Impact of Covid-19 on Mental Health of Critical Care Nurses

Copyright © 2020 Thamer Alduraywish. This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and work is properly cited. Who hasn’t heard about COVID-19? It’s an emerging disease from a Series of Coronaviruses (SARS-COV2) that originated in the city of Wuhan, China in December 2019. COVID-19 is characterized by its rapid spread and it’s already affected almost all countries in the world. The coronavirus was identified as a global pandemic by the World Health Organization (WHO) on 11 March 2020. Many countries started implementing strict preventive measures in order to control its spread. Any negligence while handling this pandemic might lead to serious and destructive consequences in the healthcare system, as it already has in some countries.

Who hasn't heard about COVID-19? It's an emerging disease from a Series of Coronaviruses (SARS-COV2) that originated in the city of Wuhan, China in December 2019. COVID-19 is characterized by its rapid spread and it's already affected almost all countries in the world. The coronavirus was identified as a global pandemic by the World Health Organization (WHO) on 11 March 2020. Many countries started implementing strict preventive measures in order to control its spread. Any negligence while handling this pandemic might lead to serious and destructive consequences in the healthcare system, as it already has in some countries.
Due to the rapid spread of SARS-COV2 and an increasing number of patients, people have become worried about the availability of Personal Protective Equipment (PPE), and other lifesaving equipment, including mechanical ventilators. Healthcare workers are at the highest risk of getting infected by SARS-COV2. Particularly, critical care nurses are facing challenges while providing the necessary care to the most critical cases of COVID-19; they are concerned about their own health and the health of their family members. They are afraid of contracting the virus and passing it to their loved ones. Due to these factors, the nurses are working under extremely stressful conditions. Besides, the overload of intensive care units, shortage of nursing staff linked with long working hours, and the deficit of knowledge about the new disease can cause a lot of stress and anxiety to the nurses. Some of the older patients denied lifesaving solutions (such as being connected to mechanical ventilators) and offered them to the younger patients instead, which led to a great deal of moral distress [1].
What is MORAL DISTRESS? It is intense psychological distress that is characterized by consequences of actions. It is a condition in which a person knows what is right and what they have to do, but they face restrictions in doing so. Moral distress is the biggest challenge faced by the nurses, since their internal conflict caused by the factors mentioned above threatens their values and principles. Moreover, moral distress may even force some nurses to quit their job. Attending webinars to enhance their knowledge about COVID-19, ensuring safety and following official guidelines, such as the Centers for Disease Control and Prevention (CDC) guidelines, might help avoiding moral distress [2].
A pandemic has an unprecedented impact on mental health after its demise. Critical care nurses may suffer from short-term and long-term mental health problems, such as sleep disorders, anxiety, Post-Traumatic Stress Submit Manuscript . 02 .

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Disorder (PTSD), and depression [3]. After all, they are the ones on the front line fighting this pandemic. We believe that any situation can be tackled if dealt with carefully. In such critical condition, nursing managers can formulate appropriate strategies to ensure safety of the nurses dealing with patients in acute care. Nurse managers are overwhelmed by stress during the COVID-19 outbreak too, as they are dealing with other important duties, such as participating in the disaster command center, preparing for patients' flow and planning for the days ahead. They prove their role is crucial by demonstrating outstanding management skills that help the units run more smoothly, and helping the nursing staff use their resources effectively during this stressful time.
There are some ways to help nurse managers mitigate this stress during the COVID-19 outbreak. Nurse managers should emphasize that we are all going through this experience together, therefore we should all focus on teamwork. They should also involve nurses in the process of decision-making and implementation of the plans. This will allow the staff to explore alternative solutions and reduce their stress levels. Proper communication is the best tool for maintaining psychological stability. Meetings must be arranged to discuss everybody's roles and give everyone praise for their efforts. It is vital to give nurses the appreciation and acknowledgment they deserve, especially considering their work is absolutely necessary in such demanding circumstances. Nurse managers must ensure the safety of their staff by providing relevant and up-to-date information about COVID-19 and making flexible working schedules [4].
Regardless of how difficult the situation is, critical care nurses have to keep working hard to save the lives of patients suffering from COVID-19. At the same time, nurse managers must have a resilience program in place to alleviate the stress levels and motivate the nurses to work efficiently in these challenging times. A resilience program is an interactive process, which helps the nurses properly adapt to any stressful environment. Nurse managers can prepare an effective resilience program using strategies such as a supportive social network, maintain the wellbeing of the staff, and introduce coping skills to avoid burnout. As social distancing is very important during COVID-19, nurses have to stay in touch with their loved ones to stay sane. They can use phone or Face Time calls, text messages and other technologies to keep them motivated [5]. Peer support is incredibly important during this work overload. Encouraging communication and appreciation of each other can play an important role in the staff's mental health. Nurse managers should focus on enhancing the coping skills and resilience of their nurses amidst the COVID-19 pandemic. Nurses must feel heard, protected and supported, and they should have access to the latest guidelines for treating patients with COVID-19 [6]. Organizational strategies must be molded in a way that they create a psychologically peaceful and safe environment for the nurses. Nurse managers should promote transparent leadership, organizational resilience, and other techniques to support their nurses. Critical care nurses should foster self-management strategies as well. These include continuous physical and mental monitoring, sleeping well, following a healthy diet and taking short breaks to cope with mental stress and improve resilience against moral distress [7]. Another step that may help in decreasing stress levels is participating in short-term trainings and therapy designed by psychologists. These will help nurses gain control over their lives and empower them to move forward. Short sessions with psychotherapists can be arranged. It is a dynamic way to let the nurses express themselves, communicate, and relax their minds [8].
It is true that COVID-19 has a very disturbing impact on the mental health of nurses and unfortunately it is impossible to prevent it completely. There is a dire need for a collective supporting framework, through which they could face this pandemic without any stress. Self-care is very important and it can help the nurses cope with this pandemic. They do such an amazing job taking care of others; they should not neglect themselves. Developing personal resilience in the nursing staff should be given a priority in order to maintain their mental health. Time is the best healer; it will heal all the wounds mentally and physically, but we are facing a breaking point. It is especially crucial for the critical care nurses who are exposed to this deadly virus through caring for patients in critical condition. Nurse managers and hospital leaders must support them to reduce the short-term and prevent the longterm effects of COVID-19.