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How might COVID-19 affect key workers?

In this step, we'll hear a nurse's story, explore factors impacting the psychological well-being of key workers, and watch a video of Dr. Jo Stubley
© Maudsley Learning © Tavistock & Portman NHS FT
In this step, we’ll hear the first part of Carol’s story. We’ll then explore factors impacting the psychological well-being of key workers, and hear again from Dr. Stubley.
In this step, we’ll focus on health workers, but many factors will translate to carers, other key workers, and employees more generally.

Carol’s Story

This is an additional video, hosted on YouTube.

Download Transcript of Carol’s Story Part 1 (right click or tap/hold and open in new tab) (right click or tap/hold and open in new tab)
Let’s begin by asking, what are frontline key workers who have been quarantined at risk of experiencing?
Suicidality? Insomnia? Irritability? Vicarious trauma? Depression? Anxiety? Alcohol and drug misuse?
The answer according to recent research is, All of the above. “Risk of experiencing”, does not mean all staff will develop these issues, and research suggests that for many, any initial symptoms will abate after a few months. Nevertheless, this is a staff group that need attention and care in the coming weeks and months.

Barriers to recognising distress in health workers

For health workers, the conversation can often be on more comfortable ground when we are talking about service users. Maybe in regard to the vulnerabilities they experience, perhaps how trust is difficult for some, or how others struggle with self-care. It can be more challenging when the conversation turns to our own stresses or concerns.
As you’ll hear from our expert speakers, now is not the time for excessive reflection or therapy work for front-line staff. We are still in the middle of our COVID-19 response. However, it can be helpful to hold in mind that frontline workers, like others, can find situations relating to well-being and vulnerability difficult.
We heard Carol talk about not being allowed to show vulnerability or weakness. She is displaying here a common state of mind – “I must be strong” – and she has conflated strength with not showing emotion or fatigue.

Pause for thought

What do we think about this as a group of learners? Have we experienced this in ourselves or colleagues?
Various factors can contribute to this. Carol is struggling at two levels – as a front-line worker, and as a manager. First, let’s think about her role as a nurse on the front-line. She has chosen a caring profession with core values of helping, being useful, alleviating suffering, and supporting others. This current pandemic will create situations where these goals are not possible.
What care situations might leave a patient or service user feeling distressed or upset? In our clinical work, we find it is situations involving uncertainty, a prolonged period of illness, not feeling looked after, and feeling powerless.
So what situations might leave a carer feeling more distressed? Unsurprisingly, the answer is similar. Uncertainty and powerlessness, not being able to fix or solve the issue, and not feeling useful or helpful. You’ll have heard about “burn out” in staff – but problems exist also at the opposite end of the spectrum. Many staff on COVID wards are currently experiencing feelings of guilt when they feel as if what they’re doing is not enough.
We know that sometimes there can be an excess of staff called to the frontline. At other times the disease is too strong. On other occasions, patients seem to not look after themselves. Each off these situations knocks us off track as care workers, putting us in the position of not being able to deliver the care that we want. When this happens, feelings of guilt and frustration can arise. This is known as moral distress and injury.
Noticing these difficulties in ourselves and colleagues can be useful. Frontline workers can often be comfortable with offering care, but at times, like many of us, they have a more complex relationship to receiving care – this is something to look out for in ourselves and our colleagues. “I’m fine,” Carol says, “I can keep going”.
The video below from Jo focuses on some of the issues that key workers may face during the COVID-19 pandemic.

This is an additional video, hosted on YouTube.

Download Transcript of Jo Stubley on Key Workers (right click or tap/hold and open in new tab) (right click or tap/hold and open in new tab)
So, these are some issues at the individual level that can affect key workers. We must also keep in mind that what counts as the frontline and who we include as key workers will shift over the coming months. To take one example, as schools re-open, we will need to think seriously about the impact on teaching staff. Do share your thoughts in the discussion below.
We’ll hear soon about Carol’s struggles as a manager, issues around not feeling looked after at a systemic level, and more about the concept of moral injury.
© Maudsley Learning © Tavistock & Portman NHS FT
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COVID-19: Psychological Impact, Wellbeing and Mental Health

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