Psychological distress of frontline healthcare workers in the intensive care unit during the early stage of the COVID-19 pandemic: a qualitative study from China

Objective The rapid spread of COVID-19 has overwhelmed healthcare systems across the world. During the early stage of the pandemic, frontline healthcare workers (FHWs) caring for patients at intensive care units (ICUs) faced extreme pressure and challenges. This qualitative study aimed to describe the different phases of psychological distress of FHWs during the early stage of the COVID-19 pandemic. Design Qualitative study. Setting The First Affiliated Hospital of Zhengzhou University, a designated hospital for patients with COVID-19 in central China. Participants Eight physicians and six nurses working in the ICU who provided direct patient care for COVID-19 patients. Methods A descriptive phenomenological study using thematic analysis was applied. Semi-structured one-on-one interviews over telephone or Wechat (a social platform in China) rather than face-to-face interviews were conducted due to quarantine. Interviews were audio-recorded and transcribed verbatim and then were analysed thematically. Findings A total of 14 interviews were conducted, and each interview lasted 20-60 min. Five thematic categories were identified, and the participants' psychological experiences were classified into five stages (1) the mobilisation period: a sense of responsibility with worries; (2) the preparation period: worries, fears and doubts about the epidemic; (3) the transitional period: complex and diverse psychological feelings; (4) the adaptation period: self-adjustment and help from external support and (5) the reflection period: a reflection on life and nature. Conclusion The study showed that the COVID-19 pandemic had significant psychological impacts on FHWs. Self-regulation and external support help FHWs to overcome challenges to a certain extent. More attention should be paid to the psychological wellbeing of ICU FHWs in COVID-19-designated hospitals.