1. Treiger, Teresa M. RN, MA, CCM, FABQAURP

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One of my private clients remarked that they were not as worried about COVID as last year, but now they are afraid to go to shopping malls and other crowded locations because of all the "crazy people." Considering they were up to date with vaccination boosters, I was not surprised by the COVID comment, but hearing about the fear of being in public places struck a chord. As I thought about it; further, it gave me pause to consider the ramifications of living life in the 2020 decade.


Where I live, the Massachusetts Department of Public Health continues to keep the public informed via its website, YouTube, and Twitter. The website is current regarding case counts, testing, vaccination, guidance, and resources about COVID-19 in the Commonwealth. There are sporadic news updates on case counts but not to the same intensity as in 2020 into 2021. On a few occasions, the news offers up wastewater virus increases but instructions on what, if anything, to do are lacking.


While masks continue to be worn in health care settings, there seem to be more recommendations than requirements about masks in other public places. As I go about my day, I do not see many people wearing masks outside, and I rarely see them worn in stores and supermarkets. When I traveled to Maine, Florida, and Illinois, the number of people wearing masks at airports was shockingly low. Those boarding my last flight were unmasked save for three, and it was a full flight.


Those working in health care delivery operate in an almost posttraumatic state after over 2 years of forced overtime, job shifting, job loss, and the horrific loss of lives. Some of us still care for long COVID patients and the unfortunate people who fall ill with the virus. The pressure remains on institutional case managers, especially those working in acute care. The pandemic is not over, despite assurances to the contrary.


So, let's shift the topic to another stress-causing issue. I speak of the constant stream of bad news, horror, and human tragedy that filters into our homes via news broadcasts and the internet. The daily news is filled with individual and mass shootings. The saddest was the premeditated murder of two law enforcement officers who two heavily armed men ambushed as they responded to a report of domestic violence. As we process the onslaught of bad news and work pressures, we must rise above our narratives to support our clients through their struggles. Too often hear my clients say, "this wasn't the way life was when I was growing up," or "Life moves too fast these days."


I pause to acknowledge their concerns, but inside my head, I struggle to guide them to help reduce their distress. It seems that, at times, I have few words of wisdom; I struggle to find my balance, let alone help someone else see it. I had a reckoning with how powerless I feel in today's world. Though I never perceived myself as being able to "fix" problems, I was usually able to provide some positive perspective or suggestions. Today, I struggle to turn conversations around, and I question if I should try. The reality is that our world has become increasingly polarized and frightening. It is a reality that must be faced, but in the context of how to provide case management services, I pause and reflect more than I did in the past.


It occurred to me that if I find myself stressed by life, there is a good chance that my clients may also have struggles in this regard. Perhaps a part of the client assessment should explore what someone considers daily life stressors and how they cope with them. It likely does not affect everyone to the same degree, but understanding this aspect of life gives me a fuller picture of both client and family. If they are already stressed, my approach to working with them needs to change, and recommended case management interventions may need altering. Because if we add too many to their to-do list, it may do more harm than helps. It may not fall into a social determinants category. It may not be an identified or measurable physical or mental health issue, but it has proven to be helpful to me in getting a clearer picture of who I am working with and how best I can partner with them to accomplish their goals.


And as for me, I have creative ways to address my stress, including mandala art, music, and journal-keeping. When I mentioned the coloring to a client, the next time I visited, their daughter had purchased a whole set of colored pencils and a book of flowers and mandalas to color. The client said that even on bad days, spending time focusing on coloring helped them refocus from away pain to something she considered more productive. She gives her complete work to friends at the senior center. Perhaps more importantly, I've learned that I do not have to have all the right words to say at the time, but I never know when something I do for myself may help clients pull themselves out of a challenging time.