We are navigating uncharted waters in the COVID-19 pandemic. Health care professionals face an increased risk for compounded stress and burnout in the wake of this global crisis. Although information about the novel coronavirus develops at a rapid pace daily, the need to monitor and manage stress remains paramount. The health and well-being of all health care professionals is integral to ensuring health care systems can keep up with the needs of COVID-19 patients.
Burnout is defined as a syndrome of emotional exhaustion, depersonalization of others, and a feeling of reduced personal accomplishment. A 2009 study of members of the American College of Surgeons found that 40% of surgeons experienced burnout. It appears safe to assume that many surgeons working on the front lines of the COVID-19 pandemic were at high risk for burnout before the beginning of the outbreak. Signs of burnout include sadness, depression, irritability, frustration, isolation, poor hygiene, social isolation, feelings of hopelessness, and low job satisfaction.
Health care professionals working in this pandemic are also at higher risk for secondary traumatic stress. Secondary traumatic stress is stress reactions resulting from exposure to another person’s traumatic experiences, rather than from direct exposure to a traumatic event. Signs of secondary traumatic stress mimic those of post-traumatic stress disorder, but the most common are excessive fear or worry, startle response, ruminations about the traumatic event, and sleep disturbance.
Self-care can be challenging for health care workers, many of whom are conditioned to prioritize the needs and care of patients over their own. It is important to keep personal well-being in mind and manage stress to prevent physical, mental, and emotional exhaustion. Here are seven tips for managing stress and fostering emotional resilience to prevent burnout while providing critical health services during the pandemic.
1. Know that what you’re feeling is a normal stress response.
Health care professionals are encountering stressors that may include direct exposure to COVID-19 while treating patients, loss of patients to death, deciding how to allocate sparse resources, working longer hours, and extended periods away from loved ones. As a result, physicians are experiencing an increased frequency of stress responses throughout the course of a day. Exercise self-compassion and give yourself grace, as all medical professionals working during this crisis are experiencing distress.
2. Engage in consistent self-reflection to identify the emotional and mental signs of stress.
Take a few moments at different points throughout the day for a personal mental health check-in. It may feel as if there’s no time to spare, but this is a critical aspect of managing stress. Some emotional signs of stress include the persistence of fear, irritability, anger, deep sadness, and overwhelmed feeling. Mental signs include loss of concentration, local memory loss, inability to make decisions, disorientation, and confusion.
Stress arousal occurs as physical, mental, and emotional reactions to stressors. Try incorporating breathing exercises in your daily self-care routine to help calm the body’s reactions to the stressors you encounter throughout the day.
3. Prioritize your basic needs.
In times of crisis, we tend to ignore our basic needs, including food, water, exercise, and sleep. To reduce stress and prevent burnout, try as best as possible to eat at least three balanced meals every day while avoiding inflammatory ingredients such as sugar, trans fats, saturated fats, and alcohol. Drink water throughout the day to stay hydrated. Exercise or take walks for at least a few minutes daily to maximize the release of endorphins. As far as possible, set a routine time for bed to gain the benefits of quality sleep.
4. Take brief mental breaks throughout the day.
Health care professionals often urge patients to prioritize self-care while dismissing the need for their own. It’s important to take scheduled breaks to rest your mind and reset. Find a quiet space during your work breaks or at home when off-duty. It’s important to be mindful of any internal chatter that may try to convince you that you don’t have enough time for a break or don’t deserve it. Ignore the chatter and take a break anyway.
5. Incorporate sensory-soothing techniques to facilitate calm and relaxation.
Research supports the effectiveness of embracing sensory-soothing activities to calm the nervous system and promote healing from trauma. Be intentional in taking time throughout the day to engage in sensory-soothing techniques, such as listening to your favorite calming music, visualizing the places where you tend to feel at peace, and imagining your favorite culinary aromas that trigger meaningful memories.
6. Create and nurture supportive connections with your colleagues.
Check-in with your colleagues and remain open to receiving support in return. Talk to them about your feelings, experiences, and accomplishments each day. The validation will help normalize your experiences and prevent feelings of isolation and moral distress. Consistent focus on the harsh realities of the pandemic can often overshadow the bright side, such as patient recovery and discharge and reductions in new COVID-19 diagnoses on a given day. Be sure to talk about the positive things occurring within your facility and personally during this crisis.
7. Seek professional support to cope with moral distress and grief.
Many health care professionals are encountering unprecedented circumstances that may cause moral injury. Decisions such as which patient is placed on a ventilator or prioritizing the treatment of COVID-19 over other chronic illnesses can result in moral distress. Symptoms of moral distress include self-criticism and excessive feelings of shame, guilt, and regret. This moral distress and anticipatory grief can be difficult to cope with, and additional support is needed to address their harmful effects.
Early support is key for addressing trauma from moral distress. Seek peer, supervisory, and external professional support to cope with moral distress. If you have access to an employee assistance program through your employer, you can receive confidential support and referrals to help you cope with moral distress. You can also contact your health insurance provider for referrals to mental health professionals who provide video and audio teletherapy.
Suggested Reading
- American Medical Association. AMA physician’s guide to COVID-19. https://app.svwps.com/ americanmedicalassociation/ ama/ covid19/ index.html
- Centers for Disease Control and Prevention. Tips for better sleep. www.cdc.gov/ sleep/ about_sleep/ sleep_hygiene.html
- Haelle T. Healthy, ethical environments can alleviate ‘moral distress’ in clinicians. October 29, 2018. www.the-hospitalist.org/ hospitalist/ article/ 178344/ practice-management/ healthy-ethical-environments-can-alleviate-moral
- Gregorio I.W. Physician burnout existed before coronavirus. It’s about to get worse. Expert opinion. The Philadelphia Inquirer. March 27, 2020. www.inquirer.com/ health/ coronavirus/ coronavirus-covid-19-physician-burnout-doctor-20200327.html
- Mayo Clinic. Know the signs of job burnout. November 21, 2018. www.mayoclinic.org/ healthy-lifestyle/ adult-health/ in-depth/ burnout/ art-20046642
- Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.
- McCallum Place. Self-soothing techniques when feeling traumatized. March 15, 2018. www.mccallumplace.com/ about/ blog/ self-soothing-techniques-when-feeling-traumatized/
- Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463-471.
- Berinato S. That discomfort you’re feeling is grief. Harvard Business Review. March 23, 2020. https://hbr.org/ 2020/ 03/ that-discomfort-youre-feeling-is-grief
- Streva V. Three breathing exercises to ease your coronavirus anxiety. PhillyVoice. March 16, 2020. www.phillyvoice.com/ breathing-exercises- coronavirus-anxiety -covid-19- pandemic/
Dawn Shedrick, LCSW-R, is the founder and CEO of JenTex Training & Consulting, a professional development company for social workers and health care professionals. She is a licensed clinical social worker, trainer, consultant and certified life/business coach, and a lecturer at the Columbia University School of Social Work in New York City, and St. Joseph’s College Department of Human Services in Patchogue, N.Y.