"Meta is when something refers back to or is about itself, like a book about books or a meme about memes." -Dictionary.com
Even before Covid, our healthcare providers were in trouble. Mental health issues were on the rise, job satisfaction was falling, and risk for burnout was rising (1). The system that taught us how to heal had neglected to teach us how to care for and heal ourselves. We deserve better and as a healthcare family, we can do better.
Mental health awareness and treatments for healthcare providers are fairly new concepts. Research began to emerge in the 80s and 90s centered around nurses who served in Vietnam (2). Conditions such as burnout, compassion fatigue, moral distress, and PTSD began to be described and uncovered in our caregivers. As the language for the conditions affecting our caregivers evolved, so did the therapies and interventions aimed at treating it. Initially, these included, counseling, psychotherapy, and medications.
In recent years, more spiritual and holistic approaches are being implemented to great success and gaining traction. Treatments and modalities such as yoga, mindful meditation, forest bathing (Shinrin Yoku), group therapy/debriefing, tapping (EFT), cognitive behavioral therapy, hypnosis, Reiki therapy, HIIT programs, acupuncture/pressure, massage therapy, psychadelic-assisted psychotherapy, and many more are assisting individuals in healing and stress/anxiety management.
The addition of new and innovative therapies is a promising development. However, varied and complex conditions call for a more sophisticated solution and problem solver. The answer to this dilemma is to develop a dedicated caregiver to the caregivers. This individual should have a high level of compassion, empathy, and curiosity regarding the human condition. This meta-care professional will have attained a high level of knowledge of anatomy, physiology, pharmacology, pathophysiology, psychology, and have real world experience of the burden of caregiving. Armed with this first hand experience and knowledge base, they can act as guidance counselors for the hospital staff, institutional health/wellness program leads, and navigation beacons for those seeking more personalized care.
Conditions like compassion fatigue, burnout, vicarious traumatization, chronic stress/anxiety, insomnia, existential dread, moral injury, PTSD, etc. are complicated and carry subtle inter-individual nuance. So, there isn't a one size fits all approach to treatment. This is where the meta-care practitioner will shine. This system is anchored in A, E, I, O, for you principles, Agency, Empowerment, Independence, and Ownership. She will listen to the individual, allowing them to debrief, and recommend homework as a first line treatment. Then, during follow up, the individual can grade what is working and abandon those interventions that aren't speaking to the issues. Ultimately, the caregiver will discover the healing modalities that address their suffering and begin the healing process. Retaining this caregiver (the cost of onboarding a nurse is 22-64k) will save money, result in staff with greater resiliency, stimulate post traumatic growth, and spur development of localized mentors on floors and units.
If we view the hospital as an organism, this new internally focused approach to healing and self compassion will allow the organization to heal and function at higher levels. The care that the hospital exhibits for itself will radiate into the community. This institutional self care and resilience will foster a healthier work force, cement customer loyalty, and increase market share, leading to healthier balance sheets.
1. Rotenstein, L. S., Torre, M., Ramos, M. A., Rosales, R. C., Guille, C., Sen, S., & Mata, D. A. (2018). Prevalence of Burnout Among Physicians: A Systematic Review. JAMA, 320(11), 1131–1150. https://doi.org/10.1001/jama.2018.12777
2. Mussell, P. G., Cumberland, G. D., & Riddick, L. (1988). Posttraumatic stress disorder. A real entity in death investigation. The American journal of forensic medicine and pathology, 9(1), 74–75.
3. https://www.rwjf.org/en/library/research/2009/07/business-case-cost-of-nurse-turnover.html
