Abstract
As the impact that COVID-19 has had on the nursing workforce continues to unfold, this paper is most welcome. Although this study is set in a country that tackled the pandemic in a different way to many, the methods and the findings in this paper are both interesting and illuminating. The paper builds on previous research carried out during and after the pandemic which has started to examine the overall well-being of healthcare professions who were exposed to a variety of stressors including: high workloads, emotional strain, exposure to trauma, death in isolation and some of the most extreme clinical pressures imaginable. The vast majority of frontline care is provided by nurses and the authors credibly point out that their health and well-being, particularly their psychological and mental well-being has been most probably affected the most during the pandemic response.
Two things really caught my attention when reading and reviewing this paper. Firstly, the measures chosen for the study. The authors combined measures of depression, anxiety, post-traumatic stress disorder and perceived social support using a latent class analysis technique to identify the probability of psychological help-seeking behaviours (PHSB) of nurses working in the community setting in China during the pandemic. They used an adaptation of the barriers for help-seeking identified in an earlier study by Shi et al. (2020) for their modelling.
PHSB is a most interesting concept. Despite the well-documented psychological stressors experienced amongst nurses, the evidence is that many nurses hesitate to seek professional help (Heslop et al., 2019). One of the most significant barriers impeding nurses’ willingness to seek psychological support cited in the literature to date has been the stigma surrounding mental health issues within the healthcare profession itself. Nurses often fear judgement, professional repercussions, or perceived weakness if they disclose psychological distress (Heslop et al., 2019, Ross and Goldner, 2009). Moreover, organisational culture and many of workplace norms or expected norms appear to discourage help-seeking by prioritising stoicism and resilience over emotional vulnerability (Laschinger et al., 2016). However, supportive organisational cultures that prioritise employee well-being and promote open communication have been shown to mitigate the stigma and encourage help-seeking (Peterson et al., 2018)
Although the limited availability of mental health resources, long wait time for appointments and concerns about confidentiality have been previously shown to deter nurses from seeking help (Bakker et al., 2020), this study shines a little more light on the utilisation of mental health resources by nurses and the role that mental health literacy (which includes the awareness of mental health strategies as well as the management of mental health illnesses) has in its uptake.
The second thing that caught my attention in this paper was that the authors used a novel latent class analysis (LCA) method for this study. LCA is a robust statistical approach that helps to identify distinct, unobserved subgroups (potential classes of PHSB and their influencing factors). In this case, it is Chinese nurses working in the community using their observed categorical variables/indicators. Credit should be given to the authors for the size of their sample (n = 667) as recruiting and managing sample size is not straightforward (as most researchers know). Size does matter however, and sample size considerations are critical when using LCA as it requires sufficient data to reliably estimate model parameters and identify meaningful latent classes (Hagenaars and McCutcheon, 2002), and managing a research sample of this size does not always get the acknowledgement it deserves.
Finally, the psychological impact of the COVID-19 pandemic on nurses continues to have significant and long-lasting implications for both individual well-being and the healthcare system as a whole. Maben and Bridges (2020) have highlighted how this will continue to impact burnout, compassion fatigue and mental health disorders among nurses and negatively influence turnover rates within the profession for the foreseeable future. This paper concludes succinctly by highlighting the role that employers and healthcare organisations have to play in prioritising the mental health and well-being of the nursing and midwifery workforce by addressing mental health literacy issues, implementing proactive comprehensive interventions such as support programmes improving and de-stigmatising or normalising access to mental health services and/or support networks. Particularly at times of adversity. The authors should be commended for bringing this to our attention.