Community healthcare workers’ experiences during and after COVID-19 lockdown: a qualitative study from Aotearoa New Zealand

Abstract

AbstractShortly after the COVID-19 pandemic reached Aotearoa New Zealand, a stringent lockdown lasting seven weeks was introduced to manage community spread of the virus. This paper reports the findings of a qualitative study examining how lockdown policies impacted upon the lives of those caring for community-based patients. The study involved nationwide surveys and ethnographic interviews with 15 registered nurses (RN) employed in community settings, two community midwives, and five personal care assistants (PCAs).During the strict lockdown levels 4 and 3, RNs and PCAs in the community showed considerable courage in answering their “call to duty” by taking on heightened care responsibilities and going “the extra mile” to help others. They faced significant risks to personal and professional relationships when they were required to take on additional and complex responsibilities for community-based patients. Despite, and sometimes due to the hypervigilant monitoring of their personal protective equipment (PPE), the need to safeguard family and community members generated considerable stress and anxiety. Many also faced personal isolation and loneliness as a result of lockdown restrictions. Although ‘care’ and ‘kindness’ became social expectations throughout Aotearoa New Zealand during the lockdown, RNs and PCAs who were already doing care work in patient homes had to do more.This article makes five core service delivery and policy recommendations for supporting community-based nurses and PCAs in respiratory disease pandemics: acknowledging the crucial role played by community-based carers and the associated stress and anxiety endured, through championing respect and compassion; demystifying the “heroism” or “self-sacrifice” projected onto care workers to facilitate boundary setting; the timely provision of adequate protective equipment; improving remuneration with adequate provision for time off; and regular counselling, peer support groups, and education on work-life balance delivered by support workers in recognition of stressors arising from these complex and isolated working conditions.What is known about the topicNurses and personal care assistants play a pivotal role in community responses to pandemics.The COVID-19 pandemic has intensified many community healthcare workers’ clinical duties.Pandemics pose risks to healthcare workers’ physical and mental wellbeing.What this paper addsCommunity healthcare workers pressured themselves to be a “good carer” or “hero” during the lockdown.Caring for patients in the community also became about caring about patients, further intensifying workload.The COVID-19 pandemic has negatively impacted community healthcare workers’ relationships, as well as their wellbeing. Impacts continued even once the virus was eliminated.Need for recognition of this workforce distinct from other care workers.