Hidden wounds

Summary

In this short blog, Stephanie O'Donohue, Content and Engagement Manager for the hub, reflects on the inner turmoil many NHS staff are experiencing as they are having to spread themselves, and their care, thin.

Content

I spend much of my time researching the impact of COVID-19 on both patients and staff, speaking to people about their personal experiences. It's a privilege to be invited into that space and to be trusted to listen. Over the past year, I have often been hit by waves of sadness, at the stark realisation of what so many people are enduring. 

It hit me again recently when reading that critical care staff, who would usually give 1:1 care, were having to dramatically 'dilute' their ratios to cope with demand. Some are now attending to three or more patients who are desperately unwell and dependent on their clinical expertise. 

Statistics like this can be easily lost amid the crisis that currently faces our health service, but I haven't been able to stop thinking about it... about how this must feel for the human being asked to respond by diluting the care they deliver. To adjust by inevitably lowering their standards. To give far less than they feel is right. 

What is the impact on their wellbeing, to see patients desperately needing levels of care they can no longer provide? How are staff being supported to cope with the emotional toll, as their capacity is being stretched between more and more patients? Are they given any guidance on how to prioritise or is this left to interpretation, and risk of blame? 

Speaking to clinicians, many feel that they are letting patients down. They blame themselves for their inability to be superhuman, to achieve the impossible and maintain the previous standards of care they have always worked hard to provide. Standards that reflect their ethics and values. 

Just last week a respiratory physiotherapist, and friend, was in tears as he recounted his feelings of not doing "enough". These tears came as he arrived home from a voluntary shift helping with the vaccine roll out. It is devastating to see those who are giving so much of themselves, feeling such distress.

There is a growing realisation that many frontline staff will face "moral injury" during this crisis. It's a term originally used in the military to describe profound psychological distress caused by actions or inactions that violate a person's moral code. There's no doubt an increasing number of NHS staff will experience this level of inner harm during the pandemic. 

How can this type of injury be eased? What will be the long term impact on individuals? Who will help repair their wounds? 

Healthcare staff are some of the most resilient people I know, but they are not invincible. They are human. They will need holding, just as they have held us. 

Further reading

Keep your light shining bright – top tips from Sally Howard

Why is staff safety a patient safety issue?

Understanding moral injury: a short film

Moral injury and the COVID-19 pandemic: reframing what it is, who it affects and how care leaders can manage it