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Psychosocial Support for Healthcare Workers in Vietnam During the COVID-19 Pandemic

By Nathan C. Gehlert, Ph.D., Quynh Xuan Nguyen Truong, MPH

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Gehlert N,  Nguyen Truong Q X. Psychosocial support for healthcare workers in Vietnam during the COVID-19 Pandemic . HPHR. 2021;53.10.54111/0001/AAA6

Psychosocial Support for Healthcare Workers in Vietnam During the COVID-19 Pandemic

Abstract

Background

As a national health care system becomes overwhelmed, healthcare workers (HCWs) are challenged in unique ways. Healthcare workers have been found to experience heightened levels of anxiety, depression, stress, burnout, and suicidality, along with decreased attention to self-care. The present study reviews a health education and capacity-building workshop in Vietnam, which focused on teaching HCWs how to develop positive coping and self-care strategies.

Methods

The three-hour workshop was presented to 856 HCWs in August, 2021, and had learning objectives related emotional intelligence, burnout, compassion fatigue, PTSD, and practical tips for self-care. Participants were surveyed eight weeks after the workshop to measure their implementation of self-care practices. Participants provided numerous comments about the helpfulness of the self-care skills they learned.

Results

Eighty-six percent of participants either agreed or strongly agreed with the statement, I have applied what I learned about self-care to my self-care routine.

Discussion

Participants in the sample clearly reported that they were implementing self-care strategies; their comments strongly support that this practice was not only functional, but also meaningful. The workshop presentations specifically targeted the areas of building social support, developing positive coping styles and self-care, improving lifestyle habits, and focusing on service to community and meaning-making. The fact that the vast majority of participants reported using these skills in their work and professional lives is an important outcome.

Conclusion

The available evidence demonstrates that participants in the workshop have implemented new strategies in their self-care practices. International collaborators in other countries are encouraged to partner with in-country teams to market and organize similar programs, and to be prepared to address the ongoing needs of the communities they support.

Introduction

Until the rise of the Delta variant, Vietnam was one of the few countries to successfully contain the spread of the COVID-19 pandemic. On July 6, 2021, Vietnam still reported fewer than 100 total coronavirus deaths.1 How did a low/middle-income country achieve such success?

 

First, for geopolitical reasons, the Vietnamese people and government are wary of the Chinese state. This apprehension is due to the history of severe acute respiratory syndrome (SARS-CoV-1) in 2003, the long border with China, and the rising political tension over the South China Sea.2 Second, and perhaps more importantly, Vietnam has a history of longstanding engagement with social security (i.e. public health) at the national, regional, and local levels.3 The centralized system consists of 63 provincial health departments, approximately 600 district departments, and more than 11,000 community health stations.3 When COVID-19 was first detected in Vietnam on January, 23, 2020, the government took immediate steps focused on closing international borders, isolating and quarantining infected and potentially infected patients, contract tracing, and providing care for the hospitalized.4

 

Despite the success of this response, the COVID-19 Delta variant effectively overwhelmed the social health care system in Vietnam. Just two months after surpassing 100 deaths, Vietnam reported over 14,000 deaths on September 8, 2021 and at the time of writing in November, 2021, deaths have surpassed 24,000. While the country’s prevention and control mechanisms were robust, the highly contagious Delta variant quickly led to increased rates of hospitalizations, primarily in district hospitals and community health stations, which are equipped to provide only basic medical care.4 Additionally, each of the provincial and national hospitals has fewer than 100 beds and there are limited infectious disease physicians in a country of 97 million people.4

 

As a national health care system becomes overwhelmed, healthcare workers (HCWs) are challenged in unique ways. While research data on the impacts of the pandemic on HCWs was not available in Vietnam, current evidence from other countries illustrates the acute psychosocial needs of healthcare workers, especially in periods of crisis. During the COVID-19 pandemic and past pandemics, healthcare workers have been found to experience heightened levels of anxiety, depression, stress, burnout, and suicidality, along with decreased attention to self-care. 4,5,6,7,8,9 HCWs in many countries face severe workforce and resource shortages, leading to increased stress. HCWs also can experience an increase in moral dilemmas as resources and care are rationed, which can result in moral injury when HCWs’ morals and ethics are challenged.10 Furthermore, working on the front lines of care brings increased personal risk. During the 2009 novel influenza (H1N1) pandemic and past outbreaks of SARS, HCWs were found to have higher risks of infection than the general population.

11

 

The impact of the COVID-19 pandemic on the psychosocial wellbeing of healthcare workers has been studied significantly in China, though also in Italy, the U.S., and Saudi Arabia. 12 Common researched mental health outcomes in HCWs include anxiety, depression, stress, insomnia, and psychological well-being. Psychological distress has been found to be higher among HCWs than other professions during the current pandemic.13,14 In studies in China, Italy, and Saudi Arabia, rates of mild to moderate anxiety ranged from 23.7% to 63.8%.15,16,17,18,19,20 In those same countries and studies, rates of depression among HCWs varied from 12.2% to 55.2%. In Croatia, China, and Italy, and Saudi Arabia, rates of mild to severe stress ranged from 39.4% to 55.1%.15,17, 21,22,23,24 In studies on insomnia, rates were found to range between 14.3% and 38.4%.20,25

 

 

The effectiveness of various coping strategies for HCWs has also been studied during the COVID-19 pandemic. Strong social support has been found to have positive impacts for HCWs in studies conducted in China, Croatia, and Italy.21,22,21,26,27,28 Specifically, symptoms such as stress and anxiety were found to be negatively associated with social support and active coping. During a pandemic, HCWs often struggle with lack of self-efficacy because they lose a sense of control over their professional and personal lives. In studies in China, positive action through learning and implementing positive coping mechanisms were found to have a negative association with anxiety, depression, and post-traumatic stress syndrome.15,25,28

 

The authors of these studies make clear recommendations about supporting the psychosocial health of HCWs during the pandemic. First, tending to the social support of HCWs is fundamental.21,22,26,27,28 Second, it is important to train HCWs on developing positive coping styles and workplaces should provide psychological support.15,25, 28 Third, HCWs should develop healthy lifestyle habits in the areas of nutrition, exercise, and sleep hygiene.29 Finally, service to community, meaning-making, and religious coping can benefit HCWs.30

 

In the present study, we discuss a health education and capacity-building workshop in Vietnam. The aim of the workshop was to address the aforementioned recommendations and provide support for the psychosocial health of HCWs in Vietnam. Specifically, we focused on teaching HCWs how to develop positive coping and self-care strategies. The need for psychosocial support for HCWs is particularly important in Vietnam because psychology and social work are new fields in Vietnam, access to mental health services are limited, and stigma about mental illness is prevalent.31,32

Methods

In August, 2021, by analyzing available infection and death data and communicating with leaders at major hospitals in urban centers, we predicted that hospitalization rates would exceed capacity across Vietnam by mid-September. This event would not only be a significant stressor on the Vietnamese healthcare system, but also on the HCWs in the system.

 

We developed a three-hour online workshop entitled Psychosocial Support for Healthcare Professionals and partnered with the Vietnam National Palliative Health Care Association and Hanoi National University of Education, Faculty of Social Work, who promoted the workshop and organized the registration and presentation logistics.

 

The workshop was presented on August 31 as part of a one-week workshop series to coincide with the period when hospitals would begin exceeding capacity in Vietnam. The workshop was advertised on social media, through local and national professional organizations, and with social work and psychology faculty at other universities. The workshop was free to attend and presented via Zoom, and livestreamed on Facebook, from 7:30am – 10:30am Indochina Time. It was presented by a native English speaker with a native Vietnamese interpreter.

 

The curriculum of the workshop focused on the following learning objectives and themes.

 

  • Identifying the benefits of self-care. HCWs tend to prioritize the needs of others over themselves and how this can jeopardize the ability of HCWs to provide quality care. To do one’s best, it is important to create time for self-care.
  • Describing emotional intelligence and its impact on well-being. Emotional intelligence helps HCWs understand and manage their emotions, while separating them from the emotions and needs of their patients. Emotional intelligence is compromised of self-awareness, self-management, social awareness, and social management. Building emotional intelligence benefits both the HCW and the patient.
  • Distinguishing signs of poor psychological, emotional, physical, and spiritual well-being. Signs and symptoms of burnout, compassion fatigue, and PTSD were shared with participants.
  • Discussing practical tips for self-care: Protect yourself and loved ones; acknowledge that you need to cope; be mindful of how you compensate for your lack of control; stay in the present moment; take care of your body; in moments of acute distress, distract yourself; stay connected with others and reach out for support.

Results

Attendance at the workshop on Zoom was 856 participants. Additionally, 80 viewers watched the presentation on Facebook. Eight weeks after the workshop, a brief anonymous survey (no identifying information was collected) was sent to all registered workshop participants soliciting their feedback about the impact of the workshop on their professional work and positive coping and self-care habits. The sample of respondents included 125 participants, out of which 39 participants identified as non-HCWs (e.g. students, teachers, business workers). Because they were not representative of the target audience, these 39 individuals were excluded from further analysis.

 

The final sample of 84 participants consisted of psychologists (n = 38), social workers (n = 21), medical doctors (n = 10), other medical staff (n = 6), monks (a role akin to chaplain in the U.S.; n = 6), and nurses (n = 4). On the survey, participants were asked to respond to a Likert-type item related to the application of the learning objectives from the workshop. The response choices on both items ranged from Strongly Disagree (1) to Strongly Agree (5) on a five-point scale. As can be seen in Table 1, 86% of participants either agreed or strongly agreed with the statement, I have applied what I learned about self-care to my self-care routine.

 

Finally, participants were invited to provide open-ended feedback. Nearly every participant provided a comment and a selection of representative comments are provided here.

  • The lecture content has many good methods of effective practice: prioritizing your own care and maintaining a good daily life schedule.
  • The contents of the training session were extremely timely and valuable. I have applied a lot of knowledge and experience. I liked how each content area was accompanied by extremely practical interpretations and examples.
  • This is a very good and meaningful training course – it’s really necessary for what we are going through during this 4th outbreak. The course helped me to calm myself and overcome difficulties in receiving daily negative information.
  • I gained new and very practical knowledge for my work with patients and the community. I learned I need to help myself before helping others.
  • The training sessions helped me gain a deeper psychological understanding to help myself and help my community as they overcome this difficult situation.

Table 1: Applying New Self-care Strategies

 

 

Strongly Disagree  1

Disagree     2

Neutral   3

Agree  4

Strongly Agree      5

Self-carea (n=84)

0%

1.2%

10.5%

39.5%

46.5%

aI have applied what I learned about self-care to my self-care routine.

Discussion

In the midst of a pandemic, educational and capacity-building programs need to be developed rapidly to meet the critical needs of HCWs. This workshop was no exception. Despite these factors, participants in the sample clearly reported that they were implementing self-care strategies; their comments strongly support that this practice was not only functional, but also meaningful. The workshop presentations specifically targeted the areas of building social support, developing positive coping styles and self-care, improving lifestyle habits, and focusing on service to community and meaning-making. The fact that the vast majority of participants reported using these skills in their work and professional lives is an important outcome. Importantly, our sample included a diversity of professions and a relatively small percent of doctors (11.6%) and nurses (4.7%), whereas most studies during the pandemic have focus primarily on these professions.33

 

There are important programmatic lessons learned from this workshop. First, we already had strong in-country connections that facilitated networking about the program and developing a curriculum that was sensitive to cultural differences. Second, dedicated in-country promotion and logistics support was essential in capturing a large audience. Third, in a time of crisis when many are under shelter-in-place orders, the online learning format worked well for reaching a sizeable and diverse audience. Fourth, we were not prepared for the outpouring of follow-up support that was requested by workshop participants. In the allotted presentation time we could not effectively respond to the large number of questions, case examples, and stories of trauma. We did develop an extensive packet of resources that were sent to participant. Furthermore, at the time of writing, we are developing a train-the-trainer programs to further support the needs of HCWs in Vietnam.

 

Regarding limitations to the present study, the COVID-19 pandemic has necessitated the rapid deployment of educational and capacity building programs and researchers have quickly published studies of low methodologic quality.34 The present study relied on data collected as part of routine workshop follow-up. Despite clear positive outcomes, our measures and analyses were simple. The use of pre- and post-testing with robust mental health outcome measures would have improved the quality of our results. Given the lack of a pre-test, we cannot know if the impact of the training was better than other educational materials and tools. Furthermore, we cannot demonstrate if the training actually increased the skills and knowledge of participants. Finally, despite the fact that the sample included a broader range of professions, there is still need for research on the impact of the pandemic on others involved in supporting patient care such as nutritionists, laboratory workers, and janitorial services.31

Conclusion

The COVID-19 pandemic has significantly strained the health care system in Vietnam and created many stressors for HCWs. Though not robust, the available evidence demonstrates that participants in the workshop have implemented new strategies in their self-care practices. International collaborators in other countries are encouraged to partner with in-country teams to market and organize similar programs, and to be prepared to address the ongoing needs of the communities they support. Such initiatives would also present the opportunity to address and investigate the limitations that accompany our findings.

 

Acknowledgements

The authors wish to acknowledge the support of the Vietnam National Palliative Health Care Association and the Faculty of Social Work, Hanoi National University of Education, in organizing the workshop series discussed in this paper.

Disclosure Statement

The authors have no relevant financial disclosures or conflicts of interest.

 

References

  1. VNExpress, Covid-19 data in Vietnam, November 15, 2021. Accessed November 15, 2021. https://vnexpress.net/covid-19/covid-19-viet-nam.
  2. Le TT, Vodden K, Wu J, Atiwesh G. Policy Responses to the COVID-19 Pandemic in Vietnam. Int J Environ Res Public Health. 2021;18(2):559. Published 2021 Jan 11. doi:10.3390/ijerph18020559.
  3. Hoang Viet Lam L. Social Security Policy in Response to the Pandemic COVID-19: A Case Study from Vietnam. Journal of Applied Social Science. July 2021. doi:10.1177/19367244211026912.
  4. Van Nguyen H, Van Hoang M, Dao ATM, et al. An adaptive model of health system organization and responses helped Vietnam to successfully halt the Covid-19 pandemic: What lessons can be learned from a resource-constrained country. Int J Health Plann Manage. 2020;35(5):988-992. doi:10.1002/hpm.3004.
  5. Reger MA, Piccirillo ML, Buchman-Schmitt JM. COVID-19, Mental Health, and Suicide Risk Among Health Care Workers: Looking Beyond the Crisis. J Clin Psychiatry. 2020;81(5):20com13381. Published 2020 Aug 4. doi:10.4088/JCP.20com13381.
  6. Maunder RG, Lancee WJ, Balderson KE, et al. Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak. Emerging Infectious Diseases. 2006;12(12):1924-1932. doi:10.3201/eid1212.060584.
  7. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020;5(9):e475–83. https://doi.org/10.1016/S2468-2667(20)30164-X.
  8. Neto MLR, Almeida HG, Esmeraldo JD, Nobre CB, Pinheiro WR, de Oliveira C, et al. When health professionals look death in the eye: the mental health of professionals who deal daily with the 2019 coronavirus outbreak. Psychiatry Res. 2020;288:112972. https://doi.org/10.1016/j.psychres.2020.112972.
  9. British Medical Association. The mental health and wellbeing of the medical workforce – now and beyond COVID-19.
  10. Blake H, Bermingham F, Johnson G, Tabner A. Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital Learning Package. International Journal of Environmental Research and Public Health. 2020; 17(9):2997. https://doi.org/10.3390/ijerph17092997.
  11. Xiaoming X, Ming A, Su H, et al. The psychological status of 8817 hospital workers during COVID-19 epidemic: A cross-sectional study in Chongqing. Journal of Affective Disorders. 2020;276:555–561. doi:10.1016/j.jad.2020.07.092.
  12. Amal Alaradi, Sobia Irum, Nowara Ebrahim, Fatima Mohamed Jaffar Mohamed, Fatima Mohamed Jaffar Hazeem, Muhammad Ashfaq. The Mental Health Impact of COVID-19 Pandemic on Health Care Workers and Coping Strategies: A Systematic Literature Review. International Journal of Online and Biomedical Engineering. 2021;17(09):48-69. doi:10.3991/ijoe.v17i09.24791.
  13. Que J, Shi L, Deng J, et al. Psychological impact of the COVID-19 pandemic on healthcare workers: A cross-sectional study in China. General Psychiatry. 2020;33. doi:10.1136/gpsych-2020-100259.
  14. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020;323(21):2133–2134. doi:10.1001/jama.2020.5893.
  15. Chen, H, Wang, B, Cheng, Y, et al. Prevalence of posttraumatic stress symptoms in health care workers after exposure to patients with COVID-19. Neurobiology of Stress. 2020;13:100261. doi:10.1016/j.ynstr.2020.100261.
  16. Li Q, Chen J, Xu G, et al. The psychological health status of healthcare workers during the COVID-19 outbreak: A cross-sectional survey study in Guangdong, China. Frontiers in Public Health. 2020;8:562885. doi:10.3389/fpubh.2020.562885.
  17. Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976.
  18. Xiaoming X, Ming A, Su H, et al. The psychological status of 8817 hospital workers during COVID-19 epidemic: A cross-sectional study in Chongqing. Journal of Affective Disorders. 2020;276:555–561. doi:10.1016/j.jad.2020.07.092.
  19. Wu K,Wei X. Analysis of psychological and sleep status and exercise rehabilitation of front-line clinical staff in the fight against COVID-19 in China. Medical Science Monitor Basic Research. 2020;26:924085. doi:10.12659/MSMBR.924085.
  20. Zhang WR, Wang K, Yin L, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom. 2020;89(4):242-250. doi:10.1159/000507639.
  21. Salopek-Žiha D, Hlavati M, Gvozdanović Z, et al. Differences in Distress and Coping with the COVID-19 Stressor in Nurses and Physicians. Psychiatr Danub. 2020;32(2):287-293. doi:10.24869/psyd.2020.287.
  22. Babore, A, Lombardi, L, Viceconti, ML. Psychological effects of the COVID-2019 pandemic: perceived stress and coping strategies among healthcare professionals. Psychiatry Research. 2020;293:113366. doi:10.1016/j.psychres.2020.113366.
  23. Gorini A, Fiabane E, Sommaruga M, et al. Mental health and risk perception among Italian healthcare workers during the second month of the Covid-19 pandemic. Archives of Psychiatric Nursing. 2020. doi:10.1016/j.apnu.2020.10.007.
  24. Pasay-an, E. Exploring the vulnerability of frontline nurses to COVID-19 and its impact on perceived stress. Journal of Taibah University Medical Sciences. 2020;15(5): 404–409. doi:10.1016/j.jtumed.2020.07.003.
  25. Chen J, Liu X, Wang D, et al. Risk factors for depression and anxiety in healthcare workers deployed during the COVID-19 outbreak in China. Soc Psychiatry Psychiatr Epidemiol. 2021;56:47–55. doi:10.1007/s00127-020-01954-1.
  26. Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: A comparative study. PLoS ONE. 2020;15(8):e0237303. doi:10.1371/journal.pone.0237303.
  27. Si MY, Su XY, Jiang Y, et al. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty. 2020;9(1):113. doi:10.1186/s40249-020-00724-0.
  28. Zhu W, Wei Y, Meng X. et al. The mediation effects of coping style on the relationship between social support and anxiety in Chinese medical staff during COVID-19. BMC Health Serv Res. 2020;20:1007. doi:10.1186/s12913-020-05871-6.
  29. Dong Z-Q, Ma J, Hao Y-N, et al. The social psychological impact of the COVID-19 pandemic on medical staff in China: A cross-sectional study. European Psychiatry. 2020;63(1):e65. doi:10.1192/j.eurpsy.2020.59.
  30. Munawar K, Choudhry FR. Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: A qualitative inquiry. American Journal of Infection Control. 2020;S0196-6553(20):30638-6. doi:10.1016/j.ajic.2020.06.214.
  31. Nguyen, Q.C., & Anderson, L.P. Vietnamese Americans’ attitudes toward seeking mental health services: Relation to cultural variables. J of Community Psychology. 2005;33(2):213-231. doi.org/10.1002/jcop.20039.
  32. Do, M., Pham, N.N.K., Wallick, S., & Nastasia, B.K. Perceptions of Mental Illness and Related Stigma Among Vietnamese Populations: Findings from a Mixed Method Study. J Immigrant Minority Health. 2014;16:1294–1298. doi: 10.1007/s10903-014-0018-7.
  33. Teixeira CF, Soares CM, Souza EA, et al. A saúde dos profissionais de saúde no enfrentamento da pandemia de Covid-19. Ciência & Saúde Coletiva. 2020;25(9):3465–3474. doi:/10.1590/1413-81232020259.19562020.
  34. Muller AE, Hafstad EV, Himmels JPW, et al. The mental health impact of the COVID-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Research. 2020;293:113441. doi:10.1016/j.psychres.2020.13441.

About the Author

Nathan C. Gehlert, Ph.D.

Nathan C. Gehlert, Ph.D., is a licensed professional counselor and Associate Professor and Chairperson of the Department of Counseling at John Carroll University. He is also a Fulbright U.S. Scholar at the University of Social Sciences and Humanities, Ho Chi Minh City. His research interests include motivational interviewing, multicultural counseling, and the psychology of religion and spirituality.

Quynh Xuan Nguyen Truong, MPH

Quynh Xuan Nguyen Truong is a public health Ph.D. candidate at Chulalongkorn University and a Fulbright Scholar and master’s student in School of Social Work at Boston College. Her practice areas include clinical and palliative care social work. Her research focuses on palliative care and public health policy and management. She is also a committee member of Vietnam National Palliative Health Care Association and a senior social work consultant for University Medical Center of Ho Chi Minh City.

 

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