COVID-19 has had a major impact on the lives of everyone in New Jersey and beyond. Health care workers, in particular, face great anxiety in treating those afflicted with this virus, and we expect they will face traumatic grief and loss as they continue to adapt to the ever-changing landscape brought by this pandemic.
To address this growing challenge, the Psychiatry and Behavioral Medicine teams at Cooper University Health Care began providing direct support to front-line health care workers in the ICU and medical/surgical units as the first suspected and confirmed cases of COVID-19 were admitted to their floors. In late March, members from our teams went to these units to address the collective distress of roughly 60 providers and support personnel. Sessions included psychoeducation on anxiety, normalization and validation of individual emotions, and practical skills focused on grounding techniques, mindfulness, and acceptance-based strategies. These efforts were repeated, expanded, and formalized into a task force known as the Resiliency Resources Team (RRT). The lessons learned from this initiative have been invaluable and will shape our continued response to this crisis and those that may arise in the future.
The elements of the program were drawn from the experience of places that had dealt with COVID-19 cases prior to New Jersey. We looked to the epicenter of COVID-19 in the United States, which was New York. One of the hardest hit health systems was the Mount Sinai Health System. There, the team focused on basic needs, psychosocial needs, and mental health of the clinical teams to enhance their well-being and reduce additional stress during the early days of the pandemic. Physicians from Stanford University, leaders in the area of Provider Wellness, conducted listening sessions during the first week of the pandemic to assess specific concerns. They identified five themes – “Hear Me,” “Protect Me,” “Prepare Me,” “Support Me,” and “Care for Me.” The team identified these five themes as vital issues for leaders of health care institutions to address with their staff. These themes focused on practical needs, providing emotional support, and facilitating ongoing, regular communication. This information helped to inform the work of Cooper’s RRT.
The main goal of the programs offered by the RRT is to provide direct emotional and social support, education, and skill-building via brief in-person resiliency workshops, peer support groups, and digital content. These sessions begin with a brief discussion of the stress response and the processing of emotional reactions. This is followed by identifying and addressing the group’s most salient needs, which become the focus of the remainder of session. Normalization of difficult emotions and education about a variety of topics such as the practice of mindfulness skills, acceptance-based skills, and grounding techniques. Practical suggestions, including reducing media intake and enhancing social connectivity, are also discussed.
To make resources available to a wider audience, an extensive digital library and wellness intranet site was developed. Topics addressed include adapting to telemedicine, engaging in self-care, talking to and caring for children, and maintaining a healthy lifestyle. A repository of open-access publications and a media section with audio and video recordings discussing coping skills for pandemic-related stressors is also available. The “Daily Dose,” inspirational and informative messages posted at 8 a.m. daily, has become a favorite destination for visitors to the website.
A main theme emerging from the early in-person sessions was that, while support from the RRT and Cooper’s administration was generally appreciated, providers and staff on the individual units and ambulatory offices have unique perspectives on their group’s needs and priorities. Peer support groups were created to connect physicians to physicians, nurses to nurses, and advanced practice providers (APP) to APPs. A training manual with video resources was created to review basic peer support principals as well as practical tips about what to do when a peer may need a greater level of support. A feedback survey was created to anonymously document the frequency and utility of these groups, as well as to assist in addressing identifiable risk issues.
The success of the RRT rests upon collaboration across the health system. Tait Shanafelt, MD, a wellness expert at Stanford University, has stressed the importance of frequent, clear communications and reliable updates. Such communications are key elements to health care providers’ wellness and ability to cope in challenging times.
At Cooper, senior leadership immediately focused on communication about COVID-19 preparedness and were transparent about Cooper’s plans and about any changes in practice as they occurred. A daily CEO update email was launched along with a nightly “Five at Five” WebEx briefing to provide updates regarding hospital admissions, virus testing, IT expansions with telehealth, surge plans, and community connections. Providers and staff continually receive special recognition for their dedication and hard work in all areas across the health care system.
Overall, the work of the RRT has been well received. In the first 45 days, the RRT reached more than 1,000 providers, as well as a wide variety of clinical and non-clinical teams. We have begun to address anxiety and traumatic grief and loss, and to emphasize building a resiliency mindset, and to promote compassion and post-traumatic growth throughout the COVID-19 pandemic. While stress can often be overwhelming and induce psychological distress, it can catalyze individual transformation and personal growth through finding new meaning and reinforcing deeply held values such as altruism, compassion, and spirituality.
Helping health care workers find greater understanding of their life experiences, thinking through new possibilities, and identifying personal strengths are all essential to managing the distress brought on by the pandemic. Identifying values, supporting self-exploration, and engaging in meaning-making through telling stories can facilitate positive growth and change during challenging and chaotic times. Resiliency building provides important ways of examining the roots of personal well-being, seeking opportunities for growth, and creating more profound meaning in our daily lives.
This article was written by the Resiliency Resources Team at Cooper University Health Care. Members of the Resiliency Resource Team at Cooper University Health Care include Kelly Gilrain PhD; Philip Fizur, PsyD; Rachel Allen, MD; Eileen Campbell, APN; Paula Watson; Siani Jordan; Eric Kupersmith, MD; and Anthony Rostain, MD.