The emotional impact of the pandemic among health professionals.

A study of the emotional impact of the coronavirus pandemic on health care professionals.

In recent months, healthcare professionals have been under significant stress in conditions that have posed a real risk to their lives. in conditions that have posed a real risk to their lives.

Repeated exposure to death experiences coupled with the characteristics of this pandemic (seclusion, isolation, poor hospital protection, lack of testing? ) can cause very intense emotional traumatic damage and is within the normal consequences during or after the most critical moments of this situation.

Mental health and its professionals play an important role in this regard.Emotional management in these conditions is vital to obtain or recover wellbeing and quality of life.

In the present study we have tried to evaluate in a generic manner the emotional impact of this crisis on health professionals in different centers and hospitals (public and private in the Community of Madrid). (public and private in the Community of Madrid). The respondents were 67 nurses, auxiliary nurses, dentists, orderlies, physicians... aged between 21 and 59.

Of the respondents, 95.5% had worked directly with patients with COVID-19.

This is the emotional impact of the pandemic on healthcare professionals.

Crisis situations require us to be quick, practical, and demand a lot of physical and mental energy.. The overload of work and the emotional intensity increase once the situation of gravity is established in the society; to this we add the social pressure and the "responsibility" that falls on some sectors, including evidently the sanitary one and that in this case, they have to "save" a country.

It has to save lives as if it were a war. The intensity increases; and it continues to increase with the context of the situation: the lack of protocols for action, the lack of effective protective measures, the lack of tests to control the movements of the epidemic and the lack of responsibility of some people?

All this provokes unpleasantly intense emotions in the professionals.. 70.1% of the professionals surveyed felt that they were sometimes overwhelmed by the situation; 17.9% felt that they were overwhelmed most of the time, 9% indicated that they were overwhelmed on rare occasions and 3% did not feel that they were overwhelmed. Why did these health professionals feel overwhelmed? What situations caused them the most anxiety?

"Living with the Pain of patients and family members on a continuous basis. Fear of infecting yourself and above all of infecting your family or friends. Being separated from your family for obvious reasons. Seeing how your colleagues are physically and emotionally exhausted.... Knowing that you are unprotected and yet you have to face the bug because the patient needs you... and lots and lots of frustration for not being able to get to everything... and lots and lots of frustration for not being able to get to everything...". Nurse, 35 years old.

"Carrying myself alone as a nurse 89 elderly." Nurse in Residence, 29 years.

"Seeing that there was no PPE, that urgent staffing was needed, and that more and more health care workers were falling ill." Nurse, 25 years.

"Above all the uncertainty, the chaos, the disorganization, the feeling of being in the middle of a war, going to a specialized service without having the years of experience that would be necessary, etc." Nurse, 25 years old.

"The arrivals of samples in avalanche." Lab technician, 29 years old.

"We left our units to help in COVID-19 plants with hardly any training or resources.. With incredibly hard shifts and most of the time without being able to help and reach all the patients. Seeing them die alone, in inhumane conditions, people who should not have died because of their age or condition without even having the opportunity to access the ICU because of the collapse at that time...". Nurse, 33 years old.

"In general the situation of loneliness, fear and uncertainty that all patients have experienced. Specific moments in which the patients themselves verbalized to us their fear, their grief, their fear of the imminent outcome they were experiencing. All this while being aware of the situation at all times. How they verbalized their awareness of clinical worsening, how they used us as a link to say goodbye to their loved ones, to their world, how our hands were the connection with those of their siblings, children, wife or husband... Those moments of communication with relatives who, without wanting to know it, had to hear the worst of the news... Situations that during our studies, fortunately, they do not teach us and for which we were not prepared". Nurse, 35 years old.

"Having a patient drowning between 60-70 years of age and knowing that he will not go to the ICU because there are no beds.having daily deaths, thinking that you can get infected and end up in one of those beds because you don't have PPE. Nurse, 29.

"People on the street without any kind of responsibility, and at the time everything in general: feeling useless because you couldn't do anything so they wouldn't die...". Nurse in hospital, 30 years old.

On the other hand, an emotional range was provided so that they could mark the emotions with which they felt identified (they also had the opportunity to add any others that were not found there). (they also had the opportunity to add any other that they did not find there). The emotions that had the greatest impact were: anxiety (85.1%), sadness (82.1%), frustration (82.1%), helplessness (80.6%), worry (80.2%), stress (79.1%), anguish (61.2%); anger (55.2%), fear (43.3%), vulnerability (34.3%) and discredit (20.9%).

Although the most experienced emotions were unpleasant (which is normal), there were also people who, along with this discomfort, experienced more pleasant emotions such as hope (35.8%), courage (32.8%) and optimism (26.9%).

The majority also claimed to have intense worries (related to situations that caused them anxiety and discomfort). 58.2% rated the intensity at 4 points out of 5 (4/5); 29.9% at a 5/5 and 11.9% at a 3/5.

Two curves that help us understand the emotional impact.

At the moment of crisis, we could differentiate several curves that grow and then flatten out. The curve of the workload and work pressure and the more emotional curve of each person. Both are influenced and depend on external aspects as well.

The work curve starts to grow from 0 and rises exponentially, faster in the first weeks and then flattens out.The work curve starts to grow from 0 and rises exponentially, faster in the first weeks and then flattens out.

The emotional curve starts from very high since it is (as we mentioned before) a situation for which one is clearly not prepared and which generates uncertainty, pressure and direct and repeated experiences with death for many health care workers. Once the work curve is descending, we can notice improvements in our mood, a kind of liberation, also as time goes by you have the opportunity to get new perspectives on the situation.

Also, it happens that when we let our guard down, all the unmanaged emotions and all the pressure of what we have been living through fall on us like an emotional rain, generating significant discomfort; or, on the other hand, we can feel liberated, but without letting our guard down and with uncertainty as to whether, how and when we will see an upturn again.

48.8% stated that they had started to feel better because of the release of workload and seeing that the situation was improving. 11.19% stated that they had not, and in fact that many of the symptoms and aspects of anxiety, fear or sadness had also been accentuated.

Within the percentage of people who said they felt better, there were responses such as "getting used to worrying". It is important to understand that resigning (or getting used to worrying) is not an aspect of being better off..... It can give us the false impression that it is, because we free ourselves from worrying but abandon ourselves to it.

What is resilience?

Once "normal" life is established, the process of resilience begins to take place. Resilience is the ability of people to overcome difficulties. Multiple studies confirm that social support is the main protagonist for a person to become resilient to a situation. Support includes family support, social environment (friends), work environment, as well as sometimes a necessary professional help.

In this case, we found positive data: 94% of respondents had been able to unburden themselves to their peers, and 92% had felt understood by them; however, 7.5% said they had not spoken to them because they felt embarrassed.However, 7.5% stated that they had not spoken to them because they felt embarrassed. 53.7% stated that they had felt support from their superiors; however, 46.3% stated that they had not, or only sometimes.

In relation to the more social and family environment, the majority did feel support from family, partners, friends or colleagues in other institutions and society in general. However, some people indicated that they had not been able to talk openly with their family members about how they felt, as well as others that they had not felt that they had been able to talk openly with their family members about how they felt.and others that they had not felt supported.

The aspects of not speaking out of shame or not being able to share emotions in such an intense situation can generate greater suffering in these people.

In the long term, the consequences can be very varied and depend on the individual person.. Unpleasant emotions can set in, we can have memories, flashbacks, nightmares, feeling short of breath at times... That is why we sometimes need external support to be resilient and regain our well-being.

89.6% rated mental health as very important (5/5).as well as the importance of psychological assistance, which also scored 89.6% ("very important") and 10.4% marked it as "important" (4/5).

16.4% had been receiving psychological assistance in hospitals (in some the psychologists came by to see how they were doing, gave voluntary Mindfulness workshops or held voluntary group sessions) and also independently. 43.3% have not been receiving psychological care and 28.4% have not been receiving psychological care either, but would like to in the future when the situation becomes more and more normalized.

What to do?

Identify emotions, express them, have support from the environment? These are some of the essential characteristics to become resilient in this situation. What can I do if I am a healthcare worker and I feel identified?

1. Consider the possibility of going to psychotherapy.

First of all, if you feel that you cannot handle the situation and that you have great discomfort (continuous nightmares, breathing difficulties, you do not want to go to work, images from work come to you in the last weeks...) consider going to a professional.

It is normal to be afraid, a little bit of rejection or uncertainty... You can ask the mental health service of your hospital or go to a private psychology office. There are times when we do not have the tools to handle a situation and we need the support of a professional.

Emotional management

How can I try to manage my emotions? Identifying the emotions we feel and knowing what function they have can help us to live the situation in a less aggressive way. can help us to live in a less aggressive way the situation. All emotions have a function and a more beneficial way of expressing and managing them.

An example: if what I feel is sadness, what provokes it? deaths and not being able to do anything. How do I react? I get frustrated, I blame myself, I demand and block myself. Do I feel satisfied with that reaction? Mmm... I don't know. I don't know, can I think of something more effective or practical to handle it? Tell myself: "it is normal to feel this way, it is a complicated situation", "I can apply relaxation techniques", "I can talk to someone I trust about how I feel", "there are things I can control and things I can't, I should focus on the things I can control".

3. Abdominal or diaphragmatic breathing

Abdominal breathing helps us to relax, increase concentration and feel better.. It increases lung capacity and oxygenation of the cells. Anxiety can alter our breathing making us feel dizzy... In times of stress or anxiety, trying to relax through breathing can be beneficial.

Concluding

In conclusion, the data provided reflect that yes there has been a great emotional impact on healthcare personnel. and that the reasons were numerous, but quite generalized and shared by all.

The emotions experienced by most of them are within the normal range of social and health crises. The vast majority thanked the elaboration of this study, and stressed the importance of health and psychological care.

"Simply, thank you for dedicating your time to carry out this survey; I hope you give it the importance it has and it really shows the situation we are living in healthcare with real sources and told from the inside. Great initiative. Nurse, 23 years old;

"After this pandemic, many professionals will need psychological care, especially those who in addition to losing patients have lost family or friends. Psychologists, mental health nurses and psychiatrists are a very important pillar. Thank you for your work. Nurse, 24 years old.

All of this reflects the need to strengthen mental health in hospital areas in order to provide support and individual work to workers and the general population to improve their well-being. to be able to provide support and individual work to workers and the general population in order to improve their well-being.

Remember that despite the obstacles or frustrations, you are fulfilling a great mission: caring for those most in need. Remember that all those who are working in hospitals in these circumstances, whatever they do, are the real heroes from the general population.