Facing this critical situation, health care workers on the front line who are directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing psychological distress and other mental health symptoms. The ever-increasing number of confirmed and suspected cases, overwhelming workload, depletion of personal protection equipment, widespread media coverage, lack of specific drugs, and feelings of being inadequately supported may all contribute to the mental burden of these health care workers.

Those health care workers feared contagion and infection of their family, friends, and colleagues, felt uncertainty and stigmatization. Experiencing high levels of stress, anxiety, and depression symptoms, which could have long-term psychological implications. Similar concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising.

Psychological assistance services, including telephone-, internet-, and application-based counseling or intervention, has  widely developed in  local and national mental health institutions in response to the COVID-19 outbreak.

 Mental health problems among health care workers treating patients with COVID-19 by  the magnitude of symptoms of depression, anxiety, insomnia, and distress and by analyse the potential risk factors associated with these symptoms.

The Role of Psychiatric Nurse During the Coronavirus Outbreak

Emerging infectious disease outbreaks, such as COVID-19, cause significant fear and uncertainty. Psychiatric nurse can play an important role in supporting the well-being of patients and families, healthcare personnel, and the general public.

Infectious disease outbreaks produce a range of psychological and behavioral effects. Inform patients about common responses, such as insomnia, anxiety, fear of illness, or desire to increase alcohol and tobacco use. Children and adolescents may experience regression, social isolation, or aggressive behaviors, all of which can be misinterpreted as "acting out." Educate patients on ways to reduce overall stress, such as getting adequate sleep, eating regular meals, exercising, staying connected to friends and family, and relaxation techniques. Inform patients when and where to get help if needed.

Recommend HealthPromoting Behaviors

Recommend patients use trusted sources, such as the Centers for Disease Control and Prevention, to obtain the most updated information on keeping their family safe and healthy, which can decrease distress. Encourage patients to develop a family plan for dealing with outbreaks, which reminds people there are steps they can take to care for themselves. Knowing your work and/or school plans for dealing with COVID-19 also helps reassure people about steps being taken by others to safeguard their health. Recommend patients to limit exposure to outbreak-related traditional and social media; increased media exposure is often associated with higher levels of distress.

Preparing your practice

• Promote frequent hand washing ( with soap andwateror 60% + alcohol-based hands rubs)
• Encourage respiratory etiquette (covering cough and sneezes)
• Provide tissues and trashreceptacle
• Discourage sharingof items and equipment( Mobile, pens, desks, etc)
• Maintain regular housekeeping practices, including cleaning and disinfectingsurfaces
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• Maintain social distanceas much as possible

Support the Health Care System

Most patients with COVID-19 illnessrelated concerns will present in primary and emergency settings. Psychiatric nurse can play an important role in optimizing population mental health by providing interdisciplinary education, consultation, and collaboration to help colleagues more effectively identify outbreak-related distress responses and provide early interventions. Non-infected patients experiencing illness-related distress should have their concerns validated, while also helping them learn ways to more effectively cope. Interventions should serve to enhance feelings of safety, calming, self- and community efficacy, social connectedness, and hope or optimism about the future.

Facilitate Problem-Solving

Uncertainty about the future is common and best addressed through practical problemsolving. For instance, Psychiatric nurse can help people consider alternative social greetings when handshaking is discouraged, or explore technology-based means of connecting for community activities when social distancing measures recommend avoiding large, group gatherings. Encourage families to involve children in problem-solving, which can decrease feelings of distress for kids. Reminding people there are steps they can take to manage through challenges enhances calming, increases selfefficacy, and reduces feelings of helplessness.

Empower Ill Patients, Their Families, and Care Providers

Psychiatric nurse can empower patients, families, and care provider through education about the psychological effects of isolation and quarantine. Short-term effects may include anxiety, anger, fear of infecting others, and frustration, with those who experience longer periods of isolation being more likely to develop post-traumatic stress symptoms or increase substance use. Ensuring quarantined patients have adequate supplies and that they and their families are given comprehensive, ongoing, updated information reduces distress and uncertainty. The use of technology to connect patients with family, friends and their health care team can decrease feelings of isolation.

Encourage Provider SelfCare

COVID-19 and other infectious disease outbreaks severely stress health systems and the providers working within them. Routine and ongoing self-care helps providers function more effectively at work and home. Sleeping, eating, hydrating, and taking breaks are important during the work-day. Providing support to peers, finding constructive solutions to work challenges, and staying connected with family and friends can lower overall stress.

How to best support to the patients

• Stay informed-check reliable sources
• Educate patients and correct patient misinformation
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• Discuss stress reactions: how to recognize and how to address them
• Identify and support high risk patients
• Don’t forget to take care of yourself

Rights, roles and responsibilities of health workers, including occupational safety and health

 Health workers are at the front line of any outbreak response and as such are exposed to hazards that put them at risk of infection with an outbreak pathogen (in this case COVID-19). Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. This document highlights the rights and responsibilities of health workers, including specific measures needed to protect occupational safety and health.

Health worker rights include that employers in health facilities:

• Assume overall responsibility to ensure that all necessary preventive and protective measures are taken to minimize occupational safety and health risks
  • Provide information, instruction and training on occupational safety and health, including;

• Refresher training on infection prevention and control (IPC); and
• Use, putting on, taking off and disposal of personal protective equipment (PPE);

• Provide adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap and water, cleaning supplies) in sufficient quantity to healthcare or other staff caring for suspected or confirmed COVID-19 patients, such that workers do not incur expenses for occupational safety and health requirements.
• Familiarize personnel with technical updates on COVID-19 and provide appropriate tools to assess, triage, test and treat patients and to share infection prevention and control information with patients and the public.
• As needed, provide with appropriate security measures for personal safety.
• Provide a blame-free environment for workers to report on incidents, such as exposures to blood or bodily fluids from the respiratory system or to cases of violence, and to adopt measures for immediate followup, including support to victims.
• Advise workers on self-assessment, symptom reporting and staying home when ill;
• Maintain appropriate working hours with breaks
• Consult with health workers on occupational safety and health aspects of their work and notify the labour inspectorate of cases of occupational diseases
• Not be required to return to a work situation where there is continuing or serious danger to life or health, until the employer has taken any necessary remedial action
• Allow workers to exercise the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their life or health. When a health worker exercises this right, they shall be protected from any undue consequences
• Honour the right to compensation, rehabilitation and curative services if infected with COVID-19 following exposure in the workplace. This would be considered occupational exposure and resulting illness would be considered an occupational disease
• Provide access to mental health and counselling resources; and
• Enable co-operation between management and workers and/or their representatives.

Health workers should

• Follow established occupational safety and health procedures, avoid exposing others to health and safety risks and participate in employer-provided occupational safety and health training.
• Use provided protocols to assess, triage and treat patients.
• Treat patients with respect, compassion and dignity.
• Maintain patient confidentiality.
• Swiftly follow established public health reporting procedures of suspect and confirmed cases.
• Provide or reinforce accurate infection prevention and control and public health information, including to concerned people who have neither symptoms nor risk.
• Put on, use, take off and dispose of personal protective equipment properly;
• Self-monitor for signs of illness and self-isolate or report illness to the concern person, if it occurs.
• Advise management if they are experiencing signs of undue stress or mental health challenges that require support interventions; and report to their immediate supervisor any situation which they have reasonable justification to believe presents an imminent and serious danger to life or health.

(Janaki Dhami teaches in Bir Hospital Nursing Campus)