Preserving mental health and resilience in frontline healthcare workers during COVID-19
Identifieur interne : 000409 ( Pmc/Corpus ); précédent : 000408; suivant : 000410Preserving mental health and resilience in frontline healthcare workers during COVID-19
Auteurs : Kristen Santarone ; Mark Mckenney ; Adel ElkbuliSource :
- The American Journal of Emergency Medicine [ 0735-6757 ] ; 2020.
Url:
DOI: 10.1016/j.ajem.2020.04.030
PubMed: 32336584
PubMed Central: 7156943
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Preserving mental health and resilience in frontline healthcare workers during COVID-19</title><author><name sortKey="Santarone, Kristen" sort="Santarone, Kristen" uniqKey="Santarone K" first="Kristen" last="Santarone">Kristen Santarone</name><affiliation><nlm:aff id="af0005">Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA</nlm:aff></affiliation></author><author><name sortKey="Mckenney, Mark" sort="Mckenney, Mark" uniqKey="Mckenney M" first="Mark" last="Mckenney">Mark Mckenney</name><affiliation><nlm:aff id="af0005">Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA</nlm:aff></affiliation><affiliation><nlm:aff id="af0010">University of South Florida, Tampa, FL, USA</nlm:aff></affiliation></author><author><name sortKey="Elkbuli, Adel" sort="Elkbuli, Adel" uniqKey="Elkbuli A" first="Adel" last="Elkbuli">Adel Elkbuli</name><affiliation><nlm:aff id="af0005">Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32336584</idno><idno type="pmc">7156943</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156943</idno><idno type="RBID">PMC:7156943</idno><idno type="doi">10.1016/j.ajem.2020.04.030</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000409</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000409</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Preserving mental health and resilience in frontline healthcare workers during COVID-19</title><author><name sortKey="Santarone, Kristen" sort="Santarone, Kristen" uniqKey="Santarone K" first="Kristen" last="Santarone">Kristen Santarone</name><affiliation><nlm:aff id="af0005">Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA</nlm:aff></affiliation></author><author><name sortKey="Mckenney, Mark" sort="Mckenney, Mark" uniqKey="Mckenney M" first="Mark" last="Mckenney">Mark Mckenney</name><affiliation><nlm:aff id="af0005">Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA</nlm:aff></affiliation><affiliation><nlm:aff id="af0010">University of South Florida, Tampa, FL, USA</nlm:aff></affiliation></author><author><name sortKey="Elkbuli, Adel" sort="Elkbuli, Adel" uniqKey="Elkbuli A" first="Adel" last="Elkbuli">Adel Elkbuli</name><affiliation><nlm:aff id="af0005">Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA</nlm:aff></affiliation></author></analytic><series><title level="j">The American Journal of Emergency Medicine</title><idno type="ISSN">0735-6757</idno><idno type="eISSN">1532-8171</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="West, C P" uniqKey="West C">C.P. West</name></author><author><name sortKey="Dyrbye, L N" uniqKey="Dyrbye L">L.N. Dyrbye</name></author><author><name sortKey="Shanafelt, T D" uniqKey="Shanafelt T">T.D. Shanafelt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, J" uniqKey="Huang J">J. Huang</name></author><author><name sortKey="Liu, F" uniqKey="Liu F">F. Liu</name></author><author><name sortKey="Teng, Z" uniqKey="Teng Z">Z. Teng</name></author><author><name sortKey="Chen, J" uniqKey="Chen J">J. Chen</name></author><author><name sortKey="Zhao, J" uniqKey="Zhao J">J. Zhao</name></author><author><name sortKey="Wang, X" uniqKey="Wang X">X. Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Senni, M" uniqKey="Senni M">M. Senni</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Clark, L" uniqKey="Clark L">L. Clark</name></author><author><name sortKey="Af Stephens, S Liao" uniqKey="Af Stephens S">S. Liao AF Stephens</name></author><author><name sortKey="Byrne, T J" uniqKey="Byrne T">T.J. Byrne</name></author><author><name sortKey="Gregory, S D" uniqKey="Gregory S">S.D. Gregory</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sani, G" uniqKey="Sani G">G. Sani</name></author><author><name sortKey="Janiri, D" uniqKey="Janiri D">D. Janiri</name></author><author><name sortKey="Di Nicola, M" uniqKey="Di Nicola M">M. Di Nicola</name></author><author><name sortKey="Janiri, L" uniqKey="Janiri L">L. Janiri</name></author><author><name sortKey="Ferretti, S" uniqKey="Ferretti S">S. Ferretti</name></author><author><name sortKey="Chieffo, D" uniqKey="Chieffo D">D. Chieffo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lai, J" uniqKey="Lai J">J. Lai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weaver, M D" uniqKey="Weaver M">M.D. Weaver</name></author><author><name sortKey="Landrigan, C P" uniqKey="Landrigan C">C.P. Landrigan</name></author><author><name sortKey="Sullivan, J P" uniqKey="Sullivan J">J.P. Sullivan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Q" uniqKey="Chen Q">Q. Chen</name></author><author><name sortKey="Liang, M" uniqKey="Liang M">M. Liang</name></author><author><name sortKey="Li, Y" uniqKey="Li Y">Y. Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Xiang, Y" uniqKey="Xiang Y">Y. Xiang</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Emerg Med</journal-id><journal-id journal-id-type="iso-abbrev">Am J Emerg Med</journal-id><journal-title-group><journal-title>The American Journal of Emergency Medicine</journal-title></journal-title-group><issn pub-type="ppub">0735-6757</issn><issn pub-type="epub">1532-8171</issn><publisher><publisher-name>Elsevier Inc.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32336584</article-id><article-id pub-id-type="pmc">7156943</article-id><article-id pub-id-type="publisher-id">S0735-6757(20)30258-8</article-id><article-id pub-id-type="doi">10.1016/j.ajem.2020.04.030</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Preserving mental health and resilience in frontline healthcare workers during COVID-19</article-title></title-group><contrib-group><contrib contrib-type="author" id="au0005"><name><surname>Santarone</surname><given-names>Kristen</given-names></name><xref rid="af0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au0010"><name><surname>McKenney</surname><given-names>Mark</given-names></name><degrees>MD, MBA, FACS</degrees><xref rid="af0005" ref-type="aff">a</xref><xref rid="af0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au0015"><name><surname>Elkbuli</surname><given-names>Adel</given-names></name><degrees>MD, MPH</degrees><email>Adel.Elkbuli@hcahealthcare.com</email><xref rid="af0005" ref-type="aff">a</xref><xref rid="cr0005" ref-type="corresp">⁎</xref></contrib><aff id="af0005"><label>a</label>Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA</aff><aff id="af0010"><label>b</label>University of South Florida, Tampa, FL, USA</aff></contrib-group><author-notes><corresp id="cr0005"><label>⁎</label>Corresponding author at: 11750 Bird Road, Miami, FL 33175, USA. <email>Adel.Elkbuli@hcahealthcare.com</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>15</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>15</day><month>4</month><year>2020</year></pub-date><history><date date-type="received"><day>11</day><month>4</month><year>2020</year></date><date date-type="accepted"><day>11</day><month>4</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Elsevier Inc. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier Inc.</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions></article-meta></front><body><p id="p0005">At a normal time, 50% of physicians are battling burnout, or emotional fatigue caused by work related stress [<xref rid="bb0005" ref-type="bibr">1</xref>]. Physician mental health was a reticent, widespread public health crisis prior to COVID-19. Now, healthcare workers are fighting a lethal virus with PPE shortages and no evidence based treatment. Where does that leave the mental state of our healthcare workers?</p><p id="p0010">Healthcare workers are known for their stamina and emotional resilience in the workplace, however, COVID-19 comes with a new set of standards. The pressure of caring for patients is amplified in the setting of a virus with human-human transmission and no specific lifesaving treatment [<xref rid="bb0010" ref-type="bibr">2</xref>]. Handling life and death situations while simultaneously putting one's own life at risk contributes to an actual sense of danger. Other physician and nurse workplace stressors during COVID-19 include extended shifts with increased volume and severity of patients [<xref rid="bb0015" ref-type="bibr">3</xref>,<xref rid="bb0020" ref-type="bibr">4</xref>]. Triaging patients while knowing that there are a limited number of ventilators and ICU beds cause emotional and psychological strain [<xref rid="bb0015" ref-type="bibr">3</xref>,<xref rid="bb0025" ref-type="bibr">5</xref>]. Physicians must make critical decisions for their patients in the absence of familial bedside input since visitors are no longer allowed in hospitals. The emotional trauma endured by physicians is intensifying as they witness high volumes of death, including infection and deterioration of coworkers [<xref rid="bb0010" ref-type="bibr">2</xref>].</p><p id="p0015">Prior to the pandemic, physicians were able to seek solace from the psychological weight of their profession with familial and social lives. Currently, the stress extends outside of the realm of healthcare facilities. Physicians worrying about infecting their families and contaminating their homes may choose to self-isolate or face the guilt of potentially infecting a family member [<xref rid="bb0030" ref-type="bibr">6</xref>]. Social isolation and subjective feelings of solitude are known risk factors for suicide, and it is already established that physicians have higher rates of suicide than the general population [<xref rid="bb0005" ref-type="bibr">1</xref>,<xref rid="bb0030" ref-type="bibr">6</xref>]. A recent study in Wuhan China demonstrated that women, nurses and frontline healthcare workers are particularly vulnerable to experiencing depression, anxiety, insomnia and distress in these work conditions [<xref rid="bb0035" ref-type="bibr">7</xref>].</p><p id="p0020">Supporting the mental wellbeing and resilience of frontline healthcare workers is imperative to ensure global recovery from the COVID-19 pandemic. In order to do this, establishing a modern day hierarchy of needs for our physicians will help prioritize efforts to alleviate their psychological burden, similar to how the Psychiatry Department and Mental Health Institute of the Second Xiangya Hospital did during China's outbreak [<xref rid="bb0010" ref-type="bibr">2</xref>]. The primary concern is protecting the physical wellbeing of physicians, followed by the psychological needs, and finally addressing and supporting the communities and families of physicians.</p><p id="p0025">Ensuring that physicians can treat patients safely by providing adequate amounts of PPE should be top priority [<xref rid="bb0010" ref-type="bibr">2</xref>,<xref rid="bb0020" ref-type="bibr">4</xref>,<xref rid="bb0035" ref-type="bibr">7</xref>]. Adequate rest, nutrition and hydration are also essential components of maintaining physical wellbeing [<xref rid="bb0010" ref-type="bibr">2</xref>,<xref rid="bb0020" ref-type="bibr">4</xref>]. One study showed that limiting shifts to <16 h yielded an 18% reduction in attentional failures [<xref rid="bb0040" ref-type="bibr">8</xref>].</p><p id="p0030">Efforts must be made to allow physicians to seek help if needed without stigma or repercussion [<xref rid="bb0020" ref-type="bibr">4</xref>]. Psychological support should be made available in a variety of methods so that the physician has the freedom to choose an approach that works best. Emphasis should be placed on individualized emotional support plans, as psychological care is not one-size-fits-all. This includes the use of telemedicine, video chats, or online forums to make appointments with psychologists and psychiatrists [<xref rid="bb0010" ref-type="bibr">2</xref>,<xref rid="bb0020" ref-type="bibr">4</xref>,<xref rid="bb0035" ref-type="bibr">7</xref>]. Support groups and reading materials pertaining to dealing with ongoing stressors should be available.</p><p id="p0035">Maintaining the mental resilience of frontline workers involves offering solutions that allow them to perform their duties. Medical journals should focus on streamlining publication of relevant materials in multiple languages on multiple platforms to dissemination critical information [<xref rid="bb0050" ref-type="bibr">10</xref>]. Education on how to emotionally support and work with patients experiencing significant mental health problems during the pandemic should also be made available, as well as access to refer patients to seek psychological treatment [<xref rid="bb0045" ref-type="bibr">9</xref>]. To prioritize safety, non-emergent health concerns, when feasible, should be addressed via telemedicine, and non-emergent procedures postponed [<xref rid="bb0020" ref-type="bibr">4</xref>]. Another major concern is what if the needs of a community surpass hospital capacity. To prepare for this, communities should have a backup force of able healthcare workers who are either retired, and even include students who are about to graduate. These workers should prepare to be activated in times of emergency or high volume [<xref rid="bb0020" ref-type="bibr">4</xref>]. Use of military resources including workers, hospitals and potentially even ships should be incorporated as needed. Employing military style triage could also help streamline patient care [<xref rid="bb0020" ref-type="bibr">4</xref>].</p><p id="p0040">Steps need to be taken in order to preserve the mental wellbeing of our frontline providers, most importantly protected them from infection. Mental health resources and education should be provided to physicians who are experiencing traumatizing work conditions and unparalleled stress levels. While action to preserve the psychological and emotional health of physicians needs to begin now, these providers will need long-term resources to fully recover from this experience. Physician wellbeing should be one of our highest priority, as public health and vitality is theirs.</p></body><back><ref-list id="bi0005"><title>References</title><ref id="bb0005"><label>1</label><element-citation publication-type="journal" id="rf0005"><person-group person-group-type="author"><name><surname>West</surname><given-names>C.P.</given-names></name><name><surname>Dyrbye</surname><given-names>L.N.</given-names></name><name><surname>Shanafelt</surname><given-names>T.D.</given-names></name></person-group><article-title>Physician burnout: contributors, consequences and solutions</article-title><source>J Intern Med</source><volume>283</volume><year>2018</year><fpage>516</fpage><lpage>529</lpage><pub-id pub-id-type="pmid">29505159</pub-id></element-citation></ref><ref id="bb0010"><label>2</label><element-citation publication-type="book" id="rf0010"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>J.</given-names></name><name><surname>Liu</surname><given-names>F.</given-names></name><name><surname>Teng</surname><given-names>Z.</given-names></name><name><surname>Chen</surname><given-names>J.</given-names></name><name><surname>Zhao</surname><given-names>J.</given-names></name><name><surname>Wang</surname><given-names>X.</given-names></name></person-group><chapter-title>Care for the psychological satus of frontline medical staff fighting against COVID-19</chapter-title><year>2020</year><publisher-name>Oxford University Press for the Infectious Diseases Society of America</publisher-name></element-citation></ref><ref id="bb0015"><label>3</label><element-citation publication-type="journal" id="rf0015"><person-group person-group-type="author"><name><surname>Senni</surname><given-names>M.</given-names></name></person-group><article-title>COVID-19 experience in Bergamo, Italy</article-title><source>Eur Heart J</source><volume>0</volume><year>2020</year><fpage>1</fpage><lpage>2</lpage><pub-id pub-id-type="doi">10.1093/eurheartj/ehaa279</pub-id></element-citation></ref><ref id="bb0020"><label>4</label><mixed-citation publication-type="other" id="or2005">Jun J, Tucker S, Melnyk B. 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