Healthcare workers post-COVID-19: Stress or Post-traumatic Stress

By Paula Levi PhD, RN

Intensive care unit nurses (and other frontline healthcare workers) have experienced unprecedented psychological stress caring for COVID-19 patients during the pandemic. Constant psychological stress can lead to mental exhaustion, burnout, and with traumatic events, post-traumatic stress disorder (PTSD). Chronic stress and PTSD can have an adverse impact on physical and mental health. Long-term physical consequences include cardiovascular disease, high blood pressure, obesity, diabetes, impaired thought processing, sleep disturbance, and chronic pain. PTSD often occurs with other conditions, such as anxiety, depression, substance and alcohol misuse. There is also increased risk of suicidal ideation, and in severe cases, suicide.

Our qualitative study investigated the lived experiences of 10 intensive care unit nurses who cared for COVID-19 patients to understand what this means in terms of the nurses’ personal and professional lives. The intricate accounts of their experiences underscored the psychological stress and trauma these nurses endured while caring for COVID-19 patients. Psychological stressors included the high death rate despite their best efforts, not being able to give patients their standard quality of care, performing futile care, fear of contracting the virus (and possibly infecting family), and isolation from family and friends because they cared for COVID-19 patients.

Similar to other studies around the globe, nurses described an emotional toll, experiencing grief, worry, sadness, anger, and fear. The nurses described traumatic events they had witnessed. One nurse recounted an episode of trying to save a COVID-19 patient’s life, saying “after the code, it literally looked like a war zone in the room...and that is what haunts me every day in my dreams.” Another nurse felt the most stressful experiences were those helping family use the telehealth to say their final goodbyes to their loved one. Yet another described uncharacteristic anger and frustration that she recognized as a symptom of her job experiences: I didn’t realize . . . that lashing out is a symptom. I was just so full of anger and I looked it (PTSD) up myself and I saw the signs and symptoms. And I was like, “this is new to me.”

PTSD can develop after an individual experiences a traumatic event (or cumulative episodes) causing considerable problems in daily functioning lasting longer than 1 month. It is characterized by four symptom clusters: (a) intrusive and recurring memories of the traumatic event(s), (b) avoidance of similar situations or reminders of the traumatic event(s), (c) negative changes in cognition and mood, and (d) hyperarousal and exaggerated startle response.

Many individuals in a multitude of professions have experienced psychological stress and trauma from their work experiences during the pandemic. Some may not recognize their symptoms as PTSD, so it is important to screen for early identification of PTSD during health checks. According to the National Center for PTSD, studies of patients seeking healthcare found that many have experienced post-traumatic stress but have not received proper mental healthcare. Last year, the United States Preventive Services Task Force recommended screening adults for anxiety and depression due to the impact of the COVID-19 pandemic. But shouldn’t patients be screened for PTSD, as well? Here is the Primary Care PTSD Screen for DSM-5. The first question asks about lifetime exposure to traumatic events. If the patient denies exposure, the screen is complete with a score of 0. If the patient indicates that they have had an exposure to trauma, there are 5 additional yes/no questions that assess how the trauma exposure has affected them over the past month.

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Article Details
Intensive Care Unit Nurses’ Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients
Paula Levi, BSN, RN and Jacqueline Moss, PhD, RN, FAAN
First published online February 3, 2022
DOI: 10.1177/21650799211064262
Workplace Health & Safety

About the Author

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Paula Levi PhD, RN is a recent graduate of the University of Alabama at Birmingham’s Doctor of Philosophy in Nursing program where she was a National Institute of Safety and Health Fellow. She is now an Assistant Professor of Adult Health Nursing at the University of South Alabama. Her research focuses on stress, psychological distress, and post-traumatic stress disorder (PTSD) in intensive care unit nurses. She is also interested in: occupational health issues in those in high-stress medical professions and first-responders (e.g., physicians, nurse managers, police, firemen); identifying reliable biomarkers that predict PTSD; and developing effective strategies and interventions that prevent or mitigate PTSD.