Supporting frontline medical staff with bite-size training

A dynamic group of scientists, academics and researchers from Greater Manchester has created a series of printable online materials to help medical professionals stay safe and supported while working on the frontline of the COVID-19 response.

The challenge

The group, made up of experts from The University of Manchester and Salford Royal NHS Foundation Trust, was commissioned by the National Health Service (NHS) tasking team to provide frontline workers with rapid psychological and behavioural support during the pandemic. 

Combining their expertise in disaster response, crisis psychology, high-pressure decision-making and human performance, they established the Support The Workers collective. Their output includes the production of 15 short evidence-based briefing notes that that can be read quickly by busy medical teams in hospital staff rooms. The information sheets give practical advice on leadership, post-traumatic stress disorder (PTSD), decision-making, sleep, anxiety and fear, and motivation. 

“There are lots of extra demands on our doctors and nurses and they’re facing additional challenges which they might not be used to,” says Dr Nathan Smith, Research Fellow in Psychology, Security and Trust at the University and a specialist on human performance under extreme stress. 

“People are comparing this to wartime but there are some stark differences. In wartime you typically have a visible enemy, but in the current situation there are so many uncertainties and unknowns that are anxiety-inducing. By working with colleagues who have been in some extreme environments, including some that have dealt with previous outbreaks such as tropical diseases, we’ve devised practical guidelines that can help in this situation.”

Inspiration from the extremes 

For Dr Smith, there are parallels between this challenge and his previous work. With an interdisciplinary team at Manchester, he has been working on the development of DRiFT, a smart, personalised tool which helps support peoples’ health in extreme situations based on a digital library of insights from experienced explorers. The tool matches user behaviour and psychology, providing guidance on staying safe in high-risk situations, such as on submarines and on remote expeditions, to maintain optimum performance and health while at work.

“In extremes, one of the consistent findings where people have lost loved ones or been affected by terrible incidents, is that the majority of people have a capacity to be resilient and cope with adversity. Those on the frontline will experience different emotions and intuitively, we’ll be drawn to the negative things first such as fear and anxiety, sadness and grief – feelings which are important to acknowledge as they are natural in these situations,” he explains.

“At the same time, people might experience emotions such as pride in doing really important work, satisfaction with saving people’s lives, feeling connected to colleagues because they are sharing the experience and feeling valued by society.”

Practical solutions in the UK and abroad

Since its launch, the Support The Workers website has drawn positive attention from global organisations. Notably, in the US, Johnson & Johnson has used the materials on their COVID-19 online learning channel

“I have been collaborating in various forms with colleagues involved in the Support The Workers activity for a number of years so to see that we are getting recognition from influential organisations like Johnson & Johnson during this crisis is incredible,” says Dr Smith. “It’s nice to be reminded of what we’re doing and, so far, up to 30 professors, junior researchers, post-PhD researchers and emeritus professors have contributed.” 

Dr John Sorensen, Consultant Clinical Psychologist at Salford Royal NHS Foundation Trust, says: “When a relatively static system with a known demand is hit with rapid and ever-changing response requests, as was the case with the early stages of the COVID-19 crisis, a risk is that well-established protocols for evidence-based practice are not adhered to in the rush to help. 

“The work led by Dr Smith has been a collaboration of immense value and rigour in keeping us grounded in best practice without slowing our response ability down. 

“There truly is nothing as practical as a good theoretical framework when this is skilfully translated into actionable guidance. That has been the case in this outstanding and rewarding collaboration between academics and practitioners amidst the COVID-19 storm.” 

Support The Workers are now producing more PDFs for UK medical teams following further NHS requests.

Dr Smith's top tips for medical professionals:

  1. Focus on the basics for healthy function: sleep, nutrition, hydration and technical and psychological preparedness.
  2. Physical (eg being free from injury/illness and having the right equipment), psychological (eg capacity to regulate mood and emotion) and social factors (eg having access to good social support) contribute to resilience: taking care of all of these areas is important to sustain function over the long term.
  3. Leaders have a crucial role to play in supporting the health and wellbeing of their staff, but they must also take care of themselves. Leaders’ mood and emotions can influence others, so it is critical that they take steps to stay happy and healthy too.
  4. There will be difficult decisions to make during the outbreak. Clear protocols and procedures, tailored to the situation and communicated to staff, are important to guide decision-making.  
  5. The majority of individuals are likely to be resilient to stress, but some may struggle with depression, moral injury or post-traumatic stress disorder (PTSD). Having space to discuss challenges and good peer and leader support will help manage potentially traumatic or morally injurious experiences. 

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