Burnout is a constellation of emotions caused by a high level of distress, which renders service providers helpless and overwhelmed and made them vulnerable to physical and mental illness (Yoder-Wise, 2019, p. 216). Maslach and Leiter (1997) describe burnout's psychological view, and they explain the impacts of physical and emotional exhaustion caused by relentless workload without relief. Yoder-Wise (2019) states that psychological stressors may originate from the person's environment or the interaction between the person and the environment. Due to COVID-19, nurses, who are the primary caregivers, have experienced burnout due to the unending workload in intensive care Units. This essay addresses the issue of burnout in ICUs due to COVID-19.
Due to the intensity of the effects of coronavirus disease 2019, nurses are advised to spend fewer hours in patients' rooms to lower their exposure time with the patients. However, most hospitals require their nurses to work for about twelve hours a day, which is longer for them, keeping in mind that the COVID-19 pandemic affects each family, including those of the nurses. The number of patients on Intensive Care Units in various hospitals has greatly increased, which directly increases nurses' workload. The long hours and the increased workload can add to their physical and emotional stress. They have the pressure of caring for more victims than usual, including those diagnosed with coronavirus in bad states requiring more care in ICUs.
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Psychological Stress of ICU nurses due to COVID-19
During the COVID-19 pandemic, hospitalized patients are not allowed to receive any visitation from family members. Therefore, the whole burden goes to the serving nurses at various treatment units, but the situation is worse at Intensive Care Units since the patients there are completely helpless. Moreover, nurses provide emotional support to patients while encouraging them to remain positive. However, less support has been implemented to address psychological stress in both the nurses and the patients. According to Greenglass et al. (2001), the increased workload directly relates to the level of emotional exhaustion. A recent increase in the number of patients in ICUs has increased the nurse's workload, which is the first cause of psychological stress. COVID-19 is a new pandemic that causes stress to nurses due to the fear of failure. Yoder-Wise (2019) confirms that nurses' fear of failure causes emotional exhaustion, which directly affects the level of somatization and cynicism, leading to burnout.
Another cause of psychological stress on ICU nurses is worry about getting infected with the coronavirus. Due to the disease's fear, nurses tend to distance themselves with the work, making them develop a negative attitude towards the nursing process. Greenglass et al. (2001) describe the concept of depersonalization as the state where a nurse distances themselves from work and ends up developing a negative attitude towards the general work. The actual condition in various ICUs causes depersonalization, which is a characteristic of burnout. It makes the nurses feel unreal, hence making them uneasy and anxious. The ICU nurses taking care of COVID-19 patients are pushed to do much in limited time. Therefore, they tend to stay away from COVID-19 patients as a way of counteracting emotional exhaustion.
Worry about their families also make nurses experience psychological stress leading to burnout. COVID-19 being a global pandemic, impacts every family and leaves every family member vulnerable to infection. The nurses' personality features at the time of COVID-19 may lean too heavily on the caregiving dimension, which always carries over to their personal life. Being a nurse, their family members expect to receive more care from them at the time of COVID-19 than those they deliver to various hospitals. Therefore, it leaves them with a lot of stress during their caregiving process at ICUs. Yoder-Wise (2019) explains that caregiving people may be challenged by life partners and families who demand a disproportionate amount of time and energy. Anxiety regarding unfamiliar working environments and processes on ICUs due to COVID-19 also leads to burnout. The handling process for infected patients has not been experienced for the past three decades. The nurses taking care of infected patients must put on different types of protective clothing to protect them from the infection since the disease is widely spreading. The working environment is also hectic, with ventilators everywhere, which psychologically stresses the nurses.
Inadequate work experience to tackle infectious diseases reduces professional competence and accomplishment, which also leads to burnout. Greenglass et al. (2001) state that higher levels of cynicism relate to low professional efficacy. Yoder-Wise (2019) defines efficacy in nursing as nurses' belief in their capabilities to execute activities according to the goals of the hospital. He argues that nurses can easily take tasks if they are certain of their capabilities to make the process successful. Due to lower efficacy levels in caregiving COVID-19, an infectious disease, nurses always believe that the tasks are harder than they are. Depression resulting from unsuccessful cure of critical COVID-19 victims leads to burnout in nurses at various ICUs. Since none of the cases has been cured, nurses often lose hope in the process since they are not certain of their activities' success.
Interventions to Reduce Burnout on ICUs due to COVID-19
Yoder-Wise (2019) states that nursing supervisors, nurse managers, and assistant nurse managers often have the task of addressing and referring nurses to seek help before the stress escalates to high levels. Brooks et al. (2020) state that if nurses' psychological problems are not solved effectively, their immunity may reduce, making them vulnerable to COVID-19. Some solutions have also been implemented in various hospitals to ensure that the causes of burnout are counteracted. A study conducted by Shen et al. (2020) in Wuhan, China, highlighted some of the measures implemented at various hospitals to lower the occurrence of burnout to ICU nurses. First, the team advised the appropriate allocation of COVID-19 victims according to the exact ability of nurses and providing the appropriate training to nurses to enable them to gain confidence in their efficacy and increase their working experience in infectious diseases. The team also suggested establishing a communication channel with the medical staff to familiarize themselves with the environment at ICUs. Also, the local medical staff should help the nurses to familiarize themselves with the working procedure as soon as possible to address the issue of anxiety concerning the unfamiliar working processes. The nurses should be trained on how to give care to COVID-19 patients without infecting themselves and their families.
Most importantly, the nurse managers should adjust the work shift to ensure that nurses get enough time to rest and spend with their families during this pandemic (Shen et al., 2020). It will help to reduce their workload and will also lower long-term fatigue. On the issue of worry about nurses' families, they should regularly communicate with their family members through WeChat videos to confirm that they are safe. The nurses should also communicate with their workmates that experiences the same thing. The nurse managers should develop a team of mental experts to offer psychological guidance and training to nurses to reduce their worry about their families. The hospital should share successful therapy cases (Shen et al., 2020) to reduce nurses’ depression resulting from unsuccessful cure of COVID-19 victims in critical state. Nurses need to be trained and educated on occupational exposure management, medical waste management, ward disinfection, hand hygiene, and personal protection.
Conclusion
In conclusion, much evidence reported high incidences of nurses' burnout in the COVID-19 period, which was related to depression and anxiety. Nurse Managers and nurses are advised to pay much attention to the nurses' mental health to avoid burnout. It is evident from various studies that psychological stress experienced by ICU nurses during the COVID-19 period originates from factors such as worry about their families; depression due to lack of cure to patients in critical condition, huge workload; worry about getting infected; inadequate work experience to handle infectious diseases; and anxiety due to unfamiliar working processes and environment. Therefore, this study analyzed some recommended measures to address ICU nurses' psychological problems taking care of COVID-19 patients.
Reference
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: a rapid review of the evidence. The Lancet .
Greenglass, E. R., Burke, R. J., & Fiksenbaum, L. (2001). Workload and burnout in nurses. Journal of community & applied social psychology , 11 (3), 211-215.
Maslach, C., & Leiter, M. P. (1997). The thruth about burnout.
Sasangohar, F., Jones, S. L., Masud, F. N., Vahidy, F. S., & Kash, B. A. (2020). Provider burnout and fatigue during the COVID-19 pandemic: lessons learned from a high-volume intensive care unit. Anesthesia and analgesia .
Shen, X., Zou, X., Zhong, X., Yan, J., & Li, L. (2020). The psychological stress of ICU nurses in the time of COVID-19.
Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed., pp. 216-217). St. Louis, MO: Elsevier.
