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Respiratory therapists balance front line jobs, mental health

Daily Item - 8/7/2022

Aug. 7—LEWISBURG — Respiratory therapists Kayla Nevil and Carthy Lepley remember sitting with severely sick or dying patients in the ICU and holding their hands as they fought off COVID-19.

As their jobs became the front line in 2020, these essential workers struggled to balance their duties and their own mental health. While much of the nation's workforce was told to stay home — and later, work from home — essential workers could not. They were taking care of sick patients, they were providing food for the hungry, they were teaching the country's students.

Nevil, employed at Evangelical Community Hospital in Lewisburg for seven years, and Lepley, employed there for four years, said they witnessed patient volume increase as the pandemic continued, those patients getting sicker and sicker.

"No one else has seen what we have seen and the way we have," said Lepley. "Nurses have seen it too, but their views are different. They have one, two, or three (COVID) patients. We had all the patients."

In health care, Lepley said they must learn to accept that death is part of the job.

"There's always death. It's just multiplied quite a bit," she said. "Before, we had to learn to accept that kind of stuff anyway. Now, it's like, 'OK, now we have to accept more.'"

The American Psychological Association (APA) reported in March 2021 that "essential workers, such as health care professionals and law enforcement officers, have had to deal with a special set of stressors that included isolating themselves from their loved ones and witnessing first-hand the effects of the coronavirus. Prolonged exposure to these stressors is taking a serious toll."

More than half of essential workers (54%) said they relied on a lot of unhealthy habits to get through the pandemic, according to the APA.

"Nearly three in 10 (29%) said their mental health has worsened," according to the APA's report. "When asked about emotional support, three in four essential workers (75%) said they could have used more than they received since the pandemic started. Essential workers were more than twice as likely as those who are not to have received treatment from a mental health professional (34% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic started (25% vs. 9%)."

The APA reported, "When it comes to physical impacts of stress, nearly three in four essential workers (74%) reported unwanted changes in weight since the pandemic started, with 50% saying they gained more weight than they wanted to. Of this group, the average amount of weight gained was 38 pounds (median of 20 pounds). Additionally, 80% of essential workers reported sleeping more or less than they wanted to and 39% said they have been drinking more alcohol to cope with stress during the pandemic.

Numbers increased

Respiratory therapists are certified medical professionals who study and treat the pulmonary system (lungs and breathing) in conjunction with the cardiac system (heart). One of the major features of COVID-19 is lung complications.

At the height of the pandemic, patients were not allowed visitors. Nevil and Lepley said the staff would help patients video chat with their loved ones.

"That was the worst part," said Nevil. "Seeing people having nobody there. We and the nurses would stay and hold their hands."

Lepley recalls staying in a room with a man who was severely impacted.

"It was tragic," she said. "Somebody had to be there for him. There was a lot of that."

When critical patients are in the hospital for COVID or other lung issues, they are given an arterial blood gas (ABG) test, which is a blood test that requires a sample from an artery in your body, to measure the levels of oxygen and carbon dioxide in a patient's blood.

"From July 2020 through June 2021, we did about 4,000 arterial blood gases," said Evangelical Community Hospital's Director of Respiratory Services Susan Telmanik-Schwartz. "From July 2021 through January 2022, we did 4,500. We did more in just that seven-month period than we did in the first year of COVID, because of how many patients were here in the hospital and how many were critically ill. The majority were unvaccinated."

Prior to 2020, those ABG tests were done about 50 percent less. One test does not equate to one patient, she said.

From November through January, Evangelical was renting pieces of equipment and contracting with outside therapists to care for the surge of COVID patients. Faced with staff shortages and the unknown, they watched patient conditions fluctuate rapidly.

"As a respiratory therapist, you're following the whole story," said Lepley. "We saw people get worse and worse and worse. It's a hard thing to cope with."

"Everyone likes seeing people get better. It's been rough," said Nevil "It's uphill, downhill, uphill, downhill. It's a roller coaster ride. People get better, then worse, and then maybe not make it. It's hard for any health care professional to not see your patient get better. You really want that. You feel like you can't really do anything to help. It just feels no matter what you did nothing was helping."

In the beginning, nobody knew what to do, said Nevil.

"I was going home terrified. My family was terrified," she said. "I lived with my mom. She would tell me to undress at the door, put clothes straight in the washer. I was scared because I didn't want to give it to my kids."

Lepley said she didn't return to New Jersey to see her family for 18 months. When she went home at Christmas 2021, her grandparents tested positive for COVID and she contracted it from them. She said she was stressed out about it despite everyone being vaccinated.

They said it helps to deal with the stress when a patient recovers.

"When a patient turned around, it brings lots of joy," said Nevil. "Especially after all the negative. It's 20 times better when you see someone recover."

"They get to see their family again, they get to see their kids again," said Lepley.

Resources for employees

Rachel V. Smith, vice president of people and culture at Evangelical, said a mental health advisory committee was formed in 2019 to put focus on mental health. That focus was especially important as the pandemic started and continued, she said.

"It was an emotional toll of watching that, and in some cases being the only human beings able to interact with the patient because at the time we had very strict patient visitation policies to keep everyone safe," said Smith. "Oftentimes, our caregivers were the ones in the room, holding hands, holding phones up to communicate with family members. I can only imagine the stress and emotional toll of that."

Employees were also asked to perform duties outside their routine duties due to shortages. While within their training, they were asked to work in acute care or help to manage the high number of people in the emergency rooms, she said.

Through the wellness programming, Smith said employees are challenged to exercise more, practice gratitude, write in journals, or practice mindfulness. They also introduced virtual art to share with their co-workers.

A program called EvanCares is also available as a resource for providing resources to employees following critical incidents. That has expanded to brainstorming ways to support mental health. Members of that committee during COVID check in on employees, Smith said.

Twice in the last two years, Smith said Evangelical offered Self Care Carts where employees could pick up stress balls, special soaps, candles, plants or other items meant to "soothe their souls and meant to enjoy."

An Employee Assistance Program is also available where employees can access online or telephonically resources, including counselors. Previously, it was three visits, now it's five visits without any kind of co-pay, Smith said.

Evangelical provided employees access to the Calm App that produces meditation products, including guided meditations and Sleep Stories. The hospital also recently rolled out a benefit where employees can access a care coach who can research child care or elder care and bring back options for that employee if they don't have time themselves to do it, Smith said.

Serenity Rooms were created during the height of the pandemic where employees can de-stress. There were comfortable chairs and calming music, as well as messages from the community hanging around the room to show the community supported the family without being there physically, Smith said.

Based on an employee survey, Smith said overall employees for the most part are "feeling the connection to their work and the ability to decompress, but there are likely pockets where we can do more. We'll be working on that."

"All these things are really important," said Smith. "It's important to provide varied resources because mental health is not one size fits all. Mental health is not always in the framework of counseling but in coaching. Sometimes we need a coach to remind us to take care of our mental health as well. It's reminding us to take a break to breathe."

Smith said there has been an increase in individuals using these resources and programs.

Strategies to de-stress

While the hospital offers resources for mental health, Lepley and Nevil said they haven't taken advantage of it yet. For some of it, like the Serenity rooms, they said they just didn't have time.

They said they have a good team of fellow respiratory therapists where they can talk to each other and lean on their co-workers for emotional support.

Nevil said she de-stresses with her family and "sweats it out" by exercising.

"I have two kids I get to go home to," she said. "My family is really supportive. Everyone always asks me how I'm doing."

Lepley said she usually calls her family after working. She also manages her mental health by hiking and reading books.

People are 'overworked'

Stephanie Stathas, a Licensed Professional Counselor with Thriveworks in Reading, specializes in coping skills, anxiety, depression, PTSD, and grief/loss. Stathas also specializes in Eye Movement Desensitisation and Reprocessing and spent the height of COVID working with nurses/health care professionals to cope with the trauma, burnout, anxiety and the feeling of helplessness brought on by the pandemic.

In addition to a lack of staffing, mental health services and funding for the services, Stathas said she is hearing about "a higher rate of burnout and quitting" the job. There are a lot of feelings of being under-appreciated, she said.

"They're overworked, they're stressed out, they're anxious, they're depressed," she said. "A lot of unresolved issues start to pop up when there's a lot of negative things in someone's life. They tend to focus on those negative things they haven't addressed in the past."

Stathas recommends self-care, finding a therapist, or having a healthy support system. Don't be afraid to reach out and talk to others about your feelings.

"If you want to get a project done, do a craft that makes you happy, that's good," she said. "Read a book, learn something new. It can be meditating, praying, mindfulness."

Stathas said a person is not selfish for putting themselves first.

"You have to be OK to show up for your partner, show up for the kids, show up for family members and do social things," she said. "It's important to remember to be in alignment with yourself. Get back to your passions. Find things that maybe you never thought you would like."

It's important to realize that everyone is living life together, she said.

"No matter what side you're on, no matter whatever's going on in this world, there's fear, there's stress, there's depression, there's trauma," said Stathas. "We all experience that to different degrees. It goes back to understanding and respecting each other instead of being angry all the time. We can channel that anger into something positive."

Every person has the power to do that, she said.

"They have to want it for them," she said.

'Burn out'

Nea Brown, the business manager for Heritage Springs Memory Care in Lewisburg and Montoursville, said employees have seen a high level of fatigue and burnout.

"Our facilities provide memory care and memory care only in a homelike setting where staff are 'family' to our residents," said Brown. "Dealing with staffing shortages during COVID and the times that family visitation was not possible was really troubling for our staff, residents and families leading to much frustration. We also rely on outside groups, clergy, et cetera, to provide additional support and services and this too was curtailed during this time."

Heritage Springs Memory Care's Board of Directors are "very supportive of staff need for some quiet time and time away to regroup or in many cases recover from the stress of COVID and the many challenges it presented," Brown added. "We have and continue to work on ways to uplift our team."

Brown said she has worked through the entire pandemic and strongly believes that everyone is in it together.

"The best medicine is caring, support and flexibility," said Brown. "It hasn't been an easy time for anyone in health care or education but together, as a team, we'll get through it."


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