It’s been a tough year, particularly for those on the frontlines of health care. At VA, we encourage you to make your mental health a priority, just as we do for the Veterans in our care.
Federal workplaces like VA have always fully supported employees in caring for their mental wellness, and that has taken on greater importance during these challenging times.
“There are things we did to cope in the past. Remember those things and do [them]. Be hopeful. We’re going to get through this,” said Dr. Ken Jones, chief of psychology service at the Southeast Veterans Health Care System.
Providers in this health system are being evaluated on the Perceived Stress Scale, a widely used psychological tool for measuring the perception of stress. VA staff also can enroll in a six-session stress management course.
We also encourage employees to take advantage of wellness resources already in place, like employee exercise programs, yoga and tai chi. You can contact VA’s confidential Employee Assistance Program (EAP) to help you manage stress and anxiety, and the Federal Employees Health Benefits Program also offers generous mental health coverage and can help connect you with a counselor or psychiatrist.
You can’t care for others if you don’t care for yourself first. As the American Medical Association reminds us, it’s like an airline asking you to put on your own oxygen mask before helping others in an in-flight emergency. Here are some tips to consider:
Develop and use coping strategies. Make sure you take time between shifts to focus on yourself. Use coping strategies that have worked for you before to manage stress, advises the World Health Organization. Get enough rest, exercise, eat well and practice deep breathing, Dr. Jones recommended. The VHA National Center for Organization Development recommends trying to take breaks from stressful situations if you can. Headspace, a meditation and mindfulness app, is offering free subscriptions to any U.S. health care professional with a National Provider Identifier through the end of 2020. VA also offers flexible work schedules and telework when possible to allow you time to recover and recharge.
Talk to someone. Find a friend, family member or colleague to confide in. Even though we can’t always be together right now, there are many virtual ways to stay in touch with loved ones. Consider phone, email, text messaging and video calls, wrote Patricia Watson, a Navy Veteran and psychologist at VA’s National Center for PTSD. If you find yourself feeling sad, hopeless or unable to sleep, talk to a professional.
Take breaks from news and social media. It seems like the bad news just keeps coming in the age of social media and the 24-hour news cycle. While technology helps keep us connected when we can’t physically be together — and even has allowed us to continue to provide health care from a distance — it’s also a good idea to put down your phone or computer and take a break.
Remember the importance of your mission. Caring for the brave men and women who have served our nation is a noble calling, and it takes on even greater significance during challenging times. Remember that what you do makes a difference in the lives of many people and that the nation is grateful to you for your continued hard work and dedication.
If you or someone you know is having thoughts of suicide, call the National Suicide Prevention Lifeline toll-free at 800-273-TALK (8255). You will be connected to a trained crisis worker immediately.
Work at VA
We’ll make sure you feel supported as you help carry out the noble mission of caring for the nation’s Veterans.
When you decided to become a nurse, you knew it wouldn’t be easy. You knew there would be hard days, probably many of them. You were prepared for brutal shifts. You expected to have your heart broken sometimes.
But you probably never expected anything like COVID-19. The reality is that the pandemic is testing you in ways you never could have imagined — physically, mentally, and spiritually.
As much as you have always loved your job, nowadays, signing in for each shift feels like a test of strength and willpower. And when you are not exhausting your every moment fighting to save your patients from this merciless enemy, you are thinking of the ones who have been lost and those whom you may lose.
You are in constant fear for your family, your friends, yourself. Your faith in a tomorrow that is brighter than today may be faltering.
And in the face of so much turmoil, you might feel like there’s simply no time and energy left to take care of yourself. But prioritizing your physical and mental health is precisely what needs to be top of mind at this moment.
As a nurse, you are the foundation. And if we’re going to keep from collapsing, we must keep our foundation strong!
Why It Matters
As a nurse, you’re undoubtedly all too familiar with the effects of significant stress on the body as well as the mind. When you’re anxious, overwhelmed, worried, and sleep-deprived, your health is going to suffer.
Your immune system pays a particularly high price for all this stress. And when you spend your days on the frontlines of a brutal war against a highly contagious virus, the last thing you need is a compromised immune system.
An Overburdened System
Let’s face it: the American healthcare system wasn’t exactly running like clockwork even before the pandemic hit. We were struggling with a shortage of care providers and shrinking financial resources, even as an aging and increasingly sick population is increasing the demands on the system day by day.
The virus has only exponentially magnified these systemic challenges. But, for nurses in the war against COVID, it’s not just the shortage of healthcare providers that’s so overwhelming.
It’s the fact that the lack of resources with which the system was struggling before the pandemic now means the nurses and other care providers simply do not have access to the tools they need to take care of patients, let alone themselves.
And the problem isn’t just with having the capacity to care for patients’ — and caregivers’ — bodies. It’s also about not having the tools to care for their minds. In fact, a recent study found that nearly 95% of more than 1400 nurses surveyed in the United States felt that the healthcare industry did not support or prioritize their mental well being. More than 35% of those surveyed felt that their psychological health was significantly worse since the outbreak of the virus.
What to Do
Right now, you might feel too physically or mentally exhausted to add something more to your to-do list. Taking steps to nurture your mental health might just feel like a bridge too far when you’re doing well right now just to keep it together.
But carving time each and every day for a bit of self-care is exactly what’s going to help you keep it together — or your family, your patients, and yourself.
Best of all, it doesn’t have to be difficult. In fact, the purpose is for it not to be difficult. The goal is to incorporate something that you can look forward to into each day. That might be just ten minutes spent jumping on the mini-trampoline or doing a little dancing or some other aerobic exercise to get those endorphins flowing and work off some of the day’s stress.
Self-nurturing should also include some emotional and psychological support, which you can literally access at the touch of a button right now. There’s a whole library of free and low-cost apps that are specifically designed for nurses, to help them manage the stress, anxiety, and depression that can accompany this most important of jobs.
And don’t forget about the things you’ve always loved, things that have nothing whatsoever to do with the pandemic. When you come home, be at home. Turn off the news reports, and turn on a favorite funny movie. Get away from the headlines and into some tunes that always bring back good memories.
Video chat with friends and family. Have virtual a virtual cocktail hour or game night. Basically, take time every day to find yourself again. Not the pandemic nurse. But you, the person.
Even under the best of circumstances, nursing is selfless and important work. But to do it during a pandemic is to transform from a good person into a great one, to morph from hero to superhero. And yet even our superheroes need care. After all, how can you possibly take care of anyone else, if you’re not first taken care of yourself?
While COVID-19 continues to infect people throughout the United States, stress levels seem to be increasing as well, especially for minorities. Unfortunately, people of color (POC) don’t often get the mental health care that they need.
Aiyana Ma’at, MSW, LICSW is CEO and founder of Perspective, an online counseling platform prioritizing the mental health needs of the Black community. She took time to answer some questions for us about minorities and mental health.
You’ve stated that Black adults experience 20% more psychological stress than whites. Why is this? Why has anxiety and depression been so much higher in the Black community?
To be a Black person in America means that on some level you are dealing with trauma, discrimination, or trials of some kind just because you exist. Black people need a safe space to release this pressure and buildup of pain in our hearts and minds. Historically, African Americans have dealt with a tremendous number of disparities in areas such as mental health care access, health care and treatment, socio-economic status, and conscious and unconscious provider bias, just to name a few. African Americans have not always trusted many of the health care systems that are here to serve. These realities easily make a Black person more susceptible to mental health issues such as anxiety and depression.
What are the most important things that minority nurses can do right now to help protect their own mental health?
It’s important for POC health care professionals to make sure that they are making time for self-care and setting boundaries personally and professionally around how they show up to support patients and colleagues and how they are expected to show up. Health care providers especially cannot give from an empty cup so they must make sure that they nourish and fill themselves up every single day. Self-care is a must.
Why did you start Perspective? What do you hope it will accomplish?
I started Perspective for a few reasons, but the first comes out of personal experience. I struggled during my childhood and struggled even more during adolescence. I experienced intense loneliness as a child and have dealt with deep issues of abandonment and rejection much of my life. My saving grace came when my mom started me in therapy as a teenager. It was literally life changing for me.
I want other people—particularly Black people and people of color—to have access to being seen, heard, and healed too. Our community can often get stuck in thinking that getting support means we’re weak; we don’t have enough faith or that something is wrong with us. We also have to deal with potential conscious or unconscious bias from non-POC therapists and potential disconnects in professionals not really understanding the context in which we come—our realities, our way of thinking, our unique experiences. There are so many barriers that can get in the way of our getting help before we even get started and this motivates and moves me deeply to do my part in dismantling these barriers.
Explain what Perspective is, how it works, what it offers, and when it will launch.
Culturally Competent Counseling for the African-American Community. It’s 100% Online in all 50 States.
Perspective is the only destination of its kind online whose mission is to prioritize the African American community by providing culturally competent professional counseling via text, audio, or video, anytime from anywhere.
It’s convenient and affordable. Unlimited counseling is available at a significantly reduced cost as compared with in-person therapy. Accessibility will be from any device—computer, laptop, tablet, or smartphone, with bank-level secure encryption, via text, live chat and video sessions. We launch in Summer 2020.
Getting started entails a pretty simple process. Each person needs to answer some questions so we can learn more about the prospective client’s needs, preferences, and what they’re looking for. They will get matched with a culturally competent therapist who is selected specifically for their professional background and life experience to ensure they are a good fit.
What can Black nurses expect to get from Perspective that they couldn’t get from any other type of therapy?
Culturally competent counseling. Cultural competence includes a therapist’s ability to recognize and understand the role culture (both the client’s and therapist’s) plays in a client’s ability to feel genuinely understood, supported, and helped. When a therapist is culturally competent, it increases the well-being and outcomes for the client being served.
Is there any other information that I haven’t asked you about that is important for our readers to know?
If readers themselves or others they know are interested in learning more about our services they can go to www.therapyforblackfolks.org. They can also complete this brief 5 question survey if they (or someone they know) are interested in having someone follow up with them about exploring therapy: https://forms.gle/96csQ1rV9ctN8W2x5
Social determinants have been the focus of our profession since the dawning of nursing time. As health care providers, we know that health starts in our homes, schools, communities, and workplaces, which are heavily influenced by the availability of access to societal and economic opportunities. If I live closer to orchards or fields, I’m more likely to pay less for fresh fruits and vegetables. If there are low-cost medical providers near my work, I’m more likely to be seen before my illness exacerbates. The conditions of our environments shape not only our health but the overall quality of life we perceive. Having nurses actively engaged in the communities they serve can help improve these determinants.
Intending to create social and physical environments that promote good health for all, the Office of Disease Prevention and Health Promotion (DPHP) created HealthyPeople.gov to lay the blueprint for communities to address health issues and disparities among their people. Daily resources such as safe housing, local food markets with healthy choices, access to educational and economic opportunities, access to affordable health care, and the need for improved public safety are all examples of social determinants that improve with focused attention.
Enter the public health nurse. This specialized role focuses on improving population health by focusing on prevention while addressing the multi-focal determinants listed above. As community health nurses, these RNs apply systems-level thinking to assess not only the actual assets, needs, and opportunities of the individuals and communities, but also the potential needs and inequalities within the population. Then they take action. Yet, these actions are not reserved for the specialty of Public Health Nursing; as we have learned, these are actions for all nurses:
• Get educated: Learn the social determinants in your area that affect the population you serve. Is there a lack of medical care or access to dental services? What are the immunization rates in your neighborhood? How about safe, reliable public transportation from your community to essential services such as the grocery store? The more you know, the more efficient you will be in your efforts to make an impact.
• Get political: I’m not talking about red vs. blue politics or social media memes. Learn what policies are up for a vote in your local area and either volunteer to advocate for – or against – the policies that will affect the social determinants of your space. Seek nursing appointments or positions that help form social change for the community and beyond.
• Get cultural: Competence in other cultures includes allowing yourself to be vulnerable enough to say, “I don’t know – teach me.” Work within people’s cultural norms to highlight where you can add value to improve their quality of life. Don’t be afraid to ask clarifying questions.
• Get moving: Once you determine what or who needs your focused nursing attention, organize fundraisers, health fairs, or awareness around the issue. High rates of diabetes in your community? Consider cooking classes featuring healthy items you’d find in the local markets. Plan a ‘Mom’s Night Out’ with childcare so you can provide healthy snacks as you educate women in your neighborhood on hypertension or the importance of immunizations.
Nurses are the past, present, and future health care providers of our communities. We are charged with improving the lives of those around us and addressing – one by one, if needed – the social determinants that are negatively affecting lives. No matter our nursing specialty, we can all make a difference to move the needle to improve the social determinants of health.
You can measure the massive toll of COVID-19 in various ways: the lives lost; the jobs eliminated; the strain on the health care system. For nurses, the toll can also be measured in the emotional and mental distress and anguish they experience in caring for patients and worrying how to protect their own families. For nurses looking for resources to help with their mental health, the American Nurses Foundation in partnership with other major nursing organizations in May launched the Well-being Initiative — a set of resources to help nurses manage the stress and overcome the trauma caused by COVID-19.
“We knew that going into the pandemic nurses were already under extraordinary stress, and that this would cause more,” said Kate Judge, executive director of the Foundation, the philanthropic arm of the American Nurses Association (ANA), in an interview. “All of us are concerned that this has taken and will take a toll that we could not ever imagine on nurses and the nursing profession. We all have to do whatever we can to mitigate that.”
The Foundation partnered with the ANA, the Emergency Nurses Association (ENA), the American Association of Critical-Care Nurses (AACN), and the American Psychiatric Nurses Association (APNA) to develop the tools for the Well-being Initiative. The goal, said Judge, is to provide direct assistance that is varied in its approach. The tools include:
Nurses Together: Connecting through Conversations: Virtual voice or video calls led be a volunteer from ENA to provide peer support and a safe space to discuss such topics as self-care, resilience and bereavement.
Narrative Expressive Writing: A five-week program in which nurses respond to writing prompts related to COVID-19. A responder provides confidential feedback.
Happy App: This app connects nurses to a Support Giver team member.
Moodfit Mobile App: With this app, nurses can set and track goals for sleep, nutrition, exercise, mindfulness and other activities.
Self-Assessment Tool: Not yet launched, this tool recommended by APNA will help nurses identify mental health needs and direct them to resources.
Hotlines and Provider Resources: Also not yet launched, the resources will include instructions for finding a mental health provider, how to get a referral, and what to seek in a provider.
As of early June, some 800 to 900 nurses had used the tools, Judge estimates. Other resources will be coming, she says, taking into account usage data and feedback. For instance, the initiative just launched a mental health survey, “Pulse on the Nation’s Nurses.”
Judge notes that nurses are using the tools to discuss topics besides COVID-19. Nurses, she said, “are really bringing their whole selves” and talking about such issues as work-life balance and financial pressures, for instance.
The tools will continue to be offered for some time. “We know that there is an ebb and flow to this disaster,” Judge said. “We are far from through it.”
pain patients expressed high satisfaction with medical cannabis
despite clinically insignificant changes in pain scores, a
prospective study showed.
a subset of chronic pain patients who used both medical cannabis and
opiate drugs, 76% successfully tapered their opioid dose over 3
months, reported Alyson Engle, MD, of UPMC Pain Medicine and the
University of Pittsburgh, and colleagues, at the American
Academy of Pain Medicine annual
chronic pain patients we see daily suffer from a complex myriad of
symptoms that goes beyond just pain, including disruption in normal
sleep patterns, exacerbation of anxiety or depression, and increased
stress response,” Engle told MedPage
this study, “we were able to track the percent change in symptom
improvement before and after certification for medical cannabis,”
she added. “The data show that patient satisfaction is high
among medical cannabis users and likely is due more to the improved
sleep and overall mood improvement than from improved pain scores.”
National Academies of Sciences, Engineering, and Medicine found
conclusive or substantial evidence
supporting cannabis for
chronic pain in its 2017 report, but data
are lacking about
the health effects of cannabis and the best treatment regimen. “We
believe this research is important since many states, including
Pennsylvania, have legalized medical cannabis for certain qualifying
conditions,” Engle said.
conduct their study, the researchers collected data from patients who
signed medical marijuana contracts for chronic pain treatment with a
certified physician, using the CHOIR platform
to assess patient responses. They evaluated satisfaction with medical
cannabis, global impression of change, and changes in pain, mood, and
sleep, and reviewed patient records.
study ran from May 2018 through July 2019. The researchers recruited
193 patients and 82 patients were included in the final analysis.
Baseline data was collected at the initial visit and follow-up data
at the next visit, typically 3 months later.
193 patients, 90 (46%) were on opioids at baseline, and 76% of these
patients tapered their opioid dose successfully. Their average
decrease was 11.67 morphine milligram equivalents (MME) over the
3-month period, reflecting a 26.86% reduction in opiate dose.
overall impression of change was high with medical cannabis, but
their scores for mood, sleep, and pain were substantially lower. Over
3 months, sleep scores improved most and pain interference scores
improved least; improvement in depression and anxiety scores fell
who stayed on the same dose of opioids while using medical cannabis
had higher pain satisfaction rates. Patients who were not on opioids
initially or who tapered opioids had lower pain satisfaction scores,
but scored their overall satisfaction with cannabis as high.
possible that better sleep with medical cannabis is a key driver of
increased patient satisfaction and successful opioid tapering, the
researchers wrote. Unknown confounders also may have influenced
finding supports a role for medical cannabis in an appropriate subset
of patients, Engle noted. “We do believe cannabis and
cannabis-derived medication merit further research, given the lack of
randomized studies describing the medical benefit, safety, and
optimal dosing,” she said.