S TAFF WE L FARE


Thriving “I got this”


Calm and steady with minor mood fluctuations


Able to take things in stride


Consistent performance


Able to take feedback and to adjust to changes of plans


Able to focus


Able to communicate effectively


Normal sleep patterns and appetite


Surviving “Something isn’t right”


Nervousness, sadness, increased mood fluctuations


Inconsistent performance


More easily overwhelmed or irritated


Increased need for control and difficulty adjusting to changes


Trouble sleeping or eating


Activities and relationships you used to enjoy seem less interesting or even stressful


Muscle tension, low energy, headaches.


Struggling “I can’t keep this up” Persistent fear, panic,


anxiety, pervasive sadness, hopelessness


Exhaustion


Poor performance and difficulty making decisions or concentrating


Avoiding interaction with co-workers, family and friends


Fatigue, aches and pains Restless, disturbed sleep


Self-medicating with substances, food or other numbing activities


In Crisis “I can’t survive this”


Disabling stress and loss of function


Panic attacks


Nightmares or flashbacks Unable to fall or stay asleep Intrusive thoughts


Thoughts of self-harm or suicide Easily enraged or aggressive


Careless mistakes, an inability to focus


Feeling numb, lost or out of control


Withdrawal from relationships


Dependence on substances, food or other numbing activities to cope.


The stages of work-related stress, adapted from Watson P et al, (2013), ‘Stress first aid for firefighters and emergency services personnel’. National Fallen Fire Fighters Foundation.


marathon and not a sprint, but the evidence suggests that this is a continuous world of exhaustion. Staff strive to ensure that the care which they deliver is of the highest quality. However, chronic fatigue and poor mental health and well being among the staff diminishes the quality of care and increases the chance of patient safety incidents, which causes further stress to others in the team.


What does the literature say? There has not been a great deal of time for specific COVID-19 data to appear in the research although some4


cite


experience from previous epidemics such as SARS and Ebola. A total of 55 studies in a systematic review found that the psychological implications to healthcare workers (HCWs) are variable with several studies demonstrating an increased risk of acquiring trauma or stress-related disorders, depression and anxiety. Fear of the unknown or becoming infected were at the forefront of the mental challenges faced. Being a nurse and being female appeared to confer greater risk. The perceived stigma from family members and society heightened negative implications; predominantly stress and isolation. Coping strategies varied among the contrasting socio-cultural settings and appeared to differ among doctors, nurses and other HCWs. Implemented changes, and suggestions for prevention in the future consistently highlighted the need for greater psychosocial


support and clearer dissemination of disease-related information.


Addressing psychological risks From the literature it appears that self coping strategies such as acceptance, resilience, active coping and positive framing were useful. Some doctors used planning as a strategy. Other staff used exercise to help reduce the burden. The level of support from supervisors was found to be a significant negative predictor for psychiatric symptoms and PTSD (post traumatic stress disorder). Self directed learning on psychological materials had helped some staff to manage their condition, together with support from team members or colleagues. Several studies cited in the systematic review suggested that greater support would be supplied through collaboration, training and education. This appeared to strengthen teams and reduce HCW stress. Additionally, clear communication was seen to be a positive factor in reducing psychiatric symptoms.5 To enhance recovery and well being, a range of support methods and psychological measures should be in place in the workplace. Furthermore, they should not be merely present for the duration of COVID-19; this disease will have a long shadow with the impact beginning to show in our healthcare workforce.


Supporting employee wellbeing In 2017, the Government commissioned a


16 l WWW.CLINICALSERVICESJOURNAL.COM


review by Lord Dennis Stevenson and Paul Farmer, CEO of the mental health charity Mind. The subsequent report6


identified a


number of core standards for employers to have in place. l Produce, implement and communicate a mental health at work plan.


l Develop mental health awareness among employees.


l Encourage open conversations about mental health and the support available when employees are struggling.


l Provide your employees with good working conditions.


l Promote effective people management. l Routinely monitor employee mental health and wellbeing.


Whether work is causing the stress or exacerbation of an existing mental health condition, employers have a legal responsibility to help their employees. Where a risk to work-related mental health issues is identified at assessment, steps must be taken to remove it or reduce it as far as possible.7 Obviously in the current situation, that cannot occur but employers can, if they have the motivation, provide extensive assistance to their employees on their intranets or by occupational health.


Advice and support Many Trusts have their own services which they have set up over the year with well being and mindfulness moments. It is the


FEBRUARY 2021


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