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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">COVID-19: Peer Support and Crisis Communication Strategies to Promote Institutional Resilience</title><author><name sortKey="Wu, Albert W" sort="Wu, Albert W" uniqKey="Wu A" first="Albert W." last="Wu">Albert W. Wu</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Connors, Cheryl" sort="Connors, Cheryl" uniqKey="Connors C" first="Cheryl" last="Connors">Cheryl Connors</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Everly, George S" sort="Everly, George S" uniqKey="Everly G" first="George S." last="Everly">George S. Everly</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32251512</idno><idno type="pmc">7146593</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146593</idno><idno type="RBID">PMC:7146593</idno><idno type="doi">10.7326/M20-1236</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000539</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000539</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">COVID-19: Peer Support and Crisis Communication Strategies to Promote Institutional Resilience</title><author><name sortKey="Wu, Albert W" sort="Wu, Albert W" uniqKey="Wu A" first="Albert W." last="Wu">Albert W. Wu</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Connors, Cheryl" sort="Connors, Cheryl" uniqKey="Connors C" first="Cheryl" last="Connors">Cheryl Connors</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Everly, George S" sort="Everly, George S" uniqKey="Everly G" first="George S." last="Everly">George S. Everly</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Annals of Internal Medicine</title><idno type="ISSN">0003-4819</idno><idno type="eISSN">1539-3704</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Caring for patients with the novel coronavirus infection is placing great stress on health care systems and health care workers. On the basis of their experiences responding to other pandemics, the authors summarize lessons learned and offer some best practices for facilitating organizational resilience and supporting health care workers during the COVID-19 pandemic.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="other"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Intern Med</journal-id><journal-id journal-id-type="iso-abbrev">Ann. Intern. Med</journal-id><journal-id journal-id-type="publisher-id">aim</journal-id><journal-title-group><journal-title>Annals of Internal Medicine</journal-title></journal-title-group><issn pub-type="ppub">0003-4819</issn><issn pub-type="epub">1539-3704</issn><publisher><publisher-name>American College of Physicians</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32251512</article-id><article-id pub-id-type="pmc">7146593</article-id><article-id pub-id-type="doi">10.7326/M20-1236</article-id><article-id pub-id-type="publisher-id">aim-olf-M201236</article-id><article-categories><subj-group subj-group-type="heading"><subject>Ideas and Opinions</subject></subj-group></article-categories><title-group><article-title>COVID-19: Peer Support and Crisis Communication Strategies to Promote Institutional Resilience</article-title><alt-title alt-title-type="short">COVID-19: Peer Support and Crisis Communication for Resilience</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Albert W.</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Connors</surname><given-names>Cheryl</given-names></name><degrees>BSN, MS, DNP</degrees><xref ref-type="aff" rid="aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Everly</surname><given-names>George S.</given-names><suffix>Jr.</suffix></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><aff id="aff1"><label>1</label>Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, Maryland (A.W.W., G.S.E.)</aff><aff id="aff2"><label>2</label>Johns Hopkins Medicine and Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland (C.C.)</aff></contrib-group><pub-date pub-type="epub"><day>6</day><month>4</month><year>2020</year></pub-date><elocation-id>M20-1236</elocation-id><permissions><copyright-year>2020</copyright-year><copyright-holder>American College of Physicians</copyright-holder><license license-type="free"><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use for research, analyses, and text and data mining through PubMed Central. Acknowledgement of the original source shall include a notice similar to the following: "© 2020 American College of Physicians. Some rights reserved. This work permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited." These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p></license></permissions><abstract abstract-type="precis"><p>Caring for patients with the novel coronavirus infection is placing great stress on health care systems and health care workers. On the basis of their experiences responding to other pandemics, the authors summarize lessons learned and offer some best practices for facilitating organizational resilience and supporting health care workers during the COVID-19 pandemic.</p></abstract></article-meta></front><body><p>An infectious disease physician in Milan described his work caring for patients with the novel coronavirus (COVID-19):</p><disp-quote><p><italic>It is an impossible-to-understand situation, with people intubated in the hall, not enough ventilators, ethical decisions regarding who to intubate, shortage of masks and gloves, confusion and exhaustion. Hell is probably like this. I have no time to understand, to think about and to express emotions.</italic></p></disp-quote><p>Novel coronavirus disease is posing an extraordinary challenge to the health and well-being of persons across the globe. Along with grave threats to social stability, economic prosperity, and human health, caring for patients places great stress on health care workers (HCWs) (<xref rid="r1-1236" ref-type="bibr">1</xref>). Because care of the patient depends on providers who are physically and mentally fit, the integrity of the health care system and its capacity to take adequate care of patients are at stake. The authors have had experience responding to severe acute respiratory syndrome (SARS) and H1N1 influenza, formulating a national medical recovery plan in Kuwait, responding to the 9/11 World Trade Center disaster, and developing peer support programs for health care. In this commentary, we summarize lessons learned from those experiences and provide consensus on best practices for fostering an organizational culture of resilience (<xref rid="r2-1236" ref-type="bibr">2–4</xref>).</p><p>Health care workers caring for patients with contagious, life-threatening illnesses, such as COVID-19, are likely to have anxiety and fear of being infected. In the case of SARS, up to 50% of HCWs had acute psychological distress, burnout, and posttraumatic stress while caring for these patients (<xref rid="r1-1236" ref-type="bibr">1</xref>, <xref rid="r5-1236" ref-type="bibr">5</xref>). Fear of contagion and of infecting family members, social isolation, and additional stressors contributed to adverse outcomes (<xref rid="r1-1236" ref-type="bibr">1</xref>, <xref rid="r5-1236" ref-type="bibr">5</xref>). The stress of prolonged exposure to COVID-19 and the need to support clinicians have been noted in recent publications (<xref rid="r6-1236" ref-type="bibr">6</xref>, <xref rid="r7-1236" ref-type="bibr">7</xref>).</p><p>We have observed similar responses to COVID-19 in our HCWs, especially among those with a high risk for exposure to infectious material, such as workers in biocontainment units and emergency departments. Shortages of personal protective equipment may provoke anger, frustration, and helplessness. Nonprofessional staff and those working in less visible parts of the hospital, such as laundry and facilities, receive less information, making them feel isolated and disempowered. Staff also must contend with sometimes daily shifts in policy, fear of contagion, and added work, as well as obligations to family and others outside the hospital. If staff are unsupported, COVID-19–related trauma may cause symptoms of distress and burnout and decrease their ability to function effectively. These symptoms may evolve into posttraumatic stress disorder or other chronic conditions (<xref rid="r5-1236" ref-type="bibr">5</xref>). Feeling out of control and unappreciated increases the
number of people calling out of work. In the case of SARS, perceived adequacy of preparatory training and support mitigated long-term adverse outcomes (<xref rid="r5-1236" ref-type="bibr">5</xref>). This calls for health care organizations to support the mental health of HCWs.</p><p>We recommend 3 strategic principles that may be of value for other health care institutions responding to the COVID-19 pandemic: First, provide leadership focused on resilience. Effective crisis management provides a clear, optimistic vision and realistic plan; takes decisive action; and facilitates open, honest, and frequent communication. Leaders should make extra efforts to thank workers and express gratitude for the extra burden being imposed on them.</p><p>Second, structure crisis communications to provide information and empowerment. In the absence of information, imagination and worst-case scenarios rush in. Information can help to reduce anxiety. Leadership should provide the most up-to-date information on COVID-19, what is being done to protect HCWs, and what they should do if exposed. Leadership should anticipate questions and answer them in advance. To restore a sense of control, they should empower workers by providing them with information about what they can do to help themselves.</p><p>Third, create a continuum of staff support within the organization. Leaders should anticipate a surge of mental health concerns among HCWs at all levels. They should normalize these feelings and encourage their expression, advocate personal wellness, and identify support resources. They should create a peer support team to provide psychological first aid, potentially by tapping into existing employee assistance, chaplaincy, or other wellness programs, with triage when needed to higher levels of support.</p><p>At Johns Hopkins Medicine, a unified command center was activated soon after the World Health Organization declared COVID-19 “a public health emergency of international concern.” We know that if workers feel they will be supported in a disaster, they will be more resilient; therefore, staff support has been included alongside other essential services, such as infection control and supply chain management.</p><p>Johns Hopkins has a confidential peer support program called RISE (Resilience in Stressful Events) (<xref rid="r8-1236" ref-type="bibr">8</xref>). RISE responds to calls 24/7 and provides in-person psychological first aid and emotional support to HCWs who experience stressful clinical events, such as an unexpected complication or the death of a patient. In the past 5 years, the program has been replicated in more than 30 U.S. hospitals and has helped thousands of workers.</p><p>For the COVID-19 response, RISE is coordinating with employee assistance and hospital wellness programs, chaplains, and psychiatrists. Team members round proactively on high-acuity units, while also responding in person to pages from individuals and groups and offering immediate phone support to callers. Attention is given to less visible units, such as the microbiology laboratory, transport, and pharmacy. A useful strategy has been pairing infection control personnel to provide updates with RISE responders to give emotional support. Support efforts will increase if allocation of scarce life-sustaining medical resources becomes necessary. RISE also monitors the command center, where senior leaders and staff work lengthy shifts.</p><p>Response to the COVID-19 pandemic is a marathon, not a sprint. Leaders and managers of health care organizations should be forewarned to pace themselves and their responses. When disaster strikes, the emotional response generally occurs in phases (<xref rid="r9-1236" ref-type="bibr">9</xref>). Much of the U.S. health care response is still in the early impact and heroic phases. However, planning should begin for a longer, disillusionment phase during which emotional needs among HCWs will grow.</p><p>In summary, we describe an approach to enhance the well-being and resilience of HCWs in response to the COVID-19 pandemic. Our recommendations are based on our observations of HCW stress during the SARS outbreak and institutional experience with delivering peer support. This approach has the potential to enhance organizational cohesion and reduce adverse effects for HCWs.</p><sec><title></title></sec></body><back><fn-group><fn id="n0-M201236"><p>This article was published at Annals.org on 6 April 2020.</p></fn></fn-group><bio id="d35e65"><p><bold>Disclosures:</bold> Authors have disclosed no conflicts of interest. Forms can be viewed at <uri xlink:type="simple" xlink:href="http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1236">www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1236</uri></p><p><bold>Corresponding Author:</bold> Albert W. Wu, MD, MPH, Johns Hopkins Center for Health Services and Outcomes Research, 624 North Broadway, Room 653, Baltimore, MD 21205; e-mail, <uri xlink:type="simple" xlink:href="awu@jhu.edu">awu@jhu.edu</uri>.</p><p>Current author addresses and author contributions are available at Annals.org.</p><p><bold>Current Author Addresses:</bold> Dr. Wu: Johns Hopkins Center for Health Services and Outcomes Research, 624 North Broadway, Room 653, Baltimore, MD 21205.</p><p>Dr. Connors: 1800 Orleans Street, Carnegie 648, Johns Hopkins Hospital, Baltimore, MD 21287.</p><p>Dr. Everly, 702 Severnside Avenue, Severna Park, MD 21146.</p><p><bold>Author Contributions:</bold> Conception and design: A.W. Wu, G.S. Everly.</p><p>Analysis and interpretation of the data: A.W. Wu.</p><p>Drafting of the article: A.W. Wu, C. Connors, G.S. Everly.</p><p>Critical revision for important intellectual content: A.W. Wu, C. Connors.</p><p>Final approval of the article: A.W. Wu, C. Connors, G.S. Everly.</p><p>Statistical expertise: A.W. Wu.</p><p>Administrative, technical, or logistic support: A.W. Wu.</p><p>Collection and assembly of data: A.W. Wu.</p></bio><ref-list><title>References</title><ref id="r1-1236"><label>1.</label><mixed-citation publication-type="unrecognized"><comment><bold>Tam CW, Pang EP, Lam LC, et al.</bold> Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34:1197-204. [PMID: 15697046]</comment></mixed-citation></ref><ref id="r2-1236"><label>2.</label><mixed-citation publication-type="unrecognized"><comment><bold>Everly GS.</bold> Psychology of viral pandemic: what we need to know and do. Psychology Today. 1 March 2020. Accessed at <uri xlink:type="simple" xlink:href="http://www.psychologytoday.com/us/blog/when-disaster-strikes-inside-disaster-psychology/202003/psychology-viral-pandemic-what-we-need">www.psychologytoday.com/us/blog/when-disaster-strikes-inside-disaster-psychology/202003/psychology-viral-pandemic-what-we-need</uri> on 22 March 2020.</comment></mixed-citation></ref><ref id="r3-1236"><label>3.</label><mixed-citation publication-type="unrecognized"><comment><bold>Perrin PC, McCabe OL, Everly GS Jr, et al.</bold> Preparing for an influenza pandemic: mental health considerations. Prehosp Disaster Med. 2009 May-Jun;24:223-30. [PMID: 19618359]</comment></mixed-citation></ref><ref id="r4-1236"><label>4.</label><mixed-citation publication-type="unrecognized"><comment><bold>Institute of Medicine.</bold> A Ready and Resilient Workforce. 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[PMID: 32196544] doi:10.7326/M20-1033</comment></mixed-citation></ref><ref id="r8-1236"><label>8.</label><mixed-citation publication-type="unrecognized"><comment><bold>Edrees H, Connors C, Paine L, et al.</bold> Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ Open. 2016;6:e011708. [PMID: 27694486] doi:10.1136/bmjopen-2016-011708</comment></mixed-citation></ref><ref id="r9-1236"><label>9.</label><mixed-citation publication-type="unrecognized"><comment><bold>Substance Abuse and Mental Health Services Administration.</bold> Phases of Disaster. Accessed at <uri xlink:type="simple" xlink:href="http://www.samhsa.gov/dtac/recovering-disasters/phases-disaster">www.samhsa.gov/dtac/recovering-disasters/phases-disaster</uri> on 22 March 2020.</comment></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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