POST 173. June 26, 2021. CORONAVIRUS. “The daily toll of COVID-19, as measured by new cases and the growing number of deaths, overlooks a shadowy set of casualties: the rising risk of mental health problems among health care professionals working on the frontlines of the pandemic.”

for links to POSTS 1-173 in chronological order, highlight and click on

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“High demand for medical services over a long period of time puts particular stress on health care settings and staff…

Many things about COVID-19 are still unknown. Health care workers risk infection to care for patients and residents who have this new disease. It is important to actively listen to, understand, and respond to their concerns, which can include: Working without needed personal protective equipment or safeguards; Witnessing human suffering; Making life and death decisions; Fear of infecting family members. Separation from family; Fear of getting sick; Mental exhaustion.”  (A)

From April 1 to April 28, 2020, the authors conducted a national survey advertised via e-mail lists, social media, and direct e-mail. Participants were self-selecting, U.S.-based volunteers. Scores on the Patient Health Questionnaire–9, General Anxiety Disorder–7, Primary Care Posttraumatic Stress Disorder Screen, and Alcohol Use Disorders Identification Test–C were used. The relationships between personal resilience and risk factors, work culture and stressors and supports, and COVID-19–related events were examined…

Nearly half of the HCWs reported serious psychiatric symptoms, including suicidal ideation, during the COVID-19 pandemic…

A considerable percentage of health care workers (HCWs) reported serious psychiatric symptoms during the COVID-19 pandemic.

Perceived workplace culture, availability of supports, and static and dynamic personal factors contributed to the symptom severity experienced by HCWs.

HCWs often have to respond to demanding and unforeseen medical emergencies, which may be compounded by staff shortages, worry about contracting and spreading the disease, competency concerns when redeployed without adequate training, inadequate and cumbersome personal protective equipment (PPE), and frequent exposure to patients’ suffering and dying. Additionally, quarantine may result in prolonged separation from family and other support systems. Many HCWs feel conflicted between their sense of duty and their willingness to work during a pandemic (5–8), and trying to strike a balance between professional responsibility and altruism and personal fear and anxiety can result in further dissonance and moral distress…

Successful organizations should remember that each HCW is different; psychological and emotional support should be offered from both internal and external providers and from various modalities (e.g., group and individual, education, validation, skills, and process). Help with basic needs, such as ensuring hydration and nourishment while HCWs work, and proactively scheduling breaks in the workday to “reset” can also reduce stress. Organizations should also aim to assist in other aspects of workers’ lives, such as child care, transportation, and providing places to rest (18). In the event of HCW illness or quarantine, staff and their families must feel cared for, and preferential access to care should be considered.

(Health care administrators and HCWs share responsibility to design and implement programs that best support HCWs during crisis events; these interventions should be pragmatic, flexible, and responsive to unique system pressures as modified by individual needs.) (B)

“As the pandemic unfolded, many health-care workers travelled to new places of work to provide patient care in overwhelmed facilities; those who volunteered in unfamiliar clinical areas were often launched into the pandemic ICU setting with insufficient skills and training. The burden of training and supervising these volunteers fell on already stressed clinicians. Hospital-based health professionals worked long hours wearing cumbersome and uncomfortable personal protective equipment (PPE), after initial shortages of PPE had been addressed. They strived to keep up with emerging knowledge, institutional and regional procedures, and changing PPE recommendations, while trying to distinguish accurate information from misinformation. Health-care workers had to adopt new technologies to fulfil patient care and educational responsibilities, including the provision of telemedicine.

Insufficient resources and the absence of specific treatments for COVID-19 added to the challenges of managing severely ill patients. Health-care workers had to care for colleagues who were ill, offer comfort to dying patients who were isolated from their loved ones, and inform and console patients’ family members remotely. Some health-care workers were burdened with emotionally and ethically fraught decisions about resource rationing and withholding resuscitation or ICU admission. They shared the pain of patients without COVID-19 who had their surgery or other essential treatments cancelled or postponed.

The fear of transmitting COVID-19 led many health professionals to isolate from their families for months. Working remotely and being shunned by community members further contributed to loneliness. Many health-care workers experienced lost earnings because of cancellations in outpatient visits and elective procedures. The training of health-care workers (eg, medical students, residents, and allied health learners) was also interrupted, leading to loss of tuition fees, missed learning opportunities, missed exams, and potentially delayed certification. Home health-care workers experienced additional challenges that exacerbated the inequities they face as a marginalised workforce, including limited or no PPE, varying levels of employer support, and the difficult choice of working with its attendant risk or losing wages and benefits…

To effectively support health-care workers—the greatest assets of our health-care systems—we must understand their challenges and needs. Burnout and other forms of work-related psychological distress are unavoidable occupational health issues. By acknowledging the commonality of psychological distress related to caring for patients with COVID-19, we can destigmatise work-related mental health issues and appropriately attend to the mental health needs of all health-care workers affected by the pandemic. Finally, we hope that the COVID-19 pandemic will prompt a redefinition of essential support workers, with recognition of the contribution of all health-care workers and appropriate education, protection, and compensation.” (C)

“The daily toll of COVID-19, as measured by new cases and the growing number of deaths, overlooks a shadowy set of casualties: the rising risk of mental health problems among health care professionals working on the frontlines of the pandemic…

“What health care workers are experiencing is akin to domestic combat… “Although the majority of health care professionals and emergency responders aren’t necessarily going to develop PTSD, they are working under severe duress, day after day, with a lot of unknowns. Some will be susceptible to a host of stress-related mental health consequences. By studying both resilient and pathological trajectories, we can build a scaffold for constructing evidence-based interventions for both individuals and public health systems.”…

“Frontline providers are exhausted, not only from the impact of the pandemic itself, but also in terms of coping day to day,” says Charles C. Benight, Ph.D., co-author of the study and a professor of psychology at the University of Colorado, Colorado Springs. “They’re trying to make sure that their families are safe [and] they’re frustrated over not having the pandemic under control. Those things create the sort of burnout, trauma, and stress that lead to the mental health challenges we’re seeing among these caregivers.”

In particular, the scientists found that health care workers who were exposed to the virus or who were at greater risk of infection because they were immunocompromised had a significantly increased risk of acute traumatic stress, anxiety, and depression. The researchers suggest that identifying these individuals and offering them alternative roles could reduce anxiety, fear, and the sense of helplessness associated with becoming infected.

Alcohol abuse was another area of concern. About 36% of health care workers reported risky alcohol usage. In comparison, estimates suggest that less than 21% of physicians and 23% of emergency responders abuse alcohol in typical circumstances. Caregivers who provided direct patient care or who were in supervisory positions were at greatest risk, according to the researchers. They say offering these workers preventative education and alcohol abuse treatment is vital…

“This pandemic, as horrific as it is, offers us the opportunity to better understand the extraordinary mental stress and strains that health care providers are dealing with right now,”… “With that understanding, perhaps we can develop ways to mitigate these problems and help health care workers and emergency responders better cope with these sorts of challenges in the future.”” (D)

“Use the strategies and resources on this page to manage your own mental well-being while also caring for patients during the pandemic or any other crisis.

1. Feel free to feel your feelings

2. Intentionally employ coping strategies

3. Perform regular check-ins with yourself

4. Take breaks from the news and social media

5. Be fortified by remembering the importance and meaning of your work…

Leadership should strive to maintain critical infrastructure and have other support in place for staff during this time, knowing that this may require modifications to existing strategies, tactics and/or roles. Practices will want to protect, to the degree possible, staff from chronic stress and poor mental health, so that they are able to support patients and because it’s the right thing to do.

1. Adjust staffing procedures and schedules (where possible)

2. Offer access to psychosocial support

3. Monitor and review staff member well-being

4. Create an environment of open communication

Take care of your patients

Mental health and psychosocial considerations should be integrated into all response activities.

1. Establish a system to identify and provide care for mental health conditions

2. Facilitate additional training for frontline staff

3. Verify referral pathways

4. Provide clear understandable communication to patients

5. Incorporate guidance about stress into general care practices

Emotional distress and anxiety are common during pandemics such as the COVID-19 outbreak. It is important to help patients acknowledge that stress exists and help normalize it. Basic strategies can be used to teach them how to recognize signs of distress (such as worry, fear, insomnia, etc.) and when discussing ways to reduce them (e.g., healthy diet, exercise, talking to loved ones, meditation, etc.).16 Additional forms of treatment, such as cognitive behavioral therapy, can also be effective.17” (E)

Prequel

“Forcing employees to return fully on-site is also a risk to diversity, equity and inclusion because underrepresented groups of talent have seen vast improvements in how they work since being allowed more flexibility — and could be lost if flexibility isn’t an option.”

https://doctordidyouwashyourhands.com/2021/06/post-172-june-23-2021-coronavirus-morgan-stanley-chief-executive-james-gorman-said-if-you-can-go-into-a-restaurant-in-new-york-city-you-can-come-into-the-office-remote-work/

for links to POSTS 1-173 in chronological order, highlight and click onhttps://doctordidyouwashyourhands.com/2021/06/coronavirus-tracking-links-to-posts-1-173/

• A.Mental Health and Resiliency Tools for Health Care Workers: COVID-19, https://www.health.state.mn.us/diseases/coronavirus/hcp/mh.html
• B.Health Care Workers’ Mental Health and Quality of Life During COVID-19: Results From a Mid-Pandemic, National Survey, by Kevin P. Young, Ph.D., Diana L. Kolcz, Psy.D., David M. O’Sullivan, Ph.D., Jennifer Ferrand, Psy.D., Jeremy Fried, M.D., Kenneth Robinson, M.D., https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000424
• C.COVID-19: a heavy toll on health-care workers, by Sangeeta Mehta et al. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00068-0/fulltext
• D.MORE THAN HALF OF COVID-19 HEALTHCARE WORKERS AT RISK FOR MENTAL HEALTH PROBLEMS, by Doug Dollemore, https://healthcare.utah.edu/publicaffairs/news/2021/01/covid-mental-health.php
• E.Managing mental health during COVID-19, https://www.ama-assn.org/delivering-care/public-health/managing-mental-health-during-covid-19
• F.An Institutional Model for Health Care Workers’ Mental Health During Covid-19, https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0684
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