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Hello everyone, my name is Chris Atherton and I am the Adult Principal Social Worker in Haringey. I wanted spend a few minutes in this podcast talking to you about my experience of working with my social care staff over the last few weeks. Specifically, I wanted to talk about the emotions that some staff have been, and are currently feeling, around the situation brought about by COVID-19.

So, there are 3 emotions specifically that I wanted to focus on for today’s podcast. Now I am only focusing on 3 because I only have a few minutes to talk with you but I did want to recognise that we have all probably felt, or are feeling, a kaleidoscope of emotions. What we are facing at the moment is unprecedented and the demand that staff are facing in health and social care is huge, and with that comes the spectrum of emotions. If any of you are having a particularly difficult time I just wanted you to know that we are with you and please do seek support through your employer.

The 3 emotions I wanted to focus on for this discussion are Fear, Helplessness and Hope.

Firstly, Fear. Given the worldwide impact that COVID-19 has had, the lives it has taken, and the effect it has had on our day to day lives, fear is a completely rationale emotion to have. Fear helps keep us and the ones that we love safe. Fear will be particularly prominent for those of us who are working directly with individuals in our community. It is something that staff have expressed to me regarding the lack of PPE (personal protective equipment) and the differing guidance being given to those working in the NHS and social care. But, even though people are afraid, they still continue to do their roles. They still continue to go out in to the community and work with those who are most vulnerable. To be fearful of something and yet to confront it shows courage, the one cannot exist without the other.

Secondly is Helplessness. For a number of practitioners, like myself, home working has come into play and face-to-face contact with those we support now being done via telephone, text, Zoom, Skype, to mention a few. This feels very alien for many of us. Social Care is about being there. It’s about showing up, supporting, empathising and enabling. So, to be told to retreat to the safe space of home and wait for further instructions has led to a lot of practitioners feeling helpless especially when other social care colleagues and those in the NHS are battling from the frontlines. The role that we all play will be invaluable and those who feel they are sitting on the bench will get their chance to join the fight, but this challenge is a marathon not a sprint.

Lastly, Hope. Even in the most challenging of circumstances we can always find hope. COVID-19 has presented devastation and despair but there is still hope to be found. So, there’s the big things we all might be feeling. Firstly, hope for the approach we have to tackling adversity as a system, a nation, a species, Hope for the environment given the pause to our normal routines and given those pauses hope to what we prioritise most in our lives.

For my practitioners, hope for better recognition of those heroes in health and social care and perhaps even hope of a decent pay rise, hope of communities, partners and systems working better together in the future as we are showing what we can do now and hope of changing our working processes – reducing red tape and reducing paperwork – getting away from our desks and into our communities more.

Thank you so much for listening keep safe everyone, goodbye.

 

Chris Atherton is the Adult Principal Social Worker in Haringey Council. In this podcast Chris draws on his experience and that of his adult social care colleagues to talk about three emotions, among others, felt in response to working during the pandemic; Fear, Helplessness and Hope.

Wellbeing Quiz Profile: #FeelingHopeless

Hello.  My name is Paul Jenkins and I am the Chief Executive of the Tavistock and Portman NHS Foundation Trust. The topic I want to cover in today’s podcast is the issue of switching off.

We are living and working through a dramatic set of events and anxiety is rife.  Staff in the NHS and social care are working exceptionally hard to support patients and each other.  Events are moving at an amazing pace and the decisions we are taking can, literally, be matters of life and death. 

Against this background I am not surprised to hear that colleagues are finding it hard to switch off and that some are also having difficulties sleeping. It is really important that we all do our best to look after ourselves and find ways to disengage from work.

In my career, I have encountered lots of situations which have put me under a lot of personal stress, and which have tested my resilience. 

Over the years I have tried to identify strategies for coping with that level of pressure.  I don’t claim to have cracked it but here are some of the things which have worked for me.

The first is to acknowledge that to be effective I do need to set some boundaries.  Nobody can work 7 days a week flat out without some time off.  However much my job requires me, at times, to work out of hours I always try still to preserve some space where I am not on duty and where I do not look at my phone. More importantly I try to do my best to respect those boundaries with others.

The second is the value of outside interests.  I am a keen cyclist, love reading and music.  All those activities help me escape from the here and now and help me recharge my batteries. 

Getting out for exercise is particularly important.  Not just in respect of looking after my physical health, but also to refresh my psychological wellbeing. #

I have always stood by the famous line of the Welsh poet W.H.Davies:

What is this life if, full of care, we have no time to stand and stare

Even at a time when the requirements of social distancing are limiting horizons, there are, in the immediate area around where I live in South London, so many places which call me to stand and stare.

I am finding it very helpful that we are going through all of this at the start of Spring when each walk or cycle offers a new treat as different trees come into leaf and new blossoms appear.  In normal times some of these things can pass me by but, at present, they are particularly comforting.

My third tip is the importance of other people and appreciating each other. We will get through this current crisis by sticking together and supporting each other.  There are moments, in what we are dealing with, for challenge and difficult conversations but there is more need for praise, gratitude and thanks.  They are the fuel on which we all best run at times of stress.

As a Chief Executive, I am pretty used to brickbats and criticism.  You develop something of a thick skin, but constant negativity gets at me and amplifies the sense of stress I feel.  So last night, when I got a lovely positive response to an all staff email, it gave me an enormous boost and helped me disengage from the pressure of other difficult issues I am dealing with.

My final point is to try not to be a hero.  There are lots of brilliant people doing brilliant work at present but no one of us is indispensable.  The world will not fall over if we’re not there for a day and we all deserve the chance to stand back, have some time to ourselves and recharge our batteries.  After all a burnt-out hero is no good to anyone. 

Paul Jenkins is the Chief Executive of the Tavistock and Portman NHS Foundation Trust. Paul talks about the importance of switching off during this difficult time, and talks through some of his personal coping strategies during periods of stress and pressure. He offers some helpful, practical tips for everyone to consider.

Wellbeing Quiz Profile: #MoreFrantic

Podcast 1: Recognising Burnout: Helpers Stress Reactions

“The first podcast emphasises ways in which specific helpers such as keyworkers, first responders, NHS workers, NHS frontline staff, responding to the corona virus crisis, can support themselves and their colleagues by recognizing the signs of stress and burnout, and learning techniques which may help to alleviate or prevent severe emotional reactions.

If you are a Keyworker responding to this crisis you are likely to be exposed to highly stressful situations in the course of your line of duty and routine tasks. Usually the traditional heroic role of helpers includes expectations that they are selfless, tireless, and somehow superhuman. However due to the unprecedented situation created by this pandemic you might also be affected by the nature of your job in this crisis. Therefore, maintaining your ability to function efficiently and effectively it is essential for you to provide this relief work.

Specific situations that increase your vulnerability to stress might be:

  • Having no control over the volume work
  • Working long hours/shifts without many breaks and rest
  • Leaving your job with a feeling of not having done enough, because needs in this situation are so overwhelming that they by far exceed your capabilities
  • Feeling guilty about life or death decisions that you have to make and carry a sense of responsibility that you fail to prevent harm by transgressing your deeply held moral beliefs and expectations
  • Being troubled by the victim’s stories
  • Feeling guilt at the death of a patient or patients
  • Feeling despair faced with the repetitive cycle of death that the present pandemic is creating
  • Feeling anxious that you will also be infected and worry about how you will cope with your own fears of contamination, death and deterioration as you assist others.

If these reactions and experiences are left unaddressed after a prolonged period of time on the job, these stress factors are likely to affect your well-being, and the quality and efficiency of your work, which in turn might lead to Burnout and compassion fatigue.

These conditions happen when stress factors have taken over, and there is an exhaustion of normal stress coping mechanisms leaving you unable to distance yourself from the situation.

Symptoms of stress and “Burnout” Amongst frontline staff

  • Excessive tiredness
  • “Loss of spirit”
  • Inability to concentrate
  • Somatic symptoms (e.g., headaches, gastrointestinal disturbances)
  • Sleep difficulties
  • Neglecting own safety and physical needs (not needing breaks, sleep, etc.)
  • Grandiose beliefs about own importance (E.g., engaging in heroic but reckless behaviours,
  • Cynicism
  • Inefficiency
  • Mistrust of co-workers or supervisors or organisation
  • Excessive alcohol or drug use, caffeine consumption, and smoking

Please listen to my other podcast where I will be talking about detecting stress and burnout signs in yourself and peers and learn effective self-care stress management techniques that will help you increase your coping capacity to deal with the present situation.”

Podcast 2: Reducing Burnout: Helpers Stress Reactions

“In the second podcast I will be talking about how to recognise signs of stress and burnout and give you tips on how to reduce these stress factors as a frontline worker tackling the corona virus crisis.

As mentioned in my other podcast it is important that you identify your own stress reactions and have coping strategies options that you can use for own self-care. You can also identify these in peers in order to provide them peer support and also help them with their own stress management

How to identify these stresses?

  1. Pay attention to your body for signs of stress. Is your body giving you warning signs? Rapid heartbeat, stomach pains, tightness in the chest, trembling, feeling tired all the time, headaches and other aches and pain.
  2. Pay attention to your mind. Do you have difficulty concentrating and /or remembering, do you find that you are more “disorganized” than usual, do you feel overwhelmed or fearful by the present work situation?
  3. Pay attention to your personal life and your emotions. Are you arguing more than normal with others including co-workers or family and friends? Do you constantly feel angry or sad or fearful or hopeless?

Therefore, it is important that you feel supported, and that you can be supported at several key points of their provision of care in order to reduce the likelihood of developing stress-related problems. So please reach out to your peers and/or managers for support and acknowledge that it is ok not to feel ok.

Self-care stress management techniques

How can you be attentive to your own self-care?

Prepare before beginning your work shift

  • The more prepared you are before taking up your work assignment, the more likely you will be able to deal effectively with the emotional challenges of nature of the work that needs to be carried out.
  • Be aware what to expect, both practically and emotionally, in yourself and in the people you will be helping.
  • Be aware if the common responses to stress and about signs of stress and burnout in yourself and in co-workers.
  • Learn as much as you can about the particular situation in which you will be working. The closer your expectations are to the realities you will face, the greater your sense of predictability and control and the less your feelings of helplessness and uncertainty will be.
  • Talk to others who have had direct experience of the particular work you will be doing.

Take care of yourself during the duration of your shift

  • Make sure you take adequate “break time” or “down time.”
  • If at all possible, this should be taken away from your work site (e.g., in a separate room like a staff room or rest room).
  • Take care of your body – Pay attention to eating properly and getting enough rest.
  • It might seem that taking time away from your work to eat, drink, and rest may feel like is a time waster in the midst of this crisis response but it will help you work at maximum efficiency and do your job better and with fewer errors.
  • Physical activity helps dissipate stress.
  • Get some form of exercise and other forms of recreation also help dissipate stress away from you job
  • Engage in an enjoyable activity at home: like drawing, painting, writing, playing music
  • Avoid the temptation to use alcohol or drugs or to engage in risky behaviours to wind down or escape the pressures of your work.

Talk about your experiences

  • Talk to others like your co-workers and/or supervisors about your experiences and your needs. What information do you need? What support do you need?
  • Be prepared for your return home after work
  • Expect that your return home after you completed and intense working day may be more complicated than you have anticipated. You have been in a very intense, demanding situation during your work.
  • Have a plan of action in advance of how you will wind down.

Reducing stress responses

These are simple stress management techniques and coping skills that you can use to protect yourself emotionally.

You might try one of the following:

  1. Visualizing a pleasant image of a safe space – like a beach or a beautiful mountain site or visualizing yourself doing a pleasant activity – like walking the woods, being in the garden. Try to visualize the scene in some detail and as vividly and clearly as you can by engaging all of your senses. What you can hear, see, smell and feel as if you are there.
  2. Another way is to reduce your muscle tension. Take a few deep breaths. Focus your attention on the feeling of the air moving in and out of your body. Continue to breathe deeply. Now imagine that the tension in the muscles of your forehead is flowing out of your body with each exhalation. Do the same thing, breath by breath, with the muscles of your jaw, shoulders, arms, and legs.
  3. Press your thumbs and forefingers together tightly. Take a slow deep breath and hold it for two or three seconds. Then slowly release your breath while you simultaneously slowly relax the pressure of your fingers and slowly say to yourself RELAX….

But there are other relaxation and mindfulness meditation exercises that you can use to help stay in the present moment.

Your own self-care is both an essential pre-requisite for effectively helping others and a means of maintaining one’s fitness to increase your capacity in responding to demands faced in the frontline.”

Silvia Miranda is the Clinical Co-ordinator and Senior Counselling Psychologist at Islington iCope IAPT Service and a Lead Counselling Psychologist at The TILS Veteran Service in Camden & Islington NHS Foundation Trust. In her first podcast she talks directly to frontline workers about the range of complicated emotional responses they may be having and gives examples of how to recognise symptoms of stress and burnout in yourself. In the second podcast, Silvia gives a range of stress management techniques and self-care tips to help you reduce stress reactions and burnout.

Wellbeing Quiz Profile: #MoreFrantic

Hello this is Tim Kent from the Tavistock and Portman NHS Foundation Trust. I’m the Director of Adult Forensic Services here and I’m a psychotherapist and a social worker by background. It’s interesting this pandemic crisis that we are in the throes of at the moment, it mostly reminds me of parents and grandparents stories of the Blitz, wartime, rationing, pulling together, and the sense that what was at stake was people’s mental coherence as much as the fear of loss of life and loved ones and of course with that fear comes the sense that we’re not always together and a lot of our work at the moment is remote. I’ve just been on a Skype, sorry, Zoom call, with several colleagues, spending a lot of time on the phone and you know managing a huge array of new experiences and feelings sort of bombarding the mind at any one point and trying to metabolise it like a new medicine so it’s quite bizarre and I think we’re all both sort stimulated and in a way very anxious about the outcome and what’s it’s going to mean.

Of course we all know people who are currently very ill and some who we’ve lost and many thankfully who had mild versions and are either recovering or haven’t yet been unwell so there’s a very strong sense of that kind of spirit of the Blitz, for want of a better description, and I think it’s valuable.

There’s something that’s been on my mind for several years about the experience of a country or nation, that hasn’t in any recent past history been through a considerable period of real adversity and I suppose before COVID-19 we thought that 10 years of austerity and cuts to the NHS was real adversity, which of course it very much is and has been and continues to be and now we are reaping the fallout from that experience.

But more immediately and more personally, my wife’s been unwell so I’ve been advised by our doctors to isolate and it feels as busy working from home as it has been the office, although I miss being around friends and colleagues and within the institutional environment. I’m thinking ahead to whether I could and should be redeployed back into social work and with experience in child protection and adults with mental problems and working the community.

I think for lots of people at the moment there is a sense of wanting to help and wanting to be able to go above and beyond the norm is shared by so many, at the same time that that some of our colleagues are just really frightened and very much wanting to retreat, so a really complex and difficult time and am very very grateful to have so many supportive colleagues.

I know it feels like a difficult thing to come to terms with the moment but it does feel great to be part of the NHS and to see the appreciation of our public for what we do. It’s also extremely worrying to see how austerity has left us unprepared in so many ways and that that ultimately is going to impact on mortality rates.

So in psychological services, just as a final note, for some of our patients if not most of our patients, the psychotherapy that we provide at the Tavistock and Portman, alongside our other services, is a lifeline, literally, for many people. As Donna Winnicott and Albert Einstein wrote to the government during the Second World War, the thing about protecting children and adults from adversity at a time of crisis, and at that point wartime, is not just about a threat to the physical body, the psychological threat to people’s emotional development and mental capacity and ability to keep going and in some cases keep living with the huge threat and therefore the huge anxiety that it causes is paramount.

It’s not really to compare the body and the mind, perhaps better to say that they’re part of the same thing and it’s important to keep going psychologically as it is physically. I think the fact is at the moment that a lot of us are experiencing a very serious traumatic impact to our mental functioning and the bombardment of new experience and change can get through some of the time, so you know you can feel all right one minute and then completely discombobulated the next and unable to think and then them you try and re-gather.

Okay I think that’s enough and I will sign off now. Thanks for listening, take care, keep well and love to you all.

Tim Kent is Director of Adult & Forensic Services, Consultant Psychotherapist and Social Worker at the Tavistock and Portman NHS Foundation Trust. He delivers a rousing commentary for NHS and social care staff about the experience of living through, and working in, the current time of adversity and how the services we provide are a lifeline, literally, for many people.

Key workers across different sectors have some big questions about how to continue to do their work and look after their children in this time of huge upheaval and uncertainty.  

How to explain that you want and need to keep working, managing your worries about the spread of the virus, and how to reassure children that you and they are safe at work and at school.

When the news came a couple of weeks ago that schools would be closing because of COVID-19 the landscape changed for all of us. Without, it seems, even a moment to draw breath, parents and children have had to find a way to trust that continuing to go to work and school is vitally important if collectively we are going to manage this crisis.  Of course there is often huge pride for children in knowing that their parents are part of the helping professions, but at this point it may feel quite difficult to hold onto this.  

Whilst many parents will have had the task of getting used to home working, key workers will have known that this was not going to be an option for many of them. 

The news that key workers’ children would continue to have a place at school came quickly, and with the relief came a number of questions in the minds of adults and children about what being a key worker now meant.  And some of these, for parents, might feel unspeakable.  

How do I keep working in situations that might put me and my family at risk?  

How do I explain that my work commitments will mean that my children have to continue to go to school?  And will they be safe there?

And other questions about what happens for key workers and their children but not for everyone.  Lockdown surely means just that! But of course lockdown means different things for adults and their families in certain professional roles. 

As this pandemic has continued to develop there is a need to keep talking to children about this changing landscape – for some children this may have felt at first like  the beginning of an extended school holiday.  But it is now week two and children of key workers have been attending school as usual, but of course there is nothing usual about school at the moment. So   as the traditional Easter break approaches, how to explain to children that this probably will continue for some time to come and that it won’t end after the holiday – key worker parents will still be working. 

As the reality of this new normal continues, parents will probably be aware of the need to stay alert to the spoken and unspoken worries that their children may have.

How do you have a conversation following the daily briefings which bring news about testing, resources and the numbers of people who are sadly losing their lives.  For those parents who are key workers, and their children, these are uncertain times, feelings of fear, upset and possibly anger are surely somewhere in the minds of your families.  

Thankfully, the thinking and more rational parts of the brain will, with your explanations and reassurances, reason away some of these thoughts, but this may only provide temporary relief for children who because of their age, or their own psychological and emotional needs, find it hard to hold onto these explanations. You may need to explain more than once, to help them regain balance. 

So, how do you manage the emotional roller coaster that you find yourself?

One key task is to find ways to not only remind yourself of the value of your role, but to allow yourself to think about your own worries.  Some of these might take you to places that ordinarily you do not usually have to visit, but by allowing yourself to notice your own ‘not knowing’ you might be able to begin the journey back to what will help you to feel fully equipped, practically and psychologically, for what you are facing.

Speak up and seek reassurance that everything is being done to keep you safe in your job, and ask how your employers will respond when you need a helping hand to get you back to somewhere near your best.  At these times, being in a team and/or finding a colleague to talk to has never been more important – and the difficulties you are facing in relation to your children are very unlikely to be yours alone. 

​ For your children it will be important to talk about your work, perhaps in a bit more detail that you would normally, to let them know that everything possible is being thought about to keep you safe.  And importantly that you would not be sending them to school if you did not trust that they will be safe there too.

Being clear yourself about how the school is operating will help you to have confidence when talking to your child.  Check in with staff about how they are managing the children, and ask them to give you feedback if they have any worries about how your child is coping.

You may also need to give space to allow your child to talk about how upsetting it is to still be going to school when their friends are not.  Whilst they may be proud of your role, they may also resent the fact that this has an impact on them.  Talk about the breaks you plan to take (because your annual leave is still important) and how you and they can spend some different time together.

You will probably be completely worn out due to the mental and physical impact this crisis is having on your well being, so take time to find something relaxing that you can do to recharge your batteries, if only temporarily, but also find short bursts of time (ten to fifteen minutes) to sit with your child doing something that they want to do with you.  The usual rules apply; give them your full attention and that little bit of tlc that you both need.​ As far as you can, it helps if you can keep being  the mum or dad that they know, even though there is so much that is new and uncertain for everybody. 

Laverne Antrobus is a Consultant Child and Educational Psychologist at the Tavistock and Portman. Laverne talks about the challenges for key workers and family life, where children (and parents) may have all sorts of feelings about a situation where work might be felt to be an unsafe place, and where school has suddenly become  a very different place. She talks about the range of feelings that there might be for both parents and children, and has some ideas about how to help children to manage and how to look after yourself as a parent, and a key worker in this difficult and constantly changing situation.

Wellbeing Quiz Profile: #MoreFrantic

Hello, this is Jane O’Rourke. I’m a Child Adolescent and Family Psychotherapist, and yoga and meditation teacher. Today we’re going to do a relaxing, calming breathing exercise, so let’s start by taking a moment to find a comfortable resting position; could belong down or sitting in a chair – whatever feels most comfortable for you.

Let’s start with a few relaxing breaths, inhaling through the nose and out through the mouth, taking deep, relaxing in-breath and slow, relaxing out-breaths, and relaxing out and releasing any tensions of the day with each out-breath, just following your natural breathing pattern: breathing in and breathing out. Breathing out through the mouth helps relax all the tensions that might have built up through the day, almost like a releasing valve.

And now let’s begin our restful breathing pattern. To do this, we’ll be inhaling though the nose, and again, breathing out through the mouth.

So inhale through the nose for a count of 1, 2, 3, 4; holding the breath for 2, 3, 4, 5, 6, 7. Exhale through the mouth: 2, 3, 4, 5, 6, 7, 8.

Inhale through the nose: 2, 3, 4, hold for 2, 3, 4, 5, 6, 7. Exhaling for 3, 4, 5, 6, 7, 8.

Now on your own, inhaling for 4, holding the breath, and then exhaling. Now inhaling 1, 2, 3, 4, holding, now exhaling.

We’re about half way through.

Inhaling, holding, exhaling.

Inhaling, holding the breath, exhaling.

Inhaling, holding the breath, and exhaling.

The last time: inhaling, holding, and exhaling.

And now letting the breath return to its regular rhythm, not trying to change the breath in any way. Breathing in and out through the nose and allowing yourself just to completely relax here, and allowing any tensions in the body to just evaporate with each out breath, Allowing each in-breath to bring strength and courage, a new life; and every out-breath just to allow the tensions of the day that have built up to release and let go. Allow yourself to do nothing.

You can focus now on the breath, wherever it’s most prominent in the body. That may be at the tip of the nose or in the chest or in the belly, but still notice the rise and fall of each in-breath and each out-breath. And of course our minds might wander, so any time you notice your mind has wandered off, just bring it back to the focus of the breath, allowing the whole body to relax and the mind to relax as well. Allowing the mind to slow down.

You can stay here for as long as you like now, just resting, or allowing yourself to fall asleep.

Jane O’Rourke is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust. Jane guides us through a 5 minute soothing sleep breathing exercise aimed at helping you to get some rest, or to get to sleep.

Wellbeing Quiz Profile: #FeelingHopeless

Hello, my name is Andrew Cooper and I work at the Tavistock and Portman as a Family Therapist and I’m Professor of social work. I’m going to speak about some of the challenges of working with death and with dying people, and some possible ways of helping ourselves with this very demanding task.

In this crisis many more NHS and social care staff find themselves caring for dying patients or are in the situation with unprecedented regularity and intensity. Increasingly, because of isolation procedures, nurses and doctors are alone with people at the moment of their deaths. Families and loved ones are excluded – on the outside looking in. You may be acutely aware of their grief and anguish. Staff are fearful for themselves and for their own families. Professionalism and a sense of duty spurs people on, while the instinct of self-preservation pulls strongly in the opposite direction.

You may want to move towards the dangerous situation and simultaneously flee from it. This conflict can cause huge anxiety, to act on all the other anxieties. Most of you will have suffered the loss of someone close to you at least once in your life. A family member or friend may be very ill right now whether from Covid-19 or another illness. Working in close contact with dying people stirs up these memories even if the pressures of the job mean you hardly have time to think about them – if a patient dies, but you have to move on to the next emergency. Your feelings for the dying person in front of you can become mixed up with your own grief and anxiety about loved ones. This is normal, but immensely stressful. It can feel somehow selfish to be preoccupied with your own losses and fears when you’re supposed to be caring for others. It isn’t selfish, it’s ordinary.

I myself had an uncle I never met because as a young man he was killed in the Second World War, but my mother told me stories about him, while his brother; my father, never spoke of him. Somewhere the grief about his loss passed into me and is still alive. Many of us carry these ghosts inside us and they can come to life in the face of our work with dying people. Will all tend to carry around an idea of what a good death might be like. Whatever that is, your experiences at present will be far removed from this image or ideal. That’s hard to bear in itself and in these pressurised circumstances, when a patient dies you may be left with painful questions: did I do enough? Make the right decisions? Give them enough at the very end of life? Sometimes these thoughts collect in a very difficult way: did I in effect kill this patient? We may know such thoughts are not rational but they can still be very real in our minds.

My colleague Jo Stubley made another podcast in the series about trauma. Most of what she says is completely relevant to you if you’re working with dying people, or people you’re afraid might die. The same situation affects different people differently. You may hardly have had time to get to know many patients, or they are sedated, but something about a particular person can still trigger powerful memories and feelings, and unexpected grief wells up in you when you are working under these exceptional conditions day after day. If you don’t find some release for these feelings they accumulate into what Jo Stubley calls cumulative trauma.

So, what can you do to look after yourself and your colleagues? Letting yourself feel and think when you’re having to work so relentlessly can feel risky. You may worry you’ll fall apart and not be able to function, so you might want to pick your time and place to let yourself slow down and allow some feelings to surface. Most people will find it a relief and feel a bit stronger afterwards.

in some acute assessment wards where patients often die, but the throughput of work is relentless, a team working with the patient who dies do something called ‘the pause’: they stop and take two minutes together to remember this was someone’s daughter, mother, son, partner, friend. But also to remember how hard they themselves worked to try to save the patient. You might try this but if not, you can find a trusted colleague and take some time with them to share your feelings from the shift: fear and anxiety, distress, grief, guilt, anger.

Closeness to death and dying frightens us and makes us want to weep. It’s the most normal reaction in the world but as the saying goes, we need a shoulder to cry on. If you can trust someone else to receive your distress and also offer them some time and understanding, this can be hugely helpful. An honest recognition of what you’re facing together is a bond and to get through this terribly difficult time, strong bonds with colleagues are vital. We are assailed by images of the crisis in the media. I remember one: an exhausted hospital worker sitting on the pavement, head in his hands, being comforted by standing colleague who has her hand on his shoulder. But lastly if these approaches don’t work here or there is just no time, and you feel the pain and distress rising up in you, then a few moments of steady deep breathing will probably settle you, calm your mind and body.

There is no magic solution for the stress of what people are doing when working so close to death and dying. whatever ways you find help yourself, it’s so important to remember that everyone is finding it just as difficult, although each in their own way to some extent. In all this there are moments of hope and success. Some patients recover and can be discharged. You feel you did as good a job as possible in breaking the bad news to a patient’s family. Colleagues thanks you for your support and understanding. It is important to hold onto these moments because they can be wiped out by the overwhelming demands of the art of our task. Everyone in the caring system may be touched by some or all of what I’ve spoken about: porters, cleaners, administrators, managers. Remember one another, everyone has their part to play and is vital to the overall effort. Reaching out to others when you sense distress and being open to others when they offer you something are the best route to getting through and being able to carry on doing your best for the patients and their families.

Andrew Cooper is a Family Therapist and a Professor of Social Work at the Tavistock and Portman NHS Foundation Trust. Andrew talks about one of the most difficult things that any of us face in the current situation, the impact of living and working with death, a particular challenge with COVID-19 even for very experienced NHS and social care staff. He brings some thoughts together about what can make our contact with death in this context so hard, and has some suggestions and practical examples of what can work well in trying to look after ourselves and each other when facing the emotional labour of caring for those at the end of their life.

Wellbeing Quiz Profile: #FeelingHopeless #RelivingTrauma

Hello, my name is Lorna Fortune and I’m the Lead Psychologist for Psychiatric Liaison Services in Barnet, Enfield and Haringey Mental Health NHS Trust and I’ve been working with the acute trust to think about how we support our physical health professionals through this crisis period.

So, I’m going to talk about Psychological First Aid. At the moment our physical health colleagues are working in extreme conditions with very high numbers of very unwell patients, with services and resources stretched in ways we’ve never seen before. So, we’ve looked at what’s helped in other countries who’ve been through similar situations and the evidence suggests that Psychological First Aid is a helpful and useful approach for our frontline staff.

Psychological First Aid or PFA provides a compassionate and supportive presence, designed to help support people in the midst of a crisis situation, by helping to stabilise them and mitigate acute stress and assess if there’s a need for continued mental health care. Psychological First Aid uses quite simple yet powerful principles to help people build support and containment within teams.

It’s worth noting that this model largely uses skills that our health professionals will already have. It’s quite an ordinary way of talking to people that optimises their existing communication and interpersonal skills. However, at times like this, teams can benefit from additional training and support in providing PFA as this will give them an opportunity to think about, practice and build upon their existing communication and interpersonal skills so that they feel more ready and confident in supporting their colleagues.

It’s worth saying that PFA is different to counselling and psychotherapy. The goal of PFA is to help stabilise and mitigate distress, rather than provide long term personal growth. PFA can be provided by almost anyone and it’s usually best provided by people within the existing team as this will help to build on and further develop existing team relationships and support.

So, what does PFA look like? It’s quite a simple model, it can be used quickly to increase connection and reduce stress. There are some basic steps. First of all, it’s noticing when colleagues are struggling or in emotional distress, prioritising them, offering them support. An important part of the support is taking time to listen and to respond, understanding and validating that person’s experiences and reactions. And then its about thinking about how to think through with them what might help and what can be done to help stabilise their emotions in the moment and think together about how they can build their existing coping skills. Also, PFA is not a once only intervention, but it’s an ongoing process that can be bedded into the team culture and structures, helping teams to be mindful of each other, the impact of this situation and feel more confident in supporting each other.

Often in these situations people feel like they’re not doing enough or not making a difference, so I want to remind you that being there for your colleagues, noticing when they are struggling and offering them support by listening and helping them through, can make a very big difference too. It might seem like a small thing, but it can have a significant impact, by helping us work together, connect with each other and look after each other.

Lorna Fortune is the Lead Psychologist for Psychiatric Liaison Services in Barnet, Enfield and Haringey Mental Health NHS Trust. Here Lorna speaks about the value of Psychological First Aid (PFA) in this time of crisis, particularly for those of you working in acute settings providing physical care. A brief introduction to PFA is provided, the goal of which is to help stabilise and mitigate distress by supporting people in the midst of a crisis situation.

Hello there, my name is Nicky Lambert. I’ve been asked to put together a few thoughts for student nurses at this very strange time that we are going through. I think when you start a course as a student nurse you assume that things will smoothly go ahead, you’ll go from module to module, placement to placement, and you’ll come out the end and you’ll have received your goal. One of the really interesting, exciting, scary, fabulous, weird things about nursing is that you can’t predict what will happen. No two days are the same and certainly no nursing journey, no learning journeys, is the same.

I think what I wanted to say to you was a story that I heard when I was a student nurse, and it was something that really stuck with me and it was about the anthropologist Margaret Mead being asked what she thought were the first signs of civilisation in the culture. I think people assume you’re going to talk about wars or axes or clay pots, and what she said was the first sign of civilisation in ancient culture was a broken leg that you could see had healed and she was saying in any situation if an animal breaks its leg, it can’t get food, it can’t hunt and an animal just doesn’t survive a broken leg usually long enough for the bone to heal.

What Margaret Mead was saying was that a broken femur that healed is evidence that somebody was there with that person, somebody stayed with them, somebody picked them up when they fell, carried them to safety, tended them, helped them to get recovered. Helping someone else through difficulties is where civilisation starts, that’s where we are at the moment. We are certainly in a difficult situation, not easy to see how it will turn out at the moment, there will be lots of changes.

The learning journey that we thought we were all on is probably going to be quite different and it’s an opportunity to grow and learn and more importantly it’s an opportunity for us to be together.

So the reason you want to be a nurse, to help other people, to serve the public, to be part of a team, all those things are still same. I think when I first started as a nurse I wanted to learn and grow and be challenged and certainly that’s what these times are bringing us.

So just a few thoughts for you. One is: prioritise your own self-care, make sure you’re rested, make sure you’re eating properly and prioritise your family and your loved ones. You can’t keep drawing on your resources if you don’t have any, so treat yourself with the compassion and respect that you treat the public and that that will help you going through this time.

Also be aware that your colleagues are there for you, your lecturers in college and your peers and even service users and the public will be there to support you. You are doing a really important job, at a very difficult time, people recognise that and I think nurses, your colleagues, really respect you stepping up. If it’s something that you can’t do, if you can’t step up through health issues and through family issues, the other thing I would say is please don’t feel bad. That’s the reason we work as a team, we each have a time and a place to act. This is a long, long game. Do what you can. Support others where you can and step back when you need, to that’s why there’s so many of us and that’s why we stand together. So I hope that’s helped and I would say as well is – thank you.

 

Nicky Lambert is an Associate Professor (Practice) at Middlesex University, where she is Director of Teaching and Learning for Mental Health and Social Work. She is registered as a Specialist Practitioner and is a Senior Teaching Fellow She is also a co-director of the Centre for Coproduction in Mental Health and Social Care. Here Nicky talks directly to student nurses as they navigate their way through their training during the Coronavirus outbreak.

Hi, I’m Rachel Surtees, I’m Director of Strategy and Transformation at the Tavistock and Portman. In my normal job I spend much of my time thinking about and planning for the future, but things don’t feel very normal for any of us right now and I don’t know if it’s the same for you but my concept of time has become pretty distorted so long-term planning right now, feels a bit more like thinking about what might be happening in three hours’ time rather than three months’ time.

But the long-term still matters. We will get through this pandemic and when we do our hospitals and organisations will all need to return to normality so that we can continue to care for our patients and vulnerable adults and children who depend on our services.

One of the really important principles of NCL In Mind is that everybody matters. Our doctors, nurses, receptionists, administrators, cleaners, porters, and everybody else whose roles means that they are really at the face of this thing are doing an incredible job and we are all very grateful. But there are also a huge number of other health and social care staff in more corporate facing roles and your jobs are also still important and your well-being matters and is being thought of too.

Computers still need to be fixed, staff still need to be paid, invoices still need to be raised and all these other hundreds of daily tasks that keep organisations running, still need to happen.

I know from talking to my own teams, who I manage, who are in corporate roles, that this feels like a really complicated and difficult time. They want to help, but just like everybody else fill a bit daunted about stepping into the unknown. They also want to try and keep their day jobs going because they know that is one of the ways to limit the long-term damage of this pandemic, but they are worried about bothering people who are busy dealing with today’s priorities.

There’s no easy answer, but if you’re in a corporate or support service role and have been asked and are able to do other things, that’s great. No-one expects you to be an expert overnight, so do your best, be clear about what is being asked of you and ask for help if you need it. And crucially, stay in regular contact with your core team. Staying connected is one of the very best things that you can be doing right now to look after your wellbeing.

And for those of you who are still plugging away at your day jobs, keep going and thank you. The way that we can help those who are really feeling the heat of this virus is to keep everything else running as smoothly as possible. You may need to adapt how you’re working, I’m sure you already have, but be available, be kind and stay in touch with colleagues.

You can use the NCL In Mind webpage to tell us what you struggling, or what you’d like to hear podcasts on, and we’ll do our best to get helpful content up and online as quickly as we can.

Rachel Surtees is the director of strategy at the Tavistock and Portman NHS Foundation Trust. Rachel speaks to the many health and social care staff who are in corporate or support service roles, who may be finding it difficult to understand their roles during this time of crisis.  

Wellbeing Quiz Profile: #MoreFrantic

What are podcasts?

Podcasts are regular, short messages from wellbeing and mental health practitioners within this network. They will be directly responding to what we are hearing from you through both the Wellbeing Quiz and the ‘How Are You Today’ survey, as well as offering more specific presentations for targeted staff groups, for example social workers.

Once you have completed the Wellbeing Quiz, keep an eye on the hashtags underneath each of podcasts to help identify those which might be most helpful for you.