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Going to work for 12 hours, perhaps not having a break, perhaps not peeing for over 8 hours and being put in challenging situations on a daily basis is pretty much the norm for many workers on the frontline ANY day of the year, despite COVID-19. But now we have the pressure of adhering to guidance that keeps changing, confusion on who to test, who to 'barrier nurse', with lack of PPE in some areas. Staff are frightened. Frightened that they will bring coronavirus home to their families, frightened that they will become ill and frightened of the things they will witness in the coming months. Currently there is a petition calling for frontline NHS staff to be tested. We would then know who has the infection, keep them isolated so not to infect the vulnerable. In my hospital it’s taking five days to get a test result back. During those five days, patients are being barrier nursed. Barrier nursing ‘usually’ is a straightforward procedure and one nurse can look after a patient with relative ease. However, when barrier nursing a COVID-19 infected patient who is on non-invasive ventilation or aerosol therapies, it is much more disruptive. It can take two nurses to care for that patient, as ‘donning and doffing’ PPE is time-consuming and risky. The second nurse will act as a ‘runner’, collecting equipment, medication, linen – anything the patient and nurse need. The nurse will also need to take breaks separately to the rest of the team, leaving them feeling isolated. I know the Trust I work in has purchased point-of-care testing for coronavirus, but this won’t be up and running for two weeks. After a 12-hour shift, healthcare workers would then shower (if you are lucky), change their clothes and go home. Simple? No, we are not robots. We are human. We don’t go home, have dinner, have a full night’s sleep and start the next day. We have stuff going on outside work. We carry these stresses with us when we come into work; it affects our ability to ‘do a good job’. Staff are often struggling with outside stressors: divorce, moving house, child care, money and health – mental and physical. These stresses have not gone away since COVID 19 turned up. There are now new stressors in town which are affecting healthcare workers ability to stay focussed and to ‘do a good job’. These stressors are HUGE. Yesterday, the Government stated that they would help businesses with ‘what ever is needed’. That’s great but a loan won’t help in the long run. My husband owns a small business. He is a sculptor and makes small-scale sculptures for the garden and home. He employs six artists. These six people have made the business what it is today. They are talented and creative. One of them has just started a family, one has relocated from abroad to be here, and one has set up a new home. They have become my husband's ‘work family’; they are more than just employees. Yesterday, my husband went into work and told them that he was no longer able to pay them after April. Bigger companies have stopped ordering as there is no requirement for his product due to the restriction on gatherings of people. Smaller companies have stopped ordering as they are uncertain of what the future holds. Never have I seen my husband look so drained. Not only is he witnessing his business that he has worked so hard for collapsing before his eyes, he has had to let down the people that have helped to make it what it is. The mood in our house at the moment is sombre. I don’t want to add to my husband’s stress with my worries about work, so I keep quiet (this blog is helping). We have two boys,12 and 14. They are like labradors, they need lots of exercise. If the country is on lock down for three months they will be climbing the walls!! For anyone who has kids of this age, you know that they eat LOADS. As soon as the cupboards are restocked, they are emptied within 48 hours. I’m struggling to get healthy food for them as the shops seem to have nothing in them. After lock down, we shall know whose been stockpiling as they will emerge after three months overweight with very clean bums! Then there is the issue with childcare. If healthcare workers are to be on the frontline who is to look after the kids? If they are old enough and you leave them at home alone, how can you ensure they eat well, they study, they stay in? If they are young, who looks after them? Grandparents are now not the go-to option. This virus has affected everyone in multiple ways on multiple levels. No, this blog isn’t just about healthcare – it’s about being human. There will be many of us out there with stresses you are unaware of. Please, be kind. Call for action: Please send in any practical tips for barrier nursing patients and advice for staff well-being during this time. Join the conversation taking place on the hub.

“Our emotions they say, guide us into facing predicaments and tasks to important to leave to intellect alone”. Daniel Goleman. Such an interesting concept, yet emotions are the things we so often suppress, don’t always know how to handle, don’t always talk about, are so very complex, yet feed into our behaviour, actions, our wellbeing and outcomes. So, guess what my blog is going to be about? We are going to be diving into emotions. Whether I am working with healthcare professionals, coroner’s officers, legal teams or any number of other professionals, I start off every training session I deliver on empathy and emotional awareness, saying this. It resonates every time. The reason it resonates, despite professional skills, is because we are all human beings first and foremost. And for us human beings, our emotions are a key player. I doubt if there is one person in this country that is having just an intellectual reaction to the COVID-19 pandemic. They will be having an emotional one too. And I am no exception, as we all battle with the threat nationally to our way of life, to our safety and the threat to our own personal world. If ever we needed empathy for each other, it is now. Let me paint a picture for you. I am sat at home (lucky that I have one) working. Nothing new there. When I am not delivering training, I am often at home running my business supporting organisations to incorporate an empathic and an emotionally aware approach to their practices, leadership and wellbeing of client group and staff. But instead of being able to go and work for a couple of hours down my local hotel, while enjoying a coffee, and connect with others, something vitally important to me (there is a reason I am very comfortable up on a stage in front of a hundred plus people – I am a people person). Or I may even have popped over the road to my mum who is now in complete isolation because of her vulnerabilities, go to the gym, or meet my bestie for an early evening drink and catch up with her in her family pub. It is now me, just me, all day, all evening. A ‘me’, in fact, that has gone from celebrating just a few days ago that I was off to Amsterdam to do a closing keynote address (yep, I had gone international!). A ‘me’ that was in discussions with the Ministry of Justice to potentially train 1000 people. A ‘me’ that was travelling all over the country and meeting amazing people. To now everything being on hold. Plus, like everyone else, absorbing the fact that we are facing a global and nationwide crisis. Now I consider myself to be a resilient person. I know overcoming adversity after losing my 15 year old daughter in hospital in patient safety circumstances and going through a brutal serious incident and inquest system. Yet, still needing to bring up three young children, when emotionally I was on my knees. But overcome I did and created a happy life. Once more, created a business that is not only embedded in my counselling background but my lived experience of empathy, or lack of it in challenging situations, indeed in my whole adult life. So yes, the impact, as for many these last few days, was indeed emotional, as well as intellectual, as I went from a euphoria and excitement, to shock, fear and worry. Compassion for others is such a crucial human attribute to have and use but is underpinned by empathy and emotional awareness. To be able to think, ‘what might it be like for that person?’ What I have found, doing the work that I do, is that people are so much better at this when they feel that someone is considering the very same about them too. Whenever I do my training, whether in leadership, investigations, or communication, it is not about giving a toolkit of magic words or phrases. Oh if only it was that easy. But it isn’t. It is about helping people firstly feel and understand their own empathic response. Taking empathy out of the textbook and into their real life application. It is to help them understand and feel proud and confident of what they do well already. To challenge their thinking, perspective and biases (yep, we all have them!!). And, very importantly, how to care for themselves, colleagues and teams, so that empathy is kept strong and apathy kept in check. And resilience is optimised. This always has been important, but even more so now. Nurses, doctors, executive teams, paramedics, cleaners, health support workers, receptionists, to name but a few, all have their own emotional felt experiences. Their own deep-routed triggers, saturation points in their real everyday lives too. They face their own fears as their own internal personal world is under threat too. Empathy for others when overwhelmed is not always easy. I don’t always get it right either, I can promise you that. Managers, take a second or two to ask how your team are? Team, in return, ask how your manager is? Nurses, ask how your patient and loved ones are? But patient, have you asked how your nurse is? In a time when human connection, touch, closeness, social activities are so restricted, our words, our tone, our empathic attitude, our emotional awareness, our care and interest in others does not have to be restricted. We have power still. All of us. To make someone else’s day a little worse, or a little better. We connect on an emotional level; it is a felt experience. I started off this blog with how I start a session and so I will finish with how I often end and with this quote, because it transcends whatever job title you hold, whatever profession you work in. It transcends race, age, culture and gender. Because our one commonality is that we are human beings, with our own real life and story and our own emotional experience. "People hear your words, but they feel your attitude". C Maxwell.

Today I was nursing a patient on the ward who was very unwell. The test result came back as positive for COVID-19 and the patient needed to be transferred to the intensive care unit (ICU). I was concerned that the masks and other personal protective equipment (PPE) being used on the wards are not adequate for such specialist nursing tasks. I consider (and it is the Trust's good practice guidance) that the mask that specialist outreach nurses should be using are the ones that ICU staff use. Specialist masks are needed for aerosoled treatment. So I use the specialist mask as the patient was going straight to ICU for aerosol treatment. When donning this specialist mask, one of the managers on the ward (someone who has budget responsibilities) said to me "you shouldn't be using that mask as it costs 8 quid." I have been 'covered by COVID-19 all day' and feels like it is just a matter of time before I succumb to the disease. Coming home last night I was convinced that the disease has been transferred to my husband and young sons. I asked my manager if, when the PPE runs out, will we be expected to nurse without a mask and protective clothing. My manager said that it wouldn't come to that. But I don't trust that. If there is not adequate PPE, I don't want to work and I believe that no one should be expected to. I am angry that nursing staff are being put in danger and that this will escalate in the coming weeks. Despite the assurance of the Deputy Chief Medical Office that the UK has "perfectly adequate" supply of PPE, my brother (a paramedic) has bough his own supply of masks as he’s sure that they will run out. It would be gruesome enough to be insufficiently protected if there weren’t enough masks to go around, and there are at the moment, but to be denied the essential equipment on cost grounds is disgraceful. The government are rightly saying ‘whatever it takes.’ Matt Hancock and the Cabinet need to know that their commitment is not being honoured. This is just my experience of course, but it’s clearly symptomatic of a culture that isn’t protecting staff and where trust is breaking down. If there are no staff, there will be no patient care. The sea near the hospital is calm this morning. But it’s like its going to drag back slowly. We know the tsunami is coming and we’re all terrified.

Today I was both humbled and deeply moved. The Royal Free Trust (RFT) continue to take the health and well-being of it's staff seriously. I’m proud to say I’m one of them. In response to COVID-19, a multidisciplinary group have been tasked to specifically look at how staff can be supported through the pandemic. It recognises that the support will need to be multi-faceted and my role as the founder of SISOS (Safety Incident Supporting Our Staff) and present SISOS lead will be to help provide emotional peer-led support for our staff alongside chaplaincy and varied mental health professionals. Released from my clinical role (scrub nurse) for the foreseeable future, I will be able to focus on, and will endeavour to promote and support, the emotional safety of my colleagues Trust wide. The mental health first aid training I undertook in preparation for my SISOS role will surely be put to the test. None of us know what obstacles and challenges we will have to face, both in our private and professional lives, as we race off track, gathering speed and moving towards an unknown destination. By and large, I envisage the peer support SISOS provides will be achieved remotely: telephone, WhatsApp, Facetime, text, emails. The experience we have gained allows us some insight into how this support will be received and I feel positive. Who could possibly have predicted two years ago when SISOS first evolved the events of the last few weeks. Implementing, embedding and sustaining a peer support initiative has thrown up many challenges but we are reassured that our colleagues can be confident of genuine emotional support from peers who are guided and supported by professionals within a Trust which cares. SISOS: caring is our passion Human being is our highest banding Read my other blogs on the SISOS journey: Part one Part two Part three Part four

These resources prompts the reader(s) to consider: tips for approaching self-care how to manage personal wellbeing what we can do to improve our workplace when to ask for help. How to use these posters Ideally the posters should not be used in isolation, but alongside other initiatives. You could set up a staff wellbeing board, where all the posters are available together for staff to view, or you could place copies of the posters around the unit in staff areas, where staff can read them freely.

My health has always been a ‘challenge’ as they say. I had a stoma in 1988, when I was 28 years old, for bowel disease. They were never sure if it was Crohn's disease or ulcerative colitis, but I was more than happy to kiss my rotten colon goodbye. It restored my bowel health and I carried on working and living my life with my husband and child. Two years after the ileostomy, I had further abdominal problems and a MRI suggested ovarian cancer. I had an emergency laparotomy which revealed severe endometriosis which had obliterated my whole pelvis and infiltrated my internal organs. The gynaecologist closed me up and said nothing could be done as my pelvis was ‘frozen’ and I would have to be treated medically. The condition plagued me for the next 20 years; I developed cysts in the pelvis which were drained repeatedly. My health was at times poor but I still managed to work and live my life. In 2010, my gynaecologist retired and I was referred to a new team. They were based 80 miles from where I lived, which was a nuisance but I felt it was worth the journey to have the best. They were adamant I needed a hysterectomy – they were not happy with the recent imaging and felt one of the cysts looked suspect. I spent years putting this off as I was very fearful. I had been told it could be very easy to make things much worse. In 2012 my mum had a massive brain haemorrhage and I became her carer, but by 2014 they were still saying I needed the surgery to find out what the suspect mass actually was so, reluctantly, I agreed. January 2015 The hysterectomy went ahead at a private hospital. I was in BUPA, my mother was brain damaged and I was her carer, I needed this op out of the way so I could go back to caring for her. I awoke from the surgery to be told it had been very difficult – I felt totally wiped out. Two days after the operation, there was no improvement. I was encouraged to get up from the bed; I could barely move but I managed a few steps when I felt something running down my legs forming a green puddle on the floor. My bowel had perforated and the contents were flooding out of my vagina. My consultant was away and I was transferred late at night to the local NHS hospital. That was a nightmare in itself as they at first wouldn’t accept me. I lay there in A&E with warm liquid pumping out of me with every spasm of my bowel. I was convinced it was blood and I tried not to think of my loved ones whom I thought I’d never see again. My poor husband looked on helplessly; he spent a freezing night in the car as he wanted to be near me. I spent 3 months in hospital being fed through my central vein. I was told I may never eat or drink again and my whole life just fell apart. It was explained the suspect mass was in fact a twisted mess of bowel, adhesions and goodness knows what possibly caused by the repeated aspirations I’d had for the endometriosis. I was told because of the perforation I now had a fistula which is essentially a connection between my small bowel and my skin. Despite my numerous surgical experiences, I had never heard of such a thing but Dr Google soon educated me and it did not make good reading. I became seriously depressed, wanting my life to end. I was discharged in the spring of 2015 to a totally different world. I could by now eat small amounts but the holes appearing on my abdominal wall were evidence the fistula had not healed. I was too afraid to move as any activity meant I’d have ominous discharges from various orifices. I totally lost confidence in myself, the doctors and the world in general… I became a recluse. Life with a fistula was difficult. Apart from the constant dressings required to contain the output, I was in permanent pain and suffered frequent infections. Considering I had gone into hospital reasonably well and come out like this was almost too much to bear. I tried to access mental health support but I was put on a waiting list whilst my mental state got progressively worse. I was told I would have to wait for two years for the fistula to be repaired. It was a long wait, my daughter had a baby so that kept me going and I looked forward to being free of this demon within. I missed the old capable me so much. March 2017 The repair op took place this time in the NHS hospital, albeit as a private patient again. I couldn’t wait any longer and so once again made use of my medical insurance. Again I had serious complications. The days that followed the surgery were horrific, I truly wanted to die. My gut had stopped working, a condition called ileus. Bile was building up in the stomach so I had a nasogastric tube inserted; the thirst was causing me to have hallucinations. I tried to impress upon everyone how ill I was feeling, but I didn’t feel believed; they told me I was anxious and all my problems were normal post op things. My husband called as usual to visit, getting more worried as each day was passing. I had spiked a temperature of 39.6⁰C. I cried into his chest as I tried to sit up to relieve the horrific symptoms I was experiencing. Next minute I had no breath, I was suffocating. My husband called for help and, even at that point, I was told I was having a panic attack until the nurse saw my oxygen levels – they were 71% which was dangerously low. I was having a stage 1 respiratory arrest, and I was rushed to ICU and spent days fighting for my life. A three month hospital stay followed and this further catastrophe had resulted in a fistula worse than the one I went in with. I now had to wear three stoma bags, two of which leaked constantly. I felt a mutilated mess. Again, I left hospital a broken shell, with no support apart from my family who were also finding it hard to accept what had happened to me. Life now... It’s now 3 years since the failed repair and I have never recovered. It actually made things much worse. As well as the fistulae and three stoma bags, I now have bladder problems as part of my bladder was excised during the last op and gallbladder disease thanks to the parenteral nutrition. The inflammation in my body has led to autoimmune diseases, such as scleritis, which is an agonising and destructive eye condition. The whole awful experience has left me a broken, psychological wreck. I finally accessed mental health support at the end of 2019 and have been diagnosed with post traumatic stress disorder (PTSD), anxiety and depression. Life is difficult. In my mind there are so many unresolved issues which have plunged me into a deep pit of depression I can’t get out of. The therapy I now receive is ‘systemic’ so basically addresses how my husband and I are responding to the trauma, rather than the trauma itself. The initial trauma of my surgery going so wrong has now been followed by a second trauma of lack of support, feelings of worthlessness and the consequences of having a complex condition whilst living in rural west Wales where my local hospital can’t treat me. How I wish I’d said NO to that fateful hysterectomy! But we don’t do we. The surgeons are the experts, they lead and we follow, that’s how it works. Lamb to the slaughter springs to mind. That is probably unfair, my surgical luck was bound to run out one day, but I am angry at losing one of life’s most important gifts – good health. To make matters worse I’ve discovered that the suspect mass that they told me had to come out, had actually been identified 30 years previously. It was a harmless benign fibroma. That makes things harder to bear as I realise I probably never even needed the surgery. I didn’t complain or even ask many questions as I was too ill, traumatised and exhausted. My mother ended up in a home, my marriage is understandably struggling, my husband and I no longer work. I had nothing left to challenge anyone. My psychologist says I need answers to help me move on but I’m now told it’s too late. I have to go back to that hospital because I am now so complex my local hospitals won’t treat me. It’s a 3 hour round trip to a place that absolutely terrifies me. An enterocutaneous fistula is a very rare complication of surgery. But as I told my Consultant, it’s only rare until it happens to you. Then statistics become irrelevant. They seem to overlook the fact that there is a person behind that tiny statistic, who has to somehow learn to live again with all the fallout of that disastrous surgical experience.