The month of May has been designated as Mental Health Awareness Month, and International Nurses’ Day is also being celebrated on May 12. Today the emotional well-being of nurses is being challenged like never before by COVID-19. Long hours caring for patients, fears about contracting the virus, separation from loved ones – the pressure on nurses has been unrelenting since March last year, especially in hard-hit countries like India.
To discuss this important issue, Omnia Health Insights spoke to Dr Shekhar Saxena, Professor of the Practice of Global Mental Health at the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health. A psychiatrist by training, he has served in the World Health Organization (WHO) since 1998. His expertise includes providing advice and technical assistance to policymakers on prevention and management of mental, developmental, neurological and substance use disorders and suicide prevention.
Dr Saxena explained the toll of COVID-19 on frontline workers and what nurses need to do to take care of themselves. Excerpts:
What has been COVID-19’s impact on mental health especially for frontline workers?
COVID-19 is a very major public health crisis all over the world. We know that it's infecting a lot of people, giving rise to severe illness, and unfortunately, many people are dying. But the mental health impact of COVID-19 has been underestimated. It has had a major impact on people's mental health and well-being. For instance, those who were coping well, now find it more difficult to cope. Those who had some psychological symptoms previously, now find these to be more severe. And for those with a mental disorder, their condition became much more disabling. COVID-19 is demonstrating that mental health is very important for all of us and not just for those people who have a mental disorder.
What has been the impact of COVID-19 on the mental health of frontline nurses in India?
COVID-19’s mental health impact has been on everybody. But on healthcare providers, including doctors, nurses and other staff, it's having a very severe impact. Take the example of nurses who have to work long hours, sometimes all through the day and night, and hardly get any time for rest, sleep or even to eat. They are wearing personal protective equipment (PPE) which are essential, but uncomfortable, especially if the temperatures and humidity are not controlled well. They also have the risk of infecting themselves. Unfortunately, many of them have got infected, and some have died because of infection. There is a lot of fear besides overwork and uncertainty and the danger of infecting their loved ones. All of this has given rise to severe mental stress and in some cases, brought out anxiety and depressive symptoms. It's also compounded by losses in their family and those at work.
In some cases, this is going to give rise to complete burnout, which is bad for nurses but it's also bad for public healthcare systems because we have a deficiency of nurses. And if we lose some of them it is going to increase the crisis that we are facing now and in the long term.
What are some of the strategies that frontline health workers, like nurses, can use to protect their mental health during these uncertain times?
It's our responsibility to look after ourselves besides looking after others. I think that applies very clearly for healthcare providers, especially for nurses. When you are flying, the airlines announce that if there is an emergency, put your own oxygen mask first before you put it on others. The same should apply to healthcare providers. While helping patients is always on their mind, they won’t be able to help if they don't look after themselves. So, they need to practice self-care, especially to manage their stress levels, such as getting proper sleep, rest and exercise.
Yes, work is important but it's also important to look after oneself and that is a very important message because most of the time, frontline workers are working and not looking after themselves, which over a long time is going to have adverse effects.
Implementing certain measures will also be useful. For example, the need to have a daily routine, which is as regular as possible, because, if you do night duty and day duty and have an irregular schedule, then your body and mind can’t have enough time to rest. I know that it is difficult to implement, but they can try. Even in the middle of a busy situation, if they can take five minutes out to sit, reflect, and do breathing exercises, that would be helpful. They should also look after themselves and other colleagues because by helping others they will be helping themselves.
I know that many of the nurses are seeing very seriously sick patients and sometimes they die, for no fault of theirs. They should realise that these are things they can’t control and shouldn’t blame themselves for those.
What role can hospitals and healthcare institutions play in mitigating the negative psychological impact? What support should they provide?
Hospital administrations and supervisors have a big responsibility to see to it that nurses are not put in difficult situations. Their work schedule should be kept as regular as possible to allow some time for rest and recuperation. You can flog somebody so hard that you can get some extra work done today, but tomorrow will be another story. So, they need to plan medium and long term to see to it that the pressures are not too much and there should be enough staff so that the work can be done satisfactorily, and nobody is put under tremendous emotional pressure.
They should also take responsibility for providing enough safety precautions. For example, PPEs and other equipment which are there are for safety and security and also for patient care, should always be provided so that the nurses and other healthcare providers can work to their optimum level. They also have a responsibility to encourage discussion and be open to discussing with nurses any problems that they are they are facing and try to solve them as much as possible.
The subject of stress, anxiety, depression and frustrations, which are very common nowadays, should also be discussed so that there is somebody to listen to, and there is somebody to do what is possible to decrease some of the pressures. Listening helps a lot. If a supervisor can take out 10 minutes of their time and talk to nurses about the emotional, and psychological factors, they are facing that can be helpful because listening and talking is the first step towards decreasing stress.
Lastly, they need to see to it that if there is anybody who is suffering from excessive stress, or anxiety and depression, then help, such as counselling, should be provided to them quickly and effectively without any stigma.