Quick Safety Issue 54: Promoting psychosocial well-being of health care staff during crisis

June 03, 2020

Issue:

A health care organization’s ability to respond to the stresses and strains of providing adequate patient care during a crisis — such as the COVID-19 pandemic — is reliant on its workers’ psychosocial well-being. The anxiety, stress, fear and associated feelings experienced by health care workers during challenging times are real, justifiable, and do not indicate weakness or incompetence. To mitigate and respond to the psychological toll of crises such as the COVID-19 pandemic, it is critical that health care organizations have systems in place that support institutional and individual resilience.

The predominant stressors reported by health care workers during the COVID-19 crisis were insufficient resources and lack of personal protective equipment (PPE); fears of infection; feelings of isolation from family; and harassment from the community for enforcing strict protective measures to reduce the spread of the virus.

Other conditions or reactions related to increased health care worker stress were:

Physical isolation from loved ones and colleagues.
Anger, anxiety and fear from lack of PPE.
Burnout, feeling overwhelmed, a sense of helplessness and loss of normalcy.
Moral distress from experiencing conditions incongruent with normal professional and ethical responsibility.
Fear of infection and transmission to loved ones.
Fatigue from longer shifts and altered sleep patterns.
Pressure to maintain up-to-date knowledge and track fluctuating policies and procedures.
Physical strain and injury from prolonged use of PPE.
Physical exhaustion, dehydration, eating unhealthy foods or eating at irregular times.
Secondary traumatic stress or symptoms resulting from exposure to another’s trauma.
Grief from witnessing death and suffering of patients and colleagues.
Reduction in force from staff falling ill, layoffs and furloughs.
Closure of services and financial strains on the organization.
Risk of blame, harm or harassment from the community.
Bombardment from continuous news and social media coverage of the COVID-19 pandemic.

Removing barriers to seeking mental health care

Adding to these stressors on the health care worker is the perception that seeing a mental health professional could adversely affect their career if they are asked about a previous history of mental health issues during the credentialing or licensing process. As a result of the strain put on the health care workforce during the COVID-19 pandemic, on May 12, 2020, The Joint Commission issued a statement affirming its support for the removal of any barriers that inhibit clinicians and health care staff from accessing mental health care services, including eliminating policies that reinforce stigma and fear about the professional consequences of seeking mental health treatment. The statement confirms that The Joint Commission does not require organizations to ask about a clinician’s history of mental health conditions or treatment, and supports the recommendations of the Federation of State Medical Boards and the American Medical Association to limit inquiries to conditions that currently impair the clinicians’ ability to perform their job.

Safety actions to consider:

All team members in health care organizations are impacted to some degree by a crisis like the COVID-19 pandemic. It is critical that health care organizations support all staff through proactive planning and providing systems and infrastructure to support psychosocial well-being and stress management before, during and after a crisis. While the impact on doctors and nurses on the front lines is clear, the impact on other team members is often overlooked. These members include environmental and food service workers, imaging techs, respiratory therapists, pharmacists, physical and occupational therapists, security personnel, social workers, and chaplains, among others.

Below are strategies that health care workers and leaders can take to promote psychosocial well-being, manage stress, and strengthen individual and institutional resilience during times of crisis and recovery. As needs may vary among individuals, respect differences in yourself and colleagues.

Health care worker: Strategies to support oneself

Practice self-care and engage in healthy coping strategies. Eat healthy foods and exercise regularly. Employ stress-management strategies — spiritual, physical, mental or emotional — that have worked for you in the past.
Take microbreaks. Take short periods of respite and relaxation from patient care to recharge the body and mind.
Practice sleep hygiene. Strive for at least seven hours of sleep to counteract fatigue.
Partner with colleagues. Engage in a buddy system at work to cross-monitor well-being and provide support when needed.
Stay connected. Stay in regular contact (while practicing social distancing) with friends and family to mitigate isolation.
Stay informed of reliable information. Seek up-to-date information from reliable sources. Inaccurate information can increase stress and worry.
Check in with yourself. Self-monitor for increased and prolonged symptoms of depression, stress or hopelessness and seek professional support, if needed.
Resilience in post-crisis recovery. Continue to employ strategies to support each other during recovery and include debriefing sessions unit by unit to facilitate conversation regarding lessons learned and improvement opportunities for crisis management. Individually, staff should remain mindful of how they are feeling, continue to engage strategies for managing stress, and nurture community among peers toward effective reintegration.

Managers and leaders: Strategies to support your staff

Resources:

Other resources:

The Joint Commission: Coronavirus (COVID-19) Resource webpage provides information to support health care organizations and professionals on the frontlines of the COVID-19 pandemic.

Hospital Peer-To-Peer Support: Resilience in Stressful Events (RISE) is a confidential peer support program developed by Johns Hopkins Medicine that provides psychological first aid and emotional support to health care workers who have experienced stressful clinical situations.

forYOU: This program is led by Sue Scott at the University of Missouri Health and is oriented toward caring for caregivers, providing peer support and resources for the second victim.

First Responders First: Sustaining Yourself During the Coronavirus Crisis tip sheet provides information on microsteps health care professionals can take for self-care and to manage stress and mental well-being.

Centers for Disease Control and Prevention: Secondary traumatic stress management strategies can be found on the CDC’s Coronavirus Disease 2019 (COVID-19) resources for Stress and Coping.

Psychological First Aid: Guide for Field Workers: Provides information on social and psychological aid strategies in response to crisis.

The Joint Commission: Workplace Violence Prevention Portal provides resources for health care organizations to support staff facing aggression or violence in the workplace.
Note: This is not an all-inclusive list.

Disclaimer notice: As a matter of policy, The Joint Commission and its affiliates do not endorse third party products or services. Readers should not infer that any specific products or services named in these resources are superior to those of other comparable companies.

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