Dec 06, 2014

Planning for the psychosocial aspects of Ebola virus disease

An excerpt from Health Workforce Resiliency: Planning for the Psychosocial Aspects of Ebola Virus Disease in Manitoba. Developed by the EVD Psychosocial Working Group, Manitoba Health, Healthy Living and Seniors. Oct. 30, 2014.


Increasing resilience at both an organizational level as well as an individual employee level is essential during any health emergency. Effective planning for health emergencies is dependent on the capacity of the health sector to identify and implement individual and systemic practices that will increase resilience. The more resilient an organization’s service providers are, the more effective system-wide EVD outbreak preparedness and response will be. Institutional and organizational issues significantly impact the level of stress and wellbeing of all staff, medical and non-medical personnel alike.

Wellbeing and quality of work can be enhanced when stress-inducing working conditions and organizational issues are addressed. Common organizational issues that contribute to significant stress during health crises include: unclear job description or role on a team; lack of access to up-to-date information about the situation; poor briefing and preparation; inadequate training for assigned tasks; lack of boundaries between work and rest time; inconsistent or inadequate supervision; lack of acknowledgement or appreciation for worker efforts; and, lack of focus on staff wellbeing.

Creating workforce resiliency during an EVD outbreak
There are three major psychosocial goals that are essential to effective EVD response. They include:

  • Maximize personal and social resilience
  • Increase understanding of and compliance with public health measures
  • Support worker resilience (e.g., first responders, health care providers, social care staff, volunteers)

Under the conditions posed by EVD, supporting worker resilience is an important but potentially daunting task for health authorities. An EVD outbreak, similar to previous pandemics, has the potential to cause extraordinary occupational stress for health care workers. EVD elicits a variety of reactions in those who may be at risk for exposure. Due to the severity of the disease, many people are fearful and the risk for stigmatization is high. Rumors and misconceptions can travel quickly throughout organizations or communities unless key information is widely and regularly shared in a variety of easily accessible ways, especially information related to how EVD is transmitted and how to prevent transmission.

Sources of stress for health sector workers during epidemics and pandemics may include, for example, increased risk of infection, exposure to a high number of distressed clients, increased workload demands, workforce shortages, shifts in roles and responsibilities, shifts in daily routines and practices, and potential to work in non-traditional sites or under exceptional circumstances. When such pressures continue over a period of time, they can reduce a person’s ability to perform assigned duties and may have long-term effects such as contributing to the development of a mental health problem.

Targeted health workforce objectives
The psychosocial impacts of EVD can be reduced through strategic planning, use of best practices, an appropriate use of human and organizational resources, and a work atmosphere which emphasizes dignity for all.

Below are key objectives and associated actions that can contribute to workforce resiliency in preparation for, and during, an EVD outbreak. The proposed actions must be undertaken and adapted depending upon the degree of exposure to EVD within the health sector and the characteristics of the epidemic.

OBJECTIVE 1: Strengthen organizational capacity to manage psychosocial aspects of an EVD outbreak and integrate psychosocial considerations into all EVD plans

  • Educate organizational leadership in psychosocial aspects and impacts of EVD.
  • Develop specific workforce resiliency plans to support all staff and essential service providers.
  • Establish an EVD worker care team to:
    1. identify general worker needs
    2. support staff in addressing immediate personal concerns that arise, and
    3. liaise with senior management about worker care concerns
  • Anticipate and plan for the negative impact of stigmatization and other social pressures on workers.
  • Coordinate psychosocial planning and response activities with other provincial departments, and regional and local partners; consider establishing an EVD Psychosocial Planning Group to work in partnership with these stakeholders.

OBJECTIVE 2: Develop a communication plan that proactively addresses the needs of all staff

  • Include key components such as: Who (target audiences), What (content), When (timing and frequency of communication) and How (multiple strategies) information is to be communicated.
  • Use a single point of contact to answer staff requests for information.
  • Initiate a process for timely follow up and response to staff-initiated questions, concerns, and suggestions.
  • Provide clear, honest, regular updates on outbreak status.
  • Develop and implement a strategy to quickly dispel contradictory messages or rumors.
  • Simplify complex messages such as those related to EVD transmission and protective measures.

OBJECTIVE 3: Senior Management to proactively create and promote a work environment in which self and mutual care is possible

  • Train supervisors in strategies for maintaining a supportive work environment.
  • Consider providing Psychological First Aid (PFA) training to staff: PFA is an evidence-based intervention to assist all individuals during and in the aftermath of an emergency. A specific PFA training for Ebola virus disease outbreaks provides particularly relevant material.
  • Engage staff in planning for psychosocial aspects of response; include consideration of any cultural, language or other special needs within the workforce, or issues that may impact staff capacity to report to work.
  • Provide repeated, clear, and accurate information about the potential emotional, behavioral and physical impacts of EVD, emphasizing the normalcy of staff reactions and providing tips for healthy coping.
  • Develop a process of training staff on the organizational EVD Response Plan.
  • Promote the EVD Worker Care Team and clearly identify its mandate and functions; plan for supplementing the Worker Care Team membership with external partners if needed (e.g., Red Cross, faith-based organizations, psychologists and counselors).
  • Prioritize stress management across the health system.
  • Provide rest and recuperation sites in workplace settings that provide space to get away from work stressors and that encourage positive coping strategies such as rest, healthy snacks, mindfulness, relaxation exercises, etc.
  • Consider a “buddy” system for staff members to encourage mutual help in coping.

OBJECTIVE 4: Be clear with workers about expectations and roles; support workers to balance work and life demands that impact capacity to work

  • Provide high standards of protection that provide both physical and psychological comfort.
  • Adopt work-related practices that positively impact stress management (e.g., post-shift debriefs and adequate rest periods).
  • Create awareness and processes to manage both major forms of work-related stress; namely, critical incident stress and cumulative stress.*

OBJECTIVE 5: Provide specific support services to workers and their families

  • Employ the EVD Worker Care Team to monitor employee health and well-being, and identify and respond to circumstances placing individual workers at increased risk of extreme stress or traumatic responses.
  • Develop and/or bring in needed psychosocial resources and practical supports and procedures to holistically meet staff needs (such as informational, psychological, emotional, physical and spiritual supports).
  • Provide employee education on how to develop their own family emergency communication plans.
  • Identify a process of communication between the organization and families of employees.
  • Develop and provide informational and psychosocial supports to families of workers as needed.

OBJECTIVE 6: Review, revise and adapt policies and practices in relation to worker health and safety as the situation evolves

  • Have a formal process for ongoing review and for making revisions and additions to worker care plans during an EVD outbreak.
  • Give particular attention to worker needs that are directly related to the outbreak in order to reduce long term negative impacts on workers and their families. For example, develop targeted psychosocial supports for special worker groups, such as those placed in quarantine.

*Critical incident stress results from an emotionally intense event that overwhelms individual coping skills. Cumulative stress is a result of a chronically stressful situation, often with multiple stressors.

For more information, contact Toni Morris-Oswald (Toni.Morris-Oswald@gov.mb.ca), Disaster Management Specialist, Office of Disaster Management, Manitoba Health.

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