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Strategies to Deal with Stress for Frontline Health Care Workers During the Pandemic

In April 2020, Women as One recorded a video “The Impact of Trauma” to explore the underpinnings of traumatic stress, common reactions to trauma and how trauma uniquely impacts women and to review related support tools. In this exchange, Dr. Patricia Watson, PhD Senior Educational Specialist for the National Center for PTSD and Assistant Professor at Geisel School of Medicine Dartmouth discusses advice for frontline health care workers related to the COVID-19 pandemic and decreasing stress. Click below to watch the exchange.

There is a really a wonderful writer that I’ve liked named Dave Snowden who talks about Complexity Theory. And…the Cynefin Framework. He acknowledges that under normal circumstances… when we are all doing our jobs, there’s a certain way to do it that usually is based on best practices. Times are predictable. Relationships amongst things are more controllable. When you introduce a public health crisis into any system – a home system, or a work system – the way of doing things has to adjust as well. And part of what really needs to adjust is immediately you have to establish…more control and order. Which means you have to be very specific about things you know being done a certain way. But, time goes by and I think we are all seeing this – there is a need to have better communication, more frequent communication. So that people are checking in with each other and saying – what’s working now, what’s not working now? We really have to be talking about this amongst everyone trying to figure out… strategies. We have to try things out and not be afraid if they fail. You know, try out different ways of doing things…and continue to get feedback from each other so we can move forward.

A lot of times it involves bringing experts in, but sometimes we’re doing things on the fly. The dance is different. The steps are different. And if people don’t make adjustments, then it can be a problem.

One of the adjustments, socially and emotionally, is the mantra that I’ve heard people use is – “none of us are at our best right now.” None of us are at our best right now! So that means we have to be patient. We have to be kind with each other more than normal. We have to make allowances that nobody is going to be doing their top game right now. We are all juggling… a lot right now.

So within the Cynefin Framework is that it’s very important to think theoretically about frameworks that might be helpful for people now. Because those frameworks allow for flexibility. If you try to just impose, “well, everybody should be doing this. Everybody should be doing that.” It’s not going to fit for everybody.

The framework that we’ve used a lot… that we’ve discovered as we were looking at situations of on-going threat. We had an expert panel. We talked about “what do we think works for people?” We looked at the research, and we came up with these five elements that seem to be related to better recovery in situations of on-going adversity. So we have developed a lot of our materials around these elements because we know that people can take that framework and be very flexible in the way they apply it – at home, at work… depending what’s happening.

The five elements are – to move toward a better sense of safety. To find ways to calm people or system. To get social connections. To help people feel they can get through a situation with what’s termed self-efficacy. That they feel like they either have the resources, or the ability to make their way through it. And, lastly, hope is the last element. Hope can be optimism. Hope can be a person feeling like they have the resources they need. Hope can be faith, or religion, or some sort of values framework that a person uses.

And we found that if you have safety, calming, social connectedness, self-efficacy, and hope that people tend to do better…no matter what system or situation they are in.

They don’t have to have all five. They can have one or a few of them and it tends to… vary depending on the person’s situation, their personality, and what’s going on with them. So, I like the flexibility of the framework.

What we’ve found is that, for instance, social support has to be modified. Some of us are introverts, so we don’t want to say “everyone needs a lot of social support.” Because that’s not going to appeal to everyone. But, what it means is that if social support is right for you, then you have to find the way that makes the most sense. For some people it’s pets. For some people it’s just that one person. But, I have found that in ongoing situations like this, you have to figure out whether your existing social skills are going to work for you because many of us, especially women are the go to people in their life. So others come to them and they now have a set of social skills that they haven’t had to use often that they now have to figure – “how do I talk to those people in my life I’m closest with and say, ‘you know what, I don’t usually ask for help but I’m going to may need help now in a typical way than I normal do.” Maybe you work out the framework that is, “I just need to vent to you five minutes of the day. I don’t want you to fix it. But, I just need that five minutes.” … You have to figure out what’s going to make the most sense for you. Maybe you also figure out that you are a person that it isn’t through social support. For you it’s through something physical through something like stretching, or yoga, or sitting in your massage chair. You know, for you it might be more being emotional where you have to listen to a song that allows you to have emotions. Or you have to watch a movie… each person is going to be different.

And, so, the idea is to try to setup a menu for yourself. “What’s going to work for me on particular days when the stress is super high, and then maybe on other days I’ll do different things.” And then just start to set those plans for yourself, and then maybe work with the people who are in your life to say, “looks all of us are going through a difficult time. How can I help you? Let’s figure out ways that I can do that for you.” And just set those in place, and allow those to change as time goes by.

But, I think authenticity is particularly important right now where I’ve seen it in my own life. My husband was trying to protect me from his stress that he was just acting weird and I didn’t know why and so I was getting irritated with him when I finally said to him, “just tell me what’s going on.” And then together we were able to figure it out, and that worked out better. So we all have to acknowledge that we can’t always protect each other, we just do the best we can and figure out things that are going to work for us.


The COVID Coach app was created by the U.S. Department of Veteran Affairs to support self-care and overall mental health during the coronavirus (COVID-19) pandemic.  Click here to download.