PTSD: National Center for PTSD
For Health Care Workers: Managing Stress from Disaster Events
For Health Care Workers: Managing Stress from Disaster Events
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The well-being and emotional resilience of health care workers are crucial. During a disaster event—such as a natural or human-caused disaster, a mass violence event, or public health emergency like a disease outbreak, chemical spill, or radiation emergency—systems and facilities must anticipate the stresses associated with providing essential health care services and put in place supports for health care workers. Monitoring and assessment of mental health and well-being of health care personnel will be important. Both institutional supports and self-care strategies are needed.
Reducing Stress Through Preparedness
Health care workers are accustomed to participating in frequent formal and informal trainings. Additional ongoing organizational efforts during disaster events can provide a measure of stress reduction. Health care workers need training in:
- How the event will affect both themselves and their patients
- When and how to screen patients, and potentially, family members
- Employing ethical decision-making about triage and surge capacity issues
- Using personal protective equipment
- When to invoke quarantine and isolation in the case of infectious disease outbreaks
In order to increase their sense of self-efficacy, workers may also want to take part in training and planning exercises that include:
- Practicing response roles
- Managing limited resources
- Handling mass casualties
- Understanding surge-related triage decision trees
- Conducting mental health screening
- Coping with high stress demands
- Implementing all levels of quarantine, preparing for the needs of their families, and enforcing movement restrictions in the case of public health emergencies
Staff in health care facilities may also want to meet with leaders to discuss the importance of stress management and psychosocial support for the workforce. Discussions could include the possibility of Stress First Aid for coworker support and self-care, frontline stress control teams, appropriate work/rest schedules, and support for the needs of providers' family members.
Dealing with Stress During Disaster Events
During disasters, mass violence, or public health emergencies, health care workers may be faced with a lack of time, difficulties in acknowledging or recognizing their own needs, stigma, and fear of being removed from their duties. All of these pressures, coupled with a strong service orientation, may prevent them from requesting support if they are experiencing stress reactions. Given this, employers should be proactive in encouraging supportive care in an atmosphere free of stigma, coercion, and fear of negative consequences.
Self-care for health care workers can be complex and challenging, given that people in these roles may prioritize the needs of others over their own needs. Therefore, a self-care strategy should be multi-faceted and phased properly to support the sense of control and contribution of health care providers without making them feel unrealistically responsible for the lives of patients. For instance, during work shifts, providers should engage in these behaviors:
- Self-monitoring and pacing
- Regular check-ins with colleagues, family, and friends
- Working in partnerships or in teams
- Brief relaxation/stress management breaks
- Regular peer consultation and supervision
- Time-outs for basic bodily care and refreshment
- Regularly seeking out accurate information and mentoring to assist in making decisions
- Keeping anxieties conscribed to actual threats
- Doing their best to maintain helpful self-talk and avoid overgeneralizing fears
- Focusing their efforts on what is within their power
- Acceptance of situations they cannot change
- Fostering a spirit of fortitude, patience, tolerance, and hope
At the same time, they should avoid:
- Working too long by themselves without checking in with colleagues
- Working "round the clock" with few breaks
- Feeling that they are not doing enough
- Excessive intake of sweets and caffeine
- Engaging in self-talk and attitudinal obstacles to self-care, such as:
- "It would be selfish to take time to rest."
- "Others are working around the clock. So should I."
- "The needs of survivors are more important than the needs of helpers."
- "I can contribute the most by working all the time."
- "Only I can do. . .."
Specific Sources of Stress in Public Health Emergencies
There are specific sources of stress for health care workers treating patients with affected by public health emergencies like disease outbreaks or pandemics. These stressors include:
Need to employ strict biosecurity measures
Health care workers who are called upon to assist or treat people who are infected or exposed to disease may experience stress related to:
- Physical strain of wearing protective equipment (dehydration, heat, exhaustion)
- Physical isolation (restrictions on touching others, even after working hours)
- Constant awareness and vigilance regarding infection control procedures
- Pressures regarding procedures that must be followed (lack of spontaneity)
Risk of disease transmission
Infection control is a significant concern that can be exacerbated by:
- Common symptoms of infection being mistaken for disease outbreaks or pandemics
- An extended symptom-free incubation period for some infections
- A higher mortality rate compared to more common influenza outbreaks
- The tension between public health priorities and the wishes of patients and their families regarding quarantine
Multiple medical and personal demands
The complexity of responding to public health emergencies may result in conflicting personal and professional demands, including:
- Continued daily workload demands competing with needs for new preparation and treatment measures
- A need to maintain high standards in the face of a low-frequency event within which official recommendations and policies change regularly
- Possible separation from and concern about family members
- Fears about infection and subsequent implications for self, patients, and family
- Inner conflict about competing needs and demands
Stigma
Health care workers can be affected by both internal and external stigma related to public health emergencies and their impact, such as:
- Others' fear of contact with those treating infected patients
- Health care workers' self-stigma about voicing their needs and fears
Dealing with Stress in the Aftermath of Disaster Events
After a period of caring for those affected by these types of events a readjustment period is to be expected. Health care workers will need to commit to making personal reintegration a priority. This includes:
- Seeking out and sharing social support
- Checking in with other colleagues to discuss work experiences
- Increasing supervision, consultation, and collegial support
- Scheduling time off work for gradual reintegration into personal life
- Preparing for worldview changes that may not be mirrored by others in one's life
- Avoiding negative coping strategies such as:
- Use of alcohol, illicit drugs, or excessive amounts of prescription drugs, which all interfere with sleep cycles and delay recovery
- Suddenly making big life changes
- Megatively assessing their work contributions
- Leeping too busy
- Viewing helping others as more important than self-care
- Not wanting to talk about work experiences with others
If stress persists for longer than two to three weeks and interferes with functioning, health care workers should consider participating in formal mental health treatment.
Sources
- Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson, P. (2006). Psychological first aid: Field operations guide. National Child Traumatic Stress Network and National Center for PTSD. Retrieved from www.nctsn.org and www.ptsd.va.gov
- Gonzales, G. (2003). Deep survival. Who lives, who dies, and why. True stories of miraculous endurance and sudden death. W.W. Norton & Company.
- Hobfoll, S. E., Watson, P. J., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, B. P. R., de Jong, J. T. V. M., Layne, C. M., Magues, S., Neria, Y., Norwood, A. E., Pynoos, R. S., Reissman, D., Ruzek, J. I., Shalev, A. Y., Solomon, Z., Steinberg, A. M., & Ursano, R. J. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315. https://doi.org/10.1521/psyc.2007.70.4.283
- Reissman, D. B., Watson, P. J., Klomp, R. W., Tanielian, T. L., & Prior, S. D. (2006). Pandemic influenza preparedness: adaptive responses to an evolving challenge. Journal of Homeland Security and Emergency Management, 3(2). https://doi.org/10.2022/1547-7355.1233
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