- Chong M.-Y.
- Wang W.-C.
- Hsieh W.-C.
- Lee C.-Y.
- Chiu N.-M.
- Yeh W.-C.
- Huang T.-L.
- Wen J.-K.
- Chen C.-L.
- Teo I.
- Chay J.
- Cheung Y.B.
- Sung S.C.
- Tewani K.G.
- Yeo L.F.
- Yang G.M.
- Pan F.T.
- Ng J.Y.
- Abu Bakar Aloweni F.
- Ang H.G.
- Ayre T.C.
- Chai-Lim C.
- Chen R.C.
- Heng A.L.
- Nadarajan G.D.
- Ong M.E.H.
- See B.
- Soh C.R.
- Tan H.K.
- Bengtsson M.
- Vaismoradi M.
- Turunen H.
- Bondas T.
Health Manpower [Table]. Retrieved from Ministry of Health Singapore website.
- THEME 1: PHYSICAL NEEDS
Food and drink
Rest and respite
Basic wages and allowances
Manpower and workload distribution
Working arrangements and hours
- THEME 2: SAFETY AND SECURITY NEEDS
Physical health and well-being
Confidence and trust in leadership
- THEME 3: LOVE AND BELONGING NEEDS
Social support and network
- THEME 4: ESTEEM NEEDS
Appreciation and recognition
Incentives and rewards
- THEME 5: SELF-ACTUALIZATION NEEDS
Advocacy for larger system changes
- Lam K.K.
- Hung S.Y.M.
- Du J.
- Dong L.
- Wang T.
- Yuan C.
- Fu R.
- Zhang L.
- Liu B.
- Zhang M.
- Yin Y.
- Qin J.
- Bouey J.
- Zhao M.
- Li X.
- O'Sullivan T.L.
- Amaratunga C.
- Phillips K.P.
- Corneil W.
- O'Connor E.
- Lemyre L.
- Dow D.
- Broom J.
- Broom A.
- Bowden V.
- Maunder R.G.
- Lancee W.J.
- Balderson K.E.
- Bennett J.P.
- Borgundvaag B.
- Evans S.
- Fernandes C.M.B.
- Goldbloom D.S.
- Gupta M.
- Hunter J.J.
- Hall L.M.
- Nagle L.M.
- Pain C.
- Peczeniuk S.S.
- Raymond G.
- Read N.
- Rourke S.B.
- Steinberg R.J.
- Stewart T.E.
- Wasylenki D.A.
- Bai Y.
- Lin C.-C.
- Lin C.-Y.
- Chen J.-Y.
- Chue C.-M.
- Chou P.
- Maunder R.G.
Strengths and limitations
|Characteristics||N (%) or Mean ± SD|
|Allied health professional||136 (22%)|
|Age||38.75 ± 11.61|
|Marital status||Single||239 (39%)|
|Vulnerable persons at home||Yes|
|Perception of exposure to COVID-19||Not at all||186 (30%)|
|1||Emotional security||116 (14.9%)||Safety needs|
|2||Manpower and workload distribution||102 (13.1%)||Physical needs|
|3||Rest and respite||79 (10.2%)||Physical needs|
|4||Workplace safety||68 (8.8%)||Safety needs|
|5||Confidence and trust in leadership||65 (8.4%)||Safety needs|
|6||Social support and network||63 (8.1%)||Love and belonging needs|
|7||Workplace camaraderie||48 (6.2%)||Love and belonging needs|
|8||Working arrangements and hours||38 (4.9%)||Physical needs|
|9||Food and drinks||36 (4.6%)||Physical needs|
|10||Employee engagement||34 (4.4%)||Love and belonging needs|
Advocacy for larger systems changes
|13||Physical health and well-being||20 (2.6%)||Safety needs|
|14||Financial motivations||18 (2.3%)||Esteem needs|
|15||Psychological well-being||16 (2.1%)||Safety needs|
|16||Basic wages and allowances||12 (1.5%)||Physical needs|
|17||Personal coping||9 (1.2%)||Self-actualization needs|
|Food and drinks||Provide food and drinks||Provide meals for us as the food option at staff canteen is limited and we have no time to venture out to food stalls outside. (AHP)|
|Provide treats/snacks fortnightly to staff from different team. An army fight on it stomach. (Nurse)|
|Rest and respite||More rest breaks||The freezing of leave has made working hours intensive, and I think a short break is definitely necessary. To make up for manpower issues, the annual leave can be made available once in two months for each employee. (AHP)|
|More rest days|
|Better leave management|
|Nurses need more off days, especially after night duty. Two night duties followed by one off day is really not enough, will cause burnout faster. (Nurse)|
|Basic wages and allowances||Basic wages and allowances||Human resource should not refuse to pay us night duty and weekend allowances. (Doctor)|
|Manpower and workload distribution||Manpower shortage||Having more ground staff can help with the workload and management to distribute the workload fairly. (Nurse)|
|…not fair for consultants to have a few days off in a week and getting to go home early once work ends, but junior doctors have to cover two OTs or get deployed to another location even when we end early. (Doctor)|
|Fairness in workload distribution|
|Please minimize audits during this period. It is very stressful to care for patients and worry about whether audits are completed. (Nurse)|
…if we are in the same ward with the same group of colleagues, we will have support and are comfortable working together. Deploying us to different disciplines adds on stress, uncertainty and more worry for us. (Nurse)
|It is good to have deployed nurses in the Emergency Department (ED), but most are not ED-trained. Not only do ED staff have to perform their duties, they have to also ensure deployed staff does things correctly, which can be taxing and stressful. (Nurse)|
|Working arrangements and hours||Rostering of shift work||Please fix the roster. Doing 12-hours shifts since the start of this pandemic is not helping healthcare workers to take care of themselves. (AHP)|
|Keep to working hours|
|Flexible work arrangement|
|Not to work continuous more than 4-5 days straight. (Nurse)|
|Allocate more support for workers with young children, elderly, family with medical or psychological needs under their care. E.g. flexible work hours. (AHP)|
|Physical health and well-being||Medical coverage and benefits||Please allow staff to take hospitalization leave when sick. Due to the number of compulsory sick leave [days] that's given [for respiratory symptoms] during this period, staff are afraid to see the doctor as they worry that it will affect their job appraisal. (Nurse)|
Special care to vulnerable staff
|We need assurance of support for healthcare workers, in terms of financial and hospitalisation coverage, should the staff contract the disease during the course of work. (AHP)|
Please give care and consideration for vulnerable staff, like pregnant staff and senior staff aged above 60 years, by assigning them to roles with less exposure infectious cases or COVID-19. (Pharmacist)
|Workplace safety||Clear work directives|
Sufficient protective equipment
Infection control protocols
Ensure personal hygiene
|Communication could have been clearer and more consistent so that staff feel reassured and supportive of the various measures that the institution and government want to implement. (AHP)|
|There are very frequent, often minor changes to the COVID-19 guidelines/protocols, and it can be frustrating to be inundated with messages and email. Duplication of updates could be avoided. (Doctor)|
|Ensure that all departments are aligned with orders… despite rules stipulating segregation, some departments were still gathering in large groups for lunch every day. (AHP)|
|Emotional security||Motivation and encouragement||Encouragement from the higher-ups boosts morale on the ground a lot. (Nurse)|
|It is important to reassure those working on the ground that their well-being is being taken care of. (AHP)|
Information should be provided clearly and fully during outbreaks like these. I understand that the situation is fluid and volatile and much information is still unknown. However, most of our anxiety comes from not knowing what is going to happen next. (Nurse)
|Frequent and clear updates|
|Tone of communication|
|Senior management should be more tactful with the way they speak… our senior management should learn to treat us like adults and not speak to us like we are kids. They often use very authoritative tones with us. (Nurse)|
|Psychological well-being||Monitor staff mental health||Clinical leaders need to support frontline staff, not only in their physical needs but also in terms of psychological and emotional support. (Nurse)|
|Psychological resources and services|
|Provide resources such as email circulars or telephone helplines to provide psychological support (AHP)|
|Confidence and trust in leadership||Empathy and understanding||Higher management need to give positive vibes, support us, be on the floor with us, rather than just give orders and expect things to be done as soon as possible. (Nurse)|
|Support and guidance|
|Avoid blame and punishment|
Understanding home needs
|We would like our supervisors to be more empathic… to listen and know staff well as to better understand their difficulties and challenging work environment. (Nurse)|
If we have to work from home and we have young children below age 7, please do not expect us to "not engage in child-minding activities". It is not a practical expectation. In fact, it creates more emotional and mental stress. (AHP)
Getting blamed for things that's out of our control is very demoralising, especially when we are trying to help as much as we can during this period. (Nurse)
|Social support and network||Peer support||Break times are the only times we get to talk our hearts out with our colleagues, but now we don't’ even have that. We also feel lost and really isolated. I would appreciate if we could still sit and interact as how we used to be. (Nurse)|
|I feel the isolation from social distancing most acutely. Perhaps we can have support groups via e-chat or video chat on weekly basis to talk, share, learn and cope together. (AHP)|
|Staff can be divided into groups of buddies – within each group there is a person identified to boost morale, check-in on each other. (AHP)|
|Caring for co-workers|
|Workplace camaraderie||Foster teamwork|
Support junior staff
|I look forward to seeing a more united team. The conflicts or prejudice we (the isolation team) faced within our department from the non-isolation team are unnecessary stress on top of this pandemic crisis that we are already dealing with daily. (Nurse)|
Seniors should show the way and step up on the frontline, rather than sacrificing juniors whenever help is needed at the frontline. (Doctor)
|Employee engagement||Regular engagement|
Listen to staff feedback
|Proactive engagement by senior leadership to check-in on staff well-being or get feedback from staff. (Doctor)|
Management needs to be more sensitive and listen to staff on the ground working to better understand the actual situation staff are facing during day to day work, especially when new directives/workflows are given. (AHP)
|Appreciation and recognition||Show appreciation|
|Boost morale of everyone working in the frontline by making them feel appreciated. A little goes a long way! (Nurse)|
We have to acknowledge that every single staff makes sacrifices one way or another. (Nurse)
|Incentives and rewards||Incentives and rewards||Incentives of 1-2 months bonus for the absolute hard work we have put in. (Nurse)|
|Personal coping||Positive mindset||Experience the joy of life from within and not be affected by external factors or situations. (AHP)|
|Advocacy for larger system changes||Improve work processes||We should find alternative ways of dispensing medications, like using robots for delivery etc, to minimise contact. (Pharmacist)|
|Advanced outbreak planning|
|Hospitals were never built for social distancing. Maybe we should consider all the lessons learnt when we are building new hospitals. (Doctor)|
Appendix. SUPPLEMENTARY MATERIALS
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- How to plan and perform a qualitative study using content analysis.NursingPlus Open. 2016; 2: 8-14https://doi.org/10.1016/j.npls.2016.01.001
- Ebola outbreak preparedness planning: A qualitative study of clinicians’ experiences.Public Health. 2017; 143: 103-108https://doi.org/10.1016/j.puhe.2016.11.008
- Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore.Occupational Medicine. 2004; 54: 190-196https://doi.org/10.1093/occmed/kqh027
- Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital.British Journal of Psychiatry. 2004; 185: 127-133https://doi.org/10.1192/bjp.185.2.127
- The Influence of the COVID-19 Pandemic on Technology: Adoption in Health Care.Nurse Leader. 2020; 18: 500-503https://doi.org/10.1016/j.mnl.2020.06.008
- Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan.General Hospital Psychiatry. 2020; https://doi.org/10.1016/j.genhosppsych.2020.03.011
- Three approaches to qualitative content analysis.Qualitative Health Research. 2005; 15: 1277-1288https://doi.org/10.1177/1049732305276687
- Maslow's need hierarchy theory: Applications and criticisms.Global Journal of Management and Business Studies. 2013; 3: 1061-1064
- Perceptions of emergency nurses during the human swine influenza outbreak: A qualitative study.International Emergency Nursing. 2013; 21: 240-246https://doi.org/10.1016/j.ienj.2012.08.008
- Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak.Emerging Infectious Diseases. 2006; 12: 1924-1932https://doi.org/10.3201/eid1212.060584
- The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned.Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences. 2004; 359: 1117-1125https://doi.org/10.1098/rstb.2004.1483
- Health Manpower [Table]. Retrieved from Ministry of Health Singapore website.2019
- Application of the Maslow's hierarchy of need theory; impacts and implications on organizational culture, human resource and employee's performance.International Journal of Business and Management Invention. 2013; 2: 39-45
- If schools are closed, who will watch our kids? Family caregiving and other sources of role conflict among nurses during large-Scale outbreaks.Prehospital and Disaster Medicine. 2009; 24: 321-325https://doi.org/10.1017/S1049023X00007044
- Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic.Journal of the American Medical Association. 2020; 323: 2133-2134https://doi.org/10.1001/jama.2020.5893
- Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: Stress and psychological impact among frontline healthcare workers.Psychological Medicine. 2004; 34: 1197-1204https://doi.org/10.1017/S0033291704002247
- Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective study.PLOS ONE. 2021; 16e0258866https://doi.org/10.1371/journal.pone.0258866
- Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study.Nursing & Health Sciences. 2013; 15: 398-405https://doi.org/10.1111/nhs.12048