Mental health for nurses and midwives in India: A reality check

Those who care for us also need to be taken care of.

A study published in BMJ Journal found that nurses while on COVID duty were most stressed about infecting others or being infected.
A study published in BMJ Journal found that nurses while on COVID duty were most stressed about infecting others or being infected.

By Radhakrishnan Govindan and Jino V James

The world witnessed first-hand the unprecedented levels of overwork by nurses and midwives, particularly those specialised in intensive care units, in management or those most directly involved in the response to the COVID-19 pandemic, or those taking care of mothers and families effected, oftentimes without adequate time for rest and recuperation, with limited considerations for their mental health and wellbeing. They were and are at the forefront stepping up to the health challenge and filling in the gap left by lack of doctors in many villages or dismal doctor-patient ratio in hospitals nationwide

As we ‘raise awareness of mental health issues around the world and mobilize efforts in support of mental health’, let us also highlight how nurses and frontline workers across the world are often the most deprived of mental health facilities to support them.

It is a well-known fact that nursing and midwifery as a profession is subjected to stress-provoking working environments that can have long-term effects on them. This is contributed by factors like understaffing, long working hours, poor nurse-patient ratio, pay disparity and others. While these issues have long been attached to the profession, COVID-19 compounded these issues that had long existed within the profession.

Why nurses need mental health support

A study titled Qualitative Study on the Psychological Experience of Nursing Officers published in the Indian Journal of Psychiatric Nursing highlights that frontline healthcare providers involved in the care of COVID-19 patients have greater risks of mental health problems; such as anxiety, depression, insomnia, and stress. It added that while caring for COVID-19 patients, nurses in India experienced mental and emotional distress during the initial stages of duty. The study also found that almost 49% of the nurses responded negatively to the stress. The common mental health issues experienced by the Indian nurses are fear, burnout, anxiety, and fatigue followed by stress, depression, insomnia and work-life imbalance. Similar kinds of mental health issues were experienced by nurses around the world. Other issues include mental fatigue, phobia, grief, insecurity and helplessness.

The importance of nurses being mentally fit goes beyond their personal well-being. As crucial support pillars of healthcare systems, their mental well-being is of optimal importance. A compromise on their mental health adversely affects healthcare delivery, patient care and safety. As per a study, a nurse’s role is closely linked to patient safety as they ‘monitor patients for clinical deterioration, detect errors and near misses, understand care processes and weaknesses inherent in some systems, identify and communicate changes in patient condition, and perform other tasks to ensure patients receive high-quality care.’ This unilaterally drives home the importance of the psychological health of nurses being free from anxiety, depression, and stress to carry out their functions and be strongly motivated to continue their invaluable service.

Need for creating a healthy environment

A study published in BMJ Journal found that nurses while on COVID duty were most stressed about infecting others or being infected. This was further heightened by the absence of adequate protective gear while on duty. In India, the medical hierarchy dedicated PPE resources to doctors and specialists over nurses and attendants, despite nurses being more prone to contagion due to longer exposure.

However, it is to be noted that these challenges were only heightened by the pandemic and that they had existed long before the pandemic as well. Nurses have long been subjected to short-staffing across the nation leading to poor nurse-patient ratio, overwhelming workload, long working hours, double shifts, workplace violence in the form of threats, verbal and physical abuse, hostility and harassment and taking on non-nursing roles. They also become prey to bearing the brunt of infrastructure inadequacies like lack of doctors, specialized equipment, or patient breakdown. Other structural factors like disparity in compensation, lack of proactive policies for human resources, and lack of supportive supervision also play a role in adding to their stress. These structural issues need to be addressed to create a safe and protective environment for effective functioning of nurses.

Focusing on the well-being of nurses

The stress contributors of nurses at their workplaces are modifiable elements. They can be rectified by creating a positive work environment that gives job satisfaction, prevents burnout and prolonged exhaustion, assures security and safety and protects the dignity and autonomy of nurses. This also includes a sufficient supply of equipment at the disposal of nurses to ensure the smooth functioning of the hospital. Ensuring pay parity between government and private hospitals can go a long way in ensuring the sustainability of nurses and allow them to focus on their roles. While some progress has been made under the National Mental Health Policy and Mental Healthcare Act 2017, for the overall mental health of the country, targeted programmes for professionals like nurses are missing.

Institutions such as hospitals, governments and authorities shall create a conducive environment that allows them to discharge their duties optimally in addition to evaluating the support structures extended to nurses. This will involve strategies that combine effective outreach and facility based mental health services to serve as a platform for the nurses to seek. Additionally, there also remains a need for awareness building, de-stigmatization and discrimination prevention for nurses reaching out for help from assured mental health services. It has been found that the stigma and discrimination experienced by people who experience mental ill health not only affect their physical and mental health, but also affects their educational opportunities, current and future earning, job prospects, and also their families and loved ones.

Indian Society of Psychiatric Nurses (ISPN India) in collaboration with Indian Nursing Counselling (INC) had supported the nurses working in the COVID-19 battle during the second wave.  More than two-thirds of the volunteers helped in providing psychosocial counseling to the nurses and common mental health issues experienced by the Indian nurses were fear, burnout, anxiety, and fatigue followed by stress, depression, insomnia and work-life imbalance.

Overall, the joint effort of INC and ISPN India served as a liaison platform, where the nurses who required mental health support received psychosocial counseling service from the mental health nursing professionals.

The growing field of mental health advocates the need of different activities aiming at mental health, diagnosis and treatment of mental disorders, mental retardation after cure and its rehabilitation. Psychiatric Nursing being a relatively younger discipline, requires a lot of ground work in order to strengthen its knowledge base. Many of the Psychiatric Nursing principles need to be modified considering the multifarious Mental Health Problems and such modifications are needed to be done in developing countries like India.

Nurses form the cornerstone of healthcare delivery in India and are the unflinching pillars on which our healthcare system rests. Enhancing their mental well-being by eliminating distressing factors in healthcare systems needs an immediate call to action.

(The author Radhakrishnan Govindan is RN, RPN, PhD, General Secretary, Indian Society of Psychiatric nurses ( ISPN), Associate Professor of Nursing, NIMHANS. Co-author Jino V James is R.N R.M, Senior Program Officer, Jhpiego. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)

Get live Stock Prices from BSE, NSE, US Market and latest NAV, portfolio of Mutual Funds, Check out latest IPO News, Best Performing IPOs, calculate your tax by Income Tax Calculator, know market’s Top Gainers, Top Losers & Best Equity Funds. Like us on Facebook and follow us on Twitter.

Financial Express Telegram Financial Express is now on Telegram. Click here to join our channel and stay updated with the latest Biz news and updates.