roles as health care provider and parent, feeling on one hand altruism and professional responsibility and, on the other hand, fear and guilt about potentially exposing their families to infection. Some nurses on units that had no patients with SARS felt that their needs became secondary. Collaboration and collegiality were observed in units that volunteered to send staff to other units to assist with care. Supervisors and leaders expressed difficulty in remaining at home or leaving work because of their sense of responsibility to be present with their staff. Throughout the hospital it was found that many staff required “permission” from peers or supervisors to refrain from doing too much. When returning to work after days off, people felt disconnected from the current state of the organization. Staff reflected on the stark contrast of the seemingly “normal” external environment and a highly stressed work environment. There were wide discrepancies in workload between those subjected by circumstances or personal attitudes to overwork and those prevented from working by quarantine or a “nonessential” designation. On medical wards that treated patients with SARS, some staff reported anxiety about infection and resentment about being chosen for the task. Nurses who were assigned to patients with SARS were not allowed to refuse the assignment (except for accommodations that could be made for pregnant nurses to avoid potential exposure to the teratogenic effects of ribavirin). Although there were incidents of professional and nonprofessional staff refusing to care for patients with SARS in respiratory isolation on general medical floors, there was no refusal of work assignments by nurses on the SARS unit. Staff attributed this to feeling confident about being well-equipped, maximally protected by isolation precautions and well supported in the hospital. On the SARS isolation unit, spikes of anxiety occurred in association with several events: when isolation precaution procedures changed, when infectious disease staff entered quarantine or treatment, when health care workers were admitted with an unclear source of infection, when one of the SARS-unit nurses developed a fever (not due to SARS) and when a discharged patient with SARS was readmitted with fever. Staff reported fatigue, insomnia, irritability and decreased appetite. SARS staff had the emotionally complex task of caring for patients who were themselves health care workers. The clear line between patients and staff became blurred as staff experienced a strong emotional identification with colleagues who were now patients. Caring for colleagues increased the anxiety of some staff regarding their competence and skills. Pyschological support Patients with SARS Patients with SARS received an initial visit from the psychiatric clinician nurse specialist, the consultation–liaison psychiatrist and/or a social worker familiar with the intensive care setting. In these screening assessment interviews, it was emphasized that a wide range of emotional responses is to be expected in the face of such an extraordinary situation. Concerns and feelings expressed were interpreted as expected, normal responses. Immediate concerns were reviewed, especially the patient’s family situation, relationship with people on his or her “contact list,” expectations and fears about their own medical condition, and current symptoms. When indicated and desired, subsequent supportive psychotherapy aimed to balance a permissive approach to expression of feelings with pragmatic attention to the particulars of the patients’ external reality. For the patients who were both parents and health care providers, particular attention was given to issues of powerlessness and the conflicting responsibilities of these 2 roles. In some cases, the simple presence of a person with the time and willingness to visit was identified as most valuable, especially for patients with SARS who were “doing well” and thus receiving relatively less nursing contact. Some useful interventions were straightforwardly pragmatic, such as arranging for pizza to be delivered to a house Impact of SARS CMAJ • MAY 13, 2003; 168 (10) 1249 under quarantine, or making a trip to the drug store for hygiene supplies