We looked at recognizing common cognitive, affective and behavioural responses that frontline healthcare providers may experience during pandemics and how these may impact performance and wellness. We then discussd evidence-based strategies to manage intense emotional responses, enhance wellness in high-stress situations and how to take steps to mitigate harm.
Dr. Maxine Holmqvist, Undergraduate Medical Education (UGME) Coordinator, University of Manitoba
Maxine Holmqvist is an associate professor in the Department of Clinical Health Psychology at the University of Manitoba. She has served in a variety of leadership roles in medical education and is a long-standing clinical teacher in the Rady Faculty of Health Sciences, where she has worked with trainees in primary care and hospital settings.
She is also a past-chair of the clinical section of the Canadian Psychological Association, and currently is working with a national team of experts building a web-based resource for evidence-based practice in psychology.
Her research interests include the primary prevention of mental health disorders, psychological influences on health behaviour, improving health care delivery and interprofessional education and collaborative care.
Dr. Holmqvist started by noting that this pandemic is unique among pandemics - it is hitting around the world at essentially the same time. The demands on staff, equipment, supplies and supply chains are exposing fragility that wasn't obvious and it's making social determinants of health, things like safe drinking water, access to nutritious food and safe housing obvious to people who may not have thought about them.
She acknowledged that many health care providers are accustomed to some degree of risk and hardship and one thing that makes that possible is having a safe home to return to. That safe home is different now - the news is constant and changing and some of the up close and personal narratives and images we are seeing from around the world are gut wrenching. It can feel like waiting for a tsunami on a beach.
There are a range of responses to stress and there is a lot of overlap between health care providers and the public, but one thing that's unique to healthcare providers is they tend to be just as worried about transmitting illness as getting it themselves. Dr. Holmqvist lists some common reactions to stress in how we think, how we feel and how we behave and then identifies things that have shown to be self-protective in times of heightened stress.
It is important that if the distress is disproportionate, if it is persistent and unrelenting or if it gets in the way of daily life, to seek help.
We are reminded that resilience is the norm, to even hugely stressful events, not the exception. Healthcare providers as a group tend to struggle with uncertainty - we're good at going to the worst case but less attentive to accounting for potential good. Another way this pandemic is unique among pandemics is that there has never been so much concentrated brainpower and resources, around the world, focused on one problem. It makes sense to prepare for the worst but there are lots of reasons to be hopeful too.
There are steps we can take to keep ourselves and our colleagues and families safe. There are steps we can take to maximize our ability to recover and cope if we do become infected. There are factors that moderate the relationship between stress exposure and psychological response and many of them are within our control.
So what can we do? We can treat self-care as an ethical imperative. We can manage worry and other intense emotions. We can remember our values and we can focus on what we can control.