Supporting Clinicians During the COVID-19 Pandemic
Identifieur interne : 000337 ( Pmc/Corpus ); précédent : 000336; suivant : 000338Supporting Clinicians During the COVID-19 Pandemic
Auteurs : Charlene Dewey ; Susan Hingle ; Elizabeth Goelz ; Mark LinzerSource :
- Annals of Internal Medicine [ 0003-4819 ] ; 2020.
Abstract
The COVID-19 pandemic has upended clinicians' sense of order and control, creating the potential for stress in the short term and burnout over the long term. This commentary offers suggestions to encourage a culture that will sustain the clinician workforce during the pandemic.
Url:
DOI: 10.7326/M20-1033
PubMed: 32196544
PubMed Central: 7106065
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Supporting Clinicians During the COVID-19 Pandemic</title><author><name sortKey="Dewey, Charlene" sort="Dewey, Charlene" uniqKey="Dewey C" first="Charlene" last="Dewey">Charlene Dewey</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Hingle, Susan" sort="Hingle, Susan" uniqKey="Hingle S" first="Susan" last="Hingle">Susan Hingle</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Goelz, Elizabeth" sort="Goelz, Elizabeth" uniqKey="Goelz E" first="Elizabeth" last="Goelz">Elizabeth Goelz</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Linzer, Mark" sort="Linzer, Mark" uniqKey="Linzer M" first="Mark" last="Linzer">Mark Linzer</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32196544</idno><idno type="pmc">7106065</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106065</idno><idno type="RBID">PMC:7106065</idno><idno type="doi">10.7326/M20-1033</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000337</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000337</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Supporting Clinicians During the COVID-19 Pandemic</title><author><name sortKey="Dewey, Charlene" sort="Dewey, Charlene" uniqKey="Dewey C" first="Charlene" last="Dewey">Charlene Dewey</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Hingle, Susan" sort="Hingle, Susan" uniqKey="Hingle S" first="Susan" last="Hingle">Susan Hingle</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Goelz, Elizabeth" sort="Goelz, Elizabeth" uniqKey="Goelz E" first="Elizabeth" last="Goelz">Elizabeth Goelz</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Linzer, Mark" sort="Linzer, Mark" uniqKey="Linzer M" first="Mark" last="Linzer">Mark Linzer</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>The COVID-19 pandemic has upended clinicians' sense of order and control, creating the potential for stress in the short term and burnout over the long term. This commentary offers suggestions to encourage a culture that will sustain the clinician workforce during the 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></listBibl></div1></back></TEI><pmc article-type="editorial"><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">32196544</article-id><article-id pub-id-type="pmc">7106065</article-id><article-id pub-id-type="doi">10.7326/M20-1033</article-id><article-id pub-id-type="publisher-id">aim-olf-M201033</article-id><article-categories><subj-group subj-group-type="heading"><subject>Ideas and Opinions</subject></subj-group></article-categories><title-group><article-title>Supporting Clinicians During the COVID-19 Pandemic</article-title><alt-title alt-title-type="short">Supporting Clinicians During the COVID-19 Pandemic</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Dewey</surname><given-names>Charlene</given-names></name><degrees>MD, MEd</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Hingle</surname><given-names>Susan</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Goelz</surname><given-names>Elizabeth</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Linzer</surname><given-names>Mark</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff3"></xref></contrib><aff id="aff1"><label>1</label>Vanderbilt University School of Medicine, Nashville, Tennessee (C.D.)</aff><aff id="aff2"><label>2</label>Southern Illinois University School of Medicine, Springfield, Illinois (S.H.)</aff><aff id="aff3"><label>3</label>Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota (E.G., M.L.)</aff></contrib-group><pub-date pub-type="epub"><day>20</day><month>3</month><year>2020</year></pub-date><elocation-id>M20-1033</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>The COVID-19 pandemic has upended clinicians' sense of order and control, creating the potential for stress in the short term and burnout over the long term. This commentary offers suggestions to encourage a culture that will sustain the clinician workforce during the pandemic.</p></abstract></article-meta></front><body><p>The coronavirus disease 2019 (COVID-19) pandemic has upended clinicians' sense of order and control. Such disruption may lead to substantial stress in the short term and higher risk for burnout over the long term. While natural disasters, such as Hurricane Katrina, demonstrated the effectiveness of short-term emergency planning (<xref rid="r1-1033" ref-type="bibr">1</xref>), the COVID-19 pandemic poses unique long-term stressors and risks to clinicians' physical, mental, spiritual, and emotional well-being. Leaders and front-line clinicians need to proactively protect the well-being of themselves and their colleagues to avoid adverse outcomes for clinicians and adverse effects on quality of patient care (<xref rid="r2-1033" ref-type="bibr">2</xref>). We provide practical suggestions to encourage a culture that will sustain the clinician workforce during the pandemic. Regardless of practice location or size, everyone must commit to supporting the well-being of those
involved in patient care.</p><p>First and foremost, organizational leaders should provide clear messages that clinicians are valued and that managing the pandemic together is the goal. Front-line clinicians must individually and collectively identify concerns that arise while facing the reality of the pandemic. Leaders must communicate current best practices clearly and compassionately, manage expectations, clarify work hours, and provide sufficient resources and effective personal protective equipment. To better enable clinicians to maintain personal well-being and resilience throughout the pandemic, leaders should aim to monitor clinician wellness and proactively address concerns related to the safety of clinicians and their families.</p><p>Leaders should aim for work schedules that promote physical resilience by enabling adequate sleep and providing access to call rooms for hospital-based clinicians working long or multiple shifts. Leaders should also take initiatives to provide basic provisions during work hours, such as easy access to water, healthy snacks, chargers for phones and other devices, and toiletries. Leaders must also designate times for clinicians to take breaks, eat, and take medications. It may also be helpful to advise clinicians working such shifts to bring at least 3 days of their own medications to work and designate a source for emergency refills. Clinicians should also continue using wellness activities that have worked for them in the past and make efforts to support each other during this challenging time.</p><p>Reduction of noncritical work activities may help to promote mental well-being. Examples include rescheduling preventive and routine patient follow-up visits and eliminating nonessential administrative tasks. Anxiety can be reduced by providing a central source for updated information and clear communication of well-defined protocols, expectations, and such resources as childcare via e-mails, tweets, and automated calls. When an individual clinician feels well but cannot be present in the clinical setting because of mandatory isolation or childcare, hospitals and practices should aim to redistribute work and have these clinicians participate in computer- and phone-based care while home.</p><p>During the pandemic, clinicians should be encouraged to openly discuss vulnerability and the importance of protecting one's emotional strength. Health care organizations can provide information on managing stress, reducing burnout, and identifying mental health professionals available to support clinicians (<xref rid="r3-1033" ref-type="bibr">3</xref>). Deploy designated wellness champions in health care systems and practices to field clinicians' concerns, advocate for clinicians, and distribute messages of gratitude and support.</p><p>We also suggest fostering spiritual resilience through distribution of positive messaging that emphasizes appreciation for clinicians' dedication and altruism. Disseminating strategies for connecting with colleagues to share stories of success, rather than focusing on failures and stresses, can help clinicians find joy amidst chaos (<xref rid="r4-1033" ref-type="bibr">4</xref>). Helping clinicians recognize what they can and cannot control helps to balance expectations with realities.</p><p>A supportive work culture is vital to maintaining the resilience of clinicians during a crisis such as COVID-19. We suggest developing an evidence-based menu of interventions, to be carefully selected from, and tailored to various workplace settings. For larger health systems, wellness committees and employee assistance programs are the logical resources to organize these interventions. In smaller settings, appointing a wellness champion could help to elucidate colleagues' needs and implement solutions. Surveys to assess stress points, fears, and concerns can inform leaders and provide insight into areas requiring attention. We also suggest developing plans to back up, cross-train, and rotate leadership to avoid leader burnout.</p><p>Sharing challenges and successes will help to meet urgent needs during the evolving pandemic. Examples of settings for such sharing include the American College of Physicians Physician Well-Being and Discussion Forum (<xref rid="r5-1033" ref-type="bibr">5</xref>), the Society of General Internal Medicine GIMConnect (<xref rid="r6-1033" ref-type="bibr">6</xref>), and the American Medical Association Physician Health (<xref rid="r7-1033" ref-type="bibr">7</xref>) resources that members can access. Other professional organizations, or organizations with access to community discussion boards, could develop similar venues for highlighting best practices in wellness.</p><p>Emphasizing clinician wellness during the COVID-19 pandemic (<xref rid="r8-1033" ref-type="bibr">8</xref>) is necessary to enable them to provide high-quality care. We propose some preliminary, common sense steps toward this goal and encourage colleagues to share strategies they find successful. How we meet the wellness needs of our clinicians may determine how well we survive the COVID-19 pandemic and future public health crises.</p><sec><title></title></sec></body><back><fn-group><fn id="n0-M201033"><p>This article was published at Annals.org on 20 March 2020.</p></fn></fn-group><bio id="d35e74"><p><bold>Disclosures:</bold> Dr. Linzer reports grants from the American Medical Association and the American College of Physicians outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at <uri xlink:type="simple" xlink:href="http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1033">www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1033</uri>.</p><p><bold>Corresponding Author:</bold> Charlene M. Dewey, MD, MEd, Center for Professional Health, Vanderbilt University School of Medicine, 1107 Oxford House, Nashville, TN 37232-4300; e-mail, <uri xlink:type="simple" xlink:href="Charlene.dewey@vumc.org">Charlene.dewey@vumc.org</uri>.</p><p><bold>Current Author Addresses:</bold> Dr. Dewey: Center for Professional Health, Vanderbilt University School of Medicine, 1107 Oxford House, Nashville, TN 37232-4300.</p><p>Dr. Hingle: Southern Illinois University School of Medicine, 913 North Rutledge cHOP, Mailcode 9623, Springfield, IL 62794-9623.</p><p>Dr. Goelz: Hennepin Healthcare, 701 Park Avenue, (P5), Minneapolis, MN 55415.</p><p>Dr. Linzer: Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, (G5), Minneapolis, MN 55415.</p><p><bold>Author Contributions:</bold> Conception and design: C. Dewey, S. Hingle, E. Goelz.</p><p>Drafting of the article: C. Dewey, S. Hingle, M. Linzer.</p><p>Critical revision of the article for important intellectual content: C. Dewey, S. Hingle, E. Goelz.</p><p>Final approval of the article: C. Dewey, S. Hingle, E. Goelz, M. Linzer.</p><p>Administrative, technical, or logistic support: C. Dewey, S. Hingle.</p></bio><ref-list><title>References</title><ref id="r1-1033"><label>DeSalvo KB.</label><mixed-citation publication-type="unrecognized"><comment><bold>DeSalvo KB.</bold> New Orleans rises anew: community health after Katrina. Ann Intern Med. 2016;164:57-8. [PMID: 26502034] doi:10.7326/M15-2284</comment></mixed-citation></ref><ref id="r2-1033"><label>Tawfik DS, Scheid A, Profit J, et al.</label><mixed-citation publication-type="unrecognized"><comment><bold>Tawfik DS, Scheid A, Profit J, et al.</bold> Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis. Ann Intern Med. 2019. 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Accessed at <uri xlink:type="simple" xlink:href="http://www.cstsonline.org/assets/media/documents/CSTS_FS_Sustaining_Well_Being_Healthcare_Personnel_during.pdf.pdf">www.cstsonline.org/assets/media/documents/CSTS_FS_Sustaining_Well_Being_Healthcare_Personnel_during.pdf.pdf</uri> on 18 March 2020.</comment></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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