The trauma of nursing

The trauma of nursing

MASERU – FIRST they come in as patients, and then they turn into friends and become part of the family.
For nurses, forming close bonds with patients – especially those who stay long at the hospital – is often unavoidable. But it comes with risks, chief among them the despair that follows when such patients die.
As a result, many of the nurses end up suffering from depression while others develop compassion fatigue with time.

Take ’Mapakiso Hlomeli, a nurse at Pshatlella Health Centre in Ha-’Mantšebo. As a new nurse in 2002, she had her first experience with the loss of a patient under her care.
Hlomeli still freshly recalls her first traumatic experience with the death of a patient close to two decades ago.
She says at times she visualises seeing the man dying, 18 years later.

“He was a cute man in his late 20s,” Hlomeli says.
“When he got to the hospital he became my patient and I was hoping that my first experience was to become a positive testimony,” she says.
“I saw him die one day and that hit me hard.”
Hlomeli says she “could not stop crying because I felt I had failed him and my profession”.

She is still struggling to get over the experience, just like she wishes she could erase from her memory several others that happened later in her career.
“Every time a patient dies I feel like a part of my heart is being ripped off,” she says.

Another nurse, ’Malillo Mothuku, who works at Motebang Hospital in Leribe, says she too is yet to get used to losing patients.
“Every patient is unique to us, their life matters individually and we cannot say some deserved to die or we didn’t feel sad when they died,” Mothuku says.

She says it is even harder when they have to inform the next of kin or relatives of the death of their loved ones.
Another stressful part of the job is the requirement to give a report to the doctor and the relatives.

“As you keep narrating what led to the death of the patient you feel the pain build up and the reality of the death becomes clearer,” she says.
“You see the disappointment in the family’s eyes when you tell them that the patient has died.”
Every life is precious, she says.

“Even the terminally ill have a right to live, they come to the hospital with trust and believe that their health will be restored but when it doesn’t happen it hits us hard.”
She adds: “We do what we can but when that fails God takes control. There is so much that we can do as health practitioners but the question of who lives and who dies is all in God’s hands,” she says.
’Mathato Motanteli has been a nurse midwife for 35 years but losing a patient still hurts.

Like many nurses, she experienced the death of a patient in her first year of service 35 years ago but it still haunts her.
“I felt like I had failed as a nurse,” she says.
“I did not want to do anything that day, I slept and cried because my grief was unbearable,” Motanteli says.

Motanteli says health training institutions do not prepare students for such experiences, and the first reaction to the death of a patient is shock.
“It is worse when you see it happen, when they take their last breath and there is nothing you can do about it,” she says.
These nurses talked to thepost at the launch of International Year of the Nurses and Midwives at the Ministry of Health last Friday.

Another nurse, ’Mabakoena Lekaota, says there is need for tailor made traumatic counselling for nurses at every health centre.
“It has never been established and I think it is high time that the Ministry of Health establishes that (the extent of trauma among nurses and the need for therapy),” Lekaota says.

So far research on the prevalence of post-traumatic stress disorder (PTSD) among health professionals in Lesotho is thin, say the nurses.
Therefore, both the health professional associations and the Ministry of Health have no data on the issue.

However, the Ministry of Health says nurses are being counselled.
Mpoetsi Makau, the Director of Nursing in the Ministry of Health, says the ministry has “four pillars and all of them work towards caring for the welfare of health practitioners”.
Makau says the Nursing Council, the Nursing Association, nursing and midwife training institutions and the Nursing Directorate all work together for the welfare of nurses.

Makau says they have a wellness programme that provides for all health care practitioners together with their families to receive health services as a priority.
She says they also have mental health service provisions for nurses who require counselling and psychiatric help.

“PTSD is an invisible illness. It manifests itself in different ways and it requires a leader or manager in health who recognises the changes that their nurses or any of their workers are going through,” Makau says.
She says like many Basotho, nurses are reluctant to report stress, trauma or mental breakdown because words like, “It is ok”, “I will get over it” or “this isn’t much of a problem” are words people use to escape reality while blinding themselves to the mental effects of their work experiences.

“Nurses need to be cognizant of each other’s behaviour and change thereof because some change in attitude may mean someone is going through a traumatic or stressful situation that needs attention,” Makau says.
“Some misconduct by a health practitioner is a call for help and does not require extensive disciplinary measures,” she says, referring to compassion fatigue that some health practitioners display because of work-related stress.

“Even in nursing school, there is a provision for pre-counselling where we refer nurses to the family health division in the adolescent and young adults department for younger nurses who have taken up nursing as a health profession,” she says.

“We are aware of trauma they might be going through and we want the best welfare for them so that they perform as expected and even more,” she says, adding: “Nurses are still human and they go through all kinds of abuse and trauma just like everyone else.”

Makau says if nurses’ “personal stresses are not addressed they will underperform at work and at times hurt patients”.
She says they crafted a care-plan for nurses who have experienced PTSD or other forms of mental illness because they need to be monitored and cared for through the whole process.
A 2011 study on the prevalence of factors associated with burnout among health professionals in Maseru found that work overload was a major factor to stress and compassion fatigue among nurses.

Appolinaire Tiam, who conducted the study and submitted it to the Faculty of Health Sciences at the University of Witwatersrand, noted that Lesotho had adopted a nurse-based care and treatment approach where services are offered to more people through task shifting and decentralisation of service provision.

“This has drastically increased workload for the limited number of health professionals, especially coupled with loss of up to 20 percent health care workforce to HIV epidemic,” Tiam notes.
“All these factors are probably expected to add to the already existing stressors in the workplace leading to possible burnout,” Tiam says in the report.

Tiam called for more research focusing on the prevalence of burnout factors in relation to workload in the clinical setting.
Another researcher, Kopo Manamolela, who is a psychiatric nurse at Berea Hospital, wrote in 2017 that depression “is one of the challenging mental health conditions in Lesotho”.

Manamolela says in most cases “it goes unreported until the late stages whereby measures to manage the condition are compromised and result in admission to hospital”.
“Health care workers are also high-risk groups because of having to work under stressful conditions with lack of staff and facilities and approaching retirement,” she says.

According to a research by Meridith Mealer, an Associate Professor at the Anschutz Medical Campus at the University of Colorado, nurses’ work puts them at risk of “triggers and traumas of PTSD”.

“Nurses see people die. They work on resuscitating patients. They try to control bleeding. They have end-of-life discussions,” Mealer says.
“And sometimes they are verbally or physically abused by patients or visiting family members,” she adds.

Rose Moremoholo


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