Essential tips for front line workers during COVID (Dr D Ong)

On the 11th of March 2020, the World Health Organisation (WHO) declared coronavirus disease (COVID-19) as a global pandemic. In the United Kingdom (UK), radical changes have been implemented within the National Health Service (NHS) affecting the way hospitals are run on a day-to-day basis. The effects of these changes are uncertain and may compound to pre-existing high levels of stress experienced by the healthcare professionals (6, 7, 8). Here, we offer several tips to help navigate through the COVID-19 pandemic.

Tip 1: Make sure you get plenty of rest.
Preparing for work is an essential but often overlooked part of the day. Getting adequate rest by routinely going to bed in a timely manner should help ensure good sleep hygiene of at least 6-8 hours’ sleep each night (9). Also plan your wake up. Allow enough time for you get ready and arrive punctually for work. In addition, you can also spend your commute preparing mentally for your shift by listening to an upbeat tune or even use a mindfulness app to encourage positivity (10).

Tip 2: Be up to date with the facts, especially in relation to personal protective equipment.
Be up to date with the facts from reliable sources but not over consumed by them. Government recommendations and hospital policies to personal protective equipment (PPE) are changing on a daily basis, predominantly governed by resource availability and emerging evidence from international bodies such as the World Health Organisation (WHO) (11, 12). If you have not been tested for the most suitable PPE for yourself, ensure you get tested prior to any exposure to suspected COVID-19 cases (13). Continue to practice social distancing by staying at least 2 meters away from others whilst at work, if possible (14).

Tip 3: Make sure you eat some food and drink plenty of water throughout the day.
This may seem obvious, however is often neglected out with a global pandemic. Ensure you eat your meals in a timely manner. Many often look forward to meal times as it breaks up the day and allows them to regroup and collect their thoughts away from the busy stressful clinical environment. Drink plenty of water or fluids especially if you are wearing PPE the whole day (15). There may be a natural tendency to delay rehydrating yourself as it will require disposing and re-donning PPE. Nevertheless, take plenty of breaks to ensure you are looking after yourself first and foremost.


Tip 4: Be supportive towards your colleagues.
Support your colleagues. No one else will really appreciate what you are dealing with on the frontline. So, check in on each other from time to time if you are working on different wards. Lean on each other and offer to help one another.

Tip 5: Be prepared to be flexible with your expected role and shift patterns.
There have been fundamental changes to in-hospital patient encounters. For example, many elective surgical procedures have been postponed and outpatient clinic appointments have been changed to virtual meetings (16). In addition, many junior doctors have been redistributed to ensure adequate care is provided to the influx of COVID-19 patients (2). So be open minded. Be prepared to acquire new skills. Support should always be available if you are uncertain.


Tip 6: Interact with individuals in your household.
There are genuine concerns about protecting loved ones who may be vulnerable, at the same time as having the unconditional desire to help those affected. Some have compromised and decided to live separately. If you are living with your loved ones, give them a hug. Hard and often, after having a shower of course and talk to each other. If you are struggling to cope, ensure you tell someone. Support is available (17).

Tip 7: If you are unwell take time off.
Self-isolate when indicated as suggested in Public Health England guidance. There may be a tendency to feel guilty knowing that your team will be stretched in your absence. However, it is important to appreciate that self-isolation forms the cornerstone of containing the spread of COVID-19 and protecting colleagues and patients.

Tip 8: Have hope.
Amongst the reported daily death toll, frustrations and worries there is good. We have inspired public support and admiration. Commercial companies are gifting free meals and refreshments to hospitals. Furthermore, many organisations are offering free/discounted services for healthcare workers. We are also honoured as ‘NHS Heroes’ and receive weekly appreciation from the public (18). Sometimes the brightest light comes from the darkest place. Remember it will pass. You can only do your best.

Conclusions
The COVID-19 pandemic has been touted as the biggest challenge faced by the NHS since its inception in 1948. We hope by adopting the above tips healthcare workers may gain some structure to their ever-changing lives during this global pandemic.

References:
1. About Worldometer COVID-19 data – Worldometer [Internet]. Worldometers.info. 2020 [cited 28 April 2020]. Available from: https://www.worldometers.info/coronavirus/about/
2. Kituno N. Junior doctors’ rotations paused amid covid-19 pandemic [Internet]. Health Service Journal. 2020 [cited 28 April 2020]. Available from: https://www.hsj.co.uk/workforce/junior-doctors-rotations-paused-amid-covid-19-pandemic/7027136.article
3. Coronavirus » Wherever you can help, your NHS needs you [Internet]. England.nhs.uk. 2020 [cited 28 April 2020]. Available from: https://www.england.nhs.uk/coronavirus/returning-clinicians/
4. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open. 2020 Mar 2;3(3):e203976.
5. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, Wang Y, Hu J, Lai J, Ma X, Chen J. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. The Lancet Psychiatry. 2020 Mar 1;7(3):e14.
6. Schaefer JA, Moos RH. Work stressors in health care: context and outcomes. Journal of community & applied social psychology. 1993 Nov;3(4):235-42.
7. Petterson IL, Arnetz BB. Psychosocial stressors and well-being in health care workers. The impact of an intervention program. Social Science & Medicine. 1998 Dec 1;47(11):1763-72.
8. Khalid I, Khalid TJ, Qabajah MR, Barnard AG, Qushmaq IA. Healthcare workers emotions, perceived stressors and coping strategies during a MERS-CoV outbreak. Clinical medicine & research. 2016 Mar 1;14(1):7-14.
9. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L, Neubauer DN. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep health. 2015 Mar 1;1(1):40-3.
10. Unmind | Mental wellbeing. Done well. [Internet]. Home.unmind.com. 2020 [cited 28 April 2020]. Available from: https://home.unmind.com/
11. Technical guidance [Internet]. Who.int. 2020 [cited 28 April 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
12. New personal protective equipment (PPE) guidance for NHS teams [Internet]. GOV.UK. 2020 [cited 28 April 2020]. Available from: https://www.gov.uk/government/news/new-personal-protective-equipment-ppe-guidance-for-nhs-teams
13. Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. Journal of Hospital Infection. 2020 Mar 6.
14. Social distancing, keeping businesses open and in-work activities during coronavirus outbreak – HSE news [Internet]. Hse.gov.uk. 2020 [cited 28 April 2020]. Available from: https://www.hse.gov.uk/news/social-distancing-coronavirus.htm
15. Sawka MN, Cheuvront SN, Carter R. Human water needs. Nutrition reviews. 2005 Jun 1;63(suppl_1):S30-9.
16. Statistics » Cancelled Elective Operations [Internet]. England.nhs.uk. 2020 [cited 28 April 2020]. Available from: https://www.england.nhs.uk/statistics/statistical-work-areas/cancelled-elective-operations/
17. If you’re worried about your mental health during the coronavirus outbreak [Internet]. Samaritans. 2020 [cited 28 April 2020]. Available from: https://www.samaritans.org/how-we-can-help/support-and-information/if-youre-having-difficult-time/if-youre-worried-about-your-mental-health-during-coronavirus-outbreak/
18. How to join in with tonight’s national ‘Clap For Our Carers’ event for NHS and key workers [Internet]. The Independent. 2020 [cited 28 April 2020]. Available from: https://www.independent.co.uk/life-style/health-and-families/coronavirus-nhs-workers-applause-clap-for-our-carers-when-time-covid-19-a9426906.html

Authors:
Daniel Ying Yao Ong DYYO
Elena Ying Ern Ong EYEO
Wen Ling Choong WLC
Mohammed Abdul Waduud MAW
*corresponding author email: daniel.ong1@nhs.net / elena.ong@nhs.net
*twitter handle: @TipTopDocs @dr_waduud

Affiliations:
1. Foundation Programme, Ninewells Hospital and Medical School, Dundee, DD1 9SY
2. Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY
3. Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds, S2 9LU.

Notes on contributors:
DYYO is a Foundation Year 2 doctor who graduated from The University of Manchester in 2018, currently working in General Surgery in Ninewells Hospital, Dundee.
EYEO is a Foundation Year 2 doctor who graduated from The University of Dundee in 2018, currently working in Medicine for the Elderly in Royal Victoria Hospital, Dundee.
WLC is a Specialty Registrar in General Surgery at Ninewells Hospital and Medical School, Dundee. She graduated from University of Dundee in 2012.
MAW is a British Heart Foundation Research Fellow at the University of Leeds and an Honorary Specialty Registrar in Vascular Surgery at the Leeds Vascular Institute.

(Visited 357 times, 1 visits today)