Supporting healthcare professionals through challenging times

COMMUNICATING THROUGH COVID #1: UNDERSTANDING THE CHALLENGES

Communicating through Covid is a multidisciplinary, collaborative research project drawing together artists, healthcare professionals and academics from drama and medical education, to investigate how arts based approaches can support healthcare professionals through the communications challenges which have arisen from COVID-19.

When the project started in January 2021, we imagined that we would identify a set of specific, COVID-related challenges to communication – relating to wearing masks and PPE, increased use of video and telephone consultations, social distancing and limitations on touch – which, by working with our team of Associate Artists, we could then devise strategies to address. But as the pandemic continued, it became clear that our landscape had almost irrevocably changed: COVID, new variants, and the challenges they bring are here to stay. Equally, many of the challenges that our research uncovered existed before COVID, but were exacerbated by the challenges and constraints of the pandemic, demonstrating the need for wider context interventions.

In the first of three blog posts, we will be reflecting on what we’ve learnt so far.

The first phase of the research saw us trying to understand the communications challenges that healthcare professionals were facing as a result of the pandemic. In addition to reviewing existing and emerging literature, we conducted 13 interviews with healthcare professionals across our four partner sites from December 2021 to January 2022. We spoke to a range of staff, including medical students, nurses, GPs, anaesthetists, paediatricians and physiotherapists, working in settings ranging from Accident & Emergency and Intensive Care Units to their own home.

We asked participants to reflect on: changes to their working life or experiences as a result of the pandemic, the impact of wearing Personal Protective Equipment on their verbal and non-verbal communication, attitudes towards online and telephone consultations, the impact of social distancing and limitations on touch, how the pandemic had impacted their own self-care, wellbeing and morale, and their thoughts on any training they had received during the pandemic.

What was clear across all the interviews, and reflected in the literature, is that in March 2020 the working lives of these individuals drastically changed. While some of the staff interviewed had their services completely stopped and were taken off wards, others were asked to take on additional responsibilities, or were redeployed to work in ICU and emergency units. All of our interview participants reported feeling unprepared for the pandemic and reflected on the first wave being a period of rapid change with little clarity on rules and regulations. Whilst the individuals interviewed differed in roles, responsibilities and professions, the themes of the challenges they highlighted were strikingly consistent.

“People would say during training ‘oh you won’t forget your first death that you see, you won’t forget your first patient death’ but when your first placement is filled with nearly all your patients dying, I think it really does change everything. It changes your perspective on life itself.” (Medical student)

Our interviewees struggled with the transition to online work, both in terms of hospital facilities – poor wifi and limited spaces to conduct Microsoft teams meetings; but also as a result of missing non-verbal cues from patients whilst conducting often emotive and challenging consultations and conversations over the phone, requiring staff to interpret new, less familiar cues such as tone of voice, and pauses and silences in speech, but received no training or formal support in this.

Staff reported negative impacts on quality of communication and their own wellbeing due to the difficulties in being heard and understood when wearing masks and PPE. The increase of Perspex screens, limitations on touch and social distancing exacerbated these feelings, with many staff noticing how these factors limited their ability to support others and demonstrate their care, leading to feelings of frustration. When social distancing was enacted it often unintentionally removed crucial social support from colleagues – like a supportive hug or being brought a cup of tea by a colleague – which respondents recognised as key to wellbeing and job satisfaction. Many interviewees also expressed concern and sadness over the rate of plastic being wasted and thrown into landfill, emphasising a feeling of disconnect and waste in their working environment.

“I think that some situations were made more difficult, because of the clinical situation, so more things about giving bad news or giving a difficult diagnosis. It just felt uncomfortable to do it over video but maybe it wasn’t more uncomfortable for the parents, maybe they were happy to be at home and that’s what’s most important.” (Paediatrician)

Social distancing itself was found to be very difficult in hospital settings and could create tension between staff members when the rules were interpreted differently. Equally, staff were required to enforce social distancing rules with visitors and patients, as well as feeling obliged to make up for lack of family interaction as patients became more isolated, putting increased pressure on them. Predictably, anxiety increased over this period for staff, and maintaining a sense of wellbeing became more difficult, especially as staff morale as a whole became increasingly diminished. As staff became more and more fatigued they also felt under-appreciated, describing feeling uncomfortable with the label of ‘hero’ with some pointing out the problems of romanticising healthcare jobs and the increase of expectations, with the disconnect between the reality experienced and respect felt by patients, managers, the government and wider society.

“They’re coming into hospital, they’re alone and frightened. There’s only so much as a nurse that you can give them. It’s not the same, and especially when you haven’t even got a face to look at. You’ve just got a set of eyes, you know, it’s just not human nature, is it?” (Paediatric Staff Nurse)

Overall, although those we interviewed described training received in donning and doffing PPE, none received any that focused specifically on communication or acknowledged the pressure, fear and stress that was being experienced along with the emotional impact of this work, which they felt would have been helpful. Working through the pandemic where much of the learning was practical and reactive, staff noted areas in which they lacked skills and a need to re-energise staff and boost morale to recover and change the system.

Ultimately, the way we all work has fundamentally changed. There is a new understanding of what it means to respect people’s space and our duty to the vulnerable in society; and there is an extraordinary emotional burden – a need for space to reflect on the last few years – to tackle which goes beyond the healthcare sector. As the research developed we began to recognise that we continue to communicate through COVID… now that we understand that things are going ‘back’ to a pre-pandemic place, we had to ask: what are we getting ‘through’ to?

Our next blog post describes some of the ideas and strategies we came up with in our next phase of the research, working with a team of artists and creative practitioners.

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