The Impact of the Covid-19 Pandemic on Nurses’ Mental Health: The Case of São Vicente Volume 3 - Issue 5

Master Suely Reis¹*, Master Jericia Duarte¹ and Master Carina Cardoso²

• ¹Master in Community Nursing, Professor, University of Mindelo, Cape Verde
• ²Master in Pharmacology, Professor, University of Mindelo, Cape Verde

Received:September 23, 2021;   Published: October 08, 2021

Corresponding author:Master Suely Reis, Master in Community Nursing, Professor at the University of Mindelo, Cape Verde, Africa

DOI: 10.32474/JCCM.2021.03.000173

Abstract PDF

The covid-19 pandemic, which has plagued humanity since March 2020, is configured as a situation of crisis in public health unprecedented for the current generation of health professionals, and as such has brought to light the need to value the mental health of professionals, namely that of nurses who are at the forefront in combating covid-19. In the middle of the pandemic, nurses’ vulnerability was perceived, since the situations previously considered stressful are aggravated by the pandemic scenario, causing feelings of uncertainty, emotional instability and fear to emerge, which consequently compromise the mental health and psychological well-being of nurses. And in this scenario, we propose the present study that has as general objective to identify the impacts of the covid-19 pandemic on the mental health of nurses in São Vicente. To develop this research, we propose to carry out an exploratory, descriptive, quantitative and cross-sectional study. The collection of the information will be carried out through a self-completed online questionnaire survey which will be properly prepared and validated. The target population of the study will consist of all nurses working in São Vicente in the context of the Covid-19 pandemic, which will be selected through a probabilistic sample. In carrying out the study we are committed to respect all ethical and legal procedures inherent to scientific research. We believe that the results of this study will be fundamental impulses for the definition of strategies and policies for the protection and promotion of mental health of health professionals, especially nurses.

Keywords:Mental Health; Nurses; Covid-19; Psychological Impact

The realization of this study arises primarily from the scientific curiosity to know the impacts of the Covid-19 pandemic in Cape Verde, focusing on the mental health of nurses, since, as is known, in the context of the provision of care to users with Covid-19, these tend to deal with a set of stressors with potential to compromise their mental health and well-being. The confrontation of the pandemic has given rise to several weaknesses and in several areas, in the case of health, the weaknesses of health systems stand out, somewhat throughout the world, where there was a shortage of human and material resources, limitations in the number of hospital beds and also at the level of the physical space itself, which are fundamental resources to manage the pandemic. These weaknesses directly affect nurses who were forced to adapt to new services, new structures, new clothing and uniforms, new methods and forms of organization and distribution of services, new circuits and protocols, hourly overload, exposure to large-scale deaths, fatigue, frustrations related to the quality of care provided and also the imminent risk of being infected.

All these situations, by themselves, inevitably generate fear, uncertainty, anxiety, and if we combine with this the fact that they are deprived of contact with their relatives and their circles of social coexistence, we will inevitably realize that this health crisis has led to the emergence of various factors that constitute potential generators of stress and psychological suffering for nurses, which further evidences the need and relevance of this study. Allied to the scientific curiosity that motivates the development of this study, we also highlight the interest as a health professional in knowing and making known the challenges and implications that the Covid-19 pandemic brings to the nursing class. Because several countries have already advanced with study in this theme, which has proved to be a fundamental strategy in the definition of policies and strategies to support nurses working on the front line in the fight against Covid-19. We believe that the Ministry of Health of Cape Verde also has every interest in conducting studies on this theme, since studies of this kind will constitute fundamental impulses for the definition of strategies and policies for the protection and promotion of mental health professionals, particularly nurses, since knowledge of experiences and experiences of practice, contribute to the definition of assertive and effective strategies.

Despite all the above motivations, we aim that this study serves to stimulate reflections and discussions about the mental health and psychological well-being of health professionals, because increasingly, the need for mental health is felt to be assisted and assisted as one of the fundamental pillars of health, whose absence can interfere in the sustainability of the quality of health care aimed at the population, since this is characterized as being crucial in strengthening resilience in the fight against the covid-19 pandemic. On the other hand, we are convinced that this study constitutes an opportunity to boost the recognition of nurses as a fundamental professional class for the proper functioning of the National Health System and as such their health should be prioritized. According to the Federal Nursing Council of Brazil (2020) Nursing has a fundamental role in combating the pandemic, not only because of its technical capacity, but also because it is the largest health professional category, and the only one that is 24 hours a day alongside the patient. They are professionals who are at the forefront of care provided, regardless of the type of care and the pandemic health situation or not. The essence of nursing is the care process, and this process is not restricted to the development of technical activities, it also involves scientific knowledge, feelings and emotions [1].

Unfortunately, throughout the history of nursing, the constant devaluation of the nursing class was noted, to the detriment of other professional classes, equally important for the provision of care to the population.

It is a class that has always been exposed to high occupational risks, such as working in unfavorable and undignified conditions and with high hourly overload, and all without due recognition of its importance in health systems. Unfortunately, and belatedly, the pandemic scenario associated with covid-19, caused the class to gain greater notoriety and recognition in the health system. The professional class historically affected by low wages and unfavorable working conditions, went from devalued to protagonist of the fight against the new Coronavirus; however, all this rise has “a price” [2]. In the scenario of the pandemic of the new coronavirus, nursing has reaffirmed its importance in human health care and coincidentally in 2020, the World Health Assembly decides to honor the profession, calling this act “Nurses and Midwives cleancare is in your hands” by the campaign “Nursing Now”, which bears the emblem “where there is life, there is nursing”, evidencing the confrontations already experienced by the class, and the current one, in which the profession sacrifices itself and makes visible its importance in health systems [3,4]. According to [5], due to the pandemic, situations previously considered stressful are aggravated, generating feelings of uncertainties and emotional instabilities, making this group more vulnerable because it is dealing directly with infected people and presenting higher proportions of pressure and fear in being affected by the disease.

In this context, the performance of the nursing team stands out. In addition to being frontline professionals, they work on strenuous journeys, deal with the excretes of patients and perhaps it is the professionals who spend the most time alongside people hospitalized for the disease. In addition, they face the scarcity of personal protective equipment (IEs), deal with death at all times and, when they return to their homes, they experience social distancing and fear of contaminating their families [6]. [7] state that the situation is critical for health professionals, especially for nurses who are at the forefront of the care process, responsible for the treatment and care of patients with Covid-19. The greater number of confirmed and suspected cases, the exhaustive workload, the scarcity of personal protective equipment and the lack of specific drugs for cure can generate significant mental suffering in these health professionals, a situation already highlighted in the guidelines for psychological care in hospitals in times of combating covid-19. In this context and corroborating the thinking of [8], it is necessary to value the experience of a crisis situation in public health unprecedented for the generation of professionals, which implies different psychological reactions to cope with the stressful daily life during the covid-19 pandemic. It is possible that psychological pressure, given the constant adaptations in the routine of care practice, insecurity and fears linked to personal life, in addition to experiences of crisis and psychological or psychiatric morbidities in the previous history of some health professionals, are reflected in depressive reactions, exacerbation of anxious symptoms and (in) disposition to work.

On the other hand, we cannot neglect that in more extreme situations, nurses and other workers from health teams and essential services recently left their homes to inhabit another environment, or even their cars, as a way to avoid contact with family members and in an attempt to protect them from any contagion. Specifically in the daily work of the teams of emergency mobile services, the care, during this pandemic period, has been offered in the most precarious way possible to patients and family members and, at the same time, seeking to protect all professionals from eventual contagion [9]. Previous studies show that mental disorders, including posttraumatic stress disorders, anxiety, depression, panic attacks, irritability, delirium, distrust and even suicidal thoughts, were prevalent among nurses who cared for patients with severe acute respiratory syndrome. Developed mental disorders can lead to psychological disorders, loss of appetite, fatigue, impaired physical capacity, sleep disorders, irritability, apathy, numbness, fear and hopelessness [10]. In the current scenario, due to the increased prevalence of the virus and also to the increase in the number of deaths of nurses, it is necessary to be attentive to the mental health of nurses because it is known that stress and mental disorders can, as a vicious cycle, weaken the immune system and lead to coronavirus infection, especially in nurses with a history of mental disorders [11].

It should also be emphasized that studies conducted in China have pointed out a high prevalence of signs and symptoms of mental illness among health professionals and highlight the importance of special interventions to promote the mental well-being of these professionals with a more careful attention to women who are on the front line (10). On the other hand, it is necessary to consider that nurses’ mental disorders can also significantly reduce the quality of care to users. Also, according to [5], these conditions raise the need for greater management of their mental health with factors that enhance psychological well-being, such as activities involving values such as altruism, belief in science, faith and hope. According to the authors [6] the mental health of nursing professionals needs to be listed as one of the priorities for health managers, ensuring strategies and public policies that ensure sanity for those who are at the forefront in combating the pandemic. Because despite the importance of this issue, unfortunately mental health tends to be neglected or underestimated, so it is imperative to pay attention to the mental and psychological issues of nurses in the care of users with covid-19 [11]. It is urgent to adopt efficient measures to mitigate the psychological implications of the pandemic, otherwise we will be compromising the quality of care provided to the population, which may further aggravate the situation experienced today, especially since the psychological implications tend to be more enduring and prevalent than the disease caused by the new coronavirus itself [12], incalculable consequences at all levels.

For Cape Verde, studies on the implications of the pandemic are scarce or non-existent, but it is assumed that the scenario does not differ from the other contexts mentioned above, as this is a new and as unprecedented historical situation. Statistical data from the Ministry of Health of Cape Verde (2021) indicate that since March 2020, when the first positive case was registered, to date 37 157 positive cases have been confirmed, of which 35975 are recovered, [13] 09 have been transferred and 331 have died. At the moment the country has 827 assets. These data reflect the situation experienced in the country, which constitutes a major challenge for the national health system. Although data on the number of nurses infected with covid-19 are not disclosed, it is known that several cases have been reported throughout the country. It is also known that in the organization of care in a pandemic scenario there are a considerable number of nurses who have been deployed for direct combat to covid-19 [14], being distributed in several hospitals’ services, namely in isolation and investigation services, health police stations, ports and airports, screening centers and monitoring of positive cases. Being Cape Verde, a developing country, it is natural that the various weaknesses and difficulties observed in other countries have also been experienced here in the country, with emphasis on health. In this scenario, nurses also had to manage the pandemic with scarce human and material resources, with limitations in the number of hospital beds and also at the level of the physical space itself. As already reported by other countries, nurses in Cape Verde were forced to adapt to new services, new structures, new clothing and uniforms, new methods and forms of organization and distribution of services, new circuits and protocols, hourly overload, exposure to deaths, fatigue and frustrations related to the quality of care. As is already known, all these situations are configured as stressors with the potential to compromise the mental health and psychological well-being of nurses [15]. Based on this concern and in an attempt to know and make known the challenges and implications of the Covid-19 pandemic in the nursing class of São Vicente, we understand it is pertinent to develop this study in an attempt to understand how the mental health of nurses in São Vicente who are at the forefront in combating covid-19 [16]. This study will be based on the following general objective to identify the impacts of the covid-19 pandemic on the mental health of nurses in São Vicente.

Given the nature and problem of this investigation, we opted for a quantitative, descriptive, exploratory, and cross-sectional study. The target population is the nurses of São Vicente who are engaged in the fight and control of the pandemic, which will be selected according to the inclusion and exclusion criteria previously defined. In the collection of information, it will be necessary to mobilize an instrument that in this case will be a self-completed online questionnaire, which after preparation and validation will be available for a period forty-five (45) days. The information collected will be analyzed using SPSS (Statistical Package for Social Science for Windows) version 21, and later will be organized in graphs and tables in order to facilitate the presentation and interpretation of the results obtained [17]. In carrying out the study, we undertake to respect all ethical and legal procedures inherent to scientific investigations, namely the request for authorization to carry out the study to the ethics committee of the Ministry of Health of Cape Verde.

We believe that the results of this study will constitute fundamental impulses for the definition of strategies and policies for the protection and promotion of mental health of health professionals, particularly nurses, since knowledge of the experiences and experiences of practice contribute to the definition of assertive and effective strategies. On the other hand, we are convinced that this study is an opportunity to boost the recognition of nurses as a fundamental professional class for the proper functioning of the National Health System and as such their health should be prioritized.

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