The COVID-19 pandemic significantly impacted the well-being of healthcare staff globally, with reports of increased rates of depression, anxiety, PTSD, and suicidality. Ethnically diverse NHS staff in the UK experienced these pressures even more acutely, facing higher mortality rates, concerns about unequal access to PPE, and perceptions of overrepresentation in high-risk frontline roles. Experiences of racism further exacerbated these stressors. While psychosocial support is commonly provided, psychospiritual support—defined as psychologically informed support addressing the need for meaning, purpose, relationship, and hope—is less prevalent. This study, commissioned by NHS England, aimed to understand the experiences of ethnically diverse NHS staff and the role of psychospirituality in meeting their support needs. The NHS, with its diverse workforce, presented a crucial case study to understand the whole-person experiences of staff who contributed significantly to the nation's COVID-19 response yet faced immense stress and pressure.

Existing literature highlights the well-being concerns of healthcare workers during the pandemic, particularly among ethnically diverse groups experiencing disproportionate impact and racism. Studies reveal elevated mental health challenges and burnout in these groups. The importance of spirituality and its potential role in building resilience and compassion in healthcare settings is acknowledged, but the provision of psychospiritual support remains limited. While some research indicates benefits of psychospiritual interventions, more understanding is needed, particularly regarding the specific needs of diverse communities.

This qualitative study employed a framework approach using thematic analysis. Data were collected through 16 remote focus groups conducted on Microsoft Teams between June 2021 and January 2022 with 55 participants from 10 NHS Trusts in England (5 Acute Hospital Trusts and 5 Community and Mental Health Trusts). Participants were English-speaking NHS staff from non-white British backgrounds, encompassing a range of professions, pay grades, genders, religions, and spiritual beliefs. Recruitment involved collaboration with trust gatekeepers, often Equality, Diversity, and Inclusion officers, and snowball sampling. Two experienced facilitators, at least one from an ethnically diverse background, conducted the 90-minute sessions. A topic guide facilitated discussions around psychospiritual perceptions, experiences, and needs related to the pandemic. Sessions were audio-recorded, transcribed, and analyzed using thematic analysis, with regular team meetings to refine emerging themes. Data saturation was reached when no new data emerged.

Thematic analysis revealed six overarching themes. First, "spirituality as connecting to something beyond oneself" highlighted the diverse meanings participants attributed to spirituality, emphasizing its role in providing meaning, direction, and a moral compass. Second, "spirituality's influence on role within the NHS" showed how spirituality guided participants' interactions with patients and colleagues, fostering compassion and ethical behavior. Third, "recognition of spirituality in the NHS" revealed a perceived lack of recognition and a need for open discussion of spiritual beliefs in the workplace. Fourth, "the connections between spirituality and ethnicity" emphasized the interdependence of spirituality and ethnicity, particularly for participants from Islamic communities, highlighting a need for culturally sensitive interventions. Fifth, "spirituality and leadership" emphasized the desire for compassionate leadership that creates safe spaces for discussing spiritual concerns and fostering connections. Finally, "spirituality during the COVID-19 pandemic" showed that the pandemic had both positive (e.g., increased time for spiritual practices) and negative (e.g., reduced access to worship, questioning of faith) effects on participants' spirituality. Many found their spirituality to be a crucial coping mechanism.

The findings emphasize the centrality of spirituality for many ethnically diverse NHS staff, demonstrating its influence on their work and well-being. The need for greater recognition and incorporation of spirituality within NHS organizational culture was strongly articulated. The study highlights the importance of culturally sensitive, holistic approaches to psychospiritual support, moving beyond individualistic interventions to embrace group settings that facilitate connection and shared experiences. The need for compassionate leadership that fosters open communication and understanding of staff's diverse spiritual and ethnic backgrounds emerged as crucial. The study supports the implementation of interventions like Schwartz rounds or compassionate leadership training to address these needs.

This study provides valuable insights into the psychospiritual experiences of ethnically diverse healthcare staff during the COVID-19 pandemic. The findings underscore the need for the NHS to address the neglected area of psychospiritual support and create a culture of inclusivity and compassion. Future initiatives should focus on culturally sensitive, holistic approaches that recognize the importance of connection and shared experiences in fostering well-being among staff. Further research could explore the effectiveness of specific psychospiritual interventions tailored to diverse cultural and religious backgrounds within NHS settings.

A key limitation was the reliance on online focus groups, potentially excluding staff with limited digital access, such as porters and cleaners. This could have skewed the sample and limited the generalizability of the findings to the entire ethnically diverse NHS workforce.