EMCR COVID-19 Think Tank: Who cares for the carers?

Who cares for the carers? Psychological wellbeing of nurses and midwives during the COVID-19 pandemic

by Dr Sara Holton, Dr Karen Wynter and Professor Bodil Rasmussen

Abstract: Nurses and midwives are the largest occupational group in health services and have direct, intense and sustained patient contact. The psychosocial impact of the COVID-19 pandemic on them is likely to be significant. Appropriate support for nurses and midwives which addresses their psychosocial distress and concerns is required.

 2020 is The International Year of the Nurse and Midwife. Like Boris Johnson ¹, it is important to recognise the crucial and life-saving work nurses and midwives are doing during the COVID-19 pandemic and the potential impact this may have on their psychosocial wellbeing.  

Health services implemented a number of measures in response to the pandemic aimed at protecting staff while providing best care for patients including: infection control measures such as mandatory staff use of personal protective equipment (PPE), cancellation or postponement of patient clinics and elective surgeries, limited access for hospital visitors, temperature checks for staff and visitors, and daily staff updates ².

Nursing and midwifery staff received training and education about disease prevention, self-protection, preservation of PPE resources, screening and reporting, containment, escalation, and handling of bed conversions and discharges. Many clinical nursing and midwifery staff were also redeployed from specialties to areas of greatest need, and nurse and midwife educators and researchers have been encouraged to return to clinical duties.

Evidence from studies ^{3, 4} conducted overseas and our preliminary findings ⁵ suggest  that about a quarter to a third of nurses and midwives have experienced depression, anxiety or stress during the COVID-19 pandemic. Nurses and midwives appear to have experienced more severe symptoms of psychological distress than medical or allied health staff. Nevertheless, our preliminary findings indicate that clinical staff who believed that their health service had responded appropriately to the pandemic and provided sufficient support had better mental health than those who did not.

Nurses and midwives are putting their physical and mental health, as well as the health of their families, at risk to care for patients during the pandemic. Without adequate support they may leave their jobs, be absent from work, become unwell, or be unable to provide high quality care for their patients. Therefore, the (continued) provision of ‘wellbeing’ initiatives including targeted discipline specific support interventions is crucial.

Further research is needed to inform appropriate health service responses, interventions and support for nursing and midwifery staff, which address their particular psychosocial needs and concerns during the current and any future outbreaks of infectious disease.

 References:

1. Booth W, Adam K, Spolar C. Boris Johnson praises immigrant nurses who saved his life, as Britain’s NHS becomes a rallying cry. The Washington Post. 2020 14 April 2020.
2. Western Health. Novel Coronavirus Information Melbourne, Australia: Western Health; 2020 [Available from: https://coronavirus.wh.org.au/.
3. Survey of UK nurses and midwives’ highlights their concerns about health, training and workload during COVID-19 [press release]. 21 April 2020 2020.
4. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behavior and Immunity. 2020.
5. Holton S, Wynter K, Trueman M, Rasmussen B. Psychosocial impact of COVID-19 on nurses and midwives Melbourne, Australia: Institute of Health Transformation, Deakin University; 2020 [Available from: https://iht.deakin.edu.au/quality-and-patient-safety/project/psychosocial-impact-of-covid-19-on-nurses-and-midwives/.

Author profile: Dr Sara Holton is a Research Fellow in the Centre for Quality and Patient Safety Research – Western Health Partnership, School of Nursing and Midwifery, Faculty of Health. Sara’s main research interests are focused on psychosocial aspects of women’s reproductive lives including their reproductive decision-making, the impact of a chronic health condition on their childbearing, mental health, and related health service use and experiences.