Monthly Archives: April 2020

Supporting Nurses’ Psychological and Mental Health

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An editorial by Jill Mabel and Jackie Bridges published on 22 April 2020 in Journal of Clinical Nursing explores the evidence regarding supporting nurses’ psychological and mental health during #COVID19.

Q: Why nurses?
A: Nurses are at the bedside 24 hours a day, 7 days a week. In previous pandemics/epidemics nurses experienced more occupational stress and resultant distress when compared to other professions.

And – little known fact – even when there isn’t a pandemic to deal with, nurses are more prone to suicide than most employed people. The authors are in the UK, but it’s the same in Australia.

Although there are lessons to be learned from SARS, MERS and Ebola, overall the evidence for supporting nurses’ psychological and mental health wellbeing during a pandemic is not very strong.

That disclaimer out of the way, here comes my interpretation of the key points from the paper:

1. Keep Maslow’s Hierarchy of Needs in Mind.
Starting at the base isn’t basic. It’s essential.
Start with
– hydration
– nutrition
– rest and recovery
– shelter from the storm

2. Safety is vital.
For #COVID19 that means that PPE is a non-negotiable need (don’t take my word for it, see Maslow’s hierarchy above).

3. Prioritise wellbeing.
Organisations that ask nurses to care for people who are #COVID19 suspected/positive should ensure that nurse wellbeing is a priority.
Q: How?
A: Insist on breaks, and – this often goes against the nursing culture/habits – make sure that nurses quarantine time for mutual support.
Q: Mutual support? What’chu talkin’ ’bout, Willis?
A: meta4RN.com/footy

4. Individual Support PRN.
Individual support should be available for nurses too.
Q: What sort of support?
A: It’s not one size fits all. It depends on what step you’re on.

Self Portrait 26/04/20

On the lower steps, support via trusted, loving family and friends might be all that’s required. That, and being intentional about self care.

5. Self-Care.
If you’re getting stressed on the boss’s time, you should try to get de-stressed on the boss’s time too. It doesn’t have to take hours, you might be able to make regular snack-sized self-care part of your everyday nursing practice.

6. Positive Practice Environment.
Good communication, a collegial multidisciplinary team, creative and collective problem-solving,and working as a team can go a long way towards dampening anxiety.
There’s more than one kind of PPE.
Aim for a Positive Practice Environment.

7. Time Out.
Embed safe places in the workplace. Something like a NOvid room would do the trick.

8. Supportive Senior Staff.
Last, but not least, senior nurses and other people in the hospital hierarchy should make themselves more available and visible than ever.
Care goes in. Crap comes out.

End

That’s the summary of the key messages I took from the Journal of Clinical Nursing editorial. Check it out yourself via doi.org/10.1111/jocn.15307

Many thanks to Jackie Bridges (one of the paper’s authors) for giving positive feedback regarding the original Twitter thread. This blog post is a replica of that thread, just with most typos corrected.

Thanks for reading. As always you’re welcome to leave feedback and/or add your own ideas in the comments section below.

Paul McNamara, 26 April 2020

Short URL: meta4RN.com/COVID19

Positive Practice Environment (the other PPE)

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At this point in time (the beginning of April 2020) PPE is popping-up in news and social media feeds frequently. Understandably, with the outbreak of the #COVID19 pandemic, clinicians are much more conscious of Personal Protective Equipment (PPE) than usual. Even crusty old mental health nurses like me have revisited and refreshed our knowledge on PPE.

That’s sensible. It’s also sensible to acknowledge that there’s more than one type of PPE.

Positive Practice Environment (PPE)

Today some nurses who work on a ward receiving patients suspected/confirmed to have COVID-19 identified elements that are contributing to their ward working well. Although there’s still some anxiety, of course, generally it is a PPE (positive practice environment). Some of the things nursing staff identified were:

  1. Team Nursing. The RNs highlighted this as a part of the PPE. In a team you never feel like it’s your burden to bear alone, there’s someone to check with donning and doffing personal protective equipment, and there’s always someone to help if you’re in the isolation room and need something extra.
  2. Communication. Communciation within the nursing team, and between the nursing staff and senior medical staff is much better than usual. Regular meetings both formal and informal are really helpful.
  3. Working Smarter. For example: before entering an isolation room, call the patient on their bedside/mobile phone to see if they need anything extra. Similarly, making an arrangement with the patient that they can buzz or phone if they need anything. Increased use of phone = decreased frequency of entering isolation room = decreased use of personal protective equipment.
  4. Getting Smarter. Asking questions and brainstorming solutions. Everyone acknowledges that they aren’t experienced or experts in pandemics, and that collaborative care is the only way to problem-solve the way forward. Patients generate solutions too
  5. Staying Focused. There is so much information swirling about regarding COVID-19, that it is important to limit the sources and exposure. We need to trust the health department that employs us to give us the correct information at the correct time. We can’t afford the time or mental/emotional energy to look at everything that’s out there.
  6. Downtime is Sacred. When everything at work seems to have a COVID-19 twist to it, it’s important to shield against overload. Strategies include:
    • Don’t watch the news, watch a movie.
    • Be careful how much time we spend in the social media echo chamber.
    • Switch off social media and the TV and listen to music.
    • Ask friends and family not to use “the C word” around you.

Downtime is Sacred.

Three Final Thoughts

One
It’s not just about wearing PPE (as in personal protection equipment) it’s about creating a PPE (as in positive practice environment) too. Nobody pretends for a moment that there are not more and/or better ideas than those above, but being intentional about both lots of PPE is helping.

Two
What’s more contagious: COVID-19 or anxiety?

Three
I can’t believe that it’s been less than 2 months since the term “COVID-19” was first coined. It has infected nearly every news article and conversation since early February 2020.

End

That’s it. Thanks for reading.

As always your feedback is invited via the comments section below.

Paul McNamara, 1 April 2020

Short URL meta4RN.com/PPE