How nurses can cope with guilt during COVID-19

While it’s important to take care of your physical body, many people often forget to take care of their mind.

Like so many aspects of the COVID-19 pandemic, it's impossible to accurately capture data outlining how many nurses working the frontlines feel guilty about potentially exposing their family to the virus. But if you consider history and anecdotal evidence, it's a safe bet that you or a high percentage of your nursing colleagues have these pangs of guilt.

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According to a report in Wired, "health care professionals willingly expose themselves to the pandemic every day. They don't begrudge the threat to their own well-being, but many are concerned about transferring that risk—and, potentially, the novel coronavirus itself—to those around them: their coworkers and patients, yes, but also the families and friends waiting for them at home. With limited official guidance, health care workers have been making tough calls about how and how often it's safe to move between hospitals and clinics and homes full of people who might otherwise never be exposed to the disease."

And while the work and nursing culture may be different in Asia, a "Qualitative Study on the Psychological Experience of Caregivers of COVID-19 Patients" published by researchers from the Henan University of Science and Technology and its School of Nursing did find that the 20 nurses studied in January and February 2020 all fretted about their "patients in an isolated environment with relatively few caregivers and many patients."

And while only some of the 25- to 40-year-old nurses in the study lived with elderly or children family members, all "expressed concern about the impact of the outbreak on the health of their families. They also said that their families were also worried about their health," according to the researchers, who named "concern for patients and family" as one of the four core psychological experiences of nurses caring for COVID-19 patients.

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If you're one of the nurses experiencing guilt about potentially exposing family members to COVID-19, how can you handle those unwelcome feelings on top of all the other swirling emotions in this mental health epidemic?

Licensed marriage and family therapist Rachel McCrickard has some down-to-earth suggestions for nurses. In addition to her work as a therapist, McCrickard is CEO of Atlanta-based Motivo, a HIPAA-compliant video platform connecting pre-licensed therapists to clinical supervisors. Here are her tips:

Reframe the feeling. "Instead of naming this feeling 'guilt,' consider reframing it as a 'great responsibility,'" McCrickard suggested. "Guilt implies shame and front line workers do not have anything to be ashamed of. Rather, they are exhibiting brave, hero-like behavior in their selfless work. Instead of feeling guilty for possibly exposing your loved ones to the virus, consider saying to yourself, 'This is a huge responsibility and I have the opportunity to take precautions to ensure my loved ones are protected. Here are the things I will do to limit my loved ones' exposure to the virus...'"

Recognize why this conflict is fairly inevitable. Nurses, like most members of the helping professions, tend to be "Type Twos" on the Enneagram scale. "A Type Two is known as 'The Helper'," McCrickard added. "Helpers are amazing resources in times of crisis because of their high level of empathy and desire to serve others. However, this can sometimes create a conflict for the Helper when trying to care for two different groups of people. Nurses likely feel conflicted about how to care for both their patients and their families. It's important to acknowledge the conflicting feeling, while also recognizing that it is a heavy weight to serve the needs of everyone."

Complete an exercise in establishing boundaries. McCrickard suggested this exercise to bat back some of the unreasonable demands being placed on nurses during COVID-19. "List the things that are within your power, such as your cleaning routine once you enter your home, how close you allow yourself to get to loved ones, etc. and the things that are not within your power, such as the actions of others," she said. "This can provide you with some emotional boundaries that help you make it through this time."

Nurture yourself. It's no news to nurses that they often put themselves last, but that's not helpful in the current conundrum, she explained. "It's important to remember to prioritize your own self-care as a caregiver. Consider developing a routine for your day-off during which you focus on your own needs. This could help you remember that your life is just as important as the lives of your patients and your loved ones."

Emergency physician Adam Levine offered more advice in Stat, based on his work as an emergency responder in another health care crisis, the Ebola outbreak in 2014. "At work, you will be a hero. Perhaps Time magazine will someday recognize you, like it did the Ebola fighters, as its Person of the Year," he said. "But when you come home... your friends and family may shun you. You may even begin internalizing this sentiment, thinking of yourself as dirty or unclean, feeling guilty about exposing your loved ones to the possibility of being infected with the novel coronavirus."

Levine urged all medical co-workers looking after others amidst the pandemic to watch out for their own mental health. "Courage alone won’t be enough," he added. "You will also need to take care of yourselves — and each other — to make it through the Covid-19 pandemic. First and foremost, get enough rest. Second, remember to eat. Exhaustion and hunger magnify stress. You are a precious and limited resource, and you must act the part."