Managing Stress & Self-Care During COVID-19

Nurses make up the bulk of the healthcare workforce and are natural problem-solvers and innovators. We therefore stand out as indispensable at any time, but especially during a public health emergency. During the COVID-19 pandemic, nurses are experiencing pressure, fear, exhaustion, isolation and ongoing emotional trauma. This ongoing stress and trauma impacts your mental health, safety, and ability to provide the best possible care. Taking steps to manage your stress is just as important as taking care of your physical health!

Tips for Managing Your Stress

Acknowledge and Understand Your Reactions

• Appreciate that you will have reactions, such as stress, anxiety, and grief, to the increased and ongoing stressors you are encountering.
• Exercise self-compassion and recognize that almost everyone impacted by an emergency will experience psychological distress. These reactions are by no means an indication of weakness.
• Understand that anyone helping during this time is susceptible to excessive stress and trauma, as a nurse, you are also vulnerable to secondary traumatic stress.
• Know that you may also experience moral distress as you have to make difficult care decisions.

Be Aware and Monitor Your Wellbeing

• Check in with yourself and monitor for the common physical and mental warning signs of extreme stress (see table to the right).
• Contact a provider if these symptoms impact your ability to provide care to your patients and your family in the same way you did before the pandemic.
• If you feel overwhelmed by sadness, depression, anxiety, or hopelessness, call 911 or 1-800-985-5990 (SAMHSA Disaster Distress Line), or text TalkWithUs to 66746.

Activate Your Parasympathetic Nervous System to Combat Stress

• Practice breath awareness
• Eat regularly scheduled meals and avoid foods that increase inflammation in the body.
• Use a daily routine to prepare for bed in order to promote quality sleep.
• Try a mind-body practice like mindfulness or yoga.
• Maintain your face-to-face connections through the technology channels available to you.

Take Time for Your Mental Health

• Create ongoing supportive connections with colleagues who can validate and normalize your traumatic experiences.
• Take a break from media coverage around COVID-19.
• Schedule time for self-care, such as talking with a friend, reading a book, journaling, or meditating.
• Give yourself permission to take just a few moments for your mental health – even if you feel like you cannot take time away.
• Seek out a trained mental health professional to help ensure that you are acknowledging your extreme stress or trauma, processing it and have the support you need to manage the lasting impacts over time.

>Coping with Moral Distress
Many nurses are encountering unprecedented circumstances that may cause moral injury. This moral distress can be difficult to cope with and you may need additional support to address the damage it can cause. Symptoms of moral distress include self-criticism and intense feelings of shame, guilt, or disgust. It can also contribute to depression or post-traumatic stress disorder.

Early support is key for addressing trauma from moral distress. Strategies include team support to discuss the challenges of providing care for patients, regular contact from supervisors, briefing on moral injuries, and more. For more information about identifying and coping with negative moral effects, please click here.

Important Reminders for Nurses

You will have reactions, such as anxiety, stress, or grief, to the increased and persistent stressors and potential trauma you are encountering.

Exercise self-compassion – almost everyone impacted by an emergency will experience psychological distress.

Nurses may experience excessive stress or other mental health impacts during this time. It is not a sign of weakness.

It is easy to play up the importance of self-care to our patients while downplaying it to ourselves. Resist that urge. Give yourself permission to schedule even a few moments for self-care each day.

Help is available if symptoms you are experiencing impact your ability to provide care to your patients and your family in the same way you did before the pandemic.

Connect with your purpose: Acknowledge the crucial and noble work you are doing.

Create ongoing supportive connections with your colleagues to help validate and normalize your experiences.

Warning Signs of Excessive Stress
Below are symptoms you may experience if you are under excessive stress. If these symptoms last for more than 2-4 weeks and/or interfere with your relationships, work or daily functioning, you may need to seek care.

Source: https://www.samhsa.gov/dtac/dbhis-collections/disaster-response-template-toolkit/disaster-responder-stress-management

Access Help
If you are in an emergency such as thinking of suicide or hurting yourself, or you know someone who is, call 911.

Find a mental health professional:

1. Contact your insurance provider to get information about your options, including referral information, coverage, and providers in your network.
2. Once you have found a professional, call to schedule an appointment. If no appointments are available, join the waitlist.
3. Ask questions! There is no one-size-fits-all approach to mental health. Finding what works for you may take time.
4. Build a relationship. This connection is there to support you in your wellness.

For more information on finding a mental health provider, visit the National Alliance on Mental Illness.

Call or text one of the Hotlines below for immediate response:

• National Suicide Prevention Lifeline
  1-800-273-TALK (8255)
  https://suicidepreventionlifeline.org/
• SAMHSA National Helpline
  1-800-662 HELP (4357)
  https://www.samhsa.gov/find-help/national-helpline
• SAMHSA Disaster Distress Helpline
  1-800-985-5990
  https://www.samhsa.gov/find-help/disaster-distress-helpline
• Crisis Text Line
  Text HOME to 741741
  https://www.crisistextline.org/

Content on this page is informational only and does not serve as a substitute for seeing a licensed professional who can provide a diagnosis.

Sources

• BMJ (2020, March 26). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. Retrieved from https://www.bmj.com/content/368/bmj.m1211
• Substance Abuse and Mental Health Services Administration Disaster Technical Assistance Center (2019, May 15). Disaster Responder Stress Management. Retrieved from https://www.samhsa.gov/dtac/dbhis-collections/disaster-response-template-toolkit/disaster-responder-stress-management
• U.S. Department of Health and Human Services Administration for Children & Families (n.d.). Secondary traumatic stress. Retrieved from https://www.acf.hhs.gov/trauma-toolkit/secondary-traumatic-stress
• Wei, Marlynn (2018, October 17). Self-care for the caregiver. Harvard health blog. Retrieved from https://www.health.harvard.edu/blog/self-care-for-the-caregiver-2018101715003
• World Health Organization (2019, June 11). Mental health in emergencies. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-in-emergencies