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On front lines of COVID-19: Mental and physical burdens

Tuesday, March 24, 2020 @ 11:35 AM | By Chantel Josiak

I’m on my seventh 12-hour shift in a row, physically, emotionally and mentally strained, but have no choice but to keep going. My legs and feet feel heavy, my brain feels slow and I’m so tired. There’s a thread of anxiety running through every part of my body. Several colleagues are off sick now. With what? No one knows yet; they’re awaiting test results. I worked with two of them just a couple of days ago and worry about exposure. Not just to myself, but to my patients. All of us have rallied as a team, but we know this might only be the deep breath before the crisis begins. COVID-19 hasn’t fully impacted us. Yet.

In part two, we discuss the physical, emotional and mental burden experienced by front line health-care workers.

Mental and physical toll of caring

The mental burden on heath care related to a major health care crisis is twofold: mental strain for all Canadians and the potential for caregiver burnout of health-care providers.

As consumers of the Canadian health-care system, everyone is feeling the mental toll of this virus, including health-care workers. There is uncertainty, misinformation, miscommunication and, in some cases, rampant fear.

Some members of our population are more vulnerable to the heightened anxiety of the moment including those with pre-existing mental health conditions (diagnosed or undiagnosed) and vulnerable populations including the homeless. Imposed quarantines, self-isolation and social distancing are an added concern because it’s unquestionably accepted that social isolation is associated with poor mental health.

Health-care providers face an additional level of stress in a crisis, the potential of caregiver burden. Burnout is characterized by emotional exhaustion, depersonalization and low sense of personal achievement and is brought on by prolonged involvement in emotionally demanding and stressful situations.

It is estimated that 25 to 65 per cent of nurses already experience burnout, which has the potential to become more prevalent as the COVID-19 pandemic intensifies. As more staff become ill themselves, the workload increases for those providing care.

As staffing shortages intensify, fatigue will increase. According to the Registered Nurses Association of Ontario (RNAO), risk factors for nurse fatigue include on-call hours, mandatory overtime, working while sick, inadequate rest between shifts, rotating shifts within a work week (e.g., nights to days), and personal factors such as working more than one job, age, home and family responsibilities, physical and mental health and working voluntary overtime.

This pandemic has the potential to elicit most of these factors, resulting in the potential for increased illness and an inability for health-care providers to work. As more co-workers become sick or self-isolated, the workload again increases for those who are well, perpetuating the strain. Despite our best intentions, health-care workers are human and burnout can be detrimental to patient safety.

As health-care professionals, we have a duty to ensure “fitness to practise” which means staying physically, mentally and emotionally healthy and prepared for the challenges of the day. When health-care workers feel worn out, they may find it hard to admit. They may feel torn between staying home to care for themselves and going to work, knowing the burden that their absence in the workplace could put on their colleagues.

It’s tough to ask for help when you’re the helper. The mental and physical toll of caring for critically ill patients can be overwhelming. But we have a duty to recognize when we’re struggling and support one another in maintaining a positive mental health focus.

This could include taking breaks from the news, remembering what we can control, talking and listening to one another, providing support for friends, family and neighbours, eating, sleeping and reaching out for help from professionals.

Caring for the mental health of everyone must be an important consideration of the public health response. Not just protection from COVID-19, but prevention of caregiver burnout. Anything less could have long-term consequences for our Canadian health-care system.

This is part two of a three-part series. Part one: On front lines of COVID-19; part three: On front lines of COVID-19: The struggle to stay informed.

Chantel Josiak is a registered nurse and legal nurse consultant with Connect Medical Legal Experts, a national company that provides health-care expertise to lawyers involved in personal injury, medical malpractice and class action litigation.

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