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Panelists include: Dr Keita Franklin, LCSW, Chief Clinical Officer, PsychHub, Tennessee, United States Bernadette Wilson, MBA, Certified Neurocoach & Mindfulness Coach, Founding Partner, BrainFit Institute, CEO, Cognitive Performance, California, United States Dr Ariele Noble, Research Psychologist & Clinical Supervisor, Mental Health Innovations, United Kingdom Anca M. Sarbu, MSPH, Head of Quality Management and Organisational Development at Klinik Meissenberg AG - Psychiatric and psychotherapeutic hospital for women, Switzerland, Founder and Project Lead at The Digital Aid Project, PSMF Ambassador Switzerland and Austria, Healthcare Innovation Mentor at EIT Health, MIT COVID-19 Challenge, EUvsVirus - EU Commission

My original plan for this blog was to explore why change is a bit Marmite – some of us love change (the ‘bring it on’ group), and others less so. Then the COVID-19 jar was opened and everything changed. We are all impacted in different ways, both staff and patients. Whether it’s even more time at work, less time with those we love, wanting to be at work but having to self isolate, loss of our identity as the one who always does x or y, how as patients we interact with our NHS, or the loss of those we love. Transitions are challenging William Bridges says it isn’t the changes that do you in, it’s the transitions. Change is something that happens to people, even if they don't agree with it. Transition, on the other hand, is internal. It's what happens in people's minds as they go through change. Change can happen very quickly, while transition usually occurs more slowly as we internalise and come to terms with the details of the new situation that the change brings about. Stages of transitioning include: Ending - letting go of the old ways and the old identity. The neutral zone - going through an in-between time when the old is gone but the new isn’t fully operational, when the critical psychological re-alignments and re-patterning take place. New beginnings – when we come out of the transition and develop a new identity, experience a new energy and discover a new sense of purpose. 3 tips for dealing with transition So what can we do to ease the transition? Here’s my three As for the day: Acceptance Accept that we will each make our transition at different paces. For some shock and denial through to acceptance and hope is rapid, for others it may take longer. So more than ever looking after each other is key. Steve Covey’s talks about making a deposit in the emotional bank account: understanding your friend, your colleague, a small act of kindness. What will be a deposit for you, may be a valuable withdrawal for them. Appreciation There’s already a zillion examples of people moving hell and high water to do what needs to be done to best respond to COVID-19, positive energy is thriving. Appreciating this is just as important. We can show our appreciation locally in our teams, on an individual basis or by joining the nation in clapping those who are helping to keep our world turning,. Awareness Be aware of high levels of anxiety and exhaustion in yourself and those around you. We are all stressed by different things. For some it’s spending too much time alone. Others ambiguity and uncertainty. Some will struggle most with decisions they think are illogical, last minute or require super human endeavours. Knowing our own limits and triggers and those of people around us is key. When you spot them, pause just for a vital moment, take a brief step back before anyone keels over and think through next steps. Explore information and ideas and talk them through with others. And where you can see that someone isn’t in a good place, give them permission to re-charge their batteries so their brilliance can continue to shine. “Not in his goals but in his transitions man is great.” —Ralph Waldo Emerson References William Bridges, Bridges Transition Model, 1988. Stephen R. Covey. The seven habits of highly effective people. Franklin Covey, 1990. Previous blogs by Sally Leading for improvement Immunity to change How a single piece of paper could help solve complex patient safety issues The art of wobbling: Part 1 The art of wobbling: Part 2

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.

'Scenario: Management of adults and children with post-traumatic stress disorder' covers the management of adults and children presenting with post-traumatic stress disorder. It includes guidance on how to manage the person whilst they are waiting to be seen by the specialist and outlines the treatments that may be offered.