Compassion fatigue, burnout and secondary traumatic stress have typically gone unnoticed amongst frontline healthcare workers. Yet the emotional cost of caring during the current COVID-19 pandemic is leaving many practitioners feeling emotionally divorced from their work or planning to quit the profession altogether.
Doctors are known to be at particularly high risk of anxiety, depression, substance abuse and suicide when compared with the wider population. So, what can be done to minimise the stresses of working in such high-pressure environments? It’s an important question and finding the answer is becoming increasingly urgent.
Going into overwhelm
At present around 30,000 NHS staff are either off sick with Covid-19 or in isolation and as shocking as these figures are, they don’t even begin to take into consideration the mental and emotional strains of working through a pandemic. Currently, mental health problems are one of the leading reasons for staff absences, with anxiety, stress and other psychiatric illness accounting for over 28% of all sick leave.
Recent research also suggests that stress-related psychiatric illness may be present in up to 50% of UK doctors and 40% of nurses with many reporting burnout, using alcohol, drugs or self-medication in an attempt to cope with the pressures of the job. Left untreated these unhealthy coping mechanisms can lead to suboptimal patient care, increased errors and potentially compromising patient safety.
So, what are the risk factors and what can be done to help medical teams take care of their personal health and wellbeing?
What are the risk factors?
Physical stress, powerlessness and anxiety are three of the leading factors associated with traumatic stress and for consultants and other key workers, these criteria are all too often a reality of their working day. Typical stressors might include:
The emotional strain of caring for growing numbers of acutely ill patients who have the potential to deteriorate rapidly.
Physical exhaustion, long shifts and inadequate breaks.
Lack of control organising duty rota.
Caring for co-workers who may become critically ill or die from COVID-19.
Fear about contracting COVID-19 or infecting family members from workplace exposure, especially if family members are older, immunocompromised, or chronically ill.
Anxiety about assuming new or unfamiliar clinical roles and expanded workloads in caring for patients with COVID-19.
Limited access to mental health services for managing depression, anxiety, and psychological distress.
Moral injury in critical care
As the devastating impact of the pandemic takes hold, moral injury, a term once only used within the military, is now entering the medical vocabulary. Defined as profound psychological distress which results from actions, or the lack of them, which violate a person’s moral or ethical code, moral injury is becoming common amongst practitioners working in overstretched critical care environments as the COVID-19 pandemic continues to place healthcare professionals across the world under extreme pressure.
The wobble room
As this second wave of infections takes hold the psychological effects are being felt amongst many frontline healthcare workers. Yet, despite increased rates of anxiety, depression and stress the persistent stigma associated with mental health problems is stopping many doctors and nurses from seeking the help they need and deserve. That said, one practical solution that has gained popularity recently is the introduction of the ‘wobble room’, a dedicated private room where staff can briefly escape from the intense pressures of caring for patients and regain their emotional equilibrium.
Investing in mental health
For some practitioners, the challenges of burnout, moral injury and secondary traumatic stress will diminish over time. For others, though it can lead to future cycles of burnout, increased errors and further stress. It’s also one of the key reasons why, despite intensive recruitment campaigns, the NHS is once again feeling the strains of staff shortages as many retired doctors and nurses who offered to come out of retirement have fallen prey to the extreme pressures of the job, resulting in yet another staffing crisis.
With this in mind, the World Health Organisation have compiled a helpful checklist of practical advice to help encourage staff retention and minimise the psychological damage of working in intensely stressful situations. For example:
Ensuring that good quality communication and accurate updates are provided to all staff.
Rotating clinicians from higher-stress to lower-stress functions.
Partnering inexperienced workers with their more experienced colleagues.
Using the buddy system to provide support, monitor stress and reinforce safety procedures.
Ensuring that outreach personnel enter the community in pairs.
Encouraging and monitoring work breaks.
Implementing flexible schedules for workers who are directly impacted or have a family member affected by a stressful event.
Ensuring time is available for colleagues to provide social support to each other.
Providing adequate emotional support to front line workers is a challenge in itself, and with face to face consultations no longer supported, video consultations are gaining prominence as a practical and successful way of providing therapy that is safe, private and effective. As well as being a valuable tool for promoting staff wellbeing, video consultations, are quickly becoming central to new models of care that avoid face-to-face contact.
Our world is changing rapidly at the moment and it’s been suggested that despite all the hardships the pandemic has created, it’s also provided an opportunity to stop and reflect on how system reforms can occur rapidly when needed. Necessity is often the catalyst for innovation and in this case, the need for reduced human contact is proving to be a major driver for change.
The tide has turned and driven by the challenges of COVID-19, the NHS is rapidly establishing remote consultations as the new normal whenever it is safe and clinically appropriate to do so. As COVID-19 has forced healthcare services to become innovative, new possibilities are opening up daily for the creation of a more modern, adaptable and resourceful healthcare system. A system that responds to the mental and emotional needs of its workforce and a system that is capable of rapid adaptation to change, enabling it to operate with much greater resilience than ever before.