By Mary Kate McGrath - June 16, 2020
In April, Dr. Lorna M. Breen, the medical director of the emergency department at New York Presbytarian Allen Hospital, one of the many hospitals battling the coronavirus in Manhattan, died by suicide. Dr. Breen did not have a history of mental illness, but after weeks in the trenches of the frontline of COVID-19 response, she had grown detached, according to the New York Times. Before her death, Breen described to her father the devastating scenes from a hospital overrun by coronavirus. Her death emphasized the incredible toll COVID-19 is taking on healthcare and nursing professionals, careers that already had high-rates of burnout before the global pandemic began.
Hospital workers across the globe have faced significant trauma as a result of the pandemic. A recent study conducted by the JAMA Network detailed the extent of the crisis - half of Chinese health care workers studied who treated COVID-19 patients earlier this year are suffering from depression, as per NPR. Nearly as many workers - 44.6% have anxiety, and a third have insomnia. Study leaders found that, as per the result of the study, healthcare workers have a high risk of developing negative mental health outcomes, and may need psychological support or intervention.
In the United States, hospitals at the epicenter of the pandemic are undergoing a similar mental health crisis among nursing professionals. Psychologist Bruce Schwartz, who works at the Montefiore Medical Center in the Bronx, said that nearly everyone in the hospital, including interns or nurses in-training, had been tapped to help address the influx of COVID-19 patients, who were dying at rates comparable with being on the frontline of a battlefield, as per NPR. The hospital’s location in a neighborhood with a vulnerable minority population - where rates of pre-existing conditions such as diabetes or asthma high due to persistent healthcare inequities - mean that patients are more likely to suffer from severe cases.
Overworked hospital staff at Montefiore Medical Center, and across the nation, are forced to cope with multiple tragedies daily, all playing out over the course of a single 12-hour shift. Hospitals have a responsibility to expand psychological care - from teletherapy to encouraging time off to prevent burnout - to address the impending mental health crisis among nursing professionals.
Schwartz, who is also the president of the American Psychological Association, recommended offering teletherapy for staff. Access to counseling services will be necessary as the crisis unfolds, but also after the first or second wave of coronavirus has passed and workers are likely to be left with significant post-traumatic stress disorder. The uncertainty of the pandemic and the anguish of treating patients without adequate resources are likely to have long term mental health repercussions for healthcare workers across departments.
It’s also necessary to make sure medical professionals focus on dispelling stigma around seeking help. Roy Perlis, a Harvard psychologist, noted that healthcare workers, “don't make great patients” since “there is still an awful lot of stigma in particular in seeking help,” as per NPR.
Many factors compound the trauma of being on the frontlines. In addition to bearing the full weight of systemic resource shortages and lack of planning on a governmental level, healthcare workers are being forced to make impossible decisions regarding care. Moral injury, a term that originated in the military, is when a person is forced to do something contrary to their personal beliefs, as per Scientific American. For medical workers, moral injury can occur when the business side of a hospital impedes a nurse or physician’s ability to deliver care, such as when a lack of ventilators forces doctors to make decisions about who is put on life support. Studies conducted on military personnel found that moral injury prohibits normal social, emotional, or psychological functioning, and often is part of a PTSD diagnosis.
Burnout is an issue among healthcare professions even under normal circumstances - the physical demands, psychological strain, and ineffective work processes contribute to burnout in nearly 50% of physicians in The United States, as per Scientific American. Burned out clinicians have worse outcomes, and are more likely to quit their jobs. Yet high burnout rates in healthcare can’t even begin to indicate the negative impact of COVID-19, as it is often the result of chronic job stressors, not an acute crisis like the one that has played out in emergency rooms across the country.
Many healthcare facilities have developed a multi-pronged approach to addressing the looming struggle for nurses and other workers. UNC Health in North Carolina extended therapy options for providers with telehealth and more flexible scheduling, and set up an emergency hotline, as per Scientific American. In the United Kingdom, the COVID Trauma Response Working Group focuses on proactive interventions and fostering resilience. Hospitals want to encourage healthcare workers to feel like the experience has increased their ability to handle future stressors, not diminished their capacity to care for others.
Efforts to increase access to mental health and wellness resources must be wide in scope, and encouraging workers to use teletherapy, meditation apps, and other virtual health services can help further expand resources for workers. Leverage technology to better manage healthcare workers struggling under the pressure of the pandemic. A healthcare safety app can help hospital administrators better manage nursing professionals’ mental health and connect them with vital resources. Through the app, hospital leaders can proactively identify and customize communications for workers in the ICU and COVID-19 wards, making sure these workers understand the risks of severe burnout and are feeling supported outside of their work.
Healthcare workers can also use the app to submit anonymous tips, informing administrators of any ongoing concerns about hospital conditions and raise awareness of any struggles with mental wellbeing among their coworkers. The app can also house a directory of mental health resources offered both internally at the hospital and through external sources. Increasing access to these resources can help fight the stigma around seeking mental healthcare, dispelling notions that trauma is "just part of the job."
Mary Kate is a content specialist and social media manager for the Rave Mobile Safety team. She writes about public safety for the state & local and education spheres.
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