Mental Health and Frontline Workers

Addressing the Mental Health

of Frontline Workers

By Steve Chasteen

The pandemic has taken its toll on a vast number of individuals’ mental health, affecting people among every age group and demographic. However, frontline health care workers face increasing challenges to their mental health. Arkansas health care workers, especially nurses, regularly encounter high workloads, burnout, and exposure to psychologically traumatic events, each of which is a risk factor associated with the increased onset of mental disorders.

The cumulative effects of repeated exposure to stressors may result in poorer mental health and functioning.1 Nurses experience symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety more frequently than the general population,2 yet current and sizeable sample data are lacking.

When comparing medical and non-medical health workers, medical health workers exhibit a higher prevalence of insomnia, anxiety, depression, and fatigue.3 As groups, nurses, women, and frontline health care workers report more severe mental health symptoms resulting from the pandemic than do others.4

Because women represent the majority of the health workforce, as a group they remain at greater risk for contracting COVID-19 and suffering its emotional toll. Among those frontline workers experiencing clinically significant distress or impairment, individuals may exhibit distinct signs and symptoms: feeling overwhelmed with growing levels of anxiety and depression.

Frontline workers cope with COVID-19’s stressors in varying degrees. Some adapt as anxiety, fatigue, and depression levels rise; in others, these conditions trigger mental disorders. The combination of fatigue and the pressure to continue working (despite the threat of contracting the virus) contributes to evolving mental health strain. It is likely that significant mental health challenges will emerge from the ongoing pandemic.

Though frontline staff and direct patient care areas are highly impacted, the pandemic also adds concerns

and pressures to other areas within hospitals, as well. Particularly of note are departments focused on medical supply procurement, finances, and the epidemiology of this virus.5

After a recent, albeit brief, respite from the initial waves of COVID – a respite primarily resulting from vaccine availability and concerted efforts to get Americans vaccinated – mask mandates began to be relaxed and businesses returned to their prepandemic status. But the emergence of the Delta variant changes everything. Its presence once again plunges this country, and the world, into yet another viral wave that is quickly filling hospital intensive care units, depleting essential resources and supplies, and causing significant frontline staffing shortages.

This resurgence has quickly moved this country from contingency planning to crisis management, and the peak of this second national surge in patients is still to come. Of concern should be the potential mental health issues for frontline health care workers that may emerge from this resurgence and being ready to provide treatment options and self-care activities that promote recovery.

The primary source of anxiety reported by nurses and other frontline health workers during the initial COVID-19 outbreak was the fear of becoming infected or unknowingly infecting others. This fear is associated with decreased job satisfaction, increased psychological stress, and increased organizational and professional turnover among frontline staff.3

Chronic stress from fear of contracting the virus, fear of infecting their patients and family members, real experiences of prejudice from the public, and distress that comes from dealing with inadequate supplies and resources can become overwhelming, leading to physical, mental, and emotional problems.

Potential health policy implications include identifying groups, such as nurses and other frontline workers, who are at higher risk of developing depression, anxiety, or stress and providing them with early intervention. Also, it’s important to raise mental health awareness and educate medical teams toward mental health assessment. Helping nurses’ peers, managers, and administrators learn to address their workers’ mental health through early and adequate support measures is key. These measures include providing emotional support, fulfilling basic needs, and making working hours more flexible. Flexibility in the work schedule ensures sufficient breaks between rigorous pandemic shifts and itself provides psychological support.

I’d like to share an example of health care administrators directly meeting the needs of their health care teams and frontline staff. This comes from Northwest Health, one of the largest health networks in Northwest Arkansas. Shanda Guenther, Chief Quality Officer at Northwest Health in Springdale, Arkansas, explains: “Our staff remain committed to providing quality medical care, and it shows in the way they care for our patients and their families. Each of our facilities continues to recognize both individual staff [members] and departments to show our appreciation for those at the bedside. Early on, we set up an emotional support hotline called the ‘COVID Care Line’ for staff to call at any time to talk to someone confidentially about their experiences. Local area businesses have made donations to help set up relaxation rooms with massage chairs. We’ve also received many donations of meals and snacks for our frontline staff. We continue to utilize the resources that we have to find ways to help our teams through this difficult time in health care.”

References

1Cavanaugh, C., Campbell, J., & Messing, J. T. (2014). A longitudinal study of the impact of cumulative violence victimization on comorbid posttraumatic stress and depression among female nurses and nursing personnel. Workplace Health & Safety, 62(6), 224–232. https://doi.org/10.3928/2165079920140514-01 2Mealer, M., Burnham, E. L., Goode, C. J., Rothbaum, B., & Moss, M. (2009). The prevalence and impact of posttraumatic stress disorder and burnout syndrome in nurses. Depression and Anxiety, 26(12), 1118–1126. https://doi.org/10.1002/da.20631 3Sampaio, F., Sequeira, C., & Teixeira, L. (2021). Impact of COVID-19 outbreak on nurses’ mental health: A prospective cohort study. Environmental Research, 194, 110620. https://doi.org/10.1016/j. envres.2020.110620 4Lai, J., Ma, S., Wang, Y., Cai, Z., et al. (2020). Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976. https:// doi.org/10.1001/jamanetworkopen.2020.3976 5American Association of Critical-Care Nurses. (2020). Lack of PPE poses clear and present danger. https:// www.aacn.org/newsroom/lack-of-ppe-poses-clear-andpresent-danger

Steve Chasteen, MNSc, RN, CPHQ, serves as the Director of Practice Transformation at the Arkansas Foundation for Medical Care.