Downs Nancy, Davidson Judy, Haddad Angela, Zisook Sidney
University of California, San Diego, San Diego, CA.
University of Guadalajara University Health Sciences Centre, Guadalajara, Jalisco, Mexico.
HCA Healthc J Med. 2024 Jun 1;5(3):285-296. doi: 10.36518/2689-0216.1613. eCollection 2024.
Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and faculty. Since its inception in 2009, the program has been staffed by 4 licensed counseling professionals who have worked both before and since the COVID-19 pandemic.
Qualitative data obtained from semi-structured, 1-hour interviews and a follow-up 1-hour focus group with 4 HEAR counselors was analyzed using reflexive thematic analysis.
Several preexisting stressors were amplified during the pandemic: financial concerns; long work hours; exposure to the suffering of illness, death, and dying; bullying; discordant values and moral distress; social inequities; individuals' lack of adaptive coping; and individuals' self-concept as a victim. New stressors included: health care demand greater than the workforce numbers and resources; caretaking for ill family/friends; homeschooling of children; social isolation; experiencing the COVID-19 crisis as a war, fire, or storm; fear of personal illness and death, especially before vaccines; and hopes of a cure with vaccines; followed by perceived opportunities for improvement in leadership response to staff concerns.
Authentically responding to staff concerns/ideas, a patient and provider-centered health care culture, grief education and support, and attention to actionable stressors affecting providers' well-being are indicated to meet the amplified and new stressors triggered by the COVID-19 pandemic and sequelae.
早在新冠疫情之前，医疗保健提供者的压力和情绪困扰就有充分记录，而且越来越多的数据表明，这些情况因疫情而有所增加。本研究的目的是利用有执照的心理健康（MH）临床医生在疫情之前和期间与医疗保健学员及临床医生合作的独特经历，来确定这场危机如何影响了持续存在的以及新出现的压力源。治疗师教育、评估和转诊项目（HEAR）为约19000名医疗保健学生、学员、工作人员和教师提供心理健康筛查、支持及转诊服务。自2009年设立以来，该项目一直由4名有执照的咨询专业人员负责，他们在新冠疫情之前和之后都在工作。
采用反思性主题分析法，对从与4名HEAR咨询师进行的1小时半结构化访谈以及1小时后续焦点小组访谈中获得的定性数据进行分析。
在疫情期间，几个先前存在的压力源被放大：财务担忧；工作时间长；接触疾病、死亡和濒死的痛苦；欺凌；价值观不一致和道德困扰；社会不平等；个人缺乏适应性应对方式；以及个人作为受害者的自我概念。新的压力源包括：医疗保健需求超过劳动力数量和资源；照顾生病的家人/朋友；在家教育孩子；社会隔离；将新冠危机体验为战争、火灾或风暴；对个人患病和死亡的恐惧，尤其是在疫苗出现之前；以及对疫苗治愈的希望；随后是认为在领导层回应工作人员担忧方面有改进的机会。
为应对新冠疫情及其后遗症引发的放大的和新的压力源，需要切实回应工作人员的担忧/想法，营造以患者和提供者为中心的医疗保健文化，提供悲伤教育和支持，并关注影响提供者福祉的可采取行动的压力源。
