Damian Sendler, M.D. – SARS-CoV-2 exposure has been linked to the COVID-19 outbreak, putting healthcare workers (HCWs) under a great deal of stress and strain. Self-reported anxiety, depression, and even symptoms of post-traumatic stress disorder are common among healthcare workers around the world, according to numerous studies. As a result, the public health response to the COVID-19 pandemic must include support for the mental health of healthcare workers. The purpose of this review is to find out how the COVID-19 outbreak affected health care workers around the world and what measures were taken to reduce their stress. We found that only a few countries have published specific psychological support protocols for healthcare workers. Multidisciplinary collaboration was central to the development of all programs. All of them had the goal of preventing HCW’s from developing mental health issues as a result of the pandemic. There is no way to tell if one program is better than the others due to the lack of a standardized protocol and consistent clinical outcomes. In order to discover the best ways to support the resilience and mental health of HCWs, more research is required.
Damian Jacob Sendler: Over 100 million cases and over 2 million deaths have been reported since the start of the COVID-19 pandemic on February 15th (World Health Organization [WHO], 2021). It was a huge challenge for Health Care Workers (HCWs) who had a large number of patients who came into hospitals at the same time, which meant an increased workload and physical exhaustion, in contrast to the limited information about virus transmission, symptoms, protection, immunity and hospitalization criteria that brought to make ethically difficult decisions on the rationing of care based on the lack of information (Buselli et al., 2019, 2020a, 2020b, 2020c; Orsini et al., 2020; Pappa et al., 2020). As a result of the high rate of infection among health care workers (HCWs) and the possibility of spreading the virus to close family and friends, SARS-COV-2 causes a sense of social exclusion and stigmatization, especially in the first wave of the outbreak, which is characterized by inadequate personal protective equipment (PPE) (Huang et al., 2020; De Sio et al., 2020; Buselli et al., 2019, 2020a; Ramaci et al., 2020). Resilience was further harmed by conflicting thoughts about balancing family responsibilities and healthcare work, according to some researchers. Many people may have mixed feelings about working during the COVID-19 emergency, which could lead to feelings of guilt (Buselli et al., 2020a, 2020b; Firew et al., 2020; Godderis et al., 2020; Jin et al., 2020; Lai et al., 2020; Pfefferbaum & North, 2020; Shanafelt et al., 2020; Tan et al., 2020). Emotional strain or residue from working with victims of such a traumatizing and unprecedented event was also found to affect healthcare workers (HCWs). HCWs have to deal with patients who are dying on their own and have to tell their families about it, which can be traumatic and lead to high levels of stress and exhaustion (Patel et al., 2018; Waterman et al., 2018, Buselli et al 2020a, 2020b, 2020c).
Dr. Sendler: A recent meta-analysis in Canada has shown that HCWs have significant levels of self-reported anxiety, depression, insomnia, and even symptoms of post-traumatic stress disorder (Buselli et al., 2020a, 2020b; Digby et al., 2020; Firew et al., 2020; Krishnamoorthy et al., 2020; Maiorano et al., 2020; Pappa et al., 2020; Trumello et al., 2020; Vagni et al., 2020) (Cenat et al., 2021).
Damian Sendler
An important public health concern in today’s healthcare environment is signs of occupational stress (Walton et al., 2020). Even in the face of a long-term pandemic scenario and its long-term consequences, preventing high levels of stress in the workplace is critical to improving the quality of work-life balance. Researchers (Marine, 2006; Ruotsalainen, 2008; Troyer, 2020) have found that (Marine and Ruotsalainen). After the pandemic is over, HCWs may suffer from even more serious mental health issues (Cenat et al., 2021).
HCWs’ mental health needs have been identified by the scientific community as a critical issue (Holmes et al., 2020). It’s no secret that the WHO has been pressing for action on this issue for some time, and from the beginning of the pandemic, they’ve emphasized how much the occupational medicine field relies on health care workers, calling for immediate action that addresses the needs and measures necessary to save lives and prevent a serious impact on the physical and mental health of health care workers. Indeed, it is critical to safeguard the mental health of clinicians in light of COVID-19 and a research-based approach to developing and disseminating comprehensive clinician mental health support is required (Schwartz et al ., 2020).
Only a few health organizations have published their treatment protocols for HCWs, despite the fact that many have already invested resources in their care. For most people, the best option was to call a helpline, which is ideal for those experiencing urgent social or psychological issues. In the wake of the COVID-19 outbreak in China, which was the first to recognize the importance of psychological assistance in emergency situations, positive examples can be found (Zaka et al., 2020). Medical staff and patients received psychological services in the form of education and face-to-face interventions in hospitals (Wang et al., 2020; Chen et al., 2020).
Evidence-based practice necessitates practice-based data, especially in regard to a newly emerging mental health problem (Barber et al., 2016; Cenat et al., 2020; Smith et al., 2020). According to a recent review, a large majority of studies pertaining to the psychological needs of healthcare workers recommended psychosocial interventions with a strong emphasis on the need for additional psychosocial support and precise care (Muller et al., 2020). A rapid and practical approach that can be easily replicated by different HCWs groups or contests is needed now that Europe is in the midst of the second wave of infections while hospitals are on the verge of collapse, or there is a risk of not closing the gap between best evidence and best practice in light of the current unprecedented situation (Buselli et al., 2020a). Specifically, the purpose of this review is to identify the worldwide efforts to reduce stress in healthcare workers (HCWs) during the COVID-19 outbreak.
Individual, organizational, and societal health care well-being efforts are all interconnected. Organizational and individual characteristics should be taken into consideration when providing psychological support for healthcare workers. It has been shown in previous pandemics that the organizational context has a significant impact on the psychological outcomes of the workforce (Blake et al., 2020). Traditionally, resources have been devoted to helping employees who have mental health issues. A shift in focus from the individual to the organization is required on a regular basis when an emergency occurs (Walton et al., 2020).
Damian Jacob Sendler
HCWs were the primary focus of this study, which examined hospital organizational protocols. We narrowed our focus to four main areas: intervention type, intervention organization, intervention departments involved, and intervention outcomes (or outcomes of the interventions).
Damian Jacob Markiewicz Sendler: Three questions were used to gather evidence-based information for the purpose of this review: Do protocols exist around the world for dealing with HCWs’ mental health issues following the outbreak of COVID-19? Secondly, how many of these protocols are there? What are these protocols, and how have they impacted public health in the long run? In our view, the answers to these questions, and the highlighting of these protocols, are essential because psychological problems among HCWs could affect their attention or understanding or decision-making, and that protocols to limit such effects could prevent more serious psychological impairments and at the same time enhance adaptation skills and promote personal empowerment useful to face a long next phase (Zaka et al., 2020).
In spite of the WHO’s call for tailored and culturally sensitive mental health interventions for HCWs, we found that only a few countries have published specific psychological support intervention programs for HCWs (Holmes et al., 2020). Surveys and cross-sectional observational studies provide the bulk of the literature’s information. As a result, the quality of the published clinical experience was lowered because the protocols were not evaluated simultaneously using both a clinical and a control group. Because they haven’t been updated in several months, the only two registered protocols retrieved from study searching appear to be underdeveloped. That’s because only The Mount Sinai Hospital System took the opportunity to create a new department with clinical and research wings, with the goal of continuing to invest in HCWs’ wellbeing even after an emergency has passed, and they could provide interesting results in the next future in this area as well (DePierro et al., 2020).
Multidisciplinary collaboration was emphasized in all of the programs, except for CopeColumbia, but only the Italian program addressed COVID-19’s psychosocial issue from an occupational medicine perspective, which could help reduce the stigma associated with psychosocial distress and psychological interventions (Buselli et al., 2020a).
It was only the Chinese program that showed a change in treatment protocols based on initial feedback from health care providers. To address the new psychosocial burdens brought on by the pandemic, China’s program was the first, and it paved the way for health institutions and even governments to implement parallel psychological assistance measures in addition to the necessary medical and economic actions (Wang et al., 2020). This same approach was taken by the French, who sought to combat isolation, boredom and a lack of time with loved ones, as well as the inability to exercise or spend time outdoors (Lefèvre et al., 2021).
Damien Sendler: Proposing a psychological support service was difficult for the University of Minnesota Medical Center in China, so they came up with an innovative solution. They created a psychological intervention based on the US Army’s Battle Buddies peer support model. An overarching assumption is that, like soldiers on the battlefield, HCWs face a constant state of uncertainty about their capabilities, resources, and risks, as well as constant suffering, death, and threats to their own safety (Albott et al., 2020). Neither the Battle Buddy nor its conversations with other Battle Buddies are intended to be confidential therapy sessions. A Battle Buddy will only be offered mental health consultation if they notice excessive anxiety or other maladaptive behaviors. Creating these Battle Buddy relationships is a way for people from similar backgrounds to connect and share their daily struggles and triumphs with someone who gets it. The daily chats between the Battle Buddies become mutually beneficial, allowing work issues to remain at work and allowing the Battle Buddies to relax at home (Albott et al., 2020; Shanafelt et al., 2020).
Additionally, a customized approach was sought by an Italian team from Pisa’s University Hospital. Aware of the Chinese findings, Italian researchers decided to wait for individual requests from workers and help them from an occupational (and non-pathological) perspective in addition to the monitoring of physical symptoms, laboratory and microbiological tests (Buselli et al., 2020a).
Lastly, Malaysia adopted a strategy based on a rapid adaptation of the International Federation of Red Crescent Societies’ (IFRCS) remote PFA. A set of guidelines for implementing the “Look, Listen, Link” principles using mobile devices and an online platform (Sulaiman et al., 2020). English-speaking groups were also interested in digital methods for enhancing the psychological well-being of healthcare workers (Blake et al., 2020).
Given the variety of programs, the lack of standardized protocols with a robust methodology, and the lack of clinical outcomes, it is impossible to know whether one program is superior to the others. They were all created in a time of rapid change, and as a result, clinical needs took precedence over traditional research methods. No evidence was found in a recent Cochrane review, which examined the effects of interventions to support the mental health and resilience of frontline health care workers during and following an outbreak, epidemic, or pandemic from 2002 onwards. In 2020, (Pollock et al.) Psychological protocols for HCWs should be implemented immediately, given the evidence of the risk of short- and long-term psychological consequences and the impact on work performance and care quality (Chen et al., 2020; Nguyen et al., 2020; Zaka et al., 2020).
It is important to note that this review has some limitations. We were unable to conduct a formal systematic analysis because of the lack of documented mental health initiatives around the world. There was also a lack of specific information about the targeted populations (such as first- or second-line HCWs), types of program administrators (such as volunteers, mental health professionals, nurses, and doctors), information about mental health expertise (such as a training process or not), and timelines for the programs in the available publications for this review. While clinical outcomes descriptions are lacking, it is important to wait for the results of two ongoing clinical trials, even though it appears that they have stopped at the recruiting phase.
