4. Discussion and Conclusion
Even though health workers are focused on the struggle to save lives and see risks as a normal part of their work during the COVID-19 pandemic32, they may overlook such critical topics as becoming infected or being the source of infection, separation from their families, burnout in the face of events which they have experienced such as the loss of a patient or a colleague, stress, or their state of psychological wellbeing. Our study showed that sleep disruption and a reduction in team and institution support increased anxiety, and also reduced team cohesion and trust in the organization. Anxiety which emerged in the uncertainty of the first months of the pandemic33 was greater in females 13; but as the pandemic advanced, it was seen that although this difference remained significant, it was reduced. It is thought that this result may have been affected by the spread of the disease and an increase in the length of time of informing the public. As well as this, perceived coworker support for women contacted in the study was low, and this may be a risk factor for anxiety. An increase in the frequency of contact with patients wears out health workers both physically and psychologically, causing high stress levels and insomnia. In addition, while approximately 35% of health workers have experienced insomnia during the COVID-19 outbreak 11 this rose to 44% in our study.
Working in high risk areas such as family health centers or in field teams establishing contact with infected persons is a cause of widespread stress disorder 14,34,35. However, one reason for there being no significant difference in our study between anxiety levels in family health centers and contact tracers may be that because contact tracers did not have trouble obtaining protective equipment (68%) and their training and knowledge levels were high, they approached a suspected or known contact with greater caution. Although a difference was found in one study in anxiety and insomnia between field workers and primary health workers in an outpatients’ department (14) in our study, no difference was found in anxiety, although field workers had more insomnia (contact tracers:8.66±4.41 and FHC:7.79±4.67). One factor may be that the hours worked by contact tracers may have disrupted their sleep patterns.
The risk to health workers employed in the pandemic of infecting their families and others close to them is a source of stress because of the fear of infection of those who carry responsibility36. At the same time, it may be said that the social role of women is greater, so that in a pandemic or time of crisis, factors such as lack of isolation because of social status and their roles in the home deepen their anxiety, reducing their perception of team support. A rise in coworker support for women may secure a reduction in problems of anxiety and insomnia.
Workers who receive less organizational support have a greater tendency for conflict with their colleagues and generally believe their organizations less 18. A feeling is created among health workers who think that their contributions are appreciated and who feel that they are of value to the organization that their psychosocial needs are met as their feelings of trust in their organizations which were reduced increase 37,38. The low organizational and coworker support for health workers can be increased by giving theoretical and practical training according to position more frequently and at specific times. Along with the training, material and spiritual rewards can be planned to encourage motivation and focus. In this way it may be predicted that people will more willingly make an effort for the organization and their connections with the organization they work in will be strengthened by having their emotional needs such as respect, acceptance and support met. Also, provision of organizational support to health workers equally irrespective of position may be a factor in increasing organizational and coworker support.
Despite fear and anxiety becoming evident at an early stage of the epidemic, depression, psychophysiological and trauma are followed in an advancing process by symptoms of stress 14,39. Factors such as being isolated, working in high-risk positions and having contact with infected people are accepted as among the main reasons for trauma 14 and this can weaken people’s organizational and friendship bonds by disrupting their social relationships. Continuity of social support can reduce workers’ need for psychosocial support as a result of the periodic furthering of individual psychological support.