Becker's Clinical Quality & Infection Control

26 PATIENT & CAREGIVER EXPERIENCE AdventHealth CMO Dr. Omayra Mansfield on creating joy amid COVID-19 By Kelly Gooch O mayra Mansfield, MD, was having a particularly hard day amid the stress of the COVID-19 pandemic. Driving home from work, the despair over- whelmed her, so she paused and decided when she got home, she would create a mo- ment of joy by jumping into her pool fully clothed to surprise her children. Her husband captured the big splash on video. "In the video is my daughter giggling like I had not heard her giggle in weeks, and certainly my own laugh at her response. en the smile on her face and my son's response wanting to jump in," said Dr. Mansfield, vice president and CMO of AdventHealth Apopka (Fla.) and AdventHealth Winter Garden (Fla.), in a health system interview. "When I look back on this a year from now, what I want to remember about that particular day is not the despair I felt at work and driving home but the smile on my daughter's face and the laughter that filled the air," she added. "And that was really a moment in time where I felt like the trajectory as a family really did change, and we embraced what we were going to do to be positive." Dr. Mansfield's passion for having and creating moments of joy is something she passes along to physicians at her hospitals to improve their mental health and well-being. She told Becker's Hospital Review she has always been concerned about physician well-being and mental health, but it's especially important during the pandemic as physicians see circumstances with patients that they may have never seen before. "It became the perfect storm, and we needed something," she said. at something at her hospitals has includ- ed identifying "battle buddies," based on a concept from retired U.S. Army Lt. Gen. Mark Hertling, DBA, who wrote a book about physician leadership based on his military experience and time at AdventHealth. e concept comes from the practice of drill ser- geants pairing up new recruits. In healthcare, a person's buddy is "a person who will look out for you, and you will look out for them [in terms of well-being]. If some- thing's on your mind, you have given them permission to call you out," said Dr. Mansfield. As far as bringing moments of joy with inten- tionality, as she did in her pool, Dr. Mansfield said a serenity room in her hospitals creates an area outside their walls where employees can decompress. Her hospitals also focus on gratitude. For example, executive leaders share what they are grateful for during meetings, and those items are posted on boards in the serenity room. "I believe as an emergency medicine phy- sician that we have two ways to look at our job. I could be cynical, or recognize every day I have a reminder we don't know how long life is, and ask, 'What am I doing with the time I'm given here?'" said Dr. Mans- field. AdventHealth Apopka and AdventHealth Winter Garden gave leaders a book for jour- naling. ey write down lessons learned in the book, which allows them to debrief. Dr. Mansfield said journaling also pro- vides a way to prepare for situations like COVID-19. n COVID-19 might cause delirium in acutely ill hospitalized patients, study finds By Anuja Vaidya D elirium, a mental state marked by intense confusion and emotional disruption, may be common in hospitalized COVID-19 patients, ac- cording to a study published in The Lancet Psychiatry. For the study, researchers searched several databases, including Medline, Embase and medRxiv, for studies related to psychiatric and neuropsychiatric conditions of individuals with suspected or confirmed SARS, MERS or the new coronavirus. They included 65 peer-reviewed studies and seven that have not been peer-reviewed. The total number of coronavirus cases in the included studies was 3,559. Twelve of the studies looked at the new coronavirus specifically and found evidence of delirium. Researchers found evidence of confusion in 26 of 40 intensive care unit patients; agitation in 40 of 58 ICU patients; and altered consciousness in 17 of 82 patients who subsequently died while they were acutely ill with COVID-19. Six studies that assessed SARS and MERS patients after recovery found frequent reports of low mood, insomnia, anxiety, irritability, memory impair- ment, fatigue and frequent recall of traumatic memories during a follow-up period ranging from six weeks to a little over three years. Researchers also estimate that the prevalence of post-traumatic stress disor- der among SARS and MERS survivors was 33 percent at an average of about three years after the illness, and rates of depression and anxiety disorders were about 15 percent at an average of two years after the infection. "While there is little evidence to suggest that common mental illnesses beyond short-term delirium are a feature of COVID-19 infection, clinicians should monitor for the possibility that common mental disorders such as depression, anxiety, fatigue, and PTSD could arise in the weeks and months following recovery from severe infection, as has been seen with SARS and MERS," said Jonathan Rogers, a clinical PhD fellow at the University College London in the U.K., who co-led the study. n

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