Healthcare Workers
As a healthcare professional, you may face stress on the job under usual conditions due to long shifts, competing responsibilities, and witnessing or hearing about difficult patient experiences. As a responder on the front lines of the coronavirus disease 2019 (COVID-19) pandemic, you are likely working longer hours, seeing loved ones less, and working in a more stressful environment. At the same time, you may be coping with the mental health effects that all types of disasters, including public health emergencies, often have. As such, you may be noticing signs of stress and distress in yourself and your coworkers.
This tip sheet explores stress and compassion fatigue, as well as signs of distress after a disaster. It identifies ways to cope and enhance resilience, along with resources for more information and support.
Stress and Compassion Fatigue
Stress encompasses the ways that your body and brain respond to something you perceive as a demand in your environment. As a healthcare professional, your career requires you to respond to multiple demands at once, and you are likely already experienced in stress management.
Issues can arise, however, when you run short of time to recover between stressors, when you feel as though you cannot respond effectively to the many demands you face, or when you are part of a disaster-affected community and you are also having reactions to that experience.
Compassion fatigue includes two elements: burnout and secondary traumatic stress. Burnout is physical and mental exhaustion leading to reduced ability to cope with your environment. Burnout involves fatigue, frustration, a sense of helplessness, and reduced pleasure in work or other responsibilities. Secondary traumatic stress is the stress you may experience due to empathy with others you see going through trauma, including physical trauma such as serious injury, illness, or death. People also may experience secondary traumatic stress through empathy with others who talk with them about their traumas.
Signs and Symptoms of Disaster-related Distress
People affected by disasters such as the COVID-19 pandemic often experience physical changes, as well as changes in thinking, emotions, and behavior. In addition to signs and symptoms of compassion fatigue, you may notice the following signs and symptoms of disaster distress in yourself and those around you.
Physical
Stomachaches or diarrhea
Changes in appetite and eating habits
Headaches or other pains without a clear physical cause
Jumpiness or exaggerated startle response
Trouble falling asleep, staying asleep, sleeping too much, or trouble relaxing
Cognitive
Difficulty remembering things
Difficulty thinking clearly or concentrating
Confusion
Increased worry
Trouble making decisions
Emotional
Anxiety and fear
Overwhelming sadness
Anger
Guilt
Numbness and inability to feel joy or sadness
Behavioral
Increase or decrease in activity levels and reduced stamina
Frequent crying
Use of alcohol or other drugs in an attempt to reduce distressing feelings or to forget
Angry outbursts
Desire to be alone most of the time and deliberate self-isolation
Risk-taking behaviors
Signs and Symptoms of Compassion Fatigue
In the current highly stressful environment, you may notice the following signs and symptoms in yourself or your coworkers:
Increased startle response to activity around you, a feeling of being “on edge”
Difficulty making decisions
Exhaustion
Difficulty sleeping
Impaired ability to care for patients and/or clients
Intrusive thoughts about patients and/or clients
Reduced enjoyment or satisfaction with work
Sense of lack of control or agency in your job
Feelings of disconnection from colleagues and work teams
Feelings of being overwhelmed by the amount of work to be done
Anger and irritability
Reduced ability to feel sympathy or empathy
Avoidance of reminders of upsetting experiences with patients
Increased use of alcohol or other drugs
Addressing and Preventing Compassion Fatigue
As a healthcare professional, you probably already understand the importance of self-care to maintain your ability to work effectively. You need to take care of yourself first, and allow others to care for you, to be able to do your best work in caring for others. This section suggests strategies for self-care, stress management, and relaxation. Based on what has worked for you in the past, you may want to come up with a set of strategies and schedule them on a regular basis as part of
a stress management and self-care plan. Such a plan can be adjusted if you find it is not realistic or helpful. Give yourself credit for all you manage to do in the current, challenging environment.
Self-care and Stress Management
Do your best to attend to your physical health and consider the following:
Try to be physically active, ideally several times each week, taking part in activities you enjoy. Try walking or running, if there are places where you can maintain a safe distance between yourself and others. (If not, try exercising early or late in the day, or choosing less sought-after routes, if you can do so safely.) You can also do push-ups or sit-ups at home, dancing, or anything else you enjoy. Many workouts are available online or on television—and many do not require payment or equipment.
Strive to sleep and eat well. If possible, get enough sleep or at least rest. Aim for 7 to 9 hours a night. Do your best to eat healthy food. Drink enough fluids to stay hydrated.
Try to avoid increasing use of alcohol and other drugs. Although substances may help feelings seem more manageable in the short term, they can also lead to dependence and keep you from addressing issues over which you have control.
Also key to health and resilience is maintenance of your support networks. Try to remember to do the following:
Stay in contact with loved ones, including family and friends. Although social distancing orders mean that many of us cannot be together in person, several online meeting platforms allow you to talk remotely with loved ones. Phone calls are helpful as well. You can also send letters and postcards to family members and friends.
Turn to colleagues for contact and support at work. Even brief interactions are important. Take opportunities to recognize colleagues who have done impressive work in patient care or team support during the outbreak—informal recognition in conversation or by email can have a positive effect too. Remember that you are part of a team; you do not have to do it alone.
Following are ideas for activities that may help you reduce stress and relax, process your experience, and reconnect to your values and priorities:
Visualization
Imagine that you are in a place that is peaceful and calming to you—a place you have been, or one where you would like to be. You may want to write a description of this place, record yourself reading what you have written, and then listen to the recording as a way to relax. Also, many visualization and guided imagery scripts and videos for relaxation are available online, as are apps and podcasts.
Progressive muscle relaxation
One sign of stress is tense muscles, which is why stress can lead to headaches, backaches, and exhaustion. Progressive muscle relaxation is a systematic way to relax your muscles. Please refer to the instructions in the callout box for steps to follow.
Mindful movement such as yoga or tai chi
In addition to offering the health benefits of other exercise, yoga and tai chi may help with stress management. Along with the many centers offering classes online, videos are available online to use as guidance.
Meditation
Meditation has many benefits, including reduced anxiety, depression, and blood pressure, as well as insomnia relief. A session can be as short as a few minutes. You can access classes that many centers and institutes are offering online, sometimes free of charge. A host of mobile apps can be used to start or strengthen a meditation habit.
Progressive Muscle Relaxation—Instructions:
Get into a comfortable position.
Choose a muscle group (e.g., muscles in your feet or lower legs).
Breathe in and tighten the muscles in the group for 5 to 10 seconds.
Breathe out and release the muscles suddenly. Relax for at least 10 seconds.
Repeat the process with another muscle group. It often helps to progress from head to toe or vice versa.
Breathing exercises
When experiencing stress and strong emotions, people often constrain their breathing, and breathing exercises can be an effective way to relax. You can try deep breathing, or breathing into and out of your abdominal area instead of from your chest. Imagine your breath going into and out of your belly as you breathe. Another option is the 4–7–8 technique. Please see the callout box for instructions.
Humor
Humor and laughter can help relieve stress and, if shared, build bonds between people. Seek out sources of humor that have made you laugh in the past, such as specific cartoonists and authors, satirical publications and news shows, stand-up comedians, and television and movie comedies.
Journal writing or drawing
Write or draw in a journal if you find it helpful. This can be on paper, on a computer, or in an app. It can be as minimal as writing down one or two things you are grateful for a few times each week, or things you are pleased that you have accomplished.
Spiritual and religious practices
Some congregations and spiritual organizations are now offering online, live-streamed services and observances. Some are archiving services online. Participation in a religious or spiritual group can be helpful for meaning-making, reflection, and connection with a community.
Tips for Managers
If you manage other employees and have adequate staff, one step you can take to reduce staff stress is to schedule employees so that they have time to rest and recover between shifts. If possible, it can also be helpful to schedule staff so that they move into shifts in positions involving less stress after completing shifts in high-stress positions, so that they have time to recover between shifts of more intense work.
In addition, recognizing staff members for the work they do may help prevent compassion fatigue. You also can offer managerial support to
The 4–7–8 Breathing Technique for Relaxation
Sit quietly, relax, and close your eyes. Place the tip of your tongue against the ridge on the roof of your mouth just behind your top front teeth. Your tongue should remain in this position throughout the exercise.
Exhale completely through your mouth, making a whooshing sound. It may help to purse your lips.
Close your mouth, and inhale quietly through your nose for a count of four.
Now hold your breath for a count of seven.
Exhale completely through your mouth, making a whooshing sound, to a count of eight.
Repeat steps 2–5 three times, for a total of four breaths. In this technique, exhalation should take twice as long as inhalation. This ratio is the important part; the exact amount of time you spend on each phase is not important.
SAMHSA offers a video about stress management for disaster responders that features a demonstration of this breathing exercise.
When To Seek Professional Support
If you or someone you care about is overwhelmed by stress and reactions to the pandemic, you may want to reach out for professional mental health and/or substance use services and treatment. Acknowledging the need for help is a sign of strength. Even just a few visits can be helpful.
One place to seek support is with your employer—most have an employee assistance program, which offers short-term counseling and referrals. Many psychiatrists, psychologists, and counselors are now offering services by phone or through videoconferencing services. Some offer weekend and evening hours to accommodate work schedules. You can also check out the Helpful Resources section for free, confidential help with crises and referrals.
Source: SAMHSA
