The Mental Toll of COVID-19 on Healthcare Providers
Mental Health Studies Show the Need for Ongoing Support
By Jennifer Larson, contributor
With the official number of confirmed cases of people in the United States with COVID-19 continuing to climb, so does the need for supportive mental health programs for front line healthcare professionals.
“People need to stand behind and support our healthcare providers and staff during and long after this public health crisis is over,” said Nancy Mimm, DNP, MSN-BC, APHN, assistant professor of nursing at the Harrisburg University of Science and Technology in Pennsylvania.
How the Stress of the Pandemic is Taking its Toll
According to recent polling by the Kaiser Family Foundation, more than half of U.S. adults report that the ongoing COVID-19 pandemic has taken a toll on their mental health. Many of them say they’re worried about job losses, pay cuts, and the virus itself. And the situation seems to be worse for front line healthcare workers and their family members, with nearly two-thirds saying that stress and worry over the coronavirus outbreak have negatively affected their mental health.
To date, just a few studies have documented this trend. For example, a new study in The Lancet documented the strain that working during the COVID-19 crisis took upon physicians and nurses in China. The doctors and nurses expressed a sense of duty toward providing the best possible care for COVID-19 patients, but they also said they felt stressed, physically and emotionally, by the intense demands of the job. The authors recommended comprehensive support for healthcare workers to protect their well-being.
And another study published online for Frontiers in Psychiatryfound a significant rate of insomnia in medical staff during the coronavirus outbreak in China. The insomnia was linked to factors such as fear of getting infected with the virus, working on an isolation unit, and fear over effective infection control.
The people with insomnia were also more likely to show signs of depression, including “notably higher rates” of both moderate and severe cases of depression.
An article in the European Heart Journal: Acute Cardiovascular Care lists some of the stressors facing healthcare workers during the COVID-19 crisis, which include increased workloads, fear of exposure to the virus for themselves and their family, continual changes to protocols, PPE challenges and caring for extremely sick patients – which could include their colleagues. The study authors noted that supporting the mental health of medical staff and affiliated workers under these circumstances is “a critical part of the public health response.”
These types of stressors faced by clinicians working through the COVID-19 pandemic can also have long-term effects, especially if they are not properly addressed, according to Albert Wu, MD, professor of health policy and management and medicine at the Johns Hopkins Bloomberg School of Public Health.
Wu recently told Time Magazine that evidence from the 2003 SARS outbreak suggests that failing to support healthcare workers in a crisis can erode their well-being and resilience, and lead to chronic burnout. These conditions can even lead to post-traumatic stress disorder (PTSD), or exacerbate any preexisting mental health conditions, he explained.
Coping Difficulties and the Need for Ongoing Support
Unfortunately, some healthcare workers may turn to unhealthy behaviors to help them get through the short-term trauma. Or, simply finding it difficult to sleep without the help of sleep aides or pain medications could exacerbate the situation.
“The lack of sleep, decrease in optimal nutrition, and reduction in physical activity and exercise will serve as the precursor for maladaptive coping mechanisms to enter the picture,” said Rodrigo Garcia, APN-BC, MSN, CRNA, MBA, CEO of the Parkdale Center in Chesterton, Indiana, which helps professionals recover from substance abuse.
And it might be hard to break those habits later if the precipitating causes aren’t acknowledged and addressed in the present.
“I have no doubt that these front line providers will need ongoing support in a variety of formats,” said Margaret Below, PhD, RN, NE-BC, who runs The Vital Self, a health and wellness coaching and consulting business. “They will need support to process the initial trauma as well as building resilience to embrace the future.”
Finding Short-term and Long-term Solutions
Solutions to this mental health crisis can take a variety of different forms, from counseling sessions to support groups to self-care. In the short-term, healthcare workers should be encouraged to discuss their feelings and be provided with the resources to manage them, as well as given strategies for reducing their anxiety around issues such as PPE shortages and financial woes, said Garcia.
“In the long-term, reassessment of staff, debriefing and increasing access to mental health services is imperative,” Garcia added.
Choosing the right strategies will require getting the input of the healthcare professionals who are directly affected.
"I think it will take an investment in listening," said Marian Reven, MSN, RN-BC, an adjunct faculty member at Wheeling University and a PhD student at West Virginia University. "We must ask, ‘What have people tried and what's working for them?’"
For example, Reven, who is also a registered aromatherapist, recently conducted a research study that explored the reactions of nurses who used aromatherapy patches to reduce their stress levels on the job. She suggests that aromatherapy could be one strategy to help healthcare professionals feel calmer and less anxious in the wake of COVID-19.
Why Healthcare May Not Want to Return to the Status Quo
Industry leaders are also watching the cumulative effect of the coronavirus crisis on a healthcare workforce that was already struggling with burnout.
In July 2019, The Joint Commission highlighted the problem of nurse burnout, and published a Quick Safety paper on how they can build resilience.
In a recent column for the New England Journal of Medicine, Pamela Hartzband, MD, and Jerome Groopman, MD, pointed out that physician burnout was already a significant crisis before the pandemic, as well. They noted that since the pandemic started, physicians, nurses and other healthcare providers have rallied and responded with great selflessness.
“Indeed, the whole medical system, including hospital administrators and insurers, among others, has rallied to support the caregivers. But will these positive changes be sustained?” they wrote. “Tectonic shifts are at work as hospitals and clinics suffer grave financial losses and the workforce is diminished by illness and exhaustion. As the current crisis ultimately abates, we need to remember the lesson that the system can be reset.”
“It is time to evaluate what has worked and what hasn’t in health care reform. We must not return to the former status quo,” Hartzband and Groopman concluded.
In the meantime, Garcia encourages healthcare workers who are struggling to remember that they are not alone and to ask for help.
“Do not keep silent anymore,” he said. “We are all in this together.”
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