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ICUs Working Together Through Trauma

Resiliency and mental health have come to the forefront of administrators’ minds as hospitals and their staffs move into a later stage of the coronavirus pandemic. For example, UMC offers staff-wide access to meQuilibrium. This award-winning, self-paced resiliency training program addresses the burnout and trauma of working in a hospital environment. However, with so many tightly knit teams having experienced the worst of the pandemic together, some of our medical staff saw potential in creating small Peer Support Groups. These groups were designed to allow nurses and doctors to talk through personal traumas, find relief in sharing their experiences, and learn that they aren't alone in their struggle to move past the most severe moments. Stephanie Dobbins, a Medical Intensive Care Unit (MICU) nurse, decided to bring the Peer Support Group model, originally established by Pastoral Care, to the MICU. The MICU was designated as the first unit to receive COVID-19 patients. When the unit was full (which it often was), patients overflowed into other ICUs. Stephanie’s experience in the MICU and her education in Critical Incident and Stress Management (CISM) made her an ideal advocate and leader for establishing a Peer Support Group program.

“We realized that we would often ask our co-workers how they were doing as a nurse, but we needed to start asking them how they were doing as a person,” Stephanie said. It’s not uncommon for the MICU staff to “code” a patient, the very physical and emotional process of trying to resuscitate a patient. Stephanie implemented a countermeasure called a "Code Lavender," a response to the emotional trauma of those events and the lasting emotional fatigue that comes from working in an intensive care unit. The gesture might seem small at first: bags with lavender essential oils, a motivational quote, helpful items that serve to heal. However, with the bag comes the critical question: “How are you doing?” and an opportunity for a conversation with those that understand. During the worst period of the pandemic, the already difficult tempo and emotional strain of working in the MICU became much worse. Therefore, it became important that the support infrastructure grew to meet the moment.

To understand the moment, it's important to recognize the pandemic's effect on the MICU before access to vaccines. The United States, like many of the most impacted countries in the world, saw ICUs filled with COVID-19 patients. As patients filled the ICUs, patients with other chronic illnesses struggled with medical access. Surrounding rural clinics and hospitals couldn't transfer patients to better-equipped facilities, putting rural medical staff under immense stress and leaving some MICU nurses to counsel smaller facilities on using specialized equipment, like ventilators. As a result of this unprecedented strain on the medical system and a lack of treatments early on, people died at an extraordinary rate, and most often, it was in these ICU settings. As of this writing, over one million Americans have died from COVID-19. Stephanie said, “In a 3-day period in December 2020, we had fifteen patients pass.” The result was feelings of hopelessness, traumatization, and isolation. As recently as this April, Stephanie and other MICU nurses knew that the nurses had not moved on from the worst of the pandemic and something needed to be done.

The first Peer Support Group meeting was scheduled to be as accessible to the busy MICU staff as possible. More than twenty nurses and doctors attended the meeting. They shared, with those who understood the most, some of the enduring challenges left from those early stages of the pandemic. Nurses and physicians shared their stories and built networks with those who understood them. While only the first of many meetings to come, the door to recovery was opened wider—our medical staff shared stories of hope, and they became contagious. Stephanie plans to ramp up meetings to meet the need. She believes an appropriate schedule would have a meeting once a month, and she expects the attendance for these meetings to increase in the future as nurses and physicians share their value. She hopes the Peer Support Group in the MICU could serve as a model for other ICUs and sections that are acutely affected by the pandemic. She believes they should be established internally by trusted team members. “We’re still dealing with PTSD. We are taking care of our patients, but we've been through a lot. Some of us still feel isolated." The Peer Support Group is the beginning of healing for many of our nurses and physicians. It's up to all of us to understand each other's stories, do what we can to heal jointly, and find ways to overcome these unique mental health challenges. We should build our own support groups, share what we learn from resiliency programming like meQuilibrium, and advocate for counseling, free for employees through the Employee Assistance Program (EAP). We should listen a little longer to one another and respect the many challenges we all face to make this critical health system work. We’re a family at UMC, and we should do everything we can to care for our family.

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