The focus on frontline health care workers has increased in the last few years, especially after the rise of the COVID-19 pandemic. With less information and resources paired with their own anxieties, frontline health care workers (HCW) had to deal with a crisis, not knowing that this was only the start—the tip of the iceberg. Who are these frontline health care workers? There is no standard definition for this term, though, suddenly, it was used everywhere. Simply, the term “frontline health care workers” describes anyone who works in the field of health care as a frontline barrier of support and care while exposing themselves to physical and mental risks. When the whole world was isolating and maintaining social distance, frontline HCWs had to report to their jobs, expose themselves to the risks of COVID-19, and work longer hours. It was less of a matter of choice, but, rather, an all-hands-on-deck crisis. The need to differentiate frontline HCWs had to be made, since this was a blurred line at the beginning of the pandemic. Frontline HCWs are individuals who are working toward the containment of the pandemic. For example, a doctor, nurse, paramedic, or mental health professional who can’t isolate or maintain physical distancing but must be physically present at work for patient care—even if they can work virtually at times—and is still engaging in emotionally taxing work and being exposed to secondary trauma. The toll the pandemic took on frontline HCWs was enormous, especially when the studies were very minimal at the beginning.
The pandemic altered the world’s routine by turning lifestyles, work culture, values, and beliefs upside down. There is no one single area of life that the pandemic did not impact massively. Just as people had to adjust to the “new normal”, so did frontline HCWs. With minimal or no training, skills, resources, or funding, they had to figure out a new normal that worked for them, their patients and clients. They dealt with all of this while managing their own families, anxieties, health, finances, and risks. It was not simple; not all frontline HCWs were medically or psychologically prepared, trained, or warned. Most frontline HWCs were in shock, merely following guidelines and slowly navigating themselves toward creative thinking to provide better, more optimistic support to their patients. Frontline HCWs experienced high levels of stress and conflict between their roles and duties at work and their concerns over their own and their loved ones’ safety. This, paired with a tremendously strained health care system, not only caused stress for frontline HCWs but also serious mental and physical health concerns.
Giorgi, Lecca, Alessio, Finstad, Bondanini, and Lulli, et al. (2020) considered this a “psychological pandemic,” and reported that mental health issues related to the health emergency—such as anxiety, depression, post-traumatic stress disorder (PTSD), and sleep disorders—were present among frontline HCWs. Job insecurity, long periods of isolation, and uncertainty worsened the psychological condition.
A study by Trumello, Bramanti, Ballarotto, Candelori, Cerniglia, and Cimino, et al. (2020) reported significantly higher levels of stress, burnout, secondary trauma, anxiety, and depression. It stated that the percentage of professionals who thought to ask for psychological support was twice that of the group that did not work with COVID-19 patients. This shows the need for further prevention and intervention programs for frontline HCWs.
A study by Kalaitzaki and Rovithis (2021) concluded that the so-called “second wave” of the outbreak, which started in August 2020, needed internal resources, such as resilience and coping. The study further mentioned that enhancing these internal resources for frontline HCWs will help them withstand, recover, and manage their psychological health and wellbeing.
In a study done by Munawar and Choudhry (2020), many frontline HCWs practiced and recommended various coping strategies to deal with the stress and anxiety that emerged from the COVID-19 pandemic. The media was reported to be a principal source of stress and anxiety among the public.
Rose, Hartnett, and Pillai (2021) found that frontline HCWs experienced high levels of stress due to the fear of potential transmission of COVID-19 to them and their loved ones and the uncertainty of when the pandemic would be under control. This study also showed coping mechanisms, such as team playing and using humor, helped in the reduction of this anxiety. The same study identified that strict personal protective measures and having separate clothes for work also helped. Motivators in this study included recognition and appreciation for their willingness to support future epidemics or pandemics despite the reported emotional trauma. The driving force was the professional and ethical duty to perform their job.
The coping strategies adopted by Australian frontline health care workers to address psychological distress during the COVID-19 pandemic were maintaining exercise (44.9 percent) and social connections (31.7 percent). Few used psychological wellbeing apps or sought professional help. Over a quarter of frontline HCWs (26.3 percent) reported an increase in alcohol use, which was associated with a history of poor mental health and poor-quality personal relationships.
Rahman, Hoque, Alif, Salehin, Islam, and Banik (2020) found that the most emerging themes of coping included engaging in daily exercise (yoga and meditation), spending time with kids and partners, making phone calls to friends and loved ones, engaging in hobbies that were previously enjoyed, working from home, being mindful of the present and visiting a general practitioner or psychologist.
What is a coping strategy?
According to the APA dictionary, a coping strategy is “an action, a series of actions, or a thought process used in meeting a stressful or unpleasant situation or in modifying one’s reaction to such a situation. Coping strategies typically involve a conscious and direct approach to problems, in contrast to defense mechanisms.” (American Psychological Association, 2022). People use coping strategies when faced with a stressful life event to maintain their wellbeing.
There are different coping styles, according to numerous theories. However, the two broad categories are active and avoidant styles. The active style of coping is when the person is aware of the stressor and makes conscious efforts to reduce the stress. On the other hand, the avoidant style lacks such awareness and ignores the source of the stress. The methods used in active coping styles are considered healthy, and the methods used in avoidant coping styles are considered maladaptive or, simply, unhealthy.
Balasubramanian, Paleri, Bennett, and Paleri (2020) identify positive lifestyle changes, such as eating healthy food, engaging in regular physical activity, practicing good sleep and hygiene when possible, and guaranteeing sufficient rest and mindfulness, as healthy coping strategies at an individual level. Mindfulness apps have been shown to significantly strengthen resilience and reduce burnout.
Coping strategies that can be adopted as an individual
- Taking vacations.
- Enjoying quality time with yourself daily to disconnect and recharge.
- Setting healthy work-life boundaries; disconnecting from work after work hours.
- Having a safe, private environment to work in.
- Journaling your thoughts.
- Letting go of things you cannot control and focusing on things you can control.
- Avoiding emotionally isolating yourself and staying connected with your loved ones.
- Practicing gratitude.
- Having a good routine for diet and water intake.
- Getting enough sleep at consistent times.
- Getting regular exercise.
- Going on a social media detox or having regular periods of disconnection from the internet.
- Practicing relaxation techniques: mindfulness, breathing practices, meditation, visualization, and progressive muscle relaxation.
- Setting wellness goals.
- Using spirituality, religion, or rituals as per your own beliefs.
- Keeping yourself occupied in doing happy and fun things; making a bucket list of things to do.
- Investing in your hobbies.
- Avoiding information overload; disconnecting from the news when you are feeling overwhelmed.
- Speaking to a counselor to get professional support.
Positive measures for the workplace and organization
- Peer support programs
- Reduced workload with flexible working hours
- Empathetic leadership
- Healthy work environment
- Psychological support through an Employee Assistance Program
- Stress relieving leisure activities
- Comfortable place for rest and destress
- Adequate training and support
- Conversations with staff about the emotional impact of their work
- Virtual psychological consultation and counseling services
In conclusion, if you are a frontline HCW, it is important to practice research-based, active, healthy coping strategies, such as: taking support from loved ones and the community, using relaxation techniques, practicing mindfulness or meditation, connecting to nature, investing in hobbies, listening to music, solving problems around daily stressors, using humor when required and appropriate, and engaging in exercise and movement in all its forms. Every HCW needs to have caution toward maladaptive coping strategies, including substance use, unhealthy ways of self-soothing (e.g. self-harm, unhealthy eating, and excessive use of the internet), and any risk-taking activities (e.g. gambling and reckless driving). Reach out for professional support or counseling and break the stigma around talking about mental health concerns. Frontline HCWs and their loved ones can become more resilient with adequate mental health support to help them adopt healthy coping mechanisms for stress.