COVID: Caring for Germany's carers
January 2, 2021
"Over the past few weeks, I was totally exhausted. I got tested for coronavirus twice, luckily the result always came back negative. I went to my doctor because it wasn't getting better, but he had only a little time for me because his practice was full. When I got home, I just cried and cried." This 51-year-old nurse for the elderly, who requested to remain anonymous, heard about the free telephone service "PSU Helpline" and dialed the number.
The psychosocial support service from Munich-based organization PSU-Akut is for workers in the health care sector. This year, 1,400 people have taken up the offer. Its core principle is peer support: specially trained colleagues listen and provide support because they understand what happens in hospitals and care homes.
Even without the coronavirus pandemic, medical and care workers experience extremely stressful situations that they often carry with them for years: A woman or her baby dies during birth, the night shift finds a patient who has died unexpectedly, a mistake is made during an operation, or the high workload due to staff shortages leads to total exhaustion — such as what happened to the nurse who called the helpline.
COVID-19 pandemic exacerbates stress
Andreas Igl, an expert in crisis management and psychosocial support, has spoken with many people working in the care sector, both by telephone and in team discussions at workplaces. He has listened to and asked about their problems: Care workers and medics are working under extreme pressure in the coronavirus crisis. Day after day, they must witness people dying without the support they deserve. Many are afraid that they will pass on the virus to patients or residents or bring the virus home to their families, perhaps endangering a child with severe asthma or an elderly grandmother. These worries were also named by nursing staff in a representative survey conducted by Diakonie, the social welfare organization of Germany's Protestant churches.
An increasing number of medical professionals have had to quarantine or become sick themselves. Diakonie President Ulrich Lilie said there was one facility where only eight out of 52 nursing staff are still on duty, and that's not an isolated case.
Andreas Igl is the managing director of PSU-Akut and heads the PSU Helpline. The helpline was expanded in March so that people working in the health sector during the pandemic could access help quickly and anonymously, from 9 o'clock in the morning to 9 o'clock at night.
Demand is increasing, said Igl, the team of about 40 call takers is expected to grow. Doctors also perceive a high need: "The pandemic is exacerbating the burden." That not only endangers health care workers; it could also become a risk for patients and residents.
The health insurer Barmer reported in its 2020 care report that nurses in aged care facilities had more sick days than other worker groups when factoring in mental illness.
The exhausted nurse for the elderly said after her call to the helpline: "The good thing for me was that I didn't have to hold anything back in the conversation. Otherwise, you think, 'What should I say? Can the other person deal with this?' We spoke for three-quarters of an hour. The colleague then recommended that I speak with a psychotherapist from the helpline team. She called me the next day. She's now helping me to stabilize myself again."
Noticing the warning signs
For years, firefighters, police, rescue forces or train drivers have had support systems in place following crisis operations, incidents with multiple casualties, or suicides, to prevent post-traumatic stress disorders. In hospitals and care homes, however, where matters of life-or-death happen day in, day out, such services are only now starting to be established, said Andreas Igl.
Psychotherapist Dr. Marion Koll-Krüsmann has many years of experience in trauma care and preventative research.
"It's incredibly important that symptoms are dealt with early," she said.
The clinical lead of the PSU Helpline recommends that affected people call as soon as possible when they need to talk. They should pay attention to changes in themselves: "Sleep problems, going around in circles with their thoughts, irritability. 'I'm more aggressive than normal, I don't have the patience to look after my children, I wish that I was in coronavirus quarantine' – noticing that you are overloaded." On the PSU Helpline's website, there's an anonymous self-test and practical tips to reduce stress.
Distance and discussion
The call-takers help to normalize the symptoms. "Yes, it makes sense that you feel burdened, it makes sense that you always have these ideas in your head that you're thin-skinned and powerless." Initially, the conversation could be about finding some distance: "What makes me feel more stable, what normally helps me in difficult situations?" The helpline also offers information on its website about strengthening resources, coping with stress and practical tips on how to combat panic and acute anxiety.
Andreas Igl fears the demands on health workers will increase in the coming weeks because fewer and fewer staff are available. Very few organizations have well-functioning plans for psychosocial support. "The plan that will take effect now is a ban on taking leave," he supposed.
This deprives the remaining doctors and nursing staff of the chance to recuperate. "But then there's often no alternative, because otherwise the clinic, the department, the aged care home would have to close," Igl said.
Marion Koll-Krüsmann has first-hand experience in crisis situations: The more chaotic it becomes "the more important it is to care for yourself well and to plan ways to restore your energy." People working in the health care sector are using a lot of energy. Recharging their batteries is more difficult than usual and extremely important. Taking a nature walk could help or meeting friends for a dance party on Zoom. Or learning something new: an instrument, a language, juggling, or carving.
It's important not to head straight for the sofa after work, but instead to do some moderate exercise, even if you have been running around the ward all day. "Chronic stress arises when you go to rest straight away after work, or when you only do exercise and don't rest."
'How painfully people die'
The psychotherapist said she has encountered many people in helping professions who are trying everything to cope with the current emergency. They are suffering not only under their own stress: "When you see how painfully people are dying, and on the other hand have to argue with someone on the tram who thinks he doesn't have to wear a mask."
After the pandemic, will health care workers remain in their jobs? Resentment is growing in the nursing sector. When the state of Lower Saxony recently increased daily working hours from eight to 12 and weekly working hours from 40 to 60, there were many protests. On social networks, some announced a "Pflexit" – a play on the word Brexit, which translates to an exit from the nursing profession.
This article was translated from German.