Puerto Rican healthcare workers' perspectives on the impact of COVID-19 pandemic on their role, patient care, and mental health

Carmen Alvarez; Noemy Diaz-Ramos; Rosalphie Quiles; Maria Jose Sanchez-Roman; Kristina Weeks; Lisa A Cooper

doi:10.1111/jnu.12820

Puerto Rican healthcare workers' perspectives on the impact of COVID-19 pandemic on their role, patient care, and mental health

J Nurs Scholarsh. 2023 Jan;55(1):112-122. doi: 10.1111/jnu.12820. Epub 2022 Oct 8.

Authors

Carmen Alvarez^{1

2}, Noemy Diaz-Ramos³, Rosalphie Quiles⁴, Maria Jose Sanchez-Roman⁵, Kristina Weeks^{2

6}, Lisa A Cooper^{2

7}

Affiliations

¹ School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
² Johns Hopkins Center for Health Equity, Baltimore, Maryland, USA.
³ Medical Sciences Campus, University of Puerto Rico, School of Nursing, San Juan, Puerto Rico.
⁴ Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ College of Public Health, Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁶ Amstrong Institute of Patient Safety & Quality, Johns Hopkins University School of Medicine, School of Medicine, Baltimore, Maryland, USA.
⁷ General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

Purpose: To explore the personal and work-related stressors of healthcare workers in Puerto Rico and the organizational support they received during the pandemic.

Design and methods: We used a qualitative descriptive design and from April - November, 2021, conducted semi-structured individual interviews with Puerto Rican frontline healthcare workers (n = 12) and supervisors (n = 5).

Findings: Thematic analysis revealed five major themes: (a) Organizations' response to COVID-19; (b) increased complexity of patients; (c) intensified work and psychological demand for nurses; (d) overwhelmed and overworked; and (e) recommendations for healthcare leadership. Participants explained that their organizations' responses to COVID-19 were insufficient for meeting the demands and acuity of the patients. Closure of outpatient services contributed to people presenting to hospitals with exacerbated chronic conditions - especially the elderly. With COVID-19 precautions prohibiting family visitation, nurses became responsible for total care, including emotional support of patients. In addition, the shortage of staff contributed to nurses assuming greater workloads, feeling overwhelmed and overworked, and healthcare worker resignations. Given their experiences, healthcare workers recommended that healthcare leadership show more appreciation for staff, demonstrate empathy, include frontline workers in decision-making, and provide mental health resources for staff.

Conclusions: This study with Puerto Rican frontline workers and supervisors uncovers the multiple stressors experienced during the COVID-19 pandemic. Our findings underscore the need for prioritizing the well-being of healthcare workers, preparing healthcare leadership on how to support staff, and mandating nurse-to-patient ratios.

Clinical relevance: Healthcare workers explained the barriers they experienced for providing quality care to their patients. They also presented recommendations for healthcare leadership to facilitate supporting frontline workers, which ultimately contributes to optimal patient care.

Keywords: COVID-19; Puerto Rico; healthcare workers; qualitative research; stress.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
COVID-19* / epidemiology
Cuba
Health Personnel / psychology
Humans
Mental Health
Pandemics
Patient Care