Watching patients—or even colleagues—suffer or die, not being able to protect yourself with the right personal protective equipment (PPE), worry about exposing loved ones, and the challenge of balancing it all contribute to an immeasurable psychological burden for nurses and other healthcare professionals during a pandemic. Studies show that the effects are serious, leading to post-traumatic stress, anxiety, depression, and, in some cases, suicide among providers.
In their article in a special section of the February 2021 issue of the Clinical Journal of Oncology Nursing dedicated to nursing during the COVID-19 coronavirus pandemic, Shah et al. discussed the potential psychological consequences of nursing during a pandemic and shared recommendations to support a psychologically healthy work environment.
Pandemics Increase Stress for Nurses
Shah et al. explained that the sheer volume of people affected by a pandemic takes an emotional toll on healthcare providers who have dedicated their lives to healing. Not only are nurses and other healthcare providers working long hours with a highly contagious patient population, but they also face ethical and moral distress when cases peak: allocating limited resources and confronting the reality that not everyone can be treated.
Oncology nurses specifically have stressors related to their vulnerable patient population. Although they’re not putting themselves on the front line of the fight against the virus, they worry about infecting their patients who are at higher risk for complications or death from the disease. And nurses have all this added to the general stress of pandemics on society, such as finding new childcare arrangements, low consumer product inventory, and concerns about infection outside of the clinical setting.
Preliminary studies are showing that COVID-19 has reduced sleep quality and increased stress, psychological distress, insomnia, post-traumatic stress, anxiety, and depression among all members of society—and healthcare workers had the second-highest psychological symptom burden, falling only behind individuals who tested positive for the virus. Meta-analyses and systematic reviews have reported high levels of fear, insomnia, psychologic distress, burnout, anxiety, depression, post-traumatic stress disorder, somatization, and stigmatization among healthcare workers, with the highest rates in women and nurses, Shah et al. said.
Health Systems Can Address Psychological Distress
Shah et al. provided a three-step process that healthcare systems can use to support their staff’s psychological and emotional needs during a pandemic.
Foster an environment of psychological safety: Create a culture of trust and transparent communication. Seek out healthcare workers’ insights and lived experiences through focus groups and online forums, which can also serve as support systems for providers to learn from each other. Add pandemic training and scenarios to staff education programs, using simulation to expose nurses to the realities of managing patient and self-care during a pandemic.
Identify the signs of psychological distress: Validated screening tools (e.g., Generalized Anxiety Disorder Scale, Primary Care Post-Traumatic Stress Disorder Screen, Patient Health Questionnaire-2, Brief Symptom Inventory, Symptom Checklist-90–Revised, Depression Anxiety Stress Scale-21, General Health Questionnaire-28) are the gold standard for measuring distress, but even informal measurement through self-reported outcomes can identify staff who need additional psychological support.
Destigmatize self-report: Nurses may believe that they could be devalued, dismissed, dehumanized, or discouraged, in addition to being perceived as less competent or reliable, if they speak up about experiencing psychological challenges and ask for assistance, Shah et al. said. They proposed solutions such as having leadership and senior staff share their own mental health challenges and needs, providing training to destigmatize the need for psychological support, and promoting a safe and supportive environment in which to self-disclose mental health needs.