An image shows a health care worker looking worried and exhausted, to illustrate the concept of health care providers experiencing burnout due to the COVID-19 pandemic.

Project COPE documented health care providers’ experiences concerning burnout and wellness, and began just as health care professionals were beginning to be affected by COVID-19 and its restrictions. Amazing people told their stories in the midst of a crisis, at risk of losing their livelihood, or close to a housing crisis.

They took time to help and to give back in some way. This really speaks to the reality of compassionate people concerned with finding a way to give back.

In April 2020, investigators Ann Blair Kennedy, LMT, BCTMB, DrPH, Smith Heavner-Sullivan, PhD, RN, and Niki Munk, PhD, LMT, along with other colleagues, began work on the Project Cope study.

Kennedy is executive editor and editor-in-chief of the International Journal of Therapeutic Massage and Bodywork, USC Greenville, South Carolina; Smith Heavner-Sullivan, has 14 years specializing in emergency and critical nursing and research at Prisma Health, Greenville, South Carolina; and Munk works at Indiana University-Purdue University Indianapolis, Department of Health Sciences, and is a board trustee for the Massage Therapy Foundation.

The project’s creators realized they had a unique opportunity to look at nurses and massage therapists in critical settings. At that time, there was not a study of its kind that looked at what might be similar between the two professions.

This article provides an update on Project COPE (“chronicling health care providers’ pandemic experiences”), a mixed-method study garnering quantitative and numerical data from surveys as well as obtaining qualitative data through video journals.

A Rich, Deep Understanding

Project COPE sought out broader and better information about COVID-19 experiences from health care providers, including massage therapists, who shut down their practices. Qualitative research, exploring experiences, provided data and insights. Collecting data in real time through video combined with survey responses, validated measures and brought data together from a rich and deep understanding of what it is like to live through the pandemic.

The project’s organizers wanted to do something for health professions and make a difference during the pandemic, instead of only watching it unfold.

They ended up expanding the study’s reach beyond nurses and massage therapists and capturing data from 21 distinct health care professions, including social workers, physical therapists, radiology technicians, acupuncturists, chiropractors, physicians, nurse practitioners, mental health professionals, and many health care subspecialties’ providers, including allied health professionals and complementary and integrative professionals.

They garnered about 1,300 unique respondents, of whom about 600 were massage therapists. The responses expanded beyond U.S. borders, including Canada, Europe and Africa. They also sparked an interesting subset of the project headed up by Chiwoneso Tinago, PhD, West Chester University, PA, and Geoffrey Anguyo, MD, of the Kigezi Health care Foundation, Uganda, Africa, studying the impact of the pandemic on health care outreach workers at Kigezi.

The results of Project COPE can help researchers and health care workers understand the impact and subtler implications of a widespread crisis on health care workers. Using both qualitative and quantitative data brought to light important insights.

Qualitatively, personal stories were heard through video blogs, which allowed investigators to see the participants.

For example, in the first four videos that came in, there were two nurses and two massage therapists; study investigators could see the differences and expressions in their faces as they explained what was going on for themselves. The exhaustion and weariness was apparent in the three- to five-minute videos, as was the moral distress that was demonstrated in many ways.

Emphasis was put on the qualitative data as researchers were capturing stories and perspectives that had not been seen in the literature before. In processing qualitative data, the researchers turned that into something understandable and useful.

They created hashtags and referred to them as they watched the videos to understand the narrative that was being told, forming a kind of 30,000-foot view of qualitative analysis. They ascertained the essence of what the person was saying and grouped similar stories together so when full analysis was later completed the situations had meanings. In the first fours videos, for example, the overarching themes were stress, budget crisis and exhaustion.  

The large volume of data collected included about 300 video blogs, which generally ranged from about five minutes to 15 minutes. The data was able to be sorted quickly and in near real time.

Project COPE grouped all the different stories together and then looked at the qualitative pieces along with the quantitative survey data to get a better understanding of the subject matter. For example, when trying to get a measure of how burned out someone was, this study looked at multiple data points together, so instead of having just one data point denoting someone is feeling burned out four times a week versus eight times a week, it also gleaned the story behind the burnout in order to look at what that person’s experience was that got them to that point. Then, these stories were aggregated with others to find helpful resources for the respondents.

[Watch “Project Cope Wrapup” on the Massage Therapy Foundation’s Research Perch.]Project COPE Results

Let’s look at some results and discoveries from Project COPE as reported by Kennedy and Heavner-Sullivan via the Massage Therapy Foundation’s podcast, “Research Perch.” For one thing, Project COPE captured stories so that people would understand terminology and experiences in regard to such vital issues as burnout and moral distress:

•Burnout syndrome is a state of emotional exhaustion where someone who does some kind of people work or social work runs out of reserves and has a component of lack of self-care and the ability to build energy back up, to the state where they start to lose empathy and concern. There is also a closely related term called compassion fatigue.

Many studies will use burnout and compassion fatigue and distress interchangeably. All are associated with increased risk of medical errors, increased risk of automobile accidents, and—long term—they are associated with an increased intent to leave a profession.

• Moral distress is that unique experience of knowing or believing you know the correct action in a situation but something— usually some sort of authority figure, policy or financial or physical constraint—prevents you from doing that.

One big takeaway from this study was the level of isolation that, especially, acute care providers put themselves in. There were also instances where people voluntarily isolated themselves from their families. Anecdotal stories were told of people sleeping in their garages so they don’t infect their families with COVID-19.

One nurse, for example, who was cross-trained as a massage therapist, talked about how she would go on long walks by herself, and would sit on another side of the house away from her family. She cared deeply about her patients but also recognized how much risk she was at personally.

Resilience and coping mechanisms were other themes. People engaged in such unhealthy coping mechanisms as increasing or starting smoking or eating junk food. Others tried to cope via walking their dogs, finding ways to volunteer or gardening.

Some trends were seen as the vaccines became available. The input from participants changed; for example, there was one nurse who talked about getting her vaccine and some of their stress and concern diminishing.

Another interesting piece allowed for the creation of a whole theme around politicization of the pandemic itself. The study employed multiple perspectives reviewing input.

The use of a hashtag evaluation created an innovative methodology to assess a large volume of data, as existing methods were not going to let researchers get at it and really understand what was going on. There are a number of rapid evaluation methodologies, such as rapid identification of themes from audio recordings.

Project COPE had two medical students review videos, in part to sort the data but also to look out for any danger signs, to see if there was anyone who is at risk of self-harm.

Researchers asked the students to create hashtags as if a video like this was posted on social media: Taking a big thought and putting it into one or two words. They came up with a list of about 200 hashtags, finding many of the same things happening during the pandemic—meaning each of these things was not happening in a vacuum—and that those things were connected to political context, environmental crises, and other current events.

Findings showed that nurses were more likely to isolate themselves, whereas massage therapists seemed more likely to try to find some means of creation-making to try to cope with the pandemic.

More Results Underway

Quantitative analysis from the surveys combined with the qualitative video analysis on the fine points of the methodology and details of the findings will be written in papers and published in the near future.

To learn more about conclusions reached Project COPE, read “I Thought I was Going to War”: Experiences of Health-Care Workers During the COVID-19 Pandemic—An Exploration of ProjectCOPE,” by Smith Heavner-Sullivan, at

About the Author

Marla M. Gamze is the development & marketing manager for the Massage Therapy Foundation ( The Massage Therapy Foundation is a 501(c)3 providing support to the massage therapy profession. Since 1990, MTF has provided over $1 million in research grants studying the science behind therapeutic massage. MTF founded and publishes an open-access, peer-reviewed scientific journal and provides many educational resources for massage therapists, educators and students. MTF also provides community service grants to populations in need of therapeutic massage who would otherwise lack access. Learn more, donate, or apply for a community service grant at