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Wellness and Self-Care During COVID-19

By Currents Editor posted 06-18-2020 09:16

  

Swarna.jpgBy Swarna Rajagopalan, neurocritical care attending/assistant professor of Neurology and Neurosurgery, West Virginia University Hospital, Morgantown, WV

Intensivists and healthcare professionals work tirelessly around the clock as the COVID-19 pandemic ravages throughout the world. This article includes heartfelt perspectives and challenges faced by colleagues on the frontlines and explores coping strategies as we tackle this pandemic together.

Challenges

I listened to my close friend, an infectious disease attending physician, on Facetime in April 2020, as she described her new day-to-day in New York City.

“This is death like we’ve never seen before,” she said. “Previously healthy 30-year-olds with COVID-19 are dying because we just don’t have the resources to support them.”

Many of us deal with life, end-of-life care and death on a routine basis in the neurocritical care unit and other intensive care units. However, most of us have never experienced a pandemic caused by a highly contagious and rapidly fatal disease, resulting in a rapid depletion of resources and an overwhelming sense of powerlessness.

A friend chimed in, “The worst part of it is they have to die alone.”

Many healthcare workers have been sitting with patients at their bedside, in place of their families and friends who cannot be there due to visitation restrictions. There is insufficient time to grieve when deaths keep piling on.

“I have been trying to check in daily with my friends sick with COVID-19. Today, I had to sit down and make a list. I got to 26 people. That’s so many friends,” said intensivist Rana Awdish.

Due, in part, to the highly contagious nature of the disease, inadequate personal protective equipment (PPE) and high exposure risk of frontline workers, many of us have witnessed colleagues, close friends and life-long mentors become very ill or die. These unique circumstances add to moral injury already faced by frontline workers. Resources, including intensivists, are spread thin, and time is coveted.

As patient care dominates, self-care falls by the wayside. Hobbies become optional, and socialization is limited due to social distancing. Endless and grueling work leads to stress and burn out, with an undertone of being unable to escape. This is compounded by fear of the unknown, implications of those disobeying social distancing rules and sense of loss of control. Many frontline workers are experiencing sleep deprivation due to anxiety, stress and exhaustion. Moreover, being essential workers, many physicians face the challenges of finding ways to homeschool their children, while being on the frontlines. As the virus is novel, its long-term impact on pregnancy remains unknown, adding further stress to pregnant frontline workers.

As disease incidence waxes and wanes, it is clear that tackling this pandemic is not a sprint but a marathon, with no end in sight. Its full impact may not be seen until the dust settles.

Coping Strategies

As the trajectory and duration of the pandemic remain uncertain, the following strategies can help us remain mindful and healthy during trying times:

Symptoms

Strategies and Resources

Overstimulation (can worsen anxiety, depression and sleep quality1)

  • Informational hygiene: Set time and notification limits on pandemic-related news and social media; channel this time to other activities.

Sense of loneliness

  • Participate in distanced socialization: Spend time with friends and/or family virtually; set up a virtual lunch or happy hour.
  • Add a new family member: Consider fostering a shelter animal.

Low mood, anxiety and negativity

 

 

  • Get fresh air
  • Home cooking and healthy eating: Decrease intake of sugary and processed foods and replace them with healthier alternatives like fruits, vegetables and nuts.
  • Set aside time to exercise daily:  This can be accomplished before/after work or even mid-day between patient activities, if time permits.
  • Meditation and mindfulness: Set aside a few minutes daily to reflect on and reframe thoughts. This can help regulate negativity and decrease emotional activity through the anterior cingulate cortex and amygdala2.
  • Yoga and breathing techniques: Employ a simple breathing technique in the middle of the day, such as inspiration for 4 seconds, holding for 7 seconds and expiration for 8 seconds.
  • Meditation, yoga and exercise can boost mood and relieve anxiety by induction of metabolic changes in the brain, release of endorphins and regulation of the sympathetic nervous system3.
  • Mindfulness apps, such as Headspace, are offering free membership to healthcare workers during the pandemic.

Burn out/moral injury

  • The interventions above may buy time and increase the threshold but do not target the cause of burn out. Discuss your experience with colleagues and/or superiors for prompt intervention.

Depression, post-traumatic stress disorder

  • Reach out for help. Consider hospital wellness resources, personal therapists, psychiatrists or national helpline.
  • The CDC has mental health resources, such as the Disaster Distress Helpline accessible by phone, 1-800-985-5990 or text, at TalkWithUs to 66746.
  • For immediate help with suicidal thoughts or ideations, contact the National Suicide Prevention Lifeline at 1-800-273-TALK, or 911.

 

Coping strategies and prioritization of time of self-care aid in resiliency and mental recovery. However, if the psychological toll is significant, they are merely a Band-Aid. Therefore, it is important to reach out early for mental health help.

References

  1. Vannucci A, Flannery KM, Ohannessian CM. Social media use and anxiety in emerging adults. Journal of Affective Disorders 2017;207:163-6.
  2. Hölzel BK, Ott U, Hempel H, et al. Differential engagement of anterior cingulate and adjacent medial frontal cortex in adept meditators and non-meditators. Neuroscience Letters 2007;421:16-21.
  3. Pascoe MC, Bauer IE. A systematic review of randomised control trials on the effects of yoga on stress measures and mood. Journal of Psychiatric Research 2015;68:270-82.


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