Systematic review of medical student willingness to volunteer and preparedness for pandemics and disasters.

OBJECTIVE: This systematic review aimed to estimate the willingness of students to volunteer during a disaster, and how well-prepared medical students are for volunteering by assessing their knowledge and medical school curriculum of disaster and pandemic medicine. RESULTS: A total of 37 studies met inclusion criteria including 11 168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%) and 5 evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD=21.7%, range=26.7%-87.8%, n=2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (p<0.0001). We identified a number of modifiable barriers which may contribute to this heterogeneity. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD=15.1%, range=37.1%-87.0%, n=2985). 36.8% of 76 medical schools curricula included teaching on disasters. However, students only received minimal teaching (2-6 hours). CONCLUSIONS: This study demonstrates that there is a large number of students who are willing to volunteer during pandemics. However, they are unlikely to be prepared for these roles as overall knowledge is poor, and this is likely due to minimal teaching on disasters at medical school. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. There is a need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared to perform these roles safely.

Videoconference-based Creativity Workshops for mental health staff during the COVID-19 pandemic.

BACKGROUND: COVID-19 presented significant challenges to psychiatric staff, while social distancing and remote working necessitated digital communications. NHS England prioritised staff wellbeing. Arts-based creativity interventions appear to improve psychological wellbeing, so this study evaluated online Creativity Workshops as a staff support response for COVID-19-related stress. METHODS: Participants were staff from a South London NHS psychiatric hospital. Group Creativity Workshops were facilitated via Microsoft Teams. Acceptability data on pre- and post-workshop mood and attitudes were self-reported by participants. Feasibility data were gathered from adherence to number of workshop components delivered. RESULTS: Eight workshops were delivered in May-September 2020 (N = 55) with high adherence to components. Participants reported significantly increased positive mood and attitudes towards themselves and others; and decreased stress and anxiety. CONCLUSIONS: Online Creativity Workshops appear feasible and acceptable in reducing stress in psychiatric staff. Integrating a programme of Creativity Workshops within healthcare staff support may benefit staff wellbeing.

Morning Connections: How do you support hospital staff working remotely during a global pandemic without providing 'staff support'?

When lockdown was announced in the United Kingdom, kitchen tables transformed into offices overnight, as many National Health Service (NHS) workers adapted to new ways of working from home. To respond to the developing situation, we established a programme of weekly 'Connections' meetings where staff could be together, remotely. This article describes the evolution of our Morning Connections and Oncology Connections virtual meetings, including the content of sessions, how they were evaluated and whether they met their intention to support colleagues during a particularly challenging time, both personally and professionally, for NHS staff.

Introduction of Wellbeing Champions in a Paediatric High Dependency Unit (Hdu)

BACKGROUND AND AIM: Alder Hey is a tertiary children's hospital in North-West England. The High Dependency Unit (HDU) is part of a large Critical Care unit consisting of 21 Paediatric Intensive Care beds and 15 HDU beds. All 120 HDU staff including medical, nursing and allied health professionals, were invited to become Wellbeing Champions and eleven members volunteered. Wellbeing Champions, supported by the two Clinical Psychologists, were introduced on HDU in February 2021 with the aim of promoting staff wellbeing, signposting to appropriate support services and developing innovative approaches to engage staff in conversations around their mental wellbeing. AIM: This evaluation aimed to determine utilisation of Wellbeing Champions and explore the perception of support offered. METHOD(S): A short-anonymised survey was circulated by email to all HDU staff and their responses collated. RESULT(S): 26 responses were returned. 92% of respondents were aware of the HDU Wellbeing Champions. 70% of respondents had taken part in psychology-led support session. 50% of respondents had received support from a HDU Wellbeing Champion. 88% of respondents felt supported at work during Covid-19 pandemic. 76% of respondents felt valued at work. Support and ease of accessibility were the top two descriptors for the Wellbeing Champions. CONCLUSION(S): The results show a positive response to the new role of the HDU Wellbeing Champions. HDU Wellbeing Champions have been a useful resource to support staff wellbeing and we aim to continue the staff support in the form staff support meetings every two weeks.

The support needs of health professional educators to teach clinical skills online: Experiences of COVID-19 lockdowns from three countries

Introduction: Supporting educators has been identified as vital for the efficacy and sustainability of online teaching. The teaching of clinical skills online presents additional challenges given the vast shift from traditional pedagogies. However, the support needs of health professional educators to teach clinical skills online are unknown. The aim of this study was to explore educator experiences of teaching clinical skills online and investigate their workplace support needs. Methods: A qualitative approach using focus groups was used to investigate educator experiences at three universities in Australia, Chile and South Africa. Data were subject to thematic analysis, and a thematic network tool was used to triangulate international experiences. Results: Seven focus groups were undertaken, with a total of 32 participants. Four global themes were identified following analysis: 1) the educator experience, 2) changes to pedagogy, 3) challenges to teaching online and 4) support for educators. Conclusions: This study has highlighted the professional challenges that teaching clinical skills online creates for health professional educators and the uncertainty regarding expectations and outcomes. Enhancing university support for educators to prepare and provide clinical skills teaching online is suggested to mitigate these challenges. Recommendations are made for universities and educators to consider in the pursuit of effective and sustainable teaching of clinical skills online.

Concerned, yet committed: A tertiary hospital healthcare workers’ concerns and readiness in the face of the COVID-19 pandemic

Background: Healthcare workers (HCWs) are a vital resource in every society. The concerns of HCWs during pandemics are unique as they have to consider multiple issues including their health as well as the risks to their loved ones. The coronavirus disease 2019 (COVID-19) pandemic provides no exception in testing HCWs’ readiness. Purpose: We aim to study the concerns and preparedness of HCWs at Singapore General Hospital (SGH), a tertiary healthcare institution, during the COVID-19 pandemic. Of interest were the differences between HCWs from the emergency department (ED) compared to other non-ED locations. Methods: A cross-sectional study was carried out in the form of a voluntary survey containing 34 questions. All data were anonymous. Chi-square analysis and Bonferroni correction were carried out to ascertain the significance of the associations between the two groups. Results: A total of 1,249 responses were received. Of all respondents, 57 percent felt that their jobs put them at great risk of exposure to COVID-19 while 67 percent accepted the risk as part of their job and 60 percent were still afraid of falling ill. Among the respondents, 78 percent responded that they would not look for another job while almost half considered it acceptable if their colleagues resigned. There were significant differences between ED and non-ED staff in terms of feeling that not only they but also those close to them were at high risk of exposure to the disease, people avoiding them and their families due to their job and ED staff feeling that there would be increased workload but inadequate manpower to handle the demands. Conclusion: Despite previous experience with pandemics, this study highlights that there still are issues faced by HCWs that need to be addressed in order for them to function effectively. Although there are differences between ED and non-ED HCWs’ concerns, all HCWs need to be recognized as crucial stakeholders and due attention should be given to them. © 2022 Weston Medical Publishing. All rights reserved.

COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland.

Background: The coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement. Methods: We conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services. Results: We included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that "COVID-19-related psychosocial care" (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential. Conclusion: More than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support. Trial Registration: ClinicalTrials.gov NCT04753242, version 11 February 2021.

Evaluating a psychological support service focused on the needs of critical care and theatres staff in the first wave of COVID-19.

BACKGROUND: In response to COVID-19, the authors used clinical psychology resources from their hospital's Pain Medicine Department to provide direct support to critical areas. AIMS: The degree to which the service met the needs of staff and managers between March and August 2020 was evaluated. METHODS: A total of 51 staff were referred. Most were nurses (43%), followed by theatre practitioners (36%), healthcare assistants (9%), consultants (8%), administrative (2%) and support staff (2%). Working status, reason for referral and presenting difficulties at first appointment and outcome were recorded. Staff were sent an anonymous survey following intervention. FINDINGS: Staff reported high rates of burnout, anxiety and low mood, with 22% experiencing exacerbation of pre-existing mental health problems. All staff reported benefit from the intervention and managers provided positive feedback. CONCLUSION: Establishing a supportive service that included psychology benefited both staff and managers at the peak of the pandemic. Recommendations are provided.

Staff support in a National Health Service mental health trust in response to the COVID-19 pandemic: qualitative study.

BACKGROUND: The COVID-19 pandemic has highlighted the impact work can have on healthcare workers and the importance of staff support services. Rapid guidance was published to encourage preventive and responsive support for healthcare workers. AIMS: To understand mental healthcare staff's help-seeking behaviours and access to support at work in response to the COVID-19 pandemic, to inform iterative improvements to provision of staff support. METHOD: We conducted a formative appraisal of access to support and support needs of staff in a National Health Service mental health trust. This involved 11 semi-structured individual interviews using a topic guide. Five virtual staff forums were additional sources of data. Reflexive thematic analysis was used to identify key themes. RESULTS: Peer-based, within-team support was highly valued and sought after. However, access to support was negatively affected by work pressures, physical distancing and perceived cultural barriers. CONCLUSIONS: Healthcare organisations need to help colleagues to support each other by facilitating open, diverse workplace cultures and providing easily accessible, safe and reflective spaces. Future research should evaluate support in the evolving work contexts imposed by COVID-19 to inform interventions that account for differences across healthcare workforces.

Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care.

BACKGROUND: There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED). AIM: A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service. METHOD: Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis. FINDINGS: This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure. CONCLUSION: PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.

'Fix the issues at the coalface and mental wellbeing will be improved': a framework analysis of frontline NHS staff experiences and use of health and wellbeing resources in a Scottish health board area during the COVID-19 pandemic.

BACKGROUND: Frontline healthcare staff working in pandemics have been reported to experience mental health issues during the early and post-peak stages. To alleviate these problems, healthcare organisations have been providing support for their staff, including organisational, cognitive behavioural and physical and mental relaxation interventions. This paper reports the findings of a study commissioned by a Scottish NHS health board area during the initial outbreak of COVID-19. The study aimed to understand the experience of NHS staff relating to the provision of wellbeing interventions between March and August 2020. METHODS: Data were gathered from free-text comments of eight surveys completed by a wide range of staff across sites within one NHS health board in Scotland. We conducted a framework analysis of the data. RESULTS: Our findings show that despite the provision of relaxational and cognitive behavioural interventions to support staff wellbeing during the early months of the COVID-19 pandemic, there were barriers to access, including heavy workload, understaffing, inconvenient locations and the stigma of being judged. Organisational factors were the most frequently reported support need amongst frontline staff across sites. CONCLUSIONS: While relaxational and cognitive behavioural interventions were well received by staff, barriers to accessing them still existed. Staff support in the context of organisational factors, such as engagement with managers was deemed as the most important for staff wellbeing. Managers play a key role in everyday organisational processes and therefore are in the right position to meet increasing frontline staff demands due to the pandemic and removing barriers to accessing wellbeing support. Healthcare managers should be aware of organisational factors that might increase job demands and protect organisational resources that can promote wellbeing for frontline staff.

Psychological First Aid Well-Being Support Rounds for Frontline Healthcare Workers During COVID-19.

Background and Objective: Frontline healthcare workers face unprecedented stress from the current SARS COV-2 (COVID-19) pandemic. Hospital systems need to develop support programs to help frontline staff deal with this stress. The purpose of this article is to describe a support program for front line healthcare workers. Methods: In this community case report, we describe a well-being support rounding program that was developed to deliver Psychological First Aid (PFA) to frontline healthcare workers in a large urban medical center to maintain their sense of psychological well-being and self-efficacy. A team of clinicians from the department of psychiatry, who were trained on the Johns Hopkins RAPID model (Reflective Listening, Assessment, Prioritization, Intervention, and Disposition) to provide PFA, were deployed throughout the hospital. These clinicians carried out daily well-being rounds from April to June during the peak of the pandemic. Results: Approximately 20% of the frontline staff members were going through an acute crisis and benefited from PFA. Anxiety, anger, exhaustion, economic worry, job insecurity, dehumanized interactions with patients due to Personal Protective Equipment (PPE), and stress of taking care of sick and dying patients without their families present, were the main themes identified by the staff. The deployed team used active listening, mindfulness, validation, reframing and other cognitive interventions to support staff. Conclusions: Our experience suggests that frontline staff are willing to engage with in-person, on-site support programs. Fostering resilience and self-efficacy through PFA is a useful model to provide emotional support to frontline healthcare workers during health crises.

Psychological distress during the acceleration phase of the COVID-19 pandemic: a survey of doctors practising in emergency medicine, anaesthesia and intensive care medicine in the UK and Ireland.

OBJECTIVE: To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland. METHODS: Initial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020-26 March 2020 and Ireland: 25 March 2020-2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being. RESULTS: 5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role. CONCLUSIONS: Findings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term. TRIAL REGISTRATION NUMBER: ISRCTN10666798.

Staff-Care by Chaplains during COVID-19.

The aim of this study was to understand how chaplains delivered spiritual care to staff during the Covid-19 pandemic. The researchers analyzed data collected from an International Survey of Chaplain Activity and Experience during Covid-19 (N = 1657). The findings revealed positive changes that emerged and new practices evolved around the use of technology as useful tools for maintaining contact with staff.

Implementation evaluation of staff support and wellbeing programmes at an academic health science centre during COVID-19: study protocol.

BACKGROUND: Evidence from previous pandemics as well as early evidence from COVID-19 suggests risk of adverse mental health and wellbeing outcomes for healthcare workers. In response to these concerns, healthcare systems and organisations rapidly established staff support and wellbeing programmes. While there is emerging literature related to the effectiveness of such interventions, what is less well understood and evaluated is the evidence base regarding how such programmes are implemented; what supports and hinders their implementation; and how or if they are maintained following the initial acute phase of the pandemic. This study addresses this gap by studying the implementation process of COVID-19-related staff wellbeing programmes in the three UK NHS Trusts that make up one of Europe's largest academic health sciences centres, King's Health Partners. METHODS: We will conduct a prospective, cross-sectional descriptive study using qualitative research methods and non-probability purposive sampling to identify a study participant group representative of the population and implementation activity of interest. We will conduct semi-structured interviews of between 30 min and 1 h. We will identify theory-driven elements in the dataset using the Consolidated Framework for Implementation Research (barriers and drivers), Exploration, Preparation, Implementation, Sustainment Framework (timeline/chronology/evolution of the implementation and different issues at different times) and Expert Recommendations for Implementing Change (implementation strategies). We will then identify indicators of these constructs within the dataset and report them, as well as their inter-relationships. DISCUSSION: Through this study, we hope to better understand what factors hindered and enabled the implementation of three inter-linked staff support and wellbeing programmes and how/to what extent have these programmes been sustained. We will also explore whether implementation science frameworks are applicable and beneficial in conceptualising and understanding crisis driven and rapidly implemented interventions and in what ways, if any, they need to be adjusted when used in unprecedented circumstances such as the COVID-19 pandemic.