Dr Rebecca Garcia PhD RN MSc CPsychol
Coronavirus and Covid-19 has unexpectedly placed nurses on the centre stage of health care services across the globe; demanding that health services respond by realigning their provision to meet the demand of unusually high numbers of acutely ill, or worse, end-of-life patients. This has resulted in nurses being redeployed; oftentimes finding themselves in practice areas that were unfamiliar, or working directly with high risk patients in technically demanding and intensive environments. Furthermore, nurses may have been confronted with emotional challenges of caring for large numbers of dying patients, distraught families (sometimes aggressive), fears of becoming infected themselves, or infecting their own families (1). Understandably, situations such as these, will add significant stress to an already demanding job (2), not to mention staff who may have pre-existing mental health issues (3). For staff who have already experienced the consequences of the first surge of Covid-19, they may be now fearful of the next spike in Covid-19 cases.
The World Health Organisation (WHO) (2020) has provided guidance to look after psychosocial health during the pandemic and considers specifically healthcare staff. However, the list of behaviours such as ‘avoid unhealthy food and alcohol’ and ‘ensure rest and respite between shifts’ are somewhat idealistic and fail to bridge the intention-behaviour gap (7). Afterall, nurses know they ought to eat well, sleep well and avoid alcohol, but overcoming habitual behaviour when feeling stressed is easier said, than done. And how do nurses address the shortage of skilled staff to operate ventilators, or specialised equipment, unless they opt to work extra hours? Given the current situation of nursing shortages, Covid-19 presents a moral obligation on staff to do what they do in ‘helping others’, however, how much perceived control do our nurses really have, given that staff numbers are reduced, and clinical demand is high? Therefore, this advice from WHO offers little resolution to the reality of many nursing staff.
Recognising the multidimensional causes of stress on nurses is essential in order to provide appropriate wellbeing interventions. The RCN, MIND, the NHS have all developed resources to support mental wellbeing in practice during Covid-19, and include items such as risk assessments, and toolkits. Specific interventions might include one-to-one counselling, supervision, group-reflection and mindfulness activities. Signposting has been integrated on staff Intranet pages and many NHS Trusts developed ‘Wellbeing/Wobble Rooms’; allocated and comfortable spaces, with supportive staff available on hand (including chaplaincy services) to signpost to further support. But are these really accessible? Can nurses leave their work area, when they experience overwhelming emotions, or competing needs such as acutely ill patients and low staff numbers demand their focus remains on delivering patient centred care in that very moment? Furthermore, there are some schemes that have been put in place to support international staff to return home, to support their families without financial penalty, facilitating the necessary emotional and practical support families need. However, this degree of financial (and vicarious emotional) support will not be found across all employers, particularly smaller businesses, and assumes that nurses from overseas have the funds available to purchase a return fare, which can be as high as £1500 each, for some destinations.
Research shows that therapeutic touch and the therapeutic relationship are important factors to success in receiving psychological support (8), and it is unclear whether online support really achieves this. Therefore, are some of these initiatives merely superficial? Importantly, establishing whether nurses are accessing and utilising the supportive interventions needs to be established, whether the said interventions are indeed timely enough, and monitoring the effectiveness of these interventions is essential. Afterall, it is of little benefit if interventions fail to meet the real-time emotional and psychological needs of the nurse, to reduce any risk of longer term sequalae such as c-PTSD, with consequences that result in absence from patient care, or worse, as leaving the profession.
At the time of writing, Covid-19 appears to be here to stay for the foreseeable future. It is time we took our nurses wellbeing seriously and make a commitment to look after the very people who look after us in our hour of need.
- MIND & NHS Employers Our Frontline https://www.mentalhealthatwork.org.uk/ourfrontline/
- MIND How to look after your mental health as a nurse https://www.mind.org.uk/workplace/coronavirus-and-work/being-a-nurse-during-coronavirus/
- NHS Employers How are you feeling today? Toolkit. https://www.nhsemployers.org/retention-and-staff-experience/health-and-wellbeing/taking-a-targeted-approach/taking-a-targeted-approach/how-are-you-feeling-today-nhs-toolkit
- Every Mind Matters https://www.nhs.uk/oneyou/every-mind-matters/
- RCN Covid-19 and your mental wellbeing https://www.rcn.org.uk/get-help/member-support-services/counselling-service/covid-19-and-your-mental-wellbeing
- Walford J. COVID-19: amid fear and anxiety, we must look after each other [Internet]. RCNi. 2020 [cited 2020 Sep 14]. Available from: https://rcni.com/nursing-standard/opinion/comment/covid-19-amid-fear-and-anxiety-we-must-look-after-each-other-159301
- World Health Organisation. Mental health and psychosocial considerations during the COVID-19 outbreak [Internet]. 2020 [cited 2020 Sep 14]. Available from: https://www.who.int/publications/i/item/mental-health-and-psychosocial-considerations-during-the-covid-19-outbreak
- Kinman G, Teoh K, Harriss A. Supporting the well-being of healthcare workers during and after COVID-19. Occup Med (Lond). 2020;70(5):294–6.
- Tehrani, N., Colville, T., Fraser, J. J., Breslin, G., Waites, B. B., Kinman, G., … & Grant C. Taking trauma related work home – advice for reducing the likelihood of secondary trauma. Br Psychol Soc. 2020;60(2):133–138.
- Ford S. Nursing Times survey reveals negative impact of Covid-19 on nurse mental health [Internet]. The Nursing Times. 2020 [cited 2020 Oct 2]. Available from: https://www.nursingtimes.net/news/mental-health/exclusive-survey-reveals-negative-impact-of-covid-19-on-nurse-mental-health-29-04-2020/
- Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, et al. Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China. Psychother Psychosom. 2020;89(4):242–50.
- Sheeran P, Webb TL. The Intention–Behavior Gap. Soc Personal Compass [Internet]. 2016;10(9):503–18. Available from: http://eprints.whiterose.ac.uk/107519/3/The Intention-Behavior Gap R1.pdf
- Coakley AB, Barron A-M, Annese CD. Exploring the Experience and Impact of Therapeutic Touch Treatments for Nurse Colleagues Amanda. J Rogerian Nurs Sci. 2016;22(February):1–10.