Responding to a call to action, healthcare professionals have quickly become our frontline defense against COVID-19. But at what cost to their psychological well being?
It’s easy to see the physical risk providers take during this pandemic. Yet, many hide emotional and mental trauma caused by Coronavirus.
Now, more than ever, is the time to de-stigmatize the topic of mental health in medical providers.
At times, we’re able to feel sympathy and empathy for strangers. Our heart aches when watching the news, scrolling through social media, or talking to a friend. Medical staff are no different, and the nature of their job puts them at added risk.
Psychological distress is a baseline term for trauma that causes anxiety or depression. Many, more specific conditions fall under this umbrella². For medical staff, the most common include anxiety, PTSD, STS (secondary traumatic stress), vicarious traumatization, compassion fatigue, and dissonance.
Secondary traumatic stress (STS) is indirect. STS causes providers to feel trauma from their patients’ experiences². When medical staff feel sympathy, they can also feel vicarious traumatization. This harms their sleep and increases feelings of anxiety and fatigue¹.
Imagine a line of dominos. Only one needs to fall for the entire structure to collapse. Providers’ mental health is similar. Distress harms their other psychological pillars.
After years in the field, many healthcare workers feel under-appreciated, tired, and unaccomplished². Such personal exhaustion can also lead to compassion fatigue. With this, providers can’t feel empathy or compassion towards their patients³.
Amidst tidal waves of change, it’s easy to forget that staying at home right now is a privilege. It’s also one medical professionals don’t have.
Without known treatment, vaccines, and reliable PPE, COVID-19 has increased provider distress. The virus also blurs professional and personal lines. Most frontline workers feel constant fear of infecting their loved ones.
A recent study found 70% of Chinese providers have signs of psychological distress. Additionally, 50% of Italian providers have reported PTSD-like symptoms because of COVID-19⁵. Trauma disturbs sleep and social activity. It also causes feelings of hopelessness, anxiety, and depression⁶. The reach of COVID-19 expands further than providers on the frontline.
Non frontline nurses work in medical facilities/departments, but don’t treat COVID patients¹. Recent studies show non frontline nurses are more psychologically impacted than frontline ones. Researchers believe this is because they have less experience with emergent scenarios. Non frontline nurses also feel fear and sympathy for their frontline colleagues.
Yet, despite the added risk, healthcare providers have and continue to show up. So how have they continued to persevere on the frontlines?
The answer is simple: resilience.
Fall down seven times, get up eight. This simple analogy encompasses resilience, or the ability for an individual to rebound from difficult experiences¹⁵.Now, it is a resilient spirit that gives many providers the strength to continue.
A pillar of resilience amongst medical providers is solidarity. Sharing identity and passion, medical colleagues remind each other they are not alone⁸.
The most resilient are those who are adaptive, positive, supported, humorous, and confident⁹. Providers are also resilient by learning from hardship. Often, they chose medicine because of adversity and early childhood experiences⁸.
Now, medical staff say their greatest motivation to work is out of moral responsibility for patients⁴.
It’s okay not to be okay, even as medical providers. Often, medical staff are afraid to seek outside help because they feel embarrassed. Some are afraid of showing ‘weakness’ in front of colleagues⁸.
Luckily, the brain is incredibly adaptive. Think, for a moment, of a car GPS. Unexpected road closures and accidents happen. But a GPS finds new routes to reach the desired destination. Like a navigation system, the brain is able to recreate neural networks. This flexibility is synaptic plasticity.
Because the brain is flexible, practice techniques increase resilience.
Mindfulness is when an individual focuses solely on the present². Practice increases flexibility and emotional control. This powerful tool also increases resilience in healthcare employees. The Connor Davidson Resilience Scale measures mindfulness through “toughness, strength, and optimism⁷”. Studies show that medical professionals’ strength lies in their optimism. They have confidence in their solutions and care.
Like mindfulness, providers can also practice cognitive reframing. This is when an individual envisions many scenarios and outcomes of a situation⁹. Other integrative practices include journaling, art therapy, working out, and yoga/meditation³.
To stay mentally strong, medical staff also need to be a friend to themselves. “Self-compassion” involves granting yourself the gift of acceptance and self love. Providers who practice self compassion are often the most resilient¹⁰.
During COVID-19, hospitals should play on their providers’ strengths.
Health care professionals are naturally resilient because they have clear individuality and goals⁸. To remind staff of this strong identity, institutions have developed COVID-19 support programs. Studies also show in depth training on COVID-19 and its transmission reduces distress⁴.
Medical staff face increased risk for psychological distress. But, the strong nature of providers lies in their passion and calling to help others. Many COVID-19 theories remain unknown. Yet, the epidemic has proven that resilience is essential.
Endnotes
Li, Z., Ge, J., Yang, M., Feng, J., Qiao, M., Jiang, R., Bi, J., Zhan, G., Xu, X., Wang, L., Zhou, Q., Zhou, C., Pan, Y., Liu, S., Zhang, H., Yang, J., Zhu, B., Hu, Y., Hashimoto, K., Jia, Y., … Yang, C. (2020). Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain, behavior, and immunity, S0889–1591(20)30309–3. Advance online publication. https://doi.org/10.1016/j.bbi.2020.03.007
Harker, R., Pidgeon, A. M., Klaassen, F., & King, S. (2016). Exploring resilience and mindfulness as preventative factors for psychological distress burnout and secondary traumatic stress among human service professionals. Work (Reading, Mass.), 54(3), 631–637. https://doi.org/10.3233/WOR-162311
McGarry, S., Girdler, S., McDonald, A., Valentine, J., Lee, S. L., Blair, E., Wood, F., & Elliott, C. (2013). Paediatric health-care professionals: relationships between psychological distress, resilience and coping skills. Journal of paediatrics and child health, 49(9), 725–732. https://doi.org/10.1111/jpc.12260
Cai, H., Tu, B., Ma, J., Chen, L., Fu, L., Jiang, Y., & Zhuang, Q. (2020). Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID‑19) in Hubei, China. Medical science monitor : international medical journal of experimental and clinical research, 26, e924171. https://doi.org/10.12659/MSM.924171
Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976
Abrams, Z. (2020, June 1). As COVID-19 cases increase, so does trauma among health providers.http://www.apa.org/topics/covid-19/trauma-health-providers
Huang, L., Wang, Y., Liu, J., Ye, P., Cheng, B., Xu, H., Qu, H., & Ning, G. (2020). Factors Associated with Resilience Among Medical Staff in Radiology Departments During The Outbreak of 2019 Novel Coronavirus Disease (COVID-19): A Cross-Sectional Study. Medical science monitor : international medical journal of experimental and clinical research, 26, e925669. https://doi.org/10.12659/MSM.925669
Winkel, A. F., Honart, A. W., Robinson, A., Jones, A. A., & Squires, A. (2018). Thriving in scrubs: a qualitative study of resident resilience. Reproductive health, 15(1), 53. https://doi.org/10.1186/s12978-018-0489-4
Hart, P. L., Brannan, J. D., & De Chesnay, M. (2014). Resilience in nurses: an integrative review. Journal of nursing management, 22(6), 720–734. https://doi.org/10.1111/j.1365-2834.2012.01485.x
Shattell, M., & Johnson, A. (2018). Mindful Self-Compassion: How it Can Enhance Resilience. Journal of psychosocial nursing and mental health services, 56(1), 15–17. https://doi.org/10.3928/02793695-20171219-01
Lavelle C. (2017). Mindfulness in Residency: Making a Case for More Research. Academic medicine : journal of the Association of American Medical Colleges, 92(7), 902. https://doi.org/10.1097/ACM.0000000000001755
Thompson, G., Wrath, A., Trinder, K., & Adams, G. C. (2018). The roles of attachment and resilience in perceived stress in medical students. Canadian medical education journal, 9(4), e69–e77.
Tan, B. Y., Chew, N. W., Lee, G. K., Jing, M., Goh, Y., Yeo, L. L., . . . Sharma, V. K. (2020). Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Annals of Internal Medicine. doi:10.7326/m20–1083
Ingate, R., Jose, Brenda?, Armstrong, J., Koehler, J., Galaska, J., . . . LCSW, F. (2020, March 27). Strengthening Resilience in the Brain. Retrieved June 26, 2020, from https://www.nicabm.com/brain-science54750/
Reid R. (2016). Psychological Resilience. The Medico-legal journal, 84(4), 172–184. https://doi.org/10.1177/0025817216638781
Comments