New guidance to support psychological needs of nursing staff during COVID-19 pandemic

,Researchers from the University of Southampton and University of Surrey have developed new guidance to support the psychological and mental health needs of nursing staff at the frontline of the fight against COVID-19.

Published in the Journal of Clinical Nursing, researchers identify the stressors and challenges nurses face during the COVID-19 pandemic and have developed guidance offering strategies for nursing team members across health and social care settings to support their psychological wellbeing. The importance of peer and team support is highlighted in the guidance and outlines of what managers, organisations and leaders can do to support nurses at this most critical of times is also included.

Prior to the outbreak of COVID-19 nurses were already under considerable stress due to understaffing (44,000 registered nurse vacancies in the UK) and the emotional and physical intensity of their work. High levels of stress in the workplace mean that nurses are a high risk group with figures from the ONS in 2017 indicating that the suicide rate in the profession is 23 percent higher than the national average. In previous infectious disease outbreaks, nurses have had the highest levels of occupational stress and resulting distress compared to other groups.

Researchers believe that the current crisis will further increase stress levels of nursing staff which will negatively affect their psychological wellbeing. Stressors include unprecedented patient numbers, concerns about not having access to the correct personal protective equipment, worry about their own families, difficult ethical and moral conflict and potentially moral distress or injury.

Jackie Bridges, Professor of Older People’s Care at the University of Southampton, said:

“When we’re caught up in trying to manage a crisis like COVID-19, it can be easy to be distracted from the price that is paid by nurses providing patient care. By making sure staff well-being is a priority and putting active measures in place to support nursing staff, employers in all relevant health and social care settings can reduce staff stress and distress and help ward off the development of longer-term mental health problems. Our guidance sets out practical, evidence-based ways to do this.”

The guidance identifies physiological and safety needs; peer support; team support; and the roles and needs of managers and leaders as well as long term recovery support needs. The guidance:

• Prioritises the need for staff to have sufficient food, drink, rest and recovery, and to be protected from infection risk;
• Emphasises managers clearly and frequently signalling that staff wellbeing is a priority, mandating and monitoring work breaks, encouraging opportunities for teams to meet together and support each other, and ensuring that individual support is accessible to all team members;
• Highlights the need for communication and mutual support amongst nursing staff when work intensity may mean that such opportunities are otherwise missed;
• Stresses the importance of openly acknowledging the emotional impact of nursing work and ensuring that staff have access to more formal psychological support if they need it;
• Recommends creating a ‘buddying up’ system to help new or temporary team members feel safe, valued and welcome as quickly as possible;
• Proposes a review of how welcoming and comfortable staff break rooms are and, in the absence of such break rooms re-purposing an existing space to enable rest and recuperation and a space to be alone and process work challenges;
• Advises managers/ leaders in organisations to be highly visible and approachable, inviting regular feedback from staff across the team.

Jill Maben, Professor of Health Services Research and Nursing at the University of Surrey, said:

“Nurses are on the frontline of care delivery, experiencing intense emotional, social and ethical difficulties as they rise to the challenge of caring for patients in such unprecedented times. If we are to avoid a generation of burnt out nurses, their physiological, psychological and safety needs must be prioritised. Nurses injured by stress may be the last to recognise it; they are ‘wired’ to look after others and not self and they therefore need colleagues, friends and managers to remind them to think of themselves.

“Researching nurse psychological and mental health for over two decades, the COVID-19 pandemic is the most critical time in my career for nurses’ well-being worldwide. Our evidence informed guidance highlights the vital role of peer and team support and the role of leaders and managers in ensuring nursing staff have the support they need; making themselves visible and listening to concerns of their staff, letting them know that their opinion matters. This is vitally important across all health and social care settings. If nursing staff are not supported during this time, there is the danger that once this is all over they will leave the profession, which will put enormous strain on an already over stretched health service.”

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