Remember when Americans banged pots and pans in the spring of 2020 to thank physicians and other health care heroes for saving lives as the COVID-19 pandemic took hold? Now, doctors are buffeted on many sides by angry patients fed by anti-science aggression.
The pattern is not unique to COVID-19. Rather, these are well-known emotional phases of disaster response, and is reflective of the pandemic’s impact as a form of collective trauma—a shared emotional reaction to a terrible event that affects an entire group or society.
Early in the pandemic, physicians and other health professionals experienced the honeymoon phase. Then, came disillusionment. With intentional effort will come reconstruction and a new beginning.
Responding to collective trauma in health care requires an organizational approach. An AMA STEPS Forward® toolkit outlines how to respond effectively to the collective trauma of COVID-19 and other awful events such as terrorist attacks, mass-casualty events, economic crises, political conflict and war.
“Unlike some collective trauma events, the COVID-19 pandemic is widespread and ongoing,” says the toolkit, “Collective Trauma: Respond Effectively as an Organization.”
“The global reach and uncertainty surrounding COVID-19 have only amplified its effects on both large-scale and local levels. Front-line health care workers are at particularly high risk of experiencing lasting reactions to this pandemic, including anxiety, depression, post-traumatic stress disorder, substance abuse, and physical illness,” the toolkit adds.
“The proximity to personal risk of illness and death, the threat of exposing their loved ones to infection, their repetitive exposure to the worst case outcomes, and the unrelenting nature of the threat over multiple years all heighten front-line health care workers’ risk of developing psychological distress.”
But, says the toolkit, by “using trauma-informed approaches, organizations can serve as powerful protectors and sources of stability during and following times of adversity.”
In 2021, the AMA adopted policy recognizing trauma-informed care as a practice that acknowledges the widespread impact of trauma on patients, identifies the signs and symptoms of trauma, and treats patients by fully integrating knowledge about trauma into procedures to avoid retraumatization. Here are some key steps to take.
A key model to help health care organizations address the collective trauma of COVID-19 is known by the acronym CARE, which incorporates these elements:
- Cope with communication, compassion, and creativity.
- Acknowledge experiences at all levels within all organizational units.
- Remember the losses, challenges and changes faced.
- Emerge by integrating experiences into values and behaviors.
Health care organizations can start by identifying and gaining buy-in from appropriate senior leadership and stakeholders about the CARE model and educating leaders about collective trauma. That includes describing responses, explaining how to initiate supportive conversations, and making resources easily available.
Removing impediments to seeking help is critical in the face of a collective trauma event, which is why organizations must consider existing obstacles to prepare for a CARE model response. Once barriers are identified and removed, make a cultural commitment to reduce the stigma of help-seeking.
These can include:
- Frequent town halls for all team members.
- Leadership communications or training.
- Protecting health professionals from any immediate or ongoing threat.
- Coordinating support resources and response teams.
- Hiring more float staff or travel nurses to assist with the stress of staffing and give time to grieve or reset.
- Offering flexibility of schedules, shifts or hours for a period of time.
- Hosting a private space for team members to gather, share, discuss or receive stress first aid or Psychological First Aid.
"Events that cause collective trauma are unpredictable and often unprecedented,” the toolkit notes. That’s why “a responsive, agile, and fluid approach” such as the CARE model is needed to promote “collective recovery for organizations and care teams.”