“We are not responsible only for what we do, but also for what we fail to do”. Jean Molière
The emotional health of employees is a primary factor for analysis during a pandemic. These professionals are exposed daily to a high level of stress and pressure, becoming vulnerable to the development of psychosomatic and / or mood disorders, in addition to the risk of illness and uncertainty about the future. After the most critical period of the pandemic, many mental disorders are expected to develop, remain, or worsen. Therefore, it is important to plan the monitoring of employees in the short, medium, and long term.
Several reasons can generate post-traumatic stress: physical sequelae, psychological sequelae, absence from work, the need for help from the State and changes in the professional situation. European studies point to cases in which victims and family members reveal the impacts and consequences also on their personal lives, such as divorce, change of residence, involvement with alcohol and drugs.
Health authorities around the world have been working to contain the spread of the disease, the threat of contamination and the increase in the number of cases causing great stress to the population and health professionals.
Health professionals know that the focus is on taking care of patients and seeing them win the battle against the disease, after all that is what they were trained for. The spirit of mission that surrounds them leaves no room to look inside. Therefore, there is still a lot of work to be done in order to effectively insert the discussion about emotional disorders within the health teams.
For many employees, there are no precedents for facing the current scenario, especially those who have never participated in situations like a crisis or pandemic. The signs of Burnout or exhaustion syndrome will certainly appear in a context that requires dexterity and precision for decision making, which are often complex, with a shortage of time or resources, whether human, equipment or material. It is necessary to identify these signs of the body and the mind.
Exhaustion Syndrome (Burnout)
The main characteristic of the exhaustion syndrome is the state of emotional tension and chronic stress caused by exhausting physical, emotional and psychological working conditions. The syndrome manifests itself especially in people whose profession requires direct and intense interpersonal involvement. There are several signs and symptoms that indicate the risk of exhaustion syndrome, research shows that the most common is the feeling of physical and emotional exhaustion that is reflected in attitudes and symptoms, such as:
- Excessive tiredness, physical and mental;
- Frequent headache;
- Changes in appetite;
- Difficulty concentrating;
- Feelings of failure and insecurity;
- Constant negativity;
- Feelings of defeat and hopelessness;
- Feelings of incompetence;
- Sudden changes in mood;
- High pressure;
- Muscle aches;
- Gastrointestinal problems;
- Change in heart rate.
The identification of these signs will depend on the way in which each professional deal with coping in critical situations. Adopting decompression measures to the most vulnerable professional will ease acute symptoms of stress.
A stressed team can affect the clinical outcome of patients, impact the teams of institutional interface, since it intermediates the strategic, tactical, and operational dimension of the institution.
Professionals, when emotionally dejected, worried, and apprehensive, can depress more quickly in the face of situations that threaten the integrity of their patients and why not tell their own integrity. This dejection, fear, demotivation and often panic, can lead health professionals to become more vulnerable and even to become physically ill, bringing great impact to their performance.
Frontline health professionals, in crisis situations, live different experiences that impact the physical, emotional, and mental aspects. Therefore, talking about their anxieties is necessary and reduces their stress levels. Another scenario that is inserted during crisis scenarios is the omission of illnesses for fear of communicating to colleagues or the boss for fear of overloading them during the period of absence. It is important that all employees are encouraged to communicate the leadership, all changes be in the psychic as well as physical state. In this context, the institution’s role is to provide safety and tranquility so that no one feels cornered to report possible eventual symptoms.
In times of crisis, being a leader can increase the risk of developing the burnout syndrome, since it will be necessary to deal with fear, anguish and insecurity for oneself and the team members. Leaders need to be well positioned and centered to lead with self-control and agility.
It will be important for leaders to:
- Train multipliers to disseminate and contribute to activities;
- Identify precisely those who are well, those who show any signs of depletion in motivation, speed of response and willingness;
- Indicate emotional support for employees who need it, even if it is themselves.
Institutions must provide ways to guarantee internal support so that the professional is able to deal with their feelings and impotence or anger as an expression of the difficulties to face the new reality. For the professional, having freedom and space to talk about their issues, leads to tension release and allows some level of support and relief.
Maintaining an environment where those who need emotional support can express themselves calmly, reduces the stigma associated with mental problems and can help to reduce the stress level. It is known that the way the team conducts its stress has a significant impact on the quality of care provided. Therefore, it is necessary to look at the issues that arise within the teams, disfavoring those that will lead to the formation of teams that are not cohesive in care and less effective for patients.
Health professionals who are contaminated and removed as a result of COVID-19, when they return to work need to be closely monitored by their leaders, to make sure they can take on the workload prior to absence.
Emotional support services are expected to be maintained after the peak of the crisis, when the pandemic stops, many professionals will manifest disturbances and will need support.
Mental health care
The World Health Organization (WHO) has published a guide to mental health care during this health emergency period:
- Be empathetic. Show empathy for everyone affected. The infected people have done nothing wrong and deserve support, compassion, and kindness.
- Do not refer to people with the disease as “covid-19 cases” or “victims”, “covid-19 families”, “sick people” etc. They are “people with covid-19 or who are undergoing treatment or recovering” and after recovering they will continue their normal life with family, work and loved ones. It is important to separate the person and the virus itself, to reduce stigma.
- Reduce reading and contact with news that can cause anxiety or stress. Seek information only from reliable sources and take practical steps to prepare your plans, protect yourself and your family. Look for information and updates once or twice a day to avoid “unnecessary bombardment” of information.
- Design yourself and support others by helping them in their time of need. Assistance to others in their time of need can help those who receive support, as well as those who give assistance.
- Create opportunities to expand positive and useful stories and positive images of people in your area who have had covid-19, such as experiences of patients who have recovered from the disease.
- Recognize and appreciate the work of all professionals involved in providing care. Recognize their role in saving lives and keeping everyone safe.
- The fact that you experience stress and the sensations associated with this condition does not mean that you are not able to do your job or that you are a weak person. It is normal to feel that way because of the surroundings of the pandemic. Managing your mental health and your psychosocial well-being during this time will be crucial for you to maintain your physical health as well.
- Take care of you. Try to use methods to deal with the situation such as taking breaks and resting between your work shifts and even, if possible, taking a moment off the clock. Try to maintain a healthy diet, exercise, and stay in touch with family and friends.
- Avoid erroneous ways of dealing with stress such as the use of tobacco, alcohol, or other drugs. In the long run, they worsen your physical and mental well-being.
- Some health professionals may be avoided by the family because of fear of contamination and stigmas, which can make the situation you already face worse. If possible, stay connected with your loved ones, virtual contact is an option.
- When communicating with other team members, be simple, objective, and polite.
- Try to keep the team away from stressful situations so they can do their job better. The current situation will not end overnight, and its role is to focus on the long term, rather than short-term responses to the crisis.
- Ensure effective communication. Rotate with teams from the most stressful areas to the least stressful ones. Put less experienced employees to work with more experienced ones. Implement journeys on scales. Try to create space for colleagues to provide social support for each other.
- Check the availability of channels for access to psychosocial and mental support services. Managers and team leaders, in addition to facing the same pressures as other team members, also carry the weight caused by leadership role and responsibility. That is why it is important that resources are available to everyone.
- Manage patients’ mental health and neurological complaints such as delirium, psychosis, severe anxiety and depression, in the areas of emergency or general practice. Specialized mental health teams should be mobilized for these areas.
- Share information about what is happening clearly, explain risks and infections in understandable words. Repeat the information whenever necessary. Instructions must be clear, concise and respect the patient’s style.
Suffering will be part of this trajectory for all professionals involved, but in the end, everyone will be sure, that they will be honoring their professional oaths.
- Blanchard EB, Hickling EJ, Forneris CA, Taylor AE, Buckley TC, Loos WR, Jaccard J. Prediction of Remission of Acute Posttraumatic Stress Disorder in Motor Vehicle Accident Victims. J Trauma Stress1997; 10(2):215-234.
- Baldo V, Marcolongo A, Floreani A, Majori S, Cristofoletti M, Zotto AD, Vazzoler G, Trivello R. Epidemiological aspect of traumatic brain injury in Northeast Italy. European Journal of Epidemiology2003; 18:1059-1063.
- Maia AC. Epidemiologia da perturbação do stress traumático (PTSD) e avaliação de resposta ao trauma. In: Pereira MG, Ferreira JM, organizadores. Stress traumático: aspectos teóricos e intervenção. Lisboa: Climepsi; 2003. p. 35-54.
- Cavalcante F G; Morita P A; Haddad S R. Sequelas invisíveis dos acidentes de trânsito: o transtorno de estresse pós-traumático como problema de saúde pública. Brasil: Ciênc. saúde coletiva vol.14 no.5 Rio de Janeiro Nov./Dec. 2009.
- ONU NEWS – Perspectiva Global Reportagens Humana – OMS divulga guia com cuidados para saúde mental durante pandemia – https://news.un.org/pt/story/2020/03/1707792
- Douglas Crispim, Maria Júlia Paes da Silva, Walmir Cedotti, Millena Câmara, Sarah Ananda Gomes – COMUNICAÇÃO DIFÍCIL E COVID – 19 – Recomendações práticas para comunicação e acolhimento em diferentes cenários da pandemia, 2020. https://ammg.org.br/wp-content/uploads/comunica%C3%A7%C3%A3o-COVID-19.pdf.pdf
- Schaefer LS; Lobo BO; Kristensen C H – Transtorno de estresse pós traumático decorrente de acidente de trabalho: implicações psicológicas, socioeconômicas e jurídicas. 2012.