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As COVID-19 progresses into its ninth month, there is growing concern about long-term psychological consequences for frontline workers, and their inability to self-monitor.
Shell shock was a term first used during World War I to describe psychological trauma among soldiers who had served on the front lines. Researchers observing symptoms such as recurring nightmares, confusion, impaired sight and hearing eventually grouped them into what is now known as post-traumatic stress disorder, or PTSD.1
Not only are first responders experiencing symptoms of PTSD; they are increasingly unaware of the impact their stressful work environment is having on their physical and psychological well-being.
In addition to the fight-or-flight response triggered by long-term stress exposure, workers are concerned about spreading the disease to family members and suffer feelings of helplessness as patients succumb to the virus.2
Staffing shortages make those on the front lines feel guilty about taking time off for self-care, if that is even an option. Hospital workers feel increasingly isolated: unable to escape the ICU, emergency wards and/or hotels they are sequestered in, in order intermingle with their own social networks and gain needed support.3
Finally, there is the unspoken heartbreak of being unable to make physical contact with patients (e.g. the human touch), for fear of acquiring the infection themselves.4 Despite all of this, frontline workers remain inherently motivated to continue their work, with many explaining that to discontinue would be immoral or unethical.5 That’s a lot to keep on the plate for an interminable period of time.
The World Health Organization suggests the following self-care practices for healthcare management and frontline workers:
- Ensure that staff are aware of where and how they can access mental health and psychosocial support services.
- Orient all responders, including nurses, ambulance drivers… and workers in quarantine sites, on how to provide basic emotional and practical support to affected people using psychological first aid.
- Keep children close to their family and parents, if considered safe, and avoid separating children and their caregivers as much as possible.
- During times of stress, pay attention to your own needs and feelings. Try as much as possible to keep your personal daily routines or create new routines if circumstances change… For those who are forced to self-isolate, stay connected via telephone, email, social media or video conference.6
In addition, healthcare workers should be aware of self-assessment tools such as the Maslach Burnout Inventoryand complete it on a regular basis. My Own Health Report (MOHR) has the advantage of generating an electronic report that highlights areas of physical and psychological health in need of attention and suggests a path forward.
In challenging times, it is particularly important to protect those who have given the most to becoming second victims of the pandemic.
- Jones, E. (2012). Shell Shocked. American Psychological Association Monitor on Psychology. Vol. 43. No. 6. p. 18.
- Silman, A. (2020). Medical Worker’s Looming Mental Health Crisis. New York Magazine Intelligencer online. nymag/intelligencer/2020/medical-workers-looming-mental-health-crisis.
- Billings, J. et al. (2020). Healthcare workers’ experiences of working on the frontline and views about support during COVID-19 and comparable pandemics: A rapid review and meta-synthesis. Medrxiv preprint. Medrxiv.org/content/medrxiv/early/2020/06/23/2020.
- World Health Organization (WHO). (2020). Mental health and psychosocial considerations during the COVID-19 outbreak. who.org.
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