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Cultivating Resilient Caregivers During the COVID-19 Pandemic

COVID-19 poses challenges for caregivers, especially at essential hospitals. The usual challenges of caring for vulnerable populations are compounded by the fear of contracting and spreading the virus, staffing challenges, and personal protective equipment (PPE) shortages. Essential hospitals around the country are promoting staff resilience through small group activities and institutional change.

The MetroHealth System, Cleveland

Busy caregivers don’t always have time to pause, process, and connect with others for support.

“We as humans, but especially in helping professions, don’t always have space to take off all of our hats and give ourselves permission to just ‘be’ from all the doing,” says Katie Kurtz, MSSA. education and consultation coordinator for MetroHealth’s Center for Health Resilience. “We preach self-care, but we don’t actually take it, especially not during the workday with each other.”

To give caregivers and community members the opportunity to forge those connections, MetroHealth created resilience circles, an opportunity for front-line caregivers and community members to share their experiences through a loosely facilitated Zoom meeting. Not quite a therapy session, not quite a support group, resilience circles are open to all, whether or not they work at the health system. Circles have included private practice physicians, staff from nonprofit health care organizations, and other community members. MetroHealth managers also can book private circles for their teams.

Resilience Circle

The MetroHealth System encourages caregivers to give themselves permission to pause through resilience circles — judgment-free, confidential Zoom sessions.

The circles use a “permission slip practice” to establish a judgment-free environment and encourage participants to be themselves. Kurtz begins each session — and opens the door for conversation — by asking participants, “How is your heart?”

“We’ve seen a lot of campaigns out there about ‘positive vibes only,’ and the really great thing is that the minute you walk into one of these circles, the first thing we’re going to tell you is that it’s ‘all vibes, all vibes only.’ This isn’t a place where you have to put on a brave face,” says Sarah Hendrickson, MEd, director of the Center for Health Resilience. MetroHealth takes steps to ensure confidentiality for circle discussions.

Kurtz and Hendrickson recognize that, in a vulnerable community, the virus itself sometimes is the least of people’s worries. It also can exacerbate social determinants that contribute to poor health, such as food insecurity, housing instability, and violence. The social effect of the pandemic is vast, and health care providers face many of the same stressors as the community they serve.

In six weeks, the health system hosted circles with 65 unique participants, many of whom attend on a regular basis. When asked if they felt better to return to work after attending a resilience circle, participants gave a 4.4 rating on a scale of 1 to 5.

Kurtz and Hendrickson hope to continue the circles after the pandemic and see them as an extension of the health system’s mission.

“This is what we were built for,” Hendrickson says. “We have been serving our community for 180 years with the least amount of resources and the most amount of passion. We know how to make hard things happen.”

Nebraska Medicine, Omaha, Neb.

As home to a renowned biocontainment facility and one of the first U.S. hospitals to respond to the COVID-19 pandemic, Nebraska Medicine has expanded its employee support programs to proactively reach staff on the front lines.

As vice chair of clinical operations in the University of Nebraska Medical Center’s Dept of Psychiatry and behavioral health consultant in Nebraska Medicine’s biocontainment unit, David Cates, PhD, works with caregivers in high-stakes situations who sometimes face stigma from outsiders because of their proximity to infectious disease. During the COVID-19 pandemic, these providers aren’t alone in treating a stigmatized illness, but they face compounded moral quandaries as they operate under resource constraints and crisis standards of care.

Noticing that virtual support groups had low attendance, Nebraska Medicine revived its dormant Peers in Need of Support (PiNS) program. Staff have trained about 90 PiNS leaders, who originally were identified as “culture partners” during a previous workplace culture initiative, to identify signs of distress in others, check in with colleagues in need, provide psychological first aid, and work together to develop a plan forward. PiNS leaders are trained to recognize when someone needs more than just a listening, supportive ear, and the health system’s psychology and psychiatry clinics are prioritizing front-line staff for referrals.

Like MetroHealth, Nebraska Medicine also promotes resilience through staff workshops that managers arrange for their teams. Modeled on Air Force pre-deployment training, the workshops help participants identify potential stressors and use cognitive behavioral therapy and relaxation tools to respond to those stressors. Additionally, Nebraska Medicine hosted a forum for families of health care workers that focused on caregiver safety, infection control, and mental wellness.

David Cates

David Cates, PhD, director of behavioral health at Nebraska Medicine, rounds in the biocontainment unit to share resources and a listening ear with caregivers.

Cates also offers a personal touch by rounding regularly in the biocontainment unit’s break room, introducing himself to caregivers and listening to their concerns.

“I’ve talked to so many people who I know would never have reached out,” he says.

ChristianaCare, Wilmington, Del.

As hospitals struggle to counter provider burnout, they often face a common pitfall: focusing solely on personal well-being.

“I like to use this canary in the coal mine analogy,” says Heather Farley, MD, MHCDS, chief wellness officer at ChristianaCare. “You can’t take the canary and teach it to be more resilient and stick it back in the same coal mine and expect it to survive, so you actually have to change the coal mine, and the coal mine is the systems surrounding our caregivers—the culture of well-being and the efficiency of practice.”

ChristianaCare wellbeing wagon

At center, ChristianaCare’s Katie Godfrey, PhD, psychologist, and Heather Farley, MD, chief wellness officer and emergency physician by training, roll the Center for WorkLife Wellbeing’s wagon through hospital units. Stocked with essentials such as snacks, lotions, and socks, the Wellbeing Wagon is an opportunity for ChristianaCare’s health care professionals to pause for support.

ChristianaCare has woven wellness into its institutional culture through its Center for WorkLife Wellbeing, established in 2017. Recognizing that people don’t always ask for help, the health system has hardwired peer support opportunities into everyday processes.

The Care for the Caregiver Peer Support Program reaches out to caregivers after adverse events to provide psychological first aid. “Ice cream rounds” for residents — quarterly reflective, supportive sessions held during the residents’ protected lecture time — give them the opportunity to reflect on and share the challenges and opportunities they’ve faced.

The Opportunity to Achieve Staff Inspiration and Strength (OASIS) project provides caregivers “bite-size,” team-based resilience lessons to teach them how the brain works under stress, improve team recognition, and provide social support. The hospital has 10 OASIS rooms for staff decompression, featuring low lighting, massage chairs, and other support resources.

For those desiring opportunities to connect, the health system’s Clinician-Organized Meetings to Promote and Sustain Satisfaction (COMPASS) groups convene clinicians over meals for 10 sessions, where they work through an internally developed curriculum.

“Not only does it enable them to really think deeply and process their experience as clinicians, but it also creates these bonds and this trust within the group and these relationships that are sustained long after the groups stop meeting,” Farley says. “That has created a tremendous forward momentum around camaraderie, mutual support, and stability in our health system.”

During the COVID-19 pandemic, the health system has leveraged that momentum to employ a new strategic framework:

  • Hear Me: Center for WorkLife Wellbeing staff make regular rounds with a cart of practical items for caregivers, including food, drinks, lip balm, and lotion, and ask caregivers about any other needs. Based on caregiver feedback received during these rounds, the health system launched a scrubs laundry service, child care services, and a COVID-19 patient dashboard to improve transparency.
  • Protect Me (and my family): The health system works to ensure adequate PPE, provide training for donning and doffing PPE, arrange hotel accommodations for caregivers working with COVID-19 patients, and reassign caregivers with underlying conditions.
  • Prepare Me: ChristianaCare is working to develop standardized evaluation and treatment protocols, training for caregivers redeployed to other areas, and resources for leaders.
  • Support Me: The health system works to support caregivers’ physical needs with access to food, virtual exercises, sleep resources, hazard pay, pre-paid child care for caregivers with children younger than 12, and 24/7 mental health support. ChristianaCare has committed to not laying off caregivers during the COVID-19 pandemic. An end-of-shift checklist helps caregivers transition from work to home, and they can opt in to a daily self-care text message.
  • Care for Me: The health system provides just-in-time resources for team leaders when caregivers test positive for the virus, one-on-one support for the infected caregiver, and hotel accommodations, if necessary, for quarantine.
  • Honor Me: To recognize caregivers’ dedication, the health system facilitates expressions of gratitude from the community, including donated meals, artwork, and a caregiver relief fund.

Even in essential hospitals operating with limited resources, it’s possible to harness existing leaders and volunteers for low-cost, high-impact wellness initiatives. And when it’s not, Farley says fostering caregiver well-being is worth the investment.

“We recognized that the well-being of our clinicians was actually a critical success factor to be able to deliver on our organization’s mission,” she says.

For more information about promoting provider well-being during the COVID-19 pandemic, view our recent webinar, COVID-19: Supporting Hospital Workers During Crisis, available on-demand for members.

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About the Author

Emily Schweich is a senior communications associate for America's Essential Hospitals.

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