ABSTRACT
Résumé Introduction: La crise de la COVID-19 a exacerbé la demande de dispositifs groupaux dédiés aux soignants et aux personnels hospitaliers et médicosociaux. Objectif: Cet article souhaite faire apparaître, par la synthèse de multiples retours d’expérience de dispositifs groupaux menés par des psychologues cliniciennes et chercheuses durant la pandémie de la COVID-19, les enjeux de l’ouverture de dispositifs groupaux, entre offre et demande, ainsi que leurs principaux apports et limites organisationnels et psychologiques. Méthode: Six chercheuses-cliniciennes se sont réunies pour échanger sur leurs expériences vécues lors de la mise en place de dispositifs groupaux. L’analyse des retours d’expérience s’est faite au moyen des concepts de la psychodynamique du travail et de la psychanalyse des groupes, permettant de faire ressortir les caractéristiques organisationnelles et psychologiques des dispositifs groupaux dédiés aux professionnels. Résultats: Nos résultats mettent en évidence que le dispositif groupal, en permettant le partage des éprouvés, aide la reconnaissance mutuelle entre professionnels, et donc de nouvelles identifications afin d’éviter la fragmentation des collectifs de travail. Le point le plus central semble être la capacité des dispositifs de groupe à traiter l’agressivité et la colère ressenties face à l’impuissance à agir dans des situations de crise. Les limites de ces groupes concernent leur difficulté à laisser s’exprimer des paroles individuelles plutôt que collectives, et le risque d’être le terrain d’une répétition du trauma pour les professionnels qui attaquent ou fuient parfois ces dispositifs, par peur de ce qu’ils pourraient faire ressurgir. Conclusion: Plusieurs points de vigilance et préconisations des expériences rapportées dans cet article sont explicités, afin d’éclairer et guider les futurs meneurs de dispositifs de groupe construits avec et pour les professionnels du champ sanitaire. Introduction: The COVID-19 crisis has exacerbated the demand for group arrangements dedicated to healthcare professionals and more widely hospital and medicosocial staff. Objective: This article attempts to shhed light on the issues at stake in the opening of group settings, between supply and demand, as well as their main organizational and psychological contributions and limitations, through the synthesis of multiple feedbacks from group arrangements carried out by clinical psychologists and researchers during the COVID-19 pandemic. Method: Six female researcher-clinicians met to discuss their experiences in setting up group care facilities. The analysis of the feedback used the concepts of work psychodynamics and group psychoanalysis, making it possible to bring out the organizational and psychological characteristics of group arrangements dedicated to professionals in the healthcare sector. Results: Our results show that the group arrangement, by allowing the sharing of experiences, helps the mutual recognition between professionals, and thus new identifications in order to avoid the fragmentation of work collectives. The most central point seems to be the capacity of group arrangements to deal with the aggressiveness and anger felt when facing the powerlessness to act in crisis situations. The limits of these groups concern their difficulty in allowing individual rather than collective words to be expressed, and the risk of being the site of a repetition of the trauma for the professionals who sometimes attack or flee from these mechanisms, for fear of what they might bring back to the surface. Conclusion: Several points of vigilance and recommendations from the experiences reported in this article are explained, in order to enlighten and guide future group facilitators when offering group arrangements built with and for professionals in the healthcare field.
ABSTRACT
OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has caused major sanitary crisis worldwide. Half of the world has been placed in quarantine. In France, this large-scale health crisis urgently triggered the restructuring and reorganization of health service delivery to support emergency services, medical intensive care units and continuing care units. Health professionals mobilized all their resources to provide emergency aid in a general climate of uncertainty. Concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising. The goal of the present article is to provide up-to-date information on potential mental health risks associated with exposure of health professionals to the COVID-19 pandemic. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature considering previous epidemics of 2003 (SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 pandemic. We highlighted most relevant data concerning the disease characteristics, the organizational factors and personal factors that may contribute to developing psychological distress and other mental health symptoms. RESULTS: The disease characteristics of the current COVID-19 pandemic provoked a generalized climate of wariness and uncertainty, particularly among health professionals, due to a range of causes such as the rapid spread of COVID-19, the severity of symptoms it can cause in a segment of infected individuals, the lack of knowledge of the disease, and deaths among health professionals. Stress may also be caused by organizational factors, such as depletion of personal protection equipment, concerns about not being able to provide competent care if deployed to new area, concerns about rapidly changing information, lack of access to up-to-date information and communication, lack of specific drugs, the shortage of ventilators and intensive care unit beds necessary to care for the surge of critically ill patients, and significant change in their daily social and family life. Further risk factors have been identified, including feelings of being inadequately supported, concerns about health of self, fear of taking home infection to family members or others, and not having rapid access to testing through occupational health if needed, being isolated, feelings of uncertainty and social stigmatization, overwhelming workload, or insecure attachment. Additionally, we discussed positive social and organizational factors that contribute to enhance resilience in the face of the pandemic. There is a consensus in all the relevant literature that health care professionals are at an increased risk of high levels of stress, anxiety, depression, burnout, addiction and post-traumatic stress disorder, which could have long-term psychological implications. CONCLUSIONS: In the long run, this tragic health crisis should significantly enhance our understanding of the mental health risk factors among the health care professionals facing the COVID-19 pandemic. Reporting information such as this is essential to plan future prevention strategies. Protecting health care professionals is indeed an important component of public health measures to address large-scale health crisis. Thus, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented, and to strengthen prevention and response strategies by training health care professionals on mental help and crisis management.
Subject(s)
Attitude of Health Personnel , Betacoronavirus , Coronavirus Infections , Health Personnel/psychology , Occupational Diseases/etiology , Pandemics , Pneumonia, Viral , Adaptation, Psychological , Anxiety/etiology , Behavior, Addictive/etiology , Burnout, Professional/etiology , COVID-19 , Delivery of Health Care , Depression/etiology , France/epidemiology , Health Workforce , Helplessness, Learned , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Influenza Pandemic, 1918-1919 , Occupational Diseases/psychology , Protective Devices/supply & distribution , Resilience, Psychological , Risk Factors , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/psychology , Social Support , Stress Disorders, Post-Traumatic , Suicide/psychology , Suicide/statistics & numerical data , Uncertainty , Work Schedule Tolerance/psychology , WorkloadABSTRACT
The COVID-19 pandemic has swept through our hospitals which have had to adapt as a matter of urgency. We are aware that a health crisis of this magnitude is likely to generate mental disorders particularly affecting exposed healthcare workers. Being so brutal and global, this one-of the kind pandemic has been impacting the staff in their professional sphere but also within their private circle. The COV IMPACT study is an early assessment survey conducted for 2 weeks in May 2020, of the perception by all hospital workers of the changes induced in their professional activity by the pandemic. The study was carried out by a survey sent to the hospital staff of Béziers and Montfermeil. The readjusted working conditions were source of increased physical fatigue for 62 % of the respondents. Moral exhaustion was reported by 36 %. It was related to the stress of contracting the infection (72 %) but above all of transmitting it to relatives (89 %) with a broad perception of a vital risk (41 %). This stress affected all socio-professional categories (CSP) and was independent of exposure to COVID. Change in organisation, lack of information and protective gear and equipment were major factors of insecurity at the start of the epidemic. Work on supportive measures is necessary. It should focus on the spread of information, particularly towards the youngest, as well as bringing more psychological support and a larger amount of medical equipment, beyond healthcare workers and the COVID sectors.