Exhaustion. Stress. Burnout. Terms, we, as health care professionals are familiar with due to the intense relational service we provide to residents, and their support system on the continuum of care. We build deep relationships with residents and partner with them through seasons of wellness or illness. We have attended general stress management trainings over time however nothing prepared us for the COVID-19 Pandemic. An abrupt, intense, and protracted/prolonged state of emergency.

Everyday Activity Professionals, front line essential workers, witnessed ever changing state and federal regulations. Senior care organizations often struggled to make sense of these demands and securing protective equipment became a threat for daily survival. Staffing shortages, extra workload demands, often outside the realm of Activity Services challenged even the most seasoned professional. Infection concerns of self, accidental transmissions in the workplace or the potential for taking COVID home to our families loomed over us like a persistent dark cloud. Personal values and standards were poked and pushed to the limit creating ethical dilemmas. Witnessing heart ache, isolation, decomposition and sometimes loss. Being the go between, setting up family face time visits. Seeing, hearing, feeling the strong emotions and vicariously absorbing them impacted Activity Professionals profoundly.

‘Moral Injury: Pandemic’s Fallout for Health Care Workers’ an article by Kathleen Doheny interviewed

Wendy Dean, MD a psychiatrist, president, and co-founder of Moral Injury of Healthcare, a nonprofit devoted to reframing clinician distress as moral injury — and to work to improve the source of it, which she and others say is the health care system itself.

“We came onto the pandemic already with distress, and the pandemic hit on top — an acute layer of distress,” Dean says.

The article shared from June to September 2020, Mental Health America polled more than 1,100 health care workers about COVID-19, finding that 93% reported stress, 86% anxiety, 77% frustration, 76% exhaustion and burnout, and 75% said they were overwhelmed.

What’s the difference between moral Injury and burnout? Moral injury is a precursor to burnout. Dean says, “moral injury occurs when health care providers are “repeatedly expected, while providing care, to make choices that transgress their long-standing, deeply held commitment to healing,” Dean continues that “moral injury happens because they’re frustrated and can’t provide the care they trained for and promised to give.” Burnout reflects the “problem” of an individual. Moral injury recognizes the healthcare system as the problem. Not that senior care industry leaders wanted to intentionally inflict “injury” rather the residual effects of challenging ethical issues wear a person down, in total. A personal collective exhaustion.

Disrupted, disconnected, and dysregulated. The prefix “dis” added to a word implies “lack of”. While “dys” implies “difficult” Collectively personal and professional routines were disrupted. Barriers of all kinds made personal connections jagged, something we need deeply as humans. High physical, emotional stress made it difficult to self-care and regulate ourselves to balanced baselines. While this long list of negative experiences challenged us the big burning question is, how will we emerge? Grounded in the NAAP pillar of Advocacy for Activity Professionals this first article is part a of 4 article series striving to openly acknowledge the moral injury and loss experienced. The second article will share results from the NAAP membership survey in hopes of recognizing the collective suffering while reminding ourselves we do not suffer alone and can empower one another. The third article will share potential solutions to support the demanding clinical work Activity Professionals provide and lastly, we will celebrate our successes and post pandemic growth as individuals and as a profession.

NAAP Mental Health Survey

Four Part Series

Part #1

Disrupted: Mental Health Impact of COVID-19 on Activity Professionals in Senior Living

Part #2

From the Frontlines of the Activity Profession: NAAP Membership Survey Result Reflections

Part #3

Potential Solutions: Supporting the Clinical Demands of Activity Professionals

Part #4

Activity Services During the Pandemic: How One Discipline Emerged, Adapted and Cultivated Hope for Senior Communities