Ministry of Public Health and Social Assistance

National Hospital of Chimaltenango

GOVERNMENT
of Department of Mental Health
GUATEMALA

Workplan
Support and Accompaniment in Mental Health
Department of Mental Health
National Hospital of Chimaltenango

Chimaltenango, May 2020.

Workplan
Support and Accompaniment in Mental Health
Department of Mental Health
National Hospital of Chimaltenango
General objective:
Establish a monitoring plan for Psychology and Psychiatry staff, to offer comprehensive mental health
care for the health personnel of the National Hospital of Chimaltenango during the state of Calamity due
to the COVID-19 Pandemic.

Specific objectives:
1. Organize a response plan to provide psychological first aid to health personnel at the National
Hospital of Chimaltenango, through electronic means.

2. Develop a psychoeducation plan for health personnel, through audiovisual media, to raise
awareness of the importance of self-care in mental health during the state of Calamity due to
COVID-19.

3. Develop spaces for group emotional self-care through telecommunication tools: implement
WhatsApp, Zoom and social media groups to support the mental health of healthcare personnel.

4. Design a protocol for managing and referring cases of psychological and psychiatric problems in
staff, through telephone follow-up and telemedicine.

5. Design a mental health monitoring program for health personnel with a positive diagnosis of
COVID-19.

Care Plan:

1. Direct links with health personnel must be coordinated.

a. It will be coordinated with the person in charge of internal communications, the
Human Resources department and the Hospital's IT department to form WhatsApp
and Zoom groups.
b. A computer team must be managed to manage the information that will be
distributed to health personnel.

2. The implementation of a specific telephone line will be coordinated to send and direct self-
care programs and to promote the psychology service available during business hours for the
staff of the National Hospital of Chimaltenango.
a. A telephone line will be requested for patient and staff care, which will be managed
by psychology staff according to an established role.
b. The telephone number for psychological emergency care will be communicated
through department heads.

3. The recording of audiovisual material (videos) aimed at staff will be coordinated with the
Social Communication department, but also for self-care support for the population that
attends the Chimaltenango Hospital.

4. Depending on the role on duty, recreational and psycho-educational activities will be

organized for staff. These will be socialized through Zoom or other social networks, to reach
health personnel.
Physical and Personnel Resources:
a. Physical resources:
For the implementation of this protocol, access to multiple physical resources is
necessary, which will be managed through the management of the National Hospital
of Chimaltenango.

1. One (or more) computers, with Internet access, with the purpose of offering
patient care through tele-psychology and tele-psychiatry.
2. High-speed internet access, with a stable connection to offer confidentiality.
3. Audiovisual equipment for the computer: microphone, speakers, video camera.
4. The computer equipment must have access to social networks, as well as
videoconferencing applications, with an adequate level of confidentiality for
ethical and quality care.
5. A cell phone line, as well as a telephone device (smartphone) to manage the
6. Office furniture is required, which is currently available within the Mental Health
Department of the National Hospital of Chimaltenango:
a. Office desks and chairs.
b. Printer.
7. Resources are required to reproduce printed audiovisual material: photocopiers,
toner, paper for reproduction.
8. Personal protective equipment is required, as in other areas of the hospital, in
order to offer protection to staff if in-person emergency care is necessary.
9. Due to universal care measures in the current situation, surface cleaning
equipment and adequate hand hygiene are required: Alcohol gel, liquid soap,
hand drying towels, trash cans and surface cleaners.

b. Human resource:
1. There are currently 3 psychologists in the department, as well as the
psychologist in charge of the Violence Clinic of the National Hospital of
Chimaltenango.
2. There are two Psychiatric doctors: the head doctor of the department and
the EPS psychiatry doctor.
3. Human Resources Department and Patient Care Department will
collaborate in the implementation of the program.

4. The support of the IT and Social Communication department is required

for the implementation of the communication platform between staff.

Methodology:
Based on the shift role currently available for psychology and psychiatry staff, the work to be done with
patients who can attend the service will be distributed, as well as the work to be done on WhatsApp,
Zoom, Facebook and other platforms. virtual platforms. Depending on the schedule, one of the available
staff members will be appointed to lead and carry out the day's scheduled activities.

The schedule of activities will be socialized within the hospital staff. A note will be made with the
schedule for each Department Head and they must be socialized within the Hospital staff, in order to
attend the virtual meetings.
Steps to Provide Psychological First Aid via Telephone:
The professional establishes contact by telephone with the patient, whether admitted within the
National Hospital of Chimaltenango, or with the member of the staff team, prior authorization to be
provided with the respective approach, where a relationship of trust is established. Based on the
following steps:

- Present yourself appropriately, make it known that you are willing to assist the person.
- Detect the patient's psychological needs.
- Provide Psychological First Aid.
- Practice emotional ventilation, if the case requires it.
- Stabilization of emotional, physiological, cognitive and behavioral responses in hospitalized
patients.
- Perform the Mental Exam.
- Detection of people with a previous psychopathological condition.
- If necessary, apply psychological anxiety and/or depression tests to determine current
psychopathological symptoms.
- Determine if pharmacological support is required.
- Inform about the next call and offer the possibility of triangulating a call, from the
nursing station, if a crisis were to activate at another time, and it was deemed necessary.
- After a telephone interview, the professional collects the information to write progress notes
and enter information.
- If the crisis intervention is carried out with a minor, the Code of Ethics that governs the
profession requires obtaining prior informed consent from those responsible for the child, as
well as making known the corresponding process regarding Firsts. Psychological Aid.
- Control of the evaluated patients will be carried out through the SIGSA sheet and an internal
clinical record will be maintained that will be managed within the Department of Mental Health.

It is suggested to see the annexes section to have a detailed explanation of emergency psychological care
through psychological first aid.

Indicators that suggest the need for psychiatric evaluation and care:
Deterioration in the different areas of operation in global activity.

- He manifests several psychological symptoms that cause clinically significant discomfort.

- The person is at risk of harming themselves, harming others, or threatening to take their own
life.
- Alteration in the course of thought, in its form and content.
- The person is receiving psychiatric treatment and is not currently under medication.
- Previous Psychiatric Diagnosis.
- Previous suicide attempts.

If the person assisted by telephone or by other means refers to any of the aforementioned aspects, a
referral will be coordinated with any of the members of the psychiatry staff, who are on duty, for
specialized evaluation and clinical considerations, pharmacological treatment and follow-up.

Psychological Crisis Intervention for Bereaved Family Members:

Grief is the emotional suffering that people feel after a loss. It is different for each person and you can
suffer different emotional and physical symptoms such as anxiety, fear, guilt, confusion, denial, sadness,
depression, among others.
The emotional experience of facing the loss of a loved one is what we call the elaboration of grief, which
leads us to the need to adapt to a new situation. Grief is a wound and, therefore, requires time to heal.
In the grieving process, there are several phases, or steps that must be overcome, although this does not
mean that all of them appear in all cases.

Phases or stages of grief:

- Denial
- Anger
- Fear or Depression
- Acceptance

Within the work plan, a care plan is included for family members with possible symptoms of complicated
grief. Upon being notified that the Customer Service Department informed the family members that a
patient has died, the following procedure will be followed:

- The Patient Care Department may provide the relatives of the deceased patient with the
telephone number available for crisis care, and will inform the Mental Health Department Staff
about these actions, in order to keep track of potential patients for grief care.
- Based on the available shift role, the professional will be in charge of answering calls to provide
crisis care and follow-up will be provided when the Mental Health outpatient clinic is open again.

Activities Program for Healthcare Personnel:

- A program will be established according to department:
o Doctors according to service:
▪ General medicine
▪ Internal Medicine
▪ Pediatrics
▪ Gynecology Obstetrics
▪ Traumatology and Orthopedics
▪ Surgery
either Non-medical professional staff
either Administrative staff
o Professional and Auxiliary Nursing
or Intendance
o Maintenance
A plan adapted to the level of each of the departments will be worked on, including basic mental
health issues for staff. These will be distributed according to the staff's shift role. Audiovisual
material will be prepared in advance, including printed material, audiovisual images that will be
distributed via WhatsApp and social networks, and previously recorded videos, as well as talks
organized via Zoom.
Posters will be prepared with self-care tips and to offer the telephone counseling service in each
of the services. Efforts will be made to change this information every week to avoid overloading
staff with information.
Each of the departments will have a scheme that will be worked as follows:

Area Activity
 Doctors: Socialization of relaxation and emotional
General medicine integration techniques, through a group via
telephone (Whatsapp) 1 or 2 times a week.

Socialization of messages motivational

Coaching once a week via telephone through the
WhatsApp group

Self-care group via ZOOM

Responsible for this group: ----XXX---

- Meetings will be held with the heads of service, to the extent possible, to present the work plan.
A short explanation will also be offered about the use of screening instruments to determine the
presence of anxiety, depression, insomnia and stress, which will be carried out as part of an
investigation process into the mental health status of the staff.
- When presenting the instrument, emphasis will be placed on the presence of alarm symptoms
for referral to the mental health department.

Self-care of Mental Health Professionals

Mental Health professionals are not exempt from suffering from stress derived from the work they do
and what we currently experience as a country. It is advisable to schedule self-care sessions among the
Psychology and Psychiatry staff of the National Hospital of Chimaltenango, promoting group containment
and adequate emotional management.

Weekly self-care sessions are planned with Mental Health professionals who will be carrying out the
psychological intervention plan for patients at the National Hospital of Chimaltenango. They will try to be
carried out via zoom, and will be facilitated by the same department staff.

In these meetings, topics and exercises will be provided that contribute to facing the situation from a
place of resilience, which will guide the staff to achieve the following:
- Maintain an optimistic and objective attitude.
- Promote a feeling of capacity.
- Take hygiene protocols into account when returning home.
- Promote and strengthen healthy habits.
- Promote the proper expression and channeling of feelings and thoughts.
- Maintain contact with family and friends.
- Become aware of your own psychological resources.

Annexes:

1. Annex 1: Rules of Coexistence to Socialize among admitted patients:

Rules of Coexistence in Patients: (Adults)

 2. Maintain personal hygiene, hand washing, use of gowns, use of a mask.
3. Use appropriate vocabulary.
4. Respect areas where they are located, without mixing.
5. Avoid comments that convey contempt for other patients and hospital staff due to their
race, social origin, sex or religion, as well as the clinical evolution of the patients.
6. Respect the rest of other patients.
7. Contribute to cleaning, avoiding throwing toilet paper or other objects.
8. Keep hallways clear.
9. Respect silence and maintain an appropriate tone.
10. Collaborate with the instructions of medical and paramedical personnel in carrying out
medical procedures.

Rules of Coexistence in Pediatric Patients:

1. That those in charge of the children ensure personal hygiene, hand washing, use of gowns, and
use of a mask.
2. Use appropriate vocabulary.
3. Address others with respect.
4. Give thanks and be grateful.
5. Listen carefully when they talk to you.
6. Treat others without aggression, without hitting or yelling.
7. Moderate the tone of voice for the rest of all the boys and girls who are there.
8. Wash your hands with soap and water after using the bathroom and before eating.
9. If during your stay at the Temporary Hospital any alarm or danger situation is detected, the
health personnel will be immediately informed, they will know how to proceed.
2. Annex 2: Intervention Guide for Psychological Crisis due to COVID-19

INTERVENTION GUIDE IN PSYCHOLOGICAL CRISIS DUE TO COVID-19

CHIMALTENANGO NATIONAL HOSPITAL
DEPARTMENT OF MENTAL HEALTH
DR. LIONEL REYES CORZANTES
APRIL 2020

Crisis intervention at the hospital level is defined as forms of intervention of short duration and limited
objectives focused on the preventive resolution of a psychological disorganization, the empathy,
solidarity and tranquility of the patients who visit our healthcare center, to the Coronavirus pandemic
( COVID-19) offers a series of recommendations and actions to address the impact on the mental health
of the population, regarding the health measures that are being implemented at the national level.

It is important to take into account, act responsibly, implement and reinforce self-care behaviors and
educate our socialization and behavioral habits. To achieve this, it will be necessary to prepare
emotionally and psychosocially, in addition to acting in line with health measures.

Certain psychosocial and emotional impacts that would affect the mental health of the population of
Chimalteango due mainly to the fear generated by the international pandemic situation, the
discontinuity of daily behaviors and the measures that may arise from quarantine situations, social
isolation, etc. That the NATIONAL HOSPITAL OF CHIMALTENANGO MENTAL HEALTH AREA, suggests this
series of actions and recommendations based on the theories of mental health experts and organization
of physical-emotional health.

1. Action. Do not be alarmed by the event, take the recommended measures, avoiding
psychological or pathological alterations, have appropriate behavior, increase personal,
family and social well-being.
2. Action. Follow health recommendations, implementing self-care measures
physical-mental health.
3. Action. Be guided by official information, avoid information of dubious origin,
Increase confidence in yourself and others.
4. Action tranquility harmony be objective to social psychosocial demands to the health system
health, in the face of the current pandemic using a series of alternatives such as: relaxation
exercises, hobbies and generating habits at home, hobbies, games, exercises, family
readings, time for spiritual coexistence to strengthen our personal integrity.
5. Actions. Take advantage of the disciplinary and professional resources that psychology
provides
psychiatry and other humanistic branches such as social work, general practitioners, all of
them have tools to carry out preventive measures in the implementation of crisis
intervention, counseling and psychological care, as well as the necessary communication, we
must address individual and collective health. comprehensively, in its physical, biological,
psychological and social dimensions at the hospital level

DEFINITION
Crisis intervention at the National Hospital of Chimaltenango in the area of mental health is defined as:
short-term forms of intervention with limited objectives, focused on the resolution of internal and
external conflicts through cognitive dissonance to prevent disorganization. psychological secondary to
the (COVID19) pandemic.

Crisis intervention is a process that seeks to actively influence a person's psychological functioning during
a period of imbalance to alleviate the immediate impact of stressful events, and help reactivate activities
affected by the pandemic crisis.

Appropriate evaluation and intervention are essential to guarantee the safety of the patient and third
parties, help them effectively confront the problem and empower them to face the events currently
occurring in the hospital area.

Crisis intervention is divided into two categories: First-order crisis intervention, also called psychological
first aid or psychological first aid (PAP), which can last minutes or hours; and the second order in which
specialized and disciplinary evaluation is recommended by general practitioners, specialist doctors and
mental health professionals for an appropriate approach.

General objective:
Address the Mental Health care protocol of the National Hospital of Chimaltenango to provide patients
who visit this center with assistance in a state of psychiatric psychological alteration to be able to
intervene in an appropriate and multidisciplinary manner, applying evaluation techniques and
psychological first aid.

Specific objectives:
Involve other medical disciplines from different specialties and sub-spatialities, nursing staff, and
maintenance staff, who must have the knowledge and tools to be able to intervene with the patients
they visit who come to this hospital.

Phases of crisis intervention processes

1. Psychological First Aid
2. Second instance intervention, crisis therapy

Psychological First Aid (PAP)

Psychological first aid is not: Therapy, deactivation technique or diagnosis.
When applying psychological first aid, the aim is to:
• Promote the physical and emotional safety of the affected person
• Provide calm and security
• Try to connect him with his social support network
• Encourage the effectiveness and self-efficacy of the affected person, community or group
• Promote coping processes
• Provide proactive and positive help

When and where to apply Psychological First Aid?

• It is the technique of choice during the first 72 hours after the impact.
• When the above is not possible, up to the first two months are considered.
• It should be applied in a safe and comfortable place, adequate temperature, delimited spaces.
for work with people, games and a place for children, protected from the vision of the affected area and
the media.

• Be nice
• Make the subject feel that no thisonly
• Allow speaking-listening
• Create a safety climate

PAP five-step protocol:

1. Make psychological contact
2. Examine the dimensions of the problem
3. Explore possible solutions
4. Help take concrete action
5. Record the tracking process

1. Make psychological contact

This first step is vital so that the intervention can be carried out since the bond of trust that can be
consolidated will depend on it. Hence the importance of using and managing the body and voice.
How I arrive, how and how close I get, the tone of voice I use when speaking must be used with caution,
observing the patient's reactions. Here it will be important to observe the patient's posture, for example,
if they are on the floor we should crouch down and not remain standing.

Empathy: consists of "putting yourself in the other's shoes" must be taken into account with the
exception that once the intervention ends we will have to "take off the shoes" of the patient.

Let us remember that if in everyday life we do not tell our problems to "anyone", the same thought will
pass through the person who is going through a crisis, where on many occasions they can even be
considered "shameful" by themselves, thereby providing security. and calm the patient will be able to
contain him.
 Some suggestions from the speech:
• Hello, can I come closer? Identify yourself, name of the department and activity carried out.
• Do you want to talk?
• What is your name?
• You need something?

2. Examine the dimensions of the problem:

This step consists of starting to talk about the situation, however, it is important to note that there will
be times when the patient does not want to talk and it will be important to respect him until he is ready
and if he is not, the procedure will be stopped making sure to make the social link so that you are not
alone.

It is important to focus on the demand of the subject in crisis, that is, the problem that specifically
concerns him/her, so we must investigate everything that the COVID19 condition entails:

• Immediate past: precipitating event (death, unemployment, separation, etc.).

• Present: personal, social resources and mortality.
• Immediate future: imminent decisions (tonight, next few days, months).

When the patient is concerned about several circumstances, we will work on the ordering of problems to
be resolved: the immediate ones and those that can be postponed.

The dimension of the problem is investigated through the question: what happened? It is necessary to let
the patient speak, that is, not interrupt him with advice or personal judgments.

This step is the one that may take the longest, since the idea is for the patient to discharge his emotions
and begin to elaborate on the situation that produced the crisis, making points that promote said
elaboration.

Some suggestions from your speech:

• What happened?
• How did it happen?
• What worries you most?
• How do you feel?
• Explore social resources

3. Explore possible solutions:

It is important to ask the patient what he has tried so far and explore what he can do that will now allow
the subject's own resources to be mobilized.

Depending on the mortality and the ability of the person in crisis to act in his or her own best interest,
the evaluator will take a facilitative attitude (where the patient makes his own decisions) or a directive
attitude (when the person is not able to take care of himself). , either due to emotional disturbance or
because he or she has consumed some type of drug).

The directive attitude is usually very common in situations where you simply have to give them
instructions on what to do, such as disasters.
We emphasize that you should leave being directive as a last resort, that is, suggesting some solution
options to the patient.

Some suggestions from your speech:

• What have you done about it?
• What can you think of that we can do?
• And as a last resort, what if you try this?

4. Help take concrete action:

It consists of a patient-evaluator negotiation process about the solution they have decided to carry out. It
is recommended that, if mortality is low, the intervener should encourage the patient to make decisions:
If mortality is high, he or she is directive.

Once the decision is made, if necessary, a symbolic contract is made between both (many times the
family is included if it is essential as a social resource), in order to ensure that the patient will really do
what was said.

The contract is recommended, especially when there is a high mortality rate. Helping to take a concrete
action means that, once the immediate solution to the problem is available, it would be promoted to be
carried out.

Some suggestions from your speech:

• Do you think you'll do tomorrow? (the agreed)
• Do you want me to accompany you to identify the body?
• Do you want to talk with...?
• In order to leave, you need to stay with someone. Who do you suggest we talk to?
(this if it were a family member or even health personnel who is in crisis)

5. Record tracking process:

Once contact has been established with the patient, it is verified whether the process was appropriate or
requires new interventions. In this case, the person in crisis will be asked to communicate or, through the
evaluator, contact the psychology or psychiatry staff (in a few hours or the next day). to follow up on the
case, which allows us to realize their emotional situation.

Follow-up is not mandatory in cases of low mortality (according to the case), much less in cases of zero
mortality (only if the patient explicitly requests it from the expert.

In cases where the vulnerability of the subject implies special attention, such monitoring should be
promoted, which may be done by the hospital through mental health personnel (Psychology and
psychiatry).
Some suggestions from your speech:
• Would you like to have a space with a psychologist to talk about all this?
• Do you think if you call that phone number... where they will give you information... they will
support you with your situation?
• I suggest you go to such an institution
 3. Annex 3: Evaluation Form of Mental Health Activities Carried Out:
BALLOT
EVALUATION OF ACTIVITIES CARRIED OUT
Psychology staff (week 1)

In this report, the results of the Mental Health program will be evaluated based on the psychological
care that is being provided to patients, medical care, administrative or operational personnel of the
National Hospital of Chimaltenango:

It will be graded as follows:

1 = bad, 2 = average, 3 = good.

1. How patients responded this week with the activities

General objective:.........................................................................................................................2
Specific objectives:.......................................................................................................................2
Physical and Personnel Resources:...............................................................................................3
a. Physical resources:................................................................................................................3
b. Human resource:....................................................................................................................3
Methodology:................................................................................................................................3
Steps to Provide Psychological First Aid via Telephone:.............................................................4
Indicators that suggest the need for psychiatric evaluation and care:...........................................4
Psychological Crisis Intervention for Bereaved Family Members:..............................................4
Activities Program for Healthcare Personnel:..............................................................................5
Self-care of Mental Health Professionals.....................................................................................6
Rules of Coexistence in Pediatric Patients:..................................................................................7
DEFINITION................................................................................................................................8
General objective:.........................................................................................................................8
Specific objectives:.......................................................................................................................8
Phases of crisis intervention processes.........................................................................................9
Psychological First Aid (PAP)......................................................................................................9
When and where to apply Psychological First Aid?.....................................................................9
PAP five-step protocol:.................................................................................................................9
1. Make psychological contact..................................................................................................9
2. Examine the dimensions of the problem:............................................................................10
3. Explore possible solutions:..................................................................................................10
4. Help take concrete action:...................................................................................................11
5. Record tracking process:.....................................................................................................11
 Consent Form..............................................................................................................................14
General Data Sheet:........................................................................................................................17
Patient Health Questionnaire – 9....................................................................................................18
(PHQ – 9).......................................................................................................................................18
GAD-7............................................................................................................................................19
Anxiety Disorder Measurement Scale – 7......................................................................................19
Sleep Impairment Index (ISI).........................................................................................................20
(Morin, 1998; Bastien et al, 2001; Fernandez-Mendoza et al, 2012).............................................20
Revised Event Impact Scale (EIE-R).............................................................................................21

2. Observations: __________________________________________________
 4. Annex 4: Instrument for Evaluation of Mental Health Events in Personnel:

Factors Associated with Mental Health Events in Health Personnel During the COVID-19 Pandemic
Coronavirus Disease 2019 (COVID-2019)

Consent Form

Dear Participant:

Selection of participants:
He has been selected to participate in this study, due to his work position within the National Hospital of
Chimaltenango. The present study is part of the research function within the National Hospital of Chimaltenango, in
view of the increase in cases in the region and as part of the research projects of the San Carlos University of
Guatemala.

Confidentiality:
For the purposes of this study, all information you provide will be completely confidential and will not be presented
individually to anyone. The information collected will be used solely for research purposes. Your name, address or
other personal data will not be necessary and will not be saved for this study.

Voluntary Participation:
Your participation is voluntary, and you can withdraw from the research even after you have agreed to participate.
You are free to refuse to answer any question that is asked. If you have any questions about this study, you can ask
the interviewer, or you can obtain information from the main researcher, whose details are at the bottom of this
page.

Consent to Participate:
By signing this consent you indicate that you understand what is expected of you and that you are willing to
participate in the interview.
(Indicate whether this consent has been read by the participant or the interviewer, as well as whether it was
accepted or rejected).

Read by Participant Read by Interviewer

Accepted Refused

Firms:
I provide below my INFORMED CONSENT to take part in this research.

Signature of Participant
Witness: Signature:

Investigator:
Dr. Eduardo Sajquim (Head of Mental Health Department Hospital Nacional de Chimaltenango; Address: La
Alameda Chimaltenango) Contact Number: 56309368.

Factors Associated with Mental Health Events in Health Personnel During the Disease Pandemic
Coronavirus 2019 (COVID-2019)

Information Sheet
Dear Participant:
Introduction:
This form describes what it means to participate in the following study, which is part of the research project to
obtain the Master's Degree in Medical Sciences with a Specialty in Psychiatry at the San Carlos University of
Guatemala.

Interview Title:
The title of the interview and this research work is: Factors Associated with Mental Health Events in Health
Personnel During the Coronavirus Disease 2019 (COVID-2019) Pandemic. It involves the use of the Patient Health
Questionnaire-9 (PHQ-9), the Anxiety Disorder Measurement Scale (GAD-7), the Insomnia Severity Scale (ISI) and
the Revised Impact of Events Scale (EIE). -R).

Survey objective:
The main objective of this study is to determine the state of Mental Health within the personnel who work at the
National Hospital of Chimaltenango, and also to evaluate the factors that are related to the mental health events
that can be detected.

Data Collection Methodology:

Information will be collected from workers in various areas of the National Hospital of Chimaltenango, through a
written survey or an electronic survey through Google Forms. The interviews will be conducted by a team of trained
evaluators. Your evaluator will ask each question and take note of your answer on the report card, or failing that,
will offer you a copy of the instrument.

What it involves:
The instrument to be used is briefly described, you can ask any question about it. An informed consent will
subsequently be presented. The questionnaire questions will be asked verbally. Initially, some general information
will be requested including:
- Age -Family data
- Education - Experiences related to your mental health.
- Employment

Time:
It is estimated that answering the questionnaire will take around 20 minutes if it is conducted as an interview and
10-15 minutes if it is self-administered.

Your rights:
It is your right to:
- Decline to be part of the study.
- Withdraw your consent at any time.
- Decline to answer any question in the interview that you do not wish to answer.

Confidentiality:
Your participation and data provided for this study will remain completely confidential.
Your name will not be saved or used in any report associated with this study.

Results:
The results will be used to help design programs that will improve worker mental health during and after the
COVID-19 pandemic period.

The results may be published in research publications, media, information sheets and reports that may be available
through the researchers.

Ethical Approval:
This study has received ethical approval from the Research and Ethics Committee of the National Hospital of
Chimaltenango.
Questions:
Do you have any questions? You can ask questions at any time before and after the interview, and through contact
with the researcher or the research unit, details below.

Contact information:

Dr. Eduardo Sajquim

Chief Physician of the Department of Mental Health
National Hospital of Chimaltenango
 General Data Sheet:
Personal Data (For tracking purposes, no personal information will be used in any portion of the study,
beyond epidemiological data) :
Full Name: (First and Last Name)_________________________________________
Place of residence:
Chimaltenango (Head): ____________
Chimaltenango (Other Municipality): ______ Specify: ______________
Other department: ___________ Specify: ____________________
Sex: ______ M ______ F Age: (in years) _________
Civil status:
Single: ___ Married: ___ United: ___ Separated: ___ Divorced: __
Other (specify: ___________________)
Education level:
Medium (Basic): _________ Diversified: ___________
Academic: ___________ Postgraduate: _______
Position within the National Hospital of Chimaltenango:
Doctor: ______ Area in which you work: ____________________________________________
Nursing (Technician): _____
Assistant Nurse: _________
Administrative: _______
Diagnostic Support Services: ________
Resident doctor: ______ Maintenance/Operation: ___ Others: (Specify): ___________________
Do you have DIRECT contact with patients?
Yeah: ___ No:______________
Do you have or have you had DIRECT contact with suspected COVID-19 patients?
Yeah: ___ No: ______________
 Patient Health Questionnaire – 9
(PHQ – 9)
Instructions: In each of the following items, mark one of the 4 possible answers.
During the past 2 weeks, how often have you had discomfort due to the following problems?
Any day Several days Almost every day
More than
half the days
1. Little interest or pleasure in doing things 0 1 2 3

2. Have you felt down, depressed, or 0 1 2 3

hopeless?

0 1 2 3
3. You have had difficulty falling or staying
asleep, or you have slept too much.
4. Have you felt tired or low on energy? 0 1 2 3

5. No appetite or overeating 0 1 2 3

6. You have felt bad about yourself – either 0 1 2 3

that you are a failure or that you have made
yourself or your family look bad.

7. You have had difficulty concentrating on 0 1 2 3

certain activities, such as reading the
newspaper or watching television.

0 1 2 3
8. Have you moved or spoken so slowly that
other people could have noticed? Or the
opposite, - very restless or agitated who has
been moving a lot more than normal
0 1 2 3
9. Thoughts that you would be better off dead
or hurting yourself in some way

If you checked any of the problems, what How much difficulty have these problems given you in
work, take care of the tasks managing your home, or getting along with other people?
Very difficult
A bit Extremely
It hasn't been difficult O Difficult
difficult EITHER EITHER
From Spitzer R, Williams J, Kroenke K, et Al.
 GAD-7
Anxiety Disorder Measurement Scale – 7
Instructions: In each of the following items, mark one of the 4 possible answers.
During the past 2 weeks, how often have you had discomfort due to the following problems?
Any day Several Almost
More than
days every day
half the days
1. Have you felt nervous, anxious or on edge? 0 1 2 3

2. You have not been able to stop or control your 0 1 2 3

worry

3. You have worried too much for different 0 1 2 3

reasons

4. You have had difficulty relaxing 0 1 2 3

5. You have felt so restless that you have not been 0 1 2 3

able to sit still.

6. You have become easily annoyed or irritated 0 1 2 3

7. You have been afraid that something terrible 0 1 2 3

was going to happen.

From Spitzer R, Williams JBW, Kroenke K, et al.

 Sleep Impairment Index (ISI)
(Morin, 1998; Bastien et al, 2001; Fernandez-Mendoza et al, 2012)

1. Please indicate the SEVERITY of your current (e.g., within the last 2 weeks) sleep problem(s):

Not at all Mild Moderate Serious Very serious

0 1 2 3 4

Difficulty falling asleep 0 1 2 3 4

Difficulty staying asleep
Wake up very early 0 1 2 3 4

2. How SATISFIED are you currently with your dream?

Very satisfied Satisfied Neutral Very satisfied
Not very satisfied
0 1 2 3 4

3. To what extent do you think your sleep problem INTERFERES with your daily functioning (e.g.,
daytime fatigue, ability to perform daily tasks/work, concentration, memory, mood, etc.)?

Nothing A bit Something A lot Very much

0 1 2 3 4

4. To what extent do you think OTHERS REALIZE your sleep problem and how it affects your quality of life?
Nothing A bit Something A lot Very much
0 1 2 3 4

5. How CONCERNED are you about your current sleep problem?

Nothing A bit Something A lot Very much
0 1 2 3 4
 Revised Event Impact Scale (EIE-R)
Adapted from Weiss DS, Marmer CR (1996), into Spanish by Baguena, Villarroya, Beleña, Díaz, Roldán and Reig
(2001)

INSTRUCTIONS:
Administration Time: 10 Minutes
Basic Administration Rules: You are asked to please, based on the situation related to Coronavirus, changes in the
person to select the most stressful life event in their recent life. In this case, the onset of COVID-19 cases in the
community will be taken as a traumatic event. You must answer how frequently you have experienced each of the
items (symptoms) of the IES on a scale of four intervals whose values range between 0 (never), 1 (rarely), 2
(sometimes) and 3 (often). in the last 7 days.

1. Any memory made me go back to 6. I thought about it even when I didn't

a. Never ( )
feel what I felt before. Never ( ) b. Seldom ( )
b. Seldom ( ) c. Sometimes ( )
c. Sometimes ( ) d. Often ( )
d. Often ( ) 7.
I felt like it didn't happen or wasn't real.
2. a. Never ( )
I had trouble staying asleep b. Seldom ( )
a. Never ( ) c. Sometimes ( )
b. Seldom ( ) d. Often ( )
c. Sometimes ( )
d. Often ( ) 8. I kept away from anything that reminded
me of what happened.
3. a. Never ( )
Other things made me think about the event b. Seldom ( )
a. Never ( ) c. Sometimes ( )
b. Seldom ( ) d. Often ( )
c. Sometimes ( )
d. Often ( ) 9. Images of the event assaulted my mind.
Never ( )
4. I felt irritable and angry b. Seldom ( )
a. Never ( ) c. Sometimes ( )
b. Seldom ( ) d. Often ( )
c. Sometimes ( )
d. Often ( ) 10. I was easily startled or frightened. Never
( )
5. I tried not to get upset when I thought or b. Seldom ( )
remembered what had happened. c. Sometimes ( )
a. Never ( ) d. Often ( )
b. Seldom ( )
c. Sometimes ( ) 11. I was trying not to think about the event.
d. Often ( ) a. Never ( )
b. Seldom ( )
c. Sometimes ( )
d. Often ( )
 12. I realized that there were 19.Things that reminded me of what
a lot of unresolved feelings but I wasn't dealing They caused physical reactions such as
with them. sweating, nausea, breathing problems,
a. Never ( ) heartbeat.
b. Seldom ( ) a. Never ( )
c. Sometimes ( ) b. Seldom ( )
d. Often ( ) c. Sometimes ( )
13. My feelings about the event were d. Often ( )
as if asleep
to. Never ( ) 20.I dreamed about what happened
b. Seldom ( ) a. Never ( )
c. Sometimes ( ) b. Seldom ( )
d. Often ( ) c. Sometimes ( )
14. d. Often ( )
I felt like I was functioning or feeling like I was
during the event.
21. I felt vigilant and on guard
a. Never ( ) a. Never ( )
b. Seldom ( ) b. Seldom ( )
c. Sometimes ( ) c. Sometimes ( )
d. Often ( ) d. Often ( )

15. I had trouble falling asleep. 22. I tried not to talk about it.
a. Never ( ) a. Never ( )
b. Seldom ( ) b. Seldom ( )
c. Sometimes ( ) c. Sometimes ( )
d. Often ( ) d. Often ( )

16. Waves of strong feelings about what had

happened washed over me.
a. Never ( )
b. Seldom ( )
c. Sometimes ( )
d. Often ( )

17. I was trying to get it out of my memory

General objective: 2
Specific objectives: 2
Physical and Personnel Resources: 3
a. Physical resources: 3
b. Human resource: 3
Methodology: 3
Steps to Provide Psychological First Aid via Telephone: 4
Indicators that suggest the need for psychiatric evaluation and care: 4
Psychological Crisis Intervention for Bereaved Family Members: 4
Activities Program for Healthcare Personnel: 5
Self-care of Mental Health Professionals 6
 Rules of Coexistence in Pediatric Patients: 7
DEFINITION 8
General objective: 8
Specific objectives: 8
Phases of crisis intervention processes 9
Psychological First Aid (PAP) 9
When and where to apply Psychological First Aid? 9
PAP five-step protocol: 9
1. Make psychological contact 9
2. Examine the dimensions of the problem: 10
3. Explore possible solutions: 10
4. Help take concrete action: 11
5. Record tracking process: 11
Consent Form 14
General Data Sheet: 17
Patient Health Questionnaire – 9 18
(PHQ – 9) 18
GAD-7 19
Anxiety Disorder Measurement Scale – 7 19
Sleep Impairment Index (ISI) 20
(Morin, 1998; Bastien et al, 2001; Fernandez-Mendoza et al, 2012) 20
Revised Event Impact Scale (EIE-R) 21
a.