Helping patients connect remotely with their loved ones modulates distress in healthcare workers: tend-and-befriend hypothesis for COVID-19 front liners

Abstract

The no-visitor policies endorsed by healthcare organizations to limit COVID-19 virus risk exposure have unfortunately contributed to the isolation of patients further exacerbating distress in relatives and frontline healthcare workers. To contrast such effects, many healthcare institutions have adopted technology-based solutions helping patients and families communicate online through the aid of virtual devices. To date, no study has investigated whether facilitating patient-family videocalls would mitigate distress levels in frontline healthcare professionals. Caring for emotional needs of patients by re-establishing affiliative connections interrupted by the pandemic through patient-family videocalls is expected to mitigate distress in engaged healthcare workers as an example of a tend-and-befriend response to stress caused by the pandemic. We tested this hypothesis in a cross-sectional study conducted during 1-30 June 2020, involving 209 healthcare workers (nurses = 146; physicians = 63) engaged in the COVID-19 frontline in Italy. Half of participants in our sample (n = 107) had assisted efforts aimed at connecting patients remotely with families through videocalls. Psychological distress measures included symptoms of burnout, post-traumatic stress, anxiety, depression, and difficulty in sleep and wakefulness. Partially in line with our expectations we found a modulation effect specific for professional category: nurses assisting patient-family videocalls reported significantly lower levels of distress and a better quality of wakefulness compared to those who did not, whereas physicians reported higher levels of distress during such virtual communications. We interpret these findings from the perspective of patient-family communication and differences in skills and training between nurses and physicians. These findings highlight that technology-based solutions aimed at reducing barriers and alleviating distress in healthcare settings should be promoted in concert with skill enhancement training for healthcare professionals especially in terms of communicating online and communicating difficult topics with patients and families.

Mental Health Differences in Healthcare Workers Exposed to Different Risks During the Coronavirus Disease 2019 Pandemic

“…Moreover, we discovered some differences in mental health between doctors and nurses, with nurses being more likely to experience fatigue, anxiety, and insomnia symptoms in the early pandemic period. Similarly, studies from other countries have revealed that the mental health burden on healthcare workers during the COVID-19 pandemic is significantly higher among nurses than doctors, owing to a greater exposure to both patients' and families' suffering and distress (28,29). More importantly, this survey showed that there were considerable disparities in the prevalence of fatigue, anxiety, and insomnia symptoms among healthcare professionals of different genders, with women scoring significantly higher than men.…”

“…Lastly, the Insomnia Severity Index (ISI), a self-report tool that assesses the intensity of insomnia during the previous 2 weeks, contains seven items with a total score ranging 0-28 (19). The corresponding relationship between the total score and severity of insomnia was normal (0-7), mild (8)(9)(10)(11)(12)(13)(14), moderate (15)(16)(17)(18)(19)(20)(21), and severe (22)(23)(24)(25)(26)(27)(28) insomnia.…”

Burnout, Attachment and Mentalization in Nursing Students and Nurse Professionals

“…In line with previous studies [1][2][3], the more pronounced insecure attachment exhibited by nursing students may affect their forthcoming clinical practice both in terms of their role as caregivers and as members of interdisciplinary healthcare teams. It may also represent a potential disturbing factor in the development of effective relationships with patients and families [11]. However, these findings should be discussed in the light of the results obtained on the mentalization measure.…”

“…Among healthcare professions, nursing is perhaps the most demanding as it requires delivering compassionate care in often stressful and adverse conditions and to effectively navigate complex interpersonal relations with patients, families and other healthcare professionals [10,11]. If more insecurely attached individuals cope less well with stress, are tendentially ill-equipped in mentalization capacities that facilitate interpersonal relationships and are more prone to burnout, then adult attachment insecurities and poor mentalization capacity may be expected to predict burnout in nurse professionals.…”

Effects of COVID-19 on Mental Health and Its Relationship With Death Attitudes and Coping Styles Among Hungarian, Norwegian, and Turkish Psychology Students

“…In addition, emotional support was positively correlated with fear of death and negatively associated with neutral acceptance among the Norwegian respondents. Fino et al (2020Fino et al ( , 2021b emphasized that physical and social isolation precautions related to COVID-19 might result in increased fear and distress regarding the disease itself among people. Additionally, some studies showed that stress may increase one's likelihood of seeking emotional support (Joo et al, 2020).…”