The healthcare providers persevered under challenging conditions . They described an innate sense of determination and persistence that guided them through challenging times . Caring for people in need is inherent in their commitment to their professional roles as healthcare providers and provided a sense of higher purpose during the pandemic .
The value and mission of providing patient care were frequently expressed . Many participants mentioned that their core identity as healthcare providers sustained them through the pandemic . For many , their professional identity gave them a sense of duty and service to others .
“ We have a sense of obligation to battle hard when things are tough ,” one respondent said . As healthcare providers working in rural Appalachia , they were motivated to provide care to their underserved communities , as expressed by a physician here : “ I see the need here , and that ’ s what keeps me moving forward , that ’ s what drives me every day . Could I retire tomorrow ? Maybe , but then what ? Who steps in ? If I ’ m not here , if our practice is not here , who ’ s going to care for these people ?”
Participants suggested strategies to enhance workplace resilience to foster a sense of teamwork such as covering for colleagues , encouraging interprofessional communication , and sharing updated evidence-based information . One physician said , “ We did what we needed to do to stay safe and healthy and yet still take care of the primary goal — patient care .” Wellness resources and updated COVID-19 guidelines regularly communicated and distributed by employers were appreciated and bolstered a sense of belonging to a caring system .
The third theme , running in crisis mode , described barriers to resilience experienced by 13 of the participants . The increased intensity of patient care , elevated morbidity and mortality , and limited resources compounded the crisis . There was a general feeling of being exhausted and overwhelmed . One physician stated : “ We ’ re tired . And we don ’ t mean just physically tired . We are psychologically tired .” Early in the pandemic , people demonstrated appreciation for healthcare providers , hailing
them as heroes , sending them encouraging messages and food packages , and making them feel valued and trusted . But , as the pandemic wore on and negative social media messages were disseminated , there was a negative shift in attitudes . Healthcare providers were frustrated by the politicization of healthcare during the pandemic , before and after vaccines became available . The false claims regarding the pandemic dismissed the healthcare providers ’ hard work and wearied them . Two physicians expressed challenges of caring for and “ dealing with ” patients who are “ naysayers ” or are at risk of serious infection “ but their values and their suspicion of science and the government prevent them from making healthcare choices that would benefit them ” causing them to “ defy what science we have by not masking , social distancing , or avoiding crowds ” or to resist “ vaccination when we now have this solution .”
Some healthcare providers felt their personal sense of resilience “ fluctuate ,” and that some days they were more resilient than others . They felt a responsibility to find answers for what was occurring , yet inadequate tools and lack of knowledge in managing the COVID-19 outbreak challenged their self-confidence as they “ had to learn about a new disease that is constantly changing .” Difficult decisions were compounded by the lack of adequate training and resources to provide care at the preferred level , which led to moral distress . The lack of resources was acutely felt in relation to shortages in personal protective equipment ( PPE ), supplies , ventilators , and staffing , raising concerns for safety in patient care and in protecting the healthcare team . “ There ’ s not enough PPE , there ’ s not enough this , not enough that ,” said one respondent . Clinics and pharmacies had to reduce hours or temporarily close due to lack of supplies or limited staff , further limiting access to care . As resources were depleted and patients feared seeking care , lag time to diagnosis and treatment increased , thereby contributing to the severity of multiple health problems .
Some participants described difficulty in finding time and context for self-care . While they recognized the benefits of exercise , rest , and social connection , their time to engage in activities that supported emotional wellness was insufficient . Closure of fitness , sports , and activity centers meant limited facilities available for physical activity . One physician described that due to the pandemic , their fitness center closed , which was hard on them . “ I didn ' t realize how much I relied on it just to be healthy and motivated and want to exercise . I tried doing the home workout . I had the equipment , it ' s not the same ,” they said .
Healthcare providers feared infection and not being able to work . “ I fear not to be able to serve ,” one response said . Constant exposure to COVID-19 at work elevated the potential level of risk for their family members being exposed . “ What risk have I been to my family by serving ? Am I putting them in danger by continuing to go to work ?” another wrote . Some healthcare providers and their families developed creative methods to limit their engagement in the household and minimize exposing the family to COVID-19 . For example , one nurse ’ s family built an outdoor shower shed so she could more safely work and keep her family and home safe .
The fourth theme , rural culture as a source of strength , is specific to the characteristics of people living in the region as described by 12 of the participants . One pharmacist shared , “ I think we ’ re pretty resilient people as a whole . I think our general upbringing probably helped prepare us to be okay .” An overall feeling of those who grew up in rural Appalachia was resilience and the ability to overcome challenges . One participant stated : “ Appalachian culture made me more resilient because I watched people who did not have resources , and yet , they were still trying to stay positive and still trying to do the best they could .” Many credited their innate resilience to their upbringing in rural communities , as one advanced practice nurse stated , “ I was just kind of raised to be resilient ... never giving up regardless of what situation ’ s handed to you ,” demonstrating an innate trait to overcome challenges .
There were noted advantages to being located in a rural area during the pandemic , where people felt that they were in a protective “ bubble ” with “ a huge safety blanket during COVID .” “ Being in the country ,
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