Photo by J W | Unsplash
While the COVID-19 pandemic is in many ways unprecedented, it is also true that research from past disasters and experiences of shared trauma can help today’s health care providers. During the second installment in the Caring for Caregivers special call series presented by IHI in partnership with Wellbeing Trust, one of the call’s guests offered insights gleaned from years of studying people who have lived through disasters, including climate change, mass violence, terrorism, and pandemics.
Joshua Morganstein, MD, Associate Professor and Assistant Chair in the Department of Psychiatry and Assistant Director at the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, addressed the leadership behaviors and system supports needed to address the mental health and well-being needs of health care providers.
The following points are adapted from his remarks on the call:
Leaders at all levels help shape community response
Following disasters, communities often progress through well-established phases, including a natural coming together — but outbreaks and pandemics like COVID-19 disrupt these phases. For instance, the community cohesion that [typically] happens as people help each other through the event has been altered in various communities by physical distancing requirements. Fear of illness has turned into, for some people, fear of others. Communities have been impacted to varying degrees and at different times, and public health emergencies open the fault lines in our society, laying bare divisions across race, religion, and socioeconomic status.
Now, all these factors complicate response efforts. Leaders and other institutional elements within our organizations play an important role in shaping community response and behaviors. It’s good to remember that leaders exist at many levels in health care, including team leaders, charge nurses, service chiefs, department heads, and others. What these people do and say will have impact not just on the well-being of their personnel, but also the trajectory of recovery for their community.
Stress is like a toxin
Risk [for work-associated harm from trauma] is a relatively complex issue, but we can think of stress kind of like a toxin, such as lead or radon. To understand risk and intervene effectively, we have to understand aspects of exposure, such as who, when, how much, and their responses over time. Caregivers involved in direct and prolonged patient care, those exposed to extremes of suffering as well as human remains and mass death, may be at increased risk.
It’s also important to remember that in this disaster, everyone has been affected in some way. In fact, those not involved in direct patient care can experience unique stresses related to increased work demands, less organizational and community recognition of their work or reduced sense of meaning in the work that they end up doing, and even feelings of guilt for not being on the front lines.
No one should go it alone
The concept of buddies has been used in different communities to promote safety, efficacy, and social support, which are all protective enterprises. The “battle buddy” system, which is a concept popularized by the United States Army, has been adopted in some health care settings to support the safety and well-being of caregivers. It’s more formal than an ad-hoc system of peer support and particularly useful in a workforce where personnel often have difficulties asking for help. Whether you call it a battle buddy or something else that works better for your organization, having someone with whom caregivers commit to maintaining a regular ongoing connection and mutual encouragement can be an invaluable source of support during a crisis event.
Supporting resetting and reintegration are essential when a crisis is protracted
The process of reintegrating into work and home and society can be challenging after prolonged exposure to highly stressful environments and separation from families or work units. For some people, this aspect of a crisis event may be more distressing than their participation in the crisis itself, such as providing care on the front lines of COVID-19. The study of professions outside health care shows us that leaders that ensure personnel are both given the opportunity and encouraged to take time to rest, recharge, connect with loved ones, and try to get back to something resembling a baseline are likely to have a more positive and productive workforce.
Grief leadership means supporting staff through multiple losses
Grief is a near-universal aspect of disasters. The term “grief leadership” was coined Colonel Larry Ingram, MD, of the Walter Reed Army Institute of Research, following observations of leadership behaviors at military bases that were impacted by a plane crash in Gander, Newfoundland, in 1985. All 248 soldiers who were returning home, as well as the crew on board, were killed in the crash. It remains the US Army’s single deadliest peacetime military air disaster. Ingram and others observed that certain leaders were able to promote healing and recovery within their communities by openly acknowledging and addressing grief, communicating with personnel and surviving family members, facilitating processes that honor losses, and helping people to look with hope to the future.
Nurturing hope is essential
Sustaining hope is difficult, but it’s necessary for leaders and for all of us. There’s got to be an honest reckoning with pain, loss, and grief that everybody’s experienced. At the same time, it’s important to seek out opportunities that have emerged out of painful lessons learned. We have to find ways to sustain helpful changes within our system. We need to remind people that eventually this will end, and most people will ultimately be okay. Truthfully and authentically balancing all these things is what allows communities to sustain a vision of a more hopeful future. Communication that balances truthfulness with a focus on moving forward, looking to the future and what needs to be done, is important in helping manage uncertainty.
Uncertainty can be especially challenging for health care providers
Uncertainty is a hallmark of pandemics, and it’s particularly challenging for those of us who are caregivers or health care providers because many of us have a perfectionistic tendency. We tend to want to get it right, and part of what it means to lead in a crisis is making decisions with less than perfect information. Not once, not twice, but all day, every day. That challenges how we, as health care providers, are taught to behave in our day-to-day work lives.
A tolerance for uncertainty is an important skill for leaders to develop, to understand that they won’t be able to get it all right. Normally leaders have the answers, or can at least help take away the uncertainty for the people who work for them. People are often selected to be leaders because of how they perform daily operations; crisis events like this tax those abilities in unique ways.
Editor’s note: To learn more — including insights from other guests — about addressing the well-being of the health care community, watch and listen to the full hour on Grief Leadership and System Supports. The free IHI Virtual Learning Hour Caring for Caregivers special series is delivered in partnership with Well Being Trust. This bi-weekly series will run every other Friday through September 11, 2020 from 10:00 – 11:00 AM ET. Learn more and register.
(Having difficulty hearing this excerpt? Watch on YouTube.)
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Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic
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Turning Moral Distress Into Moral Resilience During the COVID-19 Pandemic