Psychological trauma among nurses during the COVID-19 pandemic with strategies for healing and resilience: An integrative review

Abstract

Aims and objectives: The aim of this study was to identify nurses' responses to psychological trauma and strategies to support nurses' healing and resilience during COVID-19 and generate creative integrated understandings of nurses' responses to psychological trauma and strategies supporting nurses' healing and resilience during COVID-19.

Background: COVID-19 exacerbated trauma already experienced by some nurses. Nursing leadership called for action to improve nurses' mental health and resilience. However, policy changes have been rudimentary and insufficiently funded. Negative impacts manifesting as mental health disorders may significantly disrupt care quality, deepen nursing shortages and de-stabilize healthcare systems. Building nurses' capacity to respond with resilience is widely indicated for countering harmful effects of psychological trauma and enabling professional longevity.

Design: Integrative review design was used to support discovery of emergent knowledge, as phenomena of interest lacked a traditional empirical evidence base.

Methods: Cumulative Index to Nursing and Allied Health, ProQuest Nursing & Allied Health, and PubMed databases were searched for nursing publications, January-October 2020. Search words included nurs*, COVID-19, Coronavirus, pandemic, post-traumatic stress disorder, trauma, mental health, resilience. PRISMA Checklist standards guided reporting. Joanna Briggs Institute tools facilitated quality measurement. Inclusion criteria were English language and nursing focus on trauma, healing or resilience strategies. Thirty-five articles met inclusion criteria. Elo and Kyngäs' qualitative content analysis method guided thematic analysis.

Results: Findings suggest dysfunctional responses for some nurses to COVID-19 trauma, or living fearful, uncertain and unstable. Findings also reveal numerous potential regenerative healing and resilience strategies for nurses, or living whole, optimistic and supported. Individual actions of self-care, adjustment, social connection and finding meaning, coupled with workplace changes, hold potential to improve nurses' future.

Conclusions: Risks to nurses' mental health from COVID-19's extraordinary intensity and duration of trauma warrant timely research.

Relevance to clinical practice: Nurses' responses to COVID-19 trauma are complex, but strategies for professional resilience are abundant.

Keywords: COVID-19 pandemic; PTSD; mental health; nurses; psychological; psychological trauma; resilience.