Managing stress and building resilience for healthcare workers during COVID-19

Healthcare workers all across the country are experiencing incredible amounts of stress during this difficult time.

As healthcare workers, we all have a commitment to provide the highest quality care for our patients and we desire deeply to help our patients be well. Yet, when there is so much illness and so much uncertainty about what will come and when it will end, it is natural that many of us will experience stress and anxiety despite our best attempts at coping.  

Why does COVID19 feel so stressful?

As a healthcare worker, you are used to coping with stress. You endured high-intensity training for a very long time to be qualified to do your job. You are used to working long hours. You always care for sick people. You are good at making hard decisions. But for some reason, COVID19 feels different.

Why is that?

There are several specific stressors that you are likely experiencing that are different than your normal challenges:

1. Need to employ personal safety measures

Being constantly vigilant about handwashing and sanitizing the world around you is exhausting. 

Use of PPE is cumbersome, tiring, and can lead to excess body heat and dehydration.

2. Risk of disease transmission

Infection control is hard. People are symptom-free for long periods, but are contagious, which can increase anxiety when we are around others even if they are asymptomatic.

Mortality rate is higher with COVID-19 than the flu or other more common contagious illnesses, so it is scarier to us and our patients.

There is a constant need to balance public health priorities (like social distancing) and our desire to remain patient-centered with meeting the needs of the patients and their families.

There are constantly changing guidelines and rules to follow for best practices and staying safe and keeping up with these can be exhausting.

You want to care for your patients, but also stay safe yourself and yet, there may or may not be the PPE you need to be able to perform your job in a way that allows you to feel safe.

3. Multiple personal demands

In addition to daily work requirements, we are also required to prepare for the unique challenges of COVID19.

Many of us are learning new technologies in order to meet patient needs via telehealth, which for some can be taxing and feel like a hindrance to the patient/provider relationship or a barrier to our expectations for delivering care.

Healthcare workers may be assigned to areas of the healthcare system that are new to them, resulting in the stress of learning new skills or feeling potentially under-prepared.

Healthcare teams may be working short-staffed as team members are furloughed due to illness.

Some of us are juggling changes at home, including partners working from home and children out of school/daycare, some of whom need to be homeschooled or require additional support during this time.

Family members may have lost jobs or been furloughed due to COVID19, which can result in financial hardships and additional stress at home.

4. Physical and emotional isolation/Strained relationships

There may be fear that exposure to COVID19 could result in prolonged isolation from loved ones or even fear of yourself or a loved one dying alone due to strict restrictions on visitors in hospitals.

You may feel you are unable to express your fears and emotional needs given that you are a healthcare worker, who is “supposed to be strong.”

Many of us are not able to see friends and family members who typically serve as a source of emotional support.

Some of us have difficult relationships with partners within our homes and having more time together may exacerbate some of the stress in those relationships.

5. Moral Injury

Stories of doctors having to make decisions regarding who will live and who will die due to limited resources are prevalent in the media. This sort of situation can lead to an experience of a “moral injury,” or a trauma that occurs to our moral conscience in which someone experiences a betrayal of their sense of right or wrong.

Thankfully, our region has not experienced COVID19 to this degree yet, but just anticipating the possibility can be very stressful.

What is resilience and how can I cultivate it?

Psychologists define resilience as the process of adapting well in the face of adversity, trauma, threats, or serious sources of stress. Resilience offers us the opportunity to “bounce back” from these difficult life experiences and even experience personal growth in the midst of them.

During this pandemic, many of us are facing personal and professional challenges and trauma, so it is essential that we work to build resilience in ourselves and encourage the development of resilience in our loved ones.

But, how do we do that?

1. Foster personal wellness

Remember, you must first be well in order to care for others (i.e. always put your oxygen mask on first)! Healthy lifestyle factors can strengthen your body to adapt to stress.

Make sure you are getting adequate rest. As much as possible, maintain a consistent sleep schedule with the same wake time each day. Take brief self-care breaks when needed throughout the day.

Consider your nutrition. Be sure to eat and strive to fuel your body with nutrient-dense foods as much as possible and drink your water!

Exercise as often as possible. Not only is exercise good for your physical health, but during exercise our brains release dopamine and endocannabinoids that can generate a natural high and result in decreased stress. Even though the gym is closed, you can still get out for a walk or workout at home.

Strive to maintain a routine. When the world feels so out of order, maintaining a sense of control over your daily schedule can be very comforting.

Engage in calming activities like yoga, meditation, mindfulness, or journaling. 

2. Stay connected

While practicing social distancing, it is important that we stay connected to loved ones. Use social media, telephone, and email to remain connected to those who are your strongest support system. Get creative and move your happy hour or church group to a videoconferencing platform rather than cancelling all together.

Remain connected to healthcare colleagues who can understand your unique challenges. Most likely, they are experiencing some of the same anxiety and stress that you are. Share your story with them and ask them to share theirs with you. It helps to remember that we are all in this together.

If you are a person of faith, consider scheduling some time to focus on prayer, studying of scripture, or other spiritual activities that help you stay connected to your beliefs/values.

3. Cultivate healthy thoughts

Resist the desire to consume too much media. Your newsfeed may be full of sensational articles about the coronavirus or politics.  Spending too much time on these can increase anxiety. Instead, choose to limit your exposure to only certain reliable sources and reduce the amount of “mental bandwidth” you will dedicate to it (e.g., CDC website, local health department reports).

Be here now. All MLH Associates are familiar with this phrase, but never has it been more important! When you are at work, be all in. But, when you at home, be there fully. Practice mindfulness throughout your day by noticing when your mind is drifting to an anxious thought and bringing it back to the present moment.

Engage in positive self-talk. If you catch yourself having a negative internal dialogue (such as “I’m selfish to be afraid going into work”), stop and ask yourself if you would speak to a friend in such a manner. If the answer is “no,” replace that thought with something true and kind. 

Practice gratitude! Each day, spend a few minutes intentionally stopping and thinking about what you have to be thankful for from the day.  Even in the most difficult seasons, we all have much for which we can be thankful. Multiple studies have shown that gratitude increases mental strength, helps people experience more happiness, and reduces depression.

4. Look for ways to grow

Reconnect with old hobbies or find a new one. You may have loved to write poetry in the past and found it cathartic. Consider picking up that pen again! Perhaps you used to play pickup basketball, but your gym is closed. Could you take up bike riding instead?

Focus on others. It is easy to become overwhelmed when we are always looking at our own problems. Try focusing on the needs of others and how you can meet those needs in a tangible way. Maybe call a shut-in neighbor just to be a source of support or offer to pick up a loaf of bread for them next time you go to the store. Attending to the needs of others provides us with a sense of meaning and purpose.

Continue to move towards your goals. COVID-19 will not last forever. Keep working on that weight loss goal or planning that Disney vacation. You may have to adjust your timeline, but it is important to keep working towards goals that are important to you.

Reflect on ways in which you are growing as a result of this struggle. Perhaps you are getting more quality time with your children or learning just how adaptable you are in the face of stress. Acknowledge and name these areas of personal growth.

Resources available in the community:

Methodist Employee Assistance Program (EAP) offers free professional counseling for MLH Associates and members of their household.  Currently services are available both in-person and via telehealth.  Reach out today if you or your loved one could use some additional support: 901-683-5658.

If you do not wish to use EAP but instead want community-based professional support, Methodist’s Living Well Network can connect you with a mental health professional near you based on your specific needs.  This resource is also available to the entire community, so it is a good one to share with your family and friends.  The Living Well Network can be reached Monday through Friday at 901-762-8558 from 8 a.m. to 4:30 p.m.

OHSU and UMass have teamed up to offer a FREE interactive webinar led by Dr. Tina Runyan and Dr. Joan Fleishman, two clinical health psychologists with specialized expertise in supporting health professionals. They are offered on weekends. Click here for more information.

When might I need professional help and where can I turn?

A pandemic is a significant stressor for all of us and it is normal to have increased emotional response during this time. However, some individuals under extreme stress will experience anxiety or depression to the extent that it impairs their ability to function at work or at home.

Monitor yourself for warning signs such as increased substance use, difficulty sleeping, increased agitation, and recurrent panic attacks.  In these cases, you may need to seek professional help.

MLH’s Living Well Network can connect you with the appropriate resource for you. They  can be reached Monday through Friday at 901-762-8558 from 8 a.m. to 4:30 p.m.

If you have thoughts of hurting yourself or others, please go to the nearest emergency room or reach out to the National Crisis Line: 1-800-273-8255.  Help is available 24/7.  You are not alone.