Christmas during a pandemic

Written by Ms Hema Navaratnam, ACHH Research Fellow

Christmas is a time of celebration with family and friends, happy times with all its glitter, festivities and cheer. However, for some of us it can be stressful or lonely, or a reminder of unpleasant memories. In recent times, we have had to factor a pandemic into these celebrations, a first for many of us.

Whilst the easing of restrictions has allowed some of us to see family and friends in most states and territories of Australia, others may still be waiting to see loved ones’ both interstate and overseas. Given that we have all been living in somewhat isolated conditions and working under extreme pressures, a lot of us have had to learn to adjust and adapt to these times, creating routine and other ways of staying connected to each other. For healthcare workers, the battle is real and ongoing.

However, now that we can socialise again and even gradually return to some work settings there can be some anxiety around our perceived ‘new normal’. We have had to make lots of adjustments in very short periods of time in a constantly changing climate and, although these current changes are good, it is yet another kind of adjustment. A gradual approach and at a pace that you feel comfortable with can be a helpful way of easing yourself back to society.

The Australian Psychological Society has some good resources around ways to manage during the pandemic. Please click on the link for more information.

These are trying times for all of us. Therefore, ensuring good support networks and seeking help when needed is vital. Additionally, as we encourage our patients and clients to practice self-compassion, it is just as important that we engage in self-compassion ourselves as we move forwards together as a state, as a nation and globally.

THANK YOU TO ALL OUR HEALTHCARE WORKERS AND MERRY CHRISTMAS AND HAPPY NEW YEAR!

Training Update

In November this year we held our annual “Cardiac Disease, Rehabilitation and Secondary Prevention” training program. For the first time, the 4-day program was delivered exclusively online, with the support of JT Production Management, a company specialising in event management services. Presentations were delivered by a range of experts in the disciplines of cardiology, cardiothoracic surgery, exercise physiology, physiotherapy, pharmacy, cardiac nursing, dietetics, and health psychology.

We had a total of 68 participants attending the training, the largest ever cohort of trainees in the program. We had participants from all over Australia and one from New Zealand with the majority from the state of Victoria. Participants included nurses, physiotherapists, exercise physiologists, a group from the Royal Flying Doctors Services, an OT and others.

We were pleased to hear that participants enjoyed the online format, with feedback such as “the webinar platform has been absolutely wonderful. It was easy to use, I had no technical issues, and it made it easy to interact with others during the course”.

Many opportunities for interaction between participants were threaded throughout the 4-day program, and participants gained a great deal from the opportunity to engage with like-minded colleagues working in various CR settings, with feedback such as: “I enjoyed the breakout room, nice to hear from others and realize we all have similar struggles delivering programs. I liked that there was plenty of opportunity for interaction.” and “Well run overall and impressed by the quality of education. Like that we get to interact and network.”.

Given the success of the training, we look forward to providing future training programs using the online format.

The mental health burden of COVID-19 on cardiac healthcare workers and their patients: Summary of a recently published paper.

Early in the COVID-19 pandemic, the Centre’s researchers wrote an article titled ‘The mental health burden of COVID-19 on cardiac healthcare workers and their patients’, which was published in the British Journal of Cardiac Nursing. The article addressed the physical and psychological impact of the pandemic on healthcare workers and cardiac patients.

The article highlights that, early in the pandemic, 15% of all COVID-19 infections were from healthcare workers. As such, anxiety levels amongst healthcare workers were high and mainly related to the risk of exposure to COVID–19. Indeed, evidence shows that the pandemic has drastically impacted the mental health of healthcare workers globally, with studies highlighting high rates of anxiety, stress, depression and sleep disorders among the workforces.

The impacts are magnified for workers in direct contact with affected patients, with those working on the frontline having higher levels of both acute and post-traumatic stress symptoms than those not in direct contact. The distress and trauma related to caring for the severely ill and dying patients, as well as fears of risk to self and family members, have led to these mental health consequences. The article notes that in one study, having a colleague who had died of COVID-19 was linked to double the risk of depression and more than double the risk of post-traumatic stress symptoms. Additionally, having a colleague hospitalized or quarantined with the illness both presented a 50% increased risk of post-traumatic stress while those exposed to the virus themselves had a 50% increased risk of depression. Data from previous epidemics, such as SARS, MERS and Ebola viral outbreaks and influenza A virus subtype H1N1, have highlighted that post-traumatic stress symptoms can persist for between 1 and 3 years in up to 40% of workers.

A survey of those working in a care home showed most respondents (80%) reported negative experiences such as not being appreciated, unsatisfactory conditions of employment, a general lack of support, feeling pressured to take residents from other hospitals with unknown status of symptoms and lack of clear direction. Sadly, over half (56%) of workers felt poorly in terms of their general well-being.

The article goes on to highlight the risk of professional burnout being extremely high for those working on the frontline of the current pandemic. There can be a variety of physical symptoms including extreme fatigue and exhaustion, sleep disturbances, headaches, gastrointestinal problems, and increased vulnerability to illness. Emotional and cognitive symptoms can include anxiety, depression, anger, irritability, difficulties concentrating, forgetfulness and reduced decision-making ability.

Loneliness and social isolation have been on a steady rise to the point of being classed as an epidemic. Now with the COVID-19 pandemic, social isolation and loneliness have taken on a completely new significance. Alarmingly, the general health risk linked with social isolation is comparable to that of smoking.

As cardiac patients have an increased mortality risk if they develop COVID symptoms, they have been subject to extra tough restrictions, which only further exacerbates their isolation, fear of the virus, guilt about infecting family members, and reduced quality of life. Unfortunately, social distancing requirements have also seen changes to most face-to-face cardiac rehabilitation programs.

It is essential that services and individuals implement coping strategies to support self-care, ways to manage during and post pandemic. Some key strategies include:

  • being able to mentally step away from thoughts of work at the end of the workday

  • talking to friends and family about positive emotions

  • recognizing and naming emotional experiences

  • engaging in good sleep practices

  • exercising regularly

If you would like to read the full article, please refer to the following: Murphy BM, Higgins RO, Jackson AJ. The mental health burden of COVID-19 on cardiac healthcare workers and their patients. British Journal of Cardiac Nursing 2020 15:10, 1-8. You can access the article here: https://www.magonlinelibrary.com/doi/abs/10.12968/bjca.2020.0129

Cardiac Counselling Clinic

You may be aware that we run a cardiac counselling clinic as part of the Australian Centre for Heart Health. The clinic is a relatively new venture that began in early 2020 and provides specialist psychological and behavioural support to people who have had an acute cardiac event, and to their families too. To access the service, a current mental health care plan from your GP is required. Sessions are bulk billed and therefore cost-free and at this stage continue to be provided via telehealth, making the service available across the whole of Australia.  

We have a great team and have recently welcomed two new staff members to the Centre’s clinic, Dr Mirella Di Benedetto (Senior Health Psychologist) and Mr Justin Kelly (Clinical Psychology Registrar).

If you would like to know more about this service or to refer a patient, please visit our website at https://www.australianhearthealth.org.au/cardiac-counselling-clinic

The Heart of Mindfulness

Written by Ms Hema Navaratnam, ACHH Research Fellow

At times we can be at the mercy of our thoughts with tendencies to worry or dwell about our loved ones or of the various events going on in our lives and, in recent times, the pandemic has likely been in the forefront of our minds. Mindfulness has been around for thousands of years having originated from Eastern religions and traditions. It is a skill that teaches us to pay attention to our present moment with a sense of curiosity, openness and without judgement. Whilst it can be challenging at first to put into practice, once implemented it can become a lifelong asset.

Over the years there has been a growing presence of this ancient practice, with research showing significant benefits to our psychological well-being. It’s been known to be a useful tool in helping to manage psychological distress, improve physical health and function and increase our emotional resilience. It is a mind-body practice that is now widely recognised in the health industry, schools and workplaces. Additionally, there is evidence to suggest that mindfulness-based programs have a good influence on our hearts too (Younge et al. 2015). For example, Nardi and colleagues identified that emotional regulation, attention control and self-awareness were means by which mindfulness encouraged better cardiovascular health (Nardi et al. 2020).

A well recognised site referred to as smilingmind.com.au provides a wealth of information and mindfulness programs designed for your needs. It can also be downloaded as an app onto your smart phone or tablet. This can be a useful tool to add to your patients’ self-management tool kit and to your own self-care repertoire.

References

Nardi WR, Harrison A, Saadeh FB, Webb J, Wentz AE, et al. (2020) Mindfulness and cardiovascular health: Qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study. PLOS ONE 15(9): e0239533. https://doi.org/10.1371/journal.pone.0239533

Younge JO, Wery MF, Gotink RA, Utens EMWJ, Michels M, et al. (2015) Web-Based Mindfulness Intervention in Heart Disease: A Randomized Controlled Trial. PLOS ONE 10(12): e0143843. https://doi.org/10.1371/journal.pone.0143843

Smiling Mind website – smilingmind.com.au