Addressing Acute Stress among Professionals Caring for COVID-19 Patients: Lessons Learned during the First Outbreak in Spain (March-April 2020).

José Joaquín Mira,Susana Lorenzo-Martínez,Virtudes Pérez-Jover,Jimmy Martin-Delgado,Ángel Cobos-Vargas,Maria Pilar Astier-Peña,Pastora Pérez-Pérez,María Asunción Vicente-Ripoll,Carlos Aibar,Mercedes Guilabert,Jesús Aranaz,Irene Carrillo,Carmen Silvestre-Busto,Cesar Fernández-Peris

doi:10.3390/ijerph182212010

Abstract

Objectives: To describe lessons learned during the first COVID-19 outbreak in developing urgent interventions to strengthen healthcare workers’ capacity to cope with acute stress caused by health care pressure, concern about becoming infected, despair of witnessing patients’ suffering, and critical decision-making requirements of the SARS-CoV-2 pandemic during the first outbreak in Spain. Methods: A task force integrated by healthcare professionals and academics was activated following the first observations of acute stress reactions starting to compromise the professionals’ capacity for caring COVID-19 patients. Literature review and qualitative approach (consensus techniques) were applied. The target population included health professionals in primary care, hospitals, emergencies, and nursing homes. Interventions designed for addressing acute stress were agreed and disseminated. Findings: There are similarities in stressors to previous outbreaks, and the solutions devised then may work now. A set of issues, interventions to cope with, and their levels of evidence were defined. Issues and interventions were classified as: adequate communication initiative to strengthen work morale (avoiding information blackouts, uniformity of criteria, access to updated information, mentoring new professionals); resilience and recovery from physical and mental fatigue (briefings, protecting the family, regulated recovery time during the day, psychological first aid, humanizing care); reinforce leadership of intermediate commands (informative leadership, transparency, realism, and positive messages, the current state of emergency has not allowed for an empirical analysis of the effectiveness of proposed interventions. Sharing information to gauge expectations, listening to what professionals need, feeling protected from threats, organizational flexibility, encouraging teamwork, and leadership that promotes psychological safety have led to more positive responses. Attention to the needs of individuals must be combined with caring for the teams responsible for patient care. Conclusions: Although the COVID-19 pandemic has a more devastating effect than other recent outbreaks, there are common stressors and lessons learned in all of them that we must draw on to increase our capacity to respond to future healthcare crises.

Highlights

The rapid spread of the COVID-19 pandemic and the adverse conditions in which health care was initially carried out affected healthcare institutions’ teams’ wellbeing and work morale
There has been an urgent need to intervene to preserve the emotional stability of health professionals [8], indispensable to face the challenge of the new coronavirus
The main objective of this study is to describe the lessons learned during the first COVID-19 outbreak in the development of urgent interventions to strengthen healthcare workers’ capacity to cope with acute stress caused by health care pressure, critical decisionmaking requirements, concern about becoming infected, despair of witnessing patients’ suffering and the perception of seeing limited their ability to perform the task properly during the first outbreak of the SARS-CoV-2 pandemic in Spain

Summary

Introduction

The rapid spread of the COVID-19 pandemic and the adverse conditions in which health care was initially carried out affected healthcare institutions’ teams’ wellbeing and work morale They have led to acute stress reactions among health professionals, increased intensity during that first outbreak [1,2,3]. The overload caused by the rapid increase of cases, the uncertainty about their clinical outcome, and the emotional impact of seeing a significant number of patients dying (many of them alone), added to the constant changes in instructions, the break in the supply chain, or the fear of catching (or taking home the SARS-CoV-2) impacted the emotional balance of professionals This impact is becoming more evident as new data emerges [4,5,6]. There has been an urgent need to intervene to preserve the emotional stability of health professionals [8], indispensable to face the challenge of the new coronavirus

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