Table 3.

Main findings of the study.

Dimension	Category	Sub-Category
Communication	Communicative expression	Verbal: -Verbal communication was affected, especially at the beginning of the pandemic, due to the use of personal protection equipment (mask, screen, robe, etc.) although it is precisely due to this that communication improved over time and was re-enforced between colleagues by the surge in empathetic feelings. -Communication by telephone to contact the family was used more than before. -The nurses believed that the patients received the same amount of information about their disease. -The health professionals who worked directly with COVID-positive patients, at which time a colleague was present to “mirror” them, had better work organization. -Communication in situations of emergency was not affected, independent of whether the patient was COVID-19 positive.
		Non-verbal: -Non-verbal communication was more complicated due to the use of PPE (mask). -Facial expression was limited so that their attention was more focused on the expression of the eyes or gestures. -The participants agreed that before the pandemic, they could better observe the mood of a colleague as compared to the present time due to the use of masks. However, at present, they could still detect the emotions of others as long as they focused their attention on the eyes and gestures.
	Limitations	-Various limitations were found, among which we found elderly who were deaf, people with language barriers, patients who were under non-invasive ventilation, patients in the process of weaning, patients who had undergone a tracheostomy, etc. -Other means of communication were utilized for better communication, such as gestures or using paper and pen to write down what they wanted to say.
Emotional aspects	Positive	-The participants underlined positive feelings, such as camaraderie or the feeling of becoming close to their colleagues, and other feelings were found, such as the acquisition of new knowledge and the feeling of overcoming, the special feeling established with the “mirror” colleague, and feelings of solidarity and responsibility.
	Negative	-The main negative feelings were fear, stress, and physical and psychological wear although other feelings predominated, such as uncertainty, insecurity, chaos, frustration, impotence, and worry.
Overload	First wave	-Lack of PPE, lack of information, greater exposure, greater psychological difficulty, chaos, and in Primary Care, only the more urgent pathologies were tended to in person.
	Second wave	-The participants had more information, more equipment, and experience. There was less fear and more protocols although these were still changing. The nurses became accustomed to wearing masks and PPE.
	Third wave	-The participants characterized it as the hardest period of work due to the pressure on medical care although they were more accustomed to wearing PPE and worked faster. -The nurses had more knowledge, and things were more peaceful thanks to the start of vaccination. They agreed that they felt safer due to the use of the PPE.
Relationships	Professionals–patients	-Loss of physical contact and a much more limited communication due to the use of PPE, especially utilized to reduce the virus exposure time. -With time, the relationships evolved given the increased knowledge and therefore increased safety. -The general perception was that the patients received the same amount of information about their disease, without considering the emotional part (which was impaired). -Communication with patients under NIV or with some type of disability was more difficult.
	Healthcare professionals	-In emergency situations, the communication and actions were the same. -Nurses indicated that they had to acquire new knowledge against the clock due to the situation. -When speaking about the relationship with their colleagues, they agreed that during the pandemic, a greater camaraderie was observed. The group cohesion was generally strengthened.
	Patients–family	-This was the most difficult part, as providing in-person care was very limited to avoid the propagation of the virus, so that a great deficit in communication was observed. -We also found differences depending on the hospital service (e.g., hospital floors and ICUs had resources, such as telephones or tablets for the patients to make video calls with their family members, but in the emergency department, this was more complicated). -In difficult situations, for example, when patients had to be intubated, they were allowed to speak to their families beforehand as long as it was not an emergency situation.
	Family–professionals	-Communication was affected because it could not be in-person although more importance was given to providing information to the families via the telephone.