Material and Method: A total of 416 healthcare professionals participated in the study. They were reached via an electronic questionnaire form through social media groups and given detailed information abıut the study. They were asked 8 sociodemographic questions, 6 questions for health status of HCW, 8 questions about the changes in working and economic conditions, 11 questions for social and psychological changes of HCW.

Results: Ninetyfive percent of the employees felt burnout along with tension, anxiety and restlessness. Despite this, 88% did not receive any psychological support. There have also been changes in the family and social arrangements of the majority of the HCW (94%). Nearly 90% of the HCW worked under pressure. Only 18% of the health professionals who participated in our study did not hesitate to continue their current profession. There is a significant relationship between the participants' decreased willingness to choose the same profession again and their tension/anxiety and burnout (p <0.05).

Conclusion: HCW are effected socially, economically and psychological with the rapid spread of COVID-19 pandemic. They experienced stres, anxiety and burnout besides fatigue. This may lead to problems such as taking care of patients and quality in health care even collapses in the health sector. We suggest that providing and sustaining psychological, economical, social and behavioral support for HCW and health sector.

HCW have been one of the most affected groups, as they directly care for infected people. The rapidly increasing number of cases, hospitalizations and deaths during this period caused their increased anxiety, burn-out and feeling of heplessness ⁴. Besides, difficulties in working conditions, problems experienced by health workers with managers and other colleagues, and economic difficulties have deepened this situation.

Countries have taken various preventive measures against airborne transmission and protective equipment to protect health workers against contact with infected patients during care, in accordance with national and local health policies ⁵. In addition, some social and psychological support measures can be taken for the mental health of the employees.

We conducted a questionnaire to reveal the stress, anxiety and burnout that health professionals have experienced during this pandemic period, and the social, economic and work-related problems encountered.

Inclusion criteria include healthcare workers aged 18 years or older who have had contact with COVID-19 patients. Exclusion criteria were those who had no patient contact during the outbreak or did not want to participate in the quastionnaire.

In the study, for the demographic analysis of the partic-ipants; 1-Gender, 2-Age, 3-Marital status, 4-Having children, 5-People living together, 6-Which health profession group belonging to, 7-Time spent in the profession, 8-Institution of work were asked.

To analyze the changes caused by the covid-19 disease in the working and economical conditions of health workers; 1-The duration of contact with the patients, 2-whether they worked on demand in the pandemic ser-vice, 3-Change in the tempo or conditions of the work, 4-Increase in the workload, 5-If there was an increase in the workload, it was asked whether the managers of the institution made any arrangements in favor of the employees, 6-Whether an award or additional payment was given, 7-Whether the income obtained in this period was sufficient. 8-Change in the dialogue with hospital administrators or other colleagues, 8-Any problems in getting permission during this period; were asked to the participants.

To analyze the effects of the Covid-19 on health status of HCW; 1-Their thoughts about protecting their own health, 2-Covid-19 Vaccination status of HCW, 3-Getting caught Covid-19 disease, 4-Whether the close relatives’ affected by the Covid-19 disease, 5-The preventive cares taken to stop the disease and prevent transmission, 6-Sufficiency of the number of protective equipment and personnel were questioned.

In order to question the social and psychological changes experienced by the HCW regarding the Covid-19 disease; 1-Their feelings when they met the first Covid-19 patient, 2-Changes in family and social life, 3-The reactions they received from the families because of working in the Covid-19 service, 4-Whether they thought they were working under pressure, 5-Increase in the requests of the patients/patient relatives/hospital management and 6-Whether they were concerned about meeting them, 7-Experiencing tension-anxiety, 8-Feeling burnout, 9-Receiveing psychological support during this period, 10-Any social activities they did to relax mentally and psychologically, 11-If they had the right to choose a profession again, whether they would like to do their current job; were asked.

Our study was approved by Fırat University and complies with the principles of the Helsinki Declaration.

Statistical analysis:
The data obtained from the research were analyzed using the SPSS version 24.0 (IBM Corp., Armionk, NY, USA) package program. Number, percentage and Chi-square tests were used to evaluate the data.

In determining the sample of the study; The sample size of the study was found to be 400, since 0.33 effect size, 0.05 first type error amount, and 95% power were taken as basis (T :1,64). Considering the losses in the study, the study was completed with 416 HCW. The significance level of the data was accepted as p <0.05.

With this increased workload, 81% of HCW think that no favorable regulation had been made and approximately 72% of them think that the income they received during this period was insufficient. The 58.4% of HCW did not work in the pandemic service of their own accord. There have also been changes in the family and social arrangements of the majority of the HCW (94%). The majority of the HCW were concerned about meeting the increase in the demands of the hospital management, patients and their relatives (82%). Nearly 90% of the HCW who participated in our survey think that they worked under pressure. Ninetyfive percent of the employees felt burnout along with tension, anxiety and restlessness. Despite this, 88% did not receive any psychological support. Approximately 60% of the HCW participating in the study stated that they were interested in a social activity to relax. Fiftyseven percent of health workers say that they had problems in taking leave. However, only 18% of the health professionals who participated in our study did not hesitate to continue their current profession. About half of them definitely do not want to do the same job (Table 1).

Click Here to Zoom

Table 1: Sociodemographic variables of HCW.

There was no relationship between the marital status of the participants and the change in family life/social order. There was also no statistically significant relationship between marital status and working under pressure, the increase in the demands of the patients/patient relatives hospital management and the anxiety of meeting them, and the situations of experiencing tension/anxiety (p =0.803, p =0.220, p =0.488). It has been determined that married people have a significant increase in burnout and decrease their desire to do the same job (p <0.05) (Table 2).

Click Here to Zoom

Table 2: Comparison of Marital Status and Social/Psychological effects.

A significant relationship was found between the tension/anxiety of the participants and the increase in workload, deterioration in their dialogue with managers and colleagues, the state of receiving rewards, the feeling of working under pressure, and the feeling of anxiety in meeting the requests of patients, relatives and managers (Table 3).

Click Here to Zoom

Table 3: Comparison of tension, anxiety and social life-working environment effects.

There is a significant relationship between the participants' having children, increase in workload, deterioration in dialogue with managers and colleagues, working under pressure and anxiety in meeting demands (p <0.05) (Table 4).

Click Here to Zoom

Table 4: Comparison of feeling burnout and the effects of social life and working environment.

There is a significant relationship between the participants' decreased willingness to do the same profession and having children, making arrangements for the increased workload, deterioration in the dialogue with managers and colleagues, working under pressure, and anxiety in meeting the demands (p <0.05) (Table 5).

Click Here to Zoom

Table 5: Comparison of the effects of social life and working environment with their willingness to do the same job.

There is a significant relationship between the participants' decreased willingness to choose the same profession again and their tension/anxiety and burnout (p <0.05) (Table 6).

Click Here to Zoom

Table 6: Comparison of tension anxiety and burnout with willingness to do the same job.

In our study, among the HCW who are married and with children, we found a significant relationship between both the feeling of burnout and the unwillingness to do the current job. Different social roles and responsibilities of those who are married and have children, the decrease in the time they spend with their families, the fatigue due to the increased workload, the fear of transmitting this infection to their families and possible financial inadequacies may have been effective in this result. HCW who indicate an increase in their workload also experience tension, anxiety and burnout. The fatigue caused by the excessive workload and the inability to complete the work make this inevitable. This may be related to the intensity and irregularity of working durations and conditions during the pandemic period. The fact that healthcare workers exposed to the coronavirus did not receive any rewards or allowances despite their high self-sacrifice, also resulted in tension and anxiety. Working under pressure in intense pandemic conditions and hospital administrators' anxiety about meeting the wishes of patients and their relatives have led to tension and burnout. In addition, this situation has led to the reluctance of employees to do their current profession. We see that those who feel tension, anxiety and burnout among the HCW do not want to do their current job. This may lead to problems such as taking care of patients and quality in health care. This will lead to unavoidable problems and even collapses in the health sector.

Difficulties in dialogue with hospital administrators and other colleagues resulted in an increase in tension, anxiety and burnout, and reduced their willingness to do their current job. With the increasing workload, a significant relationship was found between the unwil-lingness to do their job and no favorable arrangement for the HCW. The fact that the main responsibility is on the HCW during the pandemic period, and the lack of any favorable regulation in return has intimidated the health workers and they have no desire to do their current profession.

Considering all these, in the case of a pandemic, it is essential to determine the need for health personnel in numbers and to make workforce planning accordingly. Considering the increasing workload, we think that it is necessary to organize working and resting areas for HCW, to plan working hours more appropriately, and to provide adaptation trainings to all employees. Also, we suggest that providing and sustaining psychological, social and behavioral support, will be beneficial for both patients and HCW, as shown in many studies ¹⁷. In addition to these, providing sufficient materials and protective equipment to the HCW and meeting their personal needs are among the necessary precautions. Considering the stress and anxiety experienced during the pandemic period, we think that it would be beneficial for health managers to make HCW feel that they are important, that they respect themselves and the work they do, and that they make rewards that will motivate employees. With the increasing workload and working hours, it has become a necessity for HCW increasing their motivation and earn enough, to adapt to these difficult conditions. In this way, employees will do their work more willingly and more carefully.

Limitations: This study is single center and limited to city hospital. The burnout and anxiety of the patients were not supported by clinical examinations.

Conclusions: With the rapid spread of COVID-19 all over the world, HCW had great responsibilities. They are effected socially, economically and psychological. They experienced stres, anxiety and burnout besides fatigue. This may lead to problems such as taking care of patients and quality in health care. So there will be unavoidable problems and even collapses in the health sector. To prevent these troubles, we suggest that providing and sustaining psychological, economical, social and behavioral support will be beneficial for HCW and health sector.

1) Dhama K, Khan S, Tiwari R et al. Coronavirus Disease 2019-COVID-19. Clin Microbiol 2020; 33: 00028-20.

2) Sevinc S A, Metin S, Basi N B, Cinar A S, Ozkan M T, Oba S. Anxiety and burnout in anesthetists and intensive care unit nurses during the COVID-19 pandemic: a crosssectional study. Braz J Anesthesiol 2022; 72: 169-75.

3) Sneyd J R, Mathoulin S E, O'Sullivan E P et al. Impact of the COVID-19 pandemic on anaesthesia trainees and their training. Br J Anaesth 2020;125: 450-5.

4) Di Tella M, Romeo A, Benfante A, Castelli L. Mental health of healthcare workers during the COVID-19 pandemic in Italy. J Eval Clin Pract 2020; 26: 1583-7.

5) Cascella M, Rajnik M, Cuomo A, Dulebohn S C, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19) 2022 In StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL.

6) Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA 2020; 323: 2133.

7) Lai J, Ma S, Wang Y et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020; 3: e203976.

8) Nemati M, Bahareh E, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Arch Clin Infest Dis 2020; 29: e102848.

9) Pappa S, Ntella V, Giannakas T, Giannakoulis V G, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020; 88: 901-7.

10) Stuijfzand S, Deforges C, Sandoz V et al. Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: A rapid review. BMC Public Health 2020; 20: 1230.

11) Chew N W, Lee G K, Tan B Y et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020; 88: 559-65.

12) Venkatesh A, Edirappuli S. Social distancing in covid-19: What are the mental health implications? BMJ 2020; 369:1379.

13) Mamun M A, Bodrud-Doza M, Griffiths M D. Hospital suicide due to nontreatment by healthcare staff fearing COVID-19 infection in Bangladesh. Asian J Psychiatr. 2020; 54: 102295.

14) Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based crosssectional survey. Psychiatry Res 2020; 288: 112954.

15) Dyrbye L N, Shanafelt T D, Johnson P O, Johnson L A, Satele D, West C P A crosssectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC Nurs 2019; 18: 57.

16) Talaee N, Varahram M, Jamaati H et al. Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire. Z Gesundh Wiss 2022; 30: 531-6.

17) Xiang Y-T, Yang Y, Li W et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020; 7: 228-9.