Emotional overload: The hidden cost of fighting Covid-19

Published: Feb. 4, 2021 at 6:24 PM EST
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SOUTH BEND, Ind. (WNDU) - With healthcare workers being at the forefront of the pandemic, they’ve seen countless tragic situations, ranging from healthy people growing dangerously ill to patients dying in hospital rooms without loved ones at their side.

Dr. Barb White, PhD, the interim assistant dean at the Indiana University South Bend School of Nursing, said her past students are already taking note of the sheer amount of suffering.

“I talked to one of our grads from four years ago, a week ago, and she said, ‘I feel really sorry for the, the nursing students who are graduating now, because they are seeing more death in six months than I saw in four years,’” recalled White. “And that’s the difference of the pandemic.

The pandemic is taking a psychological toll on healthcare workers at Spectrum Health Lakeland.

“Frontline managers were just really noticing increased tension, increased stress, nurses who usually were able to just go with the daily flows of high volumes, becoming more tearful,” reported Chris Fox, Executive Director of Patient Care Services at Spectrum Health Lakeland in St. Joseph, Mich.

For six different months in 2020, a record number of employees sought counseling services from the Spectrum Health Lakeland Employee Assistance Program - or EAP, including a record number of couples going to couples counseling in the second half of the year.

“Although they wouldn’t tell you that they were there because of COVID, definitely, COVID stress was contributing to their already existing problems and exacerbating kind of the struggles they were already having,” explained Kristen Jones, LCSW, EAP Manager at Spectrum Health Lakeland.

Jones said the most profound statistic came in November 2020, when the most employees ever went to the Lakeland EAP for help.

“And ironically, that was the same time that the hospital was experiencing an influx of COVID patients,” she pointed out.

The December EAP referrals almost matched the numbers from November.

Pandemic survey of healthcare workers

Researchers at the Yale School of Public Health sought to understand the psychological impact the pandemic was having on frontline workers, surveying roughly 1,100 healthcare workers nationwide last May. Results showed 14 percent of workers had probable depression, almost 16 percent experienced generalized anxiety disorder, with 23 percent of respondents having post-traumatic stress disorder, and a staggering 40 percent likely struggled with alcohol-use disorder.

“And I think another thing that was surprising was that what seemed to be driving our participants’ mental health was not just their experiences on the job, but their experiences at home - fear of infecting their loved ones, having to live separately from loved ones, and their experiences in their communities,” explained Dr. Sarah Lowe, PhD, Assistant Professor in the Department of Social and Behavioral Sciences.

Yale MD-PhD student Rachel Hennein, who teamed with Lowe on the study, said she was pleasantly surprised to read about the hopeful experiences the healthcare workers described in the open-ended portion of the survey.

“For example, many of them shared that they were really glad to be spending more time with their kids, because their kids were home from school. They were - they felt really great connecting with their family. Again, they did a lot of like, especially back in May, they’re doing a lot of gardening, a lot of time outside. And those were all very helpful experiences for them. That really helps them deal with the pandemic stressors,” said Hennein.

But healthcare workers reported a wealth of frustration.

“Some of the ones that stuck out to me most were, were kind of the community non-adherence to the public health recommendations of mask wearing and keeping social distance from people.” Hennein explained. “The healthcare workers said that it made them feel unappreciated, and like their sacrifices didn’t matter to anyone.”

Hennein said it wasn’t clear from the study how respondents had developed PTSD, which was gauged based on questions addressing symptoms, although she said many factors likely contributed, including possibly handling cases in which patients without preexisting conditions or young people died from Covid-19.

A clinical psychologist, Lowe said it’s possible for a person to develop PTSD as soon as one month after experiencing a potentially traumatic event.

“So I think it’s very possible that some of the experiences they’ve had already may have triggered PTSD,” she said.

What does PTSD look like?

Dr. Erin Leonard, PhD, a psychotherapist based in Mishawaka, agreed it’s possible healthcare workers already could be experiencing post-traumatic stress because of experiences they have had during the pandemic.

“Absolutely, they could,” she said. “Yes, that’s why it’s really important for health care workers to have a chance to debrief.”

According to Leonard, symptoms of PTSD include chronic sleeplessness, chronic irritability, a tendency to be hypervigilant about one’s surroundings, flashbacks of the traumatic event, avoiding an area where trauma occurred, and substance abuse.

PTSD symptoms can also emerge sporadically.

“Many times after a traumatic event, you know, that person is in shock for a little while. And so they might think that they are okay. But then, you know, months later, or like, the other professional said, you know, a little while later, they might be experiencing symptoms - and they don’t connect it to the original traumatic event because so much time has passed,” Leonard said.

She recommends seeing a counselor as soon as possible following the onset of symptoms or doing what is called “grounding work,” or activities that help to center a person. Still, she believes healthcare coworkers should debrief after difficult situations.

“Because if they don’t, what happens is, you know, they never really get a chance to, to attach that emotion to their experience. And that is actually what allows people to sort of consolidate that memory and store it in their long-term memory, and it then fades,” she said.

Offering extra support

To support frontline workers even more, Spectrum Health Lakeland added the Well-being Task Force. The group has done everything from making employees snack boxes to forming an ambassador team that checks in with coworkers serving in the Covid unit.

“And those team members were, volunteered their time to go to COVID units to talk to their colleagues about how they were doing to check in with their colleagues, and to connect them with resources that frontline workers didn’t have the time to seek out themselves, because they were really just focusing on the job,” said Jones.

Fox says the hospital is engaging more with their chaplains.

“They are coming to daily huddles. They’re rounding frequently with the staff, just trying to get to know them, not only here at work when there’s difficult times, but on days, when it’s just more of an opportunity to talk with them,” she said

Also realizing connecting employees with the EAP wasn’t enough, St. Joseph Health System launched an initiative called Take Care, a program comprised of at least 30 full- or part-time employees known as ‘Resiliency Rounders.’ The Resiliency Rounders check in on their colleagues at the hospitals, especially those working in Covid units.

“We have had quite a few examples where we’ll have a Resiliency Rounder just go in and check on a team and just make small talk, small conversation, let them know what the program is about, and then consistently build that relationship. And then weeks later, have a colleague reach out to them and say, ‘Hey, you mentioned the employee assistance program, I think I’m at that point, you know, I really need to talk to someone,’” explained Aubree Schenkel, Organizational Effectiveness Consultant at St. Joseph Health System.

SJHS is receiving corporate support to bolster the mental health of employees, with Lippert Components funding a full-time position within the Take Care program and Macy’s providing a grant for the creation of respite rooms, or quiet spaces, where employees can relax and center themselves.

“We’re ideally looking at, you know, aromatherapy and music and just things like that, to just give them a moment to be away from, you know, the quote, unquote, chaos of what’s going on in the day. And again, really even utilize it if they want to just get grounded before they go home,” Schenkel said.

Both the Mishawaka and Plymouth hospitals and the downtown South Bend Pavilion building will have a respite room.

Building resiliency

“Our patients have always been needy. And the work that we do takes a lot of personal investment. It takes emotional, spiritual, psychological, and physical investment to be a good nurse. And so, resilience has always been important,” said Dr. White.

Indiana University South Bend School of Nursing educators say the same resiliency tips and coping mechanisms that they taught before the pandemic have remained the same during the pandemic. Those include living healthy lifestyles, getting adequate sleep, and relying on social relationships to refresh for the next work day. Conversations, though, have covered post-traumatic stress disorder.

“And in particular, right now, we’ve changed our conversation to talk, particularly about making sure that they that they practice these resilience techniques, and we check on them much more than we did before,” said White.

The IU-South Bend nursing school never closed during the pandemic, allowing students doing clinicals to witness the massive transitions in local hospitals.

“And we did that specifically because we can’t teach people who are going to be nurses to run out, because we don’t run out. Nurses run in,” White said.

White’s colleague, Dr. Tina Hostetler, DNP, said healthcare workers, while they have a calling to care for others, don’t always like to take a pause for themselves.

“They’re also the ones that are last to say, ‘I need help.’ They try to have a brave face and not show anybody that they’re in trouble,” said Hostetler.

That’s why she also emphasizes healthcare workers to be their own advocates.

“From a mental health perspective, taking care of themselves has got to be key,” said Hostetler, who spent a bulk of her career working with psychiatric patients. “And number one, have to know your limits where, when you feel like you’re burnt out, when you need to take a break. And then counseling when you need it.”

If you or someone you know is contemplating suicide, you can reach out to the National Suicide Prevention Lifeline. It provides free, 24-hour support. The number is 1-800-273-TALK. You can also visit the website.

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