Psychological support for health care workers during the COVID-19 pandemic

We read with great interest the article by Wu and colleagues on mitigating the psychological effects of coronavirus disease 2019 (COVID-19) on health care workers.1 In our work providing psychological support to health care colleagues during this pandemic, we have found the following 5 principles helpful in organizing our responses.

1. Pandemics can cause enduring distress in health care workers and even disengagement from the profession.2 Concerns include capacity to care effectively, access to personal protective equipment (PPE) and personal safety, risk to family, (re)deployment, ethics of care dilemmas, moral distress, stigma, loss and grief.

2. Social integration reduces stress and strengthens morale, particularly with physical distancing and PPE use.3 Group support, in person or online, should focus on safety enhancement, calming, efficacy of individuals and the team, connectedness, and realistic hope for the present and the future.4 We aim to ensure any individual’s confidentiality but secure permission to use broad themes for advocacy and system change.

3. Severe stress impairs the capacity to recall how to cope and maintain personal well-being. Make the implicit more explicit.5 Consider coping as 3 foci with matching aims and strategies: problem-focused coping — fix what is fixable, learn about stress management and self-care, and improve interpersonal communication; emotion-focused coping — use social support and emotional ventilation; and meaning-focused coping — engage health care workers’ moral purpose and spirituality.6

4. Leadership must demonstrate the organization’s valuing of health care workers. Trust is built on organizational justice — how decisions are made and how people are treated. Leadership presence, competence, integrity and benevolence promote trust. Timely, relevant and transparent communication reduces fear and mistrust.

5. This unprecedented crisis reflects both danger and opportunity. The capacity to hold both in mind promotes individual and organizational resilience. Fostering psychological safety today enhances health care workers’ engagement and future well-being. It builds our capacity to “be better after.”