Healthcare workers experience mental health problems during and after pandemics

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Healthcare workers experience mental health problems during and after pandemics

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Healthcare workers experience mental health problems during and after pandemics

10/16/20


https://www.news-medical.net/news/20201 ... emics.aspx


Mental health problems such as Post-Traumatic Stress Disorder, anxiety and depression are common among healthcare staff during and immediately after pandemics – according to new research from the University of East Anglia.

Researchers investigated how treating patients in past pandemics such as SARS and MERS affected the mental health of front-line staff.

They found that almost a quarter of health-care workers (23.4 per cent) experienced PTSD symptoms during the most intense ‘acute’ phase of previous pandemic outbreaks – with 11.9 per cent of carers still experiencing symptoms a year on.

They also looked at data about elevated levels of mental distress and found that more than a third of health workers (34.1 per cent) experienced symptoms such as anxiety or depression during the acute phase, dropping to 17.9 per cent after six months. This figure however increased again to 29.3 per cent after 12 months or longer.

The team hope that their work will help highlight the impact that the Covid-19 pandemic could be having on the mental health of doctors and nurses around the world.


" We know that Covid-19 poses unprecedented challenges to the NHS and to healthcare staff worldwide. Nurses, doctors, allied health professionals and all support staff based in hospitals where patients with Covid-19 are treated are facing considerable pressure, over a sustained period. In addition to the challenge of treating a large volume of severely unwell patients, front line staff also have to contend with threats to their own physical health through infection, particularly as they have had to face shortages of essential personal protective equipment. The media has reported that healthcare workers treating coronavirus patients will face a ‘tsunami’ of mental health problems as a result of their work. We wanted to examine this by looking closely at the existing data from previous pandemics to better understand the potential impact of Covid-19. We estimated the prevalence of common mental health disorders in health care workers based in pandemic-affected hospitals. And we hope our work will help inform hospital managers of the level of resources required to support staff through these difficult times.”

- Prof Richard Meiser-Stedman, Norwich Medical School, UEA

A team of trainee clinical psychologists - Sophie Allan, Rebecca Bealey, Jennifer Birch, Toby Cushing, Sheryl Parke and Georgina Sergi - all from UEA’s Norwich Medical School, investigated how previous pandemics affected healthcare workers’ mental health, with support from Prof Meiser-Stedman and Dr Michael Bloomfield, University College London.

They looked at 19 studies which included data predominantly from the SARS outbreak in Asia and Canada, and which tended to focus on the acute stage of the pandemic - during and up to around six weeks after the pandemic.


" We found that post-traumatic stress symptoms were elevated during the acute phase of a pandemic and at 12 months post-pandemic. There is some evidence that some mental health symptoms such as Post Traumatic Stress symptoms get better naturally over time but we cannot be sure about this. The studies we looked at had very different methods - for example they used different questionnaires about mental health - so we need to be cautious about the results. We didn’t find any differences between doctors and nurses experiencing PTSD or other psychiatric conditions, but the available data was limited and more research is needed to explore this. Overall there are not enough studies examining the impact of pandemics on the mental health of healthcare staff. More research is needed that focuses on Covid-19 specifically and looks at the mental health of healthcare workers longer-term.”

- Sophie Allan, Norwich Medical School, UEA

‘The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis’ is published in the European Journal of Psychotraumatology on October 16, 2020.

Source:

University of East Anglia

Journal reference:


Allan, S.M., et al. (2020) The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis. European Journal of Psychotraumatology. doi.org/10.1080/20008198.2020.1810903.
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Re: Healthcare workers experience mental health problems during and after pandemics

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Fear and isolation drives PTSD among health/social workers in COVID-19

10/27/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


The load on health and social care workers (HSCWs) has been high, and sometimes overwhelming, during the course of the current COVID-19 pandemic. A new study, published on the preprint server medRxiv* in October 2020, identifies the factors that predict distress in HSCW and emphasizes the importance of adequate supplies of personal protective equipment (PPE).

HSCWs Are A High-Risk Group


The toll on the emotional and physical health of HSCWs was inevitable, considering the higher-than-usual risk of contagion to them and more challenging work conditions requiring a more demanding schedule as well as more extraordinary efforts. Moreover, it exposes them to the pain of watching suffering and death on a scale far more extensive than usual, which is likely to arouse anxiety and stress
.

Supportive interventions require knowledge of the risk factors for such anxiety peaks during future pandemics, including which category of HSCWs is at the highest risk. A general overview of risk factors operating on HSCWs is also useful.

Causes of Stress

Historical evidence demonstrates the higher risk of post-traumatic stress disorder (PTSD), depression, and anxiety, among other mental conditions, during HSCWs involved in the care of patients during a pandemic. This is so with those who work with potentially infectious patients, the nursing occupation, younger age, having dependent children, and female sex.

New evidence suggests that mental ill-health due to such fears is on the rise in many countries during the current pandemic, especially with higher infection rates and severe disease among healthcare workers.

Stress could be exacerbated by the inability to provide the desired level of care. This type of distress is called 'moral injury.' It is especially keen in areas such as Northern Italy where there was a need to select patients who would receive medical treatment due to the overwhelming health services.

High Rate of Infection of HSCWs Linked to Distress

About 10% of COVID-19 cases in England at the peak of the pandemic's first wave were in frontline HSCWs. This is linked to the perceived deterioration in the mental health of HCSW in the UK, as reported in an April 2020 survey, including the onset of depression, anxiety, and stress, and mental health problems.

Among UK nurses, too, according to an August 2020 survey, over three-quarters said they had higher stress levels since the beginning of the pandemic, with half expressing anxiety about their mental state.

Broader Spectrum of Study


The current study aims to examine risk factors for mental ill-health among HSCWs in the UK. In contrast to earlier studies, which have mostly explored medical professionals and some allied paramedical workers, the current study identifies risk factors for and compares rates of PTSD, depression, and anxiety in auxiliary hospital workers like cleaners, porters, and receptionists. It also looks into the impact of the pandemic on the mental health of social care workers.

The current study data comes from the Frontline-COVID study, which collated online survey data from May 27 to July 23, 2020. The average age was ~42 years, with over 90% being white and female.

Rates of Distress

Over three-quarters were in frontline health or social care for COVID-19 patients. Of these, ~18% had a history of confirmed COVID-19. Another ~13% suspected they had had it. This means almost one in three HSCWs were under stress from the feeling of having contracted a potentially deadly infection.

About a third reported resorting to alcohol or other drugs to ease their stress, more often than normal. At the same time, almost the same proportion said they could not express their fear or insecurity to their supervisor or another figure in authority.

Overall, ~58% met the diagnostic criteria for clinically significant distress for PTSD, depression, and anxiety, indicating that these disorders were prevalent among HSCWs during this pandemic phase.

Risk Factors: Lack of Support at Work

The researchers found that all HSCWs had the same levels of these disorders or symptoms, with the only significant differences between allied healthcare professionals and clinical support staff. The latter were consistently more affected.

They identified three variables that significantly predicted the occurrence of distress. Firstly, a third of HSCWs reported being unable to tell a manager about their inability to cope with the situation. This was linked with the highest rates of distress.

Strategies to train managers in healthcare to be more sensitive to and supportive of workers in distress are slowly entering the scene, and not too soon. Such interventions, including bringing in mental health professionals, are likely to be even more urgent for redeployed staff who were wrenched away from their old support systems. Other reasons for the perceived rift between workers and managers in healthcare should be examined in future studies.

Social Isolation

A second risk factor was the fear of carrying contagion. HSCWs who feel unprotected against infection are more likely to keep away from their loved ones to avoid transmitting infection.

Well over half of them indicated they were moderately to extremely worried about the risk of getting infected, while almost 80% were very anxious about the risk of transmitting the infection to others.

This agrees with earlier studies, which show that many more people are worried that they will transmit the infection to others than that they will catch it.

Social Stigma

The third risk factor was the feeling of being stigmatized due to the social perception (in over a third) that their role exposed those in contact with them to infection.

In addition to self-determined isolation, others may avoid interactions with HSCWs to minimize the chances of catching COVID-19 from them. This may hurt all the more because the HSCWs are putting themselves at risk for the sake of caring for other segments of society. The combination of poor social support and higher stress/distress levels is a well-known recipe for mental ill-health.

High PTSD Risk


PTSD was more likely among reassigned participants, as well as nurses and midwives. It was higher among individuals who feared becoming infected and among the group with the lowest household income (between £30,000-59,999).

Unlike earlier studies, all categories seemed to have an equally high risk of having PTSD symptoms, depression, and anxiety compared to nurses. However, most groups were too small to be separately assessed and were thus clubbed together in the heterogeneous "Others" group.
The Importance of PPE

Almost a third of HSCWs were frustrated by unreliable PPE supply, and this group had much higher rates of both anxiety and depression were in this group. The same was true of those who had any illness.

Nurses and midwives were at the highest risk for any illness than caregiving staff or allied healthcare professionals, doctors, or non-clinical staff. Finally, those with the highest income had the lowest chances of PTSD, anxiety, or any clinical illness.



The researchers point out, “These results indicate that it is paramount to provide adequate PPE to HSCWs throughout an infectious disease outbreak not only to protect their physical health but in order reduce the likelihood of mental distress.”

Implications and Future Directions


Further research will be required to explore the rates of COVID-19-related distress among all HSCWs. This group's predominant white female composition mandates more study on the potential for disproportionate impact on HSCWs identifying as Black, Asian, or other ethnic minority since other recent studies seem to indicate that this is the case.

The study's generalizability is limited by the self-reported nature of the data, as well as the convenience sampling and should be addressed in future studies.

Much of the observed distress is bound to decrease over time in the absence of any intervention for most participants. Therefore strategies should consider this factor. At the same time, it is necessary to identify those who will need care lest their symptoms become chronic or severe. This differentiation is, therefore, a priority. When the potential for future pandemics, and future waves of the current one, is considered, the need for such studies and targeted interventions is clear.

*Important Notice


medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:


Greene, T. et al. (2020). Predictors of PTSD, Depression and Anxiety in UK Frontline Health and Social Care Workers During COVID-19. medRxiv preprint. doi: https://doi.org/10.1101/2020.10.21.20216804. https://www.medrxiv.org/content/10.1101 ... 20216804v1
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Re: Healthcare workers experience mental health problems during and after pandemics

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Italian nurse on coronavirus duty sees the nightmare return

" I am having flashbacks that are heavy psychologically," she says.


https://www.tampabay.com/news/health/20 ... re-return/


MILAN — A 54-year-old nurse became convinced the coronavirus “hated” her during the first seven months of Italy’s outbreaks. Those are Cristina Settembrese’s words for it.

Settembrese, who specializes in treating patients with infectious diseases, faced huge risks during the long hours she spent in close contact with sick and dying COVID-19 patients. She was careful to scale her precautions to match and always tested negative despite getting exposed multiple times.

The nurse’s encounters with the coronavirus started Feb. 21, the day Italy’s first domestic cases were confirmed in the country’s north. Nurses and doctors were among the newly infected, so Settembrese immediately volunteered to care for people in Codogno, home to Italy’s patient zero and just an hour’s drive away from where she worked at Milan’s San Paolo Hospital.

Soon, her own hospital was under siege as the virus spread in the Lombardy region, its first foothold beyond Asia. Settembrese, a single mother, immediately sent her 24-year-old daughter to live with her parents. Alone at home, the nurse slept on the couch, partly to be ready in case she was called in to work, partly as a response to a trauma that took her by surprise.

When case numbers finally decreased and her hospital emptied of COVID-19 patients, she found it hard to share the relief she observed in other people, those who had not seen the trauma of her ward. On a short summer break, she saw the virus' fall return in the unmasked faces of fellow vacationers. And her worry grew.

Still, the resurgence came quicker -- and earlier -- than even Settembrese feared. This week alone, the number of cases in her hospital surged by one-third. It also showed up closer to home.

Italy’s brief virus respite


“By August, we had no more admissions for COVID. We had almost a month without any cases. And from September, instead we started to see again some pneumonia, then some patients with COVID, still not serious cases, and we closed the ward for patients with meningitis, tuberculosis, our usual patients. ... Then as the cases increased and the hospital admissions went up, the pneumonia got more aggressive, forcing them to reopen the intensive ward upstairs. The switch has happened: The virulence is much stronger, and we see it in the patients.”

The mid-October surge


“I can say on a numeric level, the numbers have soared. ... Nurses have been recalled from the wards they had gone back to. We are calling them back to help us, because alone we cannot keep up. There are just a few of us, and we cannot keep up with people who are wearing helmets (to assist breathing).”

Here, in her words, is her journey through the pandemic, so far.

The nightmare returns

"I am experiencing this very badly. I didn’t honestly expect to. I cried a lot, four months ago, I cried really a lot. I lost many young people, who I still carry with me. I hadn’t yet overcome these deaths. ... All of us nurses, we are feeling a psychological damage. I am experiencing this as a second wave, and I think we still have seen nothing.

"There are not the terrible deaths this time. Now, with the treatments, you manage to avoid these intensive therapies. We have found a pseudo-palliative treatment, let’s say. We know how to manage the cases better.

“But I am experiencing it inside exactly like before. For us, it is like reliving a nightmare.”

Looking back at Italy’s remarkably relaxed summer


"I had seven or eight days of vacation and I joined my mother in Riccione (on the Adriatic Sea), and I was an alien. I was seeing everyone without masks, this beach full of people. Crowds in the bars. And the only ones with masks were the Lombards, and the others, all without.

“I told them all off. It was as if I was in a frenzy. I would say, ‘Move apart and put on the masks.’ I was extremely worried. I would watch and think about October, and I would say to my mother and daughter, ‘With the free-for-all that is happening, we will be facing disaster.’ Everyone told me I was an alarmist, even friends. I told them: ‘I am not an alarmist. I have worked in the infectious diseases ward for 12 years, and the virus will return. Because all viruses return in October. And this one won’t be missing, for sure.’”

Flashbacks from a pandemic


"This young man still pulls at my heart. It is a terrible, terrible story. He was a 42-year-old guy. When he arrived, he was in pretty good shape, then we had to intubate him, with the anesthesiologist. I held his hands, and he said, ‘Cristina, swear to me that I will wake up, because I have two small children.’ And to help him go to sleep calmly, I promised him. It is a promise I could not keep, because after four or five days, the patient died. I was a mess. I am still carrying this.

“Often, when I go into a room, I see the people who were there before. All the beds have faces. They have faces that I remember. Sometimes I have nightmares, I am not ashamed to say. I am having flashbacks that are heavy psychologically. ... I still cannot go to sleep in a bed because I associate it with illness, something I never felt in 35 years working as a nurse. Slowly, I will get over it. But I have been sleeping on the sofa since March. I cannot get in a bed.”

Hitting home

"The other day I was destroyed, as if I had spent the whole day doing backbreaking work in the fields. When I couldn’t smell or taste anything, I went and got tested. Damn! I can say I am positive, but I don’t have major symptoms. I don’t have a fever, just some coughing and aches everywhere, like a terrible, terrible flu.

“In the end, the virus doesn’t hate me. My defenses were down. I worked too many hours, always wearing a mask and maintaining a distance. I have no idea where I got it. Now my daughter, who came here a few times to eat between shifts, has a fever, with a headache. She had a test yesterday. I am very worried, and feel very guilty.”
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Study: 68% of people believe they should ‘reach out’ to carers during coronavirus second wave

11/16/20


https://www.news-medical.net/news/20201 ... -wave.aspx

Amidst a coronavirus second wave, a study has found that 68% of people believe they should ‘reach out’ to carers more often – with 60% of respondents only asking carers how they are ‘now and again’, ‘rarely’ or ‘almost never’; leaving carers at risk of feeling forgotten.

Furthermore, 72% of respondents worried that carers struggled with ‘loneliness’ thanks to the full-on nature of care leaving them little time for socialising.

Throughout the pandemic, caregivers have been at the forefront of the fight, looking after the most vulnerable in society and putting their own lives on the line to do so. In light of this, a campaign called #ReachOutAndHelpOut has been launched to encourage support for carers as they continue to deliver essential care to those in need – amidst fears that carers’ wellbeing is often overlooked.

Spearheaded by Sentai, a British technology start-up focused on helping the elderly live more independently in their own homes, the campaign looks to highlight the vital role that carers play – be that professional carers or those looking after friends or loved ones.

Respondents, mindful of the associated health impact of winter, believe the biggest fears to be faced by carers in coming months is another ‘national lockdown’ (60%), while 53% of respondents saw ‘excessive workload’ as a primary worry. 50% also believed ‘difficulty visiting family and friends due to their care commitments’ was a central concern, while ‘juggling different responsibilities’ was a key issue according to 46%.

Other concerns included ‘lack of time’ (32.9%) and carers ‘feeling they’re not doing enough’ (25%).

Professor Ray Jones, Professor of Health Informatics at Plymouth University and director of eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC), which focuses on the provision of internet based healthcare services (eHealth) voiced his support for the campaign, highlighting the difficulties carers face.

" The impact of the coronavirus crisis has been profound on almost all aspects of society. For carers though, this impact has been magnified to a far higher degree. The physical and psychological toll of caring during a pandemic is huge. We must be mindful of the burden placed on carers and do what we can to help. The service they provide is essential, and we’re all indebted to their hard work. The very least we can do then is simply ask them how they’re doing and offer whatever assistance we’re able to give.”

- Professor Ray Jones, Professor of Health Informatics at Plymouth University and director of EPIC

These sentiments were echoed by Philip Marshman, founder of Sentai and orchestrator of #ReachOutAndHelpOut, who said: “The role of a carer is often overlooked. It’s all too easy to ask how the recipient of care is without extending that concern beyond to take into account the person looking after them. Carers are people, not robots, and now, more than ever we must do what we can to consider and support their wellbeing and mental health.”

As of today (November 12th), Sentai has launched a Kickstarter campaign to raise funds for the next stage of its smart device development, the success of which will see its pioneering technology brought to mass market – allowing those in need to benefit from its advanced offering.


" The experience of looking after my own father led me to create Sentai, and it’s been developed to help both the care recipient and the caregiver. Through revolutionary voice technology it initiates intelligent conversations, helping to alleviate boredom and loneliness, while also providing helpful reminders. It’s safety properties also allow the caregiver to monitor the care recipient remotely and unobtrusively, providing reassurance that the care recipient is OK and acting as normal, thereby helping to ease stress and worry for the caregiver.”

- Philip Marshman, Founder of Sentai and orchestrator of #ReachOutAndHelpOut

He added: “We have everything in place to deliver a successful solution – we want to get Sentai into people’s homes as quickly as possible – whether that’s someone’s own home, or a care home. Raising funds in this way means we can stay true to our mission which is helping people live more independently, for longer.”
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Long-term care workers, grieving and under siege, brace for COVID’s next round

11/16/20


https://www.news-medical.net/news/20201 ... round.aspx


In the middle of the night, Stefania Silvestri lies in bed remembering her elderly patients' cries.


"Help me."

"Please don't leave me."

"I need my family."

Months of caring for older adults in a Rhode Island nursing home ravaged by COVID-19 have taken a steep toll on Silvestri, 37, a registered nurse.

She can't sleep, as she replays memories of residents who became ill and died. She's gained 45 pounds. "I have anxiety. Some days I don't want to get out of bed," she said.

Now, as the coronavirus surges around the country, Silvestri and hundreds of thousands of workers in nursing homes and assisted living centers are watching cases rise in long-term care facilities with a sense of dread.

Many of these workers struggle with grief over the suffering they've witnessed, both at work and in their communities. Some, like Silvestri, have been infected with the coronavirus and recovered physically — but not emotionally.

Since the start of the pandemic, more than 616,000 residents and employees at long-term care facilities have been struck by COVID-19, according to the latest data from KFF. Just over 91,000 have died as the coronavirus has invaded nearly 23,000 facilities. (KHN is an editorially independent program of KFF.)

At least 1,000 of those deaths represent certified nursing assistants, nurses and other people who work in institutions that care for older adults, according to a recent analysis of government data by Harold Pollack, a professor at the School of Social Service Administration at the University of Chicago. This is almost certainly an undercount, he said, because of incomplete data reporting.

How are long-term care workers affected by the losses they're experiencing, including the deaths of colleagues and residents they've cared for, often for many years?

Edwina Gobewoe, a certified nursing assistant who has worked at Charlesgate Nursing Center in Providence, Rhode Island, for nearly 20 years, acknowledged "it's been overwhelming for me, personally."

At least 15 residents died of COVID-19 at Charlesgate from April to June, many of them suddenly. "One day, we hear our resident has breathing problems, needs oxygen, and then a few days later they pass," she said. "Families couldn't come in. We were the only people with them, holding their hands. It made me very, very sad."

Every morning, Gobewoe would pray with a close friend at work. "We asked the Lord to give us strength so we could take care of these people who needed us so much." When that colleague was struck by COVID-19 in the spring, Gobewoe prayed for her recovery and was glad when she returned to work several weeks later.

But sorrow followed in early September: Gobewoe's friend collapsed and died at home while complaining of unusual chest pain. Gobewoe was told that her death was caused by blood clots, which can be a dangerous complication of COVID-19.

She would "do anything for any resident," Gobewoe remembered, sobbing. "It's too much, something you can't even talk about," describing her grief.

I first spoke to Kim Sangrey, 52, of Lancaster, Pennsylvania, in July. She was distraught over the deaths of 36 residents in March and April at the nursing home where she's worked for several decades — most of them due to COVID-19 and related complications. Sangrey, a recreational therapist, asked me not to name the home, where she continues to be employed.

"You know residents like family — their likes and dislikes, the food they prefer, their families, their grandchildren," she explained. "They depend on us for everything."

When COVID-19 hit, "it was horrible," she said. "You'd go into residents' rooms and they couldn't breathe. Their families wanted to see them, and we'd set up Zoom wearing full gear, head to toe. Tears are flowing under your mask as you watch this person that you loved dying — and the family mourning their death through a tablet."

"It was completely devastating. It runs through your memory — you think about it all the time."

Mostly, Sangrey said, she felt empty and exhausted. "You feel like this is never going to end — you feel defeated. But you have to continue moving forward," she told me.

Three months later, when we spoke again, COVID-19 cases were rising in Pennsylvania but Sangrey sounded resolute. She'd had six sessions with a grief counselor and said it had become clear that "my purpose at this point is to take every ounce of strength I have and move through this second wave of COVID."

"As human beings, it is our duty to be there for each other," she continued. "You say to yourself, OK, I got through this last time, I can get through it again."

That doesn't mean that fear is absent. "All of us know COVID-19 is coming. Every day we say, 'Is today the day it will come back? Is today the day I'll find out I have it?' It never leaves you."

To this day, Silvestri feels horrified when she thinks about the end of March and early April at Greenville Center in Rhode Island, where up to 79 residents became ill with COVID-19 and at least 20 have died.

The coronavirus moved through the facility like wildfire. "You're putting one patient on oxygen and the patient in the next room is on the floor but you can't go to them yet," Silvestri remembered. "And the patient down the hall has a fever of 103 and they're screaming, 'Help me, help me.' But you can't go to him either."

"I left work every day crying. It was heartbreaking — and I felt I couldn't do enough to save them."

Then, there were the body bags. "You put this person who feels like family in a plastic body bag and wheel them out on a frame with wheels through the facility, by other residents' rooms," said Silvestri, who can't smell certain kinds of plastic without reliving these memories. "Thinking back on it makes me feel physically ill."

Silvestri, who has three children, developed a relatively mild case of COVID-19 in late April and returned to work several weeks later. Her husband, Michael, also became ill and lost his job as a truck driver. After several months of being unemployed, he's now working at a construction site.

Since July 1, the family has gone without health insurance, "so I'm not able to get counseling to deal with the emotional side of what's happened," Silvestri said.

Although her nursing home set up a hotline number that employees could call, that doesn't appeal to her. "Being on the phone with someone you don't know, that doesn't do it for me," she said. "We definitely need more emotional support for health care workers."

What does help is family. "I've leaned on my husband a lot and he's been there for me," Silvestri said. "And the children are OK. I'm grateful for what I have — but I'm really worried about what lies ahead."
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For nurses feeling the strain of the pandemic, virus resurgence is ‘paralyzing’

11/24/20


https://www.news-medical.net/news/20201 ... 28099.aspx


For Christina Nester, the pandemic lull in Massachusetts lasted about three months through summer into early fall. In late June, St. Vincent Hospital had resumed elective surgeries, and the unit the 48-year-old nurse works on switched back from taking care of only COVID-19 patients to its pre-pandemic roster of patients recovering from gallbladder operations, mastectomies and other surgeries.

That is, until October, when patients with coronavirus infections began to reappear on the unit and, with them, the fear of many more to come. "It's paralyzing, I'm not going to lie," said Nester, who's worked at the Worcester hospital for nearly two decades. "My little clan of nurses that I work with, we panicked when it started to uptick here."

Adding to that stress is that nurses are caught betwixt caring for the bedside needs of their patients and implementing policies set by others, such as physician-ordered treatment plans and strict hospital rules to ward off the coronavirus. The push-pull of those forces, amid a fight against a deadly disease, is straining this vital backbone of health providers nationwide, and that could accumulate to unstainable levels if the virus's surge is not contained this winter, advocates and researchers warn.

Nurses spend the most sustained time with a patient of any clinician, and these days patients are often incredibly fearful and isolated, said Cynda Rushton, a registered nurse and bioethicist at Johns Hopkins University in Baltimore.

"They have become, in some ways, a kind of emotional surrogate for family members who can't be there, to support and advise and offer a human touch," Rushton said. "They have witnessed incredible amounts of suffering and death. That, I think, also weighs really heavily on nurses."

A study published this fall in the journal General Hospital Psychiatry found that 64% of clinicians working as nurses, nurse practitioners or physician assistants at a New York City hospital screened positively for acute distress, 53% for depressive symptoms and 40% for anxiety — all higher rates than found among physicians screened.

Researchers are concerned that nurses working in a rapidly changing crisis like the pandemic — with problems ranging from staff shortages that curtail their time with patients to enforcing visitation policies that upset families — can develop a psychological response called "moral injury." That injury occurs, they say, when nurses feel stymied by their inability to provide the level of care they believe patients require.

Dr. Wendy Dean, co-founder of Moral Injury of Healthcare, a nonprofit organization based in Carlisle, Pennsylvania, said, "Probably the biggest driver of burnout is unrecognized unattended moral injury."

In parts of the country over the summer, nurses got some mental health respite when cases declined, Dean said.

"Not enough to really process it all," she said. "I think that's a process that will take several years. And it's probably going to be extended because the pandemic itself is extended."

Sense of powerlessness

Before the pandemic hit her Massachusetts hospital "like a forest fire" in March, Nester had rarely seen a patient die, other than someone in the final days of a disease like cancer.

Suddenly she was involved with frequent transfers of patients to the intensive care unit when they couldn't breathe. She recounts stories, imprinted on her memory: The woman in her 80s who didn't even seem ill on the day she was hospitalized, who Nester helped transport to the morgue less than a week later. The husband and wife who were sick in the intensive care unit, while the adult daughter fought the virus on Nester's unit.

"Then both parents died, and the daughter died," Nester said. "There's not really words for it."

During these gut-wrenching shifts, nurses can sometimes become separated from their emotional support system — one another, said Rushton, who has written a book about preventing moral injury among health care providers. To better handle the influx, some nurses who typically work in noncritical care areas have been moved to care for seriously ill patients. That forces them to not only adjust to a new type of nursing, but also disrupts an often-well-honed working rhythm and camaraderie with their regular nursing co-workers, she said.

At St. Vincent Hospital, the nurses on Nester's unit were told one March day that the primarily postsurgical unit was being converted to a COVID unit. Nester tried to squelch fears for her own safety while comforting her COVID-19 patients, who were often elderly, terrified and sometimes hard of hearing, making it difficult to communicate through layers of masks.

"You're trying to yell through all of these barriers and try to show them with your eyes that you're here and you're not going to leave them and will take care of them," she said. "But yet you're panicking inside completely that you're going to get this disease and you're going to be the one in the bed or a family member that you love, take it home to them."

When asked if hospital leaders had seen signs of strain among the nursing staff or were concerned about their resilience headed into the winter months, a St. Vincent spokesperson wrote in a brief statement that during the pandemic "we have prioritized the safety and well-being of our staff, and we remain focused on that."

Nationally, the viral risk to clinicians has been well documented. From March 1 through May 31, 6% of adults hospitalized were health care workers, one-third of them in nursing-related occupations, according to data published last month by the Centers for Disease Control and Prevention.

As cases mount in the winter months, moral injury researcher Dean said, "nurses are going to do the calculation and say, 'This risk isn't worth it.'"

Juliano Innocenti, a traveling nurse working in the San Francisco area, decided to take off for a few months and will focus on wrapping up his nurse practitioner degree instead. Since April, he's been seeing a therapist "to navigate my powerlessness in all of this."

Innocenti, 41, has not been on the front lines in a hospital battling COVID-19, but he still feels the stress because he has been treating the public at an outpatient dialysis clinic and a psychiatric hospital and seen administrative problems generated by the crisis. He pointed to issues such as inadequate personal protective equipment.

Innocenti said he was concerned about "the lack of planning and just blatant disregard for the basic safety of patients and staff." Profit motives too often drive decisions, he suggested. "That's what I'm taking a break from."

Building resiliency

As cases surge again, hospital leaders need to think bigger than employee assistance programs to backstop their already depleted ranks of nurses, Dean said. Along with plenty of protective equipment, that includes helping them with everything from groceries to transportation, she said. Overstaff a bit, she suggested, so nurses can take a day off when they hit an emotional cliff.

The American Nurses Association, the American Association of Critical-Care Nurses (AACN) and several other nursing groups have compiled online resources with links to mental health programs as well as tips for getting through each pandemic workday.

Kiersten Henry, an AACN board member and nurse practitioner in the intensive care unit at MedStar Montgomery Medical Center in Olney, Maryland, said that the nurses and other clinicians there have started to gather for a quick huddle at the end of difficult shifts. Along with talking about what happened, they share several good things that also occurred that day.

"It doesn't mean that you're not taking it home with you," Henry said, "but you're actually verbally processing it to your peers."

When cases reached their highest point of the spring in Massachusetts, Nester said there were some days she didn't want to return.

"But you know that your friends are there," she said. "And the only ones that really truly understand what's going on are your co-workers. How can you leave them?"
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Re: Healthcare workers experience mental health problems during and after pandemics

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Analysis of social media messages reveals struggles of care home staff during COVID-19 first wave

12/1/20


https://www.news-medical.net/news/20201 ... -wave.aspx


Analysis of social media messages between care home staff on the coronavirus front line reveal their growing concerns over how to manage in the face of the virus. Thousands of Whatsapp messages between 250 care home workers during the first coronavirus wave show workers were often asking questions which went unanswered due to a lack of proper guidance.

Staff asked where to purchase PPE; whether guidelines existed for isolating residents returning from hospital and how they could access testing. But guidance either did not exist, was conflicting, or staff were not aware of it. Care home staff formed the messaging group themselves in partnership with colleagues to offer support during the first wave. As group members, researchers at the University of Leeds analyzed the questions and uncertainties raised.

They found most of the questions were about infection control and prevention and could have been tackled immediately through timely, responsive, and unambiguous fact-based guidance. But their analyses revealed scant guidance for care homes meant these basic needs were unmet.


" This report highlights the isolation of care homes and their staff and the shortcomings of the 'arm's length' approach to the commissioning of these services. We need much more sector informed research to improve the outcome of those in receipt of care and the highest quality of care available to meet their needs. This will only be done by much closer collaboration."

- Peter Hodkinson, Managing Director of Leeds care home company Westward Care Ltd

The paper, Seeking Answers for Care Homes during the COVID-19 pandemic (COVID SEARCH), has been published in the journal Age and Ageing. The social media messages reveal staff concerns over residents' wellbeing and relatives' anxieties; uncertainties over which symptoms predicted the need for self-isolating, and questions about how long staff with symptoms should self-isolate.

Other questions around the most effective strategies for resident and staff wellbeing, recruitment, communication, and organizational impact needed further research, the group said. It is the first systematic capture of the questions and uncertainties expressed by care home staff in the early stages of the COVID-19 pandemic. The study has identified other areas of research which, importantly, have been informed by the sector itself.

Professor Karen Spilsbury, Chair in Nursing Research at Leeds' School of Healthcare, said: "COVID-19 has tragically impacted on long-term care worldwide, particularly for older people living in care homes. “The pandemic has created new and unanticipated uncertainties for care home staff caring for older people.

"Scant care home-specific guidance during the early stages meant that basic information needs of care home staff were not satisfied. “Professor Spilsbury said policy makers, commissioners and regulators should make answering these questions a priority and called for investment for research into the evidence produced by the study.

" The experiences of care home staff should serve to focus the evidence-based response to the pandemic in care homes. We want to see care home providers and staff given timely, responsive and unambiguous guidance as they learn to live with and manage COVID-19."

- Professor Spilsbury,Chair in Nursing Research at Leeds' School of Healthcare

The work was carried out in partnership with care providers Springfield Healthcare and Westward Care under the NICHE-Leeds research and innovation program.

Cyd Akrill, Chief Nursing Officer for Springfield Healthcare, said: "In the early weeks of the pandemic it was frustrating and time consuming because guidance was often conflicting, and the amount of advice was not always helpful. This research brought shared uncertainties together and helped us consider how they could be addressed. We were listened to and this was important. Our partnership with NICHE-Leeds yet again was invaluable not only to us but nationally and internationally."

Professor Carl Thompson, Dame Kathleen Raven Chair in Clinical Research at Leeds, said: "The basis for the kinds of evidence that can truly make a difference to the lives of people living and working in care homes are the uncertainties that people are struggling to address without reliable high-quality research that tackles what really matters. This is the first research to shine a light on these uncertainties, the questions that people have in homes and the research that can help."

Professor Adam Gordon, President-Elect of the British Geriatrics Society, said: "These research findings show us that care home staff were weeks, if not months, ahead of the government guidance when it came to identifying the most important areas of concern around the pandemic. They tell us that that those who write guidance for the sector need to develop better ways of rapidly consulting with and collating advice from care home staff. If we give these professionals a stronger voice, we will make the right decisions quicker, and with greater certainty."

Source:


University of Leeds

Journal reference:


Spilsbury, K. et al. (2020) SEeking AnsweRs for Care Homes during the COVID-19 pandemic (COVID SEARCH). Age and Ageing. doi.org/10.1093/ageing/afaa201
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Re: Healthcare workers experience mental health problems during and after pandemics

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How has the COVID-19 pandemic affected the wellbeing of healthcare workers?

12/21/20


https://www.news-medical.net/news/20201 ... rkers.aspx


Amid the coronavirus disease 2019 (COVID-19) pandemic, healthcare workers (HCW) have been overworked and faced with the risk of being infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2), the causative pathogen of COVID-19.

A new study by US-based researchers – at the Northwest Mental Illness Research, Education and Clinical Center and Columbia University – has found that healthcare workers have experienced significant psychiatric distress during the pandemic.

The coronavirus pandemic


The coronavirus pandemic first emerged in Wuhan City, China, in December 2019. Since then, it has spread to 191 countries and territories, infecting over 76.79 million and killing more than 1.69 million people.

Due to the scale and speed of the virus's spread, many countries' healthcare systems were overwhelmed, and hospitals faced a shortage of intensive care unit (ICU) beds, personal protective equipment (PPE), and personnel.

The impact of the prolonged physical and emotional stress on HCW and first responders (FR) working during the pandemic has attracted significant attention in the media. Previous studies have also tackled the physical and emotional stressors among these workers, linked with significant personal distress and decreased professional longevity.

Previous studies have tied the pandemic to higher psychiatric symptoms among healthcare workers, including depression, insomnia, anxiety, and post-traumatic stress disorder (PTSD).

A study in New York found increased use of medical leave, leading to decreased workforce availability among healthcare workers.

Significant psychiatric distress


The study, which appeared on the preprint medRxiv* server, aimed to determine the relationship between COVID-19 stressor frequency and psychiatric rating scale scores among HCW/FR. The team also wanted to determine if the psychiatric rating scale scores affect the perceived work function and work longevity.

To arrive at the study findings, the team assessed the rate of depression, insomnia, anxiety, and PTSD symptoms in both traditionally defined HCW, as well as in FR, such as police officers, firefighters, and EMTs working during the pandemic.

The study involved 118 HCWs and FR caring for COVID-19 patients in the United States. The team used the PTSD checklist (PCL5), the Patient Health Questionnaire (PHQ9) for depression, the Insomnia Severity Index (ISI), and the General Anxiety Disorder 7 (GAD7).

The team has found that 31% of the 104 participants who completed the COVID-19 occupational exposure assessment had been ill with known or likely COVID-19. Another 19% reported a close family member who had been ill with known or likely COVID-19, and 12% reported the death of a family member due to COVID-19. About 30% also said that they had underlying health conditions that placed them at an increased risk of COVID-19.

The team revealed that 26% of the participants had a total PCL5 score of 31 or higher, indicating PTSD symptoms. These are symptoms that are usually experienced after traumatic stress. In terms of depressive symptoms, 60% of the participants had a total PHQ9 score that is above the standard threshold for mild depression, and 28% had an ISI score for least moderate insomnia. Lastly, 67% had a GAD7 score for mild anxiety.

" These results direct attention to recognizing potentially treatable psychiatric symptoms, particularly those of PTSD, in HCW and FR experiencing COVID-19 related stressors," the researchers concluded.

The study findings showed that the HCW/FR's experiences during the pandemic had impacted their interest, willingness, or ability to continue working in their current field.

A substantial proportion of both groups reported their likelihood of staying in their current field had been somewhat or significantly decreased by their experiences working during the Covid-19 pandemic, and that they at least sometimes have trouble completing all of their usual or important work," the researchers added.

The researchers suggest mitigating COVID-19-related stressors among HCWs and FRs when possible, such as by providing adequate PPE and other measures. These can help improve their mental health, work function, and retention in the healthcare workforce.

*Important Notice


medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Source:

COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) - https://gisanddata.maps.arcgis.com/apps ... 7b48e9ecf6

Journal reference:

Hendrickson, R., Slevin, R., Chang, B., Sano, C. E., McCall, C., and Raskind, M. (2020). The impact of working during the Covid-19 pandemic on health care workers and first responders: mental health, function, and professional retention. medRxiv. doi: https://doi.org/10.1101/2020.12.16.2024 ... 20248325v1
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Re: Healthcare workers experience mental health problems during and after pandemics

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I posted the preceding articles on this thread because TSOI is currently in a Phase 2 clinical trial of 500 healthcare volunteers for the prevention of Covid 19 using QuadraMune .

For more details :

https://clinicaltrials.gov/ct2/show/NCT04421391
trader32176
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Re: Healthcare workers experience mental health problems during and after pandemics

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Study finds a distinct shift in method of nurse suicides

12/22/20


https://www.news-medical.net/news/20201 ... cides.aspx


In a new study, University of California San Diego School of Medicine and UC San Diego Health researchers report that the rate of firearm use by female nurses who die by suicide increased between 2014 to 2017. Published December 21, 2020 in the journal Nursing Forum, the study examined more than 2,000 nurse suicides that occurred in the United States from 2003 to 2017 and found a distinct shift from using pharmacological poisoning to firearms, beginning in 2014.

As part of the longitudinal study, researchers looked at data provided by the Centers for Disease Control and Prevention's National Violent Death Reporting System dataset.

" In past research, we determined opioids or other medications were more commonly used as the suicidal method in female nurses. From those findings, there was a possibility that there might be a change in the way nurses die by suicide over time. Now that we've looked at the data with a focus on firearms, we are finding that shift and it's resulted in an increase in female nurses sadly taking their own life through the use of firearms."

- Judy Davidson, DNP, RN, Senior Author, Research Scientist, UC San Diego

The World Health Organization reports that one person dies every 40 seconds by suicide, occurring at a rate of 10 per 100,000 persons. While overall mortality rates are decreasing in the U.S., the suicide rate is rising, and many fear the COVID-19 pandemic may accelerate this rise.

"Unfortunately it's very common for suicide rates to increase in conjunction with world health emergencies. We've seen it happen before during such events, including the Ebola and SARS epidemics, and we're seeing it happen now with the COVID-19 pandemic," said co-author Sidney Zisook, MD, professor of psychiatry at UC San Diego School of Medicine. "The use of firearms in death by suicide is more common amongst male nurses, so it's alarming to see this increase among female nurses now as well."

According to Davidson, many of the individuals who died by suicide all included three similar situations: use of firearm, previous attempt and known depression.

"Those three elements together represent preventable deaths of individuals experiencing very similar circumstances," said Davidson. "If the firearm had been removed from the home, research tells us these deaths may not have happened. It is vital that we inform the public about firearm safety, especially during high-risk times, such as those we're facing now."

Since 2009, UC San Diego has offered the Healer Education, Assessment and Referral Program, otherwise known as HEAR, to address the high prevalence of burnout, stress and depression specific to the health care community. HEAR provides education about risk factors and proactive screening focused on identifying, supporting and referring clinicians for untreated depression and/or suicide risk. HEAR has been acclaimed as a best practice in suicide prevention by the American Nurses Association and American Medical Association.

Co-founded by Zisook, the HEAR program was first targeted to prevent suicides in physicians and is now inclusive of all UC San Diego Health staff and faculty. The program has been replicated by other institutions throughout the country.

"As we enter the holiday season, amid a pandemic that's lasted more than 11 months now, we are concerned about members of our health care community in need of support during such a challenging time," said co-author Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention. "In 2020, there has been an unprecedented increase in the purchase of firearms across the country. This is sobering information. But there are evidenced-based approaches to suicide prevention that our community can benefit from, potentially leading to a life saved."

According to the team, tested approaches to preventing suicide include:

1.Removing lethal means from a person who is in the process of being treated for depression.

2.If in the home, ensure firearms are locked and ammunition is stored separately. If the person with suicidal ideation lives alone with a firearm in the home, make arrangements to remove it while the person is being treated for depression.

3.Increase contact. Loneliness is a risk factor for those who are depressed so increased social presence through phone calls, or virtually, can help significantly.

"Nurses are being challenged now in ways they never have before and suicide risk among nurses is higher than the general population," said Davidson. "It's important to know that people who are considering suicide are not alone and action is being taken to protect our nursing workforce. Help is available and we are here to get our team through this challenging time, together."
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