PTSD is a serious condition. It is important for hospitals to understand its signs and provide resources to help employees cope and possibly prevent PTSD.

It’s appropriate that the Mental Health Awareness Month of May is followed by the PTSD (Post-Traumatic Stress Disorder) Awareness Month of June. We are all experiencing stress in these uncertain times of the coronavirus pandemic. However, one group is particularly prone to serious stress: front-line health care workers, who tirelessly look after COVID-19 patients in very challenging conditions.

These workers are caring for critically ill patients, often serving in dual roles of providing critical care medicine and emotional-support caregiving that family members usually provide but cannot because of social distancing. Add to that the ever-present worry health care workers have about their own health and safety and it’s no wonder their stress levels are very high. A study of Italian health care workers showed that almost 50% reported PTSD Symptoms.¹

The Continuum of Stress

Dr. Patricia Watson from the National Center for PTSD describes a spectrum of stress that she calls the stress continuum,² which ranges from ready (green), reacting (yellow), injured (orange) to ill (red). PTSD is in the Red Zone.

• If you are in the Green Zone, you are doing fine.
• Many of us with a low level of stress move to the Yellow Zone, which is characterized by feeling irritable, down in the dumps, less motivated, or not quite right.
• People in the Orange Zone have an accumulation of stress over long periods of time and feel fatigued or not in control of their reactions.
• If people do not learn to deal with the stressor conditions and resulting reactions to them, they may move into the most severe Red Zone of PTSD where there is severe distress and functional impairment.

It helps for people to know that they can move between zones. The goal is to get them back to the Orange and Yellow Zones, which can happen with good self-care and manager and co-worker support.

Provide Access to Coping Strategies

The World Health Organization³ suggests several steps managers or team leaders in health facilities can take to protect staff from chronic stress and poor mental health:

1. Provide good communication and accurate information updates
2. Rotate workers from higher-stress to lower-stress jobs
3. Pair inexperienced workers with more experienced colleagues
4. Initiate, encourage and monitor work breaks
5. Implement flexible work schedules
6. Build in time for colleagues to provide social support to each other
7. Find new ways to build resilience and support

One example is for the facility to provide a dedicated white board. If someone feels ok that day, they write their name on the board. If another person needs extra support, they can easily find someone to talk to.

Finally, make sure professional help is available for those who are experiencing extended periods of stress with symptoms that are persisting, worsening and affecting functioning. Communicate to staff that these feelings are a very normal response to extremely stressful situations. Make sure everyone knows there is no stigma in reaching out to others to get the help they need.

Sources

1. Rossi R, Socci V, Pacitti F, et al. Mental health outcomes among front and second-line health workers associated with the COVID-19 pandemic in Italy. medRxiv preprint doi: https://doi.org/10.1101/2020.04.16.20067801. Posted April 22, 2020.

2. MedicalNewsToday. What can healthcare staff do to prevent PTSD during the pandemic? https://www.medicalnewstoday.com/articles/what-can-healthcare-staff-do-to-prevent-ptsd-during-the-pandemic#Finding-coping-strategies. Accessed May 19, 2020.

3. World Health Organization. WHO Mental health and psychosocial considerations during the COVID-19 outbreak. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_10. Accessed May 19, 2020.

Resources

1. Centers for Disease Control and Prevention. Healthcare Personnel and First Responders: How to Cope with Stress and Build Resilience During the COVID-19 Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/community/mental-health-healthcare.html. Accessed May 19,2020.

2. National Center for PTSD. For Health Care Workers and Responders. https://www.ptsd.va.gov/covid/list_healthcare_responders.asp. Accessed May 19, 2020.

3. National Center for PTSD. Mobil Apps: COVID Coach. https://www.ptsd.va.gov/appvid/mobile/COVID_coach_app.asp. Accessed May 19, 2020.