Pandemic Related (healthcare) Stress, Part 3 – Establishing Resilience Building and Resilience Rounding Programs

Where were you on February 25th, 2020? Were you in an outpatient clinic evaluating and treating patients in need of preventive care? Were you providing pre- and post-anesthesia care in your hospital’s PACU?  Perhaps you were providing post-operative surgical care on a Total Joint and Spine unit? Or providing resuscitative or intensive care to cardiac and/or stroke patients in an Emergency Department or an ICU? Were you attending yet another boring meeting discussing annual volume and revenue performance metrics? Or maybe having fun attending Mardi Gras parades and parties? Or were you just taking a day off from your usual routine?

      Regardless of your physical location on February 25th, chances are very good that you did not realize the magnitude of the changes that would occur in your daily routine over the next few weeks. For US healthcare workers in the initial COVID-19 “Hot Spots,” the changes experienced were “tectonic” in nature.  Medical and dental practices, schools, restaurants, gyms, and theaters closed; concerts and sporting events were cancelled; elective surgeries and procedures were cancelled with no defined plans for restarting them; hospitals were admitting COVID-19 patients, and the clinical staff were wearing PPE when caring for presumed coronavirus-infected patients; many healthcare support personnel were rapidly empowered to tele-work; and “non-essential” workers were told to stay home by their Governors.

For hospital-based healthcare systems, these rapidly developing changes caused many healthcare workers to “leave their comfort zones” as they learned how to provide care to seriously ill COVID-19 patients while wearing CDC-recommended personal protective equipment (PPE). Due to the world-wide shortage of PPE (N95 masks, isolation gowns, face shields, surgical masks, etc.), many healthcare organizations quickly implemented PPE-conservation strategies. Some workers experienced financial insecurity when their spouses/partners either had their hours reduced, were furloughed, or were laid off.  Additional social restriction measures amplified ever-growing stress levels as many workers faced childcare issues caused by school and daycare facility closures, and some healthcare workers genuinely fearing transmitting COVID-19 to their families (and many nurses and clinicians created new rituals that ensured their family members were protected from accidental transmission of the coronavirus following work shifts). The sum of these rapidly implemented experienced changes created a significant amount of stress on affected hospitals, healthcare systems, and many healthcare workers.

As time moved forward, pandemic healthcare workers found themselves facing the same challenging situation every work day (i.e. providing quality, safe care for seriously ill and dying COVID-19 patients). Many expressed new concerns as to whether their leaders would be able to supply them with adequate PPE. All of these work-related stressors, combined with the ongoing and equally unplanned life stressors, created a potentially overwhelming situation for some healthcare workers – and healthcare leaders soon discovered that some of their workers and managers were poorly prepared to manage their Pandemic Related (healthcare) Stress.

No one is arguing that our country, most of our affected hospitals and healthcare systems, and most of our healthcare workers neither planned for or anticipated the requirement for managing the COVID-19 pandemic. We also know that most of these healthcare organizations and their workforce were ill-prepared for managing this challenging medical event. Adding to an already challenging situation was an equally unprepared medical supply system that was unable to meet COVID-19 pandemic demands for CDC-recommended PPE and critical medical equipment. The rapid transition to COVID-19 operations in late February/early March 2020, extended work shifts, 2-3 months of PPE challenges, nationwide stay-at-home orders, school closures, and the fear of contracting coronavirus (or transmitting it to family or close friends) exposed the fragility of our healthcare systems, our medical supply chain, and our front-line healthcare workers to the numerous stressors induced by the COVID-19 pandemic.

Hospital and healthcare system leaders are ultimately responsible for ensuring the health and welfare of the staff and patients within their facilities. COVID-19 demonstrated that healthcare leaders should be committed to ensuring their staff not only have the resources necessary to safely provide care for their patients, but also possess the necessary resources for taking care of themselves. Due to the negative impact on work performance and patient care, staff members should have easy access to simple and accessible mental, spiritual, emotional, and physical tools that allow staff members and managers to better manage their negative signs and symptoms of stress. Some of these tools can also be used as stress prevention measures within an organization’s overall Resilience Building Program.

Psychology Today defines resilience as “the psychological quality that allows some people to be knocked down by the adversities of life and come back at least as strong as before. Rather than letting difficulties, traumatic events, or failure overcome them and drain their resolve, highly resilient people find a way to change course, emotionally heal, and continue moving toward their goals.” Although there are probably both genetic and experiential factors that make some people more resilient than others, it is generally accepted that resilience can be learned.

Psychology Today goes on to say that “healthy habits – getting enough sleep, eating well, and exercising – can reduce stress which may, in turn, boost resilience. Similarly, … nurturing close relationships can help an individual find support when trouble arises.”

      If we want our front-line healthcare staff and managers to be resilient, and if we want them to possess the flexibility and adaptability to react in a positive manner to the frequently changing healthcare landscape, then it is incumbent upon healthcare leaders to create credible Resilience Building Programs for their organizations. This RBP should accommodate all staff members, including those with disabilities, and consideration should be given to incentivizing staff members to fully participate in the program.

Recommended Components of a Resilience Building Program

An organization’s Resilience Building Program should enhance staff and organizational readiness and resilience by improving the physical, emotional and psychological resilience of its staff and managers.

NOTE: Based upon similar US military experiences, we know that “employee” stress reactions can also affect immediate family members – as such, leaders should also consider allowing staff and managers’ immediate family members to fully participate in the organization’s RBP.

A Resilience Building Program should, at a minimum, be composed of a 3-part Resilience Building Triad. Credible RBPs will also provide training and ready access to stress management/wellness techniques for its employees.

This article will also describe an innovative and proactive Resilience Rounding Program developed and implemented by one Central Maryland healthcare system.

RESILIENCE BUILDING TRIAD

  The foundational Resilience Building Triad demonstrates leadership support and commitment for helping staff and managers to live healthier lives by making informed nutritional choices, by increasing their physical activity, and by attaining a restful sleep pattern (AKA Sleep Hygiene).

      *Nutrition and hydration have a direct impact on staff fitness and endurance. Nutrients, derived from food sources, provide the essential substances to maintain the functioning of the body while proper hydration provides a balance between the body’s water and electrolyte requirements. Managers and staff should be encouraged  to recognize the correlation between proper nourishment and hydration with positive performance benefits, and then be encouraged (and perhaps incentivized) to establish a healthy dietary regimen.

      *Physical Activity is a major component of the Resilience Building Triad. Organizational leaders should emphasize and encourage routine physical activity as an important aspect of the organization’s overall Resilience Building Program. Physical activity builds strength and increases stamina resulting in improved individual and ministry readiness. Regular exercise and physical activity can lead to long-term health benefits and reduce an employee’s risk for chronic diseases such as depression, diabetes, heart disease, high blood pressure, obesity, stroke and some forms of cancer (and in many cases, regular physical activity can improve these conditions for employees).

      *Sleep is a biological requirement, and it is critical for sustaining the mental abilities needed for success (this is especially true during the continuous operations being experienced in pandemic “hot spot” healthcare organizations). Everyone requires 7 to 8 hours of quality sleep every 24-hour period in order to sustain peak performance. Healthcare workers who lose sleep accumulate a “sleep debt” and, over time, this sleep debt can seriously impair performance. The only way to eliminate or reduce the sleep debt is by obtaining the needed sleep.  

STRESS MANAGEMENT/WELLNESS TECHNIQUES

In addition to the Resilience Building Triad, various techniques have been shown to relieve stress, promote wellness, and help individuals better manage both their life and work stressors. These techniques include:

*mindfulness

*meditation (some may also use prayer as a form of meditation)

      *deep breathing exercises

      *biofeedback

      *music therapy

      *aroma therapy

      *Yoga and/or Tai Chi

      *outdoor walks (around an employee’s work location; in their neighborhood; in a park; etc.) or indoor walks (in malls)

      *enjoying nature

For these techniques to be successfully incorporated into an organization’s Resilience Building Program, introductory training in these techniques should be the minimum investment required by organizational leaders. Organizations should also provide face-to-face (live), virtual, and/or distance learning access to these stress management/relaxation techniques to ensure staff members learn them and use them for their intended purpose.

A potential employee incentive for actively participating in an organization’s Resilience Building Triad, and for routinely utilizing the stress management/wellness techniques listed above, might be created by subsidizing an employee’s choice of exercise monitoring capabilities (Apple Watch; FitBit; Exercise applications for Smartphones; etc.) and Smartphone-based stress management applications for those employees who share their exercise, dietary, and stress management technique utilization data with the organization’s Employee Health Department.

RESILIENCE ROUNDING PROGRAM

One Central Maryland healthcare system realized early in the COVID-19 pandemic that it could not eliminate the multifaceted stress and suffering created by the crisis. Leaders also realized the stigma often attached to mental health diagnoses could result in healthcare workers not self-reporting their stress symptoms. To address this gap, the health system CEO asked the organization’s mission (spiritual) leader to create a Resilience Rounding Program designed to help and support the healthcare system’s front-line workers who might be adversely affected by Pandemic Related (healthcare) Stress. The resulting program created opportunities to:

     *Communicate directly with staff members working in high-volume, high-stress environments to provide active listening and empathy around any concerns

      *Promote and model resilient behaviors

      *Provide brief, supportive messaging to staff members

      *Provide and communicate “natural recovery” tools (healthy diet; quality sleep; exercise; mindfulness moments; deep breathing exercises; meditation; etc.)

      *Identify staff members who may be exhibiting the early warning signs for post-traumatic and/or pandemic related stress

      *Identify emerging issues that might require leadership intervention

    *Connect healthcare workers with available resources

    *Mitigate the development of more serious mental health disorders by connecting significantly impacts staff members with appropriate mental health or spiritual resources

  FINAL COMMENTS

The COVID-19 pandemic has caused many front-line healthcare workers to be negatively impacted by pandemic related stress. The Resilience Building and Resilience Rounding Programs described in Part 3 of this Pandemic Related (healthcare) Stress  series are designed to increase resilience and help staff, managers, and leaders better manage life and work stressors. “Doing nothing” cannot be the option chosen by healthcare leaders while their organizations are transitioning to a manageable pandemic workload (because it will most certainly result in many impacted healthcare workers becoming unavailable for the anticipated 2nd wave of the pandemic).