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Psychiatric-Mental Health Nursing

27.1 Effects of the COVID-19 Pandemic

Psychiatric-Mental Health Nursing27.1 Effects of the COVID-19 Pandemic

Learning Objectives

By the end of this section, you will be able to:

  • Discuss the impact of the stress of the COVID-19 pandemic on mental health-care services and innovation
  • Describe nursing strategies for client care in a postpandemic context
  • Review nurses’ mental health and self-care postpandemic

The COVID-19 pandemic has had a profound impact on the landscape of mental health care, ushering in a surge of mental health challenges, such as heightened anxiety, depression, and trauma-related symptoms. It has underscored the vital role of mental health practitioners, including psychiatric-mental health nurses, in providing essential support and interventions to individuals grappling with pandemic-induced mental health tribulations. Moreover, the pandemic has prompted a rapid transformation in mental health service delivery, with the widespread adoption of telehealth and innovative technological approaches to therapy. This section explores the multifaceted ways in which the pandemic has reshaped mental health care and highlights the resilience and adaptability of nurses in responding to the evolving needs of their clients amidst a global health crisis.

Stressors and Innovation

According to the World Health Organization (WHO), as of January 21, 2024, more than 770 million COVID-19 cases had been reported worldwide, with more than 7 million deaths (WHO, 2024).

As of September 2023, COVID-19 had resulted in more than 6 million hospitalizations and more than a million deaths in the United States (Centers for Disease Control and Prevention [CDC], 2023a). It has exacerbated preexisting mental health issues and introduced new ones. The isolation, fear, uncertainty, and grief associated with the pandemic have led to a surge in anxiety, depression, and post-traumatic stress disorder (PTSD) in individuals of all ages (Mortazavi et al, 2020).

Fighting the COVID-19 pandemic required a strategy known as flattening the curve, which refers to a public health strategy aimed at slowing the spread of a contagious disease, like COVID-19, to ensure that the health-care system can manage the capacity of clients. By implementing measures, such as social distancing, mask-wearing, and lockdowns, the goal was to reduce the peak number of cases that intensified in a short period of time to spread cases out in order to protect vulnerable populations and provide appropriate health-care access. This helped keep hospitals from being overwhelmed and allowed them to provide adequate care to those in need, ultimately saving lives. Social distancing and lockdowns took a toll on the mental health of millions of people, however. In fact, the COVID-19 pandemic intensified feelings of fear and isolation in many people. Fear has been a pervasive emotion; fear of the virus itself and fear of the vaccine when it was introduced affected huge portions of the American population. Social isolation stemming from lockdowns, social distancing measures, and limited in-person interactions exacerbated feelings of loneliness and depression among mental health clients who rely on social support networks for their well-being.

The Substance Abuse and Mental Health Services Administration (SAMHSA, 2020) called attention to the potential for increased domestic violence due to stay-at-home orders.

Access to care became a significant challenge as many mental health services were disrupted or shifted to virtual platforms, creating barriers for those without reliable internet access or suitable privacy for telehealth sessions (SAMHSA, 2020). SAMHSA called for health care, schools, businesses, and law enforcement to work together to help families and communities (2020).

Nurses and other frontline health-care workers likewise experienced stress and burnout due to the demands of caring for COVID-19 clients, often witnessing high mortality rates. The COVID-19 pandemic placed immense pressure on nurse staffing, resulting in a surge in demand for health-care services and a shortage of qualified nurses. This led to extended work hours and a need for innovative strategies to recruit and retain nursing staff in health-care facilities (Chan et al., 2021). Access to mental health services became more critical than ever, with many people struggling to cope with the emotional toll of the pandemic. This prompted the rapid shift toward telehealth and virtual mental health services, which have played a crucial role in ensuring continued access to care while reducing the risk of virus transmission.

The pandemic highlighted the importance of addressing mental health as an integral part of public health. Governments and health-care systems worldwide have recognized the significance of mental well-being during crises and have begun to allocate more resources and funding to mental health services. Additionally, the pandemic brought discussions surrounding mental health out of the shadows and reduced stigma. People have become more open about their struggles, which may lead to lasting changes in how society views and supports mental health. The pandemic has also accelerated research and innovation in mental health care, with a focus on developing new treatments, interventions, and support systems to meet the growing demand for mental health services. While the negative impact of COVID-19 on mental health has been significant and challenging, the pandemic has also spurred positive changes and increased awareness about the importance of mental health care in communities.

The COVID-19 pandemic compelled psychiatric-mental health nurses to expand their skill set and adapt to new realities in health-care delivery. The pandemic accelerated the adoption of telehealth and digital mental health services and highlighted the need for the mental health-care providers to be prepared with alternative ways of providing care to their clients in case of widespread emergencies. Preparedness now encompasses a broader range of competencies, including telehealth proficiency, crisis management in a virtual context, technological literacy, and a heightened focus on client education and support.

Since the pandemic, psychiatric-mental health nurses have increasingly utilized videoconferencing, phone calls, and online platforms to provide remote care to clients. This innovation has expanded access to mental health services, reaching individuals who may have previously faced barriers to in-person care, such as those in remote areas or with transportation challenges. It has also enabled nurses to conduct assessments, provide therapy, and offer support in a safe and socially distanced manner. Additionally, some nurses have integrated digital tools and apps into their practice to monitor client progress, provide psychoeducation, and engage in therapeutic interventions. These technological advancements represent a lasting transformation in mental health service delivery, but also require certain skills in order to implement and deliver effectively.

Preparedness now includes a greater emphasis on technological literacy. Nurses became more comfortable with digital mental health tools, apps, and online resources, and they incorporated these into their practice to support client self-management. Nurses also played a pivotal role in educating clients about the availability and benefits of telehealth services, helping them navigate digital platforms, and ensuring they had the necessary resources to participate in remote sessions.

Nurses have developed new protocols for remote crisis intervention and assessing clients for signs of distress during telehealth sessions. They have adapted their crisis management strategies to the virtual environment, ensuring that clients in crisis continued to receive timely support. Nurses also incorporated preparedness for public health emergencies into their practice. They learned to adapt quickly to changing circumstances, including potential lockdowns and quarantine measures, and to ensure continuity of care for clients under challenging conditions.

Psychosocial Considerations

National Suicide Hotline

The creation of 988 as the National Suicide Hotline of the United States officially began with The National Suicide Hotline Designation Act of 2020. The decision to create a three-digit hotline, similar to 911 for emergencies, was driven by the need to improve access to mental health services and crisis intervention. In July 2022, 988 was established as the dialing code for the National Suicide Prevention Lifeline.

By having a dedicated and easily accessible number, the hope is to reduce the stigma associated with mental health issues and encourage people to seek help when needed. Additionally, a dedicated number can help streamline the process of connecting individuals in crisis with appropriate mental health professionals, improving response times.

(National Association of State Mental Health Program Directors, 2021)

Nursing Actions and Strategies for Client Care

Amid the challenges posed by the COVID-19 pandemic, psychiatric-mental health nursing has to ensure effective client care while promoting self-help and community services and supporting recovery. One crucial strategy involves emphasizing self-help resources and techniques tailored to the unique circumstances of the pandemic. Psychiatric-mental health nurses have been at the forefront of providing clients with tools to manage their mental health independently. Encouraging clients to tap into available community resources and support networks is another aspect of this approach, fostering resilience and reducing feelings of isolation.

In addition to promoting self-help and community resources, psychiatric-mental health nurses played a central role in supporting the recovery journey of clients during the pandemic. They ensured continuity of care through telehealth platforms, offering regular check-ins and therapy sessions to maintain therapeutic relationships and monitor progress. Nurses also adapted treatment plans to address pandemic-related stressors and traumas, fostering a recovery-oriented approach that acknowledges the unique challenges of these times. By implementing trauma-informed care and tailoring interventions to individual needs, psychiatric-mental health nurses strive to facilitate not only symptom management but also the broader process of healing and recovery.

Promote Self-Help and Community Services

Psychiatric-mental health nurses played a vital role in promoting self-help and community services for clients during the COVID-19 pandemic, recognizing the importance of resilience, coping, and access to support systems. Here are some ways in which they have contributed and continue to contribute to these efforts:

  • Empowering clients with self-help strategies: Psychiatric nurses can actively educate their clients about self-help strategies for managing stress, anxiety, and other mental health challenges related to the pandemic. They can provide guidance on techniques, such as mindfulness, deep breathing exercises, and grounding exercises that clients can practice on their own to alleviate symptoms.
  • Promoting psychoeducation: Nurses can be instrumental in providing psychoeducation about the psychological impact of the pandemic, emphasizing that feelings of fear, isolation, and uncertainty are normal responses. By helping clients understand the link between their emotions and the pandemic, nurses empower them to take control of their mental health.
  • Referring to community resources: Psychiatric-mental health nurses connect clients to community resources and services that provide additional support. They facilitate referrals to local mental health agencies, crisis helplines, support groups, and teletherapy services, ensuring that clients have access to a broader network of assistance.
  • Supporting telehealth and online communities: Recognizing the importance of virtual support during lockdowns and social distancing measures, nurses have encouraged clients to engage in online mental health communities, peer support groups, and virtual therapy sessions. They help clients navigate these resources, ensuring they can access assistance even when in-person options are limited.
  • Strengthening coping skills: Nurses have worked with clients to enhance their coping skills, including problem-solving, goal-setting, and building resilience. They assist clients in developing personalized coping plans tailored to their unique circumstances.
  • Providing a listening ear: Perhaps one of the most critical roles of psychiatric-mental health nurses has been providing a compassionate and empathetic listening ear. They create a safe and nonjudgmental space for clients to express their fears and concerns, offering emotional support and validation.
  • Advocating for client needs: Psychiatric nurses often advocate for their clients’ mental health needs within the health-care system and the community, helping to reduce stigma and improve access to care.

Life-Stage Context

Social Media and Adolescents during the Pandemic

Adolescents increasingly belong to a media culture. A survey of ninety-three teen girls was conducted during the COVID-19 lockdown on their connections between peer relationships, social media use, and emotional well-being. The survey found that social technologies created acceptable contact and provided emotional benefit when actual face-to-face interactions were restricted.

Limitations of the study included a high percentage of girls in socioeconomically secure groups and data collection through self-report. Most study participants identified as White, non-Hispanic. The researchers acknowledge that the pandemic had disproportionate effect on families in minoritized communities, and that their study may not be generalizable to broader, more diverse samples.

(James et al., 2023)

Support Recovery

Psychiatric-mental health nurses have assumed a pivotal role in supporting clients’ recovery in the wake of the COVID-19 pandemic. Anxiety and depression increased in the adult population during the pandemic, as did the rates of substance misuse and drug overdose deaths (Panchal et al., 2023). With a specialized focus on the mental health challenges stemming from the pandemic, nursing responsibilities encompass a range of functions.

Nurses assess the unique psychological impacts of COVID-19 on individual clients, considering factors such as isolation, grief, anxiety, and trauma. Based on these assessments, nurses collaboratively develop tailored care plans to address specific pandemic-related stressors and mental health symptoms. Medication management remains a crucial aspect of their role, ensuring that clients who require psychiatric medications for mental health challenges receive appropriate treatment and monitoring. Additionally, nurses play an active role in educating clients about the importance of mental well-being during trying times, focusing on strategies to manage stress, sleep, and overall health. Monitoring and follow-up care are integral, allowing nurses to track progress and adjust interventions as necessary, while stigma reduction efforts work to encourage clients to seek help without fear or judgment.

Nurses’ Mental Health and Self-Care

The COVID-19 pandemic has exerted a profound impact on the mental health of psychiatric-mental health nurses themselves, exacerbating existing challenges in their profession. Psychiatric nurses have faced increased stress and emotional strain while providing care during the pandemic. The isolation and social distancing measures have disrupted the therapeutic relationships they build with their clients, and the restrictions on visitations heightened the feelings of loneliness and despair among those receiving psychiatric care. Policy changes and uncertainty surrounding the pandemic response added to the stress, making it challenging for nurses to plan and provide consistent care. Additionally, controversy surrounding COVID-19 vaccines became a source of tension and stress among health-care workers, including nurses (Peterson et al., 2022). While vaccines have proven effective in preventing severe illness, some nurses expressed vaccine hesitancy, leading to concerns about workplace safety and potential conflicts with colleagues who hold differing views. This has contributed to the overall emotional burden experienced by psychiatric-mental health nurses during the pandemic.

The mental health toll on psychiatric nurses has been substantial, with many reporting higher rates of depression, anxiety, and sleep disturbances (Aloweni et al., 2022). The constant exposure to the emotional distress of their clients and the additional anxieties related to COVID-19 transmission took a toll. Moreover, changing personal priorities emerged as a significant issue. The pandemic forced many nurses to grapple with difficult decisions about their own health and the health of their families, leading to internal conflicts and guilt. Balancing the demands of work with their personal lives, including caring for children or vulnerable family members, became increasingly challenging. In sum, the COVID-19 pandemic highlighted the need for comprehensive mental health support for psychiatric-mental health nurses, addressing not only the unique stressors of their profession, but also the broader societal challenges that emerged during this global crisis.

Frontline Experience

During the COVID-19 pandemic, psychiatric-mental health nurses faced a myriad of challenges that significantly affected their mental health (Kameg et al., 2021). Issues related to the supply of personal protective equipment (PPE) added an extra layer of stress and anxiety, as they often worked in environments requiring adequate protection. The intensity of their workloads also skyrocketed as they faced the emotional burden of caring for clients who were grappling with the mental health effects of the pandemic, all while adapting to new safety protocols and an influx of COVID-19 cases. The work led to burnout among many nurses. The integration of new nurses, while essential to meet the surging demand for health-care professionals, added to the pressure of the experienced psychiatric-mental health nurses who had to train and supervise them.

Tragically, the pandemic also brought an increase in client deaths, further contributing to the psychological toll on these nurses. Witnessing the loss of clients, particularly when in-person support from families was limited or prohibited due to COVID-19 restrictions, added to their grief and emotional distress. Many nurses developed compassion fatigue, the emotional and physical exhaustion that results from providing empathetic care to those experiencing trauma or suffering. The cumulative effect of these challenges led some nurses to leave the profession, worsening staffing shortages in an already strained mental health-care system.

Real RN Stories

Nurse: Janis, BSN
Geographic Location: Missouri

Working as a behavioral health nurse during the pandemic was both challenging and eye-opening. While the world was dealing with the physical health crisis, my clients were fighting their own silent battles against the pandemic’s toll on mental health. The isolation, fear, and uncertainty magnified their struggles, and it was heart-wrenching to witness. The loneliness was one of the worst things for most people, I think. We had to stop allowing visitors for our clients and that was really hard for them. Our staff had to adapt quickly to using PPE and educated all of the clients on hygiene and distancing. Yet, there were moments of triumph, too, as I saw the resilience in my clients and the incredible strength they possessed. The pandemic taught me the vital importance of mental health support and solidified my dedication to this field, knowing that my role in helping others navigate their darkest moments during an especially stressful time was more crucial than ever.

Sustaining Nursing Workforce

Sustaining the psychiatric-mental health nursing workforce during and after the COVID-19 pandemic has been crucial, given the increased demand for mental health services and the unique challenges faced by these professionals. Several key strategies and considerations have come into play:

  • Practice environment: Ensuring a supportive and safe practice environment is paramount. Adequate staffing levels, access to personal protective equipment (PPE), and infection control measures are crucial for nurses’ physical safety and well-being. Additionally, promoting a culture of respect, support, and recognition within health-care settings can help lessen the emotional toll of the pandemic on psychiatric-mental health nurses.
  • Academy Health Interdisciplinary Research Group on Nursing Issues (IRGNI): Organizations like IRGNI have played a vital role in fostering research collaboration and knowledge dissemination within the field of nursing. During the pandemic, these groups facilitated sharing best practices, evidence-based interventions, and research findings to inform psychiatric-mental health nursing care (AcademyHealth, n.d.).
  • Nurse-led initiatives and policy: Psychiatric-mental health nurses have been at the forefront of developing innovative care delivery models and advocating for policy changes to address the pandemic’s mental health impact. Nurse-led initiatives have been instrumental in expanding access to mental health services, particularly through telehealth, and promoting policies that support mental health parity.
  • Diversity, equity, and inclusion (DEI): Efforts to promote diversity, equity, and inclusion in psychiatric-mental health nursing education and employment have gained momentum. Ensuring a diverse workforce that reflects the communities it serves is essential for providing culturally sensitive and responsive care, especially during a public health crisis.
  • Retention and recruitment: Retaining current nurses has been a priority, with health-care organizations offering mental health support, flexible work arrangements, and career development opportunities. Simultaneously, organizations have been recruiting new psychiatric-mental health nurses through targeted outreach, educational incentives, and by highlighting the importance of mental health nursing in addressing pandemic-related mental health challenges.

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