HOPE Initiative: Processing Emotions in the Pandemic

Intensivists and ICU nurses are facing extraordinary pressures and stressors as they valiantly care for desperately sick COVID-19 patients. Obstacles come from all directions: rationed ICU beds and ventilators, scarce supply of medications, and a steady stream of colleagues who have simply had enough and leave their jobs.

“A quick Google Scholar search for ‘pandemic’ ‘mental health’ ‘healthcare workers’ gave me more than 159,000 articles that ranged from socio-ecological predictors of mental health to the hidden pandemic,” said professor Raghavan Murugan, MD, MS, medical director of the UPMC Magee Women’s Hospital Adult ICU. “The potential damage to the wellbeing my colleagues is significant and concerning.”

While a similar Google search yielded more than 90 million hits! Mental Health America—the first article listed—reports healthcare workers are stressed out and stretched too thin, worried about exposing their loved ones to COVID-19, and emotionally and physically exhausted.

All these feelings were swirling—yet not talked about—among the Magee Adult ICU team in late September 2021. In non-pandemic times, this unit cares for medical and obstetric patients but it transitioned to a COVID unit in August to increase bed capacity as the Delta surge hit western Pennsylvania. The critical care, nursing and respiratory teams found themselves caring for a new wave of COVID patients, who were younger, unvaccinated and often pregnant. Many were critically ill and dying.

One very sad case became a pivot point for action. A 22-year-old man died of COVID-19 respiratory failure after spending several days with the ICU staff.

“I will never forget looking around the room after I pronounced this patient deceased and saw my coworkers whose hearts were gone and tears flowing from many eyes,” said Rob Bauer, CRNP, associate medical director of the Magee Adult ICU. “The staff had no clue what emotions they were feeling anymore. Devastated can’t describe it. Total fatigue had set in. I knew something needed to be done.”

In a matter of days, Rob’s idea for action became the HOPE Initiative. HOPE stands for “Helping Others Process Emotions.” The goal was to create a safe, virtual space where team members could share their personal stories about the emotional impact of the case. HOPE gave them a release valve for pent up emotions, a way to process their feelings, and to realize that other colleagues had similar reactions.

Five panelists from the interdisciplinary ICU team each talked about their patient-care role and the impact the case had on their own mental wellbeing. Members of the audience were also invited to share their experiences caring for COVID patients. Rachel Sackrowitz, MD, MBA, executive vice chair for the Department of Critical Care Medicine, and Priya Gopalan, MD, associate professor of Psychiatry, facilitated the HOPE event, which was held via Zoom (which may have made it easier for people to speak freely about their feelings).

“Having the opportunity to talk about my emotions surrounding these difficult cases, and hearing my co-workers empathize with these feelings was extremely helpful for me,” said Elizabeth Moore, BSN, RN. “We often feel that we don't want to burden our co-workers with our feelings, but the HOPE Initiative truly highlighted that sharing our emotions, in fact, aids us in helping each other.”

A second HOPE Initiative event was held just prior to the holiday season after another death of a young patient. She was 35-years old and had undergone an emergency C-section delivering a healthy baby. However, her prolonged ICU stay ended in her passing. This was also a highly emotional loss for the staff and left them feeling desolate.

Tami Minnier, chief quality officer of UPMC reflected on the benefit of the program, “The Hope Initiative at UPMC is a game changer. I have participated in these sessions and find them healing and inspirational. The ability to talk in a safe, supportive space is absolutely necessary for today’s health care workforce. It has been a success for all!”

The HOPE Initiative will not heal all wounds. Nevertheless, it demonstrated to team members that they were not alone in how they were feeling, and it offered a path for processing emotions.