This strategy outlines what we are expecting to see and recommends the offer that will need to be in place to support our NHS colleagues (employees, students, volunteers) to thrive through these unprecedented events and beyond.
We need to respond in line with the three phase (PAR) approach, which aligns to the NHS Improvement and NHS England offer. We will need to pay attention to these three phases when dealing with wellbeing and psychological responses to major incidents, which are likely to predict positive outcomes. We need to be able to adapt our interventions as we learn more about what is required.
Prepare(short term) – we will need to be informed by evidence and best practice but also responsive to testing and evaluating so we can adapt and change where we need to. A low-level approach will be needed to begin with, helping people cope for themselves and building in line-management and team support to enable the usual coping systems to function well. The more efforts we put into prevention, briefing and preparation the more positive outcomes will be. This includes helping people understand that the roller-coaster of change is normal (see Appendix 2) as well as helping people focus on what they can do (Appendix 3). We need to pay attention to physical, safety and belongingneeds. Messages need to be collective rather than individualistic to promote the sense of being in this together.
Active(medium term) – during the active phase, which is the ‘eye of the storm’ in terms of demand, there is little ‘head space’ for staff to attend to their own wellbeing as well as providing the care needed for patients and their families. We want to deliver the right support in a timely way, we need to focus on caring for physical, psychological and safety needs now, building a sense of belonging and preparing for the next stage when the critical period has passed.
Recover (long term) –we know that this phase usually takes place once the immediate threat or the active phase is over. This is based on short lived active phases and therefore we may see more of a presentation of psychological difficulties during the active phase. This phase is typified by the idea of survival, we got through, my patients and families no longer need my whole attention and self and therefore I can begin to think and reflect on what I have been through.
Physiological - these are biological requirements for human survival, e.g. air, food, drink, shelter, clothing, warmth and sleep. If these needs are not satisfied the human body cannot function optimally. Maslow considered physiological needs the most important as all the other needs become secondary until these needs are met.
Safety - once an individual’s physiological needs are satisfied, the needs for security and safety become salient. People want to experience order, predictability and control in their lives. These needs can be fulfilled by family and society, police, schools, business and medical care such as emotional security, financial security, law and order, freedom from fear, social stability, property, health and wellbeing, safety against accidents and injury.
Belongingness and love - after physiological and safety needs have been fulfilled, the third level of human need is social and involves feelings of belongingness. The need for interpersonal relationships motivates behaviour.
Examples include friendship, intimacy, trust, and acceptance, receiving and giving affection and love. Affiliating, being part of a group (family, friends, work).
Esteem – this is classified into two categories: (i) esteem for oneself (dignity, achievement, mastery, independence) and (ii) the desire for reputation or respect from others (e.g. status, prestige). Maslow indicated that the need for respect or reputation is most important for children and adolescents and precedes real self-esteem or dignity.
Self-actualization - refers to the realisation of a person's potential, self-fulfilment, seeking personal growth and peak experiences. Maslow (1943) describes this level as the desire to accomplish everything that one can to become the most that one can be.
Table 1: PIES principles- originated in the military and is defined as the psychological distress which results from actions, or lack of them, which violate someone’s moral or ethical code.
Treating the individual by redeploying them into an operationally significant role but one that matters to the team, utilising roles of the line manager/team leader as a listening ear and confirm that ‘we are in this together’ – ‘this is normal’, ‘how can I help’
Timely intervention of the above negates prolonged stress symptoms which could be enough to eventually overwhelm the ability to cope
Make sure that people know what is coming – ‘virtual’ tours of what the ward looks like now – prepare for the work ahead – ‘no surprises’
Focus on meeting basic needs – ‘3 hots and a cot’ – are people rested, eating and being looked after physically – focus on a good night’s sleep (See Maslow’s hierarchy)
There are many ways of thinking about change, shock and grief. What seems to be consistent is that we all regularly experience change and we all experience change differently depending on our own experiences. Helping people understand that what they are experiencing as emotions is normal – this is particularly important with Covid-19 being a collective shock to us all.
There are some tips for how we can support ourselves and each other as our immediate, medium and long-term situations become more normal.
Helping us feel in control as much as possible (Covey)
Covid-19 will inevitably have had an impact on us all and lead to us focusing our time and energy on specific thoughts, conversations and meanings. Ultimately, we have things that concern us, we can influence, and we can control. As much as possible, to have ourselves and each other be well, we should focus our energy on things that we can control and influence.
Control: anything that we can directly make happen. The circle of control is our own choices that we make about own individual behaviour.
Influence: we can’t directly control but we would be able to do something about. This often means working through other people.
Concern: we have no/very limited personal ability to amend which might cause us anxiety. This is wasted energy.
The ideal position for us is to make sure our circles of control and influence are as big as possible, and our circle of concern is as small as possible. To different extents, we have a choice about where we focus our attention and energy.
“What can I/we do?”
“What change can I make?”
“What can I do to look after myself?” Being proactive
The more “good” energy, the more we find new ways of exerting influence; we feel stronger and more creative
Getting annoyed about the situation &
Blaming and accusing others
Negativity and no ability to change = our circle of influence shrinking; wasted energy, and also prevents us focusing on what we can do
It can be incredibly liberating to realise that, in choosing how to respond as individuals and groups to circumstances, we affect those circumstances.