Staff Wellbeing in Crisis

Protecting Staff Mental Health Through Covid-19

There are still plenty of things that individuals, teams, and services can do to minimise the traumatic impact on individual staff in the impending pandemic “peak”.

The following are action points extrapolated from two key review papers. Links to those papers are provided below. Emphasis is on current staff mental and emotional well-being and reducing the risk of future sequelae of trauma.

All members have a role in the health of the team, but some individuals, on behalf of the organisation, hold explicit responsibility for the health and efficacy of teams. To highlight this I have created separate lists for individuals and those with specific leadership responsibilities.

Individuals:

• Competence and efficacy. Feeling competent and prepared helps to protect you from negative outcomes. Practice procedures. Satisfy yourself that you are ready. If there is an area you feel less confident of, seek support and develop a plan.

• Motivation. Motivation is protective. Remind yourself how important your work is.

• Fitness improves your resistance to emotional strain. Use proactive, strategies to stay mentally and physically well. Don’t deny. Use action to distract. Exercise, relax, fix something, meditate – whatever is familiar and suits you. Make relaxation a skill. Use planned problem-solving. Hold back on alcohol. Avoid drugs.

• Being integral to a team is protective. Plan together. Rehearse the plan for the day. Practice skills. Share successes as well as fears and other reactions. Do not stigmatise feelings, either in yourself or others.

• Secure your secure base. Satisfy yourself you have done what you can to protect yourself and your family. Practical steps; insurance, wills.

• Social connection is protective. Connect with friends and family. Don’t expect them to understand what work is like, exactly. Spend quality time with them, even briefly. They will want to help you but may not know how. Make clear requests.

• It helps to feel effective. If you need quarantine, use this time away from maximum exposure to recharge your emotional batteries. If it frustrates you to be prevented from work, find something you can do to support the team – revise protocols etc.

Leadership

• The wellbeing of team members depends on being and feeling Safe, Skilled, Connected, and Prepared. Make every effort to ensure all team members have the skills and the equipment to do their work safely and well.

• Team spirit and morale protect. Make yourself accessible to team members. Encourage supportive relationships within teams.

• Preparation protects. Train team members, and rehears roles, skills, and communication. Establish key phrases for difficult moral decisions, such as “your own oxygen mask first.”

• Belonging, and team morale are protective. Meet and share. Normalise (do not mandate) grief, doubt, frustration, fear. Celebrate positives, like cohesion, team spirit, tenacity. Identify learning if it can be operationalised. Divert from stigma and blame, including self-blame. Include all, including reception and support staff.

• Communication is key. Establish regular times for sharing information and updates.

• Appreciated voluntary contribution protects. Take seriously, and find a way to act on, any suggestions from individuals. As much as possible enable individuals to feel in control of their work.

• Vulnerability to trauma varies between individuals and between roles. Know your team members and be aware of early signs – fatigue, poor sleep, health worries, avoidance, increased alcohol use. Act early to support.

• Sharing protects. Try to avoid individuals having sole responsibility for areas or individual patients.

• Traumatic harm is cumulative Consider rotating a team member through roles to reduce overall exposure.

• Competent contributing protects. If rotating team members into less exposed situations ensure they understand they are recharging their batteries, and still have a skilled contribution to make. Train them in that skill if they are not confident.

• Individuals differ in what they need from down time and support. Have a flexible approach to support and down time and agree this with individuals. Establish a stepped approach to support in the organisation. Support the supporters.

Source material can be found on the website for the Association of Anaesthetists. These are review papers summarising findings from research carried out during and following the SARS pandemic:

A Systematic, Thematic Review of Social and Occupational Factors Associated With Psychological Outcomes in Healthcare Employees During an Infectious Disease Outbreak (PDF) Brooks et al JOEM Volume 60, Number 3, March 2018,

Traumatic stress within disaster-exposed occupations: overview of the literature and suggestions for the management of traumatic stress in the workplace (PDF) Brooks Rubin and Greenberg 2018 British Medical Bulletin, 2018, 1–10 doi: 10.1093/bmb/ldy04

Andrew West April 2020 2/2

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