A Creative Intervention for Supporting the Mental Wellness of Nurses: The Ameliorative Promise of Graphic Testimonials

Introduction

Even not accounting for the impact of the ongoing pandemic, the United States has a well-established nursing shortage (Haddad, Annamaraju, &Toney-Butler, 2020). In addition to recruiting more people into the nursing profession, retaining practicing nurses is crucial. COVID-19 has heightened the challenge of recruitment and retention, exacerbating difficulties of acute care that threaten the mental wellness of nurses. The prevalence of mental distress among nurses and other healthcare workers constitutes a continuing exigency in need of urgent and inventive interventions; rather than a chronic condition that can be managed and stabilized, such mental distress has manifested as the accumulation of acute distress over time. The issue of nurses’ mental health challenges might be conceptualized as a “wicked problem”--that is, a complex, multicausal, variously defined, and at least somewhat intractable problem (Conklin, 2005)--demanding a similarly complex, multipronged solution.

Drawing on emergent research, this chapter’s Background section overviews the mental health challenges for nurses, focusing on the context of the COVID-19 pandemic, and addressing institutional and societal contributors to such challenges, including the stigmatization that prevents many nurses from seeking or obtaining help. Here the authors discuss forms of trauma and moral injury that nurses experience, and the sense of duty and sacrifice that is reinforced by public representations and perceptions of nurses. The Background section also highlights and explains stigma’s roles in nurses’ mental health challenges.

The chapter’s second major section examines a range of evidence-based and experimental efforts, some recently initiated, for addressing nurses’ and other healthcare workers’ mental health challenges and supporting their well-being. Here the authors discuss the potential benefits and the limitations of existing efforts in the U.S. and beyond, including those initiated by individual nurses and those sponsored by networks or groups of nurses, hospitals and other institutions, and professional organizations. The chapter’s authors argue that individualizing approaches to self-care, particularly those that depend on a narrow notion of resilience, are insufficient and unfairly put the burden of mental wellness on nurses. Referencing creative, artistic efforts to support nurses’ mental wellness in particular, the authors then turn to the under-explored promise of graphic medicine for ameliorating nurses’ mental health challenges and for supporting their therapeutic, advocacy, and educational needs. Graphic medicine is an emergent interdisciplinary field described by Williams (2007) as at the “intersection between the medium of comics and the discourse of healthcare” (n.p.).

The chapter’s Solutions and Recommendations section reviews and proposes relevant applications of narrative-based, autobiographical comics--what some have called “graphic pathographies” (Green & Myers, 2010, with pathographies being narratives about experiences with illness or care), and what the authors of this chapter call “graphic testimonials.” The authors consider ongoing and potential responses to the mental health stigmatization and related challenges of nurses that involve, or could involve, creative applications of graphic testimonials and their unique qualities and functions. The authors argue for collective, integrated, capacity-building, and de-stigmatizing approaches to developing and deploying nurses’ graphic testimonials for mental health support, as such approaches have more potential to improve organizational, socio-cultural, and other structural conditions in ways that address nurses’ most pressing needs.

The chapter’s Future Research Directions section points to gaps in several related bodies of research, including how nurses are experiencing mental health stigma and distress in the U.S. context, the efficacy of different types of interventions to destigmatize and support nurses’ mental wellness (particularly in the context of an ongoing pandemic), and the implementation and evaluation of graphic testimonials in therapeutic, educational, and advocacy responses. Finally, the chapter concludes by returning to the promise of graphic medicine for creating better awareness of and enriching multi-pronged responses to the mental health challenges of nurses and other providers.