Building bridges and scaling heights – practicing conscious kindness during the COVID-19 pandemic

The combination of an unknown pathology, a steep clinical burden and the risk to staff has led to a change in the way we work. With an established history of burnout amongst health-care workers (HCWs), it is important that the NHS recognises the impact of mental well-being. Studies have shown that those who perform, or experience acts of kindness experience a greater feeling of well-being. We wanted to discover the way in which acts of kindness impacted on our team during the busiest times of the pandemic, and if we could improve well-being during emotionally draining times. 15 HCWs were interviewed over 4 weeks at the peak of the pandemic during May 2020 to discuss their feelings of working within our intensive care unit, their motivation, and acts of kindness they had seen or directly received.All interviewees had witnessed or received acts of kindness that had boosted their morale. They also recognised acts of kindness they had done for themselves, including self-care, hobbies and wider support networks. It is these acts of kindness that are often overlooked but have a strong evidence base for its impact on the well-being of staff. Actively integrating acts of kindness within our teams can improve overall morale and motivation to work, even during times of unprecedented stress. Examples included clinicians taking the time to check in on staff, including more formal sessions. Informal conversations, dedicated team work and shared debriefs played a vast role in helping our team identify stressors and what one could do to help.We believe leadership should not just be task-based, but rather team-focused. The herculean nature of any pandemic relies on its staff, and conscious kindness can improve successes of our teams. Leaders often practice clinical leadership, but the team that takes a biopsychosocial approach remains a sustainable one.

A Safe Approach to Percutaneous Tracheostomy for COVID-19 Patients in Intensive Care.

The novel coronavirus disease 2019 (COVID-19) has placed a burden on critical care facilities worldwide. Patients who remain critically unwell with COVID-19 require prolonged periods of ventilation, and the burden of both the resources during a pandemic and the slow respiratory wean must be managed. Percutaneous tracheostomies are commonplace in long-term intensive care patients, yet little is known about their role in COVID-19, particularly how operator safety is maintained during the procedure. Here, we describe an approach designed to minimize cross-infection of the operators undertaking percutaneous tracheostomies within this subset of patients. Focus should be on non-technical skills, prolonged periods of pre-oxygenation, and minimal ventilation during the procedure to minimize the risk of aerosolization generated from an open breathing system. Our modified technique demonstrates successful early experiences with no operators testing positive for COVID-19 or developing symptoms following any performed procedure.