In  many ways, trauma is like snowflakes. It looks different for each person, and everyone experiences it in their own unique way. How someone responds to a traumatic event—such as a pandemic—depends on their history, beliefs, values, and other factors. Addressing trauma may seem like reconstructing a shattered vase, but putting the pieces together, even when it doesn’t look perfect, can result in something strong and beautiful.

The American Psychological Association (APA) defines trauma as an emotional response to an accident or natural disaster. Immediately after the event, APA says, shock and denial are typical. Longer-term reactions include “unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.”

Identify, Acknowledge Trauma

While trauma and grief are different, they are intertwined. As Trish Childress, LCSW-S, ACHP-SW, a long term care social worker and director of supportive services, says, “Grief is a natural emotional process we go through after a loss, whereas trauma is an emotional response after a horrific event. But grief can be impacted by trauma, and trauma can be complicated by grief.”

Identifying trauma can be challenging, as people can respond in different ways. But there are signs to watch for, such as someone who was always a pleasant, cheerful person is now angry and short-tempered, or someone becomes preoccupied with death.

As with grief, ignoring signs of trauma isn’t healthy. Instead, Childress suggests, “Try to identify where the person is. Acknowledge that their mood, attitude, approach, etc. has changed, and support them through it.” She stresses that a person can’t receive information about someone’s trauma and just do nothing.

“If you open the box, you have a responsibility to help, and that can be challenging; knowing your boundaries and professional limits with co-workers is important,” she says. An option could be referring them to the Employee Assistance Program. “We don’t want to be passive, but we don’t want to be intrusive either,” she says.

Check in With Co-workers

After a situation such as a pandemic, natural disaster, or violent event, Childress says, “It is important to check in with team members and co-workers. HR [Human Resources] or other leaders can meet with team members and talk to staff. They can watch for shifts in attitudes, behaviors, or company culture and simply ask people if there is anything they need to do their jobs.”

The Role of Control

“Two of the greatest predictors of trauma are whether we feel like we had adequate support and how well we were able to take action on our own behalf after the traumatic experience,” says Carla Cheatham, MA, PhD, founder of the Carla Cheatham Consulting Group.

“I know of nurse leaders who when the pandemic began had team members who were terrified, and understandably so,” she says. “They were struggling with lack of information, understanding, and support. I suggested: Go be present with them; walk them through it.”

These leaders were concerned about their teams and took actions such as providing detailed written instruction on how to put on, take off, and dispose of Personal Protective Equipment, how to wash up, and how to protect their families when they went home. However, Cheatham observes, “Their presence gave their teams comfort that written memos and training programs couldn’t. This took time, but the impact was tremendous. It bonded teams and reassured frontline workers that they were cared for.

“Leaders who turn off their phones and listen to their people will build brand loyalty and connections and, ultimately, save much time, money, and energy in the long run.”

Offer Options, Be There

Giving people the option of initiating outreach for help is important as well. “We set up a call line where residents and employees could talk about their losses and their feelings,” says Jasmine Wadkins, LCSW, CDP, BF-CMT, CCTP, CEA, director of behavioral health services operations and education at Signature HealthCARE.

At the same time, it is important to realize that some people may not be willing or able to take that first step, she says. “If someone acknowledges feelings of trauma, you can say, ‘Would you like me to help you get assistance?’ or, ‘Can I make a call for you?’”

The personal touch is essential. For instance, instead of having corporate HR handle everything, Signature has HR people who deal with just a few buildings so they can get to know staff and communicate with them one-on-one. “We promote the Employee Assistance Program and do many referrals. We connect with area clergy and form other partnerships. As a result, we are able to make sure that employees get what they need.”

Encouraging self-care is important, especially after people have experienced a trauma or crisis. However, Cheatham stresses the need to realize that this isn’t a panacea. “We can’t tell people to exercise, eat right, take a vacation, or something else and expect everything to be okay. We need to look at what aspects of the workplace contribute to or trigger trauma and address them head on,” she says.

Trauma Beyond Disease and Death

There is no doubt that COVID has been responsible for much trauma, but there are issues beyond the illness that have negatively impacted many in long term care. The battles and controversies about vaccinations and masking, as well as conspiracy theories about the virus itself, have affected many people at all levels.

“When what we believe about the world gets smacked by reality, we hit an existential crisis,” Cheatham says. To let go of the belief that people will stop doing something that will hurt others when you find that this isn’t necessarily true, you first have to grieve, she says. “Once you do that, you can find a new place to come to. You can accept the reality of the world while understanding that when people are afraid, they’re not always their best selves.”

Post-Trauma: PTSD

With post-traumatic stress disorder (PTSD), which is not uncommon for people who have experienced traumas, specific triggers (such as loud noises) take them back to the event and make them feel fear, terror, or helplessness. Symptoms may include flashbacks, recurring dreams or nightmares, feelings of detachment, problems sleeping, and/or an exaggerated startle response.

Researchers have found that PTSD affects many COVID survivors, as well as those who have been impacted by the virus in some way. One contributor to this is economic stress, something that many people—including a number of frontline workers—experienced during the pandemic.

COVID-related PTSD can be challenging to treat. In “COVID-Related Post Traumatic Stress Disorder: What It Is and What To Do About It,” William Haseltine, PhD, said, “Building resilience is an important part of overcoming trauma, yet the ambiguity surrounding it makes it more difficult to build resilience. People can’t always resort to typical methods such as goal setting and shifting the focus away from the trauma and toward the future.”

So Many Starfish

It may be tempting to assume that once the worst of COVID is over, trauma will ease. However, this isn’t likely to be the case.

“When people have time to come up for air and reflect on what they’ve been through, we can anticipate that burnout and trauma rates will go up,” Cheatham cautions. In addition to trauma, there may be widespread compassion fatigue, the physical and emotional exhaustion that leads to diminished ability to empathize or feel compassion, and moral distress, which results when people are prevented from taking or are unable to take the correct response to a situation.

Even the best, most caring, and conscientious of leaders and organizations are likely to see these kinds of issues arise. In addition to dealing with the Delta variant and new outbreaks and infections, says Cheatham, many staff members are confronted by pushback on vaccinations and masking, as well denials of COVID’s existence or severity.

“When there are that many starfish on the beach, you can only pick up so many,” she says. “It will take time, effort, and patience to deal with the traumas resulting from the pandemic and other crises we’ve faced in the past few years.”

Person-Centered Care for Staff, Too

“We pride ourselves as an industry for doing person-centered care, but it’s not enough to do it for residents. We need to take what we do for our residents, like trauma-informed care, and do it for our staff as well,” says Cheatham, adding, “The best leaders I’ve seen understand this.”

Paige Hector, LMSW, national speaker and clinical educator, suggests encouraging staff to have an “empathy buddy.” An empathy buddy can be a colleague or co-worker or someone outside of the work setting. Engaging with an empathy buddy is an intentional practice that is different from usual conversation, one in which the individuals can share their feelings and explore underlying needs.

“This doesn’t have to be a formal arrangement or involve structured meetings,” Hector says. It could mean a "check-in," where each person has the opportunity to share while the other person listens deeply instead of typical back-and-forth talking or problem solving. It can be helpful to agree upon a set time, for example, five minutes each (or longer if the situation allows).

“It lays a foundation to help people understand and practice empathy, and it encourages mutually supportive relationships,” Hector says. Of course, she notes, “Participating in this type of practice is voluntary, and some staff may choose to not participate.”

It’s important for leaders to create a culture where everyone understands that trauma is an injury, and not a weakness, illness, or character flaw, says Hector.

“Few of us will get though life without being traumatized by something at some point," she says. “Infusing trauma-informed care in the facility fabric of daily interactions is the beautiful opportunity we all have to support each other in healing.”

Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.​