The Psychosocial Challenges of Caring for Patients with Ebola Virus Disease.

Caring for highly infectious patients in biocontainment units is a new phenomenon, and little is known about the behavioral health of workers in this setting. This is a qualitative study exploring the unique experiences of workers involved in the care of patients with Ebola virus disease (EVD) at Nebraska Medicine during the 2014 Ebola outbreak. Twenty-one in-depth interviews were conducted focused on topics of personal memories, interpersonal experiences, stress response, and patient management. Five themes were identified: (1) positive experiences were emotional while challenges were technical; (2) a significant percentage of workers encountered interpersonal stressors, with 29% of respondents having feelings of isolation, 33% having alterations in home life, and 25% experiencing at least 1 episode of discrimination; (3) physicians and nurses had stressors primarily related to patient care; (4) mental health was an important supportive service, with 45% of respondents using behavioral health counseling; and (5) working in the biocontainment unit during activation was more stressful than everyday work for 60% of respondents. Differences were also noted based on employee occupation and leadership level: nurses, physicians, and members of the leadership team tended to focus on emotional experiences and were more likely to utilize behavioral health counseling services than support staff and nonleadership personnel. These findings provide a framework for thinking about the unique aspects of caring for highly infectious patients, and understanding these issues will improve training, enable management to better support staff, and provide insights to those establishing biocontainment units.