From feelings of anxiety about health risks to facing exhaustion from extended hours or financial burdens from closed offices, healthcare providers, including ODs, are facing a wide spectrum of negative impacts resulting from the coronavirus pandemic. This article will cover some of the effects, institutional and personal responses, and resources healthcare providers can utilize to alleviate stress during this time.
Different experiences, different responses
Depending on the scope of employment, ODs will have had different experiences over the past few months. As a hospital-based optometrist, I had no work hiatus; while clinics were cut back I saw emergency patients and helped out in other areas of the hospital. Now that we have slowly begun the re-opening process, there are many factors to be considered and precautions to be taken. It is a stressful and somewhat overwhelming process. Other colleagues were out of work for some time, either having to close their own practice, or at their employer’s discretion. Some practices have made drastic changes to the way they provide care in order to remain open; switching to telehealth options and implementing new protocols for staff and patients for face-to-face care.
Employment changes could cause exhaustion and burnout from working altered or excess hours, or financial distress for those who were temporarily unable to work. Taking care of loved ones during this difficult time leads to added stress and some of our colleagues themselves may have even been ill. This has been an overwhelming time for many, and a substantial portion of it still requires sorting out. It is more important than ever to remain empathetic and compassionate to the experiences and situations of others and as we navigate forward.
Since everyone’s experience is different, a spectrum of responses can be expected as well. Stress, anxiety, guilt, depression, irritation, frustration, and difficulty concentrating are a few of the feelings shared in response to the COVID-19 pandemic. (1) The CDC also reports cases of acute stress disorder, PTSD, secondary (or vicarious) traumatization, and compassion fatigue among physicians. (2) Healthcare workers have been finding the need to socially distance themselves after seeing patients in order to protect at-risk family members. (3) Feelings of isolation and loneliness from social distancing only make matters worse for those who are already putting themself risk to care for others.
Stress and anxiety can exacerbate pre-existing physical and mental health conditions that providers themselves may have, making it more difficult to keep up with their own regular health care regimens. Incidence of alcohol and substance use also increases with higher levels of stress or anxiety. Changes in eating or sleeping add to mental and physical exhaustion and hinder optimal functioning. (1) All healthcare providers need to be aware of these increased risks for mental health disruption and make a point to self-monitor.
CovalentCareers is committed to supporting optometrists and optometry students during the Coronavirus pandemic. For more optometry-specific resources and information, visit our Optometry COVID-19 Resource Center.
The institutional perspective on mental health
Hospitals, medical offices and educational institutions face a huge challenge; continuing to provide high-quality care while also ensuring that those on the front lines can remain mentally stable and physically able. Some healthcare providers have reported feelings of betrayal and even coercion by their employers as they were required to work without proper personal protective equipment (PPE) or were required to cover exhausting shifts. In many cases individuals cannot face and address these issues on their own. It is important that both providers and staff are supported with resources and methods to reduce stress and increase protection.
Organizations have created programs to limit these aforementioned pressures and risk factors faced by healthcare practitioners. These large initiatives are occurring at the institutional and even government level. We will discuss some of the methods being incorporated in the following sections that are applicable to optometrists and other healthcare providers to protect and care for ourselves and our patients.
Tracking the impact on healthcare providers
Specific data regarding the mental and psychological states of healthcare providers amid the COVID-19 pandemic in the U.S. is not yet published; however, data for China was recently released. According to a study of over 1,000 healthcare providers, 70% reported facing some level of mental distress and approximately half reported significant anxiety and/or depression resulting from the pandemic. (4)
Shanafelt et al. propose that the best way for institutions to pinpoint what the stressors are for healthcare providers is to ask. After multiple sessions interviewing physicians, nurses and allied health professionals the top factors of concern were identified. The top 5 were access to PPE, being infected with COVID-19 at work and bringing the infection home to loved ones, not having rapid enough testing to prevent unintentional spread of the virus, the uncertainty of being able to take care of friends or family if they should become ill, and access to childcare while schools are closed and work hours have been altered or increased. (5)
The American Medical Association (AMA) offers two sample surveys to monitor the mental health of the workforce in order to better address and track specific issues. This type of information can be used to clearly identify the major stressors, prioritize them, and create an organizational structure for support. Taking this type of approach is more effective than addressing individual needs on a case-by-case basis. (6) This method, though intended for larger institutions, is applicable to medical care in any setting. Optometrists in private practice or an optical setting can consider these tenants when working with their staff to determine priorities of concern and implementing plans to address them.
Finding solutions
Government resources urge “fighting stress through preparedness” during this time. This can be done by ongoing training, educational resources, and clinical monitoring. Providing education for staff and patients from credible resources, such as the CDC and WHO, will assist in developing an environment of trust, control, and safety. The national center for PTSD suggests performing practice drills of the situations that employees are most concerned about and also routine re-assessments of their concerns. In larger institutions, periodic mental health screenings are also recommended. (7)
The AMA suggests re-evaluating and re-distributing workloads when possible. This includes incorporating telework, rotating face-to-face schedules with telework, or even training others with new skill sets to increase those available for the most in-demand areas. (5,6) Rush Medical School developed an entire “tool kit” for health systems responding to COVID-19 in order to establish an environment of wellness using a similar approach as recommended by AMA. (8) According to Johns Hopkins, the key points to any plan should be “listen, provide accurate information, focus on prevention.” (9)
Employees will look to their employers to listen to concerns regarding their stress points and needs in order to provide the highest quality care. Optometrists who are in employer positions need to establish clear leadership roles and points of contact for concerns; this is instrumental in decreasing anxiety and stress levels among employees. Also to be considered, depending on the personnel and setting, is assistance with child or family care, sick-time, and time-off policies along with resources for rest and self-care. (5) Employers should also remember to show gratitude and thanks for employees doing their best during such tough times.
Self-care in a pandemic
Take care of yourself by making time for physical exercise, eating healthy, and getting enough rest. Try to schedule breaks during which time you avoid screen-time and incorporate mindfulness techniques into your daily routines such as meditation or breathing exercises. (1,2) Consider limiting the amount of time spent reading the news or social media if that initiates feelings of stress or anxiety for you.
According to Mayo Clinic, establishing a daily routine can help you regain a sense of control and create a calming effect in and of itself. (10) When creating a routine, consider your priorities and focus on the positive aspects to center it around. Purposefully dedicate time to connecting with others; after months of strict social distancing, maintaining connections (even on the phone or over video) is especially important.
If you try these methods and are still feeling anxious or overwhelmed don’t be afraid to ask for help. For mental health support, many hospitals are offering mental health counseling options for providers. UNC, for example, is offering flexible telehealth counseling for healthcare works and other hospitals are organizing virtual support groups. (11) The hospital where I work has been offering virtual wellness classes at lunch time including yoga and meditation. Take advantage of these types of programs (and the digital tools discussed below) to help boost your mental and physical strength. We must remember that if we are not taking care of ourselves, we are not able to provide our best care to our patients or our loved ones.
In conclusion
ODs should remember the importance of their work and contribution to others in the community. We have patients eager to come back and we need to find a balance of making ourselves, our staff and our patients feel safe. Seeking support and guidance from credible resources and programs as well as maintaining proper mental and physical support are important pieces to ensuring this can happen in a successful and productive way.
The COVID-19 pandemic has impacted people of all backgrounds and socioeconomic classes. As we move forward from these difficult times remember compassion, to be considerate toward others, to take time to heal and take care of yourself and last but not least don’t hesitate to ask for help when you need it. Communication with your colleagues, staff and institutions needs to be open in order to create a safe and calm space for patient care. Mayo clinic reminds us that though the intensity of feelings resulting from the pandemic may fade with time, the coping mechanisms we learned will continue to be beneficial when tackling future challenges. (10)
Mental Health Resources
References:
- “Mental Health and Coping During COVID-19.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, https://www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/index.html.
- “Healthcare Personnel and First Responders: How to Cope with Stress and Build Resilience During the COVID-19 Pandemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/coronavirus/2019-ncov/hcp/mental-health-healthcare.html.
- Gold, Jessica. “The Hidden Covid-19 Crisis: Health Care Workers' Mental Health.” STAT, 2 Apr. 2020, www.statnews.com/2020/04/03/the-covid-19-crisis-too-few-are-talking-about-health-care-workers-mental-health/.
- Lai, Jianbo et al. “Mental Health Outcomes Among Health Care Workers Exposed to COVID-19.” JAMA Network Open, American Medical Association, 23 Mar. 2020, jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229.
- Tait Shanafelt, MD. “Understanding and Addressing Anxiety Among Healthcare Professionals During the COVID-19 Pandemic.” JAMA, American Medical Association, 2 June 2020, jamanetwork.com/journals/jama/fullarticle/2764380.
- Berg, Sara. “Mental Health and COVID-19: How a Psychiatrist Tackles Fear, Anxiety.” American Medical Association, 1 June 2020, www.ama-assn.org/delivering-care/public-health/mental-health-and-covid-19-how-psychiatrist-tackles-fear-anxiety.
- “VA.gov: Veterans Affairs.” Managing Healthcare Workers' Stress Associated with the COVID-19 Virus Outbreak, 9 Mar. 2020, www.ptsd.va.gov/covid/COVID_healthcare_workers.asp.
- Adibe, Bryant. “Creating Wellness in a Pandemic: A Practical Toolkit for Health Systems Responding to COVID-19.” Https://Www.rush.edu/Sites/Default/Files/Creating-Wellness-Pandemic-Toolkit.pdf.
- McGuire, Joseph F. “Stressed About COVID-19? Here's What Can Help.” Stressed About COVID-19? Here's What Can Help | Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/stressed-about-covid19-heres-what-can-help.
- “COVID-19: How to Manage Your Mental Health during the Crisis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 2 Apr. 2020, www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/mental-health-covid-19/art-20482731.
- Mock, Jillian. Psychological Trauma Is the Next Crisis for Coronavirus Health Workers. 1 June 2020, www.scientificamerican.com/article/psychological-trauma-is-the-next-crisis-for-coronavirus-health-workers1/.
