COVID-19 Pandemic and Frontline healthcare workers well-being

Frontline healthcare workers (HCW) are vulnerable to infection due to their close and direct exposure with the patients. The present unprecedent conditions along with increased work load and issues pertaining to personal and family safety, has consequently affected their mental health. This study was done to assess and compare the depression, anxiety and stress symptoms of nurses at the beginning of the COVID-19 pandemic and after six months. Mental health promotion strategies used during this period were also evaluated and compared. Further, the relationship between the frequency of use of mental health promotion strategies, with nurses’ depression, anxiety and stress symptoms was identified. It was concluded that it is imperative to prevent the consequences of COVID-19 outbreak on mental health of nurses, and health organisations should promote adoption of mental health promotion strategies. Along with this, mental health professionals can also be hired to help other health professionals to improve their mental health. Breaks between work shifts, physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, maintenance of remote social contacts, and verbalization of feelings/emotions were found to be effective in reducing stress, anxiety and depression among nurses.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7857980/

The mental and physical toll this crisis is having on our frontline health workers is rapidly becoming an epidemic in itself. Every new COVID-19 diagnosis means longer hours, less sleep and sporadic meals which leads to weakened immune systems.

These health professionals are more than our first responders, they will be our guides and community allies on the road to recovery once the epidemic ends. They’re taking care of us; now we must take care of them.

Addressing the needs of frontline healthcare workers to respond to the COVID-19 pandemic is a high priority, infact there is a lack of data to inform such efforts. Frontline HCWs had a significantly increased risk of COVID-19 infection, highest among HCWs who reused PPE or had inadequate access to PPE in some rural parts in India. However, adequate supplies of PPE did not completely mitigate high-risk exposures.

Strategies towards followup of COVID-19 confirmed or suspected cases can be done by the use of telephonic surveillance system for recording any AFI or ILI survey in remote areas. This can include the monitoring of the patients in terms of fever episode, medications, oxygen saturation, comorbidity data and verbal autopsy (as per WHO guidelines).

There is dearth of data in India approaching these group in representing their physical as well as their mental health in view of their safety it could be one of the way forward to be considered in public health in Indian scenario for future researches.

Frontline Health care workers are endangered and having high risk for infectious diseases, psychologically they are very stressed in terms of work environment, safety and family concerns. Nurses are life savers and they play a vital role in health care system in prevention of diseases. I absolutely agree to the post and strategies for defeating the psychological issues in health care workers. There should be some policies and stress comply programs and capacity building sessions among the HCWs for betterment of their health and work. 

During the COVID-19 Pandemic, Frontline healthcare workers are most vulnerable segment and they are at risk of mental health problems. They are at risk of experiencing tremendous psychological pressure because of stress, increased workload, sleepless nights, nightmares, discrimination,  stigma and fear of infecting themselves or their loved ones.

Link to a study conducted on Healthcare workers in Oman: //www.omjournal.org/PDF/OS-OMJ-D-20-00123%20(04R).pdf

WHO has made a short documentary film in which health care workers talking about the mental health and well-being challenges they have been facing while caring for patients during the COVID-19 pandemic.

//www.youtube.com/watch?v=mKKgx2DpP8k

During the COVID-19 pandemic, it is common for everyone to experience increased levels of stress and anxiety. Frontline health workers are particularly vulnerable to negative mental health effects as they strive to balance the duty of caring for patients with concerns about their own well-being and that of their family and friends. There is a need of establishing system to identify and provide care for mental health conditions. This system can be technological platform where health workers can assess their mental condition. It will hep them early identification of mental illness and required therapy. Secondly, telemedicine should be promoted wherever possible to decrease the burden of health care workers.

FLWs such as ASHA, AWW and ANMs, Nurses are front runners and taking most of the burden on reaching the last mile. However, well being gets often compromised as most of them are not having insurance, basic health coverage for family. The honorarium are not paid on time and many of them struggle to basic welfare need. It is very important issue and need to be addressed properly. The FLWs are the backbone of the health programme but there welfare and well being not thought through. There is need to provide them rewards, incentives on time, salary on time, performance appraisal, access to family health and hospital coverage, PPF options, immunisation preference to family members in COVID19. They need to have access to counselling, mental healthcare, hospitalisation coverage, children education benefits and maternity benefits. Access to smart phones, digital platforms to connect and avail comprehensive well being plan for them.State and National level easy access linkage with Government schemes. FLWs need to be given special privileges in linking with state and national welfare schemes.There is need to set up FLWs welfare system where inter sectoral support from WCD, Health, PRI. Rural development and SBM can be pulled on . Private institutions need to also focus on welfare of front line workers as some private institutions can be worst than government so welfare schemes need to be included in job. They need to be paid better, timely, access to health care, family health coverage. Private institutions  HR and labour laws need to check on minimum wages and maximum coverage of front line workers. Today is Nurse day and this issue is very important need to be addressed. We are seeing health system strengthening which was most neglected area now gaining focus and along with this FLWs welfare and well being can definitely bring health system to track and functional.

The huge demand placed on Frontline healthcare workers (HCWs) during 2019 novel coronavirus (COVID-19) pandemic has posed various challenges on their health and well-being. The mental health impact on this vulnerable group is due to the high work stress, risk of infection, and fear of cross infection to their closed ones. They are at the verge of emotional and physical exhaustion from providing care to the increasing numbers of patients who may then worsen progressively or they are exposed to critical illness or death of their colleagues. Moreover, providing care with limited resources further adds to extra pressure. However, certain measures can be taken to address the psychological risks to HCWs during these times. Those are as follows; 

• Psychological First Aid or Self coping strategies- priortising self care, adaptive approach, self distraction, acceptance, positive framing, online self-guided counselling and psychotherapy.
• Awareness at workplace-improved collaboration between employee and employer, hospital support systems and hospital management policy. Also, understanding the mental health issues of employees and a preventative approach towards the same, must be a part of the hospital's policy. 
• Psychosocial interventions- adequate training and education with proper dissemination information to handle stress and fear. Educating not only the HCWs but their families and an effective public communication can help lessen stigma and discrimination related to the disease.
• Digital Solutions- Online training sessions related to COVID-19 for all HCWs, policy makers, and the general public. Digital education by providing Massive Open Online Courses (MOOC) to the upcoming HCWs. Engaging public into activities that create awareness about the emerging COVID-19 related information and advisories.

Links: //www.ncbi.nlm.nih.gov/pmc/articles/PMC7246821/

//pubmed.ncbi.nlm.nih.gov/32959031/

Healthcare workers are facing a lot of stress during the COVID 19 outbreak. Most of the mental health issues arise because of job-related stress and work-life imbalance, Digital mental health and well-being platforms are gaining popularity among health workers to manage stress. The NHS UK has a wonderful digital mental health platform funded by Cambridgeshire and Peterborough Integrated Care System (ICS) to conduct psychiatric assessment and treatments, psychological therapies, and tailored occupational health support for the NHS healthcare staff.

In the current pandemic situation, it is important to address and manage mental health issues among Health care workers (HCWs) as it could have long term implications. Correct information should be disseminated to minimize the fear, educate public, HCWs and their families to lessen the stigma and discrimination. In addition to that, psychosocial support and effective measures should be available and more research on how to prevent psychological distress among frontline workers is required. There must be consistent and long term support to promote and protect well- being of HCWs

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7494453/

Doctors and Health Professionals are at the forefront in the fight against COVID-19. They are facing tremendous stress now in providing care and services, sometimes managing acute cases, through the difficult times of this pandemic. UNICEF in collaboration with the Johnson & Johnson Center for Health Worker Innovation will provide healthcare workers on the front line facilities access to dedicated mental and psychosocial services and support. It can also be done by supporting the frontline workers through reducing the health worker coverage gap, improving the quality of care and strengthening community and primary health centers. Initiatives taken by Health Ministry-

1-A dedicated toll-free helpline-08046110007, for providing psycho-social support for health care workers has been created by using suitable professionals including psychiatry department residents.

2-Health professionals are being encouraged to practice stress management techniques. Training modules have been designed in this regard and available at the website of the Ministry.

3-Life insurance cover for frontline workers.

Links to the above data-

MeasuresUndertakenToEnsureSafetyOfHealthWorkersDraftedForCOVID19Services.pdf (mohfw.gov.in)

UNICEF (jnj.com)

I was reading about a program called #FirstRespondersFirst - conceived by the Harvard T.H. Chan School of Public Health and Thrive Global. One of the main goals of the program is to help build resilience amongst frontline workers. They do this in a number of different ways - by running campaigns around prioritising mental health, by providing access to actionable microsteps (setting a cut off time for checking news for instance) and by making available a number of other relevant resources and services. 

More details about the program here: //thriveglobal.com/categories/first-responders-first/

I think if the GOI were to replicate something like that here, it would be incredible. But the truth of the matter is that we have urgent priorities we need to square away and any government intervention for frontline workers will be put on the back burner till we don't get our case numbers down. 

Personally, each time I interact with a healthcare worker virtually, I make sure to give them some appreciation. The hope/intent is that while we can't fix what's happening around the globe, we do have the power to make a small difference with our words which could hopefully add up in some way. 

//pubmed.ncbi.nlm.nih.gov/32357424/

The above article gives a 3 step evidence based plan, a digital learning package to cater to the needs of healthcare workers in the testing times of pandemic. 

(STEP 1) Public involvement activities (PPIs)

(STEP 2) Content and technical development with iterative peer review 

(STEP 3) Delivery and evaluation .

The package outlines the actions that team leaders can take to provide psychologically safe spaces for staff, together with guidance on communication and reducing social stigma, peer and family support, signposting others through psychological first aid (PFA), self-care strategies (e.g., rest, work breaks, sleep, shift work, fatigue, healthy lifestyle behaviours), and managing emotions (e.g., moral injury, coping, guilt, grief, fear, anxiety, depression, preventing burnout and psychological trauma). More research and application of similar models in different demographics and use of design thinking and healthcare to innovate interventions that cater to psychological needs of the workforce will be instrumental in preparedness and planning.

Post-pandemic research suggests any psychological supports should be based on models of adaptation and resilience
and may assist with post-pandemic absenteeism.11 Counter perhaps to expectation, such support is considered more
pertinent by staff who considered themselves to report to duty during an event13. Debriefing and psychological first
aid (RAPID-PFA), helplines and support groups for professionals have also been found helpful14. One study found
computer-assisted pre-pandemic training, increased staff ‘pandemic related self-efficacy’ and confidence11. This
feasibility trial incorporated tools to enhance coping styles and reduce maladaptive escape-avoidance patterns. The
results are encouraging, although the intervention is intended to occur prior to the pandemic as a means of
enhancing resilience and pandemic preparedness. Aspects of this training may be useful in the future stress-proofing
of healthcare staff, and the computer assisted delivery model would facilitate widespread provision in a climate that
is likely to be marked by even fewer resources than before. We have an ethical duty post Covid-19 to reflect on the
seismic and rapid work-related enforced changes and stressors, and the impact of these on staff well-being so that
we can better equip ourselves for future disasters,

Source

//www.irishpsychiatry.ie/wp-content/uploads/2020/04/Caring-for-the-Psychological-Well-Being-of-Healthcare-Professionals-in-the-Covid-19-Pandemic-Crisis-IMJ-2020.pdf