Kindness as part of supporting frontline staff under pressure | 27 May 2020

It is widely recognised that in the current COVID-19 context, frontline staff are likely to be under increased pressure. This can be challenging for mental health and wellbeing, and appropriate support is required.

As part of Mental Health Awareness Week (18-24 May 2020), the ihub Evidence and Evaluation for Improvement Team (EEvIT) reflects on two recently published articles and ideas around kindness in supporting staff.

Listening to early COVID-19 experiences
A viewpoint article from the US by Shanafelt and colleagues described what they had found in listening sessions in the first three weeks of the COVID outbreak there with groups of doctors, nurses, and other health professionals.

Common sources of anxiety related to access to appropriate personal protective equipment and testing, risk of infection for themselves and others, being able to provide competent medical care if deployed to a new area (e.g. non-ICU nurses having to work as ICU nurses), a lack of access to up-to-date information and communication, and childcare and personal/family needs out of work.

The authors suggested there were five requests from health care professionals to their organisation during the COVID-19 epidemic: hear me, protect me, prepare me, support me, and care for me. A summary table outlines these five requests and key components of responses to them.

They also highlight an implicit request to 'honour me' and state that organisations 'should not outsource gratitude entirely to the public'. They suggest that the response to this request starts with leaders, and is meaningful if co-occurring with efforts to hear, protect, prepare, support and care for staff.

Learning lessons from evidence on epidemics
A recent systematic review of the psychological effects of emerging virus outbreaks on healthcare workers by Kisely and colleagues included 59 studies on SARS, MERs, Ebola, H1N1, H7N9 and COVID-19. They found similar problems across epidemics for health services and staff caring for patients in an emerging disease outbreak, relating to 'the psychological impact of increased workload, need for personal protection, and fears of infection for themselves and their families'. 

They report that although distress is expected when staff are under pressure in epidemic situations, there are effective interventions which can mitigate this and broadly relate to communication, access to appropriate personal protective equipment (PPE), enough rest, and practical and psychological support.

Mitigating measures
The review summarises factors that increase and decrease the risk of adverse psychological outcomes and 26 recommendations for how to deal with psychological problems in healthcare workers in new outbreaks are detailed. Some of the recommended measures could be thought of as kindness such as 'staff “buddy” system to support personal precautionary measures', 'encouragement among peers' and 'recognition of staff efforts'.

Some examples of kindness in peer innovations for redeployed staff having the additional challenge of navigating a new team or workplace during COVID-19 from the NHS in England include 'I'm new here' badges which say ‘‘I’m experienced in what I do, but I’m new to this area. Please be patient’ and an ITU team giving congratulations cards to newly redeployed junior doctors on achieving procedures.

Healthcare Improvement Scotland has developed a web section to share examples of innovative practice by colleagues to support wellbeing such as NHS Louisa Jordan staff developing a check in, check through, check out system, and the 'positivi-tree' in NHS Grampian.

There are a range of other online resources available aiming to support staff mental health and wellbeing. Some examples include the summaries of the best available knowledge about psychosocial mental health and wellbeing produced by NES and SSSC advice and guidance for workforce support and wellbeing during COVID-19.

The King's Fund has produced a summary of guidance for planning early interventions to respond to hospital staff experiencing stress and The Royal College of Nursing have highlighted a helpline offering all frontline workers free, confidential online mental health and emotional wellbeing services with fully qualified therapist via Zoom, Skype or Facetime.