Self-Care Strategies for Allied Health Clinicians’ Mental Health
As the COVID-19 pandemic continues, causing severe illness and stressful work environments in healthcare facilities across the country, there is a profound concern for allied clinicians' mental health.
In October 2020, the National Institutes of Health published an article that reviewed 11 key studies addressing healthcare workers' psychological well-being during the pandemic. Their findings were troubling:
- Anxiety was prevalent in 24.1 to 67.6 percent of healthcare workers;
- Depression was reported by 12.1 to 55.9 percent; and
- Stress was prevalent in 29.8 to 63.0 percent of healthcare workers.
Some groups also appeared to be more affected: “Nurses, female workers, front-line healthcare workers, younger medical staff, and workers in areas with higher infection rates reported more severe degrees of all psychological symptoms than other healthcare workers," said the study authors. "Moreover, vicarious traumatization in non-front-line nurses and the general public was higher than that of the front-line nurses."
Addressing Mental Health and Self-care Issues
To learn more about self-care strategies that can help healthcare professionals, AMN reached out to Susan H. McDaniel, PhD, ABPP, vice-chair, Department of Family Medicine at the University of Rochester Medical Center in Rochester, New York.
The University of Rochester Medicine has a well-developed physician communication coaching program. It's comprised of trained faculty coaches who support improved patient-centered care and patient satisfaction and work to improve health professionals' satisfaction and well-being. McDaniel noted that disruptive or inadequate communication can be a sign of burnout or mental health concerns.
Two of McDaniel's communication coaching colleagues — Lauren DeCaporale-Ryan, PhD, assistant professor and associate program director for resident wellness in the Department of Surgery, and Andrea Garroway, PhD, assistant professor in the Department of Medicine who serves as a coach, educator and clinician — collaborated on the answers to the following questions.
Q. What mental health issues are clinicians experiencing due to working during the COVID-19 pandemic?
A. There was a lot of adrenaline in the first wave of COVID last spring. While stressful, many clinicians felt: “This is why I went into medicine. I will step up.” And step up, they did.
It was horrible, especially in places like New York City. And many professionals were burdened by inadequate PPE, helplessness from not knowing the nature of COVID-19 and how to treat it, and having people die alone without family members. All of this was very stressful.
But in places that were not overwhelmed by very sick patients, they eventually developed approaches to care for patients and themselves. For many, the summer brought a welcome reprieve and some hope, though we knew it unlikely, that the fall and winter would not bring COVID-19 roaring back. But roaring back it came.
Fortunately, so has the vaccine, with many health professionals vaccinated at this point. The spirits and the number of smiles in the line to get vaccinated were the best I've seen in a year.
At the same time, the adrenaline is less, and many people are fighting exhaustion, feeling the stress of both work and family demands, feeling like a heavy blanket of burden is lying on their shoulders. This can show up in crankiness, fogginess, conflict with colleagues, and difficulties coping inside or—even more likely—outside the work situation.
The frequency and pace are rough. In a recent process group, there was reflection on the number of deaths that clinicians/teams are witnessing. We have seen severe fatigue, decreased sleep, increased substance use, and inability to use vacation time, or, if they did take a vacation, not actually resting.
Q. How detrimental is this pandemic-related stress on healthcare workers?
A. When there is evidence of the institution or community not appreciating all that healthcare workers are going through, it is even more stressful. For example, health professionals cannot spend the amount of time with patients that is typical and preferred because of so many patients in need. Some patients, or family members, are complaining about this, which results in health professionals feeling underappreciated for how much they are stretching themselves to meet our community's healthcare needs.
Health professionals seeing unmasked people in the community also are distraught at community members not caring for themselves. Some institutions did not prioritize resident health professionals in getting the vaccine, even though they are often the first to care for COVID patients. Where this was an issue, it caused anger, frustration and protest.
Some health professionals and other clinical staff from surgical or other disciplines are redeployed to take care of COVID patients without feeling adequately prepared to care for very sick patients. While the institution is working to develop processes for patient care, vaccine rollout, etc., there is a feeling of hopelessness when patients' questions come before any answers that health professionals have.
All these problems — along with COVID illness, quarantining of colleagues, and increased demands — can result in turnover in the health professional workforce, and eventually in early retirements.
This second surge threatens people's self-care efforts; they are asked to give up weekends and other days off to staff up and meet the demand for services. Some trainees worry that the pandemic robs them of precious training time and some of the skills they will need in the future. All this is very difficult.
Q. What are some of the long-term effects that stress, isolation and the fear of getting sick can have on healthcare workers?
A. We will only know the long-term effects after the pandemic has subsided. However, it is reasonable to expect that we will see remarkable resilience as well as understandable depression, relationship problems and difficulties related to all they've been through.
Human beings can be enormously resilient in the face of acute and chronic stress. Some have post-traumatic growth; others have significant problems. Working to prevent problems; encourage healthy eating, exercising and sleeping; and intervene early as much as possible are essential to diminish the long-term impact of this crisis on the health professionals that are our frontline workers fighting for our collective health.
Q. What are some tips to help healthcare workers manage their stress and other mental health issues?
1. As much as possible, redouble efforts for healthy eating, sleeping, exercising, and appreciating family and loved ones.
2. Simple practices such as mindful handwashing can be beneficial.
3. Even brief daily meditations can be very helpful for stress-reduction, reflection and grounding.
4. Talk with colleagues who can become like a professional family through this experience.
5. Recognize and express gratitude, in small and large ways. For example, some internal medicine residents put together a wonderful series of brief YouTube videos expressing their gratitude, including this one during the holidays.
Additional Resources and Insights on Building Resilience
Licensed psychologist David Cates, PhD, vice-chair of clinical operations, Department of Psychiatry, University of Nebraska Medical Center, recently conducted a Pandemic Response Resilience Workshop for healthcare workers. It covers how to bounce back from challenging life situations.
"We know from research on previous pandemics that mental health impacts may indeed linger," said Cates. "In some cases, healthcare workers who did not show symptoms of psychological distress during the pandemic may begin having difficulties afterward, once they have some time to reflect.”
“Some may experience guilt about things they 'should' have done differently. Some may feel burned out. Some will have post-traumatic stress. Some may harbor resentment toward their employer or other people,” he noted.
“That said, it is likely that the majority will not experience these types of difficulties,” Cates said. “Most will cope successfully, and some will experience positive growth as a result."
AMN Healthcare places allied health professionals in part-time and full-time travel assignments across the U.S.