Nursing is not a profession for the fainthearted, but new research shows that post-traumatic stress disorder (PTSD) can strike nurses, and suggests the new coronavirus may make things even worse for those on the front lines of the pandemic.
Though the study was conducted a year ago, the results are particularly timely as nurses around the world are treating millions of Covid-19 cases in incredibly trying conditions, the researchers noted.
Study author Michelle Schuster, a registered nurse at Boston Children's Hospital, noted that many aspects of the novel coronavirus have the potential to increase PTSD rates among nurses. For example, frequency of coronavirus exposure and workplace frustrations may be heightened. To make matters worse, self-isolating means that nurses may no longer be able to draw on physical closeness with family and friends for social support, she added.
Judy Davidson, a nurse scientist at the University of San Diego who has studied suicide rates in nurses, agreed.
Awareness is key
"We know from experiences with SARS, Ebola, and even the Chinese experience with Covid-19, that pandemics result in panic disorder, stress disorders, depression and suicide," said Davidson, who wasn't part of the study. "Now more than ever, we need to be proactive in our approach to finding people at risk."
In the study, published early in May in the Journal of Clinical Nursing, Schuster and her colleagues analysed 24 previously published articles about PTSD in nurses. Their analysis highlights that PTSD is a growing concern in the nursing profession, likely related to a combination of workplace conditions, interpersonal relationships, and personal coping skills.
"Many people are unaware that PTSD can happen in individuals not connected with the military," Schuster said. "Awareness is key. Once there is more acknowledgement, we can find, develop and promote interventions to support a nurse's well-being."
PTSD prevalence rates varied widely in the articles studied, likely due to the use of five different PTSD measuring assessments across research institutions. Schuster says determining accurate prevalence rates will be an important area of further research.
The final review identifies four major themes associated with work-related PTSD among nurses: the workplace, relationships, patient connections and interpersonal strengths.
Environmental aspects such as a nurse's role in the hospital, level of exposure to disturbing experiences and organisational support can contribute to PTSD.
A crisis intervention tool
Additionally, relationships at work and at home as well as relationships to patients, especially those suffering or dying, can add to the problem. Interpersonal strengths such as coping ability and resilience may shield nurses from the development of PTSD.
Davidson cited peer emotional support and programmes like Code Lavender, a crisis intervention tool to support workers, volunteers or patients in Cleveland Clinic hospitals.
Schuster added that it is important to find what support systems already exist within a hospital. Once identified, a nurse can connect with those resources.
To foster resiliency in her own workplace, Schuster began working with nurse colleague Dennis Doherty to create a series promoting resiliency through the Association for Nursing Professional Development. Originally, the content was to be offered through an interactive classroom format, but it has since been adapted for online access.
In the future, Schuster plans to continue studying mental health and PTSD in nurses, specifically examining those within her own field of paediatric haematology and oncology. By starting conversations through her research, she says she hopes to promote mental health awareness for nurses before, during and after Covid-19.
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