Nursing in Mind

We’ve created this page to give nurses working across North Central and North East London a nursing-specific view of the resources, podcasts and long-reads available through the Together in Mind site.

This is in response to what we are hearing from the workforce, and we will continue to add more as the situation and your needs change over time.

Want to get involved? Get in touch via nclinmind@tavi-port.nhs.uk to submit blogs, podcasts or to make suggestions.

View transcript

Hello my name is Claire Shaw and I am a Consultant Nurse at the Tavistock and Portman NHS foundation Trust. I’d like to welcome you to ‘Nursing in Mind’. This page of the Together in Mind website has been developed specifically for nurses and by nurses in recognition of the centrality of the nursing workforce in providing care and innovative practice across the board, from covid wards to psychiatric liaison, from being along side our patients to influencing strategic responses, from responding to immediate crises to providing personal care for those at the end of life.

The Tavistock has a long history of reflecting, exploring and supporting those engaged in the raw work of frontline care, recognising the critical importance and meaning of this work for the patients and families who come into contact with our services. In hosting this page we hope to capture some of this, recognising the impact we have upon our patients and also how each of us will be affected by our work with patients and within the teams and organisations that we work for. The current crisis has intensified many of our daily experiences and brought new ones, some positive and others far more challenging. The wellbeing of the nursing workforce needs to be at the forefront of each of our minds, in relation to our colleagues, those we teach, supervise, manage, and in relation to ourselves.

We recognise that many nurses have had experiences that might feel ‘outside’ of their previous working lives. This may mean having risen to unprecedented challenges, having adapted to new roles or using new skills and having implemented significant changes at an operational or strategic level. We know that coronavirus has forced developments, changes and innovations in a way and a timescale that we have not previously seen. Many of us have experienced growth and development in these changing times, but we also recognise that it has brought loss, confusion and anger, amongst other things, to many of us at different points. There is a new mantra, that ‘it is OK to not be OK’, we may hear it a lot, but what does it mean? We hope that the podcasts, blogs and resources in this page will highlight that we are neither one nor the other, OK or not OK, we all have our resources and strengths and we will all inevitably have our struggles and carry some of the weight of our experiences.

We are aware that you may feel inundated with articles, guidance, and resources on wellbeing and coronavirus, but possibly without the resource of time or energy to explore these. We hope that the resources in this page provide a structure and some stimulus to reflect on the impact of the work and to consider ways of understanding, responding and managing the situations we find ourselves in. We hope that the bite-size approach of this page means that it is accessible and that you can digest it one sitting. The longer reads are available to follow up when you can, providing more information in relation to the blogs or podcasts.

To finish with, we would like to offer an open invitation to you to contribute, to shape this page with your own experiences and reflections. If you would like to share something of your work, experiences and ideas either in a blog or a podcast, or to make a suggestion, please do contact us.

Thank you.

Recommended resources

Here’s some tailored blogs, podcasts and resources we think you might find helpful.

Blogs

On not being Wonder Woman

Written by a Mental Health nurse

I am a nurse and I am writing this from home. I am not at the front line of providing physical care. I am not at the immediate interface with patients in crisis. I work from home as my husband is shielding, developing training and resources for staff support and wellbeing. But whilst I am working on this I am also not sitting in the other room with my husband who has recently returned from hospital, nor am I helping my two teenagers who are upstairs doggedly avoiding doing their school work. Neither am I tidying up the mess (and slight chaos) which surrounds me in our busy family home.

It is easy to feel guilty about each and every part of this. That I should keep working very hard, as nursing colleagues on the front line are having to do. That I don’t really deserve time off, or to switch off, as I know some of my colleagues are unable to. I find myself thinking “I’m exhausted!” and then experience a twinge of guilt, thinking of the nurses doing the ‘proper’ work at the frontline and feel that I am not entitled to feel tired. It may be guilt at being at home, guilt at working within mental rather than physical health, guilt at not being a ‘proper’ stay at home mum. I hear other parents say how well their children are doing, settling down with their school work, whilst I hear mine bickering with one another over a background of Drake, as I try to frantically quieten them before another zoom meeting takes place.

I have wondered about this sense of guilt, is it just me? Is it being a working mother? A nurse? A mental health nurse? I don’t think that it is only me (although I may experience it more or less than others) and I do think that there is a relation to being both a working mother and a nurse. I think that there are idealised views of both mothers and nurses, as if either identity automatically means you can provide some sort of perfect care or go selflessly and endlessly above and beyond, with heightened sensitivity to the needs of others. The current pandemic has brought awareness of intense anxiety, fear, loss and need. The pervasive guilt that many nurses including myself seem to experience may be linked to this, a wish to address it, attend to it, to be able to ease it. We feel we should be able to make pain better, to do something reparative, restorative. We can’t do this for the whole of coronavirus, the loss, the pain and distress. But I think we can do it in small, ordinary and every day ways with individuals, our colleagues, our patients, our friends, our families. And I think that maybe that is good enough.

Someone recently sent me a keyring with ‘Wonder Woman’ on it for a playful joke, knowing I was working hard to try and keep everything afloat. A more accurate key ring might have read ‘Fair to middling woman’, or ‘high expectations, thwarted by human limitations’. I work hard and I am conscientious about my work and my family, and to be honest, I’m probably doing alright. The problem is that ‘alright’ gets turned into not good enough, with images of nurses in super hero capes and with superhuman qualities. That, I am not. And I am the one who takes on this feeling of guilt, no one else has suggested it or put it upon me, it is mine to hold on to or to let go of as I see fit. But it is a pity for me, and for many other nurses I know if we soak up this pervasive sense of guilt. I will bring something to the table, possibly now or later, it won’t be providing physical care on a covid ward, but I will be here for nursing colleagues when they may need support or are ready for a space in which to think about their experiences. I will be there when people are looking for a way, a model, a framework, to understand what has taken place. I may also be able to offer something to my patients who experience the isolation and anxiety, but will have a point of contact in their relationship with me. I can role model to my daughters about being a working mother, I can learn about making compromises and keeping hold of values. I don’t think I will be able to altogether lose the sense of guilt, but I am more curious about it and that makes me less driven by it and more able to think about it with others.

Reflections on Zoom sessions in the context of lockdown

Written by a CAMHS nurse

The change from face to face in the room “1:1 counselling and mental health support sessions”, to zoom and telephone sessions happened literally overnight. I, like other nurses, did not have time to digest or to think about the change. However, in the last couple of weeks I have begun to take stock of what it may be like for young people to now have their sessions via zoom.

I realise that for many this has meant letting me know more about their home environment, this in itself challenges patients’ privacy in a zoom session. Often there is a lack of a private space, where they can feel confident that they will not be overheard by other family members. Often too, in these circumstances, the necessary and appropriate boundaries needed for adolescents are not securely in place. It is common for adolescents to have an experience of the lack of boundaries for many different reasons and this can contribute to a feeling of confusion and uncertainty about themselves in relation to others. In my experience adolescents both want and need to know who are the adults both at home and at school and a confidence that boundaries with both be kept appropriately.

It is also often the same young people who tell me that they have not got a laptop /device on which to use Zoom, they may have a phone, but this is not the same….. Zoom sessions can be a reminder to patients of who has what, “the haves” and “have nots” in our society. I am also worried that some families who live nearer to hospitals and mental health resources, maybe able to access face to face appointments more easily. For the families that live in other areas of a borough, the reality and risks of travel on public transport, maybe a stumbling block to access this model of treatment.

The nursing profession has a proud history of challenging social injustices and recognising the relationship between health and ill health and poverty. It is important to think imaginatively about the experience for families in accessing medical support.  As nurses we have experience of knowing the practicalities, stresses and challenges involved, for example, a single parent with several children, travelling on public transport at this time of the pandemic. In some areas of London, the social and disparities are witnessed, when moving literally from one street to the next. If we put ourselves in young people’s shoes, a journey to medical health care can often involve travelling through areas of deprivation, to areas of considerable wealth, from a deprived housing estate to walking alongside a luxury gated community. I am concerned that access to mental health support will be more difficult for those young people whose parents do not have a car, or cannot afford a taxi to bring them to appointments. They will be faced with a choice of using public transport, maybe the tube system, at very busy times of the day.  

For many young people, not having their session at school or the clinic is a great loss, I think we need to be sensitive to this and to acknowledge this within ourselves, with them and in planning their care.

This week I am feeling more hopeful, as I have managed to negotiate a doorstep visit to a vulnerable 15 year, someone who has not left his home since lockdown started. He is very frightened of becoming ill. His mother has asked if I can help access a laptop for him, to help engage with school work. The visit may be an opportunity to reach out to a young person, who has become very isolated at home. I am very glad of this opportunity to visit,  see and speak to one of my patients in a “non-virtual setting”, but also maintaining social distancing.  

Nightmares

Written by a CAMHS nurse

We were in our regular nurses meeting the other day. Discussing the stresses, strains and possible opportunities within these strange, unsettling times.  I was reminded of a time a couple of weeks ago that I had tried to put out of my mind.

I am currently working rotationally part week on site and part week working remotely.  My nursing role includes quite a lot of complex safeguarding and child protection work. As such I am often involved in discussions with distressing content around the abuse and safety of children. Whilst this can be upsetting and at times images can become preoccupying for a time – it is ‘normally’ within the confines of my work and within the physical bounds of an office or a meeting room. When it upsets me, I might talk to a colleague, take it to supervision or occasionally have a cry in my car on the way home. But now my reflective safety nets are not in place in the same way – they are more distant, behind a screen or offered alongside all that the colleague is managing.

I live in a flat with others and so my work at home happens in my bedroom. I thought it was ok but then I started having distressing, shocking and violent nightmares, waking up startled and scared. One night passed with this, I spent the next day working, tried but didn’t want to give it much thought, I put it down to the general COVID anxiety that is invariably impacting us all. But again the next night and the next. I was exhausted but anxious going to sleep for fear of what nightmares my dreams would bring.

On reflection I realised that the distress and disturbance of my day to day work was somehow hanging in the air of my bedroom, my mind associating that room with the most disturbing and upsetting aspects of my job and with less capacity to process them as I usually might. I found this blurring of boundaries intrusive and unsettling, I was angry at ‘it’, feeling that it was making my usual work life /home life balance fragile.

Once I had allowed myself to become curious and realised that this was happening I decided to make some changes. Sleep is crucial to our wellbeing but I was most bothered by my anxiety about what my dreams might bring. I swapped room with a house member for a week for my work, I bought a new duvet cover and I started listening to green noise and wind chimes on my sleep app as I fell asleep. This really helped and the nightmares have not come back.

Separated but United

Written by a CAMHS nurse

Over the last few months I have seen everyone I know separated by the Covid virus and at the same time united in the suffering it has brought. It is a strange paradox that we are all more apart than ever but experiencing the same crisis all together. The disruptions to all our lives are obvious and not in need of being restated here but what I am going to reflect on, is how the situation has changed the nature of my work as a mental health nurse.

Different teams of workers have adjusted to the situation in a variety of ways, as the requirements of their duties allow and the community of health and social care professionals has been fractured, as many of us work remotely, only seeing our friends and colleagues in a wall of Zoom or Skype windows. Many of us have felt the sense of control and influence we have in the lives of our vulnerable clients, eroded by being only present for them over a phone call. Through this, a sense of insecurity and isolation has affected many professionals deeply. On top of that, many among us were already feeling pushed to the edge by challenges in our personal lives, which also now exist in the context of Covid.

In my role as CAMHS specialist for several local authority-based teams of social and youth workers, I provide consultation to the staff, on a group and individual basis, where there is concern about mental health. Toward the beginning of the quarantine, I noticed that I was being contacted more frequently to talk about the professionals own mental health and to talk with them about their own thoughts and problems.

I thought about this with my supervisor and they reflected that many people outside our own profession, are not sure, what it is we really do. There is an understanding that we deal with the mental health problems and we are where those thoughts go. This may have been what has led many to talk with me in this way, not to get guidance on how to deal with their patients, but how to deal with themselves.

 I don’t see this as a misreading of my role by them, or as anything I am not prepared to do. I have worried about some, as there has been some real profound distress expressed to me, that has made me both care about and respect deeply, the staff that I work with in these teams but I have also felt supported by professionals close to me, who have shared this burden.

That is my uplifting conclusion on where we find ourselves; failed by structures but supported by each other as people. I do not call any specific structures to task, there are too many systemically to even start. But it is my long held belief that the best good we can do in the world, is to lift up and protect the people around us, and I have seen many teams and individuals around me commit to this action, as a response to the Covid crisis.

Beam me up Scotty

Written by a CAMHS nurse

Nursing is an embodied experience. In my experience of both general and mental health nursing, it is about doing things with and to other people, in an agreed and consensual way. To physically or mentally help and care for them, being alongside, being able to see them, touch them, feel them, relate to them and they to you, whether it’s in physical care and or mental health care, in terms of nurturing someone’s mind, alongside their body.

In watching the BBC2 COVID program about the Royal Free the other evening, a moving documentary about the momentous work being undertaken by all the hospital staff,  I was struck by how nurses were dressed, particularly those in the ITU, as if astronauts in full PPE, hot, uncomfortable,  dehydrating and causing of sores to the face and claustrophobia within the mind.. and yet and yet, they were able even through the touch of a latex gloved hand, to soothe and comfort, seriously ill and in some cases dying patients.

It made me think about the discombobulated experience of working in mental health, in a remote virtual way through Zoom. There is an intensity of what you see, the eyes and face of the person you’re looking at, a sense of intrusiveness there and in relation to the circumstances in which they are looking at you, into their bedroom or some other part of the house, where they have perhaps managed to find some privacy and quiet from a rather full house of children and/or other adults.

But there is also the lack of direct gaze and eye level contact. If you look into the lens, you don’t see the person but if you look into the persons eyes, they see your eyelids. The level of your device either reveals a very large forehead, or the internal anatomy of your nose. You are delving into me and I into you, in a way that one would normally only experience physically with a sexual partner, lying in bed or close up. Yet here you are experiencing it in a two-dimensional way with patients, whom you want to be emotionally connected to and yet you can feel emotionally remote from because of the sense of the screen and the world of distance between you and them.

As social animals we have evolved our abilities to home in on non-verbal cues, that allow us to regulate our social and emotional intimacy. Here there is a loss of body language, a loss of smell, a loss of the sight of limbs and nuanced movement, that would have in an ordinary way in a meeting room been present. A disembodied experience without touch but with emotional contact, connected with the emotional resonance of the person you are meeting with. In an ordinary way there is a need in our brains to find a form of regulation based on physical presence and addressing non-verbal cues, in all their rich cultural manifestations, brain to brain, body to body and the use of the misfit when it occurs, to understand something of what is going on in the relationship with the other; in their relationship to themselves, others and to you. Here often the loudest misfit is what is going on in your mind, which cannot easily make sense of what you are seeing or experiencing. The experience of the presence of the absence of the other, disrupting intimacy and stimulating a searching, that is taxing for our minds. Indeed, exhausting and a source of Zoom fatigue.

Here you struggle to hear, as it can sound as if the other is talking underwater, or through space and of course in space no one can hear you scream, a point memorably made in the advertising for the first Alien film. You are left to guess at times whether the silence is poignant and meaningful, and or the buffering of the system, yours or theirs, with perhaps an anxious check at the speed check, within your system. Is it functioning adequately or not and a sense of guilt that it might not be and in any case your attention is now elsewhere and there’s a further loss of contact in the context, of already diminished contact.

There is of course also their intrusiveness into your/my world, what they see, what’s on view, of what they see behind you and what they imagine they see. A sense of voyeurism on the part of both, that is perhaps both sought but in the same moment guiltily avoided. There is the sense in which we think we join with them, but in many ways they join with us and enter our world, our personal-interpersonal world both visually in the moment but as ghosts, who continue to haunt, worryingly and sometimes malevolently the spaces we see them within, once they have left. Work and home life can become mashed together with a falling way of boundaries between the two, that affects you and your family.

There is also not the distance between sessions or meetings in the ordinary way, in which you might see someone back to waiting room or say goodbye on the doorstep and walk down the road. You leave them in whatever state they are in, as you leave the meeting and managing and being aware of this is important, as you regulate the end of the session, as they are left at home alone. But they equally leave you in whatever state you are in, as you attempt to process something of their experience and yours, but all too often and too quickly beam into another hyper-real virtual world, with either another patient, or into a meeting with colleagues. All too often there is a salami slicing and connectedness between Zoom meetings…no walk down the corridor or down the road.

The sense of leaping between virtual worlds, where in fact you remain in the same space, has a disorientating quality and I’m reminded of Star Trek and the often-used phrase “Beam me up Scotty”, to rescue people from disastrous encounters in foreign lands, on other planets. However, in one episode, a malfunction in the transporter a room, results in two people being amalgamated in a hideous way, as they arrive on the transporter deck, having been beamed up. Far from rescue, they were a hideous mix of each other.

There is a sense in which moving so rapidly from one meeting to another,  leaves a whole host of feelings, thoughts and emotions from one setting, mixed up in the other, as you arrive either with another patient, or indeed with colleagues, whom you may have seen recently in another world but now in view again, in their same world but in a different context. Whilst Zoom provides temporal flexibility and a sense of no limitations on distance and space, it also can lead to a lack of sensory integration and absorption of experience, without the process of filtering, a sense at times of disinhibition, inhibition and invasion of the sense of self, in a virtual world

There is a sense of otherworldliness about Zoom meetings, in this way a sense of hyperreality but yet a distancing disconnect, in a way that the brain and mind finds hard to fathom. Adjusting to seeing and nursing patients in this hyperreality, requires a time to catch up both with the experience in the moment but equally with the strangeness of this context of nursing care in the longer term, if this is not to be the new abnormal normal and we risk losing the skills and artistry of Nursing, as an embodied experience.

Moodswings

I have been reflecting on and noticing patterns in my mood over the past few months.  Prior to the Covid situation becoming a pandemic I was often in conversation and dilemas with people about how serious things were, how much do we need to prepare, what we need to do.  As the weeks went on it quickly became apparent that the situation was very serious and we needed to take action.  This led to many weeks of planning and constant change as rapidly the situation changed nationally.

Personally, as a child and adolescent mental health nurse, I was consumed with guilt at not doing more on the ‘front line’, but recognising my skills were not necessarily best placed to support there.  Rationally I recognised that what I was doing to keep the service I manage going was enough.  The restlessness and helplessness I felt made it difficult for me to allow myself any down time, I experienced sleeplessness and mood swings that impacted on my home life.  Once I was able to reflect and name the guilt I felt and express it I was more accepting of how I felt.   I found ways I could offer support in more ordinary ways, being there to really listen to people’s experience as this was so important in a world where being in the moment was getting difficult to sit with. 

As the lockdown came and our service began to be delivered remotely I recognised the increasing exhaustion I felt and the weight of containing, managing and supporting not only our clients but also their families and the wider network.  As a manager, attending to staff psychological wellbeing feels increasingly important to attend to but it is also difficult to really gauge in the current circumstances.

I have learnt to take lots of deep breaths, be kind to others and to myself and pace myself……this is a rollercoaster and a marathon all in one.

Podcasts

External websites and related resources

RCN – Nursing: Wellbeing, Self Care and Resilience Guide – Visit the webpage

Free wellbeing Apps available for all NHS staff – Visit the webpage