YNHHS helps staff deal with COVID-19’s emotional toll

YNHH’s Psychological Medicine Team has been helping employees cope with stress, anxiety and other concerns during the COVID-19 crisis. Members are (l-r): Victoria Ogbejesi, RN, patient services manager, Psychological Medicine; Nancy Tommasini, RN, clinical nurse specialist, Behavioral Intervention Team (BIT); Joseph Fickes, MD; Michele Acton, RN, BIT; Raymone Shenouda, BIT medical director; Pat Cunningham, RN, BIT clinical nurse specialist; Kimberly Yonkers, MD, chief, Division of Psychological Medicine; Nancy Atwood, LCSW, BIT social worker; and Jessika Brasseaux, APRN, BIT.

At Yale New Haven Health and worldwide, experts are seeing COVID-19’s emotional effects on healthcare workers, and taking steps to help them cope.

YNHHS clinicians who cared – and continue to care – for COVID-19 patients in intensive care units are vulnerable to stress, particularly those who previously cared for other types of patients.

“There was a lot of disruption when units were rapidly disassembled and converted into ICUs for COVID-19 patients,” said Kimberly Yonkers, MD, chief of Yale New Haven Health’s Division of Psychological Medicine. “Dealing every day with very sick patients who are on ventilators and may never come off puts intense stress on clinical staff. Add personal stressors like financial worries, childcare or other family issues, and it is a very challenging time for staff.”

For all care providers, the severity of illness and death toll associated with COVID-19 have been difficult, especially with social distancing restrictions. “There’s no touching or hand-holding for consolation. You can’t stay in the room with a patient for very long,” Dr. Yonkers said. “You can’t be the doctor or nurse you want to be.”

Under the direction of Psychological Medicine, YNHHS has implemented various resources for physical and emotional wellbeing. These include a “buddy system,” in which staff members identify a fellow employee with whom they check in daily and Psychological Medicine team rounds on medical units, which include “huddles” for staff who want to talk.

For the wider community, Psychological Medicine held stress and resilience town halls to share coping techniques, along with daily, online meetings for anyone who wanted to drop in.

“We are making sure we can be available to as many people as possible,” Yonkers said. “What works for one person might also help another.”

Resources available on the employee intranet include information about mindfulness, resilience, coping with stress, nutrition and physical wellness. Clinical staff also received a stress self-assessment questionnaire which links to support programs.

“One of the challenges is that, as doctors and nurses, we are not trained to reach out and ask for help,” Dr. Yonkers said. “We learn to ‘stick it out and carry on.’”

Though the intensity of the pandemic has begun to wane, the psychological stress on medical workers is likely to continue and even worsen, which may lead to a wave of depression and post-traumatic stress disorder (PTSD), Dr. Yonkers said.

“When you’re in the thick of things, you just think about surviving. Then the dust settles, and you realize all that’s been lost,” she said. “The real challenges will come in the weeks and months ahead as we process the losses.”

She encourages staff to continue supporting one another and seeking help if they experience any PTSD signs: trouble sleeping or concentrating; negative thoughts; feeling overwhelmed, inadequate, or isolated; feeling detached; or irritability and angry outbursts.

“Asking for help when you need it is not a sign of weakness,” Dr. Yonkers said. “It’s a sign of strength.”