With an uptick of cases, the University of Arkansas for Medical Sciences has launched a survey addressed at identifying acute stress and ensuring resources are available to support health professionals.

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Arkansas has seen fewer cases of COVID-19 than other states, but officials there have remained vigilant in ensuring the health and well-being of physicians, other health professionals and patients across the state. As the state continues to see an uptick in cases, the University of Arkansas for Medical Sciences is looking to address the needs of all health professionals through the launch of a survey to identify how those on the front lines of COVID-19 care are coping with this pandemic.

Partly due to a smaller, less dense and rural population, Arkansas has been protected against a significant increase in COVID-19 cases. With the late surge, it has allowed the state and the University of Arkansas to learn from the experiences of harder hit areas such as Europe, California, New York and other locations with a higher incidence of COVID-19.

“Right now, in our hospital we have six confirmed patients and we are waiting for results on nine other patients,” said Erick Messias, MD, associate dean for faculty affairs at the University of Arkansas for Medical Sciences in Little Rock. “These are very low numbers overall compared to other places.”

However, even with these low numbers, the University of Arkansas for Medical Sciences closed operations for the month of April, which created a series of stressors on everyone.

“They have the stress of being at home. The state shut down the schools for the whole month of April, so people that have kids have to take care of their kids’ needs at home,” said Dr. Messias. “Then you had the people that had to stay here and do three hours of cases and they were afraid of contagions.”

That is why Dr. Messias distributed the AMA’s “Coping with COVID-19 for Caregivers” survey. This free, brief survey was designed to assess the impact of COVID-19 on clinical staff and was distributed April 7 with over 800 responses and sent for reassessment May 7.

“The way the survey helped us shape our strategies was to understand what people are afraid of and to prepare for that,” he said.

The AMA has two free surveys to help health care organizations monitor the impact COVID-19 has on their workforce during this pandemic. The surveys can be used to track trends in stress levels, identify specific drivers of stress, and develop supportive infrastructures based on these drivers. Organizations that use the surveys will receive free-of-charge support from the AMA in launching the surveys and access to data through an easy-to-use reporting dashboard.

Additionally, the AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic and provides practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.

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Exposure to COVID-19

The No. 1 fear expressed by the responding physicians and other health professionals was how they can keep their families safe after providing COVID-19 care.

“Close to half of people said that they are concerned to a great extent about exposing themselves or their family to COVID-19,” said Dr. Messias. “In April we sent a lot of people home. Now in mid-May, we are asking them back to the hospital, so they’re afraid again.”

To address concerns about keeping families safe, Dr. Messias is working on a video that will include infectious disease control experts discussing measures being taken to ensure the university hospital is a safe environment for people to practice.

“We’re going to go over those measures, which would include a universal mask policy and screening everyone that comes on campus,” he said, adding that they are also maintaining a strict policy for visitors.

Additionally, there are specific areas of the hospital where patients with COVID-19 are treated. This separates them from the general population as an added precaution.

“The measures are in place to reduce the risk to an acceptable level and we believe that if people follow the policies, we can control the risk of exposure to health care workers and their families,” said Dr. Messias.

Adequate availability of PPE

Another focus in the survey responses was on adequate supply of personal protective equipment (PPE). For example, one respondent wrote, “PPE” about 25 times throughout the survey, said Dr. Messias. “That’s the type of information you get when you do this type of survey—you get what people are thinking.”

Hearing the concerns about proper protection, “in every communication that we sent across campus, once a week, we gave them a sense of where we were in terms of PPE supply,” he said. “Instead of just telling people about the number of ICU beds and respirators available, we also talked about our supply of PPE masks, face shields, gloves and surgical scrubs.”

“We were able to tell people about the supply we had, which became part of the ongoing message,” said Dr. Messias.  

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Increased sense of meaning

A rather unexpected, but hopeful, finding from the survey was that many felt that the COVID-19 response increased their sense of meaning and purpose in health care. They were reminded of why they went into medicine in the first place.

The survey showed that 57% of physicians and other health professionals felt “that this crisis has increased their sense of meaning and purpose,” said Dr. Messias. “The vast majority of people in our organization—about 62%—felt valued by the organization. So that was important for us to hear too.”

“If there is one bright side of this crisis, it is that people will now value health care workers more and recognize the values and risks associated with our practices” he said. “Also, health care workers see more meaning and purpose in what they do.”

Other stressors

“In the beginning, people were very concerned about infections. Now, people are very concerned about reduced hours, reduced pay and some people’s partners lost their jobs,” said Dr. Messias. “We started with a public health crisis and now there is more of a mental health, emotional and financial crisis.”

“Those are different layers of stress that are going on in people’s lives today,” he said. “People used to say, ‘We’re all in this boat together.’ The truth is we’re all in the same storm but in different boats, so we’re going to have to help each other.”

Throughout this process, Dr. Messias has learned several lessons, but the most important has been to avoid assumptions about what colleagues are going through.

“In the beginning, we thought we knew when in fact there were so many different circumstances and situations that it is impossible for any of us to know,” he said. “That’s why surveys like these are important because we give people a voice so they can tell us what their concerns and worries are.”

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