Abstract
COVID-19 is a highly transmissible viral infection that caused a substantial global health burden with over 700 million and 4 million cases recorded globally and in South Africa, respectively, by the year 2024. The spread of COVID-19 soon became a crisis that necessitated deviations in the standard of care in health facilities, thus placing health care workers (HCWs) under added physical and emotional pressure. This study explored the medium-term effects of caring for COVID-19 patients on HCWs in South Africa. In 2024, we conducted in-depth interviews with 15 HCWs who cared for hospitalised COVID-19 patients at a COVID-19 isolation centre in eThekwini District, South Africa, between June 2020 and December 2021. The participants were aged 33–58 years with 4–27 years of work experience in health facilities. The thematic analysis revealed four themes: (1) changes in staff attitudes and behaviours post-COVID-19, (2) workplace transformation, (3) psychological effects, and (4) transformative impact of the COVID-19 pandemic. The Study findings signal an existing gap in the psychological support made accessible to HCWs and a need for HCWs' health to be prioritised during pandemics. To mitigate the psychological effects of pandemics on HCWs, we recommend pandemic-related psychological resources, debriefing sessions during and post-pandemic, and ongoing active surveillance to monitor the mental health of HCWs.
Introduction
COVID-19 is a highly transmissible viral infection that caused a substantial global health burden with over 700 million cases and 7 million deaths recorded by 2024 (World Health Organization, 2024). In South Africa (SA), there were over 4 million cases and approximately 102,000 deaths by the end of 2023 (Justman & Abularrage, 2024). High morbidity and mortality related to COVID-19, alongside the transmissibility of the virus had adverse effects on health care workers (HCWs) (Eftekhar Ardebili et al., 2021). First, HCWs had a higher risk of acquiring the virus due to working closely with patients who had the virus. In a study conducted in the United States, it was estimated that 10%–20% of documented COVID-19 infections occurred among HCWs. Second, poor treatment outcomes associated with COVID-19 infections rendered HCWs vulnerable to conditions, such as compassion fatigue, which is a secondary traumatic response resulting from the prolonged exposure to the pain and suffering of others.
The COVID-19 pandemic put HCWs in a unique position as they were required to administer care under significant pressure (Greenberg et al., 2020). Several factors, such as a lack of Personal Protective Equipment (PPE), a sharp increase in cases and workload (Mahlangu et al., 2023), and extensive print and digital media reporting (Barua et al., 2020), led to physical and emotional pressure. Globally, evidence suggests that HCWs had an increased risk of death from the virus due to high viral exposure (Barua et al., 2020). HCWs were at the forefront of managing the pandemic, resulting in a higher risk of acquiring the virus. In SA, it was reported that 390 HCWs had died from COVID-19 during the second wave of the epidemic, which began in November 2020 and lasted for about 4 months (Salyer et al., 2021).
The spread of COVID-19 posed challenges to HCWs, especially those working in facilities that managed both suspected and/or confirmed COVID-19 cases. These challenges included increased workloads, long working hours and emotional challenges arising from being separated from their loved ones. There is emerging evidence suggesting that the challenges experienced by HCWs may have given rise to numerous psychological conditions, such as post-traumatic stress disorder (PTSD), depression, fear and anxiety (Saragih et al., 2021). Protecting the well-being and mental health of HCWs is of great importance during disease outbreaks (Robertson et al., 2020).
The novelty of the COVID-19 virus may have influenced how HCWs care for patients, hence the medium-term effects of caring for patients suspected or confirmed for COVID-19 are a matter of research interest. Therefore, this study explored the medium-term effects of managing patients with COVID-19 among health care workers in a health facility in eThekwini, South Africa. Study findings are anticipated to empower health facility managers with useful data for more effectively managing future pandemics.
Methodology
This was an exploratory qualitative study, with data collected through in-depth interviews with 15 purposively selected health care workers who worked in COVID-19 wards during the pandemic. The study participants were drawn from a district hospital in eThekwini, South Africa. This hospital was converted into a COVID-19 centre during the outbreak of the virus. The study was rooted in the interpretivist paradigm (Hossain, 2011). This paradigm holds a view that researchers are part of the social reality being studied and cannot be detached from the subject of study.
Study Setting
The study was conducted in a district hospital in eThekwini, South Africa. The hospital is situated in Mobeni, which is a suburb located in South Durban. The hospital is gazetted as a 190-bedded specialised rehabilitation and convalescent hospital for in-patient care. At the time of this study, services at the hospital were provided by a staff complement of six full-time doctors and two community service officers, with the majority of staff being nurses and allied personnel.
This hospital was designated as a COVID-19 isolation centre by the KwaZulu-Natal (KZN) Department of health (DOH) at the beginning of the outbreak in 2020.
Target and Study Population
Doctors and nurses who worked at the COVID-19 isolation centre over the period of June 2020 to December 2021 were eligible to participate in the study. We excluded those who worked for less than 3 months in the COVID-19 isolation facility and/or those who worked only with outpatients, as their insights may have been limited. The 3-month period was chosen based on documented evidence suggesting that it usually takes up to 3 months for psychosocial symptoms to develop, although this is also stress-dependent (Center for Substance Abuse Treatment (US), 2014).
Sampling Strategy
A purposive sampling strategy was used to recruit participants, enabling a diverse group in terms of age, race, and roles and responsibilities within the facility.
Data Collection
Data were collected over a period of 3 months through in-depth interviews using an interview guide that contained semi-structured questions focusing on HCWs’ experiences. Interviews continued until data saturation was reached, which, we believe, was roughly achieved at around the 15th interview. The primary investigator conducted the interviews in English, a language agreed to by the participants. These interviews were audio-recorded (with participants’ permission). In this study, the researchers ensured trustworthiness, focusing on transferability, credibility, confirmability, and dependability (Ahmed, 2024). Hence, this study included a descriptive account of the research context, including the study setting, sample size and strategy, inclusion and exclusion criteria and interview guide to enhance the transferability of the research findings.
Reflexivity Statement
The first author is a medical doctor; however, She had not worked in the selected facility and did not know any of the staff members at the selected site prior to data collection. The first author’s experience of the COVID-19 pandemic was unlikely to be at the same level as that of the HCWs working at the isolation centre, as the first author had only worked with non-hospitalised patients; hence, the adverse influence on the research process and outcomes was not anticipated (Alvesson & Sköldberg, 2025). The researchers aimed to minimise bias and misinterpretations through adhering to the study protocol. To maintain reflexivity, the first author engaged in regular reflection and discussions with the second author, the research supervisor, throughout the research process.
Data Analysis
The analysis was conducted using inductive thematic analysis to identify repeated patterns (Braun & Clarke, 2006). Thematic analysis is a suitable approach for qualitative research that allows the researcher to identify, analyse and report repeated patterns (Braun & Clarke, 2006). As the first step, the audio-recorded interviews were transcribed verbatim immediately following each interview by the first author using the Notta transcription software (Notta Technologies Inc., 2025). The transcripts were then shared with the research supervisor, who marked them and provided detailed feedback for improvement in subsequent interviews.
The transcripts were reviewed and re-read several times by the first author for familiarisation and immersion with the data. This was followed by the coding, where important statements were assigned codes. The generated codes were then reviewed and discussed by the research team. The next step was to search for themes, in which similar codes were grouped into themes and sub-themes. These were then reviewed by the research team to refine the codes, sub-themes and themes. The analysis was conducted manually using Microsoft Word and Excel to assign codes and to group codes into themes and subgroups.
Ethical Considerations
Site permission was obtained from the KZN DoH-Health Research and Knowledge Management Epidemiology and Health Research Committee. The ethics approval was obtained from Biomedical Research Ethics Committee (BREC) of UKZN, approval number (BREC/00006328/2023), and Gatekeeper permission was sought and received from the Hospital Manager. All data was kept in a file accessible only to the researcher and transferred to a computer protected by passwords that only the researcher can access.
Study participation was voluntary and written informed consent was obtained before any study procedures were conducted. The interviewer also informed the study participants of the aims and objectives of the study and the risks and benefits of the study. Participants were also informed of their right to withdraw from the study at any point. Permission was sought from the participants to audio-record the interviews for transcription. To maintain anonymity, participants were assigned a unique participant number, and personal identifiers were not collected.
Results
Participant Characteristics
Two-thirds (n = 10) of the participants were women, and their ages ranged from 33 to 58 years, with 5 participants being older than 50 years (Table 1). Out of the 15 participants, twelve were Africans and three were Indians. This classification is rooted in apartheid, but has continued in post-apartheid South Africa. Participants were either nurses or doctors with varying occupational ranks (nurse, operational manager, nursing manager and medical doctor). The participants’ experience in the health field ranged from 4 to 27 years (Table 1).
Characteristics of HCWs Participants Who Worked in a COVID-19 Isolation Centre, June 2020 to December 2021, KwaZulu-Natal, South Africa (N = 15).
Note. Int. = Interview.
Themes and Sub-Themes
Four main themes and eleven sub-themes were identified during analysis (Table 2).
Themes and Sub-Themes on HCWs Medium-Term Psychological Effects of Managing Patients With COVID-19 in KwaZulu-Natal, South Africa (N = 15).
Changes in Staff Attitudes and Behaviour
Participants reported that working in a COVID-19 isolation centre during the pandemic changed them, which manifested in two ways: (1) emotional distress, and (2) changes in staff morale and patient care.
Emotional Distress
The uncontrollable deaths observed by HCWs who worked in the COVID-19 isolation centre during the COVID-19 pandemic led to emotional distress among health care workers, causing feelings of helplessness, as illustrated below:
“I didn’t care anymore, felt helpless and people were dying anyway, no matter what we did” (Int-10, female nurse).
The emotional distress for some health care workers stemmed from having fears of infecting family members with COVID-19. For them, this was a traumatic and draining experience. A participant shared:
“I was very scared for my family, as I thought I would make them sick. . .as we lost some of our staff members. It was very draining and very traumatic to lose one person who was still adding value to patient care.” (Int-6, female nursing manager)
Other HCWs had already lost family members from COVID-19, and they had to continue providing care to COVID-19 patients at work despite their loss:
“It was very difficult for me as I had to come to work and manage patients. I lost my brother, sister, and sister- in-law to COVID. I was very hurt having to come to work and go on as if nothing happened.” (Int-12, female professional nurse)
Changes in Staff Morale and Patient Care
During the pandemic staff morale was low due to the high number of deaths, including deaths of colleagues and high volume of COVID-19 patients. This, in turn, compromised patient care:
“The staff morale was initially one of fear. . . people that we didn’t expect to pass on, passed on. . .So the morale was stressful. And especially the nursing staff, quite a few of them died.” (Int-2, male doctor)
Now, post-COVID-19 pandemic, participants reported that the hardships imposed by COVID-19 have produced resilience, trust in the team and positive outlook about life. These attributes contribute to team cohesion.
“. . .Currently, I can say staff morale has improved, in the sense that we trust each other more and are able to work better in a team after being thrown in the deep end with COVID-19. We are more positive about life.” (Int-14, male doctor)
One of the reasons for the improvement in staff morale was due to the development of the COVID-19 vaccine, which gave HCWs hope against the COVID-19 battle:
“. . .but after the vaccine, things changed. You know people are less sick. So as the vaccines came about our morale improved because we knew we were winning the battle against COVID.” (Int.1, male doctor)
Participants expressed feelings of sympathy for other HCW colleagues since they shared a common experience of being overwhelmed from working in a COVID-19 isolation centre, which in turn strengthened team cohesion and staff morale, post-COVID-19:
“The morale amongst staff post COVID-19 is more sympathetic towards each other, since we all had to work with no break, now we get more empathetic towards someone who’s overwhelmed at work or not feeling well.” (Int-13, female doctor)
The pandemic also taught HCWs thoroughness in caring for patients post-COVID-19 and to not take any symptom lightly:
“Having managed COVID-19, I take every symptom seriously, before we took flu like symptoms very lightly.” (Int-13, female doctor) “I guess we are all extra careful now, we no longer complain about putting on masks for the whole day.” (Int-15, female doctor)
Workplace Transformation
Throughout the interviews, participants shared their opinion on how the COVID-19 pandemic transformed the management of health facilities, including: (1) availability and inadequacy of resources during the pandemic, (2) increased sense of agency, (3) hospital management and concerns for staff, as well as (4) workplace improvement post-pandemic.
Availability & Inadequacy of Resources During the Pandemic
There was a general feeling among participants that COVID-19 fostered collaboration in resource sharing, staffing and training(s) provided by different entities:
“The IPC [Infection, Prevention and Control] Department played a very big role in assisting and supporting staff. . .At that time, we had to be given additional staff because we were overwhelmed because of separation of the areas that cater for COVID-19 affected patient and our other patients.” (Int-6, female nursing manager) “. . . They [experts] provided training on correct use of PPE and how to manage patients with COVID, and when the vaccines arrived, we also received training on them. We also had online training about vaccines.” (Int-9, female professional nurse)
Despite the provided resources and trainings, it was never enough given the exponential increase in patient volume. HCWs had to figure out how to manage COVID-19 patients and to use the equipment over time on their own:
“We did receive some training from the Department of Health and Professors from the University, especially on infection control and the correct use of PPE. But most things we figured out as we went along. . .We had a lot of new equipment such as ventilators, new blood pressure (BP) machines and added oxygen cylinders, although it was never enough. . .” (Int-8, female operational manager) “. . .we sometimes did not have things we needed like enough oxygen, there were too many sick patients and we were not able to take care of them correctly sometimes. . .” (Int-10, female nurse)
Increased Sense of Urgency
In addition to the training, HCWs independently sought out resources to educate themselves about COVID-19, at a time when not much information was available:
“Yeah, it was extremely challenging because it was something new to us. Most of the time we did not know what we were going to do, we read on the internet, there was not much education around it [COVID-19].” (Int-2, male doctor)
Other institutions were also sources of information for better management of COVID-19, and these included the private sector:
“Well, we were trained on the job in terms of ventilator assistance, in terms of protocols that are available, but we also tried to get our own information from colleagues, from other institutions, from the private sector as well.” (Int-1, male doctor)
Hospital Management and Concerns for Staff
COVID-19 drew attention to how health facilities and human resources were managed. There were mixed views on how hospital management managed the COVID-19 pandemic, including facilities and personnel. While Some felt that hospital management did the best they could, others were not convinced:
“They [hospital management] were trying, I feel it was beyond everyone. Especially with something no one knew about. Something new.” (Int-12, female professional nurse) “They [hospital management] tried, but it was not enough, it was something new and no one knew anything about it. I feel they could have done more for hospital workers.” (Int-10, female nurse) “They [hospital management] were managing it in connection with the patients, but not the staff. I don’t think they’re concerned about the staff that much. Even though some of us had chronic diseases and were high risk, the management did not care.” (Int-11, female professional nurse)
Workplace Improvement Post-Pandemic
While the COVID-19 pandemic was stressful, participants witnessed improvements in the workplace:
“Now we always have the required PPE available to us and a lot of hand wash soap, which was not the case previously. Space and new wards were renovated and added to our hospital.” (Int-14, male doctor) “The people in charge seem to be more aware now, when there is an issue they seem to try and source out equipment/ attend to issues more swiftly.” (Int-15, female doctor) “Our infection control team is very strict now and they make sure we comply with infection principles in full. . .” (Int-15, female doctor)
Compliance with hygiene practices improved post-COVID-19 pandemic, including washing hands, wearing mask and using hand sanitiser:
“ I never really followed hygiene protocols before, now I make sure that I always wash my hands after every patient and I wear a mask every single day at work now, I also make sure that patients are wearing their masks, especially if they have respiratory symptoms, such as coughing.” (Int-14, male doctor)
Psychological Impact
Furthermore, participants raised concerns about the potential psychological effects of working at a COVID-19 isolation centre, both in terms of the emergence of psychological conditions and the availability and accessibility of psychological support.
Emergence of Psychological Conditions
When asked if their mental health was affected by working in a COVID-19 isolation centre, participants responded:
“Yes, we were always worried and anxious about losing patients and getting the virus.” (Int-6, female nursing manager)
Some HCWs shared experiencing fear, anxiety, stress, weight loss, loss of sleep and having to use medication:
“It [my mental health] has been affected a lot. Like most of us had COVID during this time, and now I am always scared and think about the time when patients were dying a lot, I sometimes don’t sleep at night, sometimes I use sleeping medication.” (Int-11, female professional nurse) “The anxiety and stress I had during the pandemic, I even lost weight, about 7-8kgs, I couldn’t sleep at night, I always worried. It was so stressful.” (Int-8, female operations manager)
Experiences of symptoms alluding to an undiagnosed mental health condition were also reported, pointing to the psychological effects of caring for patients with COVID-19:
“I think I have anxiety because sometimes I feel very angry and anxious, especially at home. Maybe I am not diagnosed.” (Int-9, female professional nurse) “My mental health was impacted, when you lose so many patients in a short space of time, even colleagues, it changes you. I sometimes find it difficult to sleep at night, especially when I think about all the patients that died.” (Int-5, male enrolled nurse)
Working in a COVID-19 isolation centre affected both HCWs who had pre-existing psychological conditions and those who had none:
“I had no psychological condition prior to that, but it happened during the COVID time. . .At the moment, I’m still taking medication for it [depression].” (Int-2, male doctor) “I have been on treatment for depression since 2017 when I lost my husband. . ., I feel I am worse now; I have anxiety now, I’m scared about everything.” (Int-4, female nurse)
Availability and Accessibility of Psychological Support
There were mixed views on the availability of psychological support, while some felt this was lacking, others believed this service was available:
“I think we needed a lot of counselling, which was not provided. It felt like nobody cared, everybody was scared, we were all depressed.” (Int-11, female professional nurse) “We had EAP [Employee Assistance Program] services through our staff clinic, they would aid employees if required.” (Int-6, female nursing manager) “Yes [psychological services were available], but the usual EAP, there was nothing specifically for COVID.” (Int-10, female nurse)
Others felt that EAP services were not used for various reasons, including due to fear, and lack of time due to high patient volume and reliance on private service providers:
“We had a program available through our EAP service, some were afraid to go, no-one trusted anything during the pandemic. We were also very busy, so it could have been that there was no time to go. Some HCWs used private facilities because they have medical aid.” (Int-8, female operations manager) “EAP is always there but did not help us, or me I never went there. . .It was not helpful even before COVID, there was no time to go there, it was work all the time.” (Int-11, female professional nurse)
Transformative Impact
Apart from the distress described above, the COVID-19 pandemic appeared to have a longer-term transformative impact, in that HCWs had greater appreciation of life, better and consistent use of PPEs, as well as better patient management.
Appreciation for Life
Some participants expressed a sense of appreciation for life after working in COVID-19 isolation centre:
“. . .But it [COVID-19 pandemic] obviously made me appreciate life a little more, because you realise how fragile life was during COVID. People coming here well in the morning and dying in the afternoon.” (Int-1, male doctor) “COVID-19 has made me value family and loved ones even more because I now know that things can change in an instant. It has made me appreciate life even more, even the little things like going to a party as during COVID-19 we couldn’t even meet with family and friends.” (Int-13, female doctor)
Better and Consistent Use of PPE
Use of PPE, hygiene practices, and overall resourcing of health facilities improved post-COVID-19:
“ I think in the long run it did have positive effects because now the staff are also more conscious with hygiene, like the use of the mask.”. (Int-2, male doctor) “I can say changes were good in that we now have more equipment and are better trained to use PPE- we now realize the importance of using masks and good hand hygiene.” (Int-5, enrolled nurse)
Improved Patient Management
Participants expressed that as they learned to manage COVID-19 better, they became less anxious and more confident:
“Initially, yes [they experienced anxiety], because it was something new. But as we learned to treat it better, as we improved on our PPEs, then obviously we were less anxious and more confident in treating these things.” (Int-1, male doctor) “I feel better equipped now, we now know more about the virus, and I am not scared of treating COVID patients anymore.” (Int-5, male enrolled nurse)
While some felt they were able to manage better because COVID-19 symptoms are not as severe as before, others still do get worried:
“Not really its easy now, it’s not like before, not bad anymore. I still do get worried from time to time.” (Int-12, male professional nurse)
Discussion
Our findings suggest that working at a COVID-19 isolation centre had negative emotional effects on HCWs, resulting in feelings of helplessness due to high death rate of patients, staff members and family members. In addition, our study suggests HCWs did not receive adequate scientific information on the COVID-19 virus during the early stages of the pandemic. However, HCWs eventually transitioned from demotivation and hopelessness to greater appreciation of life, adherence to IPC, empathy, and high quality patient care. Notably, that participants also reported improvements in collegiality and management support, as a result of their COVID-19 experience.
Our findings are consistent with a 2021 study on experiences of frontline HCWs across South Africa, which found increased reports of loss of hope and of despair among HCWs due to COVID-19 (Kazadi et al., 2024). Further, in our study, participants explained that these feelings arose because they were not able to save their patients, despite high energy inputs into trying to save lives. Reports of loss of control in disease management were also reported in other studies on HCWs’ experience during the pandemic (Eftekhar Ardebili et al., 2021; Mahlangu et al., 2023), where 70.23% of the 97 HCWs in Iran felt loss of control over the COVID-19 disease due to the frequency and high number of deaths (Eftekhar Ardebili et al., 2021).
Moreover, our study revealed that HCWs perceived the workplace as a challenging environment, which initially negatively affected staff morale. Furthermore, in this study, the novelty of COVID-19, fear of contracting COVID-19, fear of infecting family members, and the fear of death contributed to the perception of the workplace environment as challenging. A study conducted among HWCs in Belgium revealed that fears among HCWs increased from 9% in May 2020 to 15% in October 2020, and those fears were associated with insufficient knowledge on COVID-19 (Moretti et al., 2022). In our study, we found a positive change in staff morale post-pandemic, specifically as there was a sense of hope, trust and collegial empathy among HCWs. Prior literature found a sense of increased professional identity with HCWs having a positive attitude towards their work after having experienced the COVID-19 pandemic (Zhang et al., 2021). In addition, we found that participants’ attentiveness and awareness when managing patients improved. The pandemic was a traumatic experience that heightened HCWs' perception of COVID-19 as a threat, which had been shown to be a predictor of adherence to COVID-19 health guidelines (Moran et al., 2021).
Our study produced mixed findings on how HCWs perceived efforts put by facility management in supporting them. While some expressed gratitude, others were of the view that management could have done more. Even the training organised by the management was not received the same way by HCWs. For example, some felt that the training was not specific enough, and they had to learn on the job how to manage COVID-19 patients and use the equipment. In other countries, there were reports of HCWs' training being inadequate, rather than being too general (Elhadi et al., 2020; Odiase et al., 2024). Our findings showed that the urgency created by COVID-19 resulted in HCWs proactively seeking out resources to educate themselves about COVID-19. In another study among 1572 HCWs in Libya, over 70% of the HCWs used social media to seek information on COVID-19 (Elhadi et al., 2020). The use of social media for information has led to misinformation in some instances and perpetuated beliefs that may have led to avoidance of the vaccine (George et al., 2023), refusal to wear masks and use of alternate medicine with no benefits. Moreover, despite the additional resources (staff, ventilators and PPE), HCWs in our study setting experienced resource shortages during the pandemic as more people acquired COVID-19 and experienced severe symptoms. The shortage of resources was reported in other studies (Eftekhar Ardebili et al., 2021; Kazadi et al., 2024), ranging from shortages of N95 masks (Eftekhar Ardebili et al., 2021) to bed shortages (Kazadi et al., 2024).
Furthermore, our participants reported post-pandemic improvements in hospital management and availability of resources and equipment, including strict compliance with protocols and safety and hygiene practices. The transformation in hospital management and in HCWs could be explained by an evidence-based policy brief, which revealed that greater adherence to COVID-19 preventive measures was linked to an increase in COVID-19 knowledge and understanding of the benefits of preventive efforts (Fulone et al., 2022).
In this study, participants reported anxiety, stress, depression, fear, and/or anger as a consequence of working in a COVID-19 isolation centre. Changes to mental health were reported even in HCWs who claimed to have had no pre-existing psychological condition prior to the pandemic. In addition, the psychological impact of the pandemic manifested through weight loss, loss of sleep and flashbacks. This is consistent with a study on frontline hospital HCWs in South Africa who reported experiencing sleep disorders and flashbacks as a result of working at the hospital during the pandemic (Mahlangu et al., 2023). PTSD is known to occur in response to a traumatic event (Mann et al., 2025), such as the COVID-19 pandemic, which led to a high number of cases and deaths worldwide. Our findings point to an existing gap in the psychological support made accessible to HCWs. There is a need to prioritise the mental health needs of HCWs, even post-pandemic. Nevertheless, the pandemic had a transformative impact on lives of HCWs, in particular, there was a sense of appreciation for life and reportedly improved and more consistent use of PPE. Post-pandemic, participants felt less anxious and were more confident in managing COVID-19. After the pandemic, facilities were now reportedly equipped with adequate resources and with trained HCWs.
As a limitation, our study only included HCWs who worked in one facility, meaning that the selected centre might not represent the experiences of all HCWs who worked in the eThekwini District during the period of interest. In this study, we did not differentiate the experiences of HCWs and psychological effects by profession (doctors vs. nurses); thus, the unique experiences or subtle differences by profession may have been missed.
Conclusion
HCWs reported exhaustion, fatigue, and feelings of helplessness, demotivation and hopelessness due to the frequent and high number of deaths related to COVID-19. Once the pandemic ended, there was a positive shift in staff morale, in particular, there was a sense of hope, trust and empathy among HCWs, and HCWs reported being more attentive to and conscious of patients’ distress and needs.
There were mixed views on the training support received by HCWs, which resulted in some HCWs independently seeking information to educate themselves about COVID-19. We recommend that in future pandemics, constant training, support and updated clinical protocols should be provided to HCWs.
Finally, the pandemic appeared to have a psychological effect on HCWs. This study found an apparent gap in the psychological support made accessible to HCWs by hospital management. To mitigate the likelihood of medium-term psychological effects of pandemics on HCWs in future pandemics, we recommend pandemic-related psychological support for HCWs, debriefing sessions during and post a pandemic, and ongoing active surveillance to monitor the mental health of HCWs.
Footnotes
Ethical Considerations and Consent to Participate
This study was approved by the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (UKZN) on the 24 April 2024, approval number: BREC/00006328/2023. All participants provided written informed consent prior to participating.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.