PANDEMIC IMPLICATIONS ON NURSES, HOW TO OVERCOME ITS IMPACT

1. IMPLICATIONS ON
NURSES DUE TO
PANDEMIC AND
COPING MECHANISMS
WITH REFERENCE TO
WORK, FAMILY AND
SOCIAL RELATIONS

2. INTRODUCTION
The emergence of the COVID-19
pandemic has significantly impacted health care
professionals more than any other people group.
People panic simply by seeing “the
numbers” of new cases and daily deaths
displayed by news channels on the TV screen,
then imagine the condition of a health care
worker who has to see those many cases and
deaths everyday in front of them and deal with
the impact it leaves on their mind, soul and body.

3.  Nurses on the frontlines battling COVID-19
are at medical risks such as injuries, infection,
and depression, anxiety, stress, etc…
 But the long-term psychological impact of the
COVID-19 pandemic on nurses and other
health care workers is yet to be fully
understood.
 Attention to health workers psychological and
mental health and well being and their
function is a critical aspect of dealing with
crisis management.

4. IMPACTS ON HEALTH CARE
WORKERS ASSOCIATED WITH
COVID-19

5.  Impacts on front and second line health workers
associated with the COVID-19 pandemic in Italy.
Post Traumatic Stress Disorder (PTSD) Symptoms
(49%), Sever Depression (25%), Anxiety(20%),
Insomnia (9%), Highly perceived Distress (22%)
were reported. –Rodolfo Rossi et al 2020
 Effects of COVID-19 on health care workers in
China. Depression (47%), Anxiety (41%), Insomnia
(32%), Distress (69%)
– Kangguang Lin et al July 2020
 Pandemic impacts on nurses: a review and
implications in the Indian context amidst COVID-19.
Health Distress (including burnout), perceived
Destress and Post Traumatic Disorder, Anxiety,
Depression, Insomnia, and perceived stigma.
– Gupta S et al August 2020

6. Most Common Psychological Impacts Based On Studies
0
10
20
30
40
50
60
70
80
90
100
Depression Anxiety Distress Insomnia

7. OTHER PSYCHOLOGICAL
IMPACTS ASSOCIATED WITH
COVID-19

8. Post-Traumatic Embitterment Disorder
 (PTED) is a new subgroup of
adjustment disorders.
 It is a result of prolonged
exposure to stress and
mental trauma.
 Its emotional quality is a
mixture of anger and
hopelessness.

9. TYPICAL CASE SCENARIO
Imagine you are a nurse required to triage COVID-19 patients.
You are inside a crowded emergency room deciding which of
two patients will get you emergency wards only remaining
ventilator. Although you understand the situation requires you to
give the ventilator to the person with the highest chance of
survival, you have never faced such a situation before.
You have always had the resources to equally treat all
patients. In this scenario both patients die, despite one having
been put on the ventilator.

10. IMPACT ON THE NURSE
 You wonder whether you made the wrong decision.
 Could the other patient have survived with the ventilator?
 You keep replaying the scenarios in your mind over and over again
analyzing how different choices might have created different
outcomes, and a guilty feeling keeps coming.
 Your distress keeps increasing and you divert you mind by being busy
in your work, but the pain follows you home.
 You avoid genuine conversations with your family.
 You tell yourself that you followed the protocol, but still you feel you
violated your moral values.

11. Moral Injury
 The scenario is precisely the
context in which a moral injury
may develop.
 Moral Injury occurs when
painful emotions are avoided
and suppressed, resulting in
greater suffering that
negatively impacts a person’s
ability to function properly.

12. Moral Injury
 Although Moral Injury is
commonly seen in Military
Personnel, COVID-19 has made
it clear that it is relevant to health
care workers.
 Natural response to morally
injurious events include
emotions like guilt, shame, anger,
blaming self and others.
 Social, Psychological and
Spiritual suffering often present
in moral injury.

13. Moral Distress
 Moral Distress and Moral
Injury may appear very
similar since both deal with
moral suffering.
 The main difference is that
Moral Injury is associated
with death related events,
whereas Moral Distress is
related with moral dilemmas
or decisions taken against
one's morals.

14. Moral Distress
 Nurses experience multiple
morally distressing situations
in frontline COVID-19 care,
as a result guilt, shame and
other feelings accumulate.
 Moral Injury and Distress
accumulated overtime results
in traumatization,compassion
fatigue, PostTraumatic Stress
Disorder.

15. Compassion Fatigue
 We all know that empathy is a
key quality of a nurse.
 Compassion fatigue is a
condition of emotional and
physical exhaustion leading to
inability to empathize or feel
compassion for others.
 It is sometimes referred to as
secondary traumatic stress.
 Difficult to function well post
pandemic may be experienced.

16. Toxic Stress
 Stress is a common word we
use everyday. But did you
know that stress affects us
physically.
 There are three levels of stress:
1.Positive Stress
2.Tolerabale Stress
3.Toxic Stress

17. LEVELS OF STRESS
Its a normal and essential part
of healthy development.
 Increase in heart rate & mild
elevations in hormone levels.
Example of a situations that
might trigger a positive stress
response is “The first day of
work.”
Increase in heart rate & mild
elevations in hormone levels.
Damaging effect on brain and
other organs.
Healthy Relationships can
stop this response and help
recovery.
Eg: Death of a loved one
It is Body’s stress response
due to chronic or traumatic
experiences like dealing with a
pandemic related issues and
deaths for a long period.
Inflammation, neuropathy
nephropathy, Diabetes and
cardiovascular disease.

19. Presenteeism
 Being at work in the body but
not in the mind.
 When mind is impacted it leads
to errors.
 Increased error, mistakes and
sloppy work.
 Due to staff storage, nurses
forced to work overtime.
 Presenteeism is 4 times costly
than Absenteeism!

20. ISSUES FACED BY NURSES AT WORK IN COVID-19
 Lack of critical resources, ICU Beds, Ventilators
 Challenge of Early Detection and Testing
 Crisis in Management of patients and resources
 Nervousness, Anxious, Fear experienced by staff
 Exposure to nosocomial infection
 Staff Shortages, Physical Exhaustion
 Increasing Patient Numbers
 Deaths among nursing staff
 Lack of Masks and PPE

21. ISSUES FACED BY NURSES AT HOME
 Fear of getting disease for themselves and families
 Some females staffs were not sent to work by families
 Psychosocial Stress
 Touch Deprivation (avoiding touching their children)
 Quarantine measures and isolation
 Stigma associated with COVID-19
 Fear created by the media
 Dealing with anxious relatives

22. COPING MECHANISMS AND
RESILIENCE BUILDING

23. RESILIENCE

24. RESILIENCE
 Resilience can help us get through and
overcome hardship.
 But resilience is not something we’re born
with—it’s built over time as the experiences
we have interact with our unique, individual
genetic makeup.
 That’s why we all respond to stress and
adversity—like that from the COVID-19
pandemic—differently.
 Resilience is the ability to bounce back.

27. SELF-CALM
 Effectively managing your stress
by being aware of your nervous
system.
 Actively recover with relaxation
methods like:
1. Deep Breathing
2. Grounding
3. Sensory Engagement
4. Reassuring Self-talk
It is about creating feelings of calm and confidence in times of stre

28. "Just This" METHOD
 Ground yourself in the present
moment.
 Focus on only 1 thing at a time.
 Whether your eating, taking a
shower or finishing just one small
task, focus only on one thing.
 Tell yourself, "What I need to do
right now is “just this”.

29. “TAKE 3” a reset button for your nervous system
 Intentionally pause several times
throughout the day to take 3 deep
breaths.
 Establish routine times to help
you remember to do this. .
Example, before food, after hand
washing, finishing a task.
 Breath in for 5 seconds and out
for 5 or whatever rhythm feels
natural to you but do longer
breaths.

30. Reassuring self-talk with supportive breathing
 Start by taking a few deep breaths.
 As you exhale, tell yourself a
reassuring phrase like, "I can do
this," "I'm okay" or "whatever
happens, I can handle it."
 Slowly repeat the words to
yourself as you breathe more fully
and deeply.

31. Gratitude Breathing
 Imagine you are breathing in and
out through your heart.
 Then, think about something that
makes you feel grateful.
 Go back to breathing in and out
through your heart, letting all the
gratitude really sink into your
body, warming and relaxing it
more with each breath.

32. Self-Care
 Self-care includes all the health
behaviors that help you balance
the effects of emotional and
physical stress.
 Valuing your body and believing
that your needs matter.
 You need time to rest and recover
so you can function at your best.
 Make it a habit to check in with
yourself throughout the day.
Ask yourself, "how is my body doing right now, what can I do to feel better?"

33. Self-Replenishment
 Self-replenishment is about doing
things that “refill your energy."
 Self-replenishing activities help
you recover on the go.
 Every person is different, so your
strategies for self-replenishment
should be very personalized and
speak to your interests, values,
needs and personality.
Example: Limit your time spent listening to or reading negative news.

34. Emotional Expressiveness
 Emotional expressiveness is
having an awareness of your
emotions as they occur and
having the ability to process them
effectively.
 It is better to acknowledge and
work through your emotions than
ignore them.
 When you get better at self-
calming and you will get better at
working your emotions.

35. STEPS FOR EMOTIONAL ACKNOWLEDGEMENT
 Notice when you start to feel overwhelmed.
 Take a few deep breaths.
 Identify the biggest emotions that are bubbling under the surface of your stress.
Are you feeling scared, angry, sad, shocked or surprised?
 Notice where the emotions show up in your body, such as anger as a clenched fist,
tight jaw or hotness in the face, fear as a knot in your stomach or sadness as a
heaviness in your chest.
 Take another deep breath and give yourself permission to feel the emotion on the
inside, without judgment and without trying to talk yourself out of it.
 Tell yourself something supportive like, "It's okay to have this feeling. It's normal to
have emotions. I have the power to feel them and let them go."
 Take some deep breaths and picture the emotion lifting, releasing or letting go.

36. Non-Judgmental And Self-Supporting
 Being non-judgmental and self-
supporting means you recognize
when you are being overly harsh
or critical with yourself and
others, and you can change your
thought patterns and language to
be more positive.
 Replace your judgmental thoughts
with positive thoughts.

37. Optimism
 Optimism is having positive
expectations about the future.
 The brain can be strengthened like
the muscles of the body.
 It just takes self-awareness and
knowing how your perceptions
influence your thoughts, feelings
and actions.
 Improve your self-awareness and
train your brain to be more
positive.

38. Hope
 Hope is the ability to set goals,
take actions and staying flexible
when things do not go as planned.
 Hope is the backbone of optimism.
 Staying hopeful means staying
flexible so you can adapt to all the
change and challenges of life.

39. Hardiness
 Hardiness is giving your best
effort, even when it is tough.
 Focusing on what you can control
in your situation and view difficult
situations as learning opportunities.
 Always ask yourself, "Why is it
important for me to keep going?"
and "How will I learn and grow
from this challenge?"
 The opposite of hardiness is denial
and avoidance.

40. Sense of Coherence
 Sense of coherence is the belief
that life is meaningful and worth
the struggle.
 It also includes the belief that
there are resources, routines and
rituals to help you handle the
chaotic and unpredictable parts of
life.
 Your life is meaningful and how
you respond to the challenges of
life matters.

41. Social Support
 Social support includes the
support and encouragement shared
between friends, family, co-
workers and peers during good
and bad times.
 A good social support system can
help with a sense of belonging,
safety, self-worth and improve
depression and loneliness.

42.  Having knowledge and skills in time management, crisis intervention, specifying
the priorities.
 Improving work satisfaction.
 Having a positive attitude, making a difference or having a sense of faith.
 Building among nurses the belief for making a difference, building close and warm
relationships, and preparing environments for them to share their experiences.
 Using strategies such as debriefing, validation and self-reflection.
 Getting support from colleagues, mentors and team fellows.
 Improving the skill for sense of humor in order to know depressive agents and their
negative effects.
 Offering options such as exercise, rest, social support and interests that are efficient
to build a balance and maintain that balance between career life and daily life.
IMPACT MANAGEMENT STRATEGY

43.  World Health Organization says it is normal to feel sad, stressed, confused, scared
or angry during a crisis; talking to people you trust can help.
 Here are some counselling services to help people clear the cobwebs of the mind
caused by the COVID-19 situation:
Tamil Nadu Psychology Association: Chennai (9962346966), For contact details
of other districts, visit www.tnpsya.org
Mastermind Foundation has psychologists from across India, counselling support
round-the-clock in 11 languages visit http://www.mastermindfoundation.co
m/
NIMHANS team of psychologists, psychiatrists and social workers are spearhead
this initiative. The toll-free helpline number is 080 46110007
Arpan offering counselling through multiple modes - chat-based counselling via
Facebook, Instagram, Twitter on https://wwarpaw. nelearn.com/
YourDost an online chat-based counseling to relieve stress, anxiety & depression
IF NOTHING WORKS THEN SEEK HELP

44. COVID-19 global pandemic and public health crisis has its
impacts in every area of society and more on the health care workers.
Since nurses are in the frontline battling the disease, they
become vulnerable to the physical, psychological, emotional and
social impacts on them not only as a health care personnel but also
as a human being.
As outbreaks of novel infections continue and until a cure or
vaccine is discovered, proactive actions are required on our part not
only to save patients lives but also to protect ourselves from the
negative impact of the pandemic.
CONCLUSION

45. Thank You