Cognitive overload in a pandemic

The work of healthcare professionals has always been critical, challenging and pressure filled, but the COVID-19 pandemic is something else. With healthcare systems across the world overwhelmed, their nurses and doctors are overwhelmed, too.

Chief Nursing Officer Dr Rhonda Collins has a mission — to find ways to relieve the immense cognitive burden that sits on the shoulders of the healthcare workforce. These roles are stressful at the best of times, but things have gone next level since COVID-19 emerged on the global stage.

Healthcare workers report having never seen the degree of pressure that is currently placed on nurses and doctors around the world. When we consider what is unique to the current situation with COVID-19 there are still so many aspects of the disease that we have yet to discover and understand.

Understanding cognitive overload

Learning theory identifies three types of cognitive load: intrinsic, extrinsic and germane:

• Intrinsic cognitive load: The cognitive effort expended to complete a problem or task. For healthcare workers, intrinsic load is affected by stress factors that diminish working memory and can be compounded by larger, deeper emotions.
• Extrinsic cognitive load: The cognitive effort the environment demands. If you’re bombarded with information and you can’t control how it’s coming at you, you can have a heavy extrinsic load.
• Germane cognitive load: The effort expended to make sense of new information. If you receive a pathology value with no context and have to retrieve past values and other information to understand the complete picture, your germane cognitive load is heavy.
   

Communication problems and cognitive overload have been associated with medical errors, which hospitals can address with a communication strategy that helps reduce the cognitive load of healthcare workers.

Dr Collins’ focus is to relieve the load borne by healthcare workers by using intuitive technology in the context of a communication strategy. The aim is to simplify communication and offload the burden of retrieving, retaining and recording information.

“Short-term memory is the first thing to be impacted when we’re under cognitive strain. We may forget a medication or forget a procedure, and this can have devastating consequences.”

Pressures of the pandemic

The pandemic is contributing significantly to the cognitive burden placed on frontline health workers. When staff are cognitively overloaded mistakes occur. People lose the ability to cope and the ability to recall information.

COVID-19 throws a plethora of symptoms our way — from toothache to diarrhoea to breathlessness and cold-like symptoms. Patients can go from having a cough to needing a ventilator in four hours. The element of stealth is also a challenge, with many infected members of the population having no symptoms, thus facilitating the spread of the virus.

“The number one problem is that we’re swinging at something, but we don’t know exactly what it is that we’re swinging at,” Dr Collins explained.

“The only weapon we have is to treat the symptoms. If a patient has a fever, we attempt to bring it down; if a patient is breathless, we give them oxygen; if they’re not able to breathe, we can put the patient on a respirator.

“These are the tools we have right now and the main burden of this is being felt by nurses. Nurses are the largest healthcare force and they are on the frontline, managing symptoms of relentless streams of patients.”

Marathon not a sprint

Nurses are wearing PPE over long, gruelling shifts. The very wearing of this degree of PPE can make nurses feel isolated from their colleagues and patients. Some tape a photo of themselves onto their front to help foster a connection with their patients and colleagues. Many nurses are separated from their families out of fear of spreading the virus to their loved ones. For those that do return home after exhausting shifts, clothes are removed before entering the house and showering. Until this has been done, they cannot embrace their partner or children.

“The impact of this pandemic is compounding and we’re realising that it’s not a sprint but a marathon. Any long-distance athlete knows that you cannot maintain an intense pace indefinitely. Over time the stresses take their toll.

“The level of intensity we saw in the first weeks of the pandemic is not sustainable. Charged with adrenaline, health workers might have thought that they could sacrifice seeing their families to battle the virus, but after four weeks or so, mental resilience begins to break down.

Dr Collins explained that once health professionals came to realise that they were in this for the long haul, they understood they would have to ratchet back and take care of themselves in order to prevent burnout.

“One nurse I spoke to had been working for 157 days straight.

“This situation is not normal. Under normal circumstances one or more patients wouldn’t be dying each day. Healthcare workers wouldn’t be cut off from their support networks. There is a real sense of urgency and crisis — of life and death. It’s intense.”

So what are some of the strategies that can help in this unprecedented situation?

Support programs

Smiling Mind and the Australian Government have been working together to ensure that healthcare workers have access to mental health support.

“When people are isolated and with no outlet, their mental health really suffers, so programs such as Smiling Mind’s Healthcare Worker Program are extremely helpful resources,” Dr Collins said.

The app-based mindfulness program is designed to provide busy healthcare workers with easily accessible information, resources and practical activities designed to support good mental health and wellbeing. The program covers topics such as mindfulness, stress management, clear thinking, connection, resilience and sleep.

Cohort creation

Dr Collins explained that one strategy to relieve the burden of the pandemic on nurses is to group together patients that require increased care. The creation of COVID-only facilities allows staff rotation so that healthcare workers aren’t always dealing solely with critically ill COVID-19 patients.

Staffing levels

Boosting staff levels will be critical over the coming months. Nurses approaching retirement will not want to repeat their experience of working at the frontline of a pandemic. It is likely that the nursing profession may face critical staff shortages.

Leadership

Dr Collins said that one of the key strategies to helping our health workforce lies in good leadership.

“Leaders need to look at how they can relieve the burden that is placed on nurses and other healthcare workers, especially in the current circumstances.”

Dr Collins advocates the use of technology to lift a portion of the heavy burden that falls on the shoulders of frontline nurses.

“Technology can carry the burden of memory by providing accurate, timely information to relieve clinicians’ cognitive load and help improve patient safety.

“A device that can relieve the burden of memory is going to have a huge positive impact. Instead of having to remember all the things I need to do during a shift, the device remembers for me.

“A hands-free, voice-activated wearable really comes into its own during a time when nurses are swathed in PPE and trying to avoid touching shared surfaces. I can just say ‘Okay, Vocera!’ and communicate or get the information I need.”

Chief Nursing Officer Dr Rhonda Collins is a Texas-based registered nurse, working with nursing leadership groups globally to increase their understanding of Vocera solutions. Dr Collins is a frequent speaker on the evolving role of nurses, the importance of communication and how to use technology to improve clinical workflows and care-team collaboration.

Image credit: ©stock.adobe.com/au/vectorfusionart