Creating an online peer based intervention

for clinicians suffering with psychological

distress: The challenge aheadBy Sally Pezaro

Supervisors: Dr. Wendy Clyne, Dr. Emmie Fulton & Dr. Andy Turner

Official Advisor: Clare Gerada

Introduction

• The challenge ahead• The project• Case studies• The current situation• Epidemiology• Aetiology• The impact upon healthcare organizations• Help Seeking• Current sources of support• Methodology• The Challenges ahead• Conclusions

The project

• To construct an online support programme explicitly designed to meet the needs of clinicians.

• The goal is to facilitate and create a trusted online peer to peer support network in an era where clinicians fear disclosure (Ullström et al, 2013).

Case Studies

• Margo – A 49 year old nurse with a reputation of being grumpy, rude and uncaring. Disinterested in professional development and snaps at students.• John – A newly qualified A&E nurse. Easily startled, looks tired and

bewildered at times. John has recently made a medical error and shows a marked lack of confidence.• Emily – A midwife currently under investigation due to a patient

complaint following a critical incident. Her behaviour is markedly changed, she is jumpy and avoidant of certain situations. She doesn’t want to talk about it.

The current situation

• There is much research outlining widespread psychological distress in health care professionals, yet scant attention has been directed towards preventive interventions (Irving et al, 2009; Romani et al, 2014). • Healthcare focuses upon providing support for patients, yet limited

attention has been paid to the ‘second victim’ (Wu, 2000).• Clinicians report that they “are close to quitting or having a

breakdown in mental health” (McHugh et al, 2014; 106). • There is a clear link between staff wellbeing and patient care quality

(Boorman, 2009; Black, 2008; DoH, 2014; Rassin et al, 2005).

Epidemiology

• The prevalence of second victims in health care has been estimated to vary between studies from 10.4% (Lander et al., 2006) approximately to over 30% (Scott et al, 2010) to 43.3% (Wolf et al, 2000) • Studies in disaster response workers and routine based health

workers have returned generally similar traumatic stress incidence rates (Laposa et al, 2003) ; Clohessy et al, 1999 ; Lin et al., 2007).• In one survey of 2769 respondents in the UK, 80% of GP’s reported at

least one other practitioner in their practise is suffering from burnout, (McHugh et al, 2014)

Aeitiology

• Psychological distress can occur in health professionals as a result of:• Aggressive behaviour towards staff• Workplace bullying• Medical errors• Traumatic ‘never events’• Critical incidents• Workplace suspension• Whistleblowing• Pre-existing long term mental health disorders.

(Strobl et al, 2014)

The impact upon healthcare organizations

• Emotional exhaustion, depersonalization, negative thoughts towards others and a reduced sense of personal accomplishment (Maslach, 1986).• Lack of empathy, poor concentration, working relationships,

communication, and decision making (Beddoe et al, 2004; Skosnik et al, 2000).• Burnout has been linked to decreased patient satisfaction and longer

patient-reported recovery times (Vahey et al, 2004; Shapiro et al, 2005). • People with post traumatic stress may experience changes in their

behaviours, cognitive function and emotions. symptoms can include avoidance, hyper vigilance, paranoia, panic attacks, depression, anger, guilt and substance abuse (Rogers et al, 2000).

Help seeking

• Many health professionals never seek help or do so after years of suffering, especially during depressive episodes (Clark, 1999; Laposa et al., 2003, Dewa, 2014). • Healthcare professionals may not be aware that they need help or

may not think they need help (Dewa, 2014; Mojtabai, et al, 2011).• Fear that they may lose professional reputation, be perceived as

inadequate or lose their careers, especially when substance abuse is apparent also inhibits health seeking behaviours (Deuchert et al, 2013).

Current Sources of Support

• Compared to services provided for doctors, there is a paucity of support for nursing and midwifery professions at this time.• No support is provided directly by regulators; although the GMC commissions the

Doctor Support Service externally.• Currently, there are indications that some organizational cultures remain

punitive and blame-focused. This is counterproductive to any support • Range of internal and external support options offered by trusts, including

occupational health services, HR, unions, counselling, 24/7employee assistance programmes, formal debriefing sessions, chaplaincy services etc.

(Strobl et al, 2014)

Methodology

• Literature and narrative reviews• Delphi study or focus group • Usability and needs assessments• Develop a comprehensive evidence based intervention in readiness for

pilot work• Beta testing • Data collection and evaluation• Evaluation of the impact of the intervention, delivery and outcome

measures. • Write up

The challenges ahead

• Effectively moderate the online intervention• To maintain data confidentiality and security.• Navigate the ethical issues surrounding amnesty in cooperation with

regulatory bodies.• To explore ethical issues in relation to confidentiality versus accountability• To enable users to be private in a public space• To facilitate storytelling whilst protecting the confidentiality rights of those

involved.• To involve a range of stakeholders in facilitating private discussion whilst

acknowledging a duty of candour.

Conclusions

The hope is that this behavioural intervention will become a platform for clinicians to heal through peer support and become able to seek further medical attention in an era where clinicians fear disclosure (Ullström et al, 2013).

“All clinicians suffer from a condition called being ‘human’” (Conway et al, 2009:3).

Thank you – Questions?

Sally Pezaro

Email: pezaros@uni.coventry.ac.uk

Centre for Technology Enabled Health Research

Faculty of Health & Life Sciences

Coventry University

Priory Street

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