3.2 HCPs concerns
Many HCP narratives addressed the challenges faced by being on the "front line" in the isolated COVID-19 department. These included physical difficulty working an entire shift wearing protective gear; the constantly close contact with patients and risk of infection (especially before the availability of effective vaccines; “It's a nightmare in there”). The most frequently identified themes were emotional-psychological-spiritual, including a feeling of helplessness, frustration, depression, fear and anxiety, all of which were exacerbated by the limited effectiveness of conventional medical treatments and the unpredictable course of illness:
“I have no idea how…nothing seems to help…there is no drug, nothing…healthy people are dying…” (30-year-old Arabic-speaking male physician, after 4 months of working in the COVID-19 department).
While some HCPs shared the feeling of "professional impotence", others felt satisfaction of their professional role:
“I finally feel that I am doing something. It's like being on the battlefield…everyone is going downhill. I enjoy being able to keep them alive. We have a shining team, a gathering of the exiles…top people…” (49-year-old nurse "on loan" from the orthopedic department).
In many narratives, however, HCPs expressed excessive worrying, a feeling of being overworked, and low levels of energy. For 31 HCPs, the frustration at the inability to provide continuity of care was a major concern:
“There is no continuity of care…it's all a big mess…we work from a gut feeling…we have no anchor.” (31-year-old physician).
Other HCPs made an association between the overwhelming workload and a feeling of "imbalance":
“Unending fatigue…I lost my sense of balance…give me something to help me sleep. I never used to have any problem sleeping...How do I stop these thoughts? What is happening to me?” (39-year-old male nurse who had been working for more than 9 months in the department).
More than 50 of the narratives reported insomnia and intense fatigue, followed by pain-related symptoms, which were a main concern among 94 HCPs. An association was also made between insomnia and fatigue, felt to manifest as a sense of dissociation between mind and body:
“The fatigue…I thought I had slept plenty, but it is never enough…the body sleeps; the mind does not” (26-year-old nursing student, after 4 weeks in the COVID department).
Some openly reported experiencing a process of somatization, in which it became difficult to differentiate between themselves and their patients:
“I become attached to the patient, despite trying not to be…” (35-year-old Russian and Hebrew-speaking male nurse working in an internal medicine department).
“My mood is low…sometimes crying, especially when someone dies in my arms…there is a great intensity at work…very tired… the anxiety of the patients is transferred to us…” (48-year-old female physician working 50 weekly hours in the COVID-19 ICU).
Emotional-related concerns were reported in many HCP narratives, some specifying emotional distress (37 narratives), primarily depression and anxiety-related symptoms; intense tension or stress (34); and concern for the health of family members (12). Additional associated symptoms included gastrointestinal and appetite-related concerns (12 narratives). Dyspnea was listed as a major concern in only 5 narratives, though the distress was intense and of both real and symbolic importance:
“The image of patients hungry for air won't leave my head…I am hungry for air…” (38-year-old senior nurse who had been working for 9 months in the COVID-19 ICU).
3.3 Post-treatment HCP reflections
Most of the narratives were recorded immediately following the last IM treatment, and described a significant sense of relief and alleviation of the reported concerns. Three factors were found to be associated with this sense of relief: The first, the sense of "being cared-for" and treated, and having been given time for themselves during the long and intense shifts. The second, the "emotional", possibly "spiritual experience" of the IM treatment program. The third was the "experience of relaxation", including the relief of pain, which allowed for the "release" of the body both physically and emotionally.
The therapeutic IM setting provided a “quiet and peaceful place…cutting off.. a moment to look after myself in the heavy daily workload” (32-year-old physician starting his internship', working 60 weekly hours in the COVID-19 department); and a sense of "being cared for" (“To feel that someone is treating me…”). A related theme was the appreciation by the HCPs that ‘someone else’ was acknowledging their concerns and suffering:
“It's not taken for granted that you are here, and understand the pressure we are under…there's always this feeling that no one see us” (29-year-old female intern).
The fact that IM treatments took place in the COVID-19 department, where HCPs were expected to play the role of ‘provider’, had a significant non-specific therapeutic effect. This could be seen in the case of a 48-year-old member of the cleaning staff, who wept from excitement following a combined touch and breathing therapeutic session:
“I cry from excitement…I feel calm, my body rejuvenated…I felt your hands very well…like a mother giving to her son...after that, I no longer have any fear”.
While some of the narratives described a feeling of distrust of the medical system and intense burnout, many saw the IM program as reflecting a genuine appreciation that 'the system’ was truly interesting in their well-being:
”…that they are watching you and thinking about you and seeing you…and that the department head screamed at me that I need to make time (to get the integrative treatment), and he was right…I have the strength now to return to work.” (48-year-old physician).
Many narratives contained specific effects as well, using emotional-spiritual (ES) keywords relating to calmness, "relaxation”, "tranquility", "levity", “release", and “disengagement” (Table 1). The ES-related keywords were used significantly more frequently in the initial IM session (in 119 of 181 narratives; 65.7%); less so in follow-up assessments, in 45.8% and 19.2% of the second and third sessions, respectively.
Table 1
Distribution of narrative keywords among COVID-19 healthcare practitioners undergoing integrative medicine interventions
Integrative medicine session sequence | Entire HCPs narratives N = 299 |
Total number of HCP narratives per session | Number of narratives with identified ES* keywords | Number of narratives with no-identified ES* keywords |
1st session | 181 | 119 (65.7%) | 62 (34.3%) |
2nd session | 72 | 33 (45.8%%) | 83 (54.2%) |
3rd session | 26 | 5 (19.2%%) | 21 (80.8%) |
≥ 4th session | 20 | 5 (25%) | 15 (75%) |
All sessions | 299 | 162 (54.2%) | 137 (45.8%) |
HCPs, Healthcare practitioners |
* ES (Emotional and Spiritual) include HCP narratives with one or more of the following keywords: "calming", "release", "relaxation”, and “disengagement” |
The ES keywords used following the first IM session were most often associated with a sense of relaxation, which contrasted with the stressful environment outside the hospital:
“The treatment gives you a break, relaxation…I fell that I was able to release the constant pressure from work” (49-year-old nurse recruited from the surgical department). The "time-out" provided by the IM sessions allowed the HCPs to focus on themselves:
“An opportunity to stop the events…a moment to focus on one's self…calm…returning to a place in your imagination” (39-year-old female occupational therapist)
In some cases, the experience was accompanied by a sense of detachment, though in a positive context (“I went to a desert island…and cut off from everything”), and an insight of release and ‘letting go’ (“It's very calming…good for the soul...a moment like this for myself, my body, my soul…we forget ourselves”). A sense of levity, both emotional and physical (“a sense of lightness in the body”), was in stark contrast to the heaviness of the burden and overwhelming responsibility of the COVID-19 department:
“Reduced worries…disengaging from the surroundings…felt like all the heaviness is sinking” (33-year-old male medical student, following his second IM treatment which included an Anthroposophic medical oil massage, acupuncture, and guided imagery).
These sensations were associated with metaphors of enhanced vitality (“I received a boost of energy”), which occurred simultaneously with a sense of relaxation:
“The treatment took me to another world after a few moments…a quiet, calm, relaxed world…a feeling of warm touch, felt like a magical hand which charged my empty battery with energy…the touch gave me energy…the quiet and the warmth which encompassed me gave me a feeling of floating in an empty space” (a 45-year-old senior internist).
Other sensations included a dissociative experience, with "release" of the body from its constricted emotions:
“I am calmer…I was released…the body was tensed up, so I let go organically and emotionally. I disengaged from the pressure” (35-year-old physician).
This was expressed primarily with respect to pain-related concerns, for which the term ‘release’ was used in a more physical context:
“The touch released my neck…caused tingling in my hands…my neck is more free…I hope it lasts for a long time…it was more stiff…now much less…” (30-year-old female radiology technician).
A 36-year-old female cleaning staff member, who was being treated with massage for the first time, described the transition of her pain from her "inside" to her
"outside": “All the pain in my body was released through my feet”. Others referred to their experience of pain: “I felt that the pain during the treatment was less severe…this is the first time in a long time that I couldn’t remember that I had pain…” (41-year-old nurse working 50 hours weekly in the COVID department).