Lingering Effects of COVID-19

Nursing school is stressful. And when you add in a global pandemic, it adds another layer to an already complex situation.

Associate Professor of Clinical Teaching and Director of Psychiatric Mental Health Nurse Practitioner Program Kerry Peterson, PhD, DNP, PMHCNS-BC, PMHNP-BC, FAANP, presents at CU Nursing's May Grand Rounds

“I’ve never met a nurse who would say nursing school was easy or a walk in the park,” Associate Professor of Clinical Teaching and Director of Psychiatric Mental Health Nurse Practitioner Program Kerry Peterson, PhD, DNP, PMHCNS-BC, PMHNP-BC, FAANP, says. “It’s a lot of hard work, and nursing students report higher levels of stress compared to non-nursing students.”

Peterson looked at the consequences of high levels of stress in nursing students during the pandemic. She and her team created a course called Stress Impact and Care for COVID-19 to help the growing number of CU Nursing students facing pandemic-related stress.

The course started in January 2021 and was initially offered to 360 students. It was online and had educational and emotional support resources, including support groups run by students in the college’s Psychiatric Mental Health Nurse Practitioner (PMHNP) program. Students would complete about eight hours of course content, readings, video clips, and reflective exercises along with a one-hour support group.

An adapted version of the course is now offered through the CU Nursing Tools of Engagement curriculum.

“Extreme stress during a nursing program can impact a student’s family members and their social life,” Peterson says. “There’s also the professional implications related to stress, because they’re at clinical sites, and stress can impact their decision-making when working with patients.”

High levels of stress can also lead to burnout. Peterson cited a study from the American Nurses Foundation that found 75% of nurses reported feeling stressed. More than half felt burned out and were planning to leave their position.

“We don’t want to see that, especially for new nurses as they enter the profession,” she says. “We don’t want them to have mental, physical, or emotional exhaustion caused by work-related stressors. For us as educators, nurse leaders, and nurse supporters, it’s very important to address mental health and the stress nursing students and new nurses are experiencing.”

There are some ways to prevent burnout, including talking about and identifying what’s causing stress, utilizing coping strategies, having social support, getting enough sleep, and accessing resources.

Peterson says once stress levels are identified, it’s easier to find solutions. It’s why she and her team created a list of ways to detect stress and build resiliency in the course.

“We wanted to focus on when students will be exposed to stress and then form a plan for helping them manage it,” she says. “We also wanted to increase support networks to reduce the feeling of hopelessness that’s often associated with stress.”

Peterson had students complete program evaluation surveys after the class and said most students found the class helpful. Students reported lower levels of burnout after participating in the course and attending the support group and felt calmer and more connected to their classmates.

“They liked learning about the importance of social connection, recognizing and managing stress, and developing coping strategies,” she says. “It helps them help their classmates and their peers going through the same situations.”

Living with Long COVID

The effects of the COVID-19 pandemic are still being felt four years later. One of the effects is Long COVID. The Centers for Disease Control (CDC) describes Long COVID as signs, symptoms, and conditions after becoming infected with COVID-19.

Assistant Professor Rachel Johnson-Koenke, PhD, LCSW, at CU Nursing's May Grand Rounds

How do patients adjust to an illness like Long COVID? It’s an answer Assistant Professor Rachel Johnson-Koenke, PhD, LCSW, is trying to answer.

She spoke about a pilot intervention she designed and researched.

“Long COVID is a type of illness we don’t know a lot about,” she says. “It can impact people’s quality of life. And the illness has impacted how Long COVID patients take care of themselves, so some have had a hard time adjusting to this new illness.”

She used an asynchronous text-based intervention technique called the Narrative Intervention for Long COVID (NICO). An asynchronous text-based intervention is when emails go back and forth between the patient and the provider using various forms of treatments:

• Narrative-based therapy (example: writing a letter to the illness bothering you)
• Social work therapy (solution-focused and strength-based, including focusing on activities patients could still accomplish)
• Unitary caring sciences (expressing emotions and looking at both the positives and negatives of a patient’s experience with Long COVID)

NICO lasted eight weeks for 12 patients. Every week focused on a specific topic, including things like setting goals, getting encouragement and support, and looking at strengths and solutions to living with Long COVID.

“We want to empower people to take charge of their health and start thinking about what they want for themselves,” she says. “We want to know what’s working well for them and make it happen more often. What we’re looking for is the special sauce – the magic – that makes this type of intervention work.”

Johnson-Koenke says this type of intervention can work because it helps patients shift their mindset to avoid depression or anxiety when being diagnosed with any chronic illness.

“It’s something called adjustment of illness. It’s how you bring forward the ideas and concepts about an illness, the ideas about yourself, your ideas about the world, and then once you’re diagnosed with a chronic illness like Long COVID, you have to adjust to all of that,” she says. “Some patients in this study saw themselves as active people and being able to take care of their grandkids, but if you’re diagnosed with a chronic illness, you have to shift your mindset to adjust for that illness.”

Johnson-Koenke reports her pilot study only used a small sample size and verifying that participants had Long COVID by getting some medical documentation would have been difficult so participants were asked to self-report if they had Long COVID. The goal of the study is to continue finding ways for patients living with chronic illnesses, such as Long COVID, to get the best possible care.

“Ultimately, our next steps are thinking about how we can advance health equity for people living with chronic illnesses like Long COVID and make it possible for people living with chronic illnesses to access things like mental health treatments and other forms of healthcare to help them live their best lives,” she says.