Tired medical worker in full PPE leaning head against arm propped up on wall
HealthSeptember 14, 2021

Providing psychological first aid for nurses during the pandemic

By: Sarah Handzel, BSN, RN
As a result of the Covid-19 pandemic, record numbers of nurses are experiencing significant levels of clinical distress. Having to make difficult decisions on an almost continuous basis eventually causes moral injury, and that can have long-lasting psychological implications.

Additionally, sustained high levels of stress is associated with maladaptive coping behaviors, such as excessive consumption of alcohol, smoking, substance abuse, and sleep and eating disorders. But training in psychological first aid (PFA) can help nurse leaders quickly identify and help staff nurses and other coworkers who may have difficulty coping. A recent article in Nursing2021 describes how nurse leaders can accomplish this goal.

Applying evidence-based interventions

Psychological first aid is an evidence-based rapid intervention intended to help lessen acute distress in a crisis. These techniques can also develop hope and support future recovery.

Originally designed by the National Child Traumatic Stress Network and the US Department of Veterans Affairs’ National Center for Posttraumatic Stress Disorder, PFA deals with a person’s immediate needs and acute reactions during and immediately following any type of crisis. Its measures include:

  • Connecting personnel to collaborative resources and social support
  • Offering practical assistance
  • Promoting self-efficacy
  • Providing safety and comfort
  • Reducing stress-related symptoms

For many, PFA helps them return to pre-crisis levels of physiologic and psychological functioning sooner. PFA training focuses on six main principles and techniques:

  • Identify people who need help and engage them in a calm, tolerant manner.
  • Establish safety.
  • Identify the most concerning needs and identify practical, feasible measures to address those needs.
  • Connect recipients with others for continued support and assistance.
  • Teach recipients about normal stress reactions and techniques that help facilitate stabilization.
  • Model hope for others while maintaining and communicating empathy.

It isn’t necessary to be a mental health professional to provide PFA to those who need it. Many nurse leaders already have the emotional capacity and availability to provide PFA. Nurse managers should express concern for nursing staff while also offering help. Address negative emotions like fear and prevent actions which may help generate that fear.

It’s also important to know when PFA isn’t enough. Nurse leaders should watch out for specific red flags, such as the potential for self-harm or harm to others, inability to perform daily functions, and chronic or severe distress. In these cases, individuals should immediately be referred to a mental health professional.

Practical interventions for nurse leaders

After becoming aware of a colleague’s distress, it’s important to provide PFA and decrease stress as much as possible. Nurse leaders can do so by addressing common complaints, such as sensory overload in relation to patient monitors, etc. They can also advocate for stress-reduction measures for staff, such as emergency childcare for essential workers.

When possible, rotate staff members between the most stressful roles and less stressful roles. Try to avoid overscheduling and avoid rotating staff members between day and night shifts. Also, and maybe most importantly, nurse leaders can advocate for adequate staffing and other measures, such as sufficient personal protective equipment supplies, to help staff avoid burnout and protect mental wellness.

Finally, factors like stigmatization by other staff members and self-care should be addressed in a thoughtful, competent manner. It does no good to tell staff nurses to practice and prioritize self-care when also scheduling them to work multiple 12-hour shifts during the week.

While the Covid-19 pandemic lingers on, nurse leaders should prioritize these types of interventions to help other healthcare team members mitigate and avoid stress and burnout. Preventing stress and trauma is vital to the nation’s success handling the pandemic.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
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