Mental health problems is not something new to a career where putting others well-being before your own is the job and is often rewarded with ingratitude and sometimes violence. Most healthcare workers have a story of being spat on, assaulted or being cussed at all while trying to do the right thing for the patient for whom they are caring for. This type of treatment from patient and family members, confused or not take a toll on the recipients of this hurtful behavior.
Constant moral injury in any form can cause psychological distress and with repetitiveness lead to Post traumatic Stress Disorder. In the last few years researchers and psychology journals were beginning to acknowledge that healthcare workers are not immune to emotional trauma that can lead to PTSD. These conversations were just catching momentum when the Covid 19 Pandemic struck, bringing with it acute psychological mass trauma to the medical professionals in question.
Instantly more was required of our healthcare professionals. More work, fewer tools and an uncertainty of safety as they battled a foe that we knew so little about. Longer hours became a reality as staff themselves succumbed to the effects of the virus causing even a greater staffing shortage. As staff got better and returned to work, others who had previously been spared would be infected and taken out. This problem escalated during the peak of the surge placing an undue emotional and physical toll on those who served. Burnout came quickly.
Burnout Syndrome in Critical Care and Floor Nursing Staff
Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition. Though clearly due to the Covid 19 pandemic, if you are a health care worker who served during a surge, burn out could easily lead to PTSD.
Burn-out is defined in ICD-11 as follows: “Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
Feelings of energy depletion or exhaustion;
Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job;
Reduced professional efficacy
During these pandemic times the term encompasses most health care workers regardless of titles and places of work.
Although pre-pandemic there was a growing interest in the mental health of health care professionals, it never made headline news. Now experts are expecting an onslaught of cases and concerns as our healthcare workers have been pushed to their mental and emotional brinks. They are experiencing emotional exhaustion, loss of interest in what they are doing, death, depersonalization, loss of bidirectionality and cause of the loss of job satisfaction.
All of this is a direct consequence of the trauma suffered by our frontline workers at the hands of Covid. Feeling helpless as they watch some of their best care turn into a futile attempt at saving otherwise normally healthy people’s lives. Some trauma can also be contributed to the work environment where they regularly faced a dwindling supply of personal protective equipment. They also dealt with a shortage of crucial life saving supplies and equipment, all while being overrun with an over capacity number of patients.
Nurses and Other Frontline Workers Suffer from Anxiety and Insomnia While Working Through a COVID-19 Surge
There is a pronounced rise in cases of anxiety and insomnia in healthcare workers post the Covid19 surge. During the surges many nurses complained that they couldn’t sleep and were always on edge. They stated that they expected this to be temporary and would feel better once the surge was over. To the surprise of many, they found themselves unable to break out of their undesired negative mental and emotional state that they found themselves in.
Self treatment was a common go-to during the surge. Healthcare workers who had at some point in their lives struggled with substance abuse quickly lost that battle in the form of a relapse. They would try to treat their imbalanced emotional state by leaning on drugs and alcohol to soothe their anxiety and overcome their insomnia. They promised themselves that once the surge was over they would once again clean up. As they historically always have, these quick fixes were short term repairs and quickly lost their effectiveness. Instead of helping, these emotional crutches have brought on additional problems and concerns. Those healthcare workers now found themselves requiring them on a more frequent basis to help them through the surges.
It was not uncommon to see nurses and respiratory therapist wear the effect of their anxiety on their sleeves during work. In moments of overwhelm, staff would break down in tears, weeping and sobbing as their bodies could no longer hold in the emotions and stress they were trying to brave through.
These breakdown events were even more common during change of shift as staff would pass on their report of their day. These reports would often be a re-living of the trauma that the healthcare workers experienced that day. Going home not always provided the relief that was needed. It’s hard for the nurses to turn off their thoughts and concerns geared toward their patients. They were fully aware that while they were able to leave the hospital, the situation their patients were suffering with did not take a pause. At times, it was worse not knowing if their patient’s health condition continued trending downward or if all the work and care they had afforded their patient’s that day had provided some sort of relief.
Frontline workers are more than just doctors, nurses, therapist, technicians and people in scrubs. They are also fathers, mothers, husbands and wives which meant an additional stress as they arrived at home. There was always the concern of exposing a loved one to the coronavirus by bringing it home with them. This was an additional strong concern during the beginning of the pandemic as much was not know about Covid-19.
Many workers suffered with the inability to turn off their healthcare workers role and slip into their family role. This added to their stress and anxiety as they felt a certain impotence of not being able to meet the emotional needs of their family who was waiting for them at home. Many reported feeling that they were already hanging on by a thread when they got home, and the demands and noise of a family who was tired of being cooped up at home was enough to make these front line heroes breakdown or lose it.
Is There a Surge in PTSD Among Nurses and Health Care Workers Related to Covid-19?
Post traumatic Stress Disorder by definition is a stress disorder that lingers past or post the original trauma suffered. Since many nurses, doctors and therapist find themselves still battling with the COVID-19 infectious disease outbreak, they are nowhere near the post stage. As the covid vaccine plays its intended role of creating herd immunity, the number of PTSD cases in healthcare workers is expected to rise and rear its ugly head.
Healthcare personnel are difficult clients because they tend to hold things in and put others first. In their mind there is no time to process their trauma because others need their help. In fact many don’t even acknowledge that they have indeed suffered emotional and mental trauma. PTSD in healthcare workers from Covid is something that cannot be ignored. Our healthcare system will take a hit to its vitality and efficiency if we don’t make sure that our healthcare workers are healthy.
What Should Nurses and Healthcare Providers Do If They Think They Have PTSD?
The initial problem is that nurses and healthcare workers in general may not be aware that they are battling PTSD or depression. They may acknowledge their mood swings but attribute them to simply being tired or not getting enough sleep. Being tired may satisfy their reasoning for wanting to sleep more than normal or not wanting to socialize as they had before. When in fact these may be symptoms of depression, anxiety or PTSD.
It may be family members who first pick up on the changes in personality. They may assume that something is wrong and attribute it to their loved ones being medical workers who are dealing with the covid 19 effect. They rarely, however understand the psychological trauma that their health professional loved ones is being exposed too. They believe that the health worker in the family just needs to rest it out. No one is pushing for the frontline healthcare workers to get professional help and deal with a probable PTSD diagnosis.
This leaves it up to either the suffering individual or the actual healthcare staff and employers they work with to recognize the psychological impacted that all of these Covid 19 cases has had on themselves or their medical professionals. Hospitals are now scrambling to offer programs to their frontline healthcare workers that will assist them with their traumatic stress. If you are a nurse or a health worker who is struggling with the PTSD symptoms of anxiety, depression, insomnia, or any other mental health problem, then waiting on your facility to provide assistant when one isn’t established yet is not the answer.
Healthcare personnel need to be assertive with the acute stress and mass trauma suffered by looking for help elsewhere if their facility isn’t prepared to provide any. Most healthcare professionals have a solid insurance plan where they can reach out for mental, emotional and behavioral health. There is no reason for them not to take advantage of a plan that they are paying for. The Covid 19 outbreak brought on a lot of psychological distress to our frontline workers and now it’s time to take care of them.
There are also many online programs that may help with anxiety if frontline healthcare workers don’t feel ready to pursue professional help. A free tool to help them deal with stress and anxiety can be found at http://healthcareworkersptsd.com/free
When Family and Friends Isolate Nurses and Other Healthcare Workers Due to Covid 19
Depressive symptoms reported by healthcare workers aren’t necessarily limited to causes related to patient care. Many medical professionals report facing imposed segregation from family members. Being made felt like they have leprosy, healthcare providers feel the stigma of being a potential virus spreader. Though many times dealing with a health worker who takes constant appropriate measure to remain infection free is safer than running into people at the supermarket who are nonchalant with their personal protective equipment and activities, it is the healthcare providers who are being punished with isolation.
“My brother and sisters go over to my mom’s house all the time but it’s me that they close the door on.” states Joanna, an ER nurse who has remained Covid free despite her work environment. “They go nuts when they hear that I dropped something off at my mom’s front door or that I talked to her from my car while she sits on her porch. They threaten me with guilt by saying that if something happens to my mom it will be my fault. They conveniently ignore the fact that they work in a store or at a factory where they too can get exposed by someone who is caring the virus.” This type of moral injury is being reported more and more by medical professionals.
The psychological impact is beyond is felt beyond the bedside heroes. A nurse or a therapist might be the ones that spend the most time with a covid 19 patient, but they aren’t the only ones dealing with the hospital covid 19 effect. Social workers, cafeteria workers, security and techs from all kinds of departments deal with the Covid 19 risk factor.
“I haven’t seen my grandbabies in months,” stated Donna, an ICU staff member. Donna is not a nurse and does not engage in any Covid 19 patient care, but she does work with the constant risk of exposure. Donna works in environmental care, or as a housekeeper as often referred to. Donna’s job is to keep the hospital clean and often gown’s up to enter patients room. She has a very important job in healthcare. It’s to make sure that rooms that have had a patient with “the coronavirus disease” as she puts it, are cleaned and free from any viruses prior to the next patient being admitted.
“My family knows what kind of environment I work in and are afraid that I will bring that infection home to them. So they put me in quarantine and don’t allow me to visit. I see them through facetime, but facetime doesn’t give you the kind of hugs that a grandma needs from her babies.” You could hear her voice break as she reaches for a tissue and dabs her left eye.
Healthcare staff are feeling the acute stress and anxiety that comes from being ostracized because of the place they work. Combine this with the trauma of seeing otherwise healthy patients die in larger than ever career numbers and it is no wonder many are starting to show mental health issues. Posttraumatic stress disorder is likely to be on the rise in greater numbers than we have ever seen outside of war.
The Effect of a High Hospital Covid Death Toll on Nurses
“We all fear the day when one of our patients suffer a cardiac or pulmonary arrest under our care.” Shares Tina, a newer nurse who is just two years into her nursing career. “We know sooner or later in our career we will all have to call a code blue to one of our patients rooms. Watching them die unexpectedly is really a hard thing to do. It’s one thing when your patient is on palliative care or is a DNR and you know that death is coming. In that circumstance our job is to keep them comfortable and help their family get closure. We have a role during their death, so we feel we provide effective care even if that means we are only making them comfortable. When a patient who is doing well unexpectedly dies that is a whole different story because that is not supposed to happen. That is really hard on us. Luckily, on the regular nurses floors that does not happen often. Covid changed all of that for us. We are left spinning as otherwise healthy patients are dying daily with most days we have multiple deaths in our unit. We don’t have time to process a death because if we aren’t on top of our other patients, they may very well follow suite.” concluded Tina as she paused to catch herself from crying.
Critical care nurses on the other hand are used to seeing a higher percentage of patients dying compared to other hospital units. Naturally this does not mean that critical care nurses did not feel the psychological impact felt from the surge. The still had to deal with the mass trauma they felt as they saw so many of their patients NOT get better. This started to feed a negative sensation of futility and hopelessness among the ICU staff. Anxiety and acute stress gave way to post traumatic stress even as the surge numbers declined.
Symptoms of Anxiety or PTSD from Covd -19 Include:
Frequent or Easily Crying. You find that your emotions easily swell up and you begin crying for things that normally wouldn’t bother you. Talking about your experiences with Covid quickly causes you to tear up and cry. You may find that you are locking yourself in the bathroom especially at night to release some of the of the anxiety through tears and crying.
Feelings of impending doom. Overwhelmed with the feeling that something is wrong or is about to go wrong. Feeling that you or your loved ones are in danger and can’t explain why.
Feelings of Paranoia. You worry that any sign or symptom could be Covid or some other life threatening disease. You worry either about yourself or your loved ones and constantly take extraordinary steps to protect them or yourself. Sometimes these steps could even be harmful.
Depression. You lack desire to do things or activities that once brought you joy. You are frequently sad. You sleep long hours or all day. You can’t find the energy to start your day and frequently find yourself lounging in your sleeping wear. You turn down all invitations to socialize or be around people.
State of fear/ fight or flight. You find yourself on edge, your fight or flight drive is kicked in by certain triggers. Once you are triggered you have a very hard time talking yourself down or calming down. You may experience moments of shakiness and trembling, elevated heart rate, elevated rate of breathing and hot and cold flashes.
Insomnia. You have a hard time falling or staying asleep. You stay up all night as your mind is constantly racing. No matter how much you try to turn it off you can’t.
Excessive guilt. This could be from feeling like you didn’t do enough or could have done more. Feeling you put your family at risk because of your job especially if your family did test positive for Covd-19.
Excessive Worry about the future: This could be from the feeling of futility that was suffered during patient care. There is constant worry about what ifs because of all the bad stuff that was seen and suffered during the outbreak.
You can’t make up your mind. Stress often fogs up the mind and a person struggles to think clearly. This is amplified during the decision-making process. Frontline workers have seen the consequences of poor decisions and are afraid of making them themselves even when they are small and seem inconsequential.
Constantly blaming others. When things go wrong you lashed out at others trying blame to them. The need to find blame in someone or something other than yourself is needed to explain why things go bad. This is easier to accept than to accept consequences of your own actions.
Giving up on things quickly. Never seem to start what you finish or giving up on things when they require real effort. Not having the drive or energy to fight through things.
Easily disappointed. If things don’t work out perfectly for you or you experience and kind of bumps in the road you fall back into disappointment.
Lose trust in yourself. Believing that no matter what you try it’s not going to work out so why even try. This comes from the feelings of futility during the Covid-19 surge. No matter what the healthcare staff did, it proved not enough to curtain the decline of the patients’ health.
Thoughts about hurting yourself or others. You may have thoughts of ending your life. You might be thinking, “what is the point of living” or you want to end it all because of the emotion or physical pain you’re experiencing. You may hear voices either audible or in your thoughts encouraging doing so. Feeling of hurting other may also accompany these thoughts. (If you are struggling with suicidal thoughts or tendency please reach out for help immediately. If this is you, we encourage to contact the suicide prevention lifeline by clicking on the follow link: suicidepreventionlifeline.org Or by calling: 1-800-273-8255
Getting Help From Covid-19 PTSD
Hospitals and nurses’ unions are beginning to acknowledge and address the current mental health problem experienced by their staff. Waiting on them to get this right will not be the answer for so many who are struggling with anxiety or PTSD. For severe issues of anxiety or mental health problems you may reach out to your doctor. Most insurances have a special coverage where you can get professional in network help with little or no cost. Just contact your insurance provider.
The good news is that if you are suffering from anxiety or acute stress, you don’t have to continue to feel stuck, weak, powerless, or worthless. Many people who found themselves in the exact same situation as you were able to dig themselves out of that deep personal pit. There is a solution that doesn’t require drugs, expensive counseling sessions, or any kind of formal professional intervention. It’s a free downloadable tool that will help you overcome anxiety and get back on track and live your life the way your are suppose to. It’s the first step to feeling better.