Workforce wellbeing centres and their positive role for wellbeing and presenteeism in healthcare workers during the COVID-19 pandemic: secondary analysis of COVID-Well data

BACKGROUND

Supported wellbeing centres established during the COVID-19 pandemic provided high quality rest spaces and access to peer-to-peer psychological first aid for healthcare workers (HCWs). The centres were well accessed and valued by HCWs, but their relationship with wellbeing and job-related factors is not well established. The aim of this study was to explore the relationship between wellbeing centre use, HCWs wellbeing and job-related factors (job stressfulness, job satisfaction, presenteeism, turnover intentions).

METHODS

Secondary analysis of data from 819 HCWs from an acute hospital trust who completed an online survey in April-July 2020, as part of the COVID-Well study. Measures included the Warwick Edinburgh Mental Wellbeing Scale, and four single-item global measures of job stressfulness, job satisfaction, presenteeism and turnover intentions. ANCOVA models and regression analyses were conducted on these data.

RESULTS

HCWs who had not accessed the wellbeing centres had lower wellbeing (β = 0.12, p < .001), higher job stressfulness (β = - 0.22, p < .001), lower job satisfaction (β = 0.39, p < .001), higher presenteeism (β = - 0.22, p < .001) and were of younger age (β = 0.09, p = .002). Centre use was associated with wellbeing irrespective of job stressfulness. Those reporting presenteeism and who accessed the centre (M = 3.30, SE = 0.04) had higher wellbeing than those who accessed the centre but did not report presenteeism (M = 3.06, SE = 0.04) (F(1, 791) = 18.65, p < .001, ηp2 = 0.02). Centre use was not significantly associated with turnover intentions (B = - 0.30, p = .13; Wald = 2.26; odds = 0.74), while job stress and job satisfaction showed significant effects.

CONCLUSIONS

Accessing wellbeing centres was associated with higher wellbeing of HCWs, particularly for those reporting presenteeism. Therefore, the centres may have provided greatest respite and restoration for those present at work but not in optimal health. Younger workers were disproportionately affected in terms of wellbeing, and targeted support for this population is needed. Strategies to decrease presenteeism and maximise job satisfaction are urgently required. Healthcare organisations should provide rest spaces and psychological support to HCWs for the long-term, as part of a systems-wide approach to improving workforce health and wellbeing.

In search of an international multidimensional action plan for second victim support: a narrative review

BACKGROUND

Insights around second victims (SV) and patient safety has been growing over time. An overview of the available evidence is lacking. This review aims to describe (i) the impact a patient safety incident can have and (ii) how healthcare professionals can be supported in the aftermath of a patient safety incident.

METHODS

A literature search in Medline, EMBASE and CINAHL was performed between 1 and 2010 and 26 November 2020 with studies on SV as inclusion criteria. To be included in this review the studies must include healthcare professionals involved in the aftermath of a patient safety incident.

RESULTS

In total 104 studies were included. SVs can suffer from both psychosocial (negative and positive), professional and physical reactions. Support can be provided at five levels. The first level is prevention (on individual and organizational level) referring to measures taken before a patient safety incident happens. The other four levels focus on providing support in the aftermath of a patient safety incident, such as self-care of individuals and/or team, support by peers and triage, structured support by an expert in the field (professional support) and structured clinical support.

CONCLUSION

The impact of a patient safety incident on healthcare professionals is broad and diverse. Support programs should be organized at five levels, starting with preventive actions followed by self-care, support by peers, structured professional support and clinical support. This multilevel approach can now be translated in different countries, networks and organizations based on their own culture, support history, structure and legal context. Next to this, they should also include the stage of recovery in which the healthcare professional is located in.

Exploring the psychological impact of contact tracing work on staff during the COVID-19 pandemic

BACKGROUND

Contact tracing is a key control measure in the response to the COVID-19 pandemic. While quantitative research has been conducted on the psychological impact of the pandemic on other frontline healthcare workers, none has explored the impact on contact tracing staff.

METHODS

A longitudinal study was conducted using two repeated measures with contact tracing staff employed in Ireland during the COVID-19 pandemic using two-tailed independent samples t tests and exploratory linear mixed models.

RESULTS

The study sample included 137 contact tracers in March 2021 (T1) and 218 in September 2021 (T3). There was an increase from T1 to T3 in burnout related exhaustion (p < 0·001), post-traumatic stress disorder (PTSD) symptom scores (p < 0·001), mental distress (p < 0·01), perceived stress (p < 0·001) and tension and pressure (p < 0·001). In those aged 18-30, there was an increase in exhaustion related burnout (p < 0·01), PTSD symptoms (p < 0·05), and tension and pressure scores (p < 0·05). Additionally, participants with a background in healthcare showed an increase in PTSD symptom scores by T3 (p < 0·001), reaching mean scores equivalent to those of participants who did not have a background in healthcare.

CONCLUSIONS

Contact tracing staff working during the COVID-19 pandemic experienced an increase in adverse psychological outcomes. These findings highlight a need for further research on psychological supports required by contact tracing staff with differing demographic profiles.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond

OBJECTIVE

The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation.

METHODS

Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services.

RESULTS

Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future.

CONCLUSION

Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

COVID-19: Implications for Nursing and Health Care in the United States

PURPOSE

COVID-19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID-19 far more damaging in the United States (U.S.) than necessary.

DESIGN AND METHODS

Guided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio-ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.' handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID-19 pandemic through a review and analysis of the COVID-19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus.

FINDINGS

Four critically important, inter-related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce.

CONCLUSIONS

The four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID-19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all.

CLINICAL RELEVANCE

The novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID-19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi-level solutions across critical domains. The COVID-19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi-level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID-19 pandemic and future pandemics, and offers recommendations to achieve these aims.

Development study of psychological first aid application self-efficacy scale

PURPOSE

The aim of this study is to develop a measurement tool that can be utilized to determine in the psychological first aid application of self-efficacy.

DESIGN AND METHOD

The development of scale consisted of the following stages: literature reviews, examination of the conceptual structure, creation of scale items, expert advice, and individual and focus group interviews.

FINDINGS

A measurement tool was obtained by factor analysis, consisting of one factor and 35 items. The obtained scales were statistically significant, thereby providing a sensitive measurement (p < 0.05).

PRACTICE IMPLICATIONS

This measurement tool would assist in determining the self-efficacy of psychological first aid administered by aid providers working in disaster situations, thereby increasing the quality of their intervention.

MusicTeamCare (MTC): Theory and practice of clinical intervention for music therapists offering remote support to clients during emergencies

The COVID-19 pandemic meant that people’s lives and work changed significantly across the world. Governments took measures such as social distancing, lockdowns and quarantine protocols to stem the spread of the pandemic. This had a significant impact on music therapy clinical practice, generating reflections and adaptations among the worldwide music therapy community, with several studies still underway. A number of professional music therapy organisations have explored methods for carrying out remote interventions. MusicTeamCare is an approach developed by three Italian Certified Music Therapists that could offer access to support in emergency and crisis situations. This approach is rooted in receptive music therapy theory, with particular reference to Guided Imagery and Music (GIM). MusicTeamCare was used for the first time in March to April 2020, with healthcare workers in Italy who were treating COVID-19 patients. This article outlines theoretical framework, development and evaluation phases of MusicTeamCare. Detailed explanations are given of the theoretical framework, methods of musical analysis, assessment and evaluation strategies, criteria for constructing the playlists and interactive triangulation between the Music Therapists in the research team.

Building a critical incident peer response team: A full theatre team welfare intervention

The psychological impact (second victim effect) of in-theatre critical incidents is increasingly recognised. Different styles of psychological support programme have recently been published, including some utilising 'near in time' peer support. Most of these programmes either target their support to individuals, or focus on one vocational group rather than the multidisciplinary team. However, the in-theatre team consists of different craft groups who nonetheless function as a single team and are therefore 'peers'. This paper sets out the design and implementation of a critical incident peer response programme at Waikato Hospital, New Zealand, which provides peer-led group psychological first aid to full theatre teams. The programme is administered by trained representatives from multiple in-theatre craft groups including nurses, midwives, anaesthetic technicians, recovery room nurses, surgeons and anaesthetists. It emphasises team education and peer support, and has a wholly welfare focus. The programme has voluntary participation but mandatory activation triggers so that individuals do not need to seek support actively at a time when they may not recognise the need to do so. The programme is becoming embedded in the Waikato Hospital theatre culture so that participating in psychological support is normalised following a critical event. This framework is shared in the hope that it will assist other hospitals to develop welfare interventions to support full theatre teams.

COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement.

METHODS

We conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services.

RESULTS

We included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that "COVID-19-related psychosocial care" (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential.

CONCLUSION

More than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04753242, version 11 February 2021.

Collaborative Approach to Supporting Staff in a Mental Healthcare Setting: "Always There" Peer Support Program

This paper describes the development and implementation of a peer-support program Always There in a large public mental health service in Queensland, Australia. The program is modelled on Scott's three tier model of peer support, with trained responders providing emotional support to staff following a traumatic adverse event, or when experiencing acute or cumulative stress. Support is provided in complete confidentiality. Main lessons learned in the 2 years since the launch of the program are shared in this paper, outlining successes such as improvements in staff's perception of organisational culture, and challenges related to embedding the program to "business as usual".

Applications of peer support in disasters: connecting in times of disaster

Disasters invariably result in a surge in demand for mental health services, and this surge quickly exceeds available mental health resources. The pursuit of alternative sources of psychological support for communities adversely affected by disasters has therefore been necessitated. This paper describes the application of an awarding-winner, empirically validated, model for psychological support and its applicability for enhancing community disaster mental health resources that are consistent with United Nations' recommendations for a "whole society" approach to disaster mental health. The model utilises the concept of peer-based psychological support. Peer psychological support is defined as the utilisation of individuals specially trained in the provision of acute psychological crisis interventions and psychological first aid, but who do not possess professional-level training or licensure in one of the mental health disciplines. These peer-based crisis intervention services may be delivered telephonically, via the internet, or face-to-face. This model, referred to as Reciprocal Peer Support (RPS), is the peer support activity provided at Rutgers University Behavioural HealthCare (UBHC) National Center for Peer Support in a variety of peer programs. More than 20 years of peer support interventions have been reviewed and assessed to clarify the lessons learned for the application of RPS as a prime exemplar for the utilization of peer support during and after a disaster. The Cop 2 Cop, NJ Vet 2 Vet, and several other UBHC peer support programs, which conform to best practices criteria, have been created, sustained, and expanded based on the RSP principles discussed in this article. RPS and derivative applications for human-made disasters such as the terrorist events of 9/11/2001 as well as natural disasters such as Hurricane Katrina or the COVID- 19 pandemic represent platforms for the implementation of peer psychological support and the establishment of a peer-based continuum of psychological connection.

Psychological First Aid Training: A Scoping Review of Its Application, Outcomes and Implementation

Worldwide commitment to disseminate Psychological First Aid (PFA) training to enable frontline workers to support distressed individuals and/or manage their own self-care is increasing, but the evidence base of PFA training is uncertain. Method: a scoping review was undertaken by searching seven databases and hand-searching grey literature to maximise coverage of potential studies. Results: Twenty-three studies met the inclusion criteria. Three PFA training models were commonly used in research studies. A broad selection of PFA training outcomes were observed including learning, behavior, satisfaction and practice in crisis mental and behavior health preparedness. Conclusions: Research evidence of reasonable quality demonstrates that PFA training significantly improves knowledge of appropriate psychosocial response and PFA skills in supporting people in acute distress, thereby enhancing self-efficacy and promoting resilience. However, this review highlights inadequate guidance on how PFA training should be applied and adapted, significant shortcomings of reporting PFA training delivery, limited training evaluation and unclear training outcomes. Whilst behavioral, knowledge and system impact of the PFA training are promising, methodologically stronger evaluations which include systematic training adaptation and selection of sensitive outcome measures is needed to strengthen future implementation of PFA training and thereby enhance population preparedness for future emergencies.

Evaluating a Psychological First Aid Training Intervention (Preparing Me) to Support the Mental Health and Wellbeing of Chinese Healthcare Workers During Healthcare Emergencies: Protocol for a Randomized Controlled Feasibility Trial

AIMS/BACKGROUND

The mental health challenges faced by frontline healthcare workers responding to emergencies have become a prominent public concern. Despite the consensus that Psychological First Aid (PFA) training can effectively support public mental health during emergencies through reducing acute distress and improving self-efficacy, yet it is concerning that previous flexible delivery and neglect for evaluating PFA training has resulted in unintended potential harms which may prevent further proactive uptake of this mental health prevention strategies. Establishing the feasibility of the PFA training through adapting to the local culture, tailoring to frontline healthcare context, and evaluating systematically may be helpful to inform a large trial, or ensure effective and sustained training delivery. This study aims to present a protocol for evaluating the feasibility and acceptability of a well-adapted PFA training intervention (Preparing Me) to address the implementation gap in this mental health promotion approach.

METHOD

This is a two-armed feasibility randomized controlled trial (RCT) to be conducted among 80 Chinese frontline healthcare workers without prior related mental health training. Participants from the intervention group will receive an adapted PFA training program tailored to the Chinese frontline context to improve their knowledge and skills to support people in crisis. The primary objectives are to evaluate the training intervention's feasibility and the target population's acceptance of this educational intervention. The secondary objective is to obtain preliminary estimates of variability in participants' outcomes over a 3-months period. Measurements are taken pre-intervention (T0), post-intervention (T1), and at 1- and 3-months follow-up (T2-T3). A process evaluation using qualitative research with a subgroup of trainees, their clinical managers as well as trainers will be conducted to gain a comprehensive understanding of the intervention's acceptability and feasibility.

DISCUSSION

This present study protocol will help to establish whether this adapted PFA training intervention is feasible and accepted by the frontline healthcare workers, in preparation for a later effectiveness trial. It is anticipated that the resulted information would be an impetus to maximize usability and acceptance of this low-intensity PFA skillset by a wider population, thus supporting the mental health of frontline healthcare workers in dealing with crises for future emergencies.

TRIAL REGISTRATION

This trial has been approved by the Institution Review Board from Central South University (LYG2020029) and by the Psychiatry, Nursing and Midwifery Research Ethics Committee at King's College London, England (LRS/DP-21/22-23161). It also has been processing registration at the Chinese Clinical Trial Registry.

Report of the Academy of Consultation-Liaison Psychiatry Task Force on Lessons Learned From the COVID-19 Pandemic: Executive Summary

BACKGROUND

The COVID-19 pandemic forced consultation-liaison psychiatrists to adapt to unprecedented circumstances. The Academy of Consultation-Liaison Psychiatry (ACLP) recognized the need and opportunity to assess its response and convened a task force in mid-2020 to review the lessons learned from the initial experience of the COVID-19 pandemic.

OBJECTIVE

The aim of the study was to summarize experience and make recommendations to the ACLP Board of Directors about potential ACLP directions related to current and future pandemic response.

METHODS

In August-November 2020, the task force reviewed local experiences, ACLP list-serv contributions, and the published literature and generated recommendations for ACLP actions.

RESULTS

Recommendations addressed telepsychiatry, hospital staff wellness, support for consultation-liaison psychiatrists, the need for additional research on psychiatric and neuropsychiatric aspects of COVID-19, and the ACLP's role in advocacy and dissemination of information. The task force report was submitted to the ACLP Board of Directors in November 2020.

CONCLUSIONS

As the preeminent organization of consultation-liaison psychiatrists, the ACLP can implement actions related to pandemic awareness and preparedness for the benefit of consultation-liaison psychiatrists, other health care workers, patients, and the general population.