Workplace Strategies
During Covid19, healthcare workers have faced unprecedented challenges that are complex and ongoing. Beyond exhaustion and burnout, these experiences have led to fear, anxiety, frustration, moral distress, depression and other forms of emotional distress and psychological injury. Healthcare workers are leaving healthcare, seeking more psychological help and having more first time psychiatric admissions. Discovering ways for our healthcare facilities to support their healthcare workers and increase resiliency during this time is imperative.
Healthcare facilities can help their workers by checking in with them during these difficult times, making sure workers know how to stay informed, fostering health and resilience by encouraging healthcare workers to rest, eat healthy, exercise and also by providing support systems for their workers. Some strategies might include group meetings to discuss concerns that healthcare workers have or to discuss topics such as mindfulness or other strategies to acknowledge and address stress constructively.
From the Joint Commission: Promoting psychosocial well-being of health care staff during crisis
From Annals of Internal Medicine: COVID19: Peer Support and Crisis Communication Strategies to Promote Institutional Resilience. https://www.acpjournals.org/doi/10.7326/M20-1236
Checking in with healthcare staff to see how they are coping during this time is an important way to understand how staff are doing and offers time to normalize feelings and address concerns that staff may have. Some methods of self reporting include:
By Wocial LD and Weaver MT, Development and psychometric testing of a new tool for detecting moral distress: the Moral Distress Thermometer.
The self-score measure the Professional Quality of Life (PROQOL) Scale.
Burnout is a state of emotional, mental, and physical exhaustion brought on by prolonged or repeated stress in a work environment. This can lead to reduced productivity, withdrawing from responsibilities and mistakes along with mental health consequences.
Peer programs have emerged as a structure for healthcare workers to process and work through stressful experiences. Peer groups provide trained personnel who understand the unique stresses of the job as they themselves work in the area. Peer responders are trained to listen and provide first aid to their colleagues. Additionally, they are taught to recognize more serious mental health problems and to quickly refer to professional psychiatric help, when needed. Healthcare workers are assured confidentiality and a safe place to discuss concerns with peer responders.
The Colorado Physician Health Program (CPHP) is available throughout Colorado for licensed physicians, physician assistants, anesthesiology assistants and trainees of these licensees (medical/PA students and residents). CPHP provides peer health assistance, with the strictest confidentiality as required by law. Peer health assistance aids medical licensees with emotional, psychological or medical problems by providing support and care from trained peers. During COVID-19, the program has implemented the COVID-19 Care Line for Physicians (Care Line) at (720) 810-9131 where physicians can call and access a supportive colleague to share their struggles. Calls to the Care Line are free of charge, can be available after hours and are also completely confidential. CPHP believes that even during this pandemic that early intervention offers the best opportunity for a successful outcome and for preventing healthcare workers’ struggles from needlessly interfering with medical practice.
The Maryland Patient Safety Center is proud to deliver the Caring for the Caregiver: Implementing RISE (Resilience In Stressful Events) program, which has been designed to help healthcare organizations provide immediate, confidential psychological first aid and emotional support to “second victims” by utilizing trained volunteer Peer Responders. Caring for the Caregiver is in collaboration with the Johns Hopkins RISE Team and supported in part by the Josie King Foundation. The Maryland Patient Safety Center is currently offering a free guide for implementing a RISE program during COVID19.
Buddy systems have also been utilized, traditionally for first responders and in the military, to allow colleagues to become “buddies” who check in with each other on a frequent and scheduled fashion. The goal is to learn about the other person and to discuss stressors or traumatic events, encourage healthy habits and again, to be able to recognize more serious mental health problems and quickly refer to professional psychiatric help, if needed.
The buddy system from the Department of Health and Human Services, the Center for Disease Control and Prevention and National Institute of Occupational Safety and Health: Read more about the buddy system
Employee Assistance Programs (EAPs) are work based programs offered by many healthcare facilities and provide confidential assessments and free short term counseling from licensed professionals. Alcohol and substance use, stress, grief, family problems and psychological issues are some of the concerns that are addressed. For organizations with EAPs, ensure this is well advertised for your employees. For healthcare workers, ask at your institution to see if there is an EAP and what is covered.
Spiritual care providers (chaplains) are available in many health institutions to listen to the spiritual or existential distress that you may be experiencing. Existential distress may occur at times when there is an event, or accumulation of events, that make one stop and ask “w=What does it all mean?” ; “who am I in the midst of this?”; or “How do I make sense of this new reality?”. Often, they are interfaith and open to all spiritual orientations. They are trained members of the healthcare team and are a safe third party (other than their Rabbi, pastor or priest) to explore the spiritual or religious questions people may be uncomfortable sharing.
SDI – The home of Spiritual Companionship: Spiritual Directors
Grief and Loss
As a state and nation, we have collectively encountered a magnitude of loss that most of us never anticipated in our lifetimes. The grief surrounding these losses can at times, feel overwhelming. As healthcare workers, we may have supported individuals during their last moments of life, lost coworkers, or even faced the death of our own family members. We witnessed traumatic situations that will forever change our lives. While our professional peers may relate to these losses, individuals with whom we choose to surround ourselves outside of work have a hard time understanding the intensity of our grief. This type of grief, often called disenfranchised grief, emerges when an individual experiences a significant loss that is “not openly acknowledged, socially validated, or publicly mourned” (Doka, 2008). Thus, many healthcare workers may find themselves feeling isolated in their grief, with limited social recognition, support, or permission to claim their feelings. Disenfranchised grief can blanket us unlike other types of grief and leave us feeling in a state of shock, drained, and even unable to muster the emotional and physical energy to perform activities that once brought great meaning to our lives.
One of the first steps in understanding our disenfranchised grief is to find others that can acknowledge the enormity of our losses or who may have also experienced similar losses. Through sharing our losses and encounters with traumatic situations, we can begin to recognize the weight that they place on our bodies, minds, and hearts. Others may find emotional respite through talking with counselors or embracing mindfulness or relaxation activities. We have provided a list of many different types of resources in our resiliency exercises section of this website.
Doka, K. J. (2008). Disenfranchised grief in historical and cultural perspective. In M. S. Stroebe, R. O. Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (p. 223–240). American Psychological Association. https://doi.org/10.1037/14498-011
Grief education, resourcing and support for the Denver Metro Area: https://www.heartlightcenter.org/
From the CDC: Grief and Loss
Comprehensive solutions for employers to work through the loss of an employee: www.griefintheworkplace.com