Caring for the Carers

So by request and in honor of nurses’ week, I am going to do a post on self care for those on the front lines. This is an important topic because not only are these jobs normally stressful and physically/emotionally exhausting, that burden has reached a new level. This applies to nurses, respiratory therapists, certified nursing aids, medical techs, physical/occupational/speech therapists, social workers, physicians, nurse practitioners, physician assistants, and other front line caregivers. The list doesn’t end there but let’s get on with why self care is necessary.

Front line healthcare staff are under a lot of pressure and stress. Facing death far more often than we are accustomed to as well as limited resources and a lack of treatment to actually help some patients. This can be soul-crushing as a healthcare provider or nurse because we are trained to do everything in our power to help someone but in this pandemic, our hands are tied in many situations. Patients are not allowed visitors and with limited PPE, nurse and providers are distanced from their patients. Normally we are using therapeutic touch, sitting at their bedside with a hand on their shoulder, holding their hand, or just expressing compassion and empathy through physical touch during routine care. That bond between nurse/provider and patient is gone. We are reduced to a pair of eyes behind a multitude of protective layers. With limited PPE and changing guidelines/institution policies, nurses and providers fear exposure everyday on their way into work. They have to isolate from their loved ones for fear of spreading the virus. We are now faced with the frustration of a general public defying rules put into place to prevent a surge as well as the ridicule, harassment, and social isolation we face as a profession. It is now common for those on their way into work to be harassed or ridiculed for wearing scrubs or other medical attire in public despite employing appropriate infection control measures. People in their local communities notice they are being avoided when walking on the same side of the street as someone or being looked at like a leper. This is painful as someone whose sole job is caring for others in their worst moments.

The long hours, constant physical insult, and emotional trauma and stress of caring for COVID-19 patients has caused an accelerated burn out and severe mental health problem for those in the healthcare profession. As you may or may not have heard, sadly, an emergency room physician took her own life after she could no longer endure the stress and conditions that COVID-19 forced upon her. We are all experiencing grief and trauma right now during the pandemic however those in healthcare, especially on the front lines, are facing a far greater stress and trauma when treating these patients.

Lets talk about how to preserve oneself when working on the front lines. It is not uncommon to want to stay at work after your shift has ended during times of crisis. As a nurse practitioner, I have stayed well after my shifts in the past when things were stressful. We tend to run into the smoke, not away. This is something we should avoid doing. When your shift ends and appropriate relief has arrived, acknowledge the fact that your mind and body need rest whether you feel it’s necessary. Notice how your muscles are not sore immediately after exercise but this occurs the day after? The same works for stress and your brain. For those who know me, I have a theory called the airplane theory. They say in the event of an emergency, a mask will drop down so you must then place the oxygen mask on yourself first before you can help others. This is that exact scenario. Know that you have limits despite how you feel in the moment (adrenaline is a helluva numbing agent). As tough as we think we are and for the horrible things we have witnessed in our careers in nursing/medicine, this is something unlike anything we’ve ever encountered, and likely ever will in our lifetime. So remind yourself, just because you might feel fine in the moment, it is trauma and stress masked by adrenaline. Take a deep breath, remind yourself of this, and leave when your shift is over. Don’t overstretch yourself in an already stressful environment. Your colleagues need you to be rested and in tip top shape to relieve them when the time comes, don’t let them down.

Take note of how you feel when you’re not at work. Do you have a sour stomach, palpitations or feelings of a racing heart, headaches, joint pain or muscle soreness/stiffness, anxiety, racing thoughts, appetite changes (over-eating or poor appetite), eye strain, eye or muscle twitching, shakiness, feeling jumpy, physically tired, having little energy, depression, feelings of guilt or apathy, and of course, grief? You might feel like your memory is not as good as it once was, you have trouble doing complex critical thinking, feel mentally slower than usual, unable to concentrate, and have trouble making decisions or wanting to do anything, even leisure activities. You might feel isolated like people just don’t understand what you’re going through, deny anything is wrong or that you need help, and certainly have difficulty having fun in any way or being happy. If you experience any of these things, it’s clear that you’re feeling the effects of trauma. Be self-aware and take serious note of how you feel.

We can so easily assess and diagnose others, but when it comes to ourselves, we make the worst patients. Any healthcare worker will admit it (or deny it fervently out of denial). If you find yourself admitting to any of the above symptoms, it’s time to take care of yourself because you won’t be able to help anyone else if you fall apart. I get it…I’ve run myself ragged for my patients. We tend to sacrifice our own needs for others.

So what can we do...? First leave when you’re scheduled to leave as mentioned above. If you’re at work, take things as they come. If you’re feeling overwhelmed, take a second for a deep breath. A great means of reducing stress and anxiety in the moment is something called 4-7-8 breathing in which you inhale for four seconds, hold it for 7 seconds, and exhale for 8 seconds. Focus on your breath and it will detract from your stress. Make sure to take appropriately scheduled breaks to hydrate, have a snack, and remove yourself from acute stressors during your shift. Rely on your colleagues to help find joy or positives in the little things. Comradery is your best friend during times like these.

You’re now on your day off or time at home before your next shift. First and foremost, GET SOME SLEEP! Sleep is one of the single most important things to do in times like these. This will help your brain rest from the day's stress, repair and replenish your immune system, and reset your body for the next day. If you work odd hours like overnights, make sure to use appropriate sleep hygiene. Next is nutrition. Ensure you are eating a well-balanced diet, rich in fibrous vegetables, fruits, complex carbohydrates, lean protein, and healthy fats. This will boost your immune system, support your mental health, and provide you with the necessary nutrients and fuel for those long, grueling shifts caring for COVID-19 patients. The next recommendation is regular exercise. As we all know, exercise is so important for our health. It can reduce stress, improve mood, boost the immune system, and provide us with endurance and energy necessary to work in the settings we do.

Other more obvious things we can do that are often ignored are establishing a “normal” routine. Don’t let the home isolation and physical distancing ruin your usual habits. Adapt and react. If you like to go to your favorite coffee spot on your days off, try and buy some of that said-place’s coffee and make it at home or if they are open, have it delivered to your house. Enjoy that morning run with your mask or physically distance while walking your dogs. Don’t beat yourself up if you don’t have the energy or emotional wherewithal to do simple chores around the house; that will just add to the guilt and emotional stress. Employ a favorite hobby you never had time to enjoy like playing an instrument, painting, gardening, reading, or doing puzzles. If you are isolated from your family, use any of the multiple digital video calling applications like Zoom, Google Hangouts, FaceTime, etc. Engage your friends or loved ones while following distancing guidelines for moral and emotional support.

Something to truly follow is limiting your time on social medial or consuming news regarding the pandemic. I understand for some of us providers, we need to stay up-to-date on current research, news updates, and studies to help treat our patients but limit yourself to an allotted period of time and do not go over that. Avoid social media as misinformation and internet trolls are just as abundant as the virus itself and can be inflammatory to those fighting the fight. Laugh as often as you can and try to find humor when appropriate and often. Discuss your stress with colleagues who understand the circumstances of your feelings that your family or friends may not understand. If you are a person of faith, now is the best time to exercise prayer or meditation.

I beg my fellow healthcare workers, if you feel depressed and have even passing thoughts that you would be better off dead, have thought about hurting yourself, or thoughts of hurting someone else, PLEASE seek help. Call your PCP, mental health provider, loved one, or if it is more confidential, the National Suicide Prevention Hotline 1-800-273-8255. This is serious and an unprecedented trauma we are facing that not many people understand or can relate to at this time. We need everyone like you to help keep us going, so don’t give up and seek help when you need it!

For those of you who are NOT healthcare or front line workers, here is what you can do to help support those who are. Continue your words of encouragement, support, and love. While applause and displays of appreciation don’t lessen our burden, it is a great shot to the arm that we desperately need. For those who are financially stable or are able to donate food/meals to your local hospital, this can help be an act of appreciation and support. Many people and cultures, like my own of being Italian, show love through food. A full belly is a happy belly. If you see someone in scrubs or know someone who is a healthcare worker, thank them for their sacrifice and acknowledge their stress. And that goes for any essential employee putting their health at risk to help the world go round. For those healthcare workers that you know personally, ask them if they are okay and if they need anything…sometimes it is just an open ear to let them vent their frustrations. You don’t have to offer any advice or say something to help in anyway, just listen and show you care.

The last and most important thing you can do, is continue to wear a mask in public, physically distance, wash your hands, don’t hoard food or essential supplies, and most importantly, listen to the health experts and scientists. By protesting the stay at home orders in groups, gathering in crowds, and defying many of these guidelines, you are stabbing each and every one of us in the healthcare field in the back. I appreciate the freedom of speech and that people are experiencing hardships but these guidelines are meant to protect each and every one of us.

Thank a nurse, doctor, respiratory therapist, or other health professional today…we need the support.

Be well.

Why are you so tired?

By now, we are deep into countrywide lockdown and a new way of life exists. Have you noticed that you’re tired ALL THE TIME? Well you’re not alone. There are so many reasons for this. Let’s talk about why you feel so tired and have such little motivation to do anything.

First of all, the uncertain future puts a grand piano’s worth of weight on our shoulders. Those who are without a job or their business may or may not survive the lockdown, have financial uncertainty. People who are at high risk of COVID-19 complications are panicked about contracting the virus and its impact on their health. For those on the front lines, they fear becoming infected due to inadequate PPE or face death more frequently than they are used to in the hospital. These are all tangible, petrifying thoughts which are realistic stressors compounded by one another. Every day, people fear this disease and its acute, direct effects on their individual lives. That stress alone is enough to suck your energy dry.

Now add on the stress of having to work from home and adapt to a new routine. Add in childcare for those with kids while working from home. Those with ill family or friends. Battling the public for groceries while avoiding infection. Consider the lack of exercise and poor dietary changes, and BAM, you have a recipe for anxiety. Like your favorite infomercial…BUT WAIT, THERE’S MORE! Have you been browsing social media lately? Reading comments on news articles? Watching government press briefings? We are being assaulted by conflicting information, bitter internet trolls, protesters, and just overall negative energy from every angle. This takes a subconscious, emotional toll on our psyche.

As you can see, our brains are over-stimulated but also under-stimulated simultaneously. We are over-stimulated with stressful stimuli of the world events occurring around us, being flooded with negative information from social media, and constant news reports. Sadly, we are under-stimulated by lacking social interaction, physical touch, routine exercise, and healthy social habits. This culminates to a feeling of exhaustion, brain fog, loneliness, sadness, and anxiety.

For those with pre-existing mental health disorders, they are suffering worse than everyone else as their symptoms are magnified exponentially. All of this anxiety then leads to disrupted sleep patterns further worsening the spiral of stress and anxiety.

So what can you do to help with this. If you’re able, try to eat a diet rich in nutrient dense foods like nuts, fruits, vegetables, fish, legumes, ancient grains, and lean protein. In addition to this, try to maintain healthy sleep hygiene. Check out my video on sleep for more info. For exercise, yoga is a great option and a simple google or YouTube search will yield a helpful video for various experience levels. Other calisthenic type workouts such as air squats, pushups, crunches, planks, jumping jacks, mountain climbers, and burpees can create a home HIIT workout. For those who need some fresh air, cycling, jogging, and walking are all acceptable however avoid crowded areas, exercise physical distancing of six feet or more, and wear a face covering. Set a routine you can follow, just like you would during your usual daily routine. Avoid saturating yourself with social media, news, and overall screen time as this is mentally and physically draining. Spend time doing hobbies to distract your mind from stress. Make sure to continue usual grooming habits and while sweatpants are tempting, don’t be afraid to dress up for living room to give yourself a fresh feeling. The biggest reminder is to not put yourself down for not feeling motivated or not wanting to do things.

Humans are meant to be social creatures. For those of you, like myself, who live alone during this quarantine, it can be especially difficult and sometimes lonely. Make sure to keep in touch with family and friends. FaceTime, Google Hangout, and the ever popular Zoom, are a great means of having social interactions. Text and call those you normally see regularly. Make sure not to isolate yourself socially. This is why I call it physical distancing rather than social distancing.

This is a stressful time which can have more than emotional consequences on your health. Be kind to others, smile, and do what is best for your health. Here is a great resource for those who may need help with isolation. Be well!