Open Access 01-12-2020 | COVID-19 | Editorial
Psychological stress of ICU nurses in the time of COVID-19
Published in: Critical Care | Issue 1/2020
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As the coronavirus disease 2019 (COVID-19) pandemic accelerates, global health care systems have become overwhelmed [1], leading to great psychological pressure on nurses in the care of critically ill patients with COVID-19. Moreover, extreme incidents have occurred, such as suicide of nurses caring for critically ill patients, in Italy. In fact, the psychological problems are also common among nurses in Wuhan City, China. The Department of Critical Care Medicine, Wuhan Pulmonary Hospital, is the designated hospital for the treatment of severe patients with COVID-19. It has a total of 20 intensive care unit (ICU) beds and 102 nurses from the local hospital and other hospitals in the provinces and cities outside of Wuhan City. The critically ill patients receive mechanical ventilation. Most of them also need advanced life support, such as extracorporeal membrane oxygenation, continuous renal replacement therapy, and ventilation in the prone position. Front-line nurses experience huge workload, long-term fatigue, infection threat, and frustration with the death of patients whom they care. They also face anxiety or even misunderstanding among patients and their family members. In the early stage, nurses from other regions outside of Wuhan City did not communicate with each other and usually felt lonely. Additionally, they worried about their families and vice versa. All these factors have resulted in high psychological pressure among ICU nurses in Wuhan. We surveyed 85 ICU nurses in our ward and found that the main manifestations were decreased appetite or indigestion (59%), fatigue (55%), difficulty sleeping (45%), nervousness (28%), frequent crying (26%), and even suicidal thoughts (2%). Especially, young nurses with no experience of caring for critically ill patients face a greater psychological crisis. If these psychological problems are not solved effectively, they may not only lead to a decline in their immunity and increase the chances of COVID-19 infection but also have an adverse impact on the quality and safety of the medical care system [2‐4]. Therefore, early measures were actively taken, and the following improvements were made (Table 1):
Problems
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Solutions
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1
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Anxiety regarding unfamiliar working environment and processes.
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Establish a communication mechanism with local medical staff to get familiar with the working environment and working procedures as soon as possible.
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2
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Lack of work experience in infectious diseases.
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Allocate appropriate patients according to the actual nursing ability and provide necessary special training.
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3
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Worry about getting infected.
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Enhance education and training, including personal protective, hand hygiene, ward disinfection, medical waste management, and occupational exposure management.
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4
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Huge workload and long-term fatigue.
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Adjust work shift to ensure nurses to have plenty of rest.
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5
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Depression due to unsuccessful cure of critically ill patients.
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1) Equip each medical team with a psychologist for early psychological assessments and interventions.
2) Strengthen professional training to deepen the understanding of the disease.
3) Share successful therapy cases.
4) Actively express emotions to relieve tension and anxiety.
5) Perform relaxation exercise under the guidance of the mental health professionals.
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6
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Worry about their families, and vice versa.
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1) Communicate with colleagues who have the same experience or similar feelings.
2) Regularly chat and exchange with family through WeChat videos.
3) Establish a social care and support group to find and resolve worries accordingly.
4) Set up a professional team to provide remote mental health training and guidance, individualized psychotherapy, or appropriate medical intervention to nurses in multiple ways.
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