COVID Trauma Could Result in PTSD for Nurses
By John Ziegler
Post-traumatic stress disorder (PTSD) can be debilitating, and after the daily stress and trauma of caring for critically ill COVID patients, nurses and healthcare providers need to be aware of that this may affect them. The clinical definition of a trauma includes incidental or prolonged exposure to actual or threatened death, and this has certainly been the case with nurses during the pandemic.
And although many nurses may feel alright at the moment, we need to keep in mind that acute PTSD symptoms often present four to eight months after the traumatic events, and since COVID peaked in January, we are currently in the time window in which PTSD might begin to present.
The Alabama State Nurses Association (ASNA) communicates with our 3,000 members often and to the entire cohort of licensed Alabama nurses monthly. Our surveys have provided data from a large portion of the state's nurses and many have reported that they are exhausted. Currently, staffing shortages are contributing to their levels of stress and the pre-COVID sense of stability they experienced in their career has vanished.
We all know that nurses are resilient, and although they are known for their fortitude and stamina, physical and emotional strength does not make a person immune from PTSD. And the potential for PTSD is not limited to nurses who have worked directly with COVID patients. Many nurses, who were not in COVID units, have experienced what experts call "collective trauma" within an identity group. Collective trauma most often relates to military personnel who served in combat or combat support units. The group identity of "soldier" links them all together. Through months of COVID, nurses have experienced varying levels of exposure to actual or threatened death. This perceived threat can be to one's own life, someone you know or through repeated exposure to the details of the traumatic experiences of others. Like combat and combat support veterans, the psychological impact on nurses of this collective trauma exposure is expected to be long-term.
This trauma-induced PTSD should be taken seriously. During a trauma, your body responds to a threat by going into flight or fight mode. It releases stress hormones, like adrenaline and norepinephrine, to give you a burst of energy. Your heart beats faster. Your brain also puts some of its normal tasks, such as filing short-term memories, on pause.
PTSD causes your brain to get stuck in danger mode. Even after you're no longer in danger, it stays on high alert. Your body continues to send out stress signals, which lead to PTSD symptoms. Studies show that the amygdala, which handles fear and emotion, is more active in people with PTSD. Essentially, the prolonged trauma can impact the wiring of brain physiology with certain axons and dendrites not firing as they previously did. Some people may try to self-medicate with drugs, alcohol, or other forms of escapism, but as we all know, this only makes the situation worse.
The good news that, like any illness, PTSD can be recognized and treated, and the earlier treatment begins, the better the clinical outcomes will be. With this in mind, it is important to pay attention to how you feel, and if you notice possible symptoms, talk to a mental health professional. Likewise, pay attention to your co-workers, and if they appear to exhibit problems, encourage them to get help.
Because this summer is in the window for delayed symptoms of trauma, the Alabama State Nurses Association has started an informal, but important, ZOOM call-in group called Nurse-2-Nurse (N2N). Sharing your experiences with other peers (off the job) can be helpful to them and to you. Give it a try. Go to alabamanurses.org click on the N2N logo for more information.
Going forward, ASNA and the American Nurses Association are ramping up the issue of self-care. We hear about that so much, but studies show that nurses are prone to care for themselves last. Most nurses give so much of themselves in service, that they have little energy left to exercise and focus on other self-care methods. Therefore, be alert to the delayed symptoms of PTSD. Get help if you need to. Take care of yourself. Your physical and emotional tanks need to be refilled too.
John Ziegler is the Executive Director of the Alabama State Nurses Association.