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Too tired to serve

Is there consideration for the psychological well-being of health professionals?

Henry J
Lewis

Tuesday, February 20, 2018

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On December 31, 2017 Jamaica made history again — but not for positive reasons. The 10,990 -square kilometre island of wood and water, with almost 2.9 million people, closed the year with 1,616 murders. Up to February 6, 2018, 156 people were murdered, and many shot or otherwise violently injured and had to be hospitalised.

Very little is said about our nurses and doctors, especially in the public health sector, who are affected by this constant exposure to violent crime plaguing the island. They are the ones who must work long hours, stop the bleeding, stitch up wounds, and perform surgeries on both criminals and victims. I have a great deal of admiration for these champions in the public health sector as there is no secret that the circumstances put them under a tremendous amount of strain and stress. Reports of 18 patients suffering gunshot wounds over a 36-hour period last year were serious cause for concern — six times the daily average is not only worrying but frightening. The questions I am left to ask are:

• How many of our nurses and doctors are psychologically and emotionally fit for duty?

• Do nurses and doctors still offer patient care with the same level of compassion after much exposure to trauma cases?

• Aren't our nurses and doctors too tired to serve?

Just imagine a tired, stressed out, traumatised team of doctors and nurses scheduled to perform very complicated heart surgery on your mother. How they do it, I don't know. However they do it it cannot be the ideal for patient care and delivery. They are human beings, and I am concerned about their psychological health and well-being.

In the mid-90s South Africa faced a similar situation of heavy crime and violence in many cities. Homicide rates were 61 per 100,000, which at the time placed that African nation as the most violent country in the world. Two years ago the homicide rate was at 34.1 per 100,000. In the city of Durban, it was found that 32.2 per cent of the reported deaths were traffic-related and 13.1 per cent were said to be due to an accident. The remaining 54.7 per cent of the reported deaths were due to violence — 90.4 per cent of the victims had reportedly been assaulted and 9.6 per cent committed suicide. Almost half of the assault cases had died from gunshot wounds. Sounds very much like Jamaica, doesn't it?

Like the hospitals in Durban, our trauma care nurses and doctors at the public hospital across the island have been overwhelmed with treating trauma cases on a regular basis. It is acknowledged that the work of the trauma nurse is extremely stressful and can lead to burnout, acute stress disorders or post-traumatic stress disorder. Increased awareness of the influence that the constant confrontation with violent death has or can have on the trauma staff should be of great concern to the minister of health, Dr Christopher Tufton, and his team.

To protect and preserve the psychological well-being of the hard-working and dedicated doctors and nurses at every hospital exposed to severe stress and trauma on a daily basis several creative measures need to be employed, despite the resource constraints the health minister is faced with.

I am convinced that if I interview all the nurses and doctors across the island they will tell me that they are tired, stressed and overworked. I believe that the care of our sick loved ones is at risk if we have tired, stressed out, overworked nurses and doctors. Something has to be done, and it has to be done fast.

Let us remind ourselves that the primary task of health professionals is to meet the physical and emotional needs of their patients. This can be an immensely rewarding experience, and many of them have told me that the daily contact and care they look forward to giving to their patients is what keeps many of them working in this field. I don't know about now, but the older generation of nurses have described their job as a calling of a different kind; a highly specialised type of work that is unlike any other profession. However, when care falls short of standards — whether because of resource allocation (eg, workforce shortages and lack of needed medical equipment) or lack of appropriate policies and standards, increasingly stressful work environments, heavy caseloads and dwindling resources, cynicism and negativity from media houses, low job satisfaction and, for some, the risk of being physically and emotionally abused by patients and their families — the hospital is left with a group of willing workers too tired to serve.

Help on the way

Health professionals who deal with a daily diet of trauma need the services of a chaplaincy unit similar to what is offered to the Jamaica Constabulary Force (JCF), whose men and women are confronted with violence and trauma on a daily basis. I am told that every officer of the JCF who is exposed to a traumatic event has to receive counselling before going back on duty. The University of the West Indies and the team at the University of Technology, Jamaica, through the Caribbean School of Nursing, are willing to assist the Ministry of Health in supporting nurses who are overexposed to trauma by offering trauma counselling out of its Trauma Studies and Integrative Counselling programme.

To preserve the psychological well-being of nurses and doctors overexposed to trauma a weekly Critical Incident Stress Debriefing (CISD) session should be held. The CISD is merely a supportive, crisis-focused discussion of a traumatic event (which is frequently called a “critical incident”). It is a tool developed exclusively for small, homogeneous groups who have encountered a powerful traumatic event. The aims are to reduce stress and restoration of group cohesion and unit performance and to ensure that no one is too tired to serve.

Let's take good care of the nurses and doctors and all the health professionals in our public health service; we owe it to them. Whether you want to believe it or not, the life of a friend or a loved one depends on it. On behalf of all of us who will never get a chance to meet you in person, I want to say, Thank you, Nurse! Thank you, Doc! To all the other support staff who work under stress in the face of daily trauma, thank you for offering care and compassion even when you are tired. Keep up the good work! God bless you!

Henry J Lewis is a lecturer at the University of Technology, Jamaica, School of Humanities and Social Sciences. Send comments to the Observer or hjlewis@utech.edu.jm.

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