The emotional impact of the pandemic among health professionals

In recent months, healthcare professionals have been under significant pressure in conditions that have posed a real risk in your life.

Repeated exposure to death experiences along with the characteristics of this pandemic (seclusion, isolation, little hospital protection, lack of testing... ) can cause very intense emotional traumatic damage and falls within the normal consequences during or after the most critical moments of this situation.

Mental health and its professionals play an important role in this regard, and it is that emotional management in these conditions is vital to obtain or recover a well-being and quality of life.

In the present study we have tried to evaluate in a generic way the emotional impact of this crisis on health professionals in different centers and hospitals (public and private in the Community of Madrid). It consists of 67 nurses, nursing assistants, dentists, orderlies, doctors… between 21 and 59 years of age.

95.5% of those surveyed have worked directly with COVID-19 patients.

• Related article: "Mental health: definition and characteristics according to psychology"

This is the emotional impact of the pandemic on health professionals

Crisis situations require us to be quick, practical and demand a lot of physical and mental energy. Work overload and emotional intensity increase once the serious situation is established in society; To this we add the social pressure and the "responsibility" that falls in some sectors, obviously including the health sector and that in this case, they have to "save" a country.

You have to save lives as if it were a war. The intensity increases; and continues to increase with the context of the situation: the lack of action protocols, the lack of effective protection, lack of tests to control the movements of the epidemic and the lack of responsibility of some people...

All of this provokes unpleasantly intense emotions in professionals.. 70.1% of the professionals surveyed have felt that the situation surpassed them on some occasions; Compared to the 17.9% who felt that it exceeded them most of the time, 9% indicated that on a few occasions and 3% that they did not feel that it exceeded them. Why did these toilets feel overwhelmed? What situations have caused you the most anxiety?

"Living with the pain of patients and relatives on an ongoing basis. Fear of infecting you and above all of infecting your family or friends. Separating from your family for obvious reasons. See how your peers are physically and emotionally drained... Knowing that you are unprotected and still have to face the bug because the patient needs you and much, much frustration for not being able to get to everything... ". Nurse, 35 years old.

"Taking 89 elderly people as a nurse myself." Nurse in Residence, 29 years old.

"See that there was no EPIS, that urgent personnel were needed and that more and more health workers fell ill." Nurse, 25 years old.

"Above all the uncertainty, chaos, disorganization, the feeling of being in the middle of a war, going to a specialized service without having the years of experience that would be necessary, etc." Nurse, 25 years old.

"The arrivals of samples in avalanche". Laboratory technician, 29 years old.

"We left our units to help COVID-19 plants with hardly any training and resources. With incredibly hard shifts and most of the time without being able to help and reach all the patients. Seeing them die alone, in inhuman conditions, people who should not have done it because of their age or condition without even having the opportunity of criterion of access to ICU due to the collapse that existed in that moment...". Nurse, 33 years old.

"In general, the situation of loneliness, fear and uncertainty that all patients have experienced. Specific moments in which the patients themselves verbalized to us their fear, their grief, his fear of the imminent outcome that he was experiencing. All of this while being aware of the situation at all times. How they verbalized his awareness of his clinical deterioration, how he used us as a link to say goodbye to his family, to his world, how our hands they were the connection with those of their brothers, children, wife or husband... Those moments of communication with relatives who, without wanting to know it, had to hear the worst news... Situations that during our studies, fortunately, we are not taught and for which we were not prepared ". Nurse, 35 years old.

"Having a drowning patient between the ages of 60-70 and knowing that he is not going to the ICU because there are no beds, have daily deaths, think that you can get it and end up in one of those beds because you don't have PPE ". Nurse, 29.

"People on the street without any kind of responsibility, and at the time everything in general: feeling useless because you couldn't do anything so they wouldn't die ...". Nurse in hospital, 30 years old.

On the other hand, an emotional fan was provided with the intention that they mark the emotions with which they felt identified (They also had the opportunity to add any other that were not there). The emotions that have had the greatest impact have been: anxiety (85.1%), sadness (82.1%), frustration (82.1%), impotence (80.6%), worry (80.2%), stress (79.1%), anguish (61.2%); anger (55.2%), fear (43.3%), vulnerability (34.3%) and loss of prestige (20.9%).

Although the most experienced emotions were unpleasant (which is normal) there have also been people who, along with that discomfort has experienced more pleasant emotions of overcoming such as hope (35.8%), courage (32.8%) and optimism (26,9%).

Most also reported intense concerns (related to situations that caused them anxiety and discomfort). 58.2% rated the intensity at 4 points out of 5 (4/5); 29.9% by 5/5 and 11.9% by 3/5.

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Two curves that help us understand the emotional impact

At the time of crisis, we could differentiate several curves that are growing and then flattening. The curve of the workload and work pressure and the most emotional curve of each person. Both are influenced and depend on external aspects as well.

The work curve starts to grow from 0 and goes up exponentially, faster the first weeks and then achieve flattening.

The emotional curve starts high up since it is (as we mentioned before) a situation for which one is clearly not prepared and which generates uncertainty, pressure and direct and repeated experiences with death for many sanitary. Once the work curve is descending, we can notice improvements in our mood, a kind of liberation, also as time passes you have the opportunity to gain new perspectives from the situation.

Also, it happens that by lowering your guard, all the unmanaged emotions and all the pressure of what we have been living it falls on us like an emotional rain, generating a discomfort significant; or, on the other hand, we can feel liberated, but without lowering our guard and with uncertainty as to whether, how and when it will rebound again.

48.8% stated that they had begun to feel better due to the release of their workload and because they saw that the situation improved mainly. 11.19% stated that they had not, and in fact that many of the symptoms and aspects of anxiety, fear or sadness had also been accentuated.

Within the percentage of people who claimed to be better, there were responses such as "get used to worry." It is important to understand that resigning oneself (or getting used to worry) is not an aspect of feeling better emotionally. It can give us the false impression that it is, because we free ourselves from thinking about it but we abandon ourselves to it.

What is resilience?

Once "normal" life is established, the process of resilience begins to take place. Resilience is the ability of people to overcome difficulties. Multiple studies confirm that social support is the main protagonist for a person to become resilient to a situation. Support includes family support, social environment (friends), work environment, as well as sometimes necessary professional help.

In this case, we find positive data: 94% of those surveyed had been able to vent with their colleagues, and 92% had felt understood by them; however, 7.5% indicated that they had not spoken with them because they felt ashamed. 53.7% stated that they had felt support from their superiors, however, 46.3% indicated that they had not, or only occasionally.

In relation to the more social and family environment, most have felt support from both family, partner, friends or colleagues in other institutions and society in general. However, some people indicated that they had not been able to talk openly with their family members about how they felt, as well as others who had not felt support.

The aspects of not speaking out of shame or not having the circumstances of being able to share emotions in such an intense situation can generate greater suffering in these people.

In the long term, the consequences can be very varied and depend on each individual person.. Unpleasant emotions can be established, we can have memories, flashbacks, nightmares, a feeling of lack of air in some moments... That is why sometimes we need external support to be resilient and recover our wellness.

89.6% rated mental health as very important (5/5); as well as the importance of psychological assistance, which also obtained 89.6% ("very important") and 10.4% marked it as "important" (4/5).

16.4% have been receiving psychological assistance in hospitals (in some the psychologists came to see how they were doing, gave workshops on Mindfulness volunteers or did group sessions also voluntarily) and also independently. 43.3% have not been receiving psychological attention and 28.4% have not either, but they would like to do so in the future when the situation becomes more and more normal.

To do?

Identify emotions, express them, have support from the environment ... These are some of the essential characteristics to be able to become resilient in this situation. What can I do if I am a health worker and I feel identified?

1. Consider going to psychotherapy

In the first place, if you feel that you cannot handle the situation and that you have great discomfort (nightmares continuous, breathing difficulties you do not want to go to work, images of work come to you in the last weeks…) value going to a professional.

It is normal to be afraid, a little rejection or uncertainty... You can ask at the mental health service of your hospital or go to a private psychology office. There are times when we do not have the tools to handle a situation and we need the accompaniment of a professional.

2. Emotional management

How can I try to manage my emotions? Identify the emotions we feel and know what function they have it can help us to live the situation less aggressively. All emotions have a more beneficial function and way of expressing and managing them.

An example: if what I feel is sadness, what causes it? deaths and being unable to do anything. How do I react? I get frustrated, I blame myself, I demand myself and I block myself. Am I happy with that reaction? Hmm... I do not know. Can I think of something more effective or practical to handle it? Telling myself: "it is normal to feel like this, it is a complicated situation", "I can apply relaxation techniques", "I can talk to someone I trust about how I feel "," there are things that I can control and things that I cannot, I should focus on the things that I can control".

3. Abdominal or diaphragmatic breathing

Abdominal breathing helps us relax, increase concentration and feel better. Increases lung capacity and cell oxygenation. Anxiety can alter our breathing making us dizzy... In times of stress or anxiety trying to relax through breathing can be beneficial.

• You may be interested: "8 breathing exercises to relax you in a moment"

Concluding

In conclusion, the data provided reflects that yes there has been a great emotional impact on healthcare personnel and that the reasons have been numerous, but quite generalized and shared by all.

The emotions experienced by the majority are framed within normality in the experience of a social and health crisis. The vast majority appreciated the preparation of this study, and highlighted the importance of health and psychological care.

"Simply, thank you for taking the time to conduct this survey; I hope they give it the importance it has and it really shows the situation we health workers are experiencing with real sources and told from within. Great initiative ’’. Nurse, 23 years old;

"After this pandemic, many professionals will need psychological care, especially those who, in addition to losing patients, have lost family or friends. Psychologists, mental health nurses and psychiatrists are a very important pillar. Thanks for your work. " Nurse, 24 years old.

All this reflects the need to reinforce mental health in hospital areas in order to provide support and individual work to workers and the general population in order to improve their well-being.

Remember that despite obstacles or frustrations, you are fulfilling a great mission: taking care of those most in need. It must be remembered that all those who are working in hospitals under these circumstances, whatever they do, are the true heroes from the general population.