Editorial Board

A Refereed Monthly International Journal of Management

Recommendations Regarding Improvement of Well-Being Levels of Healthcare Professionals in the COVID-19 Pandemic Process: A Case of Turkey[1]

Muhammet Çankaya

Associate Professor

Department of Health Management,

Faculty of HealthScience, HititUniversity, Turkey

E- Mail: muhammetcankaya@gmail.com

ORCID: 0000-0003-3498-7328

Abstract

The aim of this study was that develop solutions to improve the well-being of health workers during the COVID-19 pandemic. In the study, were taken the opinions of the citizens, the employees of the institutions, the responsibilities of the institutions and the state during the COVID-19 process. Also interviews with expert psychologists (industrial psychologists) were conducted to develop solutions for improving health care professionals' well-being levels, based on the opinions of health care professionals and the study's findings. Healthcare professionals stated that the biggest responsibility that falls on the citizens is to heed the warnings and not to leave their homes unless it is absolutely necessary. In addition the biggest responsibility stated that falls on the institution employees is to take the necessary precautions to preserve their health. Besides biggest responsibility expressed that falls on the institution for which they work for is the implementation of practices aimed at improving employee motivation. Last finding was that the biggest responsibility that falls on the state is to make improvements in the financial rights of employees as such wage and performance-based supplementary payment in the COVID-19 process. As a result of the evaluations made after the interviews, some recommendations were given to increase the level of well-being of healthcare professional.

Keywords: COVID-19, healthcare professionals, well-being.

Introduction

Throughout history, epidemics have been an inseparable part of social life. It is stated that epidemic diseases that result in mass mortality in the regions where they occur may become more common in the future (Yang & Ma, 2020). While issues such as the causes of pandemics, which refer to the occurrence of epidemics in more than one country or continent, and the health measures necessary to prevent their spread, are viewed as critical fields of study by the scientific community, the social dimensions of pandemics are too important to be overlooked on the other hand (Çankaya, 2020). So far, scientific studies examining the social effects of pandemics, on the other hand, do not appear to be common. Accordingly, Lu et al., (2020) stated that the studies examining the effects of pandemics on the well-being of individuals are quite limited in the literature(Lu et al., 2020).

Healthcare professionals are regarded as the world's most important and effective force in the fight against the COVID-19 pandemic, which is threatening the world today (Hızal, 2020; Özkan et al., 2021). In the fight against COVID-19, health professionals are on the front lines. In some countries, healthcare professionals have to work without the necessary protective equipment. Moreover, in the absence of their colleagues who were ill or were quarantined during the pandemic, healthcare professionals have had to work additional shifts in order to continue to fulfill the healthcare need (Karlsson & Fraenkel, 2020; Krystal & McNeil, 2020). Healthcare professionals are reported to be at a higher risk than the general public since they are in close contact with COVID-19-infected patients despite the risks, work in high-risk departments like intensive care, and work with a high probability of catching the disease (Barrett et al., 2020; Bhagavathula et al., 2020; Gao et al., 2020; Özkan et al., 2021).

Pandemics have psychosocial consequences for individuals, including anxiety, depression, and post-traumatic stress disorder (PTSD) (Tuncay et al., 2020). The pandemic of COVID-19 has also had a negative effect on business life, acting as a stressor on individuals, teams, and organizations (Vanhaecht et al., 2021). Healthcare professionals who work actively and for an extended period of time in the fight against the pandemic may be adversely spiritually affected together with the prolonging process. One of these spiritual aspects is expressed as a state of well-being(Fessell & Cherniss, 2020). Myers et al. (2000) defined well-being as “a way of life and well-being, oriented towards optimal health, in which body, mind, and spirit are combined so that the individual can live fully and functionally in his social and natural environment”(Myers et al., 2000). Güner ve Bozkurt (2018), on the other hand, defined well-being as "a way of life in which the individual's physical, mental and spiritual functioning is aimed to be improved" (Güner & Bozkurt, 2018).

Organizations that have had their share of epidemics are struggling with the psychosocial and psychological consequences of the COVID-19 pandemic, which has recently spread to all countries. Among these organizations, particularly the healthcare organizations, struggle with insomnia, burnout, depressive symptoms, and post-traumatic stress disorders that their personnel suffer from. Regarding this issue, support teams have been formed at Wuhan hospitals in China to provide individual and group-based psychological counseling and interventions to the personnel (Burdorf et al., 2020). However, it is reported that the COVID-19 pandemic has resulted in considerable increases in healthcare professionals' anxiety levels (Pan et al., 2020). This increase is stated to be related to uncertainty caused by the pandemic (Sakaoğlu et al., 2020). Similarly, several findings support that depression, insomnia, and stress symptoms are more prevalent among healthcare personnel responsible for the diagnosis, treatment, and care of patients diagnosed with Covid-19 (Lai et al., 2020). The impacts of the COVID-19 on the human psychology pandemic may vary according to a range of individual characteristics. It is believed that the traumatic impacts of stress during and after the COVID-19 pandemic, which threatens people's lives in global extent, may vary according to the individual's social and cultural characteristics, socioeconomic circumstances, psychological well-being, and individual characteristics (Aşkın et al., 2020). In light of this knowledge, the study elicited health professionals' opinions regarding the responsibilities of relevant parties (citizens, personnel of the institution, the institution for which they work, and the state) in order to improve health professionals' well-being. In accordance with the opinions of health care professionals and the study's findings, interviews with expert psychologists (industrial psychologists) were conducted in order to develop solutions for improving health care professionals' well-being levels. According to the evaluations made following the interviews with expert psychologists, certain suggestions were made to improve the well-being levels of the health professionals.

Materials & Methods

In this descriptive study, convenience sampling method was chosen. Due of the study's relevance to the COVID-19 pandemic, firstly the approval from the Scientific Research Platform of the Turkish Ministry of Health was obtained on 02.05.2020. Then, Ethical Approval dated 01.06.2020 and numbered 2020/53 was obtained from Hitit University Non-Interventional Researches Ethics Board in order to initiate the research. Due to the ongoing COVID-19 outbreak in Turkey at the time of the research, questionnaires were distributed through the internet to participants. The questionnaires were generated using "Google Forms" and distributed to the participants between 15.07.2020 and 14.08.2020. First and foremost, the participants were provided preliminary information about the study in the first section of the questionnaire, and they were requested to sign the informed consent form after carefully reading it. The questionnaire was automatically terminated for those who hesitate or abandoned the questionnaire before the completion of the answering phase. These individuals were omitted from the sample group due to incomplete responses to the questionnaire. The responders were presumed to have comprehended all of the statements in the questionnaire and submitted their sincere opinions. A total of 525 healthcare professionals from various regions of Turkey took part in the questionnaire on a volunteer basis.

The Well-Being Scale

In the study, the level of well-being of health professionals was measured with the “Well-being Scale.” Adaptation of the scale developed by Bradley into Turkish, validity and reliability studies were carried out byŞengül (1998). Consisting of 22 items in total, the scale includes four dimensions measuring depression, anxiety, energy and positive well-being(Şengül, 1998). Each statement on the scale was assigned a score between "0" (never) to "3" (always) determined the Cronbach's Alpha value of the scale to be 0.81 and stated it to be reliable(Çallı, 2014).

Statistical Analysis

The data collected in the study were analyzed with the SPSS 22.00 package program. Firstly, the study comprised percentage describing the socio demographic characteristics of the participants. Then, percentage and frequency analyses were utilized to ascertain health professionals' views regarding the responsibilities that fall on the citizens, institution employees, the institutions they work in, and the state in the COVID-19 pandemic process.

Findings

The well-being scale and dimensions employed in the study were subjected to reliability analysis. The reliability of the wellness scale was observed to be high as a result of the reliability analysis (0.898) and was decided that the scale utilized in the study was reliable.

The participants comprised of %42 nurses, 51.4% 30 years old and older, 65.5% women, 55% married, 34.5% with bachelor's degree, 79.2% those employed in the public sector, 74.5% of those without administrative duties. Although the survey included participants from all regions of Turkey, the most participation was from the Black Sea, Central Anatolia, and southeast Anatolia regions.

The opinions of the healthcare professionals regarding the responsibilities that fall on citizens, the institution employees, the institutions for which they work and the state during the COVID-19 pandemic has also been taken. Accordingly, certain questions have been posed to the healthcare professionals. The information on the frequency and percentage of responses provided by participants to the questions is presented in Table 1.

Table 1: Administrative status variable of participants

According to Table 1, the healthcare professionals stated in the COVID-19 process;

• that the biggest responsibility that falls on the citizens is to heed the warnings and not to leave their homes unless it is absolutely necessary,
• that the biggest responsibility that falls on the institution employees is to take the necessary precautions to preserve their health,
• that the biggest responsibility that falls on the institution for which they work for is the implementation of practices aimed at improving employee motivation,
• and the biggest responsibility that falls on the state is to make improvements in the financial rights of employees as such wage and performance-based supplementary payment.

In addition, healthcare professionals stated that it is critical to prioritize efforts to reduce violence against health workers, to provide administrative leave to health workers who are exhausted in the fight against the pandemic, to provide psychological support to health workers, and to prepare health and social systems for similar health problems that may occur in the future.

Discussion

The COVID-19 pandemic has earned a place on the stage of history as a health crisis that has emerged before the first quarter of the 21st century and has had a devastating impact on the whole world. Healthcare professionals have been in the vanguard and have made invaluable contributions to the fight against this pandemic, the consequences of which will be felt profoundly in all spheres of life over the next few years. While battling the pandemic, health professionals have encountered numerous challenges. While some of these challenges are related to material factors, (Tengilimoğlu et al., 2021) such as equipment malfunctions and managerial reasons, others are related to psychological factors, such as exclusion, stress, anxiety, depression, (Pala & Metintaş, 2020) and well-being. This study focused on the level of well-being of health professionals, one of the psychological factors.

This study gathered opinions from healthcare professionals regarding the responsibilities that fall on citizens, institution employees, the institutions for which they work, and the state in the pandemic process. In this regard, healthcare professionals stated that the biggest responsibility that falls on the citizens is to heed the warnings and not to leave their homes unless it is absolutely necessary; that the biggest responsibility that falls on the institution employees is to take the necessary precautions to preserve their health; the biggest responsibility that falls on the institution for which they work for is the implementation of practices aimed at improving employee motivation; the biggest responsibility that falls on the state is to make improvements in the financial rights of employees such wage and performance-based supplementary payment. In addition, healthcare professionals stated that it is critical to prioritize efforts to reduce violence against health workers, to provide administrative leave to health workers who are exhausted in the fight against the pandemic, to provide psychological support to health workers, and to prepare health and social systems for similar health problems that may occur in the future.

Tuncay et al. (2020) stated that among the effective practices for reducing the stress and psychological distress experienced by healthcare professionals during the pandemic process may include the consistent implementation of infection control rules, the provision of adequate personal protective equipment, and the strengthening of social support interactions between employees and the society. However, taking different precautions in the fight against the virus, such as social distance, curfews, and quarantine measures that include the general public, prevents healthcare professionals from participating in activities to cope with stress effectively (Labrague, 2021). In this time of restricted social life, Huang et al. (2020) suggest that healthcare professionals can cope with the negative impacts of the pandemic on mental health by exercising or keeping a diary(Huang et al., 2020). In the struggle against mental disorders that healthcare professionals encounter during the pandemic, Vanhaecht et al. (2021) stated they rely on the support of their relatives and spouses. Furthermore, they stated that healthcare professionals require more professional guidance from psychologists rather than the support of the institutional managers(Vanhaecht et al., 2021).

Conclusions and Recommendations

COVID-19 is a global crisis situation, and countries must develop large-scale behavioral adjustments in the event of these situations. In the fight against the COVID-19 pandemic, there are many precautionary processes to be taken by health authorities. The impact of the pandemic on individuals and societies can be mitigated if and only if we are well prepared and respond rapidly to these health concerns. National pandemic strategies and policies established by health managers can accelerate the process. These programs should be kept flexible so that they can be revised in response to new factors, the degree of spreading, and treatment processes, etc. Administrative precautions implemented during the pandemic must be maintained even after the pandemic rate has slowed and stopped (Yücesan & Özkan, 2020).

To create more manageable resource management processes for the COVID-19 pandemic and other possible future health crises, hospitals should produce crisis management handbooks, form teams, and arrange training sessions and simulations to ensure that employees are informed and psychologically prepared for crises. Moreover, it has been stated that throughout the pandemic process, a rise in demand for health services in hospitals would be inevitable and that healthcare professionals should work swiftly. They also suggested that hospitals develop their workforce plans in advance and that the mandatory referral chain be integrated into health services to minimize the risk (Tengilimoğlu et al., 2021).

Health systems became significantly more burdened during the COVID-19 pandemic, thus becoming inadequate at times. Inadequacies in healthcare systems have resulted in inequalities among people in terms of accessing health care. In reaction to health inequalities, the COVID-19 pandemic has strengthened or raised the temperature of sensitive social issues such as stigmatization, discrimination, and racism. Healthcare professionals have been praised as "heroes" in the media during the COVID-19 pandemic. People applaud healthcare professionals in the evenings from their balconies all over the world. This does not, however, change the reality of discriminating attitudes toward healthcare professionals based on the concern that they are COVID-19 carriers(Doğru-Hüzmeli et al., 2021). For this reason, it is necessary to recognize stigmatization well and to develop training and policies to fight against it (Yılmaz et al., 2021).

In the final chapter of this study, interviews with expert psychologists (industrial psychologists) were conducted to develop solutions for improving health care professionals' well-being levels, based on the opinions of health care professionals and the study's findings. As a result of the evaluations made after the interviews, the following recommendations were given to increase the level of well-being of healthcare professionals:

• Preparation of educational activities and public service announcements aimed at raising public awareness in order to prevent stigmatization of health workers as potential virus carriers by the society.
• To avoid health professionals becoming overburdened during epidemics and disasters, nationwide health manpower planning should be carried out with the support of scientific findings.
• Conducting training activities in areas identified as necessary to improve the quality of the existing health manpower further.
• Some of the motivation tools are economic factors. In this regard, making considerable performance payments to all health employees who work tirelessly throughout the pandemic process, as well as major improvements the personal rights of healthcare professionals.
• Increasing the deterrent effect of punishments to minimize, if not eliminate, violence against health care professionals and inform the public about this on a regular basis.
• Assigning the status of "martyr" to healthcare professionals who died during the pandemic to honor them and urge millions of young people to join these professions. Additionally, forbidding the publication of all types of programs and works in the written and visual media degrading the dignity of healthcare professionals and harming their reputation.
• Notifying the healthcare professionals through the official communication channels about the situation, the course, and the measures taken by the state's relevant institutions regarding the pandemic.
• Increasing the efficacy of planned activities to protect and improve public health. Conducting awareness campaigns among citizens to instill a sense of personal responsibility for their health.
• Providing administrative leave to healthcare professionals when the pandemic is in regression.
• Providing facilities for employees who require psychological assistance to receive it in accordance with their wishes.

All pandemics primarily pose a serious threat to the physical and mental health of health professionals who are on the front lines of the fight. Therefore, the healthcare professionals are the working group that must be strengthened to be successful in the fight against the pandemic. In order to strengthen, all necessary introductory elements, such as job descriptions, work environment-related qualifications, risk factors, and protective factors, should be depicted systematically and holistically. Ensuring personal safety and protection against contamination at a level that includes all employees, effectively implementing quarantine protocols both within the health system and throughout society, encouraging the continuation of positive interactions between employees based on positive feedback, meeting family needs with public resources will be among the effective tools in coping with the stress caused by the epidemic (Tuncay et al., 2020).

The COVID-19 pandemic is a serious and global health crisis that impacts all of humanity and will result in new occurrences in every aspect. Healthcare professionals, who are at the forefront of the COVID-19 fight, have been the hardest hit occupational group in the fight against the COVID-19 pandemic. In order to overcome this pandemic and similar health problems that may arise in the future, a physically, financially, technologically, and humanely constructed health infrastructure will be required, which will be developed in accordance with scientific outputs. Taking into account the recommendations in this study by those who create and implement health policies will benefit society, particularly employees, managers, and politicians.

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Endnotes:

[1] This study was produced from the project that completed on 04.05.2021 and supported by İKSAD and a part of this study was presented as a paper at the Atlas 7th International Social Sciences Congress held on 23-25 September 2020.