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| VIEWPOINT |
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| Year : 2020 | Volume
: 17
| Issue : 2 | Page : 116-118 |
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Pivotal Roles of a Mental Health Nurse in the Time of COVID-19
Sreevani Rentala
Department of Psychiatric Nursing, Dharwad Institute of Mental Health and Neuroscience, Dharwad, Karnataka, India
| Date of Submission | 30-Oct-2020 |
| Date of Decision | 07-Dec-2020 |
| Date of Acceptance | 16-Dec-2020 |
| Date of Web Publication | 08-Feb-2021 |
Correspondence Address:
Dr. Sreevani Rentala
Department of Psychiatric Nursing, Dharwad Institute of Mental Health and Neuroscience, Dharwad - 580 008, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/IOPN.IOPN_45_20
How to cite this article:
Rentala S. Pivotal Roles of a Mental Health Nurse in the Time of COVID-19. Indian J Psy Nsg 2020;17:116-8 |
Nurses are always on the frontline of healthcare in the most extreme of circumstances. They play a pivotal part in achieving healthcare goals by being the most important link in the process of healthcare delivery. As the coronavirus disease 2019 (COVID-19) pandemic takes hold, the skills and spirit of service among the nursing professionals place them in a unique position to save people from this disease. Their work ranges from not only providing highly specific care but also counseling, teaching, and coordinating the work of other healthcare professionals to meet patient care goals.[1]
While the public authorities were implementing a variety of measures to contain the spread of novel COVID-19, our mental health institute, being a state-run facility, also took up a slew of measures to handle COVID-related issues.
On April 2, 2020, our institution set up a helpline to deal with psychosocial issues among the general public. The entire team was put on a roaster and involved in the COVID-19 helpline duty. The team members received phone calls from the general public and catered to their psychological issues as a part of the counseling services. The situations encountered were very diverse: people feared the contagion, had sleepless nights, and escalated somatic symptoms on account of the lockdown. Regulating the excess health crisis demand for psychological care was the major challenge at that point in time.
The media reports and the reeling out of pandemic-related statistics, especially the number of infected cases and deaths at frequent intervals by the TV channels, had a significant impact and often raised the level of anxiety, among the general population (sleep disorders, anxiety, gloomy thoughts, etc.).[2] Our role as counselors was to reassure and relieve irrational fears, to analyze and separate the real from the fantasy, and to rationalize.
In view of the large number of mild and asymptomatic cases being detected and the need to reduce burden on the existing healthcare system and overcome the shortage in availability of health professionals, the Indian Government issued guidelines for home isolation of COVID-19 patients.[3] With people going into home isolation to battle the contagion, increasing number of people reported facing social stigma, discrimination by family members, and other related issues pushing them into depression. At this juncture, our institution felt an urgent need to assess psychosocial issues and ensure psychosocial intervention over telephone/mobile phones. Later, our institute was designated as a state-level mental healthcare center to provide psychological services to home-isolated and hospitalized COVID patients. We began formally receiving a list of patients to be counseled from the district authorities on a daily basis. By the end of October 2020, our psychiatric nursing department was able to provide guidance and counseling services to over 1000 COVID patients. The main aim was to promote a safe space for the patients to freely explore, express, and improve psychological well-being.
During the numerous phone calls, it was observed that most patients experienced a great sense of relief during the interaction process. This was probably the reason that they were in total comfort while ventilating their feelings and sharing their experiences. At-most emphasis was placed on the integrity of the therapeutic relationship and set up few protocols as we are connecting through communication media. A few benefits and problems encountered while carrying out telephone-based counseling were:
Benefits
- Flexibility in scheduling
- Saved time on the commute
- Economical
- Comfort in familiar settings
- Nonjudgmental and safe environment.
Problems encountered
- Lack of verbal or visual cues
- Difficult to establish rapport
- Need for greater focus and concentration on the part of the counselor
- Internet and equipment issues
- Encountered dilemmas with providing services in severe cases
- Difficult to empathize and show concern.
In March 2020, academic nursing program made the difficult decision to remove students from clinical postings during the first lockdown phase in India. In the week following removal of students from clinical area, online teaching was started. Some of the takeaways from online teaching experience were that while a teacher must ensure her strong presence in the virtual classroom, she/he must avoid monotonous presentations, including repetition of words, use of jargon, and abstracts terminologies. In addition, there is a need to explain abstract concepts using various clinical examples to get a clear understanding. Teachers should make the students feel empowered in the virtual classroom by providing them space for interaction and making their participatory learning a meaningful experience.
Community awareness battle against COVID-19 is still ongoing. To guarantee that we win this battle, people's adherence to infection control measures are crucial. Nurse educators have an important role to play in sharing the facts and raising awareness in society about COVID-19 by challenging fake news and misinformation. Few sensitization programs were conducted for the university staff how to maintain their psychological health during the pandemic. Further, a few radio talks were given to bring awareness to the issue.
Patients in psychiatric hospitals are more susceptible to viral outbreaks when compared to patients in other healthcare facilities as they share common dining and bathroom spaces and participate in group activities that involve patient-to-patient contact.[4] Due to their disordered mental state, poor self-control and self-care, and inadequate insight, they may grossly be incapable of practicing infection control measures to protect themselves. All these may render them more vulnerable to the COVID-19 infection. At the beginning of the outbreak (March 2020), a COVID-19 prevention and control leadership team was established and ward management regulations formulated. This included temporary suspension of inpatient admission and prohibition of visits. Observation rooms for inpatients were set up in each ward to monitor them for fever and other respiratory symptoms. Health condition of the hospital staff was also monitored continuously.
In mid-July 2020, the COVID-19 pandemic reached its peak in Dharwad dist. To meet the substantial demand for hospitalization, we set up a transitional observation ward with separate rooms. The new patients were housed in these rooms for a 14-day period until the relevant standards were met, at which point they were transferred to a regular ward. Visiting was also suspended to minimize the potential risk of COVID infection. These are some of the critical administrative challenges any psychiatric hospital would have faced during the pandemic situation.
During the first half of September 2020, when over 30 inpatients at our hospital were diagnosed with COVID-19, enhanced measures were immediately enforced to prevent further transmission. Some of the measures followed were: (1) screening and testing of all new patients before admission, (2) immediate isolation of new patients in separate rooms until receipt of test results, and (3) isolation and management of residents (chronic mentally ill) with COVID infection in a separate ward supported by dedicated nurses who provided clinical care for 17 days. The nasopharyngeal swab specimens of all the patients were collected after 17 days and tested for severe acute respiratory syndrome coronavirus 2 test. Residents were placed in the isolation ward until two of their swab results tested negative. Other measures taken to prevent the spread of infection were:
- Provided mask for all the patients
- Frequent disinfection of spaces accessed by patients with COVID-19
- Cancellation of group dining/increasing the space between patients at dining tables
- Daily screening of all patients and staff members for temperature, oxygen saturation, and other symptoms.
A nurse scientist is always obligated to identify human problems and find a resolution for them. This pandemic has challenged the scientific community to break from conventional research problems and think differently. An earnest effort was made to help COVID-19 patients with their psychological problems using nursing knowledge and body–mind–spirit therapist experience.
While the aftermath remains uncertain, we have to continue to live in the present moment. We have to prepare for a profound change in society, interpersonal relations, and a new future. With the varied experiences that humanity has lived through, I am confident that we will all recover collectively and emerge transformed from this experience.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I, et al. Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic. International journal of nursing studies, 2020;111:103637. https://doi.org/10.1016/j.ijnurstu.2020.103637.  |
| 2. | Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, and Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian journal of psychiatry 2020;51:102083. https://doi.org/10.1016/j.ajp.2020.102083. |
| 3. | Government of India, Ministry of Health & Family Welfare, 2020. URL https://www.mohfw.gov.in/guidelines for home isolation of very mild/pre-symptomatic COVID-19 cases. [Last accessed on 2020 Sep 07]. |
| 4. | Xiang YT, Zhao YJ, Liu ZH, Li XH, Zhao N, Cheung T, et al., The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform. International journal of biological sciences 2020;16:1741-4. https://doi.org/10.7150/ijbs.45072. |
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