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Dr. Lisa Monaghan
Consultant Clinical Psychologist and Head of The Staff, Psychology & Welfare Service, University College London Hospitals (UCLH), UK
“Life before Covid-19” is a common saying now. Moving through this new social context feels like entering an alien world – unsure, unfamiliar surroundings, everything abstract and strange. Lockdown ushered in deserted streets, infrequent and nearly empty trains, and fear. I found myself becoming hyper vigilant, waiting in the dark, sitting alone on a train, walking home through abandoned streets. I know I was not alone in feeling this way. In such situations, our heightened levels of self-vigilance work to keep us safe. Reports in the media of assaults on NHS staff did nothing to help. This was on top of all of the other anxieties and pressures for hospital employees during Covid-19. The uncertainty is paramount. There have been so many changes in a short time. Nobody knows when things will improve, or even if there is an end to this. Staff felt unsettled and overwhelmed; the increased use of battlefield language compounded this further for some and galvanised others. Understanding that this was the new normal was hard to take in at first, especially since we were implementing big changes daily! Working in a hospital is challenging enough, but it is what our staff are trained to do, and most struggles are predictable or can be planned for. Now, everything changes on a daily basis. It causes anxiety and worry, which in turn can lead to problems with mood and sleep. Stress affects concentration and how we communicate.
It is vital for everyone to care for themselves as well as each other and to understand these are normal reactions in the circumstances. It is important for staff to hear that “it’s okay to not be okay” and “it’s okay to ask for support”. No one should think they have to be superhuman. And we all need to start practising self-care more regularly. At UCLH, with our staff wellbeing initiative, we are trying to take away as much pressure as we can to avoid the situation feeling quite so overwhelming. This is a multi-pronged approach and my team is trying to be a central point for wellbeing information and to mobilise psychological initiatives. Others have ensured that childcare needs are met, food, transport and accommodation are provided; basic needs that underpin wellbeing and resilience. I have been grateful for the offers of collaboration and support from those around me at UCLH and also outside of it. Our neighbours at The Wellcome Trust have helped us provide a comfortable and relaxing space for staff to get some respite away from the hospitals. New connections are being made that can support growth and cultural change in the recovery stages of this pandemic and beyond. Staff are being brought together into new teams and into new places and that creates a natural anxiety. We hold mini team-building events to help people connect in a shorter timeframe than usual. Teams have been encouraged to have huddles and debriefs at the beginning and end of shifts, to manage worries and expectations and check if anyone needs help. Part of making the unbearable bearable is to stop, connect and show self-compassion and kindness to others, understanding we are all affected and that the impact is expressed in different ways. Taking time to just breathe is often the most valuable thing any of us can do in the maelstrom of events. We offer extra coaching for senior doctors and nurses – many of them feel the pressure to be superhuman. But everybody is human. When a difficult clinical decision must be made, we now have three doctors who discuss and decide what to do. It takes the pressure off any one person to take sole responsibility. We know this helps but it is not possible for all decisions and we are aware of the need to support all staff to manage the short- and long-term impact of the weight of responsibility.
Home is usually a place to unwind from the stresses at work, but Covid-19 has also infected where we live. And it has taken over the news. We advise staff to limit their news intake because media consumption was raising anxiety levels and leading staff to feel overwhelmed. That then preys on people’s minds and they do not sleep so well. They get worried about being worried, and worried about not sleeping. But we can provide support and apps to help with that. Naturally, stress levels are increasing across the hospital. Admin workers now deal with upset and distressed families on the phone. This impacts them emotionally, just as it does a nurse speaking to families on the ward. Cleaners and other colleagues also feel upset and stressed out and need help. For some staff with experience of mental health issues and disabilities, this has triggered a recurrence of their problems, while others have found that their experience has helped them to be strong for themselves and others. We have provided crisis support for those that have needed it, aware that many may have had their support network interrupted. Many staff have come forward to be Wellbeing Champions to enable appropriate and timely signposting to services and support. We very much hope to build on this for the future. Because we have an in-house psychology service, we could anticipate many of the psychological issues staff would face and be proactive. Before the lockdown, we sent out a support guide and blogged on a range of topics including fake news, anxiety, working from home, redeployment and talking to your children about a pandemic. We made it as colourful and cheerful as possible while being realistic and honest about what people might need. Now we send weekly themed newsletters addressing concerns raised by staff – stress, sleep, loneliness, loss and so on – with grounding exercises and links to physical and mental health videos on our YouTube channel. Psychologists who usually see patients have joined our extended team and are now providing support to staff. We have satellite spaces for drop-in sessions and phone consultations. On the Covid-19 wards we run daily staff support groups so that any employee can drop in and, if needed, be guided towards more help. We are also ensuring that psychologists looking after our employees have space to debrief and practice self-care.
We are already planning for the long-term psychological effects of the pandemic. Feeling that you cannot help everyone and seeing patients die alone can lead to mental health issues and PTSD down the line. Anxiety and depression may emerge as a delayed reaction one or two years later. It is not helpful to intensively unload all the emotions while in the thick of it. When we are through the crisis and people can take a step back, we will support them to process what they have seen and experienced.
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