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.