Literature as a coping mechanism – waiting for the second wave

Literature study groups for WA frontline hospital staff are being trialled as a measure to help deal with stress, fear and the heavy emotional load of waiting to see if they will be called on to fight a second wave of COVID-19.

UWA School of Allied Health lecturer and former emergency department nurse Dr Brid Phillips says it is important the community finds effective coping mechanisms to address stress and fear in who are still “holding their breath” ahead of the cold and flu season. WA’s frontline health workers need to be supported to remain alert and ready in case there is a sudden surge of COVID-19 over winter.

Attended by nurses, doctors and a range of heath workers, these study groups are led by Dr Phillips, who says it is important to acknowledge and address the disconnect between what healthcare workers and the community experience during the pandemic. Post lockdown, many West Australians have started to relax, while hospital staff continue working in a state of heightened anticipation.

“We all expect them to be working harder, but it’s important we acknowledge their heavier emotional load as well,” she said.

To protect psychological health and prevent burnout while waiting out the pandemic, Dr Phillips said it was vital frontline staff received effective positive coping mechanisms.  She said it was a concern some hospital staff felt isolated, reporting they were keeping more to themselves and had cut back on socialising with friends who wrongly believed the pandemic was already over or wanted answers to their many questions about the virus.

"Research has shown that your sense of self-isolation, your ideas around sadness and depression all decrease if you can process the fact that other people go through these experiences as well."

The weekly UWA-provided, hour-long study sessions involved a “no expectations, no preparation” discussion of a relevant text and creative writing, offering busy hospital staff the chance to stop, process and engage through literature with the insights of those who had a similar experience. In WA, the recent study sessions had focused on texts that explore the theme of “waiting”, while in other parts of the world overcome by the COVID-19 storm, The Plague by Albert Camus had recently surged in popularity among frontliners. 

“These stories help give some shape to what we are living through and an understanding that we can come out the other end – that a new normal will appear,” said Dr Phillips.

“Research has shown that your sense of self-isolation, your ideas around sadness and depression all decrease if you can process the fact that other people go through these experiences as well.”

The study sessions are currently being run as a pilot at Sir Charles Gairdner Hospital, organised with the assistance of Dr Nick Martin, Emergency Consultant, and Stacey Fuller, Staff Development Educator, Wellbeing and Staff Support Activities and Programs. Dr Phillips said she hoped the program would soon expand to more hospitals following evaluation and feedback.

At UWA, Dr Phillips teaches a Narrative Medicine for Research, Education, and Practice unit aimed at using the stories of a community to “bring the human dimension into the biomedical model”.  It is part of the Humanities in Health and Medicine undergraduate course, the first of its kind in Australia to offer an interdisciplinary, humanistic and cultural study of health, illness, health care and the human body, mind and spirit.

“We need to consider the emotional responses of frontline healthcare workers here in WA, because there is quite a disconnect between what they are experiencing and what the community in general is hearing and experiencing,” Dr Phillips said. “I think that has been forgotten to a larger extent and I am really passionate that we bring that to the public forum.

“Healthcare workers are experiencing ongoing stress, tension, frustration and a lot of fear. At first, they went through that frantic, frenetic period of preparation and then they waited. One person described it as being on the beach when the tsunami wave has gone out.

“Describing her experience, a senior ICU nurse said ‘Initially we were so scared, we watched TV news and that frightened us. Staff were very scared, we all thought we would get sick and infect our families. Lots of staff cried, myself included, at home. Senior nursing staff were very brave and led by example and the fear lessened’.

“With restrictions recently eased, healthcare workers are now worried about what happens if there is a second wave. We are in a different position to overseas because in the Northern Hemisphere they are coming out of their flu season and we are just going into our flu season and nobody knows how those two situations are going to play out.”

Dr Phillips said adding to the stress of waiting, WA frontliners were also dealing with feelings of isolation and guilt that they had not done as much as colleagues in other countries.

“After a long shift, they are constantly being bombarded with questions about COVID-19, which they can’t answer most of the time because it is ‘the unknown’, and it is stopping them from socialising,” she said. “A few of them said, ‘I actually don’t like socialising at the moment because I can’t deal with all those questions and I don’t want to cut conversations off’.

“There is also quite a lot of guilt, which I found surprising. Guilt about having the extra time to safely prepare while watching things unfold in other parts of the globe. And there is a lot of guilt about what is happening to colleagues in other countries – a lot of our healthcare workers have come from overseas and they have close friends, colleagues and family working on the frontline in other situations which aren’t going well and they feel guilty about being in a safer place. 

“And one thing I feel quite sad about is that some also feel guilty that the community is calling them heroes because they feel they have not done enough yet to earn that badge. But it’s not just the actual caring for a person who might have COVID-19, it’s that heavy emotional workload on top of their normal working day that needs to be recognised. This is the reason why we are celebrating their work, why we are saying ‘You are doing a great job, you are fantastic, we are going to deliver you some free food or coffee’.”

Post pandemic, Dr Phillips believes the literature study groups could play an ongoing role in addressing healthcare worker burnout and she is currently in discussions with the WA Department of Health about a long-term program. She would also like to see sessions extended into other professions, including the legal profession.