Staff Self-Care in the Context of COVID

Many disciplines contribute to the delivery of our Health Services, from primary care to acute hospital care. These include medicine, nursing, health and social care professions and pharmacy.

As a hospital psychologist, I’m acutely aware of the additional ancillary disciplines, such as administrators, cleaners, caterers, porters, IT-experts, and security-personnel that also make invaluable contributions to the effective running of the health service.

Each profession has its own challenges, and rewards, and all of them have been impacted by COVID-19.

In this Blog, I aim to speak to three things: the general well-being of healthcare staff, added stress due to COVID-19 and how we might cope with these demands.

How ‘well’ are we, anyway?

Most of the available data is limited to the well-being of doctors and nurses (not all healthcare disciplines), from other jurisdictions (not Ireland specifically). I’m part of a research group looking to change that.

Nevertheless, the data signals some stark warnings. Doctors and nurses are at higher risk of developing mental health problems, relative to the general population1,2. They are also at an increased risk of developing ‘burnout symptoms’1,3, and are more susceptible to sickness-related work-absences, particularly if working in public sector roles, large organizations, or being in a more junior role4.

Most alarmingly, they’re also at increased risk of suicide, which must say something about the demands of working in healthcare. These issues signal a need to increase support for healthcare workers, and remedy any ‘systemic’ issues that may be contributing.

Is COVID-19 adding additional stress?

Past pandemics have taught us that healthcare staff experience increased distress. What differentiates COVID-19 from other pandemics is its scale and the risk of the ‘system’ becoming overwhelmed.

It has led to unprecedented societal measures, such as lockdown, and public health measures, which have become ‘normal’. Bearing in mind that 30% of all Irish infections have been healthcare workers, we are one of the most affected groups.

Whilst we’ve all been affected to some extent, it’s clear that select subgroups of the health-force have experienced increased levels of anxiety, depressed mood and trauma.

More specifically, approximately 10-15% of healthcare workers report clinically significant distress, particularly those exposed to the frontline, and those at the earlier stages of their careers5.

However, one very interesting study is at pains to point out that baseline rates of poor mental-health are already very high within these healthcare worker cohorts and COVID-19 is only likely to be adding marginally to this6. Food for thought.

How can we cope?

Healthcare workers are capable, resilient, caring individuals with an ability to adapt to challenging environments. It’s possible you are already coping well. What follows is intended to remind us what’s recommended at times of crisis, viral pandemics included.

At an individual level, the aim is to stabilise and mitigate acute distress. One recommendation is to be attuned to your own emotional thermometer and responsive to it when it becomes at risk of getting ‘overheated’, so to speak. Practice relaxation. If you need to, seek the support of someone who’ll listen. Remember, not all problems need to be fixed, some just need to be heard and understood.

One of the most frequently offered pieces of advice by my colleagues was to ‘control the controllables’ and also to ‘switch off’ after one’s shift was completed. Having outside interests is invaluable in this regard.

One practical piece of advice is to remain informed but limit the extent to which you’re attending to news, which generally has a negative slant. If people are working on teams, regular ‘debrief’ sessions are considered helpful, where the focus is on communal support, not forced disclosure.

Some teams also introduced ‘buddy systems’, especially for junior colleagues.  

With word limits against me, I’d finally suggest that framing one’s efforts in a meaningful way is another helpful psychological tactic. Sometimes it’s through adversity and sacrifice that we achieve something greatly significant. This is one of those times.

For those with an interest in additional resources, I’ve provided a couple of useful links below:

www.beatcovid.co.uk

https://www.psychologicalsociety.ie/footer/COVID19-Resources).

References

  1. Shanafelt TD, Dyrbye LN, West CP. Addressing physician burnout: the way forward.  JAMA 2017;317:901-2
  2. Schernhammer ES, & Colditz GA. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). The American Journal of Psychiatry.(2004) Dec;161(12):2295-302. https://doi.org/10.1176/appi.ajp.161.12.2295
  3. Ribeiro VF, Filho CF, Valenti VE, Ferreira M et al. Prevalence of burnout syndrome in clinical nurses at a hospital of excellence. Int Arch Med. 2014; 7-22.
  4. Leaker D, & Nigg W. Sickness absence in the UK labour market: Sickness absence rates of workers in the UK labour market, including number of days lost and reasons for absence. Office for National Statistics. (2018). Available online (June 4th 2020): https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2018
  5. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open. 2020 Mar 2;3(3):e203976-.
  6. Bell & Wade. Live meta-analysis: Mental Health of Clinical Staff Working in High Exposure Compared to Low Exposure Roles in High-Risk Epidemic and Pandemic Health Emergencies (last updated 2020.05.27). Online open software meta-analysis. Accessed 4.6.20 https://osf.io/knhs3/.

This Blog was written by Dr Damien Lowry, Chartered Member of the Psychological Society of Ireland and Senior Counselling Psychologist in the Mater Misericordiae University Hospital’s Psychology Department.

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