care (58), a phenomenon that is consistent with our findings. In our study, few (10%) participants sought professional mental health help, with a perceived lack of confidentiality, perception of mental health-seeking as a sign of weakness, stigmatisation of mental health as madness, and ignorance about the availability of services, were identified as key deterrents to mental health-seeking. Stigma, as deterrent to seeking mental help, is well documented (59,60). Literature has identified facility accessibility and uncertainty about available psychological supports as additional barriers (61). Interventions for mental health care support and the provision of resources for health workers to meet their mental health needs are essential to overcome these barriers.

Encouragingly, amidst pandemic challenges, some participants developed a greater appreciation of their work, as they felt valuable to society and fulfilled their career obligations imbued with professional confidence and competency for professional growth. Notably, personal growth, increased resilience and new knowledge created hope that they will better manage similar situations in future (62). The experience and skills gained through the challenges of treating diseases such as severe acute respiratory syndrome (SARS) and severe acute respiratory syndrome (COVID-19) have been associated with personal and professional development (63).

Strengths

This study qualitatively explored the mental health challenges experienced by health workers in Windhoek during the COVID-19 pandemic from their own perspective. This study contributes to the limited research on mental health in Namibia. To our knowledge, there are no qualitative studies on the mental health challenges experienced by health workers who cared for patients infected with COVID-19 in Windhoek. In contrast to other studies, we found that few positive things emerged from the COVID-19 experience.

Limitations

Nevertheless, confining the study to the lived experiences of only Windhoek health workers, was an important limitation. However, the results may still have limited utility in settings with comparable population characteristics and profiles. The findings do provide important insights into the lived experience of health workers deployed into COVID-19 wards in Windhoek.

Contribution to evidence-based research

There is a paucity of data on mental health challenges among health workers in Namibia. The Ministry of Health and Social Service (MoHSS) policymakers, governments, and stakeholders may use the study findings to guide and promote health workers’ wellness programmes. These findings can be used for advocacy purposes on matters pertaining to health workers’ mental well-being.

This study provides an in-depth analysis of Windhoek’s health workers’ experiences, which elucidates the mental health challenges they encountered while caring for patients infected with COVID-19 during the pandemic. Understanding health workers’ experiences during the COVID-19 pandemic and lessons learned is essential in order to ensure that future pandemics are better managed. Health policymakers and relevant bodies may use these results to inform the design of health workers’ wellness programmes.

COVID-19: Coronavirus Disease 2019; MERS: Middle East respiratory syndrome; MoHSS: Ministry of Health and Social Service; NGO: Non-Governmental Organisation; PHEIC: Public Health Emergencies of International Concern; PPE: Personal Protective Equipment; PSTD: Post-Traumatic Stress Disorder; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; WHO: World Health Organisation;

Acknowledgements

The authors would like to thank the management of Paramount Healthcare Centre, Roman Catholic Private Hospital, Circle Private Hospital, Katutura Intermediate Hospital, Robert Mugabe Clinic, Roland’s Physiotherapy and all the health workers who shared their experiences.

Authors’ contributions

The author(s) read and approved the final manuscript.

Funding

Not applicable

Availability of data and materials

The datasets generated and analysed during the current study are the property of the University of KwaZulu-Natal (UKZN) and are not publicly available but are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

The study was reviewed and approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (reference number: BREC/00004991/2022). In Namibia, the study was approved by the Namibia Biomedical Research Ethics Committee and Research Management Committee-Ministry of Health and Social Service (reference number: 22/3/1/1). Written informed consent was obtained from all the study participants. Participation was strictly voluntary.

Consent of publication

Not applicable.

Competing interest

The author declares no competing interest.

Author Details

¹Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa. ²Cancer & infectious Diseases of Epidemiology Research Unit (CIDERU), college of health science, University of KwaZulu-Natal, Durban, South Africa.

Zhu H, Wei L, Niu P. The novel coronavirus outbreak in Wuhan, China. Glob Heal Res Policy [Internet]. 2020 Dec 2;5(1):6. Available from: https://ghrp.biomedcentral.com/articles/10.1186/s41256-020-00135-6
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med [Internet]. 2020 Mar 26;382(13):1199–207. Available from: http://www.nejm.org/doi/10.1056/NEJMoa2001316
Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis [Internet]. 2020 Jul;20(7):773. Available from: https://linkinghub.elsevier.com/retrieve/pii/S147330992030195X
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet [Internet]. 2020 Feb;395(10223):507–13. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673620302117
Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology [Internet]. 2020 Apr;295(1):210–7. Available from: http://pubs.rsna.org/doi/10.1148/radiol.2020200274
Mishra SK, Tripathi T. One year update on the COVID-19 pandemic: Where are we now? Acta Trop [Internet]. 2021 Feb;214:105778. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0001706X20316910
World Health Organization (WHO). Situation Report No.1 for comfirmed COVID-19 Namibia [Internet]. 2020. Available from: https://www.afro.who.int/sites/default/files/2020-04/SITREP 1.pdf
World Health Organization (WHO). Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic [Internet]. 2023 [cited 2024 January 7]. Available from: https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic
WHO Data. WHO Health Emergencies Programme:WHO COVID-19 dashboard [Internet]. 2024 [cited 2024 January 7]. Available from: https://data.who.int/dashboards/covid19/about
Serdarevic A, Lepuzanovic M, Sulejmanpasic G, Hajric S, Bajramagic N. Psychological Consequences of COVID-19 on Health Care Workers. Mater Socio Medica [Internet]. 2022;34(4):254. Available from: http://www.matersociomed.org/?mno=126419
Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun [Internet]. 2020 Jul;87:11–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0889159120303482
Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry [Internet]. 2018 Nov;87:123–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0010440X18301664
Raven J, Wurie H, Witter S. Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study. BMC Health Serv Res [Internet]. 2018 Dec 5;18(1):251. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3072-3
Muzyamba C, Makova O, Mushibi GS. Exploring health workers’ experiences of mental health challenges during care of patients with COVID-19 in Uganda: a qualitative study. BMC Res Notes [Internet]. 2021 Dec 26;14(1):286. Available from: https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-021-05707-4
Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr [Internet]. 2020 Aug;52:102066. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1876201820301775
Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. Toward a new definition of mental health. World Psychiatry [Internet]. 2015 Jun;14(2):231–3. Available from: https://onlinelibrary.wiley.com/doi/10.1002/wps.20231
Wu Y, Wang L, Tao M, Cao H, Yuan H, Ye M, et al. Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years. Epidemiol Psychiatr Sci [Internet]. 2023 November 7;32:e63. Available from: https://www.cambridge.org/core/product/identifier/S2045796023000756/type/journal_article
Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Heal [Internet]. 2020 Jun;8(6):e790–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2214109X20302047
Hoedl M, Bauer S, Eglseer D. Influence of nursing staff working hours on stress levels during the COVID-19 pandemic. HeilberufeScience [Internet]. 2021 Nov 10;12(3–4):92–8. Available from: https://link.springer.com/10.1007/s16024-021-00354-y
Morgantini LA, Naha U, Wang H, Francavilla S, Acar Ö, Flores JM, et al. Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey. Murakami M, editor. PLoS One [Internet]. 2020 Sep 3;15(9):e0238217. Available from: https://dx.plos.org/10.1371/journal.pone.0238217
Proto E, Zhang A. COVID-19 and mental health of individuals with different personalities. Proc Natl Acad Sci [Internet]. 2021 Sep 14;118(37). Available from: https://pnas.org/doi/full/10.1073/pnas.2109282118
Babore A, Lombardi L, Viceconti ML, Pignataro S, Marino V, Crudele M, et al. Psychological effects of the COVID-2019 pandemic: Perceived stress and coping strategies among healthcare professionals. Psychiatry Res [Internet]. 2020 Nov;293:113366. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0165178120313755
Chorwe-Sungani G. Assessing COVID-19-related anxiety and functional impairment amongst nurses in Malawi. African J Prim Heal Care Fam Med [Internet]. 2021 Jun 30;13(1). Available from: http://www.phcfm.org/index.php/PHCFM/article/view/2823
Motahedi S, Aghdam NF, Khajeh M, Baha R, Aliyari R, Bagheri H, et al. Anxiety and depression among healthcare workers during COVID-19 pandemic: A cross-sectional study. Heliyon [Internet]. 2021 Dec;7(12):e08570. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2405844021026736
Mersha A, Shibiru S, Girma M, Ayele G, Bante A, Kassa M, et al. Perceived barriers to the practice of preventive measures for COVID-19 pandemic among health professionals in public health facilities of the Gamo zone, southern Ethiopia: a phenomenological study. BMC Public Health [Internet]. 2021 Dec 22;21(1):199. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10256-3
Haward R, G R, Kalyan M. The Impact of Personal Protective Equipment on Healthcare Workers on COVID-19 Duty in a Tertiary Care Hospital in South India. Cureus [Internet]. 2023 Jul 14; Available from: https://www.cureus.com/articles/162021-the-impact-of-personal-protective-equipment-on-healthcare-workers-on-covid-19-duty-in-a-tertiary-care-hospital-in-south-india
Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse Reports of Stressful Situations during the COVID-19 Pandemic: Qualitative Analysis of Survey Responses. Int J Environ Res Public Health [Internet]. 2020 Nov 3;17(21):8126. Available from: https://www.mdpi.com/1660-4601/17/21/8126
Alanazi TNM, McKenna L, Buck M, Alharbi RJ. Reported effects of the COVID-19 pandemic on the psychological status of emergency healthcare workers: A scoping review. Australas Emerg Care [Internet]. 2022 Sep;25(3):197–212. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2588994X21000762
Pappa S, Sakkas N, Sakka E. A year in review: sleep dysfunction and psychological distress in healthcare workers during the COVID-19 pandemic. Sleep Med [Internet]. 2022 Mar;91:237–45. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1389945721003919
Janoušková M, Pekara J, Kučera M, Kearns PB, Šeblová J, Wolfová K, et al. Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic. Sci Rep [Internet]. 2024 May 8;14(1):10534. Available from: https://www.nature.com/articles/s41598-024-59700-5
Kwaghe AV, Kwaghe VG, Habib ZG, Kwaghe GV, Ilesanmi OS, Ekele BA, et al. Stigmatisation and psychological impact of COVID-19 pandemic on frontline healthcare Workers in Nigeria: a qualitative study. BMC Psychiatry [Internet]. 2021 Dec 20;21(1):518. Available from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03540-4
Xiao H, Zhang Y, Kong D, Li S, Yang N. The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit [Internet]. 2020 March 5;26. Available from: https://www.medscimonit.com/abstract/index/idArt/923549
Chakraborty A, Karmakar S. Impact of COVID-19 on Obsessive Compulsive Disorder (OCD). Iran J Psychiatry [Internet]. 2020 Jul 29; Available from: https://publish.kne-publishing.com/index.php/IJPS/article/view/3820
Moya-Salazar J, Nuñez E, Jaime-Quispe A, Zuñiga N, Loaiza-Barboza IL, Balabarca EA, et al. Substance Use in Healthcare Professionals During the COVID-19 Pandemic in Latin America: A Systematic Review and a Call for Reports. Subst Abus Res Treat [Internet]. 2022 Jan 29;16:117822182210855. Available from: http://journals.sagepub.com/doi/10.1177/11782218221085592
Chipare MA, Mupazvihwo T, Tapera R, January J. Mental Health Research in Namibia: A scoping Review of Literature. Med J Zambia [Internet]. 2021 Aug 10;48(2):119–24. Available from: https://mjz.co.zm/index.php/mjz/article/view/872
Glaser BG, Strauss AL. The Discovery of Grounded Theory [Internet]. Routledge; 2017. Available from: https://www.taylorfrancis.com/books/9781351522168
Birks M, Chapman Y, Francis K. Memoing in qualitative research. J Res Nurs [Internet]. 2008 Jan 1;13(1):68–75. Available from: http://journals.sagepub.com/doi/10.1177/1744987107081254
Simms A, Fear NT, Greenberg N. The impact of having inadequate safety equipment on mental health. Occup Med (Chic Ill) [Internet]. 2020 Jun 20;70(4):278–81. Available from: https://academic.oup.com/occmed/article/70/4/278/5843741
Zhuang Z, Cao P, Zhao S, Han L, He D, Yang L. The shortage of hospital beds for COVID-19 and non-COVID-19 patients during the lockdown of Wuhan, China. Ann Transl Med [Internet]. 2021 Feb;9(3):200–200. Available from: https://atm.amegroups.com/article/view/61426/html
Romero-Cabrera AB, Lindo-Cavero A, Villarreal-Zegarra D, Rodriguez V, Luna-Matos ML, Rojas-Mendoza WN, et al. Perception of personal protective equipment availability and mental health outcomes in workers from two national hospitals during the COVID-19 pandemic. Heliyon [Internet]. 2024 Jan;10(1):e23327. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2405844023105354
Villar RC, Nashwan AJ, Mathew RG, Mohamed AS, Munirathinam S, Abujaber AA, et al. The lived experiences of frontline nurses during the coronavirus disease 2019 (COVID‐19) pandemic in Qatar: A qualitative study. Nurs Open [Internet]. 2021 Nov 5;8(6):3516–26. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nop2.901
Khalil A, Hill R, Ladhani S, Pattisson K, O’Brien P. COVID-19 screening of health-care workers in a London maternity hospital. Lancet Infect Dis [Internet]. 2021 Jan;21(1):23–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1473309920304035
Arora S, Bhatia S. Addressing Grief and Bereavement in Covid-19 Pandemic. Illness, Cris Loss [Internet]. 2023 Jan 22;105413732211455. Available from: http://journals.sagepub.com/doi/10.1177/10541373221145536
Ashipala DO, Nghole TM. Factors contributing to burnout among nurses at a district hospital in Namibia: A qualitative perspective of nurses. J Nurs Manag [Internet]. 2022 Oct;30(7):2982–91. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jonm.13693
Jansson M, Linton SJ. Psychosocial work stressors in the development and maintenance of insomnia: A prospective study. J Occup Health Psychol [Internet]. 2006;11(3):241–8. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/1076-8998.11.3.241
Vu DN, Phan DT, Nguyen HC, Le LTH, Nguyen HC, Ha TH, et al. Impacts of Digital Healthy Diet Literacy and Healthy Eating Behavior on Fear of COVID-19, Changes in Mental Health, and Health-Related Quality of Life among Front-Line Health Care Workers. Nutrients [Internet]. 2021 Jul 30;13(8):2656. Available from: https://www.mdpi.com/2072-6643/13/8/2656
Naushad VA, Bierens JJ, Nishan KP, Firjeeth CP, Mohammad OH, Maliyakkal AM, et al. A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders. Prehosp Disaster Med [Internet]. 2019 Dec 18;34(6):632–43. Available from: https://www.cambridge.org/core/product/identifier/S1049023X19004874/type/journal_article
Zhan J, Chen C, Yan X, Wei X, Zhan L, Chen H, et al. Relationship between social support, anxiety, and depression among frontline healthcare workers in China during COVID-19 pandemic. Front Psychiatry [Internet]. 2022 September 14;13. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.947945/full
Karadaş A, Duran S. The effect of social support on work stress in health workers during the pandemic: The mediation role of resilience. J Community Psychol [Internet]. 2022 Apr 4;50(3):1640–9. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jcop.22742
Spruijt I, Cronin A, Udeorji F, Nazir M, Shehu S, Poix S, et al. Respected but stigmatised: Healthcare workers caring for COVID-19 patients. Pongpirul K, editor. PLoS One [Internet]. 2023 Jul 21;18(7):e0288609. Available from: https://dx.plos.org/10.1371/journal.pone.0288609
Manzoor QA. Impact of Employees Motivation on Organisational Effectiveness. Bus Manag Strateg [Internet]. 2011 Aug 18;3(1). Available from: http://macrothink.org/journal/index.php/bms/article/view/904
Arafat R, Tahir T, Harisa A. Moral distress among nurses in caring COVID-19 patients. Clin Ethics [Internet]. 2023 Mar 6;18(1):62–6. Available from: http://journals.sagepub.com/doi/10.1177/14777509211057251
Robert R, Kentish-Barnes N, Boyer A, Laurent A, Azoulay E, Reignier J. Ethical dilemmas due to the Covid-19 pandemic. Ann Intensive Care [Internet]. 2020 Dec 17;10(1):84. Available from: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00702-7
Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, et al. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty [Internet]. 2020 Dec 12;9(1):113. Available from: https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00724-0
Ambrose JW, Catchpole K, Evans HL, Nemeth LS, Layne DM, Nichols M. Healthcare team resilience during COVID-19: a qualitative study. BMC Health Serv Res [Internet]. 2024 Apr 12;24(1):459. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10895-3
Kim HS, Sherman DK, Taylor SE. Culture and social support. Am Psychol [Internet]. 2008;63(6):518–26. Available from: https://doi.apa.org/doi/10.1037/0003-066X
Eftekhar Ardebili M, Naserbakht M, Bernstein C, Alazmani-Noodeh F, Hakimi H, Ranjbar H. Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study. Am J Infect Control [Internet]. 2021 May;49(5):547–54. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0196655320308968
Otu A, Charles CH, Yaya S. Mental health and psychosocial well-being during the COVID-19 pandemic: the invisible elephant in the room. Int J Ment Health Syst [Internet]. 2020 Dec 28;14(1):38. Available from: https://ijmhs.biomedcentral.com/articles/10.1186/s13033-020-00371-w
Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare. Healthc Manag Forum [Internet]. 2017 Mar 16;30(2):111–6. Available from: http://journals.sagepub.com/doi/10.1177/0840470416679413
Thornicroft G. Stigma and discrimination limit access to mental health care. Epidemiol Psichiatr Soc [Internet]. 2008 Mar 18;17(1):14–9. Available from: https://www.cambridge.org/core/product/identifier/S1121189X00002621/type/journal_article
Keyworth C, Alzahrani A, Pointon L, Hinsby K, Wainwright N, Moores L, et al. Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study. Front Psychol [Internet]. 2022 November 15;13. Available from: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.1008913/full
Finstad GL, Giorgi G, Lulli LG, Pandolfi C, Foti G, León-Perez JM, et al. Resilience, Coping Strategies and Posttraumatic Growth in the Workplace Following COVID-19: A Narrative Review on the Positive Aspects of Trauma. Int J Environ Res Public Health [Internet]. 2021 Sep 8;18(18):9453. Available from: https://www.mdpi.com/1660-4601/18/18/9453
Zhang Z, Fu W, Tian C, Zhang F, Zhao B, Mao J, et al. Professional identity of Chinese nursing students during the COVID-19 pandemic outbreak: A nation-wide cross-sectional study. Nurse Educ Pract [Internet]. 2021 Mar;52:103040. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1471595321000767

No competing interests reported.

Download PDF

Reviewers invited by journal
04 Sep, 2024
Editor invited by journal
07 Aug, 2024
Editor assigned by journal
05 Aug, 2024
Submission checks completed at journal
05 Aug, 2024
First submitted to journal
02 Aug, 2024

You are reading this latest preprint version

Mental health challenges faced by health workers who cared for patients infected with COVID-19 in Windhoek, Namibia

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

Background

Methods

Study setting

Study design

Characteristics of the participants

The selection of participants

Data generation and analysis

Ethical consideration

Results

Nature of Participants’ COVID-19 experiences

Negative experiences

Positive experiences

Triggers of Mental health challenges

Psychological distress

Work-related psychosocial factors

Posttraumatic stress disorder (PTSD) symptoms

Moral distress

Stress responses

Coping strategies

Building and nurturing resilience

Fulfilment of career obligation

Maladaptive coping responses

Deterrents to mental health-seeking

Stigma and fear of breach of confidentiality

Prioritising patient-care over self-care and ignorance

Participants’ unawareness of mental health services

Discussion

Strengths

Limitations

Contribution to evidence-based research

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1