Acutely aware of the impact of the COVID-19 pandemic on the entire health and social care workforce, South East London Integrated Care System commissioned St Christopher’s Hospice to deliver a webinar for staff in the area. Demand was high for a session designed to set the scene across all settings, recognise the pressures people have been working under and identify some techniques for managing them, with more than 150 people logging on.
The webinar drew on the huge experience of the two main presenters, Deborah Holman, who has worked for more than 40 years as a nurse, much of which has involved caring for the dying at home, and Nigel Dodds who was able to draw on 30 years as a nurse and most relevantly managing St Christopher’s Community Nursing Team during the pandemic.
St Christopher’s Senior Educationalist, Maaike Vandeweghe, hosted the webinar and set the scene with a poem written by a nurse in Glasgow reflecting on her time working on the frontline during the pandemic. Her poem opened with the line: “Tonight I held you and fought back the tears” and finished with “The next family will need us, and we will need to do the same But I hope I gave you care, and I always remember your name.” Deborah drew on all her wealth of experience, initially highlighting the fact that no one knows how they’ll cope under extreme pressure until they are placed under it.
We’re not all in the same boat
She too used a quote to illustrate what different people’s experience of a stressful situation might look like – depending on their resilience levels, or their bounce-back-ability, as she put it. She quoted writer Damien Barr,
“We are not all in the same boat, we are all in the same storm, some are in super yachts, some have just an oar.”
Knowing how to ensure you can cling on to that oar until the storm is over is what’s critical, Deborah said – in other words, knowing how to take care of yourself is an essential skill. The uncertainty of health care, amplified multiple times by COVID-19, made that task considerably harder. Added to that, many found themselves thrown into unfamiliar roles, isolated and with little control, she said.
Continuing to set the scene and establish the reasons behind the emotional, physical and mental strain many have felt over the last year, Deborah identified the sense of helplessness being present when patients have been close to death and there’s been nothing those caring for them can do. She added that feeling depressed, frustrated and angry is wholly understandable when, as a health or social care professional you are left thinking about what you think should have been done and what was actually done – or moral distress as it’s known.
Need to recognise what we’re going through
The first step to dealing with the emotional labour, compassion fatigue and burnout is to recognise it, not neglect it. “It’s about recognising the things we are going through and finding a way forward that is acceptable to us,” added Deborah.
Attendees of the webinar were then provided with a real life case study from early in the pandemic to illustrate the anxiety, fear and stress felt by members of the St Christopher’s Community Nursing Team and their colleagues in district nursing. Nigel Dodds also shared how the team dealt with these natural responses and built on the experience to manage their care over the following months.
St Christopher’s COVID-19 case study
Nigel shared the story of a man in his 90s with bladder cancer who lived with his son and daughter-in-law. In March 2020, a member of the Community Nursing Team visited in response to a call saying the patient had deteriorated. The nurse identified the man and three members of the family had clear COVID symptoms, and described the air in the house, ‘like COVID soup’.
With no community testing in place at the time and a shortage of PPE that meant staff were wearing swimming goggles, colleagues in the Community and District
Nursing Teams were extremely concerned – debilitated with fear, as Nigel put it. This was only exacerbated when the nurse who’d visited, developed symptoms and became acutely unwell. Such was the level of fear of the members of the District Nursing Team visiting the patient, they took twice as long to deliver routine care, got lost on route and one member of the team hid behind her Team Leader to avoid catching the virus.
Nigel expressed pride in the response of his colleagues.
“I still reflect on those conversations and am blown away by how we stood up to it. We felt like we had been hit by a sledgehammer and that knocked our confidence, but we had the right response and have been able to continue the work we love. We continued to visit people and put ourselves in situations of risk, and learned to recognise that we have done our best and can stand up and be proud.”
He revealed that the nurse who’d contracted COVID took her family to the memorial wall near St Thomas’s Hospital recently and wrote the initials of the man she’d visited that day, because she said it would inform everything she now does as a nurse.
What we can do to bounce back
Deborah then gave participants some practical advice, which she said had to start with the simple but crucial first step of reflecting where we’re at mentally, emotionally, physically and rationally. She recommended people use the Maslach Burnout Inventory – https://monkeypuzzletraining.co.uk/free-downloads/MBI_self_assessment_for_organisations.pdf to identify whether you’re someone who’s weathered the storm in a super yacht or just about clung on to the single oar.
Drawing on her own experience of near burnout and the need to recover, Deborah recommended taking time away from the stressors, which in her own case meant a change of job, giving more time to herself, and having less responsibility. This recovery time for her extended to a year.
Participants were recommended to identify what caused their ‘stressors’, and how they could have coped with them better as well as to acknowledge the importance of a team and the ability of people to support each other to manage stressors. Ongoing coaching and mentorship were two further mechanisms that could be employed. As Maaike said at the end of the webinar:
“Never has looking after ourselves been so important as it is now.”
St Christopher’s CARE is planning more courses about resilience for later in the year. Keep an eye on http://www.stchristophers.org.uk/CARE for more information. The Keeping Well in South East London portal is also an excellent place for further supportive resources. https://www.keepingwellsel.nhs.uk/
A bitesize version of this webinar is available to view here – https://www.youtube.com/watch?v=C4lcu_9wwOo.
Cover picture: Consultant Nurse – Nigel Dodds