The responsibility to care: lessons learned from emergency department workers’ perspectives during the first wave of the COVID-19 pandemic in Canada,Canadian Journal of Emergency Medicine

当前位置： X-MOL 学术 › Can. J. Emerg. Med. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

The responsibility to care: lessons learned from emergency department workers’ perspectives during the first wave of the COVID-19 pandemic in Canada
Canadian Journal of Emergency Medicine ( IF 2.4 ) Pub Date : 2022-05-11 , DOI: 10.1007/s43678-022-00306-z
Bertrand Lavoie ₁ , Claude Julie Bourque ₂ , Anne-Josée Côté ₃ , Manasi Rajagopal ₄ , Paul Clerc ₅ , Valérie Bourdeau ₆ , Samina Ali ₇ , Evelyne Doyon-Trottier ₈ , Véronique Castonguay ₉ , Érika Fontaine-Pagé ₁₀ , Brett Burstein _{11,

12} , Pierre Desaulniers ₁₃ , Ran D Goldman _{14,

15} , Graham Thompson ₁₆ , Simon Berthelot ₁₇ , Maryse Lagacé ₁₈ , Nathalie Gaucher ₂ ,

Affiliation

Faculty of Law, Université Sherbrooke, CHU Sainte-Justine Research Centre, Montreal, QC, Canada.
CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
Department of Pediatric Emergency Medicine, University of Calgary, Calgary, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Centre d'excellence en Éthique Et Partenariat, CHU Sainte-Justine, Montreal, QC, Canada.
Departments of Pediatrics and Emergency Medicine, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
Department of Family and Emergency Medicine, Sacré Coeur Hospital, Université de Montréal, Montreal, QC, Canada.
Verdun Hospital, CIUSSS Centre-Sud-de-L'Île-de-Montréal, Montreal, QC, Canada.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
Department of Epidemiology, Biostatics and Occupational Health, McGill University, Montreal, QC, Canada.
Department of Family and Emergency Medicine, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, QC, Canada.
The Pediatric Research in Emergency Therapeutics Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
BC Children's Hospital Research Institute, Vancouver, BC, Canada.
Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
CHU de Québec-Université Laval, Département de Médecine Familiale Et de Médecine d'urgence, Université Laval, Quebec City, QC, Canada.
CHU Sainte-Justine Research Centre, Montreal, QC, Canada.

Background

This study’s objective was to examine emergency department (ED) workers’ perspectives during the Canadian COVID-19 first wave.

Methods

This qualitative study included workers from nine Canadian EDs who participated in 3 monthly video focus groups between April and July 2020 to explore (1) personal/professional experiences, (2) patient care and ED work, (3) relationships with teams, institutions and governing bodies. Framework analysis informed data collection and analysis.

Results

Thirty-six focus groups and 15 interviews were conducted with 53 participants (including 24 physicians, 16 nurses). Median age was 37.5 years, 51% were female, 79% had more than 5 years’ experience. Three main themes emerged. (1) Early in this pandemic, participants felt a responsibility to provide care to patients and solidarity toward their ED colleagues and team, while balancing many risks with their personal protection. (2) ED teams wanted to be engaged in decision-making, based on the best available scientific knowledge. Institutional decisions and clinical guidelines needed to be adapted to the specificity of each ED environment. (3) Working during the pandemic created new sources of moral distress and fatigue, including difficult clinical practices, distance with patients and families, frequent changes in information and added sources of fatigue. Although participants quickly adapted to a “new normal”, they were concerned about long-term burnout. Participants who experienced high numbers of patient deaths felt especially unprepared.

Interpretation

ED workers believe they have a responsibility to provide care through a pandemic. Trust in leadership is supported by managers who are present and responsive, transparent in their communication, and involve ED staff in the development and practice of policies and procedures. Such practices will help protect from burnout and ensure the workforce’s long-term sustainability.

中文翻译：

照顾的责任：加拿大第一波 COVID-19 大流行期间急诊科工作人员的经验教训

背景

本研究的目的是检查加拿大 COVID-19 第一波期间急诊科 (ED) 工作人员的观点。

方法

这项定性研究包括来自 9 个加拿大 ED 的工作人员，他们在 2020 年 4 月至 2020 年 7 月期间参加了 3 个每月视频焦点小组，以探索 (1) 个人/专业经验，(2) 患者护理和 ED 工作，(3) 与团队、机构和管理机构。框架分析为数据收集和分析提供信息。

结果

对 53 名参与者（包括 24 名医生、16 名护士）进行了 36 个焦点小组和 15 次访谈。中位年龄为 37.5 岁，51% 为女性，79% 有超过 5 年的工作经验。出现了三个主要主题。(1) 在这场大流行的早期，参与者感到有责任为患者提供护理并与他们的 ED 同事和团队团结一致，同时平衡许多风险与他们的个人保护。(2) ED 团队希望根据可获得的最佳科学知识参与决策。机构决策和临床指南需要适应每个 ED 环境的特殊性。(3) 大流行期间的工作造成了新的道德困扰和疲劳，包括困难的临床实践、与患者和家人的距离、信息的频繁变化和增加的疲劳来源。尽管参与者很快适应了“新常态”，但他们担心长期倦怠。经历过大量患者死亡的参与者感到特别措手不及。