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COVID trauma, burnout, stress rising among critical care nurses: study

Conflicting instructions intensifying nurses’ mental health concerns, researchers find
According to a new study, many Canadian health care workers have felt unable to keep up with practice changes, and fear this has resulted in inadequate patient care

At least half of critical care nurses have experienced probable or significant post-traumatic stress disorder symptoms as a result of the pandemic, new research indicates.

A report by researchers from the University of British Columbia, University of Ottawa and Fraser Health Authority says nurses in critical care units have received multiple and inconsistent messages from managers, infection control officers, federal and provincial governments and the media about treating COVID patients.

They began to fear that their inability to keep up with practice changes resulted in less-than-adequate patient care while putting themselves and their colleagues at risk.

“You never knew who had the actual truth and who didn’t,” one respondent said. “It would be nice to have a set day or time for new communication to come out too, so you wouldn’t be worried that as you’re caring for a patient with COVID that there’s a new email waiting with some important piece of information that you have no time to read or even know that it’s there.”

The situation created frustration and a lack of trust, the researchers found in the report, released in April.

And, nurses accustomed to providing family-based care found themselves in new territory.

“It’s been really emotional communicating to family members who cannot be present with their loved ones,” one nurse said.

“It has been emotionally draining to see the critical level of illness that some individuals have experienced, as well as the emotional roller coaster of the patients and families,” said another. “It has been very troubling to observe patients go through this experience without the physical presence and emotional presence of their loved ones.”

Other nurses reported families getting special permission to visit a loved one before they died.

“It sucks that we can get special permission for a couple of family members to come in right before they die, but sometimes they haven’t seen them in weeks and when they see them all swollen with lines and tubes for the first and last time it’s awful,” the nurse said.

All of this, said one nurse who’s experienced PTSD, means more needs to be done to help affected workers navigate difficult psychological terrain.

“I don’t think people are even given the opportunity to process their feelings,” nurse Cecilia Yeung told Glacier Media. “A lot of nurses are exhausted. They are staying out of courtesy, out of loyalty.”

Psychological distress is the most pressing challenge experienced by nurses during the initial COVID-19 response, the report said.

The study found 37.6% had significant symptoms of PTSD and 12.8% had probable symptoms.

Some 6.4% were showing severe depression with 26.6% indicating moderate depression. About 14.7% exhibited moderate anxiety, 5.5% severe anxiety and 21.1% extreme severe anxiety.

While 45% showed normal stress levels, severe or extreme severe was exhibited in 11% of respondents.

Participants described feeling anxiety, worry, distress or fear, which appeared to be related to rapidly changing policy and information, overwhelming and unclear communication and the need to meet patient care needs in new ways while staying safe or managing home and personal commitments to self and family.

The report aligns with previous research finding increased feelings of stress and difficulty coping among other healthcare workers outside the realm of critical care registered nurses providing direct patient care.

Yeung said that with the second wave gone and the third continuing, the mental stress on health care workers continues.

She said what health workers need is access to what she calls psychological personal protection equipment.

Yeung wants the Ministry of Health to step up with such supports.

“We know that burnout leads to physiological damage,” she said.

Yeung, who lives with PTSD, wants to do what she can as well. But, she’s looking for help.

“I’m hoping to host sessions and talk to nurses, give them a safe space,” she said.

Yeung said terms such as ‘self care’ or resilience’ have lost their meaning from being over-used.

But, she adds, self-care is the name of the game in managing mental health.

“Have time for yourself, connect with your body. Express fear, anger, frustration,” she said. “Identify feelings first, acknowledge them.”

It’s about ridding oneself of negative emotions, she said.