Taking Care in a Pandemic

For resources on COVID-19 as it applies to the oncology community, please visit ACCC’s continually updated Coronavirus Resource page. ACCC members can also access ACCCExchange, a forum that allows them to communicate in real time with their colleagues about how the COVID-19 virus is affecting their communities and their patients.

When COVID-19 was first detected in China late last year, it took everyone unawares. Just as would happen in the U.S. and across the globe only a few months later, healthcare providers in China were deployed seemingly overnight to fight a disease that no one had experienced before. With the mandate to “flatten the curve” as best they could, healthcare staff worked around the clock caring for overwhelming numbers of seriously ill and dying patients. The long days of treating the sick while wearing cumbersome protective gear and masks resulted in the exhaustion of body and mind, as many providers often tend to their own needs last.

As the pandemic continues to rage on a global scale, researchers are tapping the experiences of Chinese healthcare workers for lessons learned that can be applied to others. In response to a survey administered to approximately 1,300 front-line healthcare workers in China in late January 2020, 70 percent reported distress, 50 percent reported depression, 45 percent reported anxiety, and 34 percent reported insomnia.

Considering the circumstances brought about by the COVID-19 pandemic, these numbers are hardly surprising. But it remains alarming that the professionals on whom we depend to provide care during an unprecedented pandemic are themselves suffering from want of care.

Lessons Learned

Knowing how to package and deliver healthcare amid a global health crisis is difficult, even for mental health professionals. But many have recognized that the best source of any type of advice is often the insight of those who have lived through similar experiences—and emerged with hard-won wisdom.

In the case of the coronavirus, some healthcare workers who have tended to patients during another disease outbreak—most notably, those who were involved in the recent fight against Ebola—have taken to the Internet to share their experiences. Their words of advice range from the clinical (best practices for treating patients in an overloaded health system) to the practical (self-protection in a very contagious environment). But the most compelling truths often come from individual insights into the unique psychological toll that delivering clinical care in the midst of a pandemic can take.

For example, an emergency physician who worked in West Africa during the height of the Ebola epidemic writes in a recent article that the most important thing for healthcare workers to remember while working in an intense care environment is to take care of their own health. If you don’t, he writes, you won’t be able to help others. Besides the importance of ensuring you get enough rest and enough to eat, it’s essential to take some self-care time, however short it may be. “You are a precious and limited resource,” writes the doctor, “and you must act the part.”

Mindfulness

A word often associated with the self-care that many mental health professionals recommend to busy providers is “mindfulness.” The term is tossed around so much, it’s become a cultural buzzword. But what does it really mean to practice mindfulness?

Mental health professionals agree that mindfulness starts with awareness, with fully acknowledging your surroundings, being “awake to the moments of our lives.” Rather than positive thinking, being mindful means acknowledging what you feel and not judging yourself for your reactions. Doing so may help you be able to purposefully respond to the moment rather than reacting in a knee-jerk fashion.

In a recent CANCER BUZZ mini podcast on self-care during COVID-19, Krista Nelson, MSW, LCSW, OSW-C, BCD, ACCC President-Elect and the Program Manager of Quality and Research in the Cancer Support Services and Compassion department at Providence Cancer Institute, advises healthcare providers to “really pay attention not only to what you are feeling and how you are feeling it, but also consider not dwelling on the feeling. Acknowledge that we all suffer and that we all are having a hard time right now, and give yourself permission to feel the impact of that emotion on you.”

Two doctors from The Ohio State University Wexner Medical Center recently wrote that mindfulness is “disaster preparedness” in the sense that it “helps us not freak out when our initial reaction is to freak out by catastrophizing what MIGHT happen. … Mindfulness gives you the confidence that you can solve things that you can control and let go of the worry about things you can’t control.”

When you are in the midst of a busy shift in which there seem to be more patients than time to treat them, Krista Nelson recommends taking brief moments where you can find them to re-settle yourself. “I tend to take an opportunity when I use the hand sanitizer on the wall,” says Nelson. “In that moment, I feel the cold foam on my hand and feel my feet grounded. I close my eyes for just a moment, tell myself to forget about everything that happened before now. I just focus on my breath and everything in that room waiting for me, and I tell myself, ‘You’ve got this.’”

The Power of Music

Dean Quick, a board-certified music therapist at Levine Cancer Institute, has seen his profession take on new applications since the coronavirus outbreak. Quick explains that music therapy is “the clinical use of music to address non-musical goals.” He uses it to treat cancer patients experiencing the symptoms and side effects of treatment, such as nausea or pain. “Music therapists are trained to use music to create a space in which people can experience whatever they need to experience,” explains Quick.

Music-assisted relaxation, a clinical technique that music therapists facilitate, can be delivered remotely. Currently Quick is using music relaxation to help both patients and staff under significant stress due to COVID-19. “Music is the great emotional liberator,” says Quick. “Stress clouds over other emotions that may be present. You cannot feel those emotions if you are too bowed down by stress, anger, or grief. Music bypasses thinking, helping people directly access emotions in the moment.”

In this time of social distancing, Quick is making music and guided meditation available on his YouTube channel. He recently created the Music Therapy for Self-Care channel specifically in response to the growing need for sources of self-care for overburdened patients and healthcare providers. His videos range from 13 to 19 minutes and include guided imagery, song discussion, and simple stress-reducing techniques.

If your schedule does not allow time for you to watch a full video, Quick says you can still access the self-care you need. “If you do not have 10 to 20 minutes to spare, do you have 3 to 5 minutes?” asks Quick. “Take time to listen to your favorite song, one that lifts you up. Commit to listening to that song once a day. The moment you miss a day of checking in with yourself, the stress can build up and steamroll you. The more you can take even a little time to care for yourself, the less of a long-term battle you will have.”

Take Care of You

For many healthcare providers, the typical self-care tips do not apply. Recommendations to limit working hours or take extended breaks for activities such as sports or vacations are often difficult at any time, much less during a pandemic in which patient care can be an around-the-clock need.

Therefore, self-care must be a carefully constructed strategy that takes into account the conditions of the workplace and gives you an opportunity to carve out the space and time you need to fully function. Whether that involves listening to a favorite song, going outdoors for some fresh air, or centering yourself with some deep breathing, it should be something that you can easily commit to doing each day.

Although working with patients in the time of COVID-19 can make self-care extremely difficult, adopting as many of the behaviors below as possible will go a long way toward preserving your own mental and physical health:

• Continually self-monitor and pace yourself.
• Maintain a healthy diet and get adequate sleep and exercise.
• Maintain helpful self-talk and avoid over-generalizing your fears.
• Focus your efforts on what is within your power.
• Accept situations you cannot change.
• Avoid alcohol and excessive caffeine.
• Avoid working too long by yourself without checking in with colleagues.
• Avoid consuming excessive media coverage.
• Avoid continually engaging in social media.
• Talk to family, friends, and teammates about your experiences.

Finally, recognize that this situation is stressful, and don’t judge yourself for being fearful or anxious. “As healthcare providers, we have a reasonable tolerance of uncertainty,” says Krista Nelson, “And we have the ability to be flexible and use humor in times of crisis. But this is a very hard time; this is different. We need to be gentle with ourselves and have sources of self-distraction.”

In addition to a curated list of resources tailored to the needs of the cancer care community, the continually updated ACCC Coronavirus Resource page lists upcoming and on-demand podcasts and webinars aimed at addressing the needs of the cancer care team during the coronavirus pandemic. In an upcoming episode of our mini-podcast, Dean Quick will share additional self-care techniques.