In this study, the results of articles that provided interventions to retain and sustain human resources in epidemics were reviewed. Most of the studies were conducted in the late second decade and the era of the Covid-19 pandemic. As well, most studies were conducted in the United States and the United Kingdom. Among them, the study population in 39 studies were general HCWs, five studies of physicians, five studies are dedicated to nurses, and only one study is about dentists. This data, with other features of included studies, can be seen in Table 2.
Table 2. Characteristics of included literature
Characteristics
|
Type
|
Number of References/study
|
Countries’ economic status
|
High-income
|
21
|
Upper-middle income
|
1
|
Lower-middle income
|
5
|
Low income
|
0
|
Not mentioned country
|
23
|
Total
|
50
|
Study Population
|
HCWs
|
39
|
Physicians
|
5
|
Nurses
|
5
|
Dentist
|
1
|
Total
|
50
|
The suggested interventions were categorized by thematic analysis into 15 sub-themes from five themes of preparation, protection, support, care, and feedback (Table 3). Also, in some reviewed articles, the proposed interventions were presented in the form of a model. The Witness to Witness (W2W) model in the United States during the Covid-19 pandemic (24) and the The Anticipate, Plan and Deter(APD) model in Africa and China (25) during the Ebola and Covid-19 pandemics simultaneously cover training and psychological support sub-themes. Therefore, the models do not require extensive infrastructure to implement.
Table 3 Themes, subthemes and interventions
Theme |
Subthemes
|
Interventions
|
Prepare
|
Creating communication networks
|
• Creating communication networks to share successful experiences and the most up-to-date information about the disease, ways of prevention, protection, and treatment measures (8, 26-30)
|
Providing education programs
|
• Meeting the educational needs of HCWs in various aspects, including lifestyle(31), mental health(1, 7, 9, 10, 13, 25, 27, 29, 31-41), mental exercises such as meditation(35), clinical skills (9, 17) and infection control methods (1, 3, 10, 28)
• Use of webinars (24), software (40), QR codes (29), and digital packages (42) to facilitate staff educating
• Using the presented websites to provide preparedness plans to deal with emergencies (43)
|
Protect
|
Telemedicine
|
• Use of telemedicine for in-home screening (9, 12, 44, 45)
• Refer service kiosks for physical examination through video communication with the medical staff (44, 45)
• Using Tele-ICU (46)
|
Protective measures and equipment supply
|
• Supplying personal protective equipment(1, 13, 17, 28, 31, 32, 40-43, 47-49)
• Providing vaccines and diagnostic tests for medical staff and their families (17, 28)
• Providing a suitable place to quarantine sick and suspicious HCWs(28)
• Disinfection of surfaces regularly (28, 36)
• Considering transportation facilities for HCWs to prevent disease transmission (17, 36, 47)
|
Revising and adjusting work shifts
|
• Using special staffing models(1)
• Not using vulnerable people (elderly, physically weak, etc.) in the front line (32, 37)
• Reorganizing work shifts to reduce the spread of disease among HCWs (1, 28)
|
Early detection
|
• Continuous monitoring of the condition of the HCWs for early detection(1, 21, 48)
• Quarantining the suspicious or sick staff (21)
|
Support
|
Organizational psychological support
|
• Organizing a specialized psychological team to provide counseling (24-27, 36, 50, 51)
• Establishing hot-lines and telemedicine platform to provide counseling (13, 31, 36, 38, 41, 52)
• Celebrating patients' recovery to boost positive energy (36)
• Allocating space to keep alive the memory of deceased HCWs (36)
• Allocating centers for child care staff (36, 47)
• Holding breathing sessions to relieve work pressure (3)
|
Peer support
|
• Creating a culture of support and a sincere atmosphere among HCWs to support each other (3, 10, 12, 14, 15, 27-31, 34, 35, 37, 39, 52-54)
• Holding Schwartz rounds (39)
|
Welfare support
|
• Considering the appropriate space and time for HCWs to rest(13, 14, 26, 29, 35, 39, 54)
• Providing easy access to healthy water and food for HCWs(13, 29, 36, 39, 47, 54)
|
Professional support
|
• Establishing explicit, effective, and honest communication from the manager with the staff (9, 10, 27, 39)
• Delegation of powers for decentralized decision-making (7)
• Involvement of HCWs in the decision-making process (9)
• Sending supportive and motivational messages to patients, managers, and prominent social activists(29, 30, 50)
• Establishing organizational justice and creating a flexible organizational culture (10, 11)
• Rewards and financial support (10, 11)
• HCW support during disputes with patients' families (17)
• Facilitating communication between the patient and his family to reduce the workload caused by the supportive role of the treatment staff (34)
|
Smart human resource utilization
|
• Developing a clear and realistic plan to reduce workload (7, 15, 27, 30)
• Organizing volunteer forces to compensate for labor shortages (13, 28)
• Strategic distribution of human resources by reviewing the work shift program (13, 37, 39)
• Using a support team consisting of specialists ready to work in various fields, including palliative medicine and dental team (1, 17, 26, 55)
|
Care
|
Providing psychological care services
|
• Using health applications to provide medical services(38, 56)
• Holding group therapy sessions and using special treatment techniques such as CBT(9, 29)
• Retraining counselors and psychologists and teach them treatment techniques to provide adequate human resources(9)
|
Providing non-psychological care services
|
• Prioritizing HCWs and their families in treatment and drug allocation(17)
• Providing services through narrative medicine(9)
|
Feedback
|
Getting Active feedback
|
• Creating an Environment of Trust, Psychological Safety, and aware of HCWs concerns(17, 21, 32, 51, 57)
• Managers' personal visits to the departments to check and compensate for the shortcomings various areas(29, 34)
|
Getting Passive feedback
|
• Creating a communication network to receive feedback (24, 47)
• Setting up hotlines to hear the HCWs' needs(2, 8, 32)
|
1. Prepare
1.1. Creating communication networks
Establishing communication networks at the local, national, and international levels to share successful experiences and updated knowledge about spreading the disease, prevention, protection, and therapeutic measures can be a valuable intervention (8, 26-30).
1.2. Providing education programs
Providing the educational needs of medical staff in various fields such as lifestyle (31), mental health (1, 7, 9, 10, 13, 25, 27, 29, 31, 33-41) mental exercises including meditation (35), clinical skills (9, 17) and infection control methods (1, 3, 10, 28) in the form of webinars (24), software (40), QR code-based information (29) and digital package (42) are other suggested interventions. Nurses can adjust emergency preparedness programs by visiting reputable websites to protect themselves and their families (43).
2. Protect
2.1. Telemedicine
Providing remote care with telemedicine can reduce physicians' risk of infections by creating social distance and preventing the hospital from crowding. This platform provides the initial screening and treatment of patients without the presence of a physician (9, 12, 44-46).
2.2. Protective measures and equipment supply
One of the most critical factors/measures influencing nurses' willingness to serve in emergencies and epidemics is the availability of personal protective equipment (N95 mask, gloves, etc.) (1, 13, 17, 28, 31, 32, 40, 41, 43, 47, 49, 58). Also, supplying vaccines and diagnostic tests for treatment HCWs and their families requires attention (17, 28). Other measures include: reprocessing of protective equipment (49), providing a suitable place to quarantine sick and suspicious HCWs (28, 36), developing infection control checklists to reduce the chances of infecting HCWs (18), disinfecting surfaces regularly (32), and considering transportation facilities for HCWs to prevent disease transmission (17, 36, 47).
2.3. Revising and adjusting work shifts
One way to reduce the shortage of HCWs during a pandemic is to use staffing models that take disease epidemiology into account (1). Furthermore, to minimize casualties in the medical staff, the strategic distribution of human resources and not using vulnerable people (elderly, people with underlying diseases, etc.) in the front-line is recommended (1, 28, 32, 37).
2.4. Early detection
Monitoring the HCWs' infection status for early diagnosis and considering measures for quarantine of positive and suspicious cases is one way to take care of the health status of HCWs (1, 21, 48).
3. Support
3.1. Organizational psychological support
In order to reduce burnout and fatigue, it is useful to gather a specialized psychological team (consisting of psychologists and psychiatrists) to care for front-line staff. In some studies, setting up hotlines (31, 38, 41, 52) and telemedicine (13) to communicate with this team has been suggested (24-27, 36, 50, 51). Other organizational psychological support includes: celebrating patients' recovery, allocating space to keep alive the memory of dead HCWs, allocating centers for caring for HCW's children during school closures(36, 47), and holding breathing sessions to reduce work stress (3).
3.2. Peer support
In order to reduce the psychological burden caused by crises, it is necessary to create a communication network and a cordial atmosphere between HCWs in order to support each other, increase interactions between them and express sympathy. This network also provides peer support during quarantine (3, 10, 14, 15, 26-31, 34, 35, 38, 39, 41, 52-54).
3.3. Welfare support
The physical health of HCWs in epidemics and their well-being seem essential. Therefore, providing basic needs such as break time and restrooms, sufficient time off, and easy access to water and food has been suggested (13, 14, 26, 29, 35, 36, 39, 47, 54).
3.4. Professional support
Establishing explicit, effective, and honest communication from the manager with the HCWs causes and increases security, unity, teamwork (37), and resilience in the HCWs. (9, 10, 27, 39) In this regard, HCWs involvement in the decision-making process and delegating the necessary authority for decentralized decision-making are suggested (9, 33). Other ideas and methods proposed to strengthen and maintain human resources include sending supportive and motivational messages from patients, managers, and prominent social activists to instill a sense of empathy (29, 30, 50), establishing organizational justice (such as ensuring tolerable workloads) and creating a flexible organizational culture (7, 10), rewards and financial support(34, 57) and supporting HCWs in times of conflict with patients' families (17), Furthermore, to reduce the work and psychological pressure caused by the epidemic on nurses, the possibility of communication between the patient and his family can be facilitated or mediated by someone else, taking this burden off their shoulders. (34)
3.5. Smart human resource utilization
Strategic distribution of human resources is essential to compensate for labor shortages, reduce workload, and prevent burnout. To achieve this goal, developing a clear and realistic plan(7, 15, 27, 30), organizing volunteer forces (13, 28), revising the work shift program, and taking measures to provide remote care are essential (13, 37, 39). It is also reasonable to use a support team consisting of ready-to-work specialists in various fields, including palliative medicine and dentistry, in emergencies (1, 17, 26, 55).
4. Care
4.1. Providing psychological care services
In the case of psychological trauma, the commitment of managers to provide treatment is critical. Therefore, it is necessary to establish mechanisms to assess and evaluate HCWs' mental health and, consequently, to consider specialized teams for early intervention and treatment of injured people (9, 29, 31, 34, 41, 53). In this regard, the proposed interventions are as follows: health applications with the possibility of screening and providing specialized medical services for the ones in need (38, 56), holding group therapy sessions(29), and using special treatment techniques such as Cognitive behavioral therapy (CBT) to solve and deal with psychological problems (59). To provide the human resources for these interventions, it is possible to reeducate counselors and psychologists and teach them treatment techniques (59).
4.2. Providing non-psychological care services
The two proposed interventions in this sub-theme prioritize HCWs and their families in treatment and drug allocation and provide services through narrative medicine (30, 49).
5. Feedback
5.1. Getting Active feedback
Managers need to be aware of their HCWs' concerns and respond to them accordingly. HCWs expect to be heard and understood. They also expect to be psychologically supported by managers. According to reviewed studies, effective communication with HCWs is a prerequisite for having stable and resilient HCWs (8, 57). In this regard, managers' visits of hospital wards (29, 34) and getting active feedback for solving the problems have been discussed (17, 21, 51).
5.2. Getting Passive feedback
Setting up hotlines to hear and meet the HCWs' needs and requests quickly and immediately (2, 8, 32) and creating a communication network to receive feedback are some of the suggested interventions in this sub-theme (23, 47).