Shared sources and mechanisms of healthcare worker distress in COVID-19: a comparative qualitative study in Canada and the UK

Figures & data

Table 1. Participant characteristics.

Canadian sample		UK sample
Gender	N		N
Female	16	Female	17
Male	5	Male	8
Role	N		N
Doctor	5	Doctor	7
Nurse	3	Nurse	9
Allied Health Clinician	2	Healthcare assistant	4
Clinical Manager/Administrator	5	Allied Health Clinician	1
		Paramedic	1
Other hospital service  administrator	6	Care home worker	1
		Mental health care worker	21
Setting^a	N		N
Intensive Care Unit (ICU)	3	Intensive Care Unit (ICU)	6
Emergency department	3	Emergency department	5
COVID ward	2	COVID ward	8
Outpatient medical service	1	Older adult wards	1
Inpatient rehabilitation	1	Nightingale Hospital^b	1
Psychiatric service	4	Ambulance service	1
Other hospital service	5	Care home	4
		Psychiatric service	1
Location	N		N
Toronto	21	London	9
		South East England	3
		South Central England	2
		South West England	2
		Midlands/Central England	3
		North East England	5
		Scotland	1

^a Some participants worked across more than one clinical setting during the peak of the pandemic.

^b Specialist field hospitals set up in the UK in anticipation of peak of pandemic.

Allied Health includes physiotherapist, occupational therapist, social worker, spiritual care worker.

Other Hospital Service roles includes infection prevention and control, occupational health, security, environmental services.

Health care assistants’ roles include providing personal care to patients, patient transportation, equipment sterilisation and similar activities under the direction or supervision of a nurse or physician.

Table 2. Qualitative themes and sub-themes.

Sources of distress: themes and sub-themes
	Safety	Patient care	Personal & home life	Communication challenges	Work environment	Media, public perception	Government response
Sub-themes	Fear of COVID-19 infection	Extreme conditions	‘No escape’	Changing information	Workload	Constant coverage	Inconsistency & fractured response
	Fear of infecting others	Care rationing & delays	Disconnection from own family & community	Information overload	Role change	Comparisons with other locations	Undervalued or de-valued workforce
	PPE	Caring for patients’ families	Home related stressors	Barriers to communication	Loss of autonomy & normalcy	Hero spotlight
			Lack of usual coping	Lack of clarity & transparency	Resource challenges	Broader political issues
			Prior mental health concerns		Team dynamics & cultures
					Institutional context
					Lack of recognition
					Management
Individual ↔ Structural

PPE: personal protective equipment.

Table 3. Mechanisms and mitigators of distress.

Mechanisms of distress	Mitigators of distress
Uncertainty	Supportive work environment & team cohesion
Hypervigilance	Social supports outside of work
Feeling undervalued & expendable	Meaningful work
Lack of trust & transparency
Moral injury

Figure 1. Formulation of the relationship between sources, mechanisms, and modifiers of HCW distress in COVID-19.

Data availability statement

Data are available from JB and SB upon reasonable request. Data have not been made generally available due to the personal nature of participants’ accounts.