‘In a world where you can be anything, be kind’

As defences against a deadly pandemic, kindness towards your nursing colleagues may seem inadequate but, says Catherine Gamble, RCN Professional Lead for Mental Health, it can go a long way in helping us come through this crisis.

COVID-19 is ripping apart families and communities, and those on the frontline face an exhausting fight to maintain their patients’ health while battling to protect their own physical and emotional wellbeing. There are no easy solutions to this complex juggling act, but a combination of small actions can bring a degree of comfort or respite, Catherine suggests.

“There’s value in not being critical of each other,” she says. “So rather than saying, ‘This hasn’t been done’, try instead ‘I’m concerned this need hasn’t been met’. Doing it that way means you avoid criticising each other.”

And try not to be hard on yourself, she advises. “Initially you think, right, I can handle this, it’s an emergency. But then it becomes a lifestyle and that’s what people are now having to consider. So, there’s something valuable in each one of us saying to ourselves, ‘You’re doing the very best you can in difficult circumstances’.”

Coping with threats

COVID-19 brings countless dangers, not least the risk of nursing staff infecting themselves or their families because of their work. But other, more unexpected threats have also emerged. Personal protective equipment (PPE), for example, has become another front in the battle against the virus.

“How to wear it, when to wear it, whether you’ve got enough, whether you’re wearing it properly – nurses are reporting all those things,” says Catherine. As a result PPE – designed to protect from physical harm – can also stir up all sorts of anxiety.

Then there’s the threat of moral injury, the distress caused by actions, or inaction, that go against an individual’s ethical or moral code. Deciding who to ventilate when equipment is in short supply, for instance, or having to prevent a family member from visiting a dying relative because of the risk of infection.

Catherine cites in particular the situation mental health nurses can find themselves in of urging social isolation among clients whose mental health may be threatened by lack of human contact. “As mental health nurses, we encourage people to socialise so we’re doing completely the opposite of what our training tells us to,” she says.

With no end in sight, what are the longer-term consequences of working for so long at such pressure and, in many cases, at such personal risk? An obvious possibility is post-traumatic stress which, says Catherine, anyone who experiences extreme circumstances may be vulnerable to.

There are lots of complex issues that may be storing up mental health problems for the future

Sarah Murphy, who co-ordinates the RCN counselling service, agrees that PTSD among health care staff is a real concern, compounded by bereavement issues relating to lost loved ones and colleagues.

“We’re trying to anticipate what may be a problem further down the line,” she says. “Our members are not only losing patients but family as well, who may have been cared for in the same hospital where the member works. There are lots of complex issues that may be storing up mental health problems for the future.”

And nursing staff employed in care homes can face unique challenges, Sarah says. “There’s a feeling among members we’ve spoken to of being forgotten.” The close and rewarding relationships staff often have with residents can also mean heartbreak when any of those residents die with COVID-19. Sarah says: “We really want to reach out to those members and let them know that if they’re feeling isolated, we’re here and can be a support to them at this time.”

Members calling the counselling service are, as might be expected, reporting heightened anxiety, trouble sleeping, and fear of going to work and of what they might expose their families to when they come home, says Sarah. “We’ve also had a lot of people feeling very unsettled by redeployment, finding themselves disorientated by changes happening in the workplace.”

Callers are also worried about financial and employment issues, such as workplace hearings that have been suspended, or, for those who have been on sick leave with non COVID-19 symptoms, guilt over being removed from the frontline.

Looking to the future

To emerge from the pandemic with your psychological health in good shape, Sarah says that despite uncertainty over the end point, it’s important to look forward. There are brighter days ahead. “It can feel as though this is never going to end. But it won’t go on forever and we will come through.”

You don’t need to be in crisis to reach out for support

Both Catherine and Sarah agree that one final piece of advice is critical. “You don’t need to be in crisis to reach out for support,” Sarah says. “It’s really important that, if you can, you take a proactive approach. And we are very happy to speak to people about a self-care plan or just about how they’re feeling. People do sometimes think with counselling that you have to be in a bad place to approach us but that’s certainly not the case.”

Catherine adds: “There's something very powerful in the value of talking about our vulnerabilities. It can be as simple as admitting you don't have all the answers and asking for help. This provides an opportunity to problem solve and come up with ways to support each other. The best way to do this is often through networking, finding those people like you and valuing each others' contributions."