Providing Nurses with Psychological Body Armor in this Crisis

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

The nursing stories from the front-lines of care in COVID-19 hot spots are grim. Even the most seasoned critical care and emergency department nurses are struggling with the acuity/volume of patients and personal fear for their own safety and that of their families. Many have said that what they are seeing seems unimaginable in a developed country. They equate it to war against a very formidable enemy – in this case, a virus. The lack of PPE and ventilators is an ongoing concern but so is the intensity of the workload. ED staff wonder what happened to patients that they normally would see – they are overwhelmed with COVID-19 patients. ICU staff sees patients (many in their 30s and 40s) that stay on ventilators for up to 2 weeks often with unsuccessful outcomes.

Sadly, some of the patients and patient deaths are colleagues. It is very hard. This day after day return to the battle is taking a toll on nurses. Some of the stories are heart-wrenching with nurses telling reporters that they are not sure they can continue working.

Twenty-five years of my nursing career was spent caring for veterans in the Department of Veterans Affairs. What I know from working with veterans is that the day in and day out stress of feeling both physically unsafe and psychologically unsafe impacts mental health. Some leaders that I talk with think that this time will just be a brief episode in the careers of these nurses and soon forgotten. I am not so sure about that. I see a high potential for PTSD in many of our nurses. The question in my mind is do we wait until this is over and deal with the fallout or should we be more proactive at this time.

For many years, the military struggled with this issue. What they have learned over time is that it is best to be as proactive as possible in providing soldiers headed to combat with psychological body armor in addition to their physical body armor. Dr. Martin Seligman who heads the Penn Resilience project is an expert in this area and has worked with the military. Dr. Seligman’s PERMA™ theory of well-being has five building blocks that enable flourishing – Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment with ideas on how to enhance each one of them.

A key idea that Seligman learned in working with veterans is that our resilience in crisis situations is impacted by the stories we tell ourselves about what we are experiencing – our explanatory style. It is part of the strong rationale for critical incident debriefings. At this point in the COVID-19 crisis, nurses may be telling themselves very different stories. For some, they may feel that they are really doing the best they can in a challenging situation. For others, their thinking is more catastrophic and they have nightmares about work.

This why psychological body armor matters as much as PPE. Like soldiers putting on physical body armor, “psychological body armor” is how we can improve resiliency s for protection against, and rebounding from, the psychological distress that is accompanying this crisis. Some examples of strategies that are known to be helpful include:

Setting realistic expectations about what is possible in situations and believing that you are doing the best that you can.
Practicing mindfulness – ie. staying present in the moment and taking situations as they occur while acknowledging the stress and anxiety that you may feel.
Being grateful for what you are able to do in the situation and not focusing on what you can’t do.
Deep breathing and prayer – can help to cultivate psychological immunity by allowing relaxation and fighting anxiety.
Promoting very strong teamwork creates the psychological safety that no one is alone in this.
Discussion about and relying on personal strengths to survive the crisis.
Practicing gratitude and recognition for what you are able to do rather than focus on what you are not able to do in your care.

Now is the time for leaders to work with the mental health professionals in their health systems to arm nurses with psychological body armor. Waiting until this is over could be too late. We may find we will lose some of our most highly skilled nurses who decide that the stress level is just too high.

Read Rose Sherman’s new book – The Nurse Leader Coach: Become the Boss No One Wants to Leave