Jessica Langley

A year ago, no one would have ever believed that 2020 would have turned out to be one of the most devastating years on record. Amidst the most destructive hurricane season ever, ravaging wildfires and a world-wide pandemic, frontline workers – first responders and health care professionals - have been

by the environment and its vices over the past 12 months. Appropriately, the topic of self-care for health care workers has grown in popularity, but unfortunately, many health care workers find themselves with barely enough time to breathe, much less breathe deeply.

Worse, health care workers constitute the most affected group of people in the fight against the COVID-19 virus as they have been challenged with helping the over 8 million people who have contracted the virus in the US. Additionally, there are an estimated 21 million individuals working in health care across the country

 who are often forced to work under extremely difficult and stressful conditions.

Importance of Self-Care for Health Care Workers

The wellbeing and emotional resilience of health care professionals are key components of continuing healthcare services during the COVID-19 pandemic, as stated by the National Center for PTSD (2020). Some of the common mental effects of the pandemic experienced are anxiety, panic, depression, anger, confusion, ambivalence and financial stress.

Research shows that, during this intense period, health care professionals have been observed to experience serious psychological problems and to be at risk in terms of mental health,

further demonstrating the importance of self-care for health care workers who are often so busy caring for others that they neglect themselves.

Studies have shown that health care professionals have been considerably more worried about catching the infection during a pandemic (Chua et al., 2004). Their frequent exposure to COVID-19 patients has raised anxiety and fear of virus infection. 

As a result, levels of stress, depression and anxiety have increased, which has led to some of them becoming traumatized (McAlonan et al., 2007).

 Studies have also shown that, in order to raise the psychological resilience level of health care professionals working during the COVID-19 pandemic, their quality of sleep, positive emotions and life satisfaction need to be enhanced.

Thankfully, the arrival of the COVID-19 vaccines has helped with much of the psychological stress, and the prioritizing of frontline health care workers has eased much of the tension. However, while being vaccinated against COVID-19 takes some of the fear away, it doesn’t eliminate the need for self-care for health care workers, especially in light of the trauma that many of them have endured over the past year.

4 Simple Ways for Health Care Workers to Practice Self-Care

Several other behavioral and social science researchers have developed strategies that can be used to support optimum mental health. Dr. George Everly Jr., a psychologist and professor at the Johns Hopkins University Bloomberg School of Public Health, Baltimore, who has more than 40 years’ experience studying the psychological impacts of disasters, provides the following insights to help build resilience during these trying times.

 Do not anticipate that timelines and expectations will be short lived. This will only lead to extreme disappointment when milestones are not met. Anticipating that the pandemic is a more chronic vs. acute condition can help level set the amount of stress that comes with anticipation.

. From the greatest adversities, opportunities can emerge.

 Quality sleep acts as a protective factor against the psychological problems that health care workers might experience.

 A lack of sleep can magnify levels of anxiety and depression.

. Remembering that others are here and willing to help in these challenging times can make all the difference in someone’s outlook on life, and those who reach out to others for support are often able to persevere through challenges they never thought they could overcome.

Health care professionals know first-hand the strain that COVID-19 has put on health care institutions and the people who work in them. While the future looks promising with the distribution of vaccines, it’s imperative that workers not neglect their own physical, emotional, and mental health.

There may indeed be a light at the end of the tunnel in the fight against the novel coronavirus, but the need to practice self-care for health care workers is here to stay. Healthy frontline workers are one of the key components to healthy communities. In fact, health care workers investing in their own wellbeing is one of the greatest contributions they can make to public health.

https://www.statnews.com/2020/11/30/divisions-emerge-among-u-s-officials-over-when-first-covid-19-vaccine-doses-will-be-available-and-for-whom/

2 - Bozdağ, Faruk, and Naif Ergün. “Psychological Resilience of Healthcare Professionals During COVID-19 Pandemic.” Psychological Reports 0033294120965477. 13 Oct. 2020, doi:10.1177/0033294120965477

https://www.nih.gov/building-resilience-during-covid-19-pandemic

https://directorsblog.nih.gov/2020/10/15/building-resilience-during-the-covid-19-pandemic/

4 - Center for the Study of Traumatic Stress, 2020; Dewey et al., 2020; InterAgency Standing Committee, 2020; Lai et al., 2020; W. Li et al., 2020; Liuet al., 2020; Siyu et al., 202

Articles

Health care workers constitute the most affected group of people in the fight against the COVID-19 virus.

The Importance of Self Care for Health Care Workers

As the scope of pharmacy services shifts toward a greater emphasis on direct patient care,

the Accreditation Council for Pharmacy Education and the American Association of Colleges of Pharmacy stress motivational interviewing as an essential skill for pharmacists and the delivery of pharmaceutical care.

“The way we talk to patients has not changed appreciably in 40 years. We’re still using parental ways of talking to patients and giving information as if information itself will solve the problem,” said Bruce A. Berger, PhD, president of Berger Consulting, LLC, and professor emeritus at Auburn University in Alabama. “If information were enough, why would any health care professional smoke or be overweight?”

Unfortunately, nearly 75% of adults are nonadherent in 1 or more ways, such as not filling a new prescription or taking less than a physician-recommended dose.

 Poor adherence can lead to worsening conditions, especially for those with chronic conditions.

This is why clinicians must not only identify nonadherent patients but also facilitate discussions with them to identify barriers to adherence. Specifically, pharmacists and pharmacy technicians can play a valuable role here because nonadherence may not be the result of a pharmacologic manifestation, such as adverse effects or drug interactions, and it may not be the result of patient ambivalence.

“Many times, [managing] nonadherence may be as simple as addressing affordability by finding patient assistance programs or other social programs aimed at helping patients financially,” said Jeremy Sasser, pharmacy content strategist at the National Healthcareer Association.

“Other times, providing different packaging options or recommending various compliance aids to help remind patients when to take their next dose can improve adherence,” he said. “Enrolling them in medication synchronization and auto-refill programs may also help with maintenance medications.”

Motivational interviewing is an individual-centered, collaborative approach designed to elicit and explore the patient’s own reasons for change within an atmosphere of acceptance and compassion. It can strengthen an individual’s own commitment and motivation to make healthier, adaptive changes, especially behavioral and lifestyle ones.

Better uses opportunities to discuss patients’ health-related behaviors, such as alcohol use, diet, exercise, self-management of health problems, and smoking

Builds patients’ intrinsic motivation to adopt and maintain treatment recommendations

Encourages patients to express their own reasons for concern with their lifestyle behaviors or their prescribed treatment regimens

Helps resolve patients’ ambivalence about behavioral change and strengthens their ability to take responsibility

Shifts the discussion to a patient-centered interaction, rather than a disease-focused one

Systematically explores the ambivalence associated with a behavior

Berger’s expertise is in interpersonal and organizational communication and psychology, as well as the application of these disciplines to the pharmacist’s role in treatment adherence and outcomes. When individuals are ambivalent or resistant, their decision making is impaired by inaccurate or missing information, Berger said. However, he added, when their health care providers ask open-ended questions to get an understanding of where they are coming from, practitioners stand to gain trust. This trust, combined with information, is more powerful than information alone.

“When you create faith loss in a patient, they discount the information you give them, or they stop listening,” Berger said. “We scold patients for the things they are not doing rather than finding out why they are choosing not to do some of the behaviors we request.”

Motivational interviewing can help providers find that why, and if skillfully used, motivational interviewing can contribute to a much stronger therapeutic alliance by:

Encouraging patients to fully participate in decisions affecting their health

Increasing a patient’s engagement in treatment and explicitly acknowledging and addressing ways to resolve ambivalence

Nonjudgmentally opening the conversation to consider personal preferences and values, even if those are at cross-purposes with the “evidence”

Reducing the potential for nonadherence and encouraging behavioral change to achieve better outcomes

“Patients visit their pharmacy much more often per year than they visit their medical provider. Pharmacy technicians are often their first and last point of contact and, occasionally, the only point of contact,” Sasser said.

Arming pharmacists and techs with the skills to build rapport and trust with patients allows them to more skillfully extract pertinent information and uncover concerns that can help with overall adherence rates. Indeed, motivational interviewing is seeing positive results. In 1 study led by Berger, patients with multiple sclerosis who received motivational interviewing techniques via software-based telephone conferencing demonstrated a statistically significantly lower proportion of Avonex treatment (1.2%) discontinuation than the standard-care group (8.7%). In addition, stage movement away from discontinuation of Avonex (ie, toward continuation of therapy) was significantly higher in the treatment group.

A patient’s capacity for self-management is fundamental to his or her ability to adhere to a treatment plan. Prescription medications are an essential component of treatment. But if prescription drugs are to fully realize their potential benefit and deliver improved health outcomes, practitioners need better methods of ensuring that patients have the ability and support they need to follow the drug regimen in their treatment plan. Motivational interviewing is a path toward improved self-management that, when used effectively in pharmacies, can help improve adherence and lead to better long-term outcomes for patients.

 is the executive director for education and advocacy at the National Healthcareer Association in Leawood, Kansas.

National Governors Association. The expanding role of pharmacists in a transformed health care system. classic.nga.org/files/live/sites/NGA/files/pdf/2015/1501TheExpandingRoleOfPharmacists.pdf. Accessed July 3, 2019.

Take as directed: a prescription not followed [news release]. Alexandria, VA: National Community Pharmacists Association; December 15, 2006. ncpanet.org/pdf/adherence/patientadherence-pr1206.pdf. Accessed July 3, 2019.

Berger BA, Liang H, Hudmon KS. Evaluation of software-based telephone counseling to enhance medication persistency among patients with multiple sclerosis. J Am Pharm Assoc (2003). 2005;45(4):466-472.

This tool for behavioral change contributes to positive health outcomes and improved communication with patients.