In human history, pandemics have been known to alter the usual flow of life for all the affected people. Besides the health effects due to illnesses and deaths, pandemics have a significant psychological impact. Psychological impacts due to pandemics are more intense in health workers at the frontline in combating the outbreaks. In pandemics, health workers experience mass deaths, health complications, and internal and external pressure to identify the cause and the probable solutions to the health crisis. Often, health workers are overworked as hospitals and other health facilities are overwhelmed by many critically ill patients. Many health workers develop anxiety and depression that are sometimes exhibited through suicides, violence, and mental disorders. According to Young et al. (2020), male physicians have a 40% chance of suicide compared to female physicians’ 130% when working under extreme conditions. Eghigian (2020) noted that the Spanish flu pandemic led to a rise in nervous symptoms, neuropathy, neurasthenia, and meningitis among health workers in Great Britain during and after the pandemic.
The covid-19 pandemic has shown similar mental impacts on healthcare professionals as the Spanish flu and other global pandemics. According to Tsamakis et al. (2020), many healthcare professionals on the frontline to quell covid-19 develop feelings of vulnerability threat to life, somatic, and uncertainty. Statistically, more than 50% of healthcare professionals in Greek tertiary hospitals showed high anxiety and distress (Tsamakis et al., 2020). The anxiety caused by covid-19 has significantly affected the social work practice of many healthcare workers as they fear contracting the virus and probably transmit it to their families and friends. Healthcare workers are experiencing high stress levels are they deal with patients and families who are unwilling to maintain safety protocols, thus risking the health workers' health. Though many healthcare workers have shown high levels of commitment and dedication, the feeling of loss of family members, friends, and patients has lowered their morale and effectiveness in the fight against the pandemic.
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Anxiety level due to covid-19 has been higher among African American health workers since they have to cope with the stress due to the pandemic and discrimination. African American health workers have faced neglect, racial profiling, and low social-economic status due to the challenges with diversity in the United States' workforce. According to Sonoda et al. (2020), the pandemic has exposed the racial disparity between African Americans and Whites in the American healthcare workforce. This disparity can be referred to as medical racism. The disparity in pandemic management among Blacks and Whites has been evident in the United States since the yellow fever outbreak in Philadelphia in 1793. Blacks were overworked to help end the pandemic with the belief that they were more immune (Hogarth, 2019). From the yellow fever pandemic in Philadelphia, a larger percentage of the total deaths involved black healthcare workers, regardless of the total population of blacks being a small percentage (Espinosa, 2014). During the covid-19 pandemic, African American health workers have higher levels of anxiety considering their disadvantaged position in the society that exposes them to poverty, accusations of incompetence, and unequal chances to access privileges in the workplaces. Therefore, there is a need to develop effective psychotherapy strategies for Black American healthcare workers since they are more prone to anxiety due to covid-19.
Variables
Dependent variables: The level of anxiety among African American healthcare professionals combating the covid-19 pandemic.
Independent variables: The effectiveness of the therapeutic procedures to treat anxiety-related to covid-19.
Review of the Literature
The success of the efforts to mitigate the spread and severity of the coronavirus is based on the effectiveness of professionals in the health sector. As frontline workers in the pandemic, healthcare professionals are mandated to identify covid-19 symptoms and signs, isolate suspected patients, administer treatments, and monitor recovered patients to identify cases of readmission and probable side effects (Stuijfzand et al., 2020). Besides, healthcare workers are at the core of vaccination exercises to counter the health crisis. However, anxiety and the heightening feeling of loss and vulnerability among African American healthcare workers pose a risk in the response against covid-19. Health departments have initiated programs that enable health workers to work in shifts in efforts to lower the level of anxiety among doctors and nurses. However, shift programs are not sustainable for long since the covid-19 pandemic is worsening in its several waves, thus necessitating all the available healthcare workforce. According to Tsamakis et al. (2020), healthcare workers still show high levels of psychiatric morbidity and mental disorders.
The psychological health of professionals from the health sector and predominantly the minority such as African Americans requires organizational and governmental interventions. Mental health interventions ought to create a conducive working environment by addressing the stressors that lead to anxiety and depression among healthcare workers. Zaçe et al. (2021) recommend whole-system approaches that include organizational support and effective leadership in health facilities. Organizational support includes creating a working environment that ensures all employees work under minimal stress. Organizational support includes good leadership in the medical health institutions and employee engagement. Leaders in medical facilities identify the potential stressors and develop mitigation strategies to improve the workspace. In an environment with mixed races, leaders develop integration strategies and address cultural and racial differences that can intimidate some health care employees. Gibbs et al. (2020) supports the idea of organizational support and encourage leaders in medical facilities that include African American health workers to build trust and access to eliminate discrimination and exploitative practices. Gibbs et al. (2020) argue that effective leadership and organizational support can eliminate policies and systems that propel structural racism. Organizational support was an effective intervention in the influenza AHIN1 pandemic countermeasures that lead to the establishment of the Psychosocial Pandemic Committee (PPC) to address the mental health of medical practitioners (Zaçe et al., 2021). Organizational support has been effective in addressing racial disparities among workers in the healthcare sector during the covid-19 pandemic by creating unified response teams that optimize the workforce's efficiency.
Emotional and psychological interventions have also been effective therapeutic interventions to address anxiety and mental distress caused by pandemics and infectious diseases. Psycho-education and training provide knowledge to healthcare workers concerning mental health symptoms and available solutions (Zaçe et al., 2021). The training can either be computer-based training or in-attendance training. Besides, psycho-education and training educate health workers on avoiding or minimizing stress and anxiety during pandemics and outbreaks that lead to overwork and pressure (Stuijfzand et al., 2020). Health workers’ training and education were applied among Canadian health workers during SARS, where pamphlets with anxiety and stress symptoms were distributed to all nursing units (Zaçe et al., 2021). Building the resilience of the health workers, including the minority groups, effectively manages stressors and mental disorders.
Besides, group support is a psychological intervention that minimizes internal discrimination and improves peer support. According to Zaçe et al. (2021), group support includes psychological health support teams, support groups, and inner counseling. Mental support teams include counselors and social workers who provide guidance and counseling to healthcare workers during stressful working periods. Mental health teams were an effective intervention during SARS in Canada since they addressed the individual needs of the healthcare workers (Zaçe et al., 2021). Peer support involves internal support of the employees towards a subset that is experiencing stressors and anxiety. Benhamou and Piedra (2020) extend the group support idea and include interpersonal effectiveness where healthcare professionals assess each other and offer interpersonal support for all to manage through pandemics and outbreaks. Healthcare employees are encouraged to identify peers who show mental disorders and establish solutions. In cases of racial discrimination, peer groups can establish integration sessions that help all health workers to cope with the health demands.
Therapy and patient rehabilitation comprise Cognitive Behavioral Therapy (CBT) that makes it possible for the healthcare workers to identify the stressors that cause negative emotions and behavior. Zaçe et al. (2021) affirm that therapy and rehabilitation were effective during the Ebola pandemic in Sierra Leone, where healthcare workers experienced anxiety and depression. Also, therapy and rehabilitation are being used in Malaysia as a psychological intervention to foster acceptance of the situation and motivation in doctors and nurses (Zaçe et al., 2021). Italy implemented music therapy that involved breathing therapy to help alleviate anxiety, an energy therapy song list to reenergize the healthcare workers and improve concentration, and a serenity playlist to counter tension and facilitate peace of mind (Zaçe et al., 2021). In addition, therapy includes empathic listening that helps therapists listen to all healthcare employees' concerns without prejudgment and acknowledging that a pandemic can have psychological impacts on the healthcare workforce (Benhamou & Piedra, 2020). For minority groups within the healthcare workforce, empathy and validation address the fears and realities that cause anxiety and depression due to discrimination.
Self-monitoring is a strategy proposed by Benhamou and Piedra (2020) to enable healthcare workers to monitor their thoughts, emotions, and behaviors during pandemics. Self-monitoring aims at helping healthcare workers to identify and study behavioral triggers through cognitive patterns. For example, healthcare workers can identify mental patterns that make them angry, depressed, or anxious. However, Benhamou and Piedra concede that self-monitoring might be difficult for the already burnt-out healthcare workers during pandemics or disease outbreaks. Therefore, healthcare workers are advised to have a diary to keep track of their cognitions, behaviors, and positive events that caused relief and satisfaction. Benhamou and Piedra (2020) further suggest that healthcare workers should limit their intake of information about the health crisis if they identify it as a cause of stress and anxiety. However, limited access to critical information can have detrimental effects on the mental health of some workers. While some workers feel more protected when exposed to limitless information, some may experience desperation and uncertainty about the future. During the HIN1 pandemic, information about the spread of the infection and protection strategies was availed, after which many employees felt more protected and motivated (Benhamou & Piedra, 2020). Nevertheless, misleading information can worsen situations and discourage many healthcare workers.
While many interventions have focused on organizational stressors, few have addressed the social aspect of psychological treatment of anxiety due to covid-19. This research will investigate the effectiveness of emotional connection as a remedy to anxiety caused by discrimination and covid-19 on African American healthcare workers. According to Bender et al. (2020), relationship with others is beneficial for healthcare worker's mental health. Qualitative research done on nurses from an intensive care unit and quoted by Bender et al. (2020) found that resilient healthcare workers significantly relied on social networks to counter stress and anxiety. In this research, social networks will be limited to family members of the workers in the healthcare sector combating the pandemic. Based on ancient Chinese healthcare settings, social connections and emotional support are the most effective strategies to cope with demanding health situations (Bender et al., 2020). There exists a significant relationship between emotional connectivity and positive adaptation to adversity and challenging experiences.
The covid-19 pandemic has limited social interactions and thus heightened anxiety as healthcare workers worry about their families. Bender et al. (2020) note that quarantine conditions and lockdowns that limit interactions with family for healthcare workers are a major cause of anxiety and depression. Healthcare workers are forced to avoiding frequent interactions with their families due to the fear of infecting them with the covid-19 virus. Besides, the social connection between healthcare workers and their families has been affected by the long working hours and frequent shifts that make it difficult for many to interact (Bender et al., 2020). The social connection problem is worse among African American health workers since they are likely to be overworked and denied equal opportunities to interact with their families through technology such as social media and mobile calls. Moreover, African American healthcare workers are more likely to worry about their families since they are more prone to the covid-19 virus due to their lower living standards and limited access to quality health care.
Therefore, this research proposes emotional connection to family members as a strategy to minimize anxiety among healthcare workers and especially the African American health workers in the frontline of the coronavirus pandemic. Emotional connectivity with family members can be facilitated through enhanced communication strategies that will enable the healthcare workers to interact frequently though remotely with their family members. Health departments should provide technologies such as video communications to sustain the bond between the workers and their families. Also, healthcare providers should get reasonable breaks from duty and permits to have time with their families. However, the healthcare workers should be tested before being permitted to go to their families. Also, the government and the health departments should consider the immediate families of healthcare workers as essential aspects in policy formulation to counter covid-19. The families should be beneficiaries to state insurance policies since they are directly exposed to the risk of covid-19. With better access to healthcare, healthcare givers will be less anxious about their families and the risk of interacting with them. Therefore, this research formulates the hypothesis that there is a significant relationship between the level of emotional connectivity of African American health workers and their families and the level of anxiety due to the pandemic.
Method
Purpose
This research will study the effectiveness of emotional connectivity as a therapeutic procedure to treat anxiety in African American healthcare workers combating the coronavirus pandemic. Also, the research will investigate why it is important to have a therapeutic intervention for the minority, African American health workers, especially during a pandemic such as the covid-19 or the outbreak of a disease.
Paradigm
This research will take an interpretive approach since the experiences of African American healthcare workers can only be understood by subjecting their situations to race and social status. The study holds the idea that racism is the basis of the higher levels of anxiety among African American healthcare providers since blacks are likely to work in an unconducive environment and be exposed to more risks. Racism is a national concern in the United States and is present in the health sector.
Study Design
This research will be qualitative since it will address why and how emotional connection affects anxiety. According to Cleland (2017), qualitative research is essential in understanding human experiences that cannot be expressed in numbers. The research will be an interview study since it aims at getting individual experiences of workers in the health sector during the coronavirus pandemic.
Population and Sample
This study will engage African American health workers in the United States public health facilities, including doctors and nurses. After that, the study will employ a random sampling plan to acquire samples from the total population of African American health workers. A simple random technique will be used since the study intends to normalize the data used and minimize bias. Also, random sampling is faster thus more appropriate to provide solutions to the ongoing covid-19 pandemic. During data collection, the study will focus on age range, social class, gender, family's residence, location of the health facility where the healthcare worker is assigned, place of residence of the healthcare worker, frequency of family visits in a month, frequency of family engagement while at work, average working hours per day, and frequency of anxiety and depression.
Investigative Techniques
This research will use interviews and questionnaires as the primary data collection methods. Oral interviews will be used among healthcare workers within the vicinity of the study location, where questions will be delivered orally. At the same time, the answers will be written down corresponding to each question. In cases where the interviewee will be unavailable or unable to answer face-to-face, the interviews will be done through video conferencing platforms such as Zoom. Due to the movement restrictions and the need to minimize physical interactions due to covid-19, structured online questionnaires will be sent to all participants and collected after five days. The questionnaires will be in a document format to enable the participants to type their responses. Else, the participants will be required to print the document and scan it after filling using a pen. The majority of the questions involved will apply the closed-question format to facilitate more straightforward analysis.
The study intends to eliminate the gap in research about the intervention strategies to counter anxiety in healthcare workers during pandemics. The dependent variable will be the level of anxiety measured on a scale from 1 to 10. The independent variables will age on an interval scale, social class, gender, family residence, hospital location, individual’s residence, frequency of family visits, family engagements, average working hours per day, and frequency of anxiety and depression nominal scale.
Instrumentation
This study will not involve any standardized instrument.
Data Collection
Questionnaires will be distributed online across all the states in the United States to pre-engaged healthcare workers in major public hospitals. The data collection exercise will take two weeks, but the respondents using questionnaires will be sent an email to remind them to return the questionnaires within five days after receiving the document.
Data Analysis Plan
The study will collect descriptive statistics, which will be analyzed using the SPSS software at a confidence interval of 95%.
Ethical Consideration (Human Subjects’ Protections)
The research will be submitted to the Institutional Review Board (IRB) immediately after completion. The study will use formal language to minimize cultural and social conflicts in communication. The research will inform the subjects of all information to be gathered and the strategies to safeguard the information provided.
Bias
Work experience will be the most significant bias since some fundamental details may have been overlooked. This bias is likely to cause overgeneralization in some aspects of anxiety and healthcare workers’ experience.
Assumptions
This study assumed that all African American healthcare workers are likely to be exposed to similar experiences. Also, it assumed that all the responses provided are accurate and true.
Limitations
This study is limited to healthcare providers in public hospitals regardless of the pandemic affecting all sectors. Also, the study will not include personal aspects and behaviors that can trigger anxiety and depression. If I had three years and $1,000,000, I would extend the time of study and the sample size to improve the level of accuracy. Besides, I would include the private sector to get a holistic approach to mental health among healthcare providers countrywide.
References
Bender, A. E., Berg, K. A., Miller, E. K., Evans, K. E., & Holmes, M. R. (2021). “Making sure we are all okay”: healthcare workers’ strategies for emotional connectedness during the covid-19 pandemic. Clinical Social Work Journal . https://doi.org/10.1007/s10615-020-00781-w
Benhamou, K., & Piedra, A. (2020). CBT-informed interventions for essential workers during the covid-19 pandemic. Journal of Contemporary Psychotherapy , 50 (4), 275–283. https://doi.org/10.1007/s10879-020-09467-3
Cleland, J. A. (2017). The qualitative orientation in medical education research. Korean Journal of Medical Education , 29 (2), 61–71. https://doi.org/10.3946/kjme.2017.53
Eghigian, G. (2020, May 29). The Spanish flu pandemic and mental health: A historical perspective . Psychiatric Times. https://www.psychiatrictimes.com/view/spanish-flu-pandemic-and-mental-health-historical-perspective
Espinosa, M. (2014). The question of racial immunity to yellow fever in history and historiography. Social Science History, 38 (3-4), 437-453. http://www.jstor.org/stable/90017043
Gibbs, T., Pauselli, L., Vieux, D. U. O., Solan, M., & Rosenfield, P. (2020, October 11). Mental Health Disparities among Black Americans during the COVID-19 Pandemic . Psychiatric Times. https://www.psychiatrictimes.com/view/mental-health-disparities-among-black-americans-during-covid-19-pandemic
Hogarth R. A. (2019). The Myth of Innate Racial Differences Between White and Black People's Bodies: Lessons From the 1793 Yellow Fever Epidemic in Philadelphia, Pennsylvania. American Journal of Public Health , 109 (10), 1339–1341. https://doi.org/10.2105/AJPH.2019.305245
Sonoda, Y., Matsuzaki, Y., Tsubokura, M., Takebayashi, Y., Ozaki, A., Moriya, H., & Hiroaki, S. (2020). Ethnic-minority health care workers discrimination: An example from Japan during COVID-19 pandemic. Journal of Global Health , 10 (2), 020393. https://doi.org/10.7189/jogh.10.020393
Stuijfzand, S., Deforges, C., Sandoz, V. et al. Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: a rapid review. BMC Public Health 20, 1230 (2020). https://doi.org/10.1186/s12889-020-09322-z
Tsamakis, K., Rizos, E., Manolis, A., Chaidou, S., Kympouropoulos, S., Spartalis, E., Spandidos, D., Tsiptsios, D., & Triantafyllis, A. (2020). COVID-19 pandemic and its impact on mental health of healthcare professionals. Experimental and Therapeutic Medicine . Published. https://doi.org/10.3892/etm.2020.8646
Young, K. P., Kolcz, D. L., O’Sullivan, D. M., Ferrand, J., Fried, J., & Robinson, K. (2021). Health care workers’ mental health and quality of life during covid-19: Results from a mid-pandemic, National Survey. Psychiatric Services , 72 (2), 122–128. https://doi.org/10.1176/appi.ps.202000424
Zaçe, D., Hoxhaj, I., Orfino, A., Viteritti, A., Janiri, L., & Di Pietro, M. (2021). Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: A systematic review. Journal of Psychiatric Research , 136 , 319–333. https://doi.org/10.1016/j.jpsychires.2021.02.019
