board approved the study and informed consent was obtained prior to each interview .
FINDINGS
Eighteen healthcare providers working in rural Appalachia during the COVID-19 pandemic were interviewed , including 11 physicians , five nurses and advanced practice nurses , and two pharmacists ( Table 1 ). Four themes were identified : personal meaning of resilience , developing resilience in self and in others , running in crisis mode , and rural culture as a source of strength .
The first theme , personal meaning of resilience , contained subthemes of the ability to endure and recover from hardship , adaptability , and an optimistic outlook . Fifteen participants perceived resilience as determination and resolve to get through challenges , “ the ability to make lemonade out of lemons ,” and to recover from hardship , with phrases “ return to normal ” and “ bounce back ” repeated to describe this sentiment . Some participants considered resilience as a chance to emerge stronger from a challenging situation , “ to end up on top and to thrive .”
This trait was particularly associated with participants ’ internalization of their identity as healthcare providers and their professional responsibility .
“ You have to be able to pull yourself together if you just had a crisis . You still have five other patients you have to take care of , so you have to get yourself together quickly and be able to adapt ,” said one participant .
Some participants placed the importance of patient care at the forefront .
“ When you sign up to be a physician or nurse or anything in healthcare , one of the things you ’ re signing up for is , no matter what , you do your job . You take care of the patient first , not yourself ," said another participant .
The ability to adapt to the ever-changing healthcare environment during the pandemic was attributed to resilience . Learning from difficult experiences was framed as an opportunity to grow from them , learn from them , and move forward . Furthermore , they valued a sense of hope ,
Sex
Ethnicity
Marital Status
Highest Level of Education
TABLE 1 : Self-Reported Characteristics of the Healthcare Providers Working in Rural Appalachia During the COVID-19 Pandemic Who Participated in the Qualitative Interviews ( n = 18 )
Professional Role
Employment Setting
Characteristic % ( n )
describing resilience as the ability to get through with grace and smile and hope and move on with life and not be sour .
The second theme reflects 13 participants ’ development or reinforcement of resilience in themselves and in others through internal locus of control , wellness activities , social connections , and workplace support . Participants regarded spending time with and caring for family , friends , neighbors , and pets as providing a sense of purpose and social connection beyond work . Technology was commonly used for communication , keeping in touch , and playing games with family and friends . Conversing with fellow co-workers helped them face challenges with a sense of camaraderie and support .
Many participants engaged in exercise and hobbies for physical and mental health , adapt ing their activities to the pandemic guidelines . Outdoor physical activities such as running , walking , and kayaking were means of getting out of the house , staying fit , and managing isolation . Living in the country offered benefits such as outdoor space , enjoying nature , and exercising , perceived by the respondents as an opportunity to
Male 22.2 % ( 4 ) Female 77.8 % ( 14 ) White 88.9 % ( 16 ) Asian 11.1 % ( 2 ) Married 88.9 % ( 16 ) Divorced 11.1 % ( 2 ) Parity ( median ) 2 ( range 0-6 ) Undergraduate 11.1 % ( 2 ) Graduate 88.9 % ( 16 ) Physician 61.1 % ( 11 ) Advanced Practice Nurse 16.7 % ( 3 ) Nurse 11.1 % ( 2 ) Pharmacist 11.1 % ( 2 ) Hospital 27.8 % ( 5 ) Community Clinic 72.2 % ( 13 )
escape the pressure . As the pandemic afforded more time at home , the activities mentioned were creative hobbies , quiet reflection , mindfulness , and meditation .
Self-care that contributed to individual resilience involved reflecting on core beliefs and values during the pandemic . A physician voiced feeling inspired by what the human spirit is able to accomplish in times of need . For some individuals , the belief in spirituality or a higher power strengthened their resilience during the pandemic . Acknowledging silver linings and maintaining optimism were valuable in coping with uncertainties and augmenting participants ’ internal locus of control .
One physician stated , “ I am an optimist . I have been able to identify things that are different this year because of COVID that actually are beneficial . So , it ' s about putting a positive spin on the changes .”
This positive approach was expressed as focusing on “ silver linings and victories , albeit so small , those victories help you get through it ” and looking “ for little things throughout the day that make me smile .”
West Virginia Medical Journal • March 2023 • 19