More than a third of nurses working in the UAE during the coronavirus pandemic showed signs of post-traumatic stress disorder, a study has shown.
It revealed that healthcare workers experienced unwanted memories and nightmares as a result of their experiences on the front lines.
Issues that made nurses more likely to develop stress symptoms were experiencing Covid-19 deaths, and a lack of management recognition, along with two non-work factors – not exercising and being a smoker.
The findings lay bare the reality of life in Covid-19 wards and highlight, the scientists behind the study said, the need for officials to prioritise the support of staff who may be under stress.
“Policymakers must expand healthcare policies to address frontline nurses’ mental health as a priority during the pandemic,” they wrote in the journal International Nursing Review.
The researchers, from the University of Sharjah, University Hospital in Sharjah, Sheikh Khalifa General Hospital in Umm Al Quwain and universities in Jordan and Brunei, received responses from 370 nurses who cared for Covid-19 patients at UAE government hospitals.
How the survey was completed
Recruited to the study between November 2020 and January 2021, each nurse answered a standard 20-question post-traumatic diagnostic scale questionnaire, which is widely used to detect PTSD.
Each question relates to a particular symptom, such as experiencing unwanted memories, reliving traumatic events, having a lack of positive feelings and finding it difficult to concentrate.
The respondent scores herself or himself between zero and four for each, with zero representing no symptoms, and four indicating that the symptom was experienced at least six times a week.
The researchers found that 36.2 per cent of respondents had symptoms associated with a probable PTSD diagnosis, which means a score of 28 or more out of the maximum possible, 80.
Unwanted memories were experienced by 62.2 per cent of respondents two to three times a week, while 12.7 per cent of nurses had them four to five times a week. Nightmares or bad dreams were experienced by 11.4 per cent four to five times a week.
Key factors that motivated the nurses at work were availability of personal protective equipment and support from management or family.
Poor lifestyle habits
Issues that made nurses more likely to develop PTSD symptoms were experiencing Covid-19 deaths, a lack of management recognition, and two non-work factors – not exercising and being a smoker.
“Those with poor lifestyle habits may have negative perceptions of their health status and greater fear of infection, and may therefore be more likely to develop PTSD,” the researchers wrote.
“Nurses must be trained in health promotion practices to minimise the negative feelings and potential development of PTSD in situations such as pandemics.”
In further advice, the authors of the new study, “Post-traumatic stress disorders and influencing factors during the Covid-19 pandemic: A cross-sectional study of frontline nurses,” said managers could consider “small practical interventions”, such as telephone calls or debriefing sessions, to help staff.
The study also said it was important that nurses were consulted on what policies and guidelines were needed to safeguard their mental health. The UAE government has implemented a range of initiatives to promote the mental well-being of medical staff, including the introduction of a free phone-counselling service. The Frontline Heroes Office was also established in 2020 to applaud those working on the front lines.
Research in other countries also found high levels of PTSD symptoms, anxiety and related conditions in healthcare professionals during the pandemic, indicating that extra stress is not limited to the UAE.
For example, a study of intensive care staff working in hospitals in England in June and July last year found that 40 per cent probably met the criteria for PTSD. Smaller numbers had signs of severe anxiety or depression.
Dr Davinder Pal Singh, a cardiologist at NMC Royal Hospital in Dubai Investments Park, said medical staff had faced a workload that increased “quite significantly” during the pandemic.
“Sometimes there is a shortage of staff [in hospitals] because of how staff have to go into quarantine. It will increase the workload of staff quite significantly, and the number of patients increases,” he said.
Another doctor in the UAE, Ashar Jamal, an emergency doctor at Al Zahra Hospital in Sharjah, said the uncertainty about the outcome of Covid-19 patients was a particular stress.
“With other medical conditions, you usually know the pathway,” he said, but with Covid-19 it was different.
“We may see a very old patient recover and a very young one getting intubated [where a tube is inserted into the windpipe to aid breathing].”
Staff working during the pandemic, he said, also fear contracting the coronavirus, bringing it home and infecting a family member.
“There’s always a chance no matter how many times you wash your hands and [use] PPE. That’s adding more to the pressure,” he said.
Abu Dhabi's Seha group sets out support for nurses
Abu Dhabi's public hospital operator Seha told The National that the mental well-being of staff was more in focus now than ever before.
Samah Mahmoud, Seha's deputy chief nursing officer, said: "The fight against the coronavirus is regarded as the most difficult challenge for the healthcare system, having lasted nearly two years and it is expected to continue indefinitely.
“This adds to the [burden on the] already overworked healthcare workforce, particularly frontline nurses, both physically and mentally.”
The organisation holds weekly sessions for frontline workers to allow them to talk about the pressures they face, even now that the worst of the hospital admissions has passed.
"The process has included the implementation of weekly sessions on various topics to assist the teams, as well as the establishment of a special hotline that provides counselling to healthcare employees," Ms Mahmoud said.
"Seha is passionate about its involvement in various initiatives and programmes aimed at the mental health and well-being of frontline workers in these unprecedented times."