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This content is taken from the Maudsley Learning & The Tavistock and Portman NHS Foundation Trust's online course, COVID-19: Psychological Impact, Wellbeing and Mental Health. Join the course to learn more.

Skip to 0 minutes and 1 second OK. I’m going to try to keep it down because I need to not get too excited. After all, I am just getting back to full health. I’m going back to work and I’m going back anew. There’s a roll, a step up, that is being advertised that would give me more scope over the decisions to look after my team, but. I am not invincible. It’s so silly to realise that now, I  know, but this has knocked me for 6. One of my team has gone back after being ill, and apparently she is struggling. She’s finding it really hard to be on the Ward and is constantly leaving for breaks, and I don’t blame her.

Skip to 0 minutes and 50 seconds If I have any intention of doing what I love, speaking up for my team while we try to carve out a space for good care, I have got to pace myself. It wasn’t sustainable. I don’t know whether I’m going to have to have stricter rules on when I leave work or ensure that management don’t put targets over staff well being, but something different has to come after this. Clapping once a week is one thing, but enforcing structural and financial changes at an institutional level is another.

Skip to 1 minute and 29 seconds I’m doing it again aren’t I? I’ve got excited.

What next for key workers?

Let’s listen more closely to Carol’s video through the lens of implementing action. We can see she has gone beyond contemplation and has a strong intention or determination to make a change at work.

Her attitude towards the care of her team is positive - it matters to her. She hopes to start a new role where she may feel more in perceived control over implementing some of the change she hopes to see. From the raft of current research papers, frameworks, and governmental policies in place around care for healthcare staff after COVID, it is certainly an accepted social norm to be caring about key workers.

But let’s look at the COM-B model to unpack things further.

  • Capability: Carol knows what care looks like. She knows what it involves and she is able to observe and notice how her team is doing. In this sense, she has some of the skills and knowledge required. But we have also heard that she can struggle at times to recognise and make room for vulnerability, especially her own. In order to care for her team, she may need to be thinking about supervisory courses to gain further skills.
  • Motivation: Carol’s motivation is clearly strong. She consistently aims to look after her team. One thing for Carol to look out for in the coming months is whether she can maintain consistent motivation. A potential threat to this at the moment is that she is recovering from illness and has overworked in the past. This will involve thinking about her own mental and physical health. Though she is identifying a wish to get things done at work, in order to this she will also need to attend to herself to ensure she able to continue to be motivated. A key message being sent to health workers at the moment is: it’s okay not to be okay. Notice how different this is to Carol’s wish in Week 1 for her and her team to be fine.
  • Opportunity: This is where Carol will be more dependent on her surroundings. She wants to ensure her team are well looked after. When we think about this, further useful questions about details and logistics begin to emerge:
  • is there a physical space for staff to meet for supervision or support?
  • is there a regular time to meet?
  • if the wellbeing of her team is to be higher on the agenda, what will give? Another target or outcome? Time with patients?
  • from whom does Carol need permission to make this change? This may not only be immediate management, as targets are issued sometimes at the trust, borough or even national level.
  • recalling our discussion on levels of evidence, how might research articles and data feature in Carol’s plans to implement changes?

Now, with what we’ve learned in our step about psychotherapies, relationships and our emotional world, what and who else Carol might need to think about?

Carol’s husband has played a key role in her care and recovery and is likely to continue to be a source of support. Has she spoken with him about the potential impact of this new role? She also has a son. This means she has other priorities, but her role as a parent may reinforce how motivated she is to ensure care is offered at work, and how much she values this. Kevin speaks to people on a forum and he attends therapy. Will there be a space for Carol in the coming months to receive emotional support as and when she needs it? Will her attitude, motivation, intention, capability, and opportunity to engage in her own care be as powerful?

As we start to drill down on how to usefully convert intention to action, we see how much needs to be thought about. For healthcare behaviour change, where multiple people and systems are involved, more detailed exploration by researchers and clinicians has been done. For example, the Theoretical Domains of Behaviour Change Framework and a recent framework for improving staff wellbeing demonstrate the different levels at which considerations need to be made. We’ll revisit this when thinking about teams and systems.

Let’s now apply our learning to Susan’s situation.

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This video is from the free online course:

COVID-19: Psychological Impact, Wellbeing and Mental Health

Maudsley Learning