STRATEGIES FOR REDUCING MENTAL HEALTH IMPACTS ON HEALTHCARE WORKERS

Healthcare workers include any and all who work in healthcare services. Besides physicians and nurses, this includes first responders, housekeeping personnel, clerical personnel, lab technicians, respiratory therapists, occupational therapists, physical therapists, pharmacists, community-based workers, those who work in mortuaries, among many others.

The mental and psychological well-being of healthcare workers is imperative to their ability to function effectively, particularly when exposed to extreme conditions. Such exposure could result in negative mental health consequences, which may in turn affect the functioning and productivity of entire healthcare organizations. Keeping all healthcare workers from chronic stress and poor mental health means that they will have a better capacity to fulfill their roles. This can be quite difficult to accomplish during a pandemic. Following are some strategies that can be applied to help reach this goal.

Supporting Coworkers

During a crisis situation such as a pandemic, it is necessary for coworkers to care for each other to ensure everyone’s physical and mental safety and to provide safe patient care. It can be helpful to partner with another for support and to monitor one another’s stress levels and safety. During the work shift, partners can set up times to check in and to listen carefully while sharing experiences and feelings. Partners can offer each other help, monitor their workloads, and encourage breaks. It is helpful to share opportunities for stress relief using deep breathing and other relaxation techniques.

When a coworker exhibits exhaustion, irritability, inability to concentrate or remember important things, or begins making errors, displays lack of confidence, and withdraws from contact, it is also necessary to communicate these concerns to management.

WORKING IN “PODS”

In order to best utilize available personnel, healthcare workers can be organized into “pods” consisting of a group of individuals skilled at different levels who work together throughout a shift. For example, when caring for a COVID-19 patient in the ICU or on a ventilator, such a pod may include a skilled ICU nurse to care for those specialized needs, a nurse without ICU experience to provide skilled nursing care, a respiratory therapist to manage respiratory care, and nursing assistants to provide other basic skills.

Self-Care Strategies

During the increased stress of a pandemic, it is vitally important for healthcare workers to be active in taking good care of themselves. The following are recommendations to help reduce stress levels among frontline workers:

Schedule and take brief breaks to care for basic needs.
Schedule and take brief relaxation breaks at work. A few minutes of a break during a shift can be calming. Even a 5-minute walk can improve energy and focus.
Take time each day to do something that brings joy, even if just for a brief moment.
Maintain a healthy diet; bring your own meals to work.
Keep your schedule of daily activities as regular as possible.
Get some sunlight.
Try chair yoga or stretching at work.
Get regular exercise, such as walking or biking to work.
Avoid or limit the use of alcohol and caffeine.
Monitor yourself for excessive fatigue, irritability, poor focus, or anxiety.
Pace yourself.
Take a moment for a slow breath before entering a work area, entering a patient room, or clocking out. This can be difficult while wearing personal protective equipment like a mask, but breathing is calming and helps the body cope with physical symptoms of stress.
If you regularly see a mental health professional, video visits or a phone call may be a good idea.
If you do not regularly see a mental health professional but feel doing so could be helpful at this time, many mental health providers are offering free sessions for healthcare workers.
If a spiritual practice is important to you or has been in the past, work it into your regular routine.
(NCCN, 2021)

Pandemic-Related Training

Formal and informal training during a pandemic can prepare healthcare workers to face the stressors involved in working under such conditions. Such training can include:

Specific and accurate information about transmission of the infectious agent and methods of containment
When and how to screen patients and, potentially, family members
When to appeal for quarantine and isolation
Ethical decision-making about triage and surge capacity issues

In order to increase the sense of confidence in one’s work-related performance, workers can also take part in training and/or planning exercises such as:

Management of limited resources
Implementation of various levels of quarantine
Enforcement of movement restrictions
How to handle mass fatalities
How to conduct mental health screening
How to cope with high stress demands
Ways to prepare for family needs when required to be more involved at work or when in quarantine
Ways to provide psychosocial support to colleagues
(VA, 2022)

Management Strategies to Support Staff

Team leaders or managers in a health facility also face similar stressors and additional pressures due to the level of responsibility inherent in their roles. It is important that stress-relief provisions are in place for both workers and managers, and that managers serve as role models for strategies to mitigate stress. The following measures can be taken by management to help reduce the impact of stress on healthcare frontline staff:

Ensure a clear system for coordination and communication with frontline workers to keep them apprised of the current recommendations for patient care and personal protection.
Establish policies regarding work hours, duration of deployment, shift rotation, and rest periods, rotating workers from higher-stress to lower-stress functions.
Train all frontline workers, including nonhealthcare workers in quarantine sites, in essential psychosocial care principles, psychological first aid, and how to make referrals when needed. Online training can be used if it is not possible to bring staff together due to infection risks.
Partner inexperienced workers with more experienced colleagues, and ensure that outreach personnel enter the community in pairs. A buddy system can help provide support, monitor stress, and reinforce safety procedures.
Develop stress-management protocols for frontline medical personnel and ensure that time is built in for colleagues to provide social support to one another.
Create psychological supports for healthcare workers, including hotlines and access to trained mental health professionals.
Once the pandemic begins to recede, actively monitor, support, and (where necessary) provide all staff with evidence-based treatments.
Once the pandemic is over, allot debriefing time to reflect on and learn from the difficult experiences to create a meaningful rather than traumatic narrative.
(Sadeghi & Wen, 2020; IASC, 2020; Greenberg et al., 2020)

CASE

Ginger is a 40-year-old registered nurse who is divorced and lives with her two young children and her elderly mother. Ginger has a history of treatment for anxiety and depression in the past and has been doing well for quite some time. She is a fairly recent nursing graduate and works in a large hospital in a major metropolitan area. There is a global pandemic occurring, and Ginger has been working 12-hour shifts for the past 12 days in a row. The hospital has no more beds available for the large influx of patients needing care, and PPE is being severely rationed.

As Ginger tends to her duties, she finds herself feeling more and more isolated from her coworkers, since they are all very busy. She becomes extremely fearful of making an error, becoming infected herself, and “killing my mom.” As the days pass, Ginger is no longer sleeping well, has lost her appetite, and has difficulty staying focused. She now feels irritable, hopeless, and fatigued, and she begins to severely doubt her abilities as a nurse.

Elizabeth is a coworker who has been covering the same unit and shift along with Ginger. While she, too, is under a great deal of stress, she has begun to notice that Ginger is not doing well. She approaches Ginger in the hallway and asks her how she is coping. When Ginger begins to cry, they go to the breakroom, where Elizabeth encourages her to talk about how she is feeling and asks her what she can do to help her.

Ginger tells Elizabeth she does not think she can continue to come to work anymore. Ginger explains that there are so many ill patients and that they are scared. They cannot see their families, and she wants to help them cope with the isolation and fear. Elizabeth reassures Ginger that she is doing a good job and that she will be there to help her when needed. After their discussion, Elizabeth talks to her supervisor, who approaches Ginger, talks with her, and promptly refers her to employee assistance for mental health management.

Discussion

Ginger provides an example of how someone with preexisting mental health issues can quickly succumb to stress and become symptomatic once again. Her situation might have been improved if she had been assigned to work in a team along with a more experienced nurse. Together they could have supported each other, monitored each other’s stress level and safety, and perhaps avoided the present situation. When a coworker, Elizabeth, does recognize Ginger’s signs of inability to continue to cope with stress, she immediately intervenes to assess her status and to refer her so that she can receive mental health support.