在 COVID-19 大流行期间解决护士的心理健康问题：寻求支持的时间 | JCN

Full text

The COVID-19 pandemic has exerted a profound impact on the emotional and mental well-being of nurses (Jackson et al., 2020). Globally, highly skilled nursing professionals, often with limited infectious disease experience, have encountered numerous stressors whilst providing vital nursing care to communities during this pandemic. These stressors include the risk of being infected with COVID-19 because of inadequate protective equipment, bearing the brunt of verbal and physical violence from anxious consumers of health services, having to work in understaffed clinical areas and fear of exposing loved ones to infection. As a result, elevated levels of stress, anxiety, frustration, depression, burnout, sleep disruption, feelings of being underappreciated, and, in some cases, suicide has been reported in nurses during the pandemic. Many nurses have witnessed nursing colleagues, and other health professionals die after contracting the virus. The significant psychological strain experienced by frontline nurses during the pandemic has received much attention, reflected by research publications in the Journal of Clinical Nursing.

Given the extent of the psychosocial impact of previous public health emergencies on nurses, including, for example the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003, supporting the mental health of nurses during a pandemic is of paramount importance. Indeed, as previously reported in the Journal of Clinical Nursing, the SARS outbreak demonstrated the need for appropriate psychological support for healthcare professionals affected by post-traumatic stress disorders, anxiety and depression associated with the outbreak (Thompson, Lopez, Lee, & Twinn, 2004). Due to the unpredictable nature of COVID-19, the demands placed on nurses are constantly changing, exemplified by the impact of the Omicron variant in the 5th COVID-19 wave in Hong Kong. Since 2020, Hong Kong has appeared to have an effective response to the pandemic by pursuing a zero-tolerance plan. However, the arrival of the highly contagious Omicron variant in Hong Kong in late 2021 changed that, with the healthcare system stretched to its limit, placing an enormous psychological burden on nurses, and other healthcare professionals, working on the frontline.

From an organisational perspective, the provision of psychological support for frontline workers is essential. Healthcare providers are uniquely positioned to alleviate or exacerbate adverse working conditions. However, despite awareness of the importance of providing organisational support for the emotional and mental health of nursing personnel working at the clinical frontline during the COVID-19 outbreak, the response internationally does not appear to be at a scale commensurate with the nursing need for support. It is important that this is corrected as a failure to address the psychological health needs of nurses increases the ticking ‘time bomb’ scenario of mental health problems around the world, potentially leading to attrition of nurses from the profession.

Despite the unprecedented levels of resilience and versatility shown by nurses during the pandemic, the provision of psychological and emotional support for nurses appears to be lacking worldwide (Smith, Ng, & Ho Cheung Li, 2020). Therefore, appropriate organisations and professional bodies need to be informed of the need to implement mental health interventions and programmes to support nurses and other health staff, including self-help interventions. The increased risk of developing mental health disorders, like PTSD, and suicide within the profession could be greatly reduced with appropriate measures. Additionally, providing appropriate support for nurses may reduce the risk of occupational burnout.

In the Journal of Clinical Nursing, Maben and Bridges (2020) highlighted the many stressors and challenges faced when addressing the psychosocial needs of nurses during the pandemic. A layered approach has been advocated that promotes psychological well-being in nursing staff, including flexible organisational processes and offering a multitude of strategies that can be used effectively in various situations. These should be tailored to meet individual needs, including psychological support being provided in various formats, including e-mental health counselling and Internet-based interventions. Due to the unpredictable nature of COVID-19, there will not be a quick fix as nurses will need access to interventions to deal with established trauma-related mental health problems, including post-traumatic stress disorder, which may be required now and long after this pandemic is over. It is important for healthcare providers to foster a proactive, as opposed to a reactive, approach towards the triage and management of emotional and mental health issues experienced by nurses because of the pandemic. Transparency in all forms of communication should be prioritised to destigmatise mental health issues, as well as to encourage and empower nurses to seek support for their mental health needs.

From a public health perspective, it is important that any support provided by organisations to nurses is supplemented with appropriate training and resources to enable them to access supportive networks and structures should future pandemics strike. Interventions could be mobilised from within the profession, for example the use of peer and team support that promotes psychological coping to deal with the adversity caused by COVID-19. The emotional resilience of nurses is well recognised, and the importance of resilience is never far away in any discussion of nurses' psychological health during the pandemic. Personal resistance clearly plays a role; however, resilience should not be seen as an individual responsibility (Smith et al., 2020 JCN). Health care providers, health agencies and the public need to support nursing resilience with appropriate and supportive actions and resources.

The COVID-19 pandemic has placed significant psychological strain on nurses working on the clinical frontline. Actions are clearly needed to mitigate the impact of COVID-19 on mental health by protecting and promoting the psychological well-being of nurses and other healthcare professionals. Support may be required to help improve and maintain levels of psychological health and resilience, as well as reducing the risk of developing long-term mental health problems. Healthcare providers have a duty to provide short and long-term support during and after the current COVID-19 pandemic, to ensure that their nurses are retained within the profession, giving them an optimal clinical environment to enhance psychosocial well-being. They also have a responsibility to signpost nurses to sources of support, encouraging work-life balance initiatives that boost psychological health. Currently, protecting the mental health status of nurses around the world is an important component of public health measures to reduce the impact of this pandemic.

In the United Kingdom, considerable financial resources have been invested to support nurses experiencing difficulties with their mental health, due to working through the pandemic. The National Health Service has invested in providing support for nurses, including creating a national support service for critical care staff and a national outreach service giving frontline nurses rapid access to mental health services .The Royal College of Nursing has also sought to ensure that their members are aware of their services . What has yet to be determined is if these resources meet the needs of the nursing workforce or if nurses are accessing them. What is clear is that access to such valuable resources is not universal, and there are many nurses around the globe who have not experienced anywhere near this level of support. This calls for nursing leaders, directors of health services and political influencers across the world to share the learning from different countries, so that nurses globally can receive the support that they need.

全文翻译（仅供参考）

COVID-19 大流行对护士的情绪和心理健康产生了深远的影响（Jackson 等人，  2020）。在全球范围内，传染病经验有限的高技能护理专业人员在这场大流行期间为社区提供重要护理的同时遇到了许多压力源。这些压力源包括因防护设备不足而感染 COVID-19 的风险，首当其冲受到焦虑的医疗服务消费者的言语和身体暴力，不得不在人手不足的临床领域工作，以及害怕让亲人受到感染。因此，据报道，在大流行期间，护士的压力、焦虑、沮丧、抑郁、倦怠、睡眠中断、被低估的感觉，在某些情况下甚至自杀。许多护士目睹了护理同事和其他卫生专业人员在感染病毒后死亡。临床护理杂志。

考虑到以往突发公共卫生事件对护士的社会心理影响程度，包括例如 2003 年的严重急性呼吸系统综合症 (SARS) 流行病，在大流行期间支持护士的心理健康至关重要。事实上，正如《临床护理杂志》先前报道的那样， SARS 的爆发表明，需要为受到与爆发相关的创伤后应激障碍、焦虑和抑郁影响的医疗保健专业人员提供适当的心理支持（Thompson、Lopez、Lee 和 Twinn，  2004年）。由于 COVID-19 的不可预测性，对护士的要求不断变化，香港第 5 次 COVID-19 浪潮中 Omicron 变体的影响就是例证。自 2020 年以来，香港似乎通过推行零容忍计划有效应对了疫情。然而，具有高度传染性的 Omicron 变种于 2021 年底在香港的到来改变了这一点，随着医疗保健系统的发展达到极限，给在前线工作的护士和其他医疗保健专业人员带来了巨大的心理负担。

从组织的角度来看，为一线员工提供心理支持至关重要。医疗保健提供者具有独特的优势，可以缓解或加剧不利的工作条件。然而，尽管意识到在 COVID-19 爆发期间为在临床前线工作的护理人员的情绪和心理健康提供组织支持的重要性，但国际上的反应似乎并未达到与护理支持需求相称的规模. 重要的是要纠正这一点，因为未能解决护士的心理健康需求会增加世界各地心理健康问题的“定时炸弹”情景，可能导致该行业的护士流失。

尽管护士在大流行期间表现出前所未有的韧性和多才多艺水平，但全世界似乎都缺乏为护士提供的心理和情感支持（Smith、Ng 和 Ho Cheung Li，  2020 年）。因此，适当的组织和专业机构需要了解实施心理健康干预和计划以支持护士和其他卫生人员的必要性，包括自助干预。通过适当的措施，可以大大降低患上心理健康障碍（如 PTSD）和职业内自杀的风险增加。此外，为护士提供适当的支持可能会降低职业倦怠的风险。

在临床护理杂志上，Maben 和 Bridges（2020 年）) 强调了在大流行期间解决护士的心理社会需求时面临的许多压力和挑战。提倡采用分层方法来促进护理人员的心理健康，包括灵活的组织流程和提供可在各种情况下有效使用的多种策略。这些应量身定制以满足个人需求，包括以各种形式提供的心理支持，包括电子心理健康咨询和基于互联网的干预措施。由于 COVID-19 的不可预测性，不会有快速解决方案，因为护士需要获得干预措施来处理已确定的与创伤相关的心理健康问题，包括创伤后应激障碍，这可能是现在和很久以后需要的这场流行病结束了。对于医疗保健提供者而言，重要的是要培养一种积极主动的方法，而不是被动的方法，对护士因大流行而经历的情绪和心理健康问题进行分类和管理。应优先考虑所有形式沟通的透明度，以消除心理健康问题的污名，并鼓励和授权护士为他们的心理健康需求寻求支持。

从公共卫生的角度来看，组织向护士提供的任何支持都必须辅以适当的培训和资源，以使他们能够在未来大流行病爆发时获得支持性网络和结构。可以从专业内部动员干预措施，例如使用同伴和团队支持来促进心理应对以应对 COVID-19 造成的逆境。护士的情绪复原力是公认的，在任何关于大流行期间护士心理健康的讨论中，复原力的重要性都不会被忽视。个人抵抗显然起了作用；然而，复原力不应被视为个人责任（Smith 等人，  2020JCN)。卫生保健提供者、卫生机构和公众需要通过适当和支持性的行动和资源来支持护理弹性。

COVID-19 大流行给在临床前线工作的护士带来了巨大的心理压力。显然需要采取行动，通过保护和促进护士和其他医疗保健专业人员的心理健康来减轻 COVID-19 对心理健康的影响。可能需要支持来帮助改善和维持心理健康和复原力水平，以及降低发生长期心理健康问题的风险。医疗保健提供者有责任在当前 COVID-19 大流行期间和之后提供短期和长期支持，以确保他们的护士留在专业领域，为他们提供最佳的临床环境，以提高社会心理健康。他们还有责任为护士指明支持来源，鼓励促进心理健康的工作与生活平衡举措。目前，保护世界各地护士的心理健康状况是减少这一流行病影响的公共卫生措施的重要组成部分。

在英国，已投入大量财政资源来支持因应对大流行而在心理健康方面遇到困难的护士。国家卫生服务局已投资为护士提供支持，包括为重症监护人员建立国家支持服务，以及为一线护士提供快速获得心理健康服务的国家外展服务 。护理学院还试图确保其成员了解他们的服务。尚未确定的是这些资源是否满足护理人员的需求，或者护士是否正在使用它们。显而易见的是，获得如此宝贵的资源并不是普遍的，全球有许多护士没有经历过接近这种支持水平的任何地方。这呼吁世界各地的护理领导者、卫生服务主管和政治影响者分享来自不同国家的经验教训，以便全球护士能够获得他们需要的支持。

THE  END