Nurses Overwhelming Stress Responses from the COVID-19: Phenomenological Analysis

Nurses Overwhelming Stress Responses from the COVID-19: Phenomenological Analysis

Sample Answer for Nurses Overwhelming Stress Responses from the COVID-19: Phenomenological Analysis Included After Question

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This is what I am trying to do but I am not successful at Chapter 2 have written a lot but need corrections

Better language

I NEED TO ADD SYNTHESIS AND ANALYSIS OF THIS PROGRAM, 

PLUS EXPLAIN AND evaluate the theory

  • DISCUSS THE DISCOVERY, ETC. I HAVE ISSUES IN 

UNDERSTANDING HOW TO EVALUATE THIS. PLEASE, HELP 

  • What other theory identifies with Horowitz’s developments

Found other research studies that were discussed surround 

Need by Sunday noon

  • Must have citations and references added, including EDIT

Horowitz’s theory explains their development, of theories, and explains how key parts are identified.

A Sample Answer For the Assignment: Nurses Overwhelming Stress Responses from the COVID-19: Phenomenological Analysis

Title: Nurses Overwhelming Stress Responses from the COVID-19: Phenomenological Analysis

What other theory that identify’s with Horowitz developments 7) Found other researcher studies that were discussion surround Horowitz theory explaining their developments, theories and also explain how key parts are identified. 8) What can be done by Wednesday morning around 10am is okay. If not completed. 9) Must have citation and references added, including EDIT 2 3 Literature Review The purpose of literature review is to seek and establish the sources with relevant information on the research topic. The topic purpose is to seek and address the poor adjustment that inpatient nurses exhibit due to the trauma and stress associated with handling the cases of COVID-19 at the care facilities. In addition, purpose of this qualitative interpretative phenomenological analysis (IPA) study is to address the increased of the COVID-19 inpatient nurses care (Smith et al., 2003). Therefore, having in place proper mechanisms for research helps one access a variety of credible information that is essential in completing the research. It is critical to ensure that the outcome of the research is valid and reliable in terms of its contribution to existing information and solving an impending problem. The research process requires proper preparations to come up with reliable information to answer the question. It is critical to ensure that the outcome of the research is valid and reliable in terms of its contribution to existing information and solving an impending problem. The caseloads are high, which is overwhelming to them. Overall, the literature review highlights the problem statement and study purpose as preludes to the literature review. It helps understand the motivation for studying literature. Consequently, the literature review examines diverse peer-reviewed and non-peer-reviewed publications that reveal the issues nurses working with patients at different hospitals face during the ongoing pandemic. The research process used various databases and search engines to develop the articles for review. Some databases include Google Scholar, Academic Search Complete, ProQuest, and EBSCO Host. The databases were effective in finding peer-reviewed sources suitable for research. Using credible databases proves essential in coming up with credible sources to help 3 4 complete the research. The following paragraph highlights some keywords instrumental in finding credible peer-reviewed literature for the review. Theoretical Framework The theory that will be used in this research study is Horowitz’s (1975) stress response theory. Horowitz’s stress response theory operates on the principle of psychodynamic observation of the expected reactions by people to traumatic situations (Horowitz, 1975). In building up Horowitz’s findings, the studies began in the early in the 1970s. Horowitz set the standard for psychotherapy with victims of trauma. The roots and development of Horowitz’s stress response theory began to take note after the various breakdowns of the syndromes soldiers of war were evolving. Horowitz conducted clinical investigations of persons struggling to master recent stressful events. At the time, there was no diagnosis of posttraumatic stress disorder (PTSD) in the official terminology, of Diagnostic and Statistical Manual of Mental Disorders (DSM II). Yet in our clinical observations, we found that intrusive and repetitive thought, especially unbidden images, was a typical symptomatic response to stress and often occurred in conjunction with its apparent opposite phases of ideational denial and emotional numbing related to the potentially traumatic experiences (Horowitz, 1975). The theory presupposes that individuals’ moods and states of mind vary across situations and experiences depending on the severity of traumatic events (Horowitz, 1975). Although different factors such as personality and culture have been identified to affect how people react to stressful events, a relatively stable pattern exists, denoted by phases, followed by persons upon encountering an emotionally destabilizing scenario (Horowitz, 1975). 4 5 The first phase includes individuals experiencing intrusive and successive episodes of traumatic scenes, which manifest through deep thoughts, imagery, behaviors, and emotions, also referred to as the outcry phase (Horowitz, 1975). The second phase consists of a response strategy to attempt to suppress the harmful intrusions engendered by the initial replay of fear during the intrusion phase (Horowitz, 1975). During the second phase, the individual attempts to get a sense of the cautious information presented during the outcry phase in preparation for a rebuttal mechanism that initially counters the phobia made apparent (Brewin & Holmes, 2003). The third stage involve intrusive memories that occur in quick succession, and victims witness information overload that may lead to physical and emotional imbalance (Horowitz, 1993). In the fourth phase, victims strive to balance between two opposing forces, one that triggers the stressful or traumatic memories and another that tries to suppress the painful thoughts. The two last phases are the most critical steps and determine an individual’s ability to cope with stress or trauma. Horowitz’s theory implores that there are two processes contingent on the stressful situation: one that signals the mind of the impending danger and the other one that diverts the attention of the brain from the danger, thus suppressing the appearance of the stressor in mind (Horowitz, 1993). The phases emphasize people’s experience of trauma and different magnitude of the trauma, and the extent to reappear in the mind of the healthcare worker. In the development of his phases for the theory, Horowitz first explored trauma in 1975. In this study, he examined the stress suppression approach as the alternative when victims try to assimilate the information by avoiding trauma memories and focusing on reconciling old information with the new (Horowitz, 1975). Therefore, Horowitz’s stress response theory focuses 5 6 on human responses to traumatic situations to explain how people react to undesirable occurrences such as stress. Horowitz started by researching the psychological responses of humans toward stressful events in life (Horowitz, 1983). Horowitz discovered two common types of responses to stress or trauma. The first response is the mode that utilizes invasive recurrences of the trauma or stress in emotion, thought, behavior and imagery. Since states of intrusions are considered painful, the second response developed when trying to suppress the intrusions utilizing mechanisms like emotional numbing, intentionally avoiding the reminders and ideational denial. The findings aided in shaping the understanding of his stress theory by giving more information on how people respond to stress is defined as containing five phases. In the first phase, the initial realization or outcry that the stressor has on an individual usually recognizes that they are undergoing stress. Initially, an individual may not realize that he is stressed, but in this stage, the person should identify the cause of the stressor and begin to work on controlling the stress. Secondly, emotional numbness and denial are a state used by most individuals when dealing with stress. This is where individuals shut out their feelings. Feeling numb is usually a temporary feeling; however, some of the emotional numbness experienced becomes a strategy used by individuals to protect themselves from more physical and emotional pain. Even though it can provide temporary relief, teaching self to cope with complicated feelings using emotional numbness can cause long-lasting effects (Lindberg, 2022). Thirdly, the intrusive repetition sequence of the above phases may not be considered universal because some individuals might skip some of the phases or show different sequences of responding to stress (Horowitz, 1993). Horowitz discovered that the working stage comprises a prolonged change of intrusion and denial, with the strength of responding decreasing gradually. The completion stage happens 6 7 when a resolution between the new information and lasting mental models discovered. In this fourth phrase, a person tries working through to solve the problem causing the stress by talking to someone about the issue, accepting the results, and finding a way to solve the issue. However, the fifth and final phase states that even if the completion stage is attained, later events can rekindle the initial emotional meaning of traumas, whereby the repetition of the sequence of phase’s results. Horowitz (1983) explains further the relapse of traumatic memories from two perspectives through the psychoanalytic theory. Horowitz suggests that the contents linked to primary memory can be represented repetitively in consciousness until the completion of cognitive processing of the episode hence storing the occurrence in semantic memory (Horowitz, 1983). The second perspective is that repetitions are involuntary and not defined as static duplication of the initial trauma. Horowitz’s theory gives a conceptually comprehensive and rich record of cognitive processes used to adapt to trauma. The approach provides information on the strategies that can hinder or facilitate. Through the theory, it becomes easier to account for intrusive images, thoughts like nightmares, and those phenomena like stressful changes and events of the intensity of symptoms over time. The recovery from trauma is describe as revisions of present schemas or assimilation of traumatic memory to accommodate new information. The theory of humanistic needs was also the basis of Maslow’s hierarchy of needs developed by Clayton Alderfer (Shin & Kim, 2019; Yin & Zeng, 2020). According to Alderfer, human beings have three basic needs, in this case are subdivided into three, that is, existence needs (Yin & Zeng, 2020). Existence needs include all material and physiological desires such as food, water, air, clothing, safety, physical love, and affection (Huang et al., 2020). For nurses to deal with the current dramatic COVID-19 pandemic, 7 8 they require current needs (Muller et al., 2020). According to this theory, the second category of needs is relatedness (Adams & Walls, 2020; Yin & Zeng, 2020). These needs include security, respect, and love/belonging-related needs (Li et al., 2014). This emphasizes the feeling of security or belonging to a particular group, such as family and friends (Huang et al., 2020; Yin & Zeng, 2020). In this case, nurses are in dire need of a sense of security and belonging. The third category of needs includes growth needs that include personal development (Muller et al., 2020). Just like any other person, nurses got the desire for self-development (Adams & Walls, 2020; Shin & Kim, 2019). However, other authors, like White (2021), studied inpatient nurses and their experiences with COVID-19 at one hospital in the United States. White interviewed participants about their role and encounters with COVID-19 while working in the setting. The research revealed that particular findings from his research demonstrate that inpatient nurses are frontline staff who become a high risk for contracting COVID-19 and increase their stress levels given the uncertainty of their safety and job requirements. Recognition of the nurses in the workplace at the time becomes a bold step toward addressing their problems amicably. Nurses require significant help to deal with stressful problems (White, 2021). Similarly, Nelson et al. (2021) studied frontline nurses. They found that these nurses’ level of uncertainty plays a significant role in their ability to cope and perform their job efficiently. Nelson, the researcher’s qualitative approach sought to examine the role of nurses during the onset of the global pandemic. The research findings reveal that the nurses did not anticipate the situation. The phenomenological analysis cites emotional challenges as some of the prevailing 8 9 consequences nurses had to deal with during this time. The uncertainty of communication challenges and the lack of elaborate leadership further complicated the issue. The nurses experience significant problems that hinder their proper working and handling of patients. Traumatic stress tends to profoundly, affect nurses’ productivity while compromising their caregiving role during the pandemic when their services are critical in the health sector (Simeone et al., 2021). This suggests that Horowitz’s research studies were more in-depth and gave more insight into how to handle their fears and concerns. Horowitz’s creation of stress response syndromes gives the most influential and far-reaching social-cognitive model to react toward trauma. The theory is inspire by classical psychodynamic psychology (Mitch Medical, 2021). The approach of Horowitz primarily focused on discussing thoughts in terms of cognitive processing of information linked to trauma, for example, images, thoughts, effects, and ideas. According to Horowitz (1976), the core impetus found in the cognitive system helps process trauma-linked information induced by completion tendency. Horowitz’s stress response model contains two central tenets used by PTSD’s cognitive theories and has been further expanded by Mineka and Monroe (Berntsen et al., 2008). The idea of flashbacks, created in Horowitz’s work that focused on patients with LSD, used in the literature was focus on stress to show occurrences of involuntary traumatic memories with high levels of behavioral and emotional reliving (Berntsen et al., 2008). The DSM model, which is currently used in different institutions, has been created from the effects of Horowitz’s theory. The effect of Horowitz (1976) could be summarized in three key points. First, the general response tendencies like that of stressful events do not depend on the person’s predisposing factors. Secondly, Horowitz could identify the avoidance, re-experiencing, and arousal 9 10 symptoms like that of PTSD (Horowitz, 1976). According to his conception, a simple stress response usually involves fluctuating different phases with invasive recurrence of events in emotional behavior and thoughts. Thirdly, Horowitz classified involuntary recollection as a typical stress response mechanism dependent on the active memory storage where there is automatic repetition of content until the stressful material is complete; therefore, the stressful material is integrated into the preexisting cognitive schemata. In the current trends in researching “Horowitz’s stress response theory.” The “Impact of Event Scale” has been used in most research. The model has been utilized to analyze different populations facing a wide array of traumatic events to analyze the stress reactions. “Impact of Event Scale” was created through the stress response theory, which defines how a person copes with the various subjective effect of main life events. The conceptualization of Horowitz toward the stress response entails an oscillation from avoidance to intrusion experiences (Kolokotroni et al., 2021). The instrument “Impact of Event Scale” is used to evaluate the distress caused by traumatic occurrences. The test focused on two sub-scales: avoidance and intrusion. The instrument is linked closely to symptoms of PTSD. Usually, the test format is a 22-item self-report that the respondents use to point scale identify a stressful event. On the scale, the respondents were asked to measure their distress using a 5-point scale (Hendrix, 1994). Subtopic: Inpatient Nursing in the United States (U.S.) 10 11 Nurses are a significant part of healthcare and are the most in the health profession. Around 29 million nurses are working, and 3.9 million are in the United States (U.S.) (Haddad, 2022). From the information provided by “The American Nurses Association,” the availability of jobs in nursing will be more available in 2022 compared to other professions in the U.S. (Haddad, 2022). The nursing profession faces a shortage because of the high turnover rate, lack of potential instructors, and inequitable workforce distribution. There is a shortage of nurses because of the aging population, the high number of the aging workforce, nurse burnout, career and family, regions, and violence in the healthcare industry. Some institutions have employed different strategies to ensure the nursing shortage is controlled. The utilization of technology and empowering nurses are some strategies used to ensure the rate of turnover is mitigate. In the United States, inpatient nurses provided an overwhelming majority of bedside patient care and witnessed the impact of COVID-19 firsthand on their patients and communities. The pandemic created stressors of workers having poor adjustments that inpatient nurses exhibit due to the trauma and the associated stress with handling the cases of COVID-19 (Sun et al., 2020; Zhang et al., 2020). COVID-19 and Inpatient Nursing When starting the nursing journey, one is usually driven by the desire to help enhance an individual’s life. Before COVID-19, the healthcare sector in the United States of America (USA) was well streamlined even though it faced several challenges. Streamlined ways enabled individuals to become licensed practice nurses and registered nurses. Before the pandemic, the number of registered nurses increased by approximately 4% (Berlin et al., 2022). COVID-19 11 12 altered the career plans of many US nurses. In the past two years, according to a report, more people have been willing to leave the nursing industry compared to the past decade (Berlin et al., 2022). The US healthcare providers are experiencing operational and workforce challenges even if the COVID-19 cases are fluctuating. Patient demand is anticipated to increase given the growing number of people and the aging population in the United States. During the COVID-19 pandemic in the United States, the inpatient frontline nurses showed minimal research on the impact of traumatic stress on nurses or their risk of developing posttraumatic stress disorder (PTSD) among American nurses. Besides, PTSD is a disorder in which individuals experience intense thoughts or feelings related to an experience after the trauma and can develop after a shocking, scary, or dangerous event. That is what happens with inpatient nurses. These nurses, like individuals with PTSD, may experience flashbacks, sadness, anger, fear, and detachment from others (Hernandez et al., 2021). The nurses representing a large percentage of healthcare workers were at the forefront of the battle against the COVID-19 pandemic. Nurses who provide care to the patient are physically close, exposing them directly to the virus. During the pandemic, the nurses entailed a group with a high likelihood of contracting the virus. The high risk of nurses infected by the virus affects their mental health because of stress when treating patients in close physical proximity (Galleta et al., 2021). During the pandemic, the nurses worked for long hours; their job was demanding, faced fatigue, stigmatization, psychological distress, and psychological and physical violence. The nurses are mentally affected in terms of insomnia, fatigue, anxiety, worries, stress, and depression. The increased percentage of deaths recorded during the pandemic resulted in high exposure to psychological and emotional suffering. Impact of COVID 19 on Nurses 12 13 White (2021) studied inpatient nurses and their experiences with COVID-19 at one particular hospital in the United States. The nurses were the frontline staff in patient caregiving (White, 2021). White interviewed participants about their role and encounters with COVID-19 while working in the setting. The COVID-19 outbreak led to an immeasurable increase in the caregiver workload in various hospital facilities. The research revealed that the nurses suffered emotional consequences as pioneer leaders in managing the pandemic. Besides, the nurses’ routine management experiences brought psychological trauma that negatively affected their well-being. In particular, findings from White’s research demonstrate that inpatient nurses are frontline staff who become a high risk for contracting COVID-19 and increase their stress levels given the uncertainty of their safety and job requirements. Recognition of the nurses in the workplace at the time becomes a bold step toward addressing their problems amicably. Nurses need significant help to deal with stressful problems (White, 2021). Similarly, Nelson et al. (2021) examined the role of nurses during the onset of the global pandemic. The research findings reveal that the nurses did not anticipate the situation. Wherefore, Nelson found that nurses’ level of uncertainty plays a significant role in their ability to cope and perform their job efficiently (Nelson et al., 2021). They suggest that the phenomenological analysis cites emotional challenges as some of the prevailing consequences nurses had to deal with during this time. The uncertainty of communication challenges and the lack of elaborate leadership further complicated the issue. The nurses experience significant problems that hinder their proper working and handling of patients (Nelson et al., 2021). The frontline staff played a significant role in the pandemic, which gave them diverse experiences from the encounter (Mohammed & Lelièvre, 2022). However, the research findings reveal that, as a result, they suffered emotional consequences as pioneer leaders in managing the 13 14 pandemic. Nurses’ routine management experiences brought psychological trauma that negatively affected their well-being. It may require adequate changes in the workplace conditions to enhance their safety, organization, and preparedness to deal with the problem (Mohammadi et al., 2022). While dealing with the patients, some nurses contracted COVID-19 in the process. In their research, Moyo et al. (2022) established that the nurses faced both emotional and psychological experiences resulting from the pandemic following such occurrences of contracting the disease while at work (Adom, Mensah, and Osei, 2021). Besides, the physical strain the nurses were undergoing destabilized them, and they tended to be very emotional. Consequently, they faced stigma from the public, further aggravating the whole issue (Simeone et al., 2021). The nurse practitioners did not have the peace of mind to undertake their roles diligently because of the disturbances they faced during the encounters. Fear and anxiety were prevalent among the nurses while conducting the study. The nurses feared the worst if they contracted the disease because they visualized death from a distance based on their encounters with their patients (Simeone et al., 2021). Another major problem that inpatient nurses had was the fear of uncertainty concerning the recovery process from COVID-19. It is because there was no sure medicine to cure the COVID19 illness (Moghaddam-Tabrizi & Sodeify, 2021). Therefore, they did not know if there was recovery at sight or just trial and error. The whole undertaking brought confusion to the nurses, further contributing to the further escalation of the issue. Consequently, the lack of structural support from the whole system at the care facilities and back at home did change the perspective of those nurses who sacrificed themselves for the well-being of others. The trauma of not 14 15 knowing whether the patient or the nurse giving care to the patient will recover will immensely affect the nurse, hence requiring professional help (Moghaddam-Tabrizi & Sodeify, 2021). Stress Responses In stress response scenarios, the nurses found themselves during the COVID-19 pandemic and tended to establish an understanding of what was happening. Traumatic stress tends to affect profoundly the nurses’ productivity while compromising their caregiving role during the pandemic when their services are critical in the health sector (Simeone et al., 2021). The nurse practitioners found themselves in compromising situations amid the happenings. McGlinchey et al. (2021) establish that the circumstances surrounding COVID-19 nurses working at inpatient hospitals made them feel unwanted in society. Therefore, they had mixed feelings about being undervalued and misunderstood at the same time, despite the critical role that they were playing in the healthcare sector, helping patients suffering from the pandemic recuperate. They wanted to express themselves and air their views to the public concerning the seriousness of the disease. However, in the beginning, people were unlikely to give them the attention they deserved to turn things around. The weight of the happenings rested on them, a premium hindrance to their smooth handling of the whole situation (McGlinchey et al., 2021). Following the intensity of the issues in society, there was an endeavor to develop effective stress response strategies. Khatatbeh et al. (2021) found that short-term coping strategies were essential in dealing with the pandemic. In particular, they proposed using psychosocial support to deal with the problem effectively. Psychosocial support includes support from social networks that understand the nurse’s problem (Khatatbeh et al., 2021). The problems of nurses have become integral in lessening the entire problem; one will use the support as a stepping-stone to 15 16 dealing with the devastating effects of the pandemic. In essence, psychosocial support helps reconstruct the nurse(s) to ensure that one remains positioned to offer critical services to the needy populace as the pandemic strikes (McGlinchey et al., 2021). One of the responses that would have arisen due to the lack of support systems to manage the already disillusioned nurses is secondary trauma. Witnessing what was happening at the hospitals as caregivers gave them first-hand information on what was happening to the patients who contracted the disease (Huntley & Bratt, 2022). Essentially, this implies that nurses needed an elaborate support system to deal with the devastating effects of working with COVID-19 patients. In essence, it remains essential for nurses to focus on doing things that would contribute to their overall well-being in terms of lessening those effects (Huntley & Bratt, 2022). The institution of protective mechanisms doubles up as one of the effective ways of the stress response. Besides the use of a robust support system, elementary aspects such as education also prove essential. Through education, nurses find new ways to deal with the problem. Therefore, ensuring that the nurses take through an education system that takes care of their concerns emerges as one way of dealing with the problem. In addition, team cohesiveness amid traumatic stress will effectively respond to the problem at hand (He et al., 2021). In particular, ensuring that nurse work as a unit, helping each other in whichever way they visualize an idea, would enable them to counter the stress issue. The mechanism serves as an ideology of teamwork, improving the consolidated efforts for working within the workplace (He et al., 2021). Summary 16 17 Nursing is a demanding job in the U.S., as proved during the COVID-19 pandemic, where nurses were considered front-line workers (Galleta et al., 2021). During the pandemic, the nurses experienced significant challenges like working many hours, treating patients nearby, increasing the likelihood of nurses contracting the virus, and emotional distress from many patient deaths. Stress is an everyday part of our lives. Stress response changes how we perceive other people, evaluate threats and danger, and solve problems, in addition to a host of body changes that maximize, in the short term, our physical ability to handle material, psychological, and social threats (Tanz & McClintock, 2017). However, it can have significant adverse effects if not appropriately controlled; according to “Horowitz’s stress response theory,” the findings aided in shaping the understanding of his stress theory by giving more information on how people respond to stress. 17 18 References Adom, D., Mensah, J. A., & Osei, M. (2021). The psychological distress and mental health disorders from COVID-19 stigmatization in Ghana. Social sciences & humanities open, 4(1), 100186. American Psychiatric Association, (2022). Treatment of Stress Response Syndromes Second Edition. Retrieved from https://www.api.org/Products?Trauma-Violence-andPTSD/Treatment-of- Stress-Resonse-Syndromes-Second-Edit Becker, L., Kaltenegger, H. 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