photo by: Kindel Media
Do you remember where you were, or what you were doing on March 11, 2020 when the World Health Organization (WHO) declared Covid-19 as a pandemic? About a week prior, I was having lunch with a friend and fellow nurse, and we just thought the notion of a pandemic was completely absurd and that the dust would assuredly settle, and life would resume, as usual. It didn’t fully hit me until I decided to go out for groceries with my young daughter, 10 months at the time. When I arrived at the grocery store, it was sheer chaos. I had barely set foot in the store and I encountered frustrated and frightened shoppers, pushing me and my daughter’s stroller to get past. We left immediately, in a daze at what I had just encountered. Did you think this would just blow over? Did you share that same experience? Did you fully realize just how serious this was? Were you unnerved? Even still, over a year later, and I am still in disbelief. Are you as well?
The upshot of the Covid-19 pandemic is that is presents as an emerging health concern. We know the psychological toll it will unavoidably take on the mental health and well-being of all, as it will likely persist for much longer than we can comprehend at this time. These psychological impacts are pervasive, affecting each and every one of us in a cascading effect, ultimately changing and shaping our lives into one we never imagined, taking us to a new sense of normalcy that is drastically and markedly different from the one we’ve always known (Hotopf, et al., 2020).
The psychological influence from this pandemic is overwhelming and ubiquitous. We’ve endured the shutting down of schools, restaurants, shopping, workplaces. We’ve felt the pang of loneliness through self-isolation from our family and friends. Our homes instantaneously became makeshift workspaces and school classrooms for some, but for others, particularly the frontline workers from various work sectors, including nurses, we had to leave the confines of our safe home and our loved ones behind, and we continued to go to work with great trepidation. And with good reason! Nurses are faced with concerns of insufficient supply and quality of personal protective equipment (PPE); inadequate staffing complement and long working hours; isolation from loved ones and while managing family responsibilities; concern for patients; and at an increased risk of contracting Covid-19 themselves (Stelnicki, Carleton, & Reichert, 2020). The diagram below, by Crowe, et al., 2021 illustrate the various factors which contribute to overall psychological distress, anxiety, and fear.
Prior to Covid-19, an estimated 20% of Canadians would experience a mental health illness in any given year. Research on the mental health individuals during unanticipated disasters, such as Covid-19, now assert a heightened prevalence of mental illness, particularly for healthcare workers, who are already predisposed to higher risk of burnout/compassion fatigue even without the onset of a pandemic! (Gardiner, DeMuy, & Tran, 2020).
The Canadian Nurses’ Association (CNA) highlights the following key messages regarding Covid-19 and the mental health of nurses:
· Mental health is just as important as physical health
· It is normal to experience fear, apprehension during these difficult times
· Nurses are experiencing unprecedented challenges due to work related stressors
· Additionally, nurses also experience the same stressors as the rest of the population
· 67% of nurses report feeling anxious, overwhelmed, or unsafe
And with that, we need to consider the construct of “moral injury” to describe the “overwhelming demands for which one feels unprepared and where actions or inactions challenge an ethical code”. Moral injury is unquestionably associated with difficult emotions and can result in the development of mental illnesses, such as depression and post-traumatic stress disorder (PTSD) (Tracy et. al., 2020), specifically in relation to the Covid-19 pandemic.
Do you remember SARS? Were you a practicing frontline worker at that time? Do you know that 50% of the fatalities during the SARS epidemic were front line workers? Past studies conducted have found that PTSD, anxiety, depression, irritability, delirium, mistrust, and even suicidal ideation were all prevalent amongst the nurses who provided care to SARS patients? With the development of these mental health challenges, we know the outcome effects can include loss of appetite, fatigue, sleep disorders, irritability, apathy, and a sense of hopelessness (Puradollah & Ghasempour, 2020).
How do we focus on the mental health and well-being of healthcare providers, such as nurses? We all know that supporting nurses psychologically is fundamentally important to the nurses’ own well-being, but that in what translates into safe and competent patient centered care. However, ensuring this well-being requires a multitiered response, with varying components needed at different times (Maben & Bridges, 2020). Nelson and Lee-Win (2020) assert that hospitals and healthcare facilities should demonstrate support through employee assistance programs (EAP), which enable healthcare workers to connect with mental health professionals for appointments and services. This is an ethical reciprocity tenet, wherein, the nurse provides care to patients with Covid-19 or another emerging disease, and the hospital ensures that the healthcare provider has adequate access to appropriate PPE, and that they receive the necessary and individually specific level of support in order to maintain their wellbeing while caring for very ill individuals (Puradollah & Ghasempour, 2020).
It is imperative to grasp the many factors which influence a nurse’s mental health, particularly during a pandemic. Kim, Quiban, & Montijano (2021) report that recent studies have found that there are various factors while influence the mental health of nurses, particularly during Covid-19. The impact of these factors often result in stress, anxiety, and depression. However, there is a gap in research to learn about the association between these factors and their corresponding coping mechanisms which nurses are utilizing during this chaotic time (Kim, Quiban, & Montejano, 2021).
Some ways in which to mitigate the affects of Covid-19 on nurses and healthcare providers to improve their mental health during these unmatched times:
· Organizational: open communication, transparency, comprehensive organizational risk assessments, sufficient and appropriate staffing, access to appropriate PPE and better information about the supply of said PPE; rapid virus testing, extensive training, and assisting with the nurses’ physical needs such as meals during work, laundering of uniforms, and assistance with paying for lodging while in isolation (Stelnicki, Carleton, & Reichert, 2020).
· Researchers: working with healthcare workers to track psychological stress throughout Covid-19, evaluate the organization’s responsiveness over time to mental health training, post crisis debriefing, and the response to incidents, with the intention of informing best practice promoting forward (Stelnicki, Carleton, & Reichert, 2020).
Please click on this link, to see a compilation of resources and supports during Covid-19 from the Registered Nurses of Ontario (RNAO).
Additionally, the Mental Health Commission of Canada (MHCC) has a mental health first aid Covid-19 self-care and resilience guide
References
Canada Nurses’ Association. CNA. (2020, May 20). CNA’s Key messages on COVID-19 and mental health. Coronavirus disease COVID-19. From https://cna-aiic.ca/-/media/cna/covid-19/cna-key-messages-on-mental-health-re-covid_e.pdf?la=en&hash=9A63AA5778DBD2B7E90E163A0E2E24AD4DDC266E
Crowe, S., Howard, A.F., Vanderspank-Wright, B., Gillis, P., McLeod, F., Penner, C., & Haljan, G. (2021). The effect of COVID-19 pandemic on the mental health of Canadian critical care nurses providing care during the early phase pandemic: A mixed method study. Intensive & Critical Care Nursing, 63. From https://doi.or/10.1016/j.jccn.2020.102999
Gardiner, M., DeMuy, A., & Tran, N.K. (2020). Here4hHealthCare: A response to the emerging mental health crisis of the frontline healthcare workforce. Canadian Journal of Community Mental Health, 39(3), 85-88. From https://doi.org/10.7870/cjcmh-2020-021
Galehdar, N., Kamran, A., Toulabi, T., & Heydari, H. (2020). Exploring nurses’ distress during care of patients with COVID-19: A qualitative study. BMJ Psychiatry, 20. From https://doi.org/10.1186/s12888-020-02898-1
Hotopf, M., Bullmore, E., O’Connor, R.C., & Holmes, E.A. (2020). The scope of mental health research during the COVID-19 pandemic and its aftermath. British Journal of Psychiatry, 217(4), 540—542. From https://doi.org/10.1192/bjp.2020.125
Kim, S.C., Quiban, C., Sloan, C. & Montejano, A. (2021). Predictors of poor mental health among nurses during COVID-19 pandemic. Nursing Open, 8(2), 900-907. From https://doi.org/10.1002/nop2.697
Maben, J., & Bridges, J. (2020). COVID-19: Supporting nurses’ psychological and mental health. Journal of Clinical nursing, 29(15/16), 2742-2750. From https://doi.org/10.1111/jocn.15307
Mental Health Commission of Canada. MHCC. (2021). Mental health first aid COVID-19 self-care & resilience guide. Mental Health First Aid Canada. From https://www.mhfa.ca/en/blog/mental-health-first-aid-covid-19-self-care-resilience-guide
Nelson, S.M., & Lee-Winn, A.E. (2020). The mental turmoil of hospital nurses in the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice and Policy, 12(s1), s126-s127. From https://doi.orr/10.1037/tra0000810
Puradollah, M., & Ghasempour, M. (2020). Necessity of attention to mental health of frontline nurses against COVID-19: A forgotten requirement. International Journal of Community Based Nursing & Midwifery, 8(3), 280-281.
Registered Nurses’ Association of Ontario. RNAO. (2020, April 8). Mental health and well-being: Resources for psychological support during the COVID-19 pandemic. From MH_and_Well_being_Psychosocial_supports_during_Covid_19_-_April_9.pdf (rnao.ca)
05/MH_and_Well_being_Psychosocial_supports_during_Covid_19_-_April_9_0.pdf
Stelnicki, A.M., Carleton, R.N., & Reichert, C. (2020). Nurses’ mental health and well-being COVID-19 impacts. Canadian Journal of Nursing Research, 52(3), 237-239. From https://doi.org/10.1177/0844562120931623
Tracy, D.K., Tarn, M., Eldridge, R., Cooke, J., Calder, J.D.F., & Greenberg, N. (2020). What should be done to support the mental health of healthcare staff treating COVID-19 patients? The British Journal of Psychiatry: the Journal of Mental Science 217(4), 537-539. From https://doi.org/10.1192/bjp.2020.109
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