The COVID-19 pandemic is causing unprecedented anxiety and stress for all of us, and its unique circumstances make coping difficult. For healthcare workers immersed in the fight against coronavirus, the burdens are incredible — fear for their personal safety, stress of increased demands, and the pain of witnessing lives taken too soon.
While much attention is (rightly) focused on protecting healthcare workers from coronavirus infection, the emotional toll is high. Healthcare leaders nationwide are desperate for ways to support their employees’ emotional wellbeing, especially now when maintaining a robust and stable workforce is particularly crucial for saving lives.
Kate Walsh, president and CEO of Boston Medical Center, sat down with Beth Milaszewski, a clinical social worker who specializes in trauma treatment modalities, to discuss how to mitigate the effects on employees’ mental and emotional health as the coronavirus pandemic unfolds and the country faces weeks of higher-than-usual stress for hospital workers.
Their conversation offers insights for understanding a normal trauma response and how healthcare leadership can respond to help employees — front-line and otherwise — to de-escalate their stress response in the midst of an ongoing threat.
Kate Walsh: What do you want staff members to be thinking about, and how can we prepare ourselves for what will be an increasingly difficult time during the COVID-19 outbreak?
Beth Milaszewski: I know everybody knows this logically, but this is a pandemic. It is a crisis and your stress response will be activated. Just like when we exercise, you're going to have increased heartbeat, shallow breathing, possibly tense muscles, jaw, eyebrows, dry mouth. The body instinctually responds to a threat this way. It's not a choice.
The other things that tend to happen is people behaviorally start to get more anxious, more irritable, more worried. They end up getting combative or very defensive and protective and withdrawn. And so people's personalities are going to change during this time, with reason, because this is a really stressful situation that we're dealing with.
KW: Our lives have changed inside the hospital and they've changed outside the hospital. How do you advise us to think about that and remain productive?
BM: That's the tricky part. Normally when our stress response is activated by a threat, we do what we need to do to escape the threat and then we come back into a state of recovery and recuperation. During this pandemic, it's very hard to come back to that state of recuperation. We're going to have to be proactive in being able to do that.
And so we created something called the PULSE check. It helps people in the moment start to do a check on themselves. We go through some questions that you can ask yourself or your peers about basic symptoms of distress, and you can determine, "Oh okay, this is what's going on. I'm freaking out because of X, Y, and Z. Okay, who am I going to touch base with?"
Ideally, we're going to be able to touch base with a friend, a colleague, a family member. Unfortunately, many of us are in isolation and can't do that... so that's what makes it even more difficult. Feelings of loneliness and isolation have been coming up a lot over the last couple of weeks. In trauma research, we know part of processing a trauma is being able to talk about it, to give it a narrative; a beginning, middle, and end. It is so important to talk about it.
KW: You're out and about on the inpatient floors, places that are stressful on a good day. Tell me what you're finding.
BM: People are surprised by their own responses. This is a huge challenge and our defense, our stress response, is going to be activated. People tend to be more teary-eyed, more worried, tend to get more defensive or blame others more often. These symptoms are instinctual to a threat. We are in the midst of a threat.
KW: So you see these reactions even on floors with no COVID-positive patients?
BM: It's a lurking fear undertone, whether you're on the front lines or not. I've heard people say, "I don't know why I can't go to sleep," or "I don't know why I have racing thoughts." And they're like, "What's wrong with me?" And there's nothing wrong with the people experiencing the stress response. This is not pathological in any way, shape, or form.
When the stress response is activated, we tend to have negative thoughts about ourselves and it usually falls under three themes. Responsibility: it was my fault. Power and control: I don't have any power or I can't control any of this. Or safety: we're not safe or no one's safe anymore.
One of my concerns is that employees leave here taking ownership of this pandemic that they shouldn't be taking ownership of.
One of my concerns is that employees leave here taking ownership of this pandemic that they shouldn't be taking ownership of. I want them to know that they did the best that they could do with the resources that they had available to them in that moment, during that shift.
KW: What could hospitals as employers, or me as a CEO, be doing differently or better?
BM: I would love to incorporate some ways of being able to deescalate our bodies throughout the workday and workflow. In the beginning, middle, and end, during the day, how can we incorporate a breathing exercise, a being in the moment, for checking in with each other?
KW: Like taking a moment after a code?
BM: Like taking a moment after a code. A PULSE check is basically a two-minute exercise, if that, for us all to get back into our bodies. That's what I'm hoping becomes part of the norm — because what that's going to do is add a little bit of recovery and prevent people's stress response from being stuck on, all day.
One of the big crisis intervention techniques that are used are debriefings. A debriefing usually happens when the crisis is over —we don't have the luxury of doing that right now. This crisis is going to be ongoing. My hope is that we have closing huddles with the teams that you worked with where you can go through the PULSE check, check in with each other, and ask, "Are you doing okay? Who are you going to check in with?" And then leave together knowing that you did the best that you could do.