Health and wellbeing for trainers and trainees during Covid-19

Prof Gaye Cunnane and Ms Hadas Levy, Department of Health and Wellbeing, RCPI, outline how medical professionals can manage their mental wellbeing during these challenging times

The rapid spread of the novel Covid-19 virus, an unpredictable and potentially very serious issue, has created a worrying time for everyone. How is the health service going to cope? How are we going to manage? Are we going to be completely overwhelmed with work? What about our elderly/vulnerable patients, friends and relatives? What will happen if we get sick?

The uncertainty and intense media scrutiny of the situation, in addition to the vast amounts of speculation and conjecture, can significantly add to our own anxiety about an unprecedented situation.

As frontline workers in the healthcare system, we are particularly at risk because we encounter very sick people every day. However, we also have the advantages of being able to understand the risk, interpret the data correctly, and utilise our training in hygiene practices and the correct use of personal protective equipment (PPE) to prevent infection spreading to ourselves and those around us.

This is a rapidly evolving situation. We are fortunate in that we have both the data and the experience of other countries, particularly China, Italy and The Netherlands, who have encountered many cases before we have, in order to understand more about how Covid-19 spreads within populations and how containment measures work. We are also extremely privileged to have the expertise of our superb public health, infectious disease and microbiology specialists who are working tirelessly to interpret and communicate the ever-changing news about how the virus is behaving in our community. Helping people to hear the truth above the din of fake news is a challenge, in addition to carefully balancing decisions about the cancellation of public events without creating undue panic or unnecessarily disrupting people’s lives. It is important to remember that these are the experts and have many years of proficiency in this type of scenario. We applaud the amazing job they are doing.

As healthcare individuals, what can we do as we brace ourselves for ‘Storm Covid19’?

1. Firstly, it is important to acknowledge how difficult this situation is for everyone. Even those who are young and healthy have friends or relatives who fit into a risk category for this virus to which no-one has pre-existing immunity.

2. We have a responsibility to inform ourselves and keep up to date with information from accurate sources, including the HSE website and WHO website, amongst others. We should also ensure that we help share this information with others, many of whom are scared and worried for themselves and those they love.

3. When a situation is unclear, it is normal to feel anxious and to seek methods to regain a sense of control.

This table might help as a guideline:

For example, if you are over-exposed to social media content, consider it not important, not under your control, and therefore a waste of time. If you are looking for correct information, this is under your control – you have knowledge of the best data to access. It is not possible to control everyone else, but what they are doing might have an impact on you. Good coping skills include reaching out, switching off (from news/social media), doing things you enjoy and helping others.

4. We need to understand what we can and cannot control. We can control our attitudes and behaviour during this challenging and difficult time and prepare as best we can for what is likely to be a very unpredictable period over the coming weeks and months. We don’t know how long it might take, but it is important to foster hope and a belief that we will get through this together.

5. It is important to model good hygiene practices – for ourselves and those around us. Diligent hand hygiene, cough etiquette, etc, have a huge role to play.

6. Know how to put on and take off PPE before you need it. HSE national lead for healthcare-associated infection Prof Martin Cormican has an excellent YouTube/Twitter video in this regard (see @profgayecunnane). Be a ‘spotter’ for those around you to ensure that they are also employing safe PPE techniques.

7. Have empathy for patients who are unfortunate enough to have contracted this virus. This is a very frightening time for them, especially in the context of HDU/ICU care. And don’t forget that ‘normal medicine’ will still be part of the job – remember the importance of a differential diagnosis and the relevance of co-morbidities, even in the setting of proven Covid-19.

8. Self-care is a major priority. Where possible, try to practice good sleep habits, get some outdoor aerobic exercise, eat healthy food and stay hydrated. We acknowledge that these basic tenets of self-care are difficult at the best of times for NCHDs in particular.

9. Manage your exposure to social media. Some of its content over recent days and weeks has amounted to catastrophising, especially amongst ‘non-experts’. Decide carefully before you forward something you receive. Consider if this is going to be helpful or would it increase someone else’s anxiety. Misinformation can have a negative effect on our wellbeing without changing the reality of the situation we face. This is a good time to focus on and enjoy healthy habits and direct human connections. Concentrate on the here and now.

10. In relation to training programmes and completion of Continuous Professional Development (CPD), Covid-19 has created new learning opportunities, while potentially reducing others e.g. attendance at conferences. It is very disappointing for those who have worked hard to prepare for such events to find them cancelled or postponed. Any difficulties with completion of CPD for the year ending 30 April 2020 can be registered with your professional training body where these current circumstances will be taken into account.

11. Employers have an important role in communication with staff, providing clear policies on pay, sick leave and self-isolation. Support for the latter is vital to guarantee compliance and to prevent the unnecessary spread of infection.

12. If you do find yourself in self-isolation, inform yourself about what it means and ensure that you do not expose anyone else to the possibility of contracting the virus. During this time you should keep in touch with others – for your own wellbeing and in order that they know you are okay. Use the time to re-examine your goals – personal and work – so that you can return to the work force healthy and revived.

13. Extra provision will be made available to the HSE to provide the medical supports needed to care for patients affected by Covid-19. All we can ask of any healthcare workers is that they perform to the best of their ability within the resources available – i.e. to do what is possible, not what is impossible.

14. If you think you have developed symptoms of Covid-19, inform occupational health or the HSE helpline or your GP by phone (do not present to them in person), and isolate yourself until you get further advice.

15. If you find that your mood is being affected by your workload or that you are becoming overwhelmed by these events, it is essential to let someone know – a colleague, line manager, friend – someone who can provide perspective, advice and direction. Added resources are appended below.

Managing the current situation presented by Covid-19 is a collective responsibility where every single person has an important role to play. We can get through this by staying well-informed, acting on the expert recommendations and looking out for one another, both inside and outside of work.

Some helpful resources:

Covid19 information and updates: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/ https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html https://www.who.int/emergencies/diseases/novel-coronavirus-2019 www.rcpi.ie Health and wellbeing wellbeing@rcpi.ie https://www.rcpi.ie/physician-wellbeing/

Employee assistance programme – details available on your employer’s website or at HSE.ie

The association of anaesthetists have very helpful resources in relation to sleep and fatigue http://anaesthetists.org/Fatigue