Stress coping tips for providers during COVID-19

By Melanie Fox, PsyD and Carolyn Turek, PhD. 

Any time of uncertainty commonly leads to increased stress, and the COVID-19 pandemic is the perfect definition of uncertainty. Things are changing daily, we are learning in real time, and we cannot predict with certainty exactly what is going to happen.

What we do know with certainty though is that if providers don’t practice self-care during these tumultuous times, you cannot be as effective for patients, your team and your family.  

While it can feel impossible to engage in self-care right now, it is truly imperative as stress can easily rise to traumatic and toxic levels and this biochemical reaction can cause a range of physical and mental health problems.

Read on for some tips that can easily be worked into your day – and can make a big difference.

Common stress responses

First, it’s important to understand what happens to our bodies when we experience overwhelming stress. Humans often respond in these four characteristic ways:

  • Flight: We may feel trapped, fidgety, tense in our bodies, numb in our extremities, or experience urges to leave work or cancel patients.

  • Fight: We may feel irritable or agitated. Our jaw can tighten. We may grind our teeth. We can glare, show anger in our voice, or feel a burning sensation in our chest or stomach.
  • Freeze: We often experience a sense of dread, hoping for cancellations, difficulty making decisions, feel our heart pounding, or notice ourselves checking out.
  • Avoidance: We may feel calm and composed, but anxiety manifests through impatience, irritability, short-temper, tense muscles, changes in sleep or eating patterns, and/or increased use of substances.

Tips to help in the short term

To remove yourself from the fight/flight/freeze/avoidance response, try to focus your mind and body to the present moment. Grounding exercises can help. Here are a few exercises to try:

  1. 5-4-3-2-1: Name to yourself five things you see, four things you feel, three sounds you hear, two things you smell and one thing you taste.
  2. Box breathing: Breathe in counting to four with each inhalation and count backward from four with each exhalation. Do this 4 times.
  3. Get moving: Take a quick walk before starting your next task.

These exercises can be helpful when you notice yourself reacting from a stressed place, or when you notice patients, families or other health professionals responding to you in ways that feel unhelpful or stress-inducing.

Tips to build  wellness

While no one will ever be completely stress-proof, building wellness can strengthen our ability to withstand stress.

One way to do this is by focusing on the meaning behind our work. When things seem uncontrollable or stressful, it often helps to reflect on our values and why our work is important to us.

Practicing consistent self-care is another way to build wellness. Self-care is actually patient care. Here are a few ideas to try:

  • Take deep breaths.
  • Maintain regular meals and snacks, as possible.
  • Try to get as much sleep as is possible.
  • Engage in regular physical activity.
  • Practice mindfulness.
  • Stay connected with loved ones.
  • Reduce consumption of news and social media: Studies from previous epidemics find a link between time spent on social media and increased anxiety/stress. Try to consume news at a set time from a reliable source and then try to leave it until that time the next day.
  • Try technology: Headspace, a mindfulness app, is free until the end of 2020 for anyone with a national provider number.

6 telehealth tips for providers

For many providers, the COVID-19 pandemic has accelerated the use of telehealth to serve patients and families. With that, this may be a developing skill set for many physicians and advanced practice professionals. Here are a few tips to ensure a successful video visit:

Determine if the patient is a good telehealth candidate

It’s up to each clinician to gather enough information to make appropriate medical decisions. Refer the patient to in-person care if you determine a video exam is not adequate to provide high-quality medical decision-making.

Here are some things to consider:

  • Is the patient in a private location? Do not provide telehealth services when a patient or parent is driving or in a public location.
  • Does the patient or family have access to the internet and a computer or mobile device?
  • Do you have a medical license for the state in which the patient lives? Restrictions during COVID-19 have been waived but this may change.
  • Is the patient and family able to help with the physical exam, testing and vital signs, if necessary? For example, do they have a thermometer and scale? Are they able to count respirations?

Prep your virtual exam room

Take a few steps to prepare your environment for an optimal video experience:

  • Check for clutter and any personal health information visible in the camera frame. Consider activating the virtual background if necessary.
  • Check your self-view and make any needed lighting adjustments so your face can be seen clearly.
  • Be aware of the position of your devices. If you’re using two screens, ensure they are positioned optimally so you can look back to the patient frequently when documenting.
  • Shut your door, if possible, and hang a sign indicating a video session is in progress.
  • Once the visit begins, be mindful that any typing from charting or notetaking will likely be picked up by the microphone.

Perform some housekeeping

Once the session begins, you’ll need to start with a few housekeeping matters:

  • Verify you are with the correct patient and family by using two patient identifiers such as full name and date of birth.
  • Obtain consent for the telehealth visit from the patient and parent.
  • Explain to the patient and family that the video visit is not recorded, meets HIPAA requirements, and cannot be posted or forwarded.

Ensure comfort and privacy

For both the provider and patient, this visit will certainly “feel” different than a typical encounter. Acknowledge that to the family and then take some steps to increase comfort:

  • Your usual techniques to connect with families can translate well on video. For example, help your patient warm up by asking them to show you their favorite toy or book.
  • To help the family feel more comfortable – particularly if the exam will require clothing to be removed – ask non-essential staff and family members to leave the respective rooms.
  • If others are in the room, introduce everyone in the location. Ask the family to do so as well for anyone who is in the room but off camera and in the microphone’s range.

Double down on communication

Communication is always important – but doubly so during a video exam. Be engaging and encourage cooperation from the patient and parent throughout the exam:

  • Be comfortable giving the patient and family direction to improve the experience. This could mean asking them to adjust lights; move closer or farther from the camera; remove objects obstructing your view; or speak more loudly.
  • Let the patient and family know they may hear you typing but this is because you want to accurately document the visit.
  • Make eye contact with your camera, not the patient’s eyes.
  • Do not cover your camera or mute your microphone; this could make the patient and family feel you’re not giving them your full attention.

Ask for assistance from the patient and family

In the absence of physical proximity, you might need the patient and family to help you perform exam maneuvers:

  • Direct them to remove clothing, as necessary, and remember to tell them when it is OK to put on their clothing again.
  • Tell them how to palpate to localize pain.
  • Explain how to perform range of motion maneuvers.
  • Describe the landmarks you use in clinic to find the right location for an exam component, such as ribs or the pelvic bone.
  • Watch carefully and ask them to repeat anything that appears questionable.
  • Verbalize what you think you are seeing, allowing the patient and their parent to clarify as needed.

Find more resources for telehealth services.