COMMENT

EDITORIAL BOARD Irene Anderson, Principal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Her tfordshire Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Freelance Lecturer and Writer Jacqueline Boulton, Lecturer in Adult Nursing, Faculty Lead for student mobility, electives and global health, Florence Nightingale Faculty of Nursing, Midwifer y & Palliative Care, King’s College London Beverley Brathwaite, Senior lecturer University of Roehampton Nicholas Castle, Head of Professions/ Assistant Executive Director, Hamad Medical Corporation Ambulance Ser vice, Qatar Jothi Clara J Micheal, Group Director – Nursing, Global Hospitals Group, India Emma Collins, Nurse Consultant, Sexual Health In Plymouth, University Hospitals Plymouth NHS Trust Alison Coull, Lecturer at Queen Margaret University, Edinburgh Angela Grainger, Senior Lecturer, BPP University Barr y Hill, Assistant Professor of Nursing and Critical Care, Nor thumbria University Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Felicia Kwaku, Associate Director of Nursing/Senior Head of Nursing Acute Speciality Medicine, Kings Hospital NHS Foundation Trust and Chair Chief Nursing Officer & Chief Midwifer y Officer’s Black Minority Ethnic Strategic Advisor y Group,NHS England Jacqueline Leigh, Professor and Director of Nursing and Midwifer y Education, Edge Hill University, Ormskirk John McKinnon, Senior Lecturer, School of Health and Social Care, University of Lincoln Aby Mitchell, Senior Lecturer in Nursing Education, King’s College London Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Hilar y Paniagua, Principal Lecturer/Head of Doctoral Studies Faculty of Health & Well Being at the University of Wolverhampton Ian Peate, Programme Director University Glasgow Singapore Jo Rixon, Head of Nursing (Croydon), University of Roehampton Kendra Schneller, Nurse Practitioner, Health Inclusion Team – Vulnerable Adults and Prevention Ser vices, Guy’s & St Thomas’ NHS Foundation Trust John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Ser vices Poole Hospital NHS Foundation Trust Jamie Waterall, Deputy Chief Public Health Nurse, Office for Health Improvement & Disparities; Honorar y Professor, University of Nottingham Cate Wood, Senior Lecturer, University of Winchester

Nurses need PTSD support in the aftermath of COVID-19

Liam Benison, Researcher, University of Verona and University of Porto (liam.benison@posteo.net)

The first years of the COVID-19 pandemic had a severe impact on the mental health of nurses, who were already struggling with low morale owing to low pay and understaffing. For many, the mental strain of working through the pandemic cr isis did not end with the politicians’ expedient claim that the pandemic is ‘over’ (even as the coronavirus continues to mutate, infect and kill). Although many celebrate the freedoms of the end of lockdown policies and mask mandates, those who bore, and continue to bear, responsibility for nursing cr itically ill patients through times of cr isis are often left alone and unsupported to cope with the toll it has taken on their lives and mental health.

Among the costs for healthcare staff at the frontline of COVID-19 care are post-traumatic stress disorder (PTSD) and moral loss or moral injury. PTSD, suicidal ideation and suicide were recognised as r isks to nurses on the frontline from the start of the pandemic (Chidiebere Okechukwu et al, 2020). Gabra et al (2022) found that nurses on the frontline of care for COVID-19 patients were significantly more likely to exper ience PTSD compared with other nurses (P=0.025).This was associated with the intensity of working dur ing the cr isis with inadequate breaks and a lack of institutional support.

Moral loss may be defined as a betrayal of what is considered r ight in a high-stakes situation (Walton et al, 2020). Delany and McDougall (2023) explained that moral loss occurs, for example, when a nurse must deny a family the r ight to visit their dying relative or when a nurse holds a dying patient’s hand while the family is ‘present’ only via tablet computer.

The effects of PTSD and moral loss can continue long after the cr isis situation is over. Nurses who exper ience PTSD or moral loss through their care for COVID-19 patients need much better support and acknowledgement than they currently receive.

Andrew Ridgway is a registered general nurse who worked in an intensive care unit (ICU) dur ing both waves of the pandemic. The extreme exper ience of nursing in the shadow of so much illness and death – exper iencing sor row and fear, as well as love, loyalty and humour – remain with him.

His trust offered inadequate support, and to help cope with the intensity of his exper iences, he resorted to wr iting poetry dur ing the darkest days, jotting down notes of his feelings and memories after his shifts:

‘The world looks strange Through the same eyes So many finals So many silent goodbyes

‘But everything changed for me In such a short time But not to be seen Is the largest of cr imes.’

Ridgway, 2022

Ridgway was profoundly changed by his exper ience of COVID-19 nursing. But the present is almost more difficult to bear because of the widespread expectation to ‘retur n to normal’ and to ‘put the pandemic behind us’. This constant demand denies those who exper ienced the most intense pain the r ight to gr ieve, to reflect and to heal.

Ridgway has now published a collection of his poems, which he hopes will help others to connect with their own exper iences of the pandemic and work through their pain in their own way (Ridgway, 2022).

As much as we might wish to put the past behind us, ‘we beat on, boats against the current, borne back ceaselessly into the past’, to quote F Scott Fitzgerald in The Great Gatsby (1925). Without due reflection and acknowledgement, the traumas of the past will haunt the present and may create new ter rors.

PTSD can kill, and the moral loss associated td

Healthcare L

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British Journal of Nursing, 2023, Vol 32, No 10