SCIENTIFIC
Resilience Among Healthcare Providers in Rural Appalachia During COVID-19
AUTHORS :
Ilana Azulay Chertok , PhD , Professor , Associate Director of Nursing Research and Scholarship 1
Dawn Graham , PhD , Assistant Professor of Social Medicine 2
Kavya Yellamraju , BS , Medical Student 2
1
College of Health Sciences and Professions , Ohio University , Athens , Ohio
2
Heritage College of Osteopathic Medicine , Ohio University , Athens , Ohio
INTRODUCTION
During the COVID-19 pandemic , healthcare providers have been positioned on the frontline , working in hospitals and in the community facing critical decisions , moral dilemmas , and trauma . 1 Social distancing and quarantine requirements magnify the multilevel strain of the pandemic , fear of exposure , and burden of the disease , which can precipitate stress . Resilience enables individuals experiencing physical and emotional stress to adapt to life changes in a positive and productive manner . 2 Preparedness and resilience among healthcare providers contribute to mitigating the crisis associated with unexpected emergencies . 3-4 Moreover , healthcare providers ’ adaptive resilience contributes to improved teamwork , flexibility , and adaptability during challenges and resilient public health systems , which support the health and wellness of communities . 5
Resilience is influenced by individual , environmental , and organizational factors . 2 Personal resilience characteristics of healthcare providers include optimism , flexibility , adaptability , initiative , tolerance , organizational skills , team-member attitude , maintaining professional boundaries , assertiveness , humor , and self-worth . 6 Resilience contributes to improved teamwork , flexibility , and adaptability among physicians working in regions of socioeconomic disparity . 7 Physicians and nurses working in intensive
ABSTRACT
BACKGROUND Health disparities and lack of resources in rural Appalachia have compounded the stress of the COVID-19 pandemic , yet resilience may facilitate healthcare providers ’ ability to overcome difficulties . The purpose of the study was to explore the perception of resilience among healthcare providers in rural Appalachia .
METHODS Qualitative interviews explored the perceived experience of resilience among 18 healthcare providers working in rural Appalachia during the COVID-19 pandemic .
RESULTS Four themes were identified , including the personal meaning of resilience , developing resilience in self and in others , running in crisis mode , and rural culture as a source of strength .
care interviewed early in the COVID-19 pandemic in Denmark felt professional responsibility and contribution to the organizational effort . 8 Nurses working in North America during the pandemic expressed confusion and frustration with the lack of evidence-based protocols and resources along with pride in their frontline provision of care . 9
Rural Appalachia faces health , resource , and socioeconomic disparities , which may be exacerbated by the strain of COVID-19 . People in the region have increased risk factors , including smoking and chronic obstructive pulmonary disease 10 along with health disparities that are associated with poor health outcomes . 11 The COVID-19 pandemic intensified health needs , increased workloads , and elevated demands on healthcare providers working in the region . Historically , Appalachian culture espouses resilience regarding resourcefulness , connection , and family support . While there is limited published research on resilience among adults in Appalachia , two qualitative studies of Appalachian men and women identified cultural values and markers of
DISCUSSION Findings of the qualitative study demonstrate that adaptive resilience strengthened healthcare providers ’ dedication to caring for their patients and communities . Internal sources such as self-care and optimism and external sources , including support from family , friends , and community , were critical in healthcare providers ’ resilience during the pandemic . Characteristics and experiences particular to the people in rural Appalachia may contribute to their inner strength . The study findings highlight the importance of promoting resilience among healthcare providers in the region who experience high levels of personal , professional , and community stress .
resilience to include strong social networks ( family and community ), spiritual beliefs and religion , sense of place , and humor . 12-13
METHODS
Qualitative semi-structured interviews were conducted to explore perceived resilience among healthcare providers working in clinical settings in Appalachian Ohio and West Virginia during the COVID-19 pandemic , between June 2020 to June 2021 . Healthcare providers were recruited through health affiliates , online advertisements , and the snowball method . Interviews were conducted by phone , video conference , or inperson while following COVID-19 protocols of social distancing and wearing masks . Interviews were audio-recorded and professionally transcribed . Transcripts were de-identified and coded to identify themes from the interviews . Initially , a subset of nine interviews were independently coded by each team member and then compared for the development of the coding manual , which was used to code the remaining transcripts . Participant characteristics were summarized and described using frequencies . The researchers ’ institutional review
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