The pandemic’s connection paradox

And when staff thrive, their patients have better clinical outcomes. It’s vital that we tackle the paradox of bringing teams closer together while staying physically remote from one another.

Australian clinicians are learning from experiences here and overseas. The recent outbreak in Victoria challenged healthcare workers at a time when the usual informal support mechanisms were unavailable. How can we best support our colleagues when there’s no close tearoom chat or comforting hug after a difficult shift?

For starters, it’s worth remembering that psychological connectedness doesn’t necessarily require physical proximity. Consider Lifeline’s work providing many hundreds of thousands of crucial calls each year – people in extremis receive essential support from volunteers possibly thousands of kilometres away.

First things first

As vital as psychological connectedness is for staff wellbeing, other basic factors must already be in place. Maslow’s hierarchy of needs reminds us of the importance of ensuring that clinicians are not thirsty, hungry or exhausted so that the care they offer to patients isn’t compromised. The reality is that meeting these basic physiological needs can’t be taken for granted – particularly in a pandemic.

Maslow also reminds us that people need physical and psychological safety to thrive. Mental health risks among staff increase when they feel that, in caring for patients, they are potentially jeopardising their own health or those of vulnerable family members at home – e.g. by risking becoming infected with SARS-CoV-2. Adequate personal protective equipment is a must.

Third in Maslow’s needs hierarchy is belonging. This is where psychological connection comes in. Earlier this year, the British Medical Journal published an article by Prof Greenberg et al¹ describing ways to manage pandemic-related mental health challenges for healthcare workers. Notably, much of the advice from Greenberg et al relates to the need for belonging, or interconnects with both belonging and safety.

Practical tips to foster safety and belonging

From Greenberg et al¹ 

• Prepare staff adequately. It makes a positive difference if they have an idea of what they may face at work, including when the situation is going to be difficult.
• Provide opportunities for staff to discuss both practical and emotional challenges. Opportunities for reflection and validation may be informal and incidental, or planned and formal, e.g. Schwartz Rounds bring together clinical and non-clinical staff, reduce feelings of isolation and, where necessary, can be held virtually.
• Address the potential for, and anguish resulting from, any distress which can occur if staff have to act at odds with their personal ethics, e.g. if suboptimal choices must be made due to the unavailability of resources or competing demands. Clinical ethics committees can help resolve issues of moral distress.
• Be alert to those who don’t attend staff discussions. Avoidance is a common mechanism for managing distress, so it’s possible that someone who’s always “too busy” or “not available” might be struggling with the emotional demands of the work. If this is the case, they’ll need particularly sensitive help or referral to an appropriate support service.
• Single session psychological debriefing is not advised – it can augment rather than decrease distress.
• Senior managers need to support their juniors’ wellbeing. All team members are strongly influenced by the attitudes of their seniors.
• Once any immediate crisis is over, senior staff “… should ensure that time is made to reflect on and learn from the extraordinarily difficult experiences” the team may have encountered. Staff should continue to actively check on each colleague’s wellbeing. 

Opportunity for post-traumatic growth

The concept of post-traumatic stress is well known, but we would like to emphasise another possible consequence of great stress – post-traumatic growth. While there’s the potential for poorly supported doctors to experience psychological difficulties later, well-supported doctors may experience psychological growth, bolstered personal resilience, and strengthened self-esteem.

Give connection attention

The pandemic could lead to a reimagining of how we care for one another at the individual, departmental or organisational level. It’s heartening that in recent years, staff wellbeing has received increasing attention. Now is the time to ensure words and intentions are put into action. There are many wonderful initiatives already in place, e.g. ‘kindness cafés’, peer support groups, Schwartz Rounds. For the most part though, these rely on staff volunteering their time. We ask all medical organisations to think about appropriately resourcing such initiatives with funding and time.

A well-managed response to supporting staff during a crisis is both a practical and moral imperative. Wouldn’t it be wonderful if, as a legacy of this time of relative physical isolation, the issue of psychological connection receives the attention it desperately needs?

Reference

1. Greenberg N, Docherty M, Gnanapragasam S, et al. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. Br Med J 2020;368:m1211. Available at: bmj.com/content/368/bmj.m1211