Exploring perceptions of work motivation through the experiences of healthcare professionals who provided end-of-life care during the COVID-19 pandemic (PRECA-C project): a qualitative study.

Background: The COVID-19 pandemic posed unprecedented challenges for frontline healthcare professionals (HCPs), leading to high rates of burnout and decreased work motivation. Limited ability to provide adequate end-of-life (EOL) care caused moral distress and ethical dilemmas. However, factors that prevent burnout, reduce intent to leave, and enhance professional fulfillment remain underexplored. This study aimed to explore HCPs' perceptions of work motivation during the pandemic, seeking insights to support their continued dedication.

Methods: A qualitative descriptive study was conducted through online semi-structured interviews (from August to December 2021) with HCPs who provided EOL care, working at intensive care units, specialized COVID-19 wards, and general wards across Japan. Aiming for a diverse sample in terms of gender, occupation, hospital size, and location, interviewees were recruited via the network of the Department of Health Informatics, School of Public Health, Kyoto University. Inductive thematic analysis was applied to interpret the data semantically.

Results: The study participants were 33 HCPs (15 physicians and 18 nurses) from 13 prefectures. The following four main themes with 13 categories were revealed: Developing proficiency in COVID-19 EOL care through HCP experiences, Unity as a multidisciplinary COVID-19 team, Managerial personnel who understand and support staff in fluctuating work, and Social voices from outside of hospitals. These themes uncovered possibilities beyond the personal traits of HCPs and influenced their motivation by incorporating factors associated with healthcare teams, organizations, and wider societal contexts.

Conclusion: In this study, four themes, including the importance of organizational management to prevent isolation, maintaining connections among colleagues, and the need for supportive social voices from outside the hospital, emerged from interviews regarding HCPs' work motivation during the pandemic. These findings highlight the complex interplay of individual, organizational, and societal factors in shaping HCPs' motivation during pandemic waves.