HELPING FRONT-LINE NURSES - COPE WITH THE ANGUISH OF COVID-19
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HELPING
FRONT-LINE
NURSES
COPE WITH THE ANGUISH OF COVID-19
BY ARTHUR ROWSHAN, RCC
C
OVID-19 has wreaked havoc the world healthcare workers. We all went on our balconies,
over. It has not only caused millions rooftops, and sidewalks to perform a nightly ritual
of deaths but also has increased the of clapping or banging pots and pans. Gradually the
prevalence of anxiety, depression, cheering stopped, and the number of pandemic deniers
loneliness, social isolation, and post- increased.
traumatic stress disorder. Emotional well-being is In mid-April 2021, Kendall Skuta, a B.C. nurse,
being challenged like never before by the psychological posted an emotional plea on Instagram after watching
consequences of coronavirus. a 60-year-old patient die of COVID-19. Skuta wrote:
As the world battles the pandemic, recent data “Please, I’m begging you all. Stay home, wear a
shows that the hardest hit are the front-line healthcare mask, and get vaccinated if you’re eligible. We are all
workers1 and, particularly, nurses.2 The pressure on exhausted, and I don’t know how much more pain my
nurses has been unrelenting since the beginning of the heart can take.”
pandemic. Aside from the anguish of watching their Christine Sorensen, the BC Nurses’ Union, said:
patients struggle with and die of a deadly virus, they also “Before the pandemic, nurses were being greatly
face the fear of infecting family.3 impacted by the nursing shortage and burnout due to
This article explores their experience of anguish high workloads.”4 According to Sorensen, even long
amidst the COVID-19 pandemic and suggests a before the current health crisis, nurses “have been
therapeutic strategy to help these professionals. The suffering in silence for too long.”
aim is to offer a diagnostic clarification and a homework A survey conducted by researchers at the University
assignment conveyed with a particular therapeutic of British Columbia showed a strong link between
language to heal the emotional pain caused by the the COVID-19 pandemic and nurses’ deteriorating
pandemic. mental health.5 According to this survey, burnout and
anxiety have increased among nurses with high levels
SUFFERING IN SILENCE of emotional exhaustion. Dr. Farinaz Havaei, the head
At the beginning of the pandemic, every day at 7 p.m., researcher and an assistant professor at the UBC school
people around the world cheered for their front-line of nursing, says the findings show “trends of worsening
30 BC ASSOCIATION OF CLINICAL COUNSELLORS
The pressure on nurses has
been unrelenting since the
beginning of the pandemic.
Aside from the anguish
of watching their patients
struggle with and die of a
deadly virus, they also face
the fear of infecting family.
mental health among B.C.’s front-line of distress that does not offer anything happen no matter what they do. They
nurses.” This study revealed that 80 positive.6 It is a continuous feeling become convinced that it is useless to
per cent of nurses are fearful about of discomfort, a state of negative do anything about the state of affairs.
contracting the virus at work and 86 expectation regarding future events, Unlike anxiety, which is more
per cent are concerned about bringing with the conviction that things will associated with the state of arousal
it home. Moreover, about half of nurses inevitably get worse. and panic, anguish is associated with a
reported not having confidence in their Individuals struggling with anguish depressive state. They feel no matter
personal protective equipment. feel they are faced with a punishment how much they combat the present or
from which they cannot escape and live the immediate future, they will never
ANGUISH IS NOT ANXIETY in a state of subjugation waiting for it to win the battle.
In the light of the above information, take place. This feeling of helplessness The studies on depression have
I would like to address the differences and defeat leads to a depressive crisis. highlighted that at the centre of this
between anxiety and anguish. They feel unable to change their disorder lies an attitude characterized
Often these two disorders are used situation and harbour expectations of by resignation.7 When there is no
interchangeably, and confusion about an inevitable and impending doom. possibility to overcome certain
them may lead to inexact diagnosis and Their pessimistic outlook causes them obstacles, individuals surrender
inappropriate treatments. to expect the worst to happen. themselves to a present that is
While anxiety is an adaptive Moreover, they feel incapable of unbearable. They give up and succumb
activation of our organism that becomes preventing or stopping their own to the torment of the agonizing present
pathological when it exceeds a certain catastrophic prophecies. They feel moment.
threshold, anguish is an intense state certain that bad things are going to Thus, depression is the most frequent
INSIGHTS MAGAZINE | FALL 2021 31corresponding symptomatology of
anguish with its specific psychosomatic
effect. While the solar plexus is the seat
of anxiety, the abdominal area acts as the
nest of anguish.
A STRATEGY TO TREAT ANGUISH
Before suggesting a strategy to treat
anguish, I will give a short introduction
of the model behind this intervention.
The technique and its corresponding
communication style are based on
Brief Strategic Counselling (BSC).
The BSC model uses a structured and A SURVEY
CONDUCTED BY
pragmatic approach to the treatment
RESEARCHERS AT THE
of psychological problems. The focus does this problem persist?” and “What UNIVERSITY OF BRITISH
of therapy is on the client’s attempted is required to change it?” COLUMBIA REVEALED THAT
solutions, which maintain or even
exacerbate the problem.8 For clients
Strategic counsellors aim at breaking
the dysfunctional cycle created by 80%
OF NURSES ARE FEARFUL
struggling with anguish, common- clients’ unhelpful actions. The goal is ABOUT CONTRACTING
sense solutions such as distraction to provide effective tools for clients THE VIRUS AT WORK.
and avoidance of pain are often to take control of their life. The
self-defeating. Generally speaking, recommended strategies are not the
attempted solutions fall into three result of strokes of counsellor ingenuity
86 PER CENT ARE CONCERNED
categories: action is necessary but not in moments of creativity. These are ABOUT BRINGING IT HOME.
taken, action is taken when it should the fruit of a complex theory and ABOUT HALF OF NURSES REPORTED NOT
not be, and action is taken at the wrong HAVING CONFIDENCE IN THEIR PERSONAL
painstaking forms of investigation
PROTECTIVE EQUIPMENT.
level.9 dedicated to developing effective and,
As proposed by Paul Watzlawick and at the same time, apparently simple
his collaborators at Mental Research solutions to complicated problems.
cycle: “I am better with the medication,
Institute of Palo Alto, a strategic Thus, the strategic intervention
but I feel even more powerless because
clinician follows a four-step process:10 proposed in this article belongs to
my physiological reactions are numb.”
1) A clear definition of the problem in an internationally recognized and
Among the most common
concrete terms, evidenced-based model.
dysfunctional attempted solutions
2) An investigation of the solutions of front-line nurses who suffer from
THE THERAPEUTIC HOMEWORK
attempted so far, anguish is to avoid looking at “the
Although in some cases
3) A clear definition of the concrete beast that devours the soul.” Although
pharmacotherapy can be helpful,
changes to be achieved, and distractions may offer temporary relief,
sedation of the physiological symptoms
4) The formulation and implementation is not the most appropriate solution it is hardly ever the solution. Contrary
of plan to produce this change. to anguish. The clinicians must help to conventional wisdom, the most
In the BSC model, the search for a their clients change their perception appropriate course of action is just
solution is not directed toward the past of considering themselves as a victim. the opposite: clients must dedicate a
but rather is focused on the present. Furthermore, in these cases, when specific space, time, and procedure
The key questions are not “Why does sedation reduces the symptoms, it to face their anguish. Namely, in the
this problem exist?” or “Why does the could inhibit the individual’s resources, morning, they must foresee all the most
client have this disorder?” but “How thus, initiating a vicious pathological terrible and most feared outcomes and
32 BC ASSOCIATION OF CLINICAL COUNSELLORSwrite them down and describe them these clients to follow through the nurses are beginning to see the end
in detail on paper. Then, they let the above homework. of their fierce battle with this virus.
day pass and, at night, check if those Since each person is unique, there However, the COVID-19 variants and
catastrophic predictions have been are no universal canned phrases to possible mutations still haunt front-line
fulfilled. utilize with our clients. However, nurses. Since this battle seems to be a
Checking at night which of their here are few aphorisms and evocative long one, counsellors must hone their
dire predictions have been fulfilled is imageries for counsellors to incorporate skills to be ready to help individuals
a way of dismantling the mechanism in their dialogue to validate their affected by the psychological impact of
of catastrophic thinking. Even if their clients’ experience of anguish: this daunting crisis. As Marcel Proust
catastrophic predictions come true, said, “The real voyage of discovery
this procedure makes those negative The exercise of writing ominous consists not in seeking new landscapes
thoughts more acceptable and easier
expectations allows individuals but in having new eyes.” ■
to develop an emotional
to manage. The act of writing, as
numerous investigations have shown,11
distance precisely because they Arthur Rowshan, MC, RCC, PhD, is a
immerses us completely in our
accept its inexorability.
counsellor in private practice in Kelowna. He
suffering but also allows us to get away also offers training courses in Brief Strategic
Counselling. www.arthurrowshan.com
from it.
The exercise of writing ominous “You feel that there is no way to
expectations allows individuals escape from this beast that devours
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to develop an emotional distance your soul.”
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wrote, “When I write what I feel, I bites you.” H. (2020). Exploring nurses’ experiences of
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6 Nardone, G. (2016). El miedo a decidir: cómo
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