Volume 41 Number 1

Introduction

In recent weeks, I read and re-read the 2020 article by Ramalho and colleagues¹ and was moved by this paper where they so eloquently stated:

Health professionals, especially the nursing staff, are world renowned for their heroism, their struggle, and their self-sacrifice in caring for others. However, it is fundamental that self-care prevails at this time of pandemic, because it is necessary that professionals have their health preserved in order to collaborate with effective care for society (p. 8).

This article seeks to remind us of the human side to the pandemic and the importance of health workers and nurses deliberately engaging in self-care. The Canadian Federation of Nurses Unions created a 2020 ‘In Memoriam’ site to honour staff working in the healthcare sector in Canada who have died from COVID-19 while in the line of duty². At the time of writing, 40 healthcare workers names are listed.

Background

The Government of Canada provides regular COVID-19 statistical updates for Canadians, nurses, healthcare professionals and workers. Wide-ranging information provided is vital in nationwide efforts to prevent and manage the pandemic³. To date, there have been a total of 801,057 cases, 45,711 cases are active, and a total of 20,702 persons have died, of which 73% are persons from long-term care and retirement home settings³. Provinces and territories, in turn, have established websites and communiques to relay to the public the current COVID-19 situation, assessment and testing centre availability, and progress with vaccine availability and administration rates.

Nursing During a Pandemic

Nursing’s contribution and expertise is highly visible during these challenging times⁴. Providing care to patients and families is demanding and can be traumatic. Fernandez and colleagues stated that, in response to the pandemic, nurses play a pivotal role, of which maintaining self-care is part⁵. Nurses and employers are reminded of the demands of providing compassionate care, especially during a crisis. Crane and Ward remind nurses that self-healing and self-care can help to maintain a balance between physical, emotional, mental and spiritual health⁶. Self-care for nurses crosses all sectors, including clinical practice, education, leadership, policy, research and service; each are deeply aware of the burden of COVID-19. For some nurses, conducting self-care may be a challenge as they manage demands of home, school and their ever-changing practice settings. This is especially true for those nurses specialised in wound, ostomy and continence (NSWOCs). NSWOCs and wound clinicians, in the beginning months of the pandemic, responded, adapted and moved from face-to-face wound, ostomy and continence clinics to a virtual platforms; however, some clinics were not considered an essential service, adding to the demand to provide skin and wound care services⁷.

The International Council of Nurses states that, when providing care during the pandemic, some nurses have experienced attacks – emotionally, physically and verbally⁸. In response, the Canadian Nurses Association have developed supportive resources and videos for nurses on topics such as mental health, vulnerable populations, ethics and staying healthy while working during a pandemic⁹.

Self-care is essential¹⁰, especially as nurses continue to respond to growing COVID-19 case numbers and to the families and communities who have experienced deep loss. Many nurses come to the profession due to their caring and compassionate nature, and thereby put the needs of patients ahead of their own⁶. However, recent COVID-19 studies evaluating the mental health and well-being of staff working in the pandemic are of concern. Rossi and colleagues report that healthcare workers in Italy involved in the pandemic were exposed to elevated level of stress and traumatic events; for this group, negative mental health outcomes were expressed¹¹. Liu and colleagues report healthcare professionals who worked in intensive care during COVID-19 were committed to care delivery and were also physically and emotionally exhausted. When working in this crisis, healthcare staff showed their resilience and the spirit of “professional dedication” to overcome difficulties¹². In addition, Lia et al., in a large study (n=1257) across 34 hospitals, reported that physicians and nurses caring for patients with COVID-19 experienced mental health issues that led to depression, anxiety, insomnia and distress, when compared to providers not caring for those with COVID-19¹³.

Personal Eye and Skin Care

The peak Canadian body representing NSWOCs, the Nurses Specialized in Wound, Ostomy and Continence, Canada (NSWOCC), created a personal protective equipment (PPE) toolkit in support of nurses’ prevention and management of skin damage, thereby promoting self-care^14,15. During the pandemic, there has been an increase in the prolonged use of mandatory PPE¹⁴. As a result, nurses have experienced facial pressure injuries¹⁶. This impact on the skin of the face and head causes discomfort, adding to a reduction of enthusiasm for an already extensive workload; this can lead to anxiety. The ‘face of COVID-19’ was sketched in reflection by the lead author and in response to reading about COVID-19, viewing images on television, and in speaking to peers (Figure 1). In addition, excessive handwashing to reduce the risk of contamination leads to dermatitis, erosion and irritation, and maceration, creating a bleak outlook on working in the healthcare environment¹⁷. Furthermore, nurses may be prone to eye strain when spending long hours in front of computer screens conducting telehealth activities¹⁸.

Figure 1. The ‘face of COVID-19’.

The crisis caused by the COVID-19 pandemic has also placed a strain on NSWOCs as they navigate new ways to provide safe and effective wound, ostomy and continence care. This has included the use of telehealth in order to provide skin and wound services¹⁹. This poses challenges such as the ability to develop a trusting relationship and rapport with the patient and family that typically occurs during patient visits, being unable to palpate a wound, or having to support vulnerable persons through an ostomy change using a phone or virtual platforms.

In relation to keeping your eyes safe a few tips are suggested¹⁷. In consultation with your health or eye-specialist, establish best practices in eye care when working on computers for extended periods of time. For example:

• to interrupt visual fatigue, adhere to the 20:20:20 rule, i.e. for every 20 minutes of screen time, look at an object 20 feet (6m) away for 20 seconds;
• if you are online for over 2 hours, a 15-minute break is recommended; and
• stay >50cm from the computer screen, and consider anti-fatigue spectacles, lenses with anti-reflection coatings, blue-blocking lenses, and eye lubricants¹⁷.

Self-Care Matters

The World Health Organization (WHO) defines self-care as a broad concept; they highlight that it is especially important that nurses practise self-care activities during a pandemic²⁰. The WHO reminds us that feeling pressure and stress are to be expected when working in a pandemic. They recommend that, during work, it is important to take breaks, stay hydrated, eat sufficient and healthy foods, engage in activity, and be in contact with trusted peers and friends. Yet some nurses may experience avoidance by friends and family, often due to fear of the virus²¹.

Clancy and colleagues emphasise the importance of keeping nurses and staff healthy during a pandemic. They state healthcare staff and nurses need to engage in self-care to mitigate fatigue. Nurses live with the pressure to keep working despite the threat of illness, becoming exhausted, and potentially bringing the COVID-19 virus home to their family members. As healthcare professionals it is our responsibility to incorporate self-care in our professional practice, aiding us to provide care to others and maintain our health. We must make the effort to take care of ourselves physically and psychologically. Self-care allows us to maintain motivation, energy and empathy towards patients, families and communities that we serve.

The Canadian Association of Mental Health reminds us it is normal to feel stressed and anxious during the COVID-19 pandemic²². Furthermore, nurses are ethically responsible to conduct activities to maintain individual health and well-being physically, mentally, spiritually and psychologically⁶.

The Canadian Nurses Association outlines several key strategies on staying healthy during a pandemic:

• take care of your body, physically and emotionally, and avoid substances such as vaping, alcohol, caffeine;
• keep your mind healthy and engage in journalling, reading, sharing with others and drawing;
• stay virtually connected with friends, family, neighbours, your manager and peers;
• of note is the recommendation to set boundaries with blogs, newsfeeds and ‘breaking-news’ alerts as they can become daunting;
• follow trusted and credible COVID-19 sources such as the WHO, your country’s leading health agency, and your national nurses’ association(s); and finally
• ask for help in times of stress and ask for guidance to engage in a self-care plan by turning to trusted co-workers, friends to ask for support⁹.

Conclusion

Self-care is the greatest gift you can give to yourself while working in any nursing role during the pandemic. Staying healthy – spiritually, mentally, physically and emotionally – is important in sustaining one’s well-being and ability to provide effective safe care. Identify areas of self-care that can be improved. Develop a reasonable and achievable plan to support your self-care. We are together in providing care to clients during a pandemic. Be supportive and be kind.

Conflict of Interest

The authors declare no conflicts of interest.

Funding

The authors received no funding for this study.

Author(s)

Janet L Kuhnke*
RN, BA, BScN, MS, NSWOCC
Dr Psychology, Assistant Professor, Cape Breton University, Sydney, NS, Canada
Email  janet_kuhnke@cbu.ca

Cathy Harley
eMBA, RN, IIWCC
Chief Executive Officer, NSWOCC, Ottawa, ON, Canada

Tracy Lillington
RN, BScN, MN, NSWOCC
Clinical Nurse Educator, Cape Breton University, Sydney, NS, Canada

* Corresponding author

References

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