Table 3.
Themes in the soul–role–context lens
| BCW | Soul | Role | Context |
|---|---|---|---|
| Behaviour—threats (140/24) | Distress: psychological; existential; suicidal, strong emotions: anger; betrayal; numbness; fear; helpless; hopeless; undervalued, Loss of: joy; faith; reflection; meaning; touch; trust, pessimism, remorse | Communication challenges, death, medicalisation of suffering, no time for self-care, PTSD, serving others at cost of well-being | Abuse, assault and violence; compromised care; reduced social contact (patients, relatives at work or family, friends in personal life); unacceptable/unavoidable risk-taking; and uncertainty |
| Behaviour—protectors (79/24)5 | Address spiritual needs of staff, admit vulnerability, awareness (of self and others), bear not avoid limitations, strong emotions: joy, hope, optimism, physically safe, meaning-making, normalise responses | Agents of noble cause, bridge between patient and family, protect clinician health, sharing family emotional moments | Address basic physical needs of staff, ethical social and professional obligations, mindfulness, service support |
| Intervention—threats (9/2)5 | High cost of social deprivation to self-efficacy, isolated, distanced | Patients’ psychological distress, redeployment anxiety | Loss of: quiet spaces; usual workplace and interventions, how to decrease stress |
| Intervention—protectors (35/2)5 | Organisational culture of caring, decrease stress/anxiety, support, track well-being | Check-in, time off for courses, listening/processing moral injury | Self-care resources, peer support, physical safety, recognition from leaders, space to share stress, redeployment specialist training |
| Policy—threats (17/3)5 | Social isolation | Staff shortages, system overload, scant resource allocation | Focus on medical care, scant resource allocation, burnout/stress risk, lowering standards, limited infrastructure |
| Policy—protectors (38/3)5 | Communication to empower and raise morale, mental and emotional strength, self-care | Train staff in physical protection and technology to assist patients keeping in touch | Care: best available; capacity for, protect staff needs, clear communication, PPE, safety, support, recognition from leaders |
| Total | 177 | 34 | 136 |
5Numbers of words, phrases and concepts found/numbers which are both protectors and threats.