Introduction
Mental health in nursing is increasingly vital since it affects patients’ safety and quality of life. In fact, the issue gained attention after the results showed that many nurses were at a higher risk of mental health outcomes during the COVID-19 pandemic (Shaukat et al., 2020). Mental health, for this paper, refers to “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and can contribute to his or her community” (Cheesmond et al., 2019, p. 46). In nursing research, mental health is determined by the lack of mental health disorders such as depression, burnout, post-traumatic stress disorder (PTSD), and anxiety.
Definition of the Problem
In the recent past, the mental health needs and issues of nurses have been gaining attention, especially since they are closely related to patient safety and quality care delivery. It is essential to recognize that nurses frequently face numerous challenges and stressors in their work environment, which can impact their physical, mental, and emotional well-being. For instance, nurses may develop PTSD after being exposed to a traumatic event, such as witnessing patients dying and patients in life-threatening situations. Consequently, most individuals suffer from impaired concentration, exhibiting avoidance behaviors in the workplace. Similarly, stress factors in the workplace often lead to nurse burnout, characterized by emotional exhaustion and depersonalization.
Nursing burnout is regarded as one of the leading causes of mental health issues among nurses. ICD-11 defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed (Atroszko et al., 2020, p. 603). Dall’Ora et al. (2020) identified burnout as both an indicator and predictor of poor mental health. According to Dall’Ora et al. (2020), adverse job characteristics, including high workload, poor staffing, long shifts, time pressure, and role conflict, contribute to burnout in nursing. In a different study, Couser et al. (2020) identified burnout as one of the most direct causes of poor mental health among nurses. In fact, burnout is a critical issue in healthcare, primarily because it affects nurses’ well-being.
The problem of poor mental health is increasingly becoming common among hemodialysis (HD) nurses. Ling et al. (2020) carried out a study to determine the burnout level and other manifestations of mental health issues among hemodialysis nursing staff. The authors noted that the staff work in a high-pressure and risk environment (Ling et al., 2020).
Besides burnout, most HD nurses are also exposed to additional types of stress related to vigorous activities during initiation and termination of dialysis sessions. Other activities that contribute to mental health problems include grave interventions when patients suddenly develop life-threatening complications or become verbally or physically abusive. In addition, HD nurses are sometimes required to handle complex dialysis techniques, advanced modern machines, and the timely implementation of infection control – all of which can be significant sources of stress and burnout.
Relevance of the Topic
Nursing is a fast-paced profession that requires an immense amount of focus, energy, and responsibility, which makes nurses more susceptible to mental health-related issues. Hartin et al. (2020) argued in their study that the “culture of survival”, a phrase used to describe the nature of the nursing profession, is demeaning and intimidating (p. 609). In most cases, nurses are required to work for long hours and in an environment where they are verbally and physically abused. The same views were echoed in Tavakoli et al.’s (2018) study, in which the authors observed a direct relationship between job satisfaction, job stress, and burnout among nurses. It is important to note that once a nurse is depressed, they may face challenges with concentration, communication, and managing time.
Therefore, the topic is timely and relevant, as it strives to address the silent challenges of nursing, which ultimately impact patient safety and quality of care. Recent studies show that mental health problems could be one of the factors causing a decrease in the quality of patient care (Dragioti et al., 2022). As explicated further in Dragioti et al.’s (2022) study, “Providing safe, quality patient care is impossible without a healthy nursing workforce” (p. 137).
This calls for healthcare professionals to focus more on work environment factors that contribute to the problem of mental health in nursing. Dall’Ora et al. (2020) describe these factors as high workload, low staffing levels, long shifts, and a lack of control. Similarly, this topic is relevant because it helps remind healthcare professionals to include nurses’ mental health as a critical component of a comprehensive set of quality indicators within hospitals.
Finally, the topic is relevant because it emphasizes the need for healthcare professionals to develop instruments for measuring mental health status among nurses. For instance, the care providers can implement the instruments proposed in Permarupan et al.’s (2019) study. Some of these instruments include Mardia’s online test for the multivariate normality and the PLS-SEM test. For instance, these instruments may be used in developing interventions such as psychological empowerment, which, as explicated by Permarupan et al. (2019), reduced the effects of burnout, age, gender, marital status, and working experience” (p. 282). Overall, nurses should be encouraged to be more open, particularly on issues related to mental health.
Legal and Ethical Nursing Considerations
As evidenced above, nurses experience a great deal of distress associated with various work stressors. It is essential to recognize that work-related stress affects the mental and physical well-being of nurses, ultimately compromising the quality of care. From a legal perspective, the Occupational Safety and Health Act of 1970 stipulates that employers are liable for the physical and mental well-being of their workers.
However, critics argue that the regulation does not always offer a straight answer on issues related to compensation for mental disabilities resulting from work stress. On the other hand, recovery claims may be sustained once all the relevant standards, such as those related to personal injury, are met. While this is the case, nurses must understand that mental claims are controversial in most states and courts. This paper recommends that nurses monitor and influence legislation to develop requirements that encourage employers to implement evidence-based preventive approaches to address work-related stress.
From an ethical point of view, mental health issues stem from unmet needs and unclear boundaries about the duty of care. According to Danaci and Koç (2020), “a nurse’s obligation toward patients above all else makes nurses particularly vulnerable to burnout because it places pressure upon nurses to accept working in any situation (p. 301). From a professional nursing point of view, duty of care is a balancing act between professionals’ efforts and personal risks, which are compensated with a reward structure. Whenever this delicate act is disrupted, nurses end up suffering from issues such as burnout, an indicator of mental health. In fact, a lack of ethical education drives nurses to put themselves in harm’s way for their patients. It often results in nurses’ needs, such as the emotional aspect of care, being overlooked.
Another ethical nursing consideration is altruism, which holds that the moral value of nurses’ actions depends exclusively on impact on others, regardless of the consequences they may incur. This often leads to moral distress, where nurses must deal with complex issues related to patient care. These issues sometimes make nurses feel they cannot provide quality care per their professional standards. It is also critical to note that nurses constantly make decisions during their work, which sometimes becomes an emotional burden, especially those made in challenging circumstances.
Conclusion
Mental health is continuously becoming a frequent issue, especially since nursing is a constantly evolving profession. Likewise, nursing is a demanding and fast-moving profession that demands significant focus, energy, and responsibility, making nurses more vulnerable to mental health challenges. Although various factors can influence mental health issues in nursing, burnout is the most prevalent.
As previously noted, burnout in nursing is linked to unfavorable job conditions, including heavy workloads, inadequate staffing, long shifts, time pressures, and role conflicts. Therefore, nurses must strive to understand the ethical and legal nursing considerations related to mental health. For instance, issues such as duty of care, recovery claims, and altruism are all critical as far as mental health is concerned.
References
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