'I never leave my house without praying': a qualitative exploration of the psychospiritual experiences of ethnically diverse healthcare staff during the COVID-19 pandemic

The COVID-19 pandemic exacerbated mental health challenges among healthcare staff globally, with increased depression, anxiety, PTSD and suicidality. In the UK, ethnically diverse NHS staff faced disproportionate risks and stressors, including higher mortality, concerns about unequal access to PPE, perceived over-representation on the frontline, and experiences of institutional racism. Experiences of racial discrimination predicted adverse mental health outcomes and burnout beyond pandemic-related stressors. Psychospiritual support—psychologically informed support addressing meaning, purpose, relationship and hope—may buffer against burnout, yet is limited within NHS structures outside chaplaincy. This study, commissioned by NHS England, aimed to understand the role of spirituality in the lives and work of ethnically diverse NHS staff during the COVID-19 pandemic and to inform development of psychospiritual support interventions.

Spirituality is an integral component of health and well-being, but spiritual support reportedly declined in quality and quantity during the pandemic. Psychospiritual interventions can enhance patient–practitioner relationships and reduce stress; spiritual development opportunities for staff are limited in the NHS outside chaplaincy. Calls exist for spiritual support for frontline workers. Evidence suggests staff value accessible, team-based supports (NHS Check Survey). Group reflective practices (e.g., Schwartz Rounds) show positive impacts on compassion and staff reflection. Organizational spirituality has been associated with reduced chronic fatigue, improved general health, reduced occupational stress, and improved organizational performance in healthcare settings. Literature also notes healthcare professionals use personal spirituality to support patients and cope with grief, reinforcing potential value of psychospiritual support for staff.

Design: Qualitative study using remote focus groups via Microsoft Teams. Context: Part of the NHS England–commissioned 'Listen, Share, Hold, Respond' (LiSHoRe) Project on psychospiritual experiences and needs of ethnically diverse NHS staff during COVID-19. Setting: 10 NHS Trusts in England (5 Acute Hospital Trusts; 5 Community and Mental Health Trusts). Participants: English-speaking NHS staff of any pay band/profession/gender/religion/spirituality who self-identified as non–white British (including white non–British such as Eastern European or Gypsy/Traveller). Exclusion: exclusively white British background; no access to Microsoft Teams. Recruitment: Trust gatekeepers (often EDI officers or leaders in BAME networks) advertised; volunteers contacted researchers; snowball sampling used. Data collection: June 2021–January 2022 during UK lockdowns; two experienced facilitators (at least one from an ethnically diverse background) ran groups; average 3–4 participants; ~90 minutes; topic guide on psychospiritual perceptions/experiences/needs; audio-recorded, professionally transcribed, anonymized; facilitators prepared to offer support and signpost services. Sixteen focus groups were conducted until data saturation. Data analysis: Thematic analysis using the framework approach; coding into categories, entered into framework matrix (Excel); narrative summaries; iterative team meetings to refine themes.

Sample: 55 participants from 10 NHS Trusts; 16 focus groups. Demographic highlights included diverse ethnicities (e.g., Black British African n=17; Asian/Asian British–Indian n=14; Muslim n=16; Christian n=22) and a range of pay bands and roles. Six overarching themes emerged: 1) Spirituality as connecting to something beyond oneself: Spirituality seen as a way of life and the essence of self, providing meaning, direction, and a moral compass; personalized by ethnicity, life history, and circumstances; often inseparable from identity. 2) Spirituality's influence on NHS role: Spiritual beliefs guided compassionate, ethical interactions with patients/colleagues; motivated endurance during pandemic strain and framed healthcare work as an expression of spirituality. 3) Recognition of spirituality in the NHS: Many felt compelled to hide spirituality at work; spirituality seen as potentially contentious like race; some reported supportive managers and faith accommodations, but overall desire for deeper integration into supervision, reflective practice, appraisals, and organizational culture. 4) Connections between spirituality and ethnicity: Religious and ethnic identities were interdependent; existing supports were perceived as white/Western-centric and individualistic (e.g., mindfulness, 1:1 therapy). Participants preferred approaches fostering connection and community (e.g., daily team check-ins), and called for more diverse spiritual support services (e.g., chaplains from Black churches) and holistic well-being recognizing religion/spirituality. 5) Spirituality and leadership: Desire for compassionate, human-centered leadership; need for safe spaces to discuss spirituality; regular, kind check-ins valued. Some managers hesitant due to fear of misinterpretation; participants empathized but sought more relational, culturally sensitive leadership. 6) Spirituality during COVID-19: Mixed impacts. Negatives included time constraints, bereavement, questioning of faith, reduced connectedness due to remote work and closure of places of worship. Positives included strengthened spirituality for some, with increased time for practice, acceptance of suffering, and appreciation of life. Overall, spirituality remained a pillar of strength and hope (e.g., prayer, meditation, online worship).

Findings demonstrate spirituality's centrality to many ethnically diverse NHS staff, inseparable from personal identity and professional roles. Participants sought organizational recognition of spirituality and culturally sensitive, connection-oriented supports. Preferences leaned toward group- and community-focused interventions over individualistic models. Leadership style was pivotal; compassionate leadership that emphasizes listening, empathy, and human connection was perceived as essential for fostering psychospiritual well-being. The results align with literature indicating clinicians draw on personal spirituality to support patients and themselves, and that team-based, accessible supports (e.g., Schwartz rounds, multifaith networks, regular group check-ins) can be effective. Organizational-level attention to spirituality may benefit staff well-being and, consequently, patient care. COVID-19 both constrained and catalyzed spiritual engagement; maintaining connectedness and opportunities for compassionate action appears crucial for sustaining staff spirituality.

Spirituality plays a vital role in the well-being and work of ethnically diverse NHS staff, yet is under-recognized within NHS organizational culture. Staff desire safe spaces and structural integration of spirituality into supervision, reflective practice, and development processes, alongside compassionate leadership and community-oriented supports (e.g., Schwartz rounds, multifaith networks, team check-ins). These insights can inform the development of psychospiritual support interventions tailored to ethnically diverse staff. Enhancing psychospiritual well-being has implications for workforce satisfaction, retention, and quality of care. Future work should develop and evaluate culturally sensitive, connection-focused psychospiritual interventions and explore organizational strategies to embed spirituality respectfully and inclusively.

Participation required access to computers and online working, likely excluding some staff groups (e.g., porters, cleaners, staff intensively needed on wards), which may limit representativeness. Focus groups were conducted online during lockdowns, which may have influenced participation and disclosure.