A Note to Our Readers
Just one month ago Real Time planned to launch an informational piece on how to “Avoid Nursing Burnout” caused by a shortage of nurses in the acute and post-acute care communities. Our initial thought was to provide strategies focused on the use of different techniques and technologies that would alleviate challenges faced by an overworked and overwhelmed nursing workforce. Just when we thought the load carried by clinicians couldn’t get any heavier, they are now faced with an even more challenging environment due to COVID-19.
So, we decided to change the direction of our blog to provide a more personal look into what DONs, facility owners, CNAs, and clinical and facility staff can do to care for themselves, their teams, and the residents and families they serve to better cope during this unprecedented time.
We sat down with Cindy Kreider (RN,BC, RAC-CT), Clinical Specialist with Real Time Medical Systems, to get a clinician’s perspective on how nurses and facility staff can take care of their mental wellness, as well as ways facilities can avoid what is slated to be the “Great Depression” amongst residents and clinicians within the industry, due to COVID-19.
Real Time: As a clinician, what advice would you provide to Nurse Leaders to ensure that they and their nursing staff and teams are taking care of themselves during this time?
Cindy Kreider: I know it’s ‘easier said than done’ when your staff’s primary focus is caring for residents, but as clinical leaders it’s our responsibility to make sure our staff is taking care of themselves, and that we take care of ourselves too. Everyone knows the basics – wash your hands, use sanitizer, etc., but it’s important to remind your team to also try and get at least a solid 6-8 hours of sleep on a daily basis and to fuel their bodies with nutritious meals. Oranges or any citrus during the day is great “pick-me-up” and good for the immune system.
I always liked to encourage our teams to steal a few minutes during their breaks to go for a walk, meditate, read or do something relaxing. I also found it immensely helpful to keep an open dialog with my staff. These days especially, it’s important to remind everyone they are not in this alone. Laughter is also great, as it releases endorphins – the body’s natural feel-good chemical. It can boost your mood and decrease stress hormones. Laughter has also been proven to help strengthen your immune system by increasing immune cells and infection fighting antibodies, thus helping to improve your resistance to disease. Finding the humor in even the darkest of situations can help alleviate stress in you and those around you.
Real Time: Are there any techniques that nurses and facility staff should be incorporating into their daily routine, to help them mentally de-stress?
Cindy Kreider: Mental health is so important to address. It’s inevitable to feel overwhelmed, scared, and even depressed. We all need to remind ourselves that these feelings are natural and are okay to feel. You don’t always have to be everyone’s rock. There are a variety of ways to refresh yourself mentally. First thing I like to practice is breathing exercises. Deep breaths slowly in through the nose and out through the mouth done repeatedly for a minute or two really helps me relieve stress and anxiety. There are a few ways to take advantage of breaks – I like to call or video-chat with family or friends, take a walk, and journal. Of course, exercise, rest and healthy eating helps me combat mental fatigue too. Most importantly, I’ve found that support amongst my co-workers and industry peers is an invaluable asset. These are the people who can truly relate to what we are experiencing. Sometimes you just need an understanding person to commiserate with or provide a shoulder to cry on.
Real Time: What can healthcare facilities do to provide continued support to their nursing and facility staff to avoid burnout?
Cindy Kreider: In the field, some of my peers have shared that their facilities are providing additional rest breaks, meal delivery, and time for staff to interact with family via video chat, phone, or similar. I believe it’s also absolutely essential to remind staff how much you support them and appreciate their dedication. Asking staff members what they need and soliciting their input always allowed me to provide better support by being able to address their needs directly. Likewise, let your team members know they can come to you with any sort of issue – especially if they are feeling overwhelmed or just need to talk.
Another more timely idea, since PPE is so hard to come by these days, is to ask your administrators to work with local community groups who could sew personalized facemasks for all the workers in your facility or run a campaign to provide your staff with messages of thanks and gratitude. That gentle reminder of unity and team spirit is the push your staff can use to get past some of the burnout.
Real Time: What can clinicians do to comfort the family members of residents, who are now unable to visit with their loved ones?
Cindy Kreider: I have seen some very creative ways facilities continue to comfort and engage the families of their residents. From the use of video technology, to writing email updates with the residents as an activity, to allowing family to visit residents through the window while on the phone – the use of today’s digital technology is really helping to keep people connected. More and more facilities have tablets and iPads at their disposal, so including photos in an email or text correspondence can help too.
Above all, communication is key – routine status updates to family members regarding their loved ones is important. Stay in contact via email, but also by phone so family members can ask questions and hear their loved one’s voice. You can also create, and use dedicated social media pages to keep family members aware of facility-wide changes and happenings.
Real Time: In the same sentiment, with residents not being able to see their loved ones, how can nurses help avoid resident depression from occurring?
Cindy Kreider: Throughout my career, I have found that one of the most impactful ways to positively affect a resident is to reminisce with them about their families. Ask questions, look at photos, and listen to their stories. Following social distancing rules of course, you can allow social service and activity staff additional time to spend one-on-one with each resident.
I’ve also seen the power of music help brighten the mood of many residents. Some facilities I know are playing music and/or games via overhead speakers. If possible, allow residents to choose their own music to play in their rooms. Doorway bingo was a hit at one facility, while I’ve seen others share online classes or tour museums around the world with the use of a laptop, tablet, or iPad.
I think it’s also vital to give residents a purpose – have them crotchet or knit hats to donate to a local homeless shelter or bring them materials to make a scrapbook (families can email or mail in photos).
Real Time: It’s been mentioned that the emergence of COVID-19 may lead to what the industry is labeling the “Great Depression” amongst residents and those that care for them. What early warning signs of depression should nurses be paying attention to, both in their residents and within themselves?
Cindy Kreider: Depression can be a tough one because it varies from person to person, but there are some common signs and symptoms. I do feel it’s important to be observant of the early warning signs and aware of any changes in the mood or behavior of any resident. Feeling sad, lonely or depressed at times can be a normal part of life and can be an expected reaction to life struggles or loss. When the feelings become overwhelming, cause physical symptoms, and last for longer periods of time, you should seek medical help.
One way to stay on top of potential depression, especially during this challenging time, is to monitor for it more frequently. You can use the tools contained in the MDS (BIMS and PHQ9), or your tools of choice, as a guide to keep a repository of relevant data on each resident that can be continually referenced when considering mental health status. Though MDS assessments are typically done every 90 days, you certainly can use the information contained in the cognitive and mood behavior sections when evaluating a resident’s mental health more frequently, during this unprecedented time.
General signs of depression to look for in both residents and within yourself (or co-workers) are memory difficulties or personality changes, physical aches or pain, fatigue, loss of appetite or sleep – which are not caused by a medical condition or medication.
Real Time: What are you doing to get yourself through this tough time?
Cindy Kreider: I’ve been doing everything I can to offer up as much support, encouragement and thanks to my clients and colleagues – and to all healthcare workers who are fighting this thing. We can’t lose sight of the fact that there is hope as the world comes together, which is an amazing thing to observe. I’m doing my part with the rest of society – staying at home and social distancing. It’s tough not to be able to hug my loved ones, but we spend a ton of time on video chats making cards to send to residents and staff at local skilled nursing facilities. I’ve been doing a lot of cooking too. Keeping it healthy, except for some of those old family recipes I’ve been trying to replicate.
We would like to thank Cindy for taking the time to share her insights. We hope that you have found this information useful, as you and your facility continue to provide unwavering support and care to those that you serve. From all of us at Real Time, we are immensely grateful for all of the positive contributions you are making during these challenging times.
Cindy Kreider, RN,BC, RAC-CT
Clinical Specialist, Real Time Medical Systems
Beginning her career in healthcare over 30 years ago, Cindy has worked in nearly every role within a nursing facility, including MDS Coordinator, Nursing Assistant, RN Supervisor, Director of Nursing Services, and Chief Clinical Officer for a 21-chain skilled nursing facility. Certified in Gerontology, she has worked with clinical and administrative teams for hundreds of facilities nationwide and served as Chair for the Clinical Practice Committee at the Pennsylvania Health Care Association.