Christine Kovner, PhD, RN, FAAN, on Support Services Lessen Depression, Anxiety Experienced By Frontline COVID-19 Nurses
In this video, Christine Kovner, PhD, RN, FAAN, Mathy Mezey Professor of Geriatric Nursing at New York University’s Rory Meyers College of Nursing, New York, discusses the impact support services have on depression and anxiety experienced by nurses as well as the need f for further academic training on “disaster” settings for healthcare workers.
In part 1 of this series, Dr. Kovner discusses the key findings of her recent study that found home-life conflict and work‑home conflict were major predictors of anxiety and depression experienced by frontline RN nurses during the first wave of the COVID-19 pandemic. Dr. Kovner and her co-authors published the study online in Nursing Outlook.
Kovner C, Raveis VH, Van Devanter N, et al. The psychosocial impact on frontline nurses of caring for patients with COVID-19 during the first wave of the pandemic in New York City. Nursing Outlook. 2021 Apr 5:S0029-6554(21)00093-2. [Epub ahead of print].
Christine Kovner, PhD, RN, FAAN, is the Mathy Mezey Professor of Geriatric Nursing at New York University’s Rory Meyers College of Nursing, New York. She is a Professor in the Division of Translational Medicine at the Grossman School of Medicine and affiliated faculty at the School of Global Public Health both at New York University.
Christine Kovner is a public health nurse by training and experience and has been an educator at the Rory Meyers College of Nursing, New York University for over 30 years. During that time, she has taught and advised hundreds of undergraduate and graduate students. She has taught courses such as Community Health Nursing, Nursing Leadership and Management, Professional Nursing, Nursing Policy, and Financial Management. She is the Editor of the journal Policy, Politics and Nursing Practice.
Q: How have the support services affected the depression and anxiety experienced by nurses responding to the COVID-19 pandemic?
A: We found that there were some support services, in addition to their colleagues providing support, that the hospital and the city provided. Those people who used those services were less anxious and less depressed than those who didn't. Among those, one that I found surprising was our hospital provided free housing to anybody who wanted it.
We contracted with a number of hotels and other kinds of housing units. If the nurse wanted to stay for whatever reason and not go home to his or her usual housing, that service was offered. I was surprised that the people who had remote housing, hospital housing, or ambulatory care housing, NYU housing were less depressed than those people who did not use that housing.
We thought about, why might that be? I would have thought I would want the comfort of my own home and I would want to be able to be in my own setting, that that would make me more comfortable after an exhausting day at work rather than a sterile hotel room. What we think was going on is many of the nurses have children. I think 50% of them had children still at home.
One of the fears that people had, if you remember back to then, was that the person working in healthcare was going to bring that disease back to their family. I have friends who would say that they'd pull into their garage and strip all their clothes off, and then run to the shower, take a shower, then put on new clothes and put the clothes they wore to work in the washing machine right away.
As we understand more about the disease, we're less concerned about that now, but that was a big problem. The other thing the hospital provided was free mental health kinds of counseling. There was a number that you could call anonymously, talk to somebody and/or be put in touch with some kind of regular source of mental health care. We think that that helped a lot.
The other thing that some of the nurses found were those who had had experience working in communicable disease were less anxious and less depressed. That's not surprising. I worked in a sexually transmitted disease clinic when I was a public health nurse.
Knowing that and knowing about the contact tracing that we did— I also worked in a TB clinic— was very helpful to me, in terms of understanding COVID. For those people who knew that, they knew how to use PPE and they knew about whatever at the time we knew about the COVID disease, were more comfortable. That may be the explanation for why they were less depressed and less anxious.
Q: Are you conducting more research in this area and what additional research do you feel is needed?
A: One of the things I wanted to say is we found that about 24% of the respondents to our study met the clinical definition of depression and 26% met the definition of anxiety. We measure that by an anxiety scale and a depression scale.
One of the things that I don't know— maybe someone who's listening to this video now can let me know— is what's the percentage of anxiety and depression among nurses in general when there is no major pandemic going on?
In terms of are we doing in additional research, we have a lot of data that we haven't analyzed yet. We left at the end of the survey an open‑ended question, "Do you have anything to add?"
Very commonly done in survey research. We got about 560 responses to that, many of them paragraph‑long responses to that.
Again, I was surprised, as I thought these nurses were so overwhelmed with the disease that they wouldn't want to take the time to write what was going on. We have analyzed that qualitative data and put it into themes and we're in the process of writing up that manuscript.
In addition, I'm the Mathy Mezey professor of geriatric nursing, and Vicki, one of my other co‑authors, specializes in care of older adults. We've analyzed some of the data, but we're still analyzing data comparing older nurses to younger nurses, because partly, that relates to my geriatric interest but also my interest in how new nurses cope with things that are going on.
I can imagine, if you were a nurse who graduated in January of 2020 and started your job in February of 2020 and suddenly were thrown into this situation, it could be quite stressful. We're working on that. We also have some data on post‑traumatic stress disorder.
We have some data on nurses' perception of quality of care prior to COVID and quality of care during the COVID epidemic that we want to analyze. That's going to keep us busy for a little. We don't have any other surveys planned at the moment, but we are working on other papers using the data that we have.
Q: Do you have any other final thoughts that we didn't touch on?
A: One of the questions that listeners might have is, how many of these nurses had COVID?
We asked that question in terms of a health professional diagnosing you with COVID, because there were a lot of people at the time who had sore throats or congested noses and thought maybe they had COVID and maybe they didn't.
In terms of our sample, about 13% of the nurses had had COVID. Almost all of them had a family member or a close friend who had COVID. They were dealing with both what was going on at the hospitals and in the ambulatory care centers. We closed a lot of our ambulatory care facilities. We stopped doing any kind of elective surgery. We did that starting in March.
Many of those nurses were deployed to inpatient settings or to other places. I wanted to thank all of the nurses who took the time to participate in this survey. We have a lot to learn about organizations' response to disasters.
We need to look further at the academic training of health workers, in terms of what they learn about how to deal with disasters and what they learn about communicable diseases or communicable diseases. I look forward to continuing to work in this area and writing more papers, because I'm an academic.