{"id":47484,"date":"2020-05-12T08:59:59","date_gmt":"2020-05-12T07:59:59","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47484"},"modified":"2020-05-19T19:48:14","modified_gmt":"2020-05-19T18:48:14","slug":"richard-smith-support-for-health-and-social-care-staff","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/12\/richard-smith-support-for-health-and-social-care-staff\/","title":{"rendered":"Richard Smith: Support for health and social care staff"},"content":{"rendered":"

Health and social care staff are under enormous strain. The weekly clap and being given priority in shops is much appreciated, but how can more direct, practical, and evidence-based emotional support be provided?<\/span><\/p>\n

The Point of Care Foundation<\/a><\/span>\u00a0(of which I\u2019m the unpaid chair) has been providing such support for years\u2014mainly through Schwartz Rounds, which were developed in the United States and are regularly used in some 200 health and social care organisations in the UK and Ireland<\/a>.<\/span>\u00a0They are hour-long confidential meetings of all staff who are interested. They are facilitated and comprise three volunteers telling stories of difficulties and then everybody reacting to the stories, perhaps by sharing their own experiences. They are not about either problem-solving or blaming, but about reflection, sharing, and support. The National Institute for Health Research funded a review of ways of supporting staff emotionally and concluded that Schwartz Rounds had the strongest evidence base<\/a>.<\/span><\/p>\n

Schwartz Rounds are not suitable for support during the pandemic because they depend on a large group meeting together and volunteers share experiences that happened months or years ago and are not too emotionally raw.<\/span><\/p>\n

Recognising the great current need for support, the Point of Care Foundation has come up with Team Time, a new method of support that uses some of the ideas of Schwartz Rounds but with extra safety features. They are shorter (45 minutes), happen online with only the two facilitators and two (not three) storytellers visible, and are restricted to 30 people from the same team. The Point of Care Foundation trained facilitators for Team Time and then piloted it. It\u2019s now being used in the NHS.<\/span><\/p>\n

I\u2019ve attended and written about Schwarz Rounds<\/a>,<\/span>\u00a0but I couldn\u2019t attend a live meeting as I would be an intruder on a team\u2014but I could watch the pilot, which was attended by volunteers from several institutions.<\/span><\/p>\n

The session began with the facilitators describing the nature of Team Time, and then a NHS psychologist told how she had had to self-isolate. She joined work meetings online and saw how tired and drained her colleagues looked, felt bad that she was working at home, and wondered how she could help more. She didn\u2019t like the constant military talk of battles, frontlines, surges, and defenses. At the same time she was hearing unbearable stories of illness in people close to her, some of whom had died. She was close to feeling overwhelmed when she saw her teenage daughter who was having a tantrum over a minor domestic matter. The storyteller took a breath and managed to hug her daughter and say \u201cWe are all doing the best we can.\u201d<\/span><\/p>\n

A surgeon, who was also having to self-isolate and had had colleagues die, described how she worked with a team within a network that had tensions. The network had established a WhatsApp group, which worked well, but one day one of the other surgeons on the network made a derogatory remark about the storyteller\u2019s team. The storyteller was distressed and pointed out the remark to the person who had made it, who immediately apologised. There is, said the storyteller, \u201cso much distress\u201d and we must \u201cbe kind to each other.\u201d<\/span><\/p>\n

Everybody was on mute apart from the person speaking, and people indicated that they wanted to speak by using the chat function. Almost everybody began by saying \u201ccan you hear me?\u201d and I imagine that people will drop that as they get used to online meetings. When I attended Schwartz Rounds there were often pauses before people spoke, but here there were no pauses between speakers. Everybody thanked the storytellers for being brave enough to share their stories, and there were many mentions of \u201csharing\u201d and of there being \u201cstrength in vulnerability.\u201d<\/span><\/p>\n

One man talked about it being hard to manage the wait for something to happen. Many people talked of being scared and those who had had to self-isolate described a feeling of helplessness. A recurrent theme was the difficulty of \u201cswitching off\u201d at home, the increased difficulty of separating work and home, and the worry of infecting family members. One woman described how her seven-year-old daughter kept telling her she was \u201cstaring again.\u201d People spoke of \u201cbeing at war,\u201d and one man compared the pandemic to \u201c9\/11 and the aftermath,\u201d only then the main worry was about the past, whereas now it was about the future.<\/span><\/p>\n

People were asked to feedback after the session not with a survey but in their own words in answer to open questions. I\u2019ve read through all the feedback and it was almost all positive, although it had made people feel emotional.\u00a0<\/span><\/p>\n