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Ireland The emergency in the emergency: psychological support for nursing staff

14:31  07 april  2020
14:31  07 april  2020 Source:   liberation.fr

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Grandstand. Clinical psychologist, I assist and I support today many medical personnel who fight against the disease and often find themselves facing death. It is from them, their psychological and emotional state that I would like to discuss in these lines. It’s an emergency now: caregivers need psychological help; they say it more and more often. But the way is narrow to hear their suffering while allowing them to continue fighting. These health professionals are neither burned out nor even victims of psychological trauma. They live a completely new professional experience, which requires an approach resembling the care of professionals during attacks. Certainly, with the Covid-19, they are daily faced with death. But it's not new to them. Healthcare workers are used to working with her. So this is not what changes with the advent of the new virus in their daily lives. What changes for them is the chaos and the absurdity that has come into their lives, upsetting the usual order of the hospital world.

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Lack of resources

The hospital - and its heart, the resuscitation service - is in essence the place of competence. A space where a difficult fight is played out every day, certainly, but one in which each professional is experienced. The rules are clear. Death lurks, but each time a patient dies, the fight against the disease is too uneven. Never before has death been the result of a renunciation of treatment, for lack of means. Today, some caregivers sometimes have to choose who can be saved. We read this choice collectively as an indelible stain on our humanity. Choose who will live and who will die; no longer to accompany the death of a human being with dignity; no longer being able to appease families ... So many moments understood as nonsense for the one who chose the medical profession. He was there to save lives and he finds himself facing constraints that deprive his mission, his efforts, his abnegation of meaning.

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Faced with this increasingly expressed distress, a large number of professionals are ready to mobilize to help. Generous, this intention illustrates the capacity for solidarity of the vast majority of French people and their desire to participate in a collective commitment. However, providing help to caregivers facing such a specific situation cannot be improvised. This desire to support those on the front line should not make us forget that these treatments are difficult and very sensitive. The challenge is to manage to support them enough without breaking down the psychic defenses that allow them to continue working and resume their tasks each morning. Allow a subtle distancing of emotions, a parenthesis, temporary, of this need that what they accomplish has a meaning, so that they can continue their essential mission and save lives.

Order in chaos

The challenge is to relieve them by putting a little order in the psychic chaos caused by the feeling of absurdity of the situation that they feel violently; without putting them face to face with a reality they might find too unsustainable to return to. The challenge is to support the necessary dissociation while ensuring that it is not pathological; to resist our desire to reassure or exculpate at the risk of not allowing anxiety to name itself. The challenge is also to manage to bear our own helplessness to help; in the end, it is a question of going out of our usual psychiatric functioning to invent a median path, of finding a just balance which will relieve by integrating the need that our colleague has to be able to continue functioning psychically and emotionally…

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The profession psychic care requires humility and especially to know its limits. Knowing how to listen does not make us specialists in crisis. And being a crisis coach does not make us a caregiver. The best way to help those who, every day, feel that they are leaving a little of their humanity in their daily struggle, is to allow them to be supported by trained professionals, themselves supported. Because there is no mistaking it, the second line too must be ready to take a wound in its deep humanity. The violence of the crisis facing this hospital will not leave those who wanted to help more unscathed than the front line fighters.

Emmanuelle Lépine headed in 1995 the psychic trauma care service of the Paris police headquarters when the attacks tore Paris apart. A former student of General Crocq, a pioneer in the care of victims, creator of the medico-psychological emergency cells, she began her career in the care of victims but also and above all of professionals (the police in this case).

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