Concerns and Care for Health Care Colleagues during the COVID-19 Pandemic

Dear Editor:

Providers face unprecedented challenges during the COVID-19 pandemic. As we work to provide palliative, end-of-life, and bereavement care for patients who are declining, dying, or have died during the pandemic providers face uncertainty about their own health, and the health of their families and colleagues. Health care providers and staff may be reminded of their own mortality and personal risks as they struggle to cope with the high volume of critically ill patients. To maintain the highest level of care possible, we must acknowledge our physical and psychological vulnerabilities and actively engage in personal and team activities to foster our resilience.

Strategies

Four pillars of support are recommended to promote personal and professional well-being: connection, advocacy, reflection, and engagement (Table 1).¹

Table 1.

Care Strategies for Health Care Colleagues during the COVID-19 Pandemic

Care strategies
Connection	• Share faces of providers
	• Utilize chaplain/spiritual care and social work services1,4
	• Connecting patients with families with Video Chat4
Advocating	• Creating or joining taskforce
	• Sourcing equipment
	• Virtual nightly rounds7
Reflection	• Three Good Things6
	• Signage of progress
	• Scheduled debriefings
	• Moment of silence
Engagement	• “Hope huddles”8
	• Connecting coworkers through words12
	• Wellness cart9

Connection

Connection creates a sense of safety allowing for sharing and supporting in a time of vulnerability. With isolation of the quarantined patient, pinning life size pictures of nurses and doctors on gowns allows the patient to “see” their care provider,² which has now been adopted and used during the COVID pandemic.³ In addition, telecommunication allows patients to be present with their loved one.⁴ These meetings can help with goals of care and treatment decisions, but also alleviate moral distress on behalf on the patient and their loved ones.

Advocating

Protecting basic human rights of others and advocating for colleagues and patients can help provide a sense of control and help coping. The unique palliative requirements during the pandemic should be represented in policy initiatives both institutionally and regionally. Examples include emergency medicine palliative care providers adapting palliative care materials for rapid goals of care conversations within the emergency department (ED)⁵ or grouping together to obtain electronic tablets to facilitate video conservations with family and caregivers.

Reflection

Reflection may allow one to make sense of what is happening and to learn new insights of processing and coping. For example, “Three Good Things” (3GT)⁶ is an intervention that helps improve well-being by reflecting on 3GT that happened during the day to associate positive emotion. Scheduled mandatory debriefings or moments of silence also help providers continue to value patients and connection to each other. Creating signage or programs can remind clinicians that they are valued. In Orlando, Florida,⁷ a unit-based sign tracks how many patients are able to be weaned off the mechanical ventilator. Another example is hospitals playing an empowering song over the sound system to celebrate each COVID-19 patient discharged.

Engagement

Engagement tools include conversation and presence¹ to help providers cope and understand how their care makes a difference. The “Hope Huddles” program⁸ is where an inpatient nurse joins the emergency department rounds to share stories of patients recovering. In addition, another hospital created “Wellness on Wheels” where chaplain services deliver food, stress relief tools, cards from the community, and readings for hospital staff.⁹

Conclusion

We offer these four pillars to support our patients, families, and colleagues as they face unprecedented challenges of physical, moral, and ethical distress during the COVID-19 pandemic. By increasing our human connection during this uncertain time, we can take an active role in sustaining emotional resilience in our workforce.