Table 3 Subthemes for theme 2, Implications of resource strain descriptions and quotes, Participant ID_SexAge_Region_InstitutionType
Personal subthemes | Quote |
1. Psychological impacts Fear, anxiety and other emotions related to working during a pandemic | “It’s not necessarily a logical fear. It’s fear because of fear. In some sense, we’ve talked about this anticipation of this terrible thing coming has been more fear generating than if we just had a whole bunch of patients and we’re working with them. Because then you’d be so busy working, you’d forget. Perhaps the fear will be put aside to a certain extent.” – Participant 5_M60_Central_ Tertiary |
2. Concerns for personal and familial safety (of oneself and their family) Potential to be exposed to patients who are contagious and the added risk that anybody you interact with may be infected were an implication as was changes to daily routines to minimize transmission of the virus | “The worst-case scenario is that you’re put in a position where you’re interacting with patients who are contagious, are infected, are contagious, and you’re potentially going to get it. And this has personal implications all along the line. Anybody can be infected. Anybody can get seriously ill and die from it, so that is a risk. And then of course if you do, then you’re perhaps unwittingly taking it home and spreading it to other members of the household and family members. So that is always in the background.” – Participant 5_M50_Central_ Tertiary “I guess with PPE shortages in place, I think I’ve changed some of my behaviors when I’m working, things that I haven’t really done before. Like I wash my hair every single day now and I put everything in the laundry like right after I come back from work and stuff that I wouldn’t have really thought of doing before.” – Participant 12_F35_Prairies_ Tertiary “I think a lot of the distress that we have or I certainly have had is the waiting. […] Waiting for the disaster to happen. It’s like a minute-to-minute assessment of the count and the situation and the admissions because I just don’t know when the next shoe is going to drop, and when I’m the one that’s there on the front lines, having to deal with it is quite anxiety-provoking. I almost feel like I just want it to come so then we can just get started.” – Participant 4_F49_Central_ Tertiary |
Professional subthemes | Quote |
1. Deteriorating health of colleagues As colleagues get sick the size of the healthcare team reduces. | “If we start getting healthcare worker getting infected for example the intensivists then we will have less physician working in the ICU and then pushing our leads that have to work more in the ICU.” – Participant 7_F44_Central_Community |
2. Changes to physician practice Practice changes to reduce the amount of PPE used | “If we don’t have adequate PPE then I’m not going to be as good a physician for my patients because I’m going to be scared to go into the rooms and less likely to go into the rooms, and the patients won’t get the attention that they would otherwise have gotten.” – Participant 9_F42_Atlantic_ Tertiary “There’s been strategies to, if a room is in isolation, limit the numbers of in and outs. So grouping tasks so that they can be done together, grouping medication administration so done together, reducing the number of times medications are administered if possible to reduce the number of times in and out. The cohorting of activities and people to minimize the use of PPE” – Participant 5_M60_Central_ Tertiary “Usually I must have 50% of my time protected for research, but now with this pandemic there’s no protected time for that. So I’m doing more clinical work than I should do. So I think everything that is not related to clinical activity has been pushed aside for a while.” – Participant 6_M40_Central_ Tertiary “One thing we’ve done to try to preserve PPE is that COVID patients who are in a negative pressure room who are not intubated, or even if they’re intubated, if they’re awake and have a cell phone, we communicate with them by texting. So, if there’s no urgency to go in, we can ask some questions from outside the room and they can answer us, or if they need something they can text us. So, it’s to reduce the number of times people have to go into the room and use PPE and expose themselves.” – Participant 15_F56_Central_ Tertiary |
3. Legal and ethical considerations of working within the context of limited resources Conversations around legal protection, resource allocation and expectations for physicians working during a pandemic | “I am worried because the [governing college of physicians] said that they would not support us if we were not going to give care to patients because we don’t have the protection. So that worries me a lot. I don’t think we should go and blindly fight for a disease if we’re not protected adequately.” – Participant 3_F32_Central_ Tertiary “What we were told [by our governing body] was that the hospital is responsible to its employees but not to the physicians because we’re not employees. And so a nurse could certainly say, “I’m not doing this and not come to work if there was inadequate PPE”. But as physicians, as contract workers, where our Hippocratic oath says otherwise, we probably would have a harder time defending it.”– Participant 9_F42_Atlantic_ Tertiary “There’s really no labor law for physicians. Literally, I don’t think that there’s any protection for physicians when it comes to not wanting to take care of patient because of a lack of PPE. That being said, we did very briefly bring that up, but none of us really could deny care. When we have a lack of PPE, I think morally and ethically, I don’t think that we would do that” – Participant 7_F44_Central_Community “The major impact [a PPE shortage] would have for me professionally that I would be caught between prioritizing my own safety and taking care of my patients. And that’s a dilemma I actually don’t want to be in. So, that would cause a fair bit of stress and anxiety if we reached that level.” – Participant 10_M47_Atlantic_ Tertiary |