The Emotional Impact Of The Pandemic Among Health Professionals
In recent months, healthcare professionals have been under significant pressure in conditions that have posed a real risk to his life.
Repeated exposure to death experiences together with the characteristics of this pandemic (confinement, isolation, little hospital protection, lack of testing…) can cause very intense emotional traumatic damage and falls within the normal consequences during or after the most critical moments of this situation.
Mental health and its professionals play an important role in this regard and emotional management in these conditions is vital to obtain or recover well-being and quality of life.
In the present study we wanted to evaluate in a generic way the emotional impact of this crisis on health professionals in different centers and hospitals (public and private in the Community of Madrid). These are 67 nurses, nursing assistants, dentists, orderlies, doctors… between 21 and 59 years of age.
95.5% of respondents have worked directly with COVID-19 patients.
This is the emotional impact of the pandemic on health professionals
Crisis situations require us to be quick, practical and demand a lot of physical and mental energy Work overload and emotional intensity increase once the serious situation is established in society; To this we add the social pressure and the “responsibility” that falls on some sectors, evidently including the health sector and that in this case, they have to “save” a country.
You have to save lives as if it were a war. The intensity increases; and it continues to increase with the context of the situation: the lack of action protocols, the lack of effective protection measures, the lack of tests to control the movements of the epidemic and the lack of responsibility of some people…
All of this provokes unpleasantly intense emotions in professionals 70.1% of the professionals surveyed have felt that the situation overwhelmed them on some occasions; compared to the 17.9% who felt that it overwhelmed them most of the time, 9% indicated that it rarely and 3% indicated that they did not feel that it overwhelmed them. Why did these health workers feel overwhelmed? What situations have caused you the most anxiety?
“Living with the pain of patients and family members continuously. Fear of infecting yourself and, above all, of infecting your family or friends. Separating yourself from your family for obvious reasons. Seeing how your colleagues are physically and emotionally exhausted… Knowing that you are unprotected and still have to face the bug because the patient needs you and a lot, a lot of frustration for not being able to get to everything…” Nurse, 35 years old.
“Carrying 89 elderly people alone as a nurse.” Nurse in Residence, 29 years old.
“Seeing that there was no PPE, that urgent personnel were needed and that more and more health workers were falling ill.” Nurse, 25 years old.
“Especially the uncertainty, the chaos, the disorganization, the feeling of being in the middle of a war, going to a specialized service without having the years of experience that would be necessary, etc.” Nurse, 25 years old.
“Sample arrivals in avalanche.” Laboratory technician, 29 years old.
“We left our units to help in COVID-19 plants with hardly any training or resources With incredibly hard shifts and most of the time without being able to help and reach all the patients. Seeing people die alone, in inhuman conditions, people who should not have done so due to their age or condition without even having the opportunity to access the ICU due to the collapse that existed at that time…” Nurse, 33 years.
“In general, the situation of loneliness, fear and uncertainty that all patients have experienced. Specific moments in which the patients themselves verbalized to us their fear, their grief, their fear of the imminent outcome they were experiencing. All of this while being aware in everything moment of the situation. How they verbalized their awareness of clinical worsening, how they used us as a link to say goodbye to their loved ones, their world, how our hands were the connection with those of their brothers, children, wife or husband… Those moments of communication with relatives who, without wanting to know it, had to hear the worst of the news… Situations that during our studies, fortunately, they do not teach us and for which we were not prepared”. Nurse, 35 years old.
“Having a drowning patient between 60-70 years old and knowing that he is not going to go to the ICU because there are no beds “, having daily deaths, thinking that you can get infected and end up in one of those beds because you don’t have PPE.” Nurse, 29.
“People on the street without any type of responsibility, and at the time everything in general: feeling useless because you couldn’t do anything so they wouldn’t die…” Nurse in hospital, 30 years old.
On the other hand, An emotional fan was provided with the intention of marking the emotions with which they felt identified (They also had the opportunity to add any others that were not there). The emotions that have had the greatest impact have been: anxiety (85.1%), sadness (82.1%), frustration (82.1%), helplessness (80.6%), worry (80.2%), stress (79.1%), anguish (61.2%); anger (55.2%), fear (43.3%), vulnerability (34.3%) and discredit (20.9%).
Although the most experienced emotions were unpleasant (which is normal), there have also been people who, along with this discomfort, have experienced more pleasant emotions of improvement such as hope (35.8%), courage (32.8%) and optimism (26.9%).
Most also reported having intense concerns (related to the situations that caused them anxiety and discomfort). 58.2% rated the intensity at 4 points out of 5 (4/5); 29.9% in a 5/5 and 11.9% in a 3/5.
Two curves that help us understand the emotional impact
At the moment of crisis, we could differentiate several curves that grow and then flatten. The workload and work pressure curve and the most emotional curve of each person. Both influence and depend on external aspects as well.
The work curve starts to grow from 0 and goes up exponentially faster the first weeks and then manage to flatten out.
The emotional curve starts from the top since it is (as we mentioned before) a situation for which one is clearly not prepared and which generates uncertainty, pressure and direct and repeated experiences with death for many healthcare workers. Once the work curve goes down, we can notice improvements in our mood, a kind of liberation, also as time passes you have the opportunity to gain new perspectives on the situation.
Also, it happens that when we let our guard down, all the unmanaged emotions and all the pressure of what we have been experiencing falls on us like an emotional rain, generating significant discomfort; or, on the other hand, we can feel liberated, but without letting our guard down and with uncertainty as to whether, how and when we will see a rebound again.
48.8% stated that they had begun to feel better due to the release of workload and seeing that the situation was improving mainly. 11.19% said no, and in fact that many of the symptoms and aspects of anxiety, fear or sadness had also become more pronounced.
Among the percentage of people who claimed to feel better, there were answers like “getting used to worrying.” It is important to understand that Resigning yourself (or getting used to worry) is not an aspect of being better emotionally It can give us the false impression that it is, because we free ourselves from thinking about it but we abandon ourselves to it.
What is resilience?
Once “normal” life is established, the resilience process begins to occur. Resilience is the ability that people have to overcome difficulties Multiple studies confirm that social support is the main protagonist for a person to become resilient to a situation. Support includes family support, social environment (friends), work environment, as well as sometimes necessary professional help.
In this case, we find positive data: 94% of those surveyed had been able to vent with their colleagues, and 92% had felt understood by them ; However, 7.5% indicated that they had not spoken to them because they felt embarrassed. 53.7% stated that they had felt support from their superiors, however, 46.3% indicated that they had not, or only occasionally.
In relation to the more social and family environment, the majority have felt support from family, partner, friends or professional colleagues in other institutions and society in general. However, Some people indicated that they had not been able to talk openly with their families about how they felt as well as others who had not felt support.
The aspects of not speaking out of shame or not being able to share emotions in such an intense situation can cause greater suffering in these people.
In the long term, the consequences can be very varied and depend on each specific person Unpleasant emotions can set in, we can have memories, flashbacks, nightmares, a feeling of lack of air at times… That is why sometimes we need external support to be resilient and recover our well-being.
89.6% rated mental health as very important (5/5) ; as well as the importance of psychological assistance, which also obtained 89.6% (“very important”) and 10.4% marked it as “important” (4/5).
16.4% have been receiving psychological assistance in hospitals (in some cases the psychologists came by to see how they were doing, they gave voluntary Mindfulness workshops or they did voluntary group sessions) and also independently. 43.3% have not been receiving psychological care and 28.4% have not been receiving psychological care either, but they would like to in the future when the situation becomes more and more normal.
To do?
Identify emotions, express them, have support from the environment. These are some of the essential characteristics to be able to become resilient in this situation. What can I do if I am a healthcare worker and I feel identified?
First of all, if you feel that you cannot handle the situation and that you are very uncomfortable (continuous nightmares, breathing difficulties, you do not want to go to work, images of work in recent weeks come to you…) consider going to a professional
It is normal to have fear, a little rejection or uncertainty… You can ask the mental health service at your hospital or go to a private psychology office. There are times when we do not have the tools to handle a situation and we need the support of a professional.
2. Emotional management
How can I try to manage my emotions? Identify the emotions we feel and know what function they have It can help us live the situation less aggressively. All emotions have a function and a most beneficial way to express and manage them.
An example: if what I feel is sadness, what causes it? the deaths and not being able to do anything. How do I react? I get frustrated, I blame myself, I demand myself and I block myself. Am I satisfied with that reaction? Mmm I do not know. Can I think of anything more effective or practical to handle it? Telling myself: “it’s normal to feel this way, it’s a complicated situation”, “I can apply relaxation techniques”, “I can talk to someone I trust about how I feel”, “there are things I can control and things I can’t, I I must focus on the things I can control.”
3. Abdominal or diaphragmatic breathing
abdominal breathing helps us relax, increase concentration and feel better Increases lung capacity and cell oxygenation. Anxiety can alter our breathing, making us dizzy… In times of stress or anxiety, trying to relax through breathing can be beneficial.
Concluding
In conclusion, the data provided reflect that yes There has been a great emotional impact on healthcare personnel and that the reasons have been numerous, but quite generalized and shared by all.
The emotions experienced by the majority are framed within normality in the experience of a social and health crisis. The vast majority appreciated the preparation of this study, and highlighted the importance of health and psychological care.
“Simply, thank you for dedicating your time to carrying out this survey; I hope you give it the importance it has and it really shows the situation that healthcare workers are experiencing with real sources and told from within. Great initiative.” Nurse, 23 years old;
“After this pandemic, many professionals will need psychological care, especially those who, in addition to losing patients, have lost family or friends. Psychologists, mental health nurses and psychiatrists are a very important pillar. Thank you for your work.” Nurse, 24 years old.
All this reflects the need to reinforce mental health in hospital areas to be able to provide support and individual work to workers and the general population with the aim of improving their well-being.
Remember that despite the obstacles or frustrations, you are fulfilling a great mission: caring for those most in need. We must remember that all those who are working in hospitals under these circumstances, whatever they do, are the true heroes coming from the general population.
