Supporting Clinicians during Covid-19 and Beyond — Learning from Past Failures and Envisioning New Strategies

Shapiro, Jo; McDonald, Timothy

doi:10.1056/nejmp2024834

Cited by 62 publications

(69 citation statements)

References 5 publications

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“…Certainly, the COVID-19 pandemic has highlighted the urgent need to address the emotional wellbeing of clinicians, particularly if they were affected by COVID-19. Programs should be designed with a range of strategies, including psychological support and resources for mitigating workplace stressors [30].…”

Section: Discussionmentioning

confidence: 99%

Neurological and cognitive sequelae of Covid-19: a four month follow-up

et al. 2021

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Central and peripheral nervous system involvement during acute COVID-19 is well known. Although many patients report some subjective symptoms months after the infection, the exact incidence of neurological and cognitive sequelae of COVID-19 remains to be determined. The aim of this study is to investigate if objective neurological or cognitive impairment is detectable four months after SARS-CoV-2 infection, in a group of patients who had mild–moderate COVID-19. A cohort of 120 health care workers previously affected by COVID-19 was examined 4 months after the diagnosis by means of neurological and extensive cognitive evaluation and compared to a group of 30 health care workers who did not have COVID-19 and were similar for age and co morbidities. At 4 month follow-up, 118/120 COVID-19 cases had normal neurological examination, two patients had neurological deficits. COVID-19 patients did not show general cognitive impairment at MMSE. In COVID-19 cases the number of impaired neuropsychological tests was not significantly different from non COVID-19 cases (mean 1.69 and 1 respectively, Mann–Whitney p = n.s.), as well as all the mean tests’ scores. Anxiety, stress and depression scores resulted to be significantly higher in COVID-19 than in non COVID-19 cases. The results do not support the presence of neurological deficits or cognitive impairment in this selected population of mild–moderate COVID-19 patients four months after the diagnosis. Severe emotional disorders in patients who had COVID-19 in the past are confirmed.

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Section: Discussionmentioning

confidence: 99%

Neurological and cognitive sequelae of Covid-19: a four month follow-up

et al. 2021

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“…Other useful methods such as Wu’s RISE (Resilience in Stressful Events) model [ 35 ] or Shanafelt’s list of requests to health-care organizations [ 1 ] can guide and support health-care managers in this endeavor. The support programs should be designed using a range of strategies to overcome the cultural and structural barriers that cause many programs to fail [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 is having a destructive impact on health-care workers’ mental well-being

Vanhaecht

Seys

Bruyneel

et al. 2020

International Journal for Quality in Health Care

180

163

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Background The coronavirus disease 2019 (COVID-19) may aggravate workplace conditions that impact health-care workers’ mental health. However, it can also place other stresses on workers outside of their work. This study determines the effect of COVID-19 on symptoms of negative and positive mental health and the workforce’s experience with various sources of support. Effect modification by demographic variables was also studied. Methods A cross-sectional survey study, conducted between 2 April and 4 May 2020 (two waves), led to a convenience sample of 4509 health-care workers in Flanders (Belgium), including paramedics (40.6%), nurses (33.4%), doctors (13.4%) and management staff (12.2%). About three in four were employed in university and acute hospitals (29.6%), primary care practices (25.7%), residential care centers (21.3%) or care sites for disabled and mental health care. In each of the two waves, participants were asked how frequently (on a scale of 0–10) they experienced positive and negative mental health symptoms during normal circumstances and during last week, referred to as before and during COVID-19, respectively. These symptoms were stress, hypervigilance, fatigue, difficulty sleeping, unable to relax, fear, irregular lifestyle, flashback, difficulty concentrating, feeling unhappy and dejected, failing to recognize their own emotional response, doubting knowledge and skills and feeling uncomfortable within the team. Associations between COVID-19 and mental health symptoms were estimated by cumulative logit models and reported as odds ratios. The needed support was our secondary outcome and was reported as the degree to which health-care workers relied on sources of support and how they experienced them. Results All symptoms were significantly more pronounced during versus before COVID-19. For hypervigilance, there was a 12-fold odds (odds ratio 12.24, 95% confidence interval 11.11–13.49) during versus before COVID-19. Positive professional symptoms such as the feeling that one can make a difference were less frequently experienced. The association between COVID-19 and mental health was generally strongest for the age group 30–49 years, females, nurses and residential care centers. Health-care workers reported to rely on support from relatives and peers. A considerable proportion, respectively, 18 and 27%, reported the need for professional guidance from psychologists and more support from their leadership. Conclusions The toll of the crisis has been heavy on health-care workers. Those who carry leadership positions at an organizational or system level should take this opportunity to develop targeted strategies to mitigate key stressors of health-care workers’ mental well-being.

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“…Social-distancing requirements and remote work practices have produced challenges to member connectedness and communications. Efforts must be made to support, [14] that function both to reach out to individuals when necessary and simply to check in and that allow team members to "reach in" for help and resources when appropriate.…”

Section: Building and Sustaining High-functioning Teamsmentioning

confidence: 99%

“…Be these administrative or teaching roles, committee or task force membership, inclusion in a research project, involvement in a regional or national organization, or even time to focus on an outside activity, innumerable opportunities exist for becoming involved and finding meaning. Being or becoming resilience is a complex and controversial topic [14]; members of your team will manifest signs and symptoms of stress differently and respond to different stress reduction strategies [36,37]. Perfectionism and a lack of self-compassion (rather than a lack of resilience) seem to be an Achilles heel for physicians.…”

Section: Personal Wellness Behaviorsmentioning

confidence: 99%

“…With time, approaches to mitigating stress and burnout have evolved to fostering wellness and professional fulfillment at work [12], while addressing existing moral and cultural inconsistencies in our organizations [13]. However, the occurrence of a major pandemic and the significant and additional detrimental impacts this would have on our practices, our workforce, and our ongoing efforts for fostering wellness were not anticipated [14]. The pandemic has revealed the importance of developing proactive wellness programs that both address chronic system-based issues impacting physician well-being and are able to adapt to unique stressors as they arise.…”

Section: Introductionmentioning

confidence: 99%

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