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Invisible PPE

On top of jobs that are busy and stressful, healthcare workers now have to deal with fear.  How can colleagues look after themselves - and be looked after by others - in these extreme circumstances?

The outpouring of support for those who work in any form of healthcare is unprecedented, as shown in the “Clap for carers” happening around the globe. Being valued for what you do is a major contributor to feeling positive about work, and in times like these, recognition goes a long way to feeling purposeful even when the days are long and tough.

But, being fêted isn’t enough. Public support, though welcome, cannot mitigate healthcare workers’ valid fear of the effects of Covid-19 on their patients, their families, and themselves. Being classed as an essential worker doesn’t grant you immunity to the anxiety that an infectious disease brings. People working in healthcare settings are exposed to spit, blood, poo and wee on a daily basis. They’re used to taking routine precautions around these occupational hazards. These consistent protocols give them a sense of control about their environment.

Even when staff know their safety can never be completely guaranteed, the provision to staff of appropriate personal protective equipment (PPE) is non-negotiable. This is as true for the anaesthetist working in intensive care, the mental health nurse in the community, or the care assistant in a residential home. The rush by authorities from New Delhi to New York to procure supplies from wherever they can shows the seriousness with which this is being taken.

Yet in the dash for masks there’s a risk that we turn the conversation about protection into a robotic one: solve the supply of surgical masks, and the machine is good to go.

Yet in the dash for masks there’s a risk that we turn the conversation about protection into a robotic one: solve the supply of surgical masks, and the machine is good to go. Although understandable, such a fixation on equipment risks overlooking the humans we’re actually equipping. Regardless of what they’re wearing, the physical, mental and moral pressures Covid puts on staff creates significant potential for harm, as seen in gut wrenching technicolor in Bergamo.

While visible PPE is highly necessary, it is not sufficient to protect staff from Covid’s grasp. What’s needed is the invisible PPE to help colleagues cope with the current situation. What does this look like? Three areas to start, for staff and their organisations alike:

1. Conversation

Having an environment of psychological safety to be able to decompress, reflect and learn. For individuals to remember to stay in contact with friends outside their job, and know who inside work they can debrief with and share stories, both good and bad. For organisations to acknowledge the stress that staff will be under and to proactively support reflective conversations rather than leaving it to chance. For leaders to role-model the behaviours they want to see, being open as to their fears, showing vulnerability, and how they are taking care of themselves.

2. Space

Carving out the physical and mental space to pause. For individuals finding space from caring to get a bite to eat, to take a moment for deep breaths while hand washing; finding outdoor space away from strip lights and machines, and not just walking to your car; finding space from other pressures (that new diet can probably wait) or the news (the context doesn’t change the reality of what you’re doing). For organisations to provide wobble rooms, or accommodation and wellbeing centres, or going home checklists to help staff switch off.

3. Love

For ourselves and each other in some of the most testing circumstances of our careers. For individuals to say thank you and to take a moment to appreciate the thanks others offer, to write down what they are doing that makes themselves proud, to celebrate the positives and not let the agonising challenges crowd them out. For organisations to do everything with kindness, empathy and appreciation, caring about the details (meals, transport, good communications) that can sap energy no-one will have left over to give. For all to show love to those they are caring for, and the families waiting, apart, in isolation.

Conversation. Space. Love. Some may feel uncomfortable at the third, preferring ‘niceness’ or ‘kindness’ instead. So why love? At its heart, love is about commitment and devotion over time. All of us are capable of kindness for a moment, and it is undoubtedly highly needed. Yet our systems will need love to keep them functioning for the years in which Covid’s effect will be felt.

Those clapping on their front doorstep will remember why they did so. The love that is so necessary to carry us through the storm now can carry us forward to create stronger healthcare systems for the future. Post-Covid planning has already started in France with pledges of more funding and facilities. Such ‘visible’ change is needed, yet it might be the ‘invisible’ changes to the fabric of healthcare, the cultural contract held with, and between, healthcare staff that could have the biggest long term effect. Out of darkness, can come light.

With thanks to Samantha Buttemer, David Haslam and Rich Taunt for their contributions to this blog.

Ted Adams15 April 2020


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