Effects of Covid-19 on Nurse’s Mental Health
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Coronavirus (Covid-19) is an illness that results from a novel coronavirus called an acute respiratory syndrome. It was first identified in Wuhan city in Hubei province China in December 2019, and the World Health Organization (WHO) declared it a global pandemic on March 11, 2020 (Rajmkumar, 2020). Since then, the Coronavirus has become a severe health crisis that the world has faced since the end of world war two. All the continents of the world except Antarctica have experienced Coronavirus’s wrath (Kang et al., 2020). Many people who are suffering from Coronavirus experience mild to moderate symptoms, which result in respiratory illness. The elderly and the people who have been suffering from medical conditions such as diabetes and cancer are at serious risk of contracting the infection. The virus has been known to spread through droplets of saliva or any other discharges from the nose.
Coronavirus has become an issue of global concern, focusing on aspects of diagnosis, prevention, and the treatment of the deadly infection (Rajkumar, 2020). However, efforts must be directed to examining and handling the health care issues affecting clinicians and all the other healthcare workers who are participating in taking care of Covid-19 patients. According to a study carried out on more than 1200 workers from the healthcare sector and published by JAMA Network Open, there were more than 10,000 patients who required intensive care in China. The research further stated that most healthcare workers were suffering from psychological distress, depression, insomnia, and anxiety (Kang et al., 2020). Additionally, most healthcare workers suffering from mental health problems were those attending to patients suffering from Covid-19. Further, women were found to be more affected by psychological issues more than men.
Like Covid-19, Tuberculosis, and Influenza (Flu) are some of the highly infectious diseases that primarily affect the respiratory system. These highly contagious diseases spread from one person to another through the spread of infected droplets ejected from a person’s mouth when they speak, sneeze, cough, or even sing. According to Disease Control and Prevention (CDC), as mentioned by Fleming (2020), influenza cases estimate that there have been 13 million influenza illnesses, 120,000 hospitalizations, and 6600 flu-related deaths. On the other hand, “about 10 million people fell ill with tuberculosis (TB), and about 1.5 million dies in 2018” (WHO, 2020). In the study conducted by the group of Helen Bernard last September 2009, during an influenza pandemic, suggest that the risk for infectious diseases by airborne transmission might be higher for nurses than for the general population. Nurses interact frequently and intensively with potentially infected patients along their line of duty.
In the field of their duty, nurses face occupational exposure to infectious diseases with different modes of transmission. Given the procedures they are expected to conduct during their assignment, this exposure increases nurse’s fear of contagion. “In several studies, healthcare workers (HCW) expressed fear of inadvertent transmission of the disease to family and friends during the SARS outbreak. HCWs were particularly worried about more vulnerable family members such as children and the elderly”. (Koh, Hegney, & Drury, 2012). The stigma of infectious diseases shows that Covid-19 does not have any particular mental health effects on nurses. The main point of argument in this paper is that nurses and other healthcare personnel who are at the front line in the fight against the Coronavirus are at risk of suffering from mental health hazards that come with such infections.
Counter – Argument
Since December 2019, Coronavirus has been the leading cause of mental challenges in nurses and other healthcare workers as they have been at the frontline in the fight against Covid-19 (Koh, Hegney, & Drury, 2012). However, Coronavirus is not the only cause of mental challenges in healthcare workers; the working environment also may cause occupational stress on healthcare workers. Nurses develop stress from handling stressful situations and working in uncomfortable environments.
The resulting occupational stress has a substantial impact on the healthcare workers absenteeism, turnover, family life, general welfare and health. The factors behind occupational stress on nurses include huge workload, long working hours, poor supervision, disagreements between colleagues, and inadequate working conditions (Kang et al., 2020). Additionally, nurses also develop occupational stress from physical health in the hospital, such as sound effects, lighting, and uncomfortable temperature.
According to research from several hospitals in the south of England, out of 870 nurses, approximately 27 per cent were suffering from occupational stress and other mental challenges. The Health and Safety Executive in the UK states that the leading cause of work-related stress among nurses is job dissatisfaction with approximately 22 per cent of nurses every year wanting to change their employers (Worldometers, 2020).
Nurses attending to patients in the Intensive Care Unit (ICU) face severe stressful working conditions than nurses attending to patients in the other wards. As a result, a high turnover rate has been affecting nurses working in the ICU. In 2012, Koh et al. published an article stating that for every 744 ICU nurses, 11 per cent had symptoms of depression, and 18 per cent were showing anxiety symptoms. Additionally, the percentage of ICU demonstrating poor personal achievements, emotional drainage, burnout syndrome, and depersonalization were 50%, 61%, 80%, and 44% respectively (Koh et al., 2012).
The main factors leading to occupational stress among ICU nurses were the death of patients, abusive language and behaviour of patients’ families, and provision of intensive care to ICU patients (Pappa et al., 2020). Nurses face traumatic conditions while attending to patients at the ICU, and thus they are likely to suffer from anxiety, depression, and post-traumatic stress disorder (PTSD). Nurses also experience mental health challenges as a result of their working environments apart from being in the frontline in the fight against Coronavirus.
Personal Argument
However, COVID-19 that is caused by a newly discovered Coronavirus can lead to respiratory illness. “It has, in a few short months, infected more than 11, 845, 377 million people. More than 543,500 have died” (Worldometers, 2020). While there are actions we can take to help slow its spread, there’s currently no vaccine or treatment available, apparent lack of herd immunity, and it affects all ages.
While the race to find a vaccine for COVID-19 continues, modern medicine and today’s sophisticated healthcare systems go a long way to protect us from many of these organisms (Koh et al., 2012). However, even so, we are still at risk of the diseases they can cause, especially to all healthcare providers who are exposed and is at higher risk of getting infected.
Nurses and the other healthcare workers fear to take the virus from the healthcare facilities to their families. Their greatest fear is in the inadequacy of the protective gear they are supposed to use while attending Covid-19 patients. They are afraid that while visiting the coronavirus victims, they might contract the infection and later take it home to their loved ones who may be members of the most vulnerable group. Some healthcare workers live with members of the exposed group, such as the elderly, kids, and those who suffer from chronic illnesses. For instance, Dr Jessica Kiss, a family physician at California, has four young kids, and one of them is asthmatic (Pappa et al., 2020). The physician has been using only one N95 respirator mask since March 16, and she fears her children.
Her greatest fear is that she leaves for work every morning because she might contract the infection while at work and bring it home to her children in the evening (Rajkumar, 2020). On the other hand, the children are old enough, and thus they are aware of the infection and how it is spread. They also fear that their mother might bring the infection home from her workplace. The doctor fears most because she depends on only a single N95 respirator mask to protect her for a couple of months. As a result of Dr Jessica’s and others’ situations, a group of physician parents has written an impassionate letter to Congress to release the necessary protective gear from the Strategic National Stockpile (Jun, Tucker & Melnyk, 2020).
Additionally, healthcare professionals in American have also been reporting that there is a shortage of personal protective gear, which forces them to either reuse the ones they have or even opt for homemade solutions (Huang & Zhao, 2020). According to recent statistics, approximately 3,300 healthcare professionals have been infected with Coronavirus in China at the beginning of March. Further, statistics also state that about 22 healthcare workers lost their lives by the end of February. Similarly, in the United States, the American College of Emergency Physicians recorded two healthcare workers; one in New Jersey and another in Washington were severely suffering from the virus (Ahmed et al., 2020).
Nurses and clinicians are also in distress as they fear to lose their colleagues to the pandemic (Kang et al., 2020). In the course of executing their duties, some healthcare workers have been contracting the infection, and thus many have been deeply affected while others end up losing their lives. According to recent statistics, approximately 41 healthcare professionals in Italy have lost their lives due to Coronavirus. Statistics further indicate that nearly 5,000 healthcare professionals, including technicians, paramedics, doctors, and nurses, have tested positive of Coronavirus since it was first reported in the country (Mo et al., 2020). Most of the medics contracted the infection while attending Covid-19 patients in the Northern region of Italy, which was the first region to have many reported positive cases.
The gradual increase in the number of infected healthcare workers is associated with limited personal protective gear. Distress among the healthcare workers erupted when the pandemic first hit them. They were unprepared and torn between saving the lives of the citizens or saving the lives of fellow medics with the available resources (Esfandiri et al., 2014). As a result, many doctors and nurses lost their lives in the beginning when the Coronavirus pandemic hit the Northern region. The other reason associated with many of the medics contracting Covid-19 is the fact that they had little or no knowledge about the infection and how to go about it. Therefore, distress and depression erupted as the same medics that citizens depend on for fighting the pandemic have little or no knowledge on how to handle it. The number of positive cases in Italy increased drastically within a short time. As a result, at the end of March, there were approximately 80,500 positive cases in the region. The medics were deeply affected as they were struggling to save lives under depressed working conditions. The primary source of distress for the doctors was seeing Cobid-19 patients battling with their lives, and others losing their lives in total solitude when they had done all they could with the available resources to help save their lives (Rajkumar, 2020).
According to Lombardy, the situation was overwhelming, as some of them were forced to stay in the hospital and abandon their families for several weeks (Torales et al., 2020). According to recent research by the Lancet newspaper, in the Hubei region of China, where the coronavirus pandemic was first reported, approximately 70 per cent of the healthcare workers have been deeply affected mentally. Fifty out of the 70 per cent have been suffering from depression, 34 per cent were suffering from insomnia, while 44 per cent were suffering from anxiety. It is most likely that the healthcare workers in the Northern region of Italy will develop similar mental disorders (Chung & Yeung, 2020).
The shortage of personal protective gear among frontline healthcare workers is another source of mental health issues (Waldock, 2012). As the dreadful pandemic continues to spread to different parts of the world, it is becoming clear that many countries, including the United States, were not prepared enough to fight the pandemic. The preparedness has to begin from the health car personal then to patients and the general public. The lack of readiness is causing distress among the healthcare workers as they have to use the available equipment under similar working conditions to save their lives, the lives of the patients, and protect the public from contracting the infection. According to the New York Times in February 2020, nurses and other female healthcare personnel were requested to shave their heads in the region of Wuhan China for hygiene purposes while the media on the other side referred to them as the most elegant warriors in fighting the pandemic (Kang et al., 2020).
Further, the newspaper reported that healthcare workers, nurses, and clinicians reused the N95 respirator masks (Maben & Bridges, 2020). As a result, approximately 3,300 contracted the infection, while almost 22 lost their lives due to inadequate personal protective gear. On the other hand, many hospitals in the United States struggle to adequately prepare for patients who might require intensive respiratory care for long periods. For instance, the general surgeon at the United States, Jerome Adams, stated that people should stop buying and wearing masks as protective gear against Coronavirus because if healthcare personnel cannot freely access them in line of duty, then it means they are not sufficient. The nurses are also complaining that some hospitals are not adequately prepared to fight the infection because they do not have enough personal protective equipment (PPE). For instance, according to the NNU (National Nurses United), during a national survey conducted on approximately 6,500 nurses, only 30 per cent of the nurses attested that their healthcare institutions had an adequate PPE (Rajkumar, 2020).
Thirty-eight per cent of the nurses had no idea of what to answer, 63 per cent were in a position to access the N95 respirator masks, and 27 per cent were able to access complicated and expensive power enabled air-purifying respirators (Ahmed et al., 2020). However, only 44 per cent of the nurses were able to attest that their employers made efforts in educating them about the Coronavirus, that is, about diagnosis, treatment, and prevention. A shortage of information about Coronavirus has led to the national authorities’ failure to disseminate information and distress among the healthcare workers because they need for themselves as much as they are trying to save lives. For instance, the Center for Disease Control and Prevention (CDC) recommended that nurses use face masks rather than the N95 respirators due to the shortage in N95, which are more effective. Such actions put the healthcare workers at the frontline in fighting the pandemic at risk of contracting the infection while attending to patients (Torales et al., 2020).
The mental health professional may execute their help to the healthcare workers through aspects such as telehealth services such as mobile apps, virtual peer support, video visits, and other online resources. To protect and sustain the healthcare professionals who are at the frontline in fighting the Coronavirus, medical researchers and healthcare institutions have to focus on the mental health of the nurses, clinicians, and the other healthcare professionals (Kang et al., 2020). In as much as much is needed to curb the spread of the Coronavirus, healthcare organizations also have to focus on the mental and physical health of the healthcare professionals and prevent them from suffering as they try to save lives of the Covid-19 victims.
Conclusion
Nurses and other healthcare personnel who are at the front line in the fight against the Coronavirus are at risk of suffering from health hazards that come with such infections. The main form of a health hazard that nurses and other healthcare workers suffer is mental health. The sight of patients going the pain of infectious diseases, the fear of losing colleagues to the infection, and inadequate personal protective gear are some of the reasons that leave nurses and the other frontline workers with depression and anxiety. However, Coronavirus is not the only cause of mental health problems among frontline healthcare workers. Nurses and other frontline healthcare workers also suffer from occupational stress that leads to mental health challenges. Physical conditions such as sounds, lighting, and temperatures are some forms of occupational stresses that affect nurses. Therefore, state governments and healthcare organizations should adopt strategies to assist nurses and other healthcare workers in fighting occupational stress and other mental challenges related to infectious diseases such as Coronavirus.
One of the critical measures that state governments and healthcare organizations should adopt is providing adequate training on an annual basis concerning PPE’s use and how to undertake their roles in the event of a global pandemic like Coronavirus. Exercise is important as it reduces anxiety among healthcare professionals in the course of executing their duties. Additionally, state and local governments should invest intensively in healthcare systems and increase bed capacities and healthcare facilities that are important in handling patients in critical conditions. Therefore, hospitals should be fitted with modern state of the art equipment for treating critical care patients.
State and local governments, as well as healthcare organizations, should ensure an adequate supply of PPE. The shortage of PPE among healthcare professionals has been a major source of distress, especially when handling patients suffering from infectious diseases. Many are forced to reuse the available protective equipment to avoid contracting the infection and infecting their loved ones. However, governments should ensure the production of reusable respirator masks because disposable masks may be a major source of environmental waste. To ensure the effectiveness of the reusable masks, healthcare workers and the public, should be trained on the proper and hygienic cleaning, disinfection, and storage of the masks to avoid contamination. Further research can be done to establish the mental health hazards that affect healthcare personnel’s families during dreadful pandemics such as the Coronavirus.
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