Nursing Mental Health: Care for those who Care
Contributors: Alex Fu, Sophia Hwang, Anne Pham, Chris Yuen
Overview
Designing a mobile application to aid in alleviating the emotional and mental issues that nurses are facing and providing another outlet to reduce their stress.
Challenge
As COVID-19 case numbers continue to persist or rise in various areas of the United States, nurses working on the frontline are at high risk of experiencing struggles with mental health. As workers who directly interact with patients, nurses face specific challenges in their job that prevent them from feeling mentally well enough to care for patients to the best of their ability. Despite the large amount of responsibilities they carry at work, nurses themselves feel like they do not have adequate emotional support. They must be prepared every day to properly take care of patients infected with the virus, while also supporting those patients’ family members. In addition, they also need to consider the needs and safety of their own families as well as their personal needs during a stressful, uncertain, and traumatic time.
Solution
There is a need for a strong support system for nurses as they face the uncertainty of the pandemic, on top of the stressors that are already associated with their duties. Our proposed solution is a chat based mobile app designed to help nurses navigate the stressors and obstacles of working during COVID-19. Similar to a “chat roulette”, users will be anonymously matched with other nurses based on state location where they can share worries or simply check in with each other. In addition, nurses can schedule an appointment with or talk to mental health professionals at any time.
We hope that, through this design, our app can reduce barriers between nurses and mental health resources which exist due to their positions as COVID-19 frontline healthcare workers.
User Research
We utilized two methods to collect data about this problem: personal interviews and an anonymous online graffiti board.
The interviews were a good way to get more fine-grained information about the problems faced by nurses, giving us the most insight into the problem space. However, we also realized that nurses were likely to be very busy, especially during this current time, and may not always have the time needed to commit to an interview. So, the quick responses of a graffiti board served as a convenient alternative that would be much easier to fit into a nurse’s busy schedule while still providing us valuable insight.
We used an online Miro board as our graffiti board and, through friends, family, and online forums, asked nurses to anonymously respond with methods that have been helpful in supporting themselves and factors that have prevented them from getting adequate support. We also managed to set up three interviews with nurses: two nurses that directly worked with COVID-19 patients, one of which was in her residency, and a new graduate nurse that worked alongside other nurses with direct exposure to COVID-19.
Research Findings
Nurses primarily rely on family and friends (and occasionally coworkers) for emotional support, yet would still want more support from people who they can relate to.
From our responses, almost all nurses had people they vented to in order to deal with stress, frustration, and emotional management. Those who have managed their mental health better reported having a solid group of other nurses who are in a similar situation and with whom they can talk to about their stressors. Two of our interviewees cited their family as people whom they typically talk to for support, but they faced barriers venting to those without experience in healthcare. Many of our responses suggest that a significant number of nurses tend to utilize venting towards their loved ones as a common way of destressing and regulating their emotions. However, their loved ones may not always be able to relate to their problems as well as they would like. Expressing frustrations is also a common stress-relief tactic for nurses, and is an avenue we felt we could help support.
Nurses tend to not reveal too much about their mental health struggles to their coworkers.
Many nurses reported struggling to rely on their coworkers — they either found it difficult to form close enough relationships with them, or were working in conditions where they felt it would not be a good idea to share too much or appear vulnerable. This was exacerbated by additional social or language struggles navigating through a white-dominated space as a non-white individual, a problem which was brought up and faced by two interviewees. Additionally, nurses that were forced to float or move to new units were suddenly forced to have to renavigate and form new bonds in a new environment with people they didn’t know, losing any existing support systems from their old units. This suggested to us that there may be various tensions and factors at play within workplaces that make it hard to form long-lasting, supportive relationships with coworkers and meant if we involved coworkers or managers in some way, we would need to consider some degree of separation, such as anonymity.
Many hospitals do not provide adequate support for, and resources that are considerate towards, nurses.
Many of the nurse responses we received mentioned and suggested that mental health and various health resources tend to not be a focus for their hospitals. Some were not aware of any resources provided by their hospitals or had, at best, an emergency distress line to call. Those hospitals that provide at least some resources do not always do so in a considerate way, for example having very limited hours for getting mental health support such as therapists that did not work around the shift hours of nurses, meaning services were closed by the time they finished their shifts. Hospitals may also provide various services at the hospital building itself, which tends to be the last place nurses want to go to on their time off. Being able to provide, inform, or possibly connect them with resources was a high priority area to explore in our design. Due to the working schedules of nurses, we felt it would be helpful for any service or resource to be asynchronous, available at all times, and/or available at their homes.
Nurses reported very high workloads and chronic understaffing at their hospitals.
Some nurses complained about the sheer amount of work they had to do, which they found overwhelming and left them with little to no time to think about seeking out mental health resources. There were also complaints about their hospitals always being understaffed, which increased the workload that every nurse had to do and also increased the likelihood of burnout and that nurses would be floated to other departments to cover, adding additional stress and responsibilities and removing people or resources they could rely on from their old unit. We needed to be sure to consider that many of the users of our design will likely be mentally and physically exhausted and that convenience, ease of use, and efficiency would be key factors for us to design around.
Our Design
Our proposed solution is a mobile application that allows its users to anonymously talk about stressors and mental health concerns with other nurses, as well as schedule appointments with and talk to mental health professionals.
This was the initial, high level skeleton of our app. We were originally considering an optional video chat feature between nurses alongside a text chat, however, it conflicted with our idea of anonymity between nurses so we ultimately decided against it. We have also considered the option to allow anonymous concerns and complaints to be sent to hospital management, allowing for a space of better communication between nurses and management. While that still seems like a valid option, we ultimately tried to refine our research into the two most core areas that we could provide for nurses: being able to talk about stressors and mental health concerns with other nurses safely and being able to schedule mental health counseling conveniently at any time.
Nurses reported wanting to be able to confide in people that could relate to them, but some noted they had difficulties doing so with coworkers due to social stigma or being unable to share deeper concerns; therefore, the app features a “chat roulette” design that anonymously matches nurses with other nurses in their state (since COVID-19 policies can vary significantly from state to state), and a chat box to share worries or simply check in with each other. These features will hopefully foster a sense of community and create a safe space for nurses to openly voice concerns without any barriers.
Our second feature provides the ability to schedule an appointment with and/or talk to a mental health counselor at any time. There are 24/7 volunteer helplines that we plan on connecting users with through the app if they wish to talk immediately. We are also planning on relying on external resources to create a service where mental health professionals or social workers designate their availability and users can sign up for any of their available slots which align with their own schedule. We considered this an extremely important issue to address, because many of the responses we received mentioned difficulties in scheduling appointments and getting necessary care from the hospital due to inflexible therapist hours that did not work around nurses’ shifts. If we are able to connect or provide external professional services, our users would be able to use this function on their own individual schedule and if their workplace does not have these resources. Both these tasks also influenced our overall design itself; we decided a chat-based app would best address both tasks and provide the most flexibility and convenience considering the hectic schedules of nurses.
We considered other designs, but they were not as portable, involved new hardware and/or required the user to be in a certain location to use the product, something we felt would be not as effective as a solution utilizing an existing device that many nurses would very likely carry around with them and can use at many different times. Therefore, we felt this was the best option out of all of the ones we considered.
Conclusion
Our focus is to provide as much support for nurses as we can to lessen their hefty burdens. We recognize that the amount of hard work that goes into their jobs has been especially heightened during this global pandemic. The high amounts of stress and burnout inherent to the hospital setting and exponentiated by the pandemic leave nurses needing support within a system that doesn’t always seem to care. We hope for our app design to help with lessening the burden and providing some much needed support. We need our nurses to be supported and happy so that they can continue doing great things for the world.
