**5. Protecting and strengthening the mental health of COVID-19 nurses**

The topic of focusing on the mental health of health professionals has been brought to the agenda during the COVID-19 pandemic [54]. It is necessary to have spiritual endurance to overcome this unprecedented situation: nurses have the need be supported by the employer, the team, and professional and community resources. During this time, the applause given to healthcare professionals every day of the week across Europe has been a morale boost for healthcare professionals. However, this is not a satisfactory solution. In addition to that, healthcare professionals need to feel that their needs are met and that they are safe in all environments [14]. In this regard, the development of psychological resilience of nurses through both individual, social, and organizational studies comes to the fore.

Resilience (psychological resilience) is defined as the process and result of successfully adapting to difficult life experiences through mental, emotional, and behavioral flexibility and adaptation to internal and external demands. The ways individuals see and relate to the world in the face of problems, the availability and quality of social resources, and certain coping strategies contribute to adaptation [55]. Psychological resilience, which increases the ability to cope with and resist difficulties, ensures that healthcare workers are less affected by the consequences of the stress they face and are more successful in crisis management, and it helps them recover more easily after the pandemic [56]. At the same time, resilience plays a role as a protective factor so that mental problems might not develop in all individuals exposed to high adverse effects or crisis situations [37, 57].

When all these factors are considered, it is seen that high levels of psychological resilience are important for healthcare workers to effectively combat COVID-19 infection and maintain mental health. To increase nurses' psychological resilience, needs should be determined early, initiatives should be made to reduce or eliminate factors that have negative effects on mental health, and approaches to increase mental health protective factors should be determined [15, 25, 48, 56, 58]. Taking effective psychological support measures, and removing and balancing the fear, anxiety or sadness caused by the epidemic will help healthcare professionals to feel psychologically safe. This may also improve crisis resistance, adaptation, and prevent mental disorders [43].

Studies have shown that nurses battling against the COVID-19 epidemic need mental support [4, 17–26]. It is necessary to determine and implement appropriate and effective strategies for the development of psychological resilience and mental health protection of nurses. For future epidemics like COVID-19, protective and supportive measures to protect health professionals' mental health should be taken in addition to measures to protect their physical health. Organizational, managerial, physiological, social, and psychological protective measures are needed in this regard.

#### **5.1 Organizational support**

Organizational support, or the degree to which an organization provides resources, empowerment, encouragement, and communication for an individual to perform their functions effectively, is a vital factor that also contributes to organizational success. There is a positive relationship between higher organizational support levels, patient satisfaction in nurses, and positive outcomes [59]. Resilience intervention implemented in response to the COVID-19 epidemic, focuses on self-care, self-efficacy, and social relationships, as well as providing quick access to mental health consultation and support when needed [60]. Nine evidence-based organizational strategies are recommended to encourage participation of health system leaders and managers and to reduce burnout: acknowledging and evaluating the problem; harnessing the power of effective leadership; developing, and implementing targeted interventions; improving the community at work; using rewards and incentives wisely; aligning values and strengthening culture; promoting flexibility and work-life integration; providing resources to promote endurance and self-care; and facilitating and financing organizational science [61].

#### **5.2 Managerial support**

Providing managerial support in this period is of critical importance. Strategies must be developed so that health system leaders and managers may stay well in these turbulent and sad times, and so that organizations become able to lead the repair and revitalization of a post-COVID-19 world [61]. Nurse managers play a vital role in providing evidence-based measures, supportive organizational policies, and a safe and secure work environment to support the mental, psychological, and emotional health of nurses, thereby relieving their fears or anxieties [4, 59]. Managers should also assess the mental state of nurses and identify high risk individuals, provide psychological support and counseling, and collaborate with expert teams to provide professional psychological services when needed [43]. In this regard, managers need to adopt the issue of mental security of nurses with a holistic approach that recognizes the broader impact of the emotional distress caused by COVID-19. This will lead nurses to feel safe psychologically and will encourage them to communicate security concerns and problem-solving strategies to managers [11].

#### **5.3 Physiological support**

To eliminate psychological stress responses to the COVID-19 pandemic and to create personal resilience, it is important to implement physical measures. The working environment and daily life should be optimized to support proper nutrition, rest, sleep, and security requirements [5, 14, 60]. Also, hospitals should be careful about physical security issues in addition to meeting basic physiological needs, such as busy working times and provide protective equipment against infections [8, 61]. Ensuring physical security will help prevent symptoms such as fear, anxiety, fatigue, and exhaustion, and thereby protect mental health.

#### **5.4 Social support**

There is good evidence that social support has a stronger effect than material support and that it is often protective for mental health [48, 51]. Social and peer support has been identified as an important protective factor against trauma effect and general mental well-being [8]. Start and end of shifts create natural opportunities for interactions to develop friendship and teamwork. Social support should be developed within the team, and friend relationships of potential shift colleagues should be strengthened for them to monitor each other's

#### *COVID-19 Pandemic and Mental Health of Nurses: Impact on International Health Security DOI: http://dx.doi.org/10.5772/intechopen.96084*

well-being [5, 14]. Social support has a positive effect on nurses' professional satisfaction, commitment to work, health, and well-being. Sufficient social support is needed for healthcare professionals for them to effectively manage stressful events, including emergencies, disasters, and infectious disease outbreaks [59]. The social isolation measures taken to minimize the transmission in the COVID-19 pandemic forces nurses to stay away from family, social circles, and team colleagues, which makes it difficult for nurses to reach the adequate support system that is very important.

### **5.5 Psychological support**

With a few exceptions, hospitals all around the world are generally not designed or adaptable to provide continued emotional support to its staff. Despite that, there are many services that a healthcare worker can use when he or she feels in distress. However, these systems are rarely used [54]. In many countries, consultancy teams that include psychiatrists have been established to reduce the effects of COVID-19, and healthcare professionals have been provided with counseling and psychotherapy services; various mental support programs have also been developed to address the mental health problems among health professionals [33, 50].

Wuhan University RenMin Hospital and the Mental Health Center in Wuhan formed psychological intervention teams that included four groups of healthcare personnel. The first, the psychosocial response team (consisting of hospital directors and press officers), is the team that coordinates the work and promotional tasks of the management team. The second, the psychological intervention technical support team (consisting of senior psychological intervention professionals), is responsible for formulating psychological intervention materials and guidelines and providing technical guidance and supervision. The third, psychological intervention medical team, consisting mostly of psychiatrists, participate in clinical psychological intervention for healthcare professionals and patients. The fourth group, the psychological helpline team (consisting of volunteers trained in psychological assistance to cope with the COVID-19 pandemic), provides telephone guidance for dealing with mental health problems [16].

Psychiatrists have published various guidelines to prevent the development of mental problems worldwide and promote social and peer support, psychological support and resilience programs have been developed, and online and telephone mental support lines have been established [5, 14, 33, 39, 54]. In addition, consultation liaison psychiatric support was emphasized concerning the necessity for awareness studies, nutritional and exercise supplement, communication skills, stress management and relaxation skills, psychoeducational interventions, small group therapies, cognitive restructuring, yoga, music and art therapy, grief counseling, pharmacological treatment, and suicide protocols for severe cases. [41, 42].

As a result, the COVID-19 pandemic has shown us that there are numerous resilience initiatives in various forms, both those specific to COVID-19 and those more general. Digital interventions common in recent years are increasingly used to improve healthcare and outcomes. Within the scope of COVID-19 measures, it has been discovered that it is not always possible to work elbow to elbow, and the best applications can be carried out without contact are possible through online environments. It is very important to develop studies in this regard, considering their positive effect on nurses.

In **Table 1**, the causes and results of the mental problems experienced by nurses in the COVID-19 pandemic are stated, and attempts to protect and strengthen the mental health of nurses are summarized.


**Table 1.** *Mental problems of COVID-19 nurses and prevention strategies.* *COVID-19 Pandemic and Mental Health of Nurses: Impact on International Health Security DOI: http://dx.doi.org/10.5772/intechopen.96084*
