British Journal of Nursing - These are the hands that care

Abstract

Sam Foster, Chief Nurse, Oxford University Hospitals, considers how leaders can help their staff in times of stress, grief and bereavement during the current pandemic

I have written about the many impressive guides that have been generated, predominantly by NHS England and NHS Improvement, to support our response to the COVID-19 pandemic. Sadly, many of us have found the need for the latest guidance advising on ‘good leadership during bereavement and complex grief’ (NHS England and NHS Improvement, 2020). We have all seen an increase in deaths across our settings and, sadly, these include those of a number of healthcare workers. Providing leadership during these times has been professionally and personally challenging for us all.

The guide acknowledges that these times are more difficult, with little-to-no down time, with social distancing and a steady stream of anxiety-provoking media. The guidance recognises that we will have colleagues or, indeed, family or friends, who are being cared for, with some recovering and others not.

Bailey and West (2020) have published a paper on behalf of The King's Fund, recognising the importance of compassion in leadership, stating that it is required to unleash healthcare staff's collective wisdom and resilience. Compassion, they say, means paying attention to all staff, truly listening to them and being present with them. They go on to say that this means fully understanding the challenges they face, rather than seeking to impose understanding. Empathising with them, feeling their fears, stresses, uncertainties, anxieties and exhaustion, provides the motivation to always ask the question ‘how can I help you?’, the most important task of leadership.

The NHS England and NHS Improvement guidance recognises that a death from COVID-19 means that colleagues and relatives will have little time to prepare, may not have been able to spend time with the patient because of infection risks, and were unable to say goodbye. Others may need to continue working or may be ill themselves.

Dyregrov and Tehrani (2020) have described some of the issues that have become more challenging to frontline staff in the face of COVID-19, suggesting some practical considerations for frontline staff. They recognise that:

We are all vulnerable: unlike other relatively short-term major events such as train crashes, the COVID-19 threat is ongoing, and behaviours symptomatic of this can manifest, including recognition of our own vulnerability. To some extent, we may start to grieve for what may happen to us or our loved ones. Not only do we fear for our family and ourselves, we fear that we may bring the disease to others

Coping with increased death in the home environment: this process can be very upsetting for those living in the house, and for those caring for them. The bereaved rightly want the deceased to be treated with respect and care, but the necessity of the virus precautions may mean the perception that this is being achieved is skewed. Added to this is the loss of the ‘normal’ rituals of bereavement, such as the gathering of family and friends for funerals, and being able to physically comfort each other at this time

Coping with increased death in hospitals: the situation for those who die in hospital is upsetting for the families, especially as there are currently visiting restrictions other than at the end-of-life. Many of those who die from COVID-19 will be in the older age range. Although it may be understandable that the death of an elderly person may be viewed as less tragic than the death of a younger person, it needs to be remembered that, for the family, each death is significant and worthy of sympathy

Dealing with grief alone: the death of a family member, friend or colleague typically brings people together in a shared expression of loss and grief. Dyregrov and Tehrani (2020) reflect that people comfort each other through kind words and actions. Talking and crying together are actions that not only bring comfort, but also bind relationships together for the future. The bereaved do not usually grieve alone. COVID-19, they observe, has halted normal grieving, with families and friends of the deceased being physically separated and the grief often having to be handled alone. The bereaved do not currently have their usual social networks to rely on.

In order to support frontline staff, consider how to support patients, relatives and colleagues. Dyregrov and Tehrani (2020) have also published a helpful checklist of advised behaviours and actions.

In conclusion, as we emerge through one of the most difficult times of our careers, we must remember to care for each other to enable us to care for others. I will end with some lines by Michael Rosen (2020):

‘These are the Hands/That touch us first/Feel your head/Find your pulse/Make your bed … And these are the hands that … Log the dose/And touch us last.’

Rosen, 2020