Silvia Miranda is the Clinical Co-ordinator and Senior Counselling Psychologist at Islington iCope IAPT Service and a Lead Counselling Psychologist at The TILS Veteran Service in Camden & Islington NHS Foundation Trust. In her first podcast she talks directly to frontline workers about the range of complicated emotional responses they may be having and gives examples of how to recognise symptoms of stress and burnout in yourself. In the second podcast, Silvia gives a range of stress management techniques and self-care tips to help you reduce stress reactions and burnout.
Podcast 1: View transcript
Recognising Burnout: Helpers Stress Reactions
“The first podcast emphasises ways in which specific helpers such as keyworkers, first responders, NHS workers, NHS frontline staff, responding to the corona virus crisis, can support themselves and their colleagues by recognizing the signs of stress and burnout, and learning techniques which may help to alleviate or prevent severe emotional reactions.
If you are a Keyworker responding to this crisis you are likely to be exposed to highly stressful situations in the course of your line of duty and routine tasks. Usually the traditional heroic role of helpers includes expectations that they are selfless, tireless, and somehow superhuman. However due to the unprecedented situation created by this pandemic you might also be affected by the nature of your job in this crisis. Therefore, maintaining your ability to function efficiently and effectively it is essential for you to provide this relief work.
Specific situations that increase your vulnerability to stress might be:
- Having no control over the volume work
- Working long hours/shifts without many breaks and rest
- Leaving your job with a feeling of not having done enough, because needs in this situation are so overwhelming that they by far exceed your capabilities
- Feeling guilty about life or death decisions that you have to make and carry a sense of responsibility that you fail to prevent harm by transgressing your deeply held moral beliefs and expectations
- Being troubled by the victim’s stories
- Feeling guilt at the death of a patient or patients
- Feeling despair faced with the repetitive cycle of death that the present pandemic is creating
- Feeling anxious that you will also be infected and worry about how you will cope with your own fears of contamination, death and deterioration as you assist others.
If these reactions and experiences are left unaddressed after a prolonged period of time on the job, these stress factors are likely to affect your well-being, and the quality and efficiency of your work, which in turn might lead to Burnout and compassion fatigue.
These conditions happen when stress factors have taken over, and there is an exhaustion of normal stress coping mechanisms leaving you unable to distance yourself from the situation.
Symptoms of stress and “Burnout” Amongst frontline staff
- Excessive tiredness
- “Loss of spirit”
- Inability to concentrate
- Somatic symptoms (e.g., headaches, gastrointestinal disturbances)
- Sleep difficulties
- Neglecting own safety and physical needs (not needing breaks, sleep, etc.)
- Grandiose beliefs about own importance (E.g., engaging in heroic but reckless behaviours,
- Mistrust of co-workers or supervisors or organisation
- Excessive alcohol or drug use, caffeine consumption, and smoking
Please listen to my other podcast where I will be talking about detecting stress and burnout signs in yourself and peers and learn effective self-care stress management techniques that will help you increase your coping capacity to deal with the present situation.”
Podcast 2: View transcript
Reducing Burnout: Helpers Stress Reactions
“In the second podcast I will be talking about how to recognise signs of stress and burnout and give you tips on how to reduce these stress factors as a frontline worker tackling the corona virus crisis.
As mentioned in my other podcast it is important that you identify your own stress reactions and have coping strategies options that you can use for own self-care. You can also identify these in peers in order to provide them peer support and also help them with their own stress management
How to identify these stresses?
- Pay attention to your body for signs of stress. Is your body giving you warning signs? Rapid heartbeat, stomach pains, tightness in the chest, trembling, feeling tired all the time, headaches and other aches and pain.
- Pay attention to your mind. Do you have difficulty concentrating and /or remembering, do you find that you are more “disorganized” than usual, do you feel overwhelmed or fearful by the present work situation?
- Pay attention to your personal life and your emotions. Are you arguing more than normal with others including co-workers or family and friends? Do you constantly feel angry or sad or fearful or hopeless?
Therefore, it is important that you feel supported, and that you can be supported at several key points of their provision of care in order to reduce the likelihood of developing stress-related problems. So please reach out to your peers and/or managers for support and acknowledge that it is ok not to feel ok.
Self-care stress management techniques
How can you be attentive to your own self-care?
Prepare before beginning your work shift
- The more prepared you are before taking up your work assignment, the more likely you will be able to deal effectively with the emotional challenges of nature of the work that needs to be carried out.
- Be aware what to expect, both practically and emotionally, in yourself and in the people you will be helping.
- Be aware if the common responses to stress and about signs of stress and burnout in yourself and in co-workers.
- Learn as much as you can about the particular situation in which you will be working. The closer your expectations are to the realities you will face, the greater your sense of predictability and control and the less your feelings of helplessness and uncertainty will be.
- Talk to others who have had direct experience of the particular work you will be doing.
Take care of yourself during the duration of your shift
- Make sure you take adequate “break time” or “down time.”
- If at all possible, this should be taken away from your work site (e.g., in a separate room like a staff room or rest room).
- Take care of your body – Pay attention to eating properly and getting enough rest.
- It might seem that taking time away from your work to eat, drink, and rest may feel like is a time waster in the midst of this crisis response but it will help you work at maximum efficiency and do your job better and with fewer errors.
- Physical activity helps dissipate stress.
- Get some form of exercise and other forms of recreation also help dissipate stress away from you job
- Engage in an enjoyable activity at home: like drawing, painting, writing, playing music
- Avoid the temptation to use alcohol or drugs or to engage in risky behaviours to wind down or escape the pressures of your work.
Talk about your experiences
- Talk to others like your co-workers and/or supervisors about your experiences and your needs. What information do you need? What support do you need?
- Be prepared for your return home after work
- Expect that your return home after you completed and intense working day may be more complicated than you have anticipated. You have been in a very intense, demanding situation during your work.
- Have a plan of action in advance of how you will wind down.
Reducing stress responses
These are simple stress management techniques and coping skills that you can use to protect yourself emotionally.
You might try one of the following:
- Visualizing a pleasant image of a safe space – like a beach or a beautiful mountain site or visualizing yourself doing a pleasant activity – like walking the woods, being in the garden. Try to visualize the scene in some detail and as vividly and clearly as you can by engaging all of your senses. What you can hear, see, smell and feel as if you are there.
- Another way is to reduce your muscle tension. Take a few deep breaths. Focus your attention on the feeling of the air moving in and out of your body. Continue to breathe deeply. Now imagine that the tension in the muscles of your forehead is flowing out of your body with each exhalation. Do the same thing, breath by breath, with the muscles of your jaw, shoulders, arms, and legs.
- Press your thumbs and forefingers together tightly. Take a slow deep breath and hold it for two or three seconds. Then slowly release your breath while you simultaneously slowly relax the pressure of your fingers and slowly say to yourself RELAX….
But there are other relaxation and mindfulness meditation exercises that you can use to help stay in the present moment.
Your own self-care is both an essential pre-requisite for effectively helping others and a means of maintaining one’s fitness to increase your capacity in responding to demands faced in the frontline.”