ANZICS recognises the following contributory factors to psychological stress in ICU staff:
- Being unable to meet basic physiological needs such as access to food, water, adequate rest, and time to toilet as a result of PPE or restrictions/ increased activity at work or at home
- Restrictions to social activities and being unable to see family and friends due to non-pharmaceutical interventions in the community
- Perceiving that they are a potential health risk to their family and friends
- The need to quarantine due to COVID-19 exposure at work or in the community
- Feeling unprepared or untrained to perform the duties expected for the role (particularly for staff working in an unfamiliar environment or beyond their normal skill level)
- Having been conscripted to work in an area of risk rather than volunteering to do so
- Moral distress due to visitor restrictions and difficulty in communicating with family and friends of patients
- Restricted resources and the need to triage or reallocate healthcare provision, with a perceived inability to provide best practice and compassionate care to patients
- Mistrust in the organisational infection control processes
- Poor communication pathways within healthcare organisations.
Stress and anxiety in healthcare staff can present in many ways (Table 2). It is important during a pandemic that we normalise heightened emotions and feelings of anxiety and stress. Leaders must acknowledge this anxiety before providing strategies to manage it.
The potential sequelae of increased stress and anxiety in healthcare staff is wide-ranging and includes:
- Increased staff turnover
- Poor staff retention
- Increased sick leave and absenteeism
- Reduction in working hours
- Adverse work culture
- Increased risks to patient safety
- Poor quality patient care.
Download Table 2 pdf
It is important that ICU staff recognise stress and anxiety in themselves and adopt strategies for the maintenance of mental and physical wellbeing (Table 3). Health care workers are self-reliant and often reluctant to reach out for help.
Download Table 3 pdf
ANZICS recommends that leaders maintain an awareness of the strategies they can use to monitor and support staff wellbeing during the pandemic and that this is reviewed regularly. Organisational support for ICU staff wellbeing during the pandemic is paramount.
In maintaining the health needs of the workforce, ANZICS recommends:
- That units/hospitals provide meals and drinks for frontline staff to boost morale and minimise staff leaving the hospital for meals
- The provision of rest breaks and rest areas compliant with social distancing guidelines
- Access to clean showers and change areas after a shift before returning home. The option to wear hospital scrubs allows staff to feel “decontaminated” as they change clothes before returning home
- Access to psychological support with clear messaging on where to receive this support
- Providing education and resources to support psychological health
- Rostering of shifts sympathetic to the needs of the workforce, that may need to change during a more protracted pandemic response. This may include shorter shifts, smaller work areas/pods, limiting exposure to high-risk zones, and rostering adequate time off between shifts.