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Mental Wellbeing of Nursing Staff during the COVID-19 Outbreak: A Cultural

Perspective

Psychol. Sonia Mukhtar

PII: S0099-1767(20)30124-0
DOI: https://doi.org/10.1016/j.jen.2020.04.003
Reference: YMEN 3630

To appear in: Journal of Emergency Nursing

Received Date: 13 April 2020

Accepted Date: 14 April 2020

Please cite this article as: Mukhtar PS, Mental Wellbeing of Nursing Staff during the COVID-19
Outbreak: A Cultural Perspective, Journal of Emergency Nursing (2020), doi: https://doi.org/10.1016/
j.jen.2020.04.003.

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 Mental Wellbeing of Nursing Staff during the COVID-19 Outbreak: A Cultural
Perspective

Psychol. Sonia Mukhtar1

1
University of Management and Technology, Lahore, Pakistan

https://orcid.org/0000-0003-4480-648X

Author Note

Correspondence concerning this article should be addressed to Sonia Mukhtar, at

Allama Iqbal Town, Lahore, Pakistan. Phone: +92-323-6668316. Email:

sonia.mukhtar12@gmail.com

Psychol. Sonia Mukhtar, Counselling Psychologist, MS (Counseling Psychology),

certified in Integrative Counseling and Narrative Therapy, published books’ author, is a

former-visiting faculty and Alumnus at University of Management and Technology,

Lahore, Pakistan.
1 Mental Wellbeing of Nursing Staff during the COVID-19 Outbreak: A Cultural
2 Perspective

3 Keywords:
4 Mental wellbeing; coronavirus; COVID-19 pandemic outbreak; Pakistan; nursing staff;
5 psychological issues
6 The mental health of healthcare professionals, in general, and nursing staff, in particular,
7 has been challenged in the wake of COVID-19 pandemic outbreak throughout the world. During
8 previous outbreaks such as severe acute respiratory syndrome (SARS), psychological distress in
9 emergency frontline nursing staff appeared gradually. Fear, anxiety, depression, psychological
10 symptoms, posttraumatic symptoms and general decrease in overall wellbeing were observed
11 (Wu et al., 2009). Isolation, high-risk working conditions, and direct contact with infected
12 individuals could become immediate factors of mental health problems in emergency frontline
13 nursing staff. The intense experience of infectious pandemic disease could have short-term and
14 long-term impact on the mental health of nursing staff in the absence of effective support and
15 timely training. The Pakistani government has made various attempts to reduce the pressure on
16 the nursing staff such as reducing workload by shift-system, introducing more nursing staff to
17 manage work pressure, recommending infection control measures, and advising personal
18 protective equipment and adherence to practical guidelines and standards. Additionally,
19 Pakistani government should establish psychological crisis intervention teams to provide
20 psychological services which include psychological counselling and psychotherapy, read-on and
21 listening materials and informative manuals (Mukhtar, 2020). In Pakistan where television news
22 and online media are prevalent and highly influential forms of entertainment in the lives of
23 community so information dissemination about coping mechanisms for psychological help
24 through these mediums would be more effective. Evidence based mental health services, efficacy
25 of psychological care, and the assessment of psychological care needs is necessary for nursing
26 staff (Kang et al., 2020). Continuous mental healthcare services are essential for even mild
27 psychological reactions during this pandemic to attenuate the possibility of escalating
28 psychological health problems (Rana, Mukhtar & Mukhtar, 2020). The number of medical
29 healthcare professionals (doctors, nurses, paramedics) suffering from mental health impacts after
30 epidemics and pandemics are often greater than the physical injury (Wang, Chen and Ye, 2020).
31 And while mental health effects of such events lasts longer yet psychological health
32 interventions captures much less attention (Allsopp et al., 2019). Psychological counselling and
33 psychotherapy guidance could demonstrate effectiveness of psychological protection and
34 awareness for nursing staff through manuals (print media) and television (electronic media)
35 resources. Mental health of nursing staff can be effectively addressed and managed through
36 psychological counselling, convenient group sessions, and micromanagement of stress caused by
37 infectious disease’ pandemic (Mukhtar, 2020). Psychological counselling sessions of nursing
38 staff could help in depersonalization, modifying life perspective, meaning of work, and
39 psychological reactions towards an adversity (West et al., 2014). Professional knowledge about
40 the risk of exposure and transmission of infectious diseases could offer a cautionary control over
41 the situation which in the case of COVID-19 is markedly different due to the pernicious
42 characteristics of novel coronavirus pandemic outbreak.

43 Many individuals’ exhibit minimal symptoms while contagious and in asymptomatic

44 state or indirectly through skin contact involves a substantial risk of exposure for all medical,
45 nursing and paramedics professional transmitted the disease (Bai et al., 2020). The resultant
46 stress in this particular situation is evidently dissimilar with other epidemics and thus this
47 infectious risk indiscriminately affects large number of medical healthcare, paramedics and
48 nursing professionals both physical and psychologically. In Pakistan, immediate need of
49 addressing and recognizing mental health issues in nursing staff emerged from mobilizing a
50 psychological crisis intervention team on a large scale therapeutic response for psychological
51 support for frontline nurses, relieving stress, reducing fear and anxiety of infection, minimizing
52 psychosocial and behavioral changes brought by isolation (Rana, Mukhtar & Mukhtar, 2020).
53 Local nursing staff – at the epicenter of the COVID-19 pandemic outbreak crisis – is pivotal for
54 the effective working of healthcare system so resources should be mobilized to ensure their
55 sound mental health. The training included self-protection, infectious disease pandemic
56 knowledge (epidemiological characteristics, transmission route of COVID-19 and clinical
57 diagnostic criteria and treatment), professional knowledge and skills, and preventive psychology
58 counselling (coping mechanisms, emotional distress management) training (videos, manuals, and
59 online guidance).

60 Pakistan is severely on the threshold of being understaffed due to people self-isolating

61 which may lead to staff shortage across all workplaces. This raises the question on the state’s
62 decision towards medical healthcare on departmental functioning with fewer nursing staff,
63 untrained junior nursing staff’s competence, and working in the minimal presence of personal
64 protective equipment. Ensuring sound mental health would prevent the culture of learned
65 helplessness in nursing staff. Pakistan’s government and hospital administration should make
66 every effort to manage and distribute personal protective equipment to doctors and nurses alike
67 to ensure their safety on frontline. Adequate personal protective equipment and supplies (e.g.,
68 protective gowns, goggles, N95 masks, latex gloves, and isolation gowns) utilization would
69 safeguard security, confidence and motivation among clinical nurses. Psychological crisis
70 intervention (for psychological coping strategies and psychosocial support platform) by
71 practitioner counselling psychologists and psychological experts would reduce fear, anxiety,
72 panic and insecurity among nursing staff. Personal activities could also enhance the emotional
73 wellbeing through activities like colleagues’ encouragement, writing positive reinforcement
74 messages, active listening of each other’s concerns.

75 Funding

76 None.

77 Ethical approval

78 Not applicable.

79 Declaration of competing interest

80 None.

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