The International Council of Nurses (ICN) highlighted the increased anxiety and stress for nursing staff working during the Covid-19 crisis in countries around the world. (Ford 2020)
ICN president Annette Kennedy said: “There is strong evidence that nurses are experiencing unprecedented levels of stress and are at risk of burnout, threatening their ability to continue to do their vital work.”
Mental health awareness month in may 2020 may have ended but the continuous campaign of understanding mental health awareness continues.
Care providers are well used to pressures and stress. However monitoring for signs and symptoms of when our Normal pathophysiological response to stress is becoming detrimental to our mental health can be harder to detect. Care providers may be used to running on empty, but just like an engine without fuel this can only go on so long before we bring to a halt.
We have to be careful to not fall in to the resistance trap. As care givers we often hear the term resilience used when staff continuously demonstrate ability to deal with stressful situations and intense emotional work. This status quo is consistently challenged by nurse academics as treating resilience as an individual trait is seen to ‘let organisations off the hook’ (Traynor 2018); yet has often been the focus of organisational strategies to date. This does not work at the best of times and certainly is not appropriate now in these most difficult of circumstances (Maben & Bridges).
I’m not a mental health nurse but I am a carer and nurse for 20 years who has seen, like all of us, many a crisis for our patients and organisations.
Burnout is rarely from one event but from an accumulation of stressful events and running on empty for too long. You can not force a car to run without fuel, thus it is the same for all of us to stop and care for ourselves and our colleagues.
As we continue through this pandemic I know my colleagues I speak too are feeling increased anxiety. With many concerned how they will recover from this period of continuous stress and high emotions. There is concern amongst the psychology professional groups of long term effects on care givers.
‘Hospital personnel, including caregivers, support staff, administration, and preparedness teams, all will be stressed by the challenges of a prolonged response to COVID-19, and leadership must emphasise the importance of self-care as the centre of the response. Transparent and thoughtful communication could contribute to trust and a sense of control. Ensuring that workers feel they get adequate rest, are able to tend to critical personal needs (such as care of an older family member), and are supported both as health care professionals and as individuals will help maintain individual and team performance over the long run’ (Adams & Walls 2020)
Physical signs of anxiety
Effects on your body:
- a churning feeling in your stomach
- feeling light-headed or dizzy
- pins and needles
- feeling restless or unable to sit still
- headaches, backache or other aches and pains
- faster breathing
- a fast, thumping or irregular heartbeat
- sweating or hot flushes
- problems sleeping
- grinding your teeth, especially at night
- nausea (feeling sick)
- needing the toilet more or less often
- changes in your sex drive
- having panic attacks
Effects on your mind:
- feeling tense, nervous or unable to relax
- having a sense of dread, or fearing the worst
- feeling like the world is speeding up or slowing down
- feeling like other people can see you’re anxious and are looking at you
- feeling like you can’t stop worrying, or that bad things will happen if you stop worrying
- worrying about anxiety itself, for example worrying about when panic attacks might happen
- wanting lots of reassurance from other people or worrying that people are angry or upset with you
- worrying that you’re losing touch with reality
- rumination – thinking a lot about bad experiences, or thinking over a situation again and again
- depersonalisation – feeling disconnected from your mind or body, or like you’re watching someone else (this is a type of dissociation)
- derealisation – feeling disconnected from the world around you, or like the world isn’t real (this is a type of dissociation)
- worrying a lot about things that might happen in the future
How can you help yourself?
Below tips and advice taken from the experts and will act as a reminder to check in with ourselves and ensure we are self caring.
After all, how can you provide care when you are not cared for yourself.
Talk – numbers and groups:
Reporting you need help may be the first and most important step.
You know yourself better than anyone, but we may not always recognise the early warning signs of burnout.
Long term stress can lead to PTSD, anxiety, depression and suicide so its paramount we ensure we all monitor and care for our own well-being and of those around us.
Depending where you are, there may be local counselling services already set up within your work place. If you’re not sure, ask the occupational health department or line manager.
Remember, saying your struggling is not a weakness! Getting advice early and making a self-care plan may prevent an escalation leading to chronic mental health issues.
See below links with helplines available:
There is a free webinar on managing stress for care providers on the 25th June. This course is aimed at health and social care staff as well as managers of services. Click here for a link.
In times of high stress falling or staying asleep can become an issue (we have all probably used the term to lose sleep over).
As we become more exhausted the body continues to pump out adrenaline to keep us going which in turn can make it harder the following night.
If you don’t sleep enough at night, your body boosts its levels of stress hormones. The brain chemicals connected with deep sleep are the same ones that tell the body to stop the production of stress hormones. As a result, when you don’t sleep well, your body keeps pumping out those hormones The next day, you feel more stressed, the following night you find it harder to fall asleep, and so on.
Where sleep deprivation can exacerbate symptoms of stress in periods of worry. Prolonged chronic exposure to stress can potentially lead to the increased incidence and pre-valence of metabolic disorders such as obesity and type 2 diabetes. (Hirostu et al 2015)
See below tips to try taken from the sleep foundation:
Take time to wind down.
A healthy bedtime routine allows your body and mind time to slow down before lights out. Take at least half an hour to play quiet music, take a bath, or read a book.
Steer clear of stressful activities before bed.
Leave the bill paying for earlier in the day, stay away from heated social media exchanges, and skip the evening news.
Put your to-dos on paper.
Instead of letting your brain swirl with all the things that you don’t want to forget to take care of, write them down so your brain can relax and let go.
Tense and relax.
Try this relaxation exercise in bed: Squeeze your toes for several seconds, and then relax them. Then do the same thing with your lower legs, and on up your body, feeling each part of yourself send tension packing.
Don’t lie in bed awake.
If you can’t fall asleep for more than 20 minutes, give yourself a do-over. Get up, keeping the lights low, and do something relaxing (and ideally sleep-inducing). Have a cup of herbal tea and read a book. But avoid screens: The light that they emit can signal to your brain that it’s time to wake up.
Mindfulness.Meditation may have huge benefit for taking a 10 minute time out but has also shown to have health benefits too such as:
- Reduces Stress. Stress reduction is one of the most common reasons people try meditation.
- Controls Anxiety.
- Promotes Emotional Health.
- Enhances Self-Awareness.
- Lengthens Attention Span.
- May Reduce Age-Related Memory Loss.
- Can Generate Kindness.
- May Help Fight Addictions
- Improves Sleep
- Help control pain
- Decrease blood pressure (Thorpe 2017)
Meditation Apps such as calm or headspace have free membership options. You can access these from your phone. This means you can access it anywhere with a set of headphones, although perhaps not recommended while driving!
Any form of exercise
From yoga, to taking a walk, to signing up for the coach to 5k goal, all forms of exercise can benefit mental health. Feeling exhausted at the end of the shift can mean exercising is the last thing we want to do.
Get up 10 minutes earlier to adopt 10 minute yoga session following youtube
Do a 10 minute high intensity interval training at home
Do a wind down pilates session before bed.
Ask your family to support you to do 30 min walk three times a week.
Imbedding a new form of exercise into our already busy routines can be a trial and error affair. Trying any of the 10 minute to full hour workouts available online may be more sensible when starting with a SMART goal. Such as 10 minute yoga 3 x a week. This is especially beneficial as focuses on breathing and is a form of meditation.
I hope that some of these resources have been helpful and you can share with even just one of your team members too engaging in discussion on mental health awareness at your work place.
Adams JG & Walls RM (2020): Supporting the health care workforce during the COVID-19 global epidemic. JAMA. Available online. accessed on 2nd June 2020 https://jamanetwork.com/journals/jama/fullarticle/2763136
Ford, S (2020) Global nursing body issues warning on nurse mental health during Covid-19 crisis. Nursing Times. available online. accessed 1st June 2020 at: https://www.nursingtimes.net/news/mental-health/global-nursing-body-issues-warning-on-nurse-mental-health-during-covid-19-crisis-30-04-2020/
Hirostu, C. Tufik, S. Andersen, M. (2015) Interactions between sleep, stress, and metabolism:From physiological to pathological conditions. Science Direct. accessed online 2nd June. available at https://reader.elsevier.com/reader/sd/pii/S1984006315000607?token=A5887862BDEB8E1E08F962A8FAC79A45B3EA37D046D0FD6A2D36692891EB0E8B038A53668997258231D6A3494BB3EB79
Maben, J. Bridges, J (2020) Covid‐19: Supporting nurses’ psychological and mental health. Journal of Clinical Nursing. Available online. accessed 2nd June 2020 https://onlinelibrary.wiley.com/doi/10.1111/jocn.15307
Thorpe, M (2017) 12 Science-Based Benefits of Meditation. Healthline. available online. accessed 1st June 2020 https://www.healthline.com/nutrition/12-benefits-of-meditation#section2
Traynor, M (2018) Guest editorial: What’s wrong with Resilience?.Journal of Research in Nursing;23 (10) available online. accessed 2nd June 2020 https://journals.sagepub.com/doi/full/10.1177/1744987117751458 https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/anxiety-symptoms/?gclid=CjwKCAjw8df2BRA3EiwAvfZWaMNdys0FRJTd35jKSsh05U7NLUVjVmCATvRh3vGnaFCsxToA_0PAGRoC9r4QAvD_BwE