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Midwife Burnout: A Brief Summary

This week I have seen midwife burnout rear its head more than a few times. This is an issue close to my heart and one I dedicate my research to on a daily basis. Being a registered midwife and having practised through turbulent times myself, I know how it feels to give all that you have and yet forget to put yourself first at any time. You become a burnt out midwife, unable to give the highest quality or safest maternity care.

Here’s how it may happen…

 

The recent National  Maternity Review highlighted that midwives were more likely than any other professional group to report feeling pressured at work. Also, levels of staff stress in the NHS are the highest of any sector and staff consistently report a lack of compassion shown to them from leaders and managers within their organisations.

I find this incredibly sad…. We want to care so much for women and their babies…yet we fail to care for ourselves and each other.

The latest  work-related stress guidance cites one of my paper’s, which claims that “Midwives are entitled to a psychologically safe professional journey”… This is wonderful to see…but will we ever see midwives being cared for in equal partnership with the women and families they care for?

A colleague of mine recently noted that ‘as soon as we say that patients come first…we immediately devalue the staff’….

This got me thinking….and writing this blog post.

In the midwifery news this week:

I have come across the following articles in one way or another…

The experience of professional burnout can be one of extreme personal pain which some midwives feel they may never recover from. Despite global recognition of the destructive phenomenon of burnout, midwives may not understand what was happening to them. They can feel judged as managing their practices poorly, experience isolated feelings of shame, and feel unable to disclose their escalating need for help.

Young, C. M., Smythe, L., & Couper, J. M. (2015). Burnout: Lessons from the lived experience of case loading midwives. International Journal of Childbirth, 5(3), 154-165.

My 3 latest papers have addressed the issue of midwife burnout and psychological distress in great detail…I shall be publishing more shortly… for further reading see:

Pezaro, S. The midwifery workforce:  A global picture of psychological distress – ARTICLEinMIDWIVES: OFFICIAL JOURNAL OF THE ROYAL COLLEGE OF MIDWIVES 19:33 · MARCH 2016

Pezaro S (2016) Addressing psychological distress in midwives. Nursing Times; 112: 8, 22-23.

Pezaro, S., Clyne, W., Turner, A., Fulton, E. A., & Gerada, C. (2015). ‘Midwives overboard! ‘Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women and Birth. In press.

Midwife burnout is rarely understood…Yet one thing is clear, we really do need to find new ways to support each other and look after ourselves for the benefit of all midwives working within midwifery profession, and the families we care for.

This week I will continue to write my systematic literature review which aims to identify the nature and existence of interventions designed to support midwives in work-related psychological distress, and their effectiveness at improving the psychological well-being of midwives.

Once this is complete, we will be one step closer towards effectively supporting midwives in work-related psychological distress.

Until then, look after yourselves…and each other.

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The #WoundedHealer a reflection on #resilience #empathy #Support & #compassion in the #NHS workforce

Last week I attended the Wounded Healer – Helping Each Other to Care in the Modern Health Service conference on Tuesday 15th September 2015. I have a certificate to prove it and everything 🙂

I have spent the whole week reflecting on this conference, which brought together many experts who are passionate about exploring the plights of the wounded healer, and supporting those in need to care compassionately in challenging healthcare workplaces. There were also many who shared their own experiences of being a wounded healer (Including me)! Many had left the profession, moved to another part of the profession, or were still struggling to cope in challenging times. These stories were powerful, moving and also uplifting, as we also heard many stories of recovery. The main challenge of the day was of course focused upon finding new ways to help each other in practice to care compassionately in the way we all want to when we enter the health profession as ‘eager & excited puppies’ wanting to change the world.

This conference was facilitated by the practitioners health programme (PHP). The NHS Practitioner Health Programme is an award winning, free and confidential NHS service for doctors and dentists with issues relating to a mental or physical health concern or addiction problem, in particular where these might affect their work. The conference was also led by the Medical Director of the PHP, Dr Clare Gerada (). Clare is one of the advisors to my own research project, and I always draw so much strength from her knowledge, passion and wisdom. I am sure I will be consulting clare again once my Delphi Study has drawn its conclusions.

One of the highlights for me was meeting Professor Jill Maben, Director of the National Nursing Research Unit at Kings College London. Her work focuses upon the workforce issues facing today’s nursing populations (). Jill disclosed that she had left clinical practice as a result of unhealthy levels of stress in the workplace. She outlined to all of us her own work in discovering how new nursing students are indeed ‘eager & excited puppies’ wanting to change the world. These students quickly then realize that these dreams may never become a reality in the current working cultures of the NHS. As a result, they may choose to give preferential treatment to ‘favored’ patients or ‘poppets’ (Maben et al, 2007). I myself was privileged to finally make contact with such an inspiring research team.

We also heard from Professor Ivan Robertson, Mr Julian Lousada, Mr John Ballatt & Dr Penny Campling who all spoke about the importance of intelligent kindness, compassion for one another in the workplace and about how challenging workplace behavior may actually indicate a deeper pain. How do we cope? Do we deflect our pain on to others?

My thoughts were “Unkind people are unhappy people” and perhaps this is why we are seeing a lack of compassion between colleagues in the workplace. Those who display adverse behaviors need support too. There were certainly some stories of challenging workplace behaviors that suggest that this might be the case.

It was suggested that NHS staff enjoy hard work in their profession of choice. But this demanding work is only satisfying if it is matched by adequate support, resources and control.

This was followed by reflective sessions where professionals shared their own experiences, suggested advice for others and new forms of support. I think I was the only midwife there, and I am still concerned that there is little focus placed upon the well being of other nursing professions. I always find it cathartic to reflect among my own kind. I may have been the only midwife, but we are all one big professional family. This is my tribe. The people that understand and can empathize with the wounded healer. I hope that our insights can propagate among those who need it most.

The workshops that followed included:

Dr Derek Chase – Mindfulness and its Benefits

Dr Jane Marshall- The Addicted Professional

Dr Caroline Elton – Under the White Coat

Dr Peter Ilves and Mr Nigel Praities – GP’s, Resilience and Burnout

Mr Gary Marson, Dr Clare Gerada and Ms Pip Hardy – The Wounded Healer

Ms Debbie Sandford – Schwarz Rounds

Although these workshops largely focused upon the experiences of GP’s & Doctors, I could consistently relate the issues being raised with any other healthcare professional to a higher or lesser extent. The issues remain the same in any healthcare profession.

Along with the health practitioner programme, the  were referred to as a valid source of support for health care professionals. Schwartz Rounds are a multidisciplinary forum designed for staff to come together once a month to discuss and reflect on the emotional and social challenges associated with their jobs. The rounds are designed to offer emotional and social support for staff – not look for clinical outcomes.  Yet my concern is that these rounds require face to face talking and the time to attend a meeting at the planned time and location. I hope that the online intervention I intend to build in order to help midwives in distress can compliment these rounds in supporting all health care professionals in time.

For more information and reflection upon this conference, I would like to direct you to this blog post by Jonathon Tomlinson, as it holds some great references to other reflections and narratives in relation to the wounded healer.

I would particularly like to quote this from his reflective blog “There is a distinction between strength – to carry on regardless, and courage – to admit ones’ vulnerability – which is key to overcoming shame.”

It concerns me that the NHS may indeed be unwell. I reflect lastly upon the NMC Code of professional conduct which states that nurses and midwives must: 8.7 be supportive of colleagues who are encountering health or performance problems. However, this support must never compromise or be at the expense of patient or public safety.  We are in fact duty bound to look after one another for the safety of patients and the public.

So be excellent to each other.

Always.

Maben J, Latter S, Clark JM. The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal qualitative study. Nurs Inq 2007;14:99–113. doi:10.1111/j.1440-1800.2007.00357.x

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Designing a platform to support midwives…The Research Protocol is out!…are you in?

As I was preparing for my yearly performance review this week, I had a new maternity unit want to learn more about my research. More and more people are wanting to join the swell of participants, willingly giving their time to help shape the design of a platform designed to support midwives in psychological distress. This is becoming a powerful collective movement just in time for the launch of the first round of Delphi questioning. By the end of this month I will be sending out the questions whose answers will shape the design of an online intervention. These are indeed exciting times.

Midwives online support

I wanted to thank those who have shown a last minute interest in taking part in this study. Your opinions will be valued ones and I cannot wait to see the ideas and opinions that will shape this project. There is still time to get involved if you, or someone else you know would like to enhance the evidence base for this project. You can read more about becoming involved with the project here.

For those already invested, I wanted to share the full protocol with you in the interests of transparency. This has now been published within the Journal of Medical Internet Research protocols, and you can read it in full here or below.

Pezaro, S, Clyne, W (2015) Achieving Consensus in the Development of an Online Intervention Designed to Effectively Support Midwives in Work-Related Psychological Distress: Protocol for a Delphi Study. JMIR Res Protoc 2015 (Sep 04); 4(3):e107

This paper details how this study will generate a consensus around the development of an online intervention designed to support midwives in psychological distress. With your involvement and support, the ideas you contribute will inform the design and build of a new platform, which I hope will go on to make a difference.

Thank you to all of you for showing your support and giving your time to this research. I am so looking forward to launching this study with you in a couple of weeks! – Until then my friends…be excellent to each other.

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How might we apply Isaac Asimov’s “Three Laws of Robotics” to underpin the #NHS?

This week, as usual… my mind has been whirring with a multitude of issues relating to staff well being in the NHS. Except lately I have been trying to look at everything from a different angle. So, being a bit of a Sci-fi geek as well as a Tudor History fan and doctoral researcher, it suddenly dawned on me how I was, in my own mind, equating the professional duties of NHS staff with Isaac Asimov‘s “Three Laws of Robotics“.

This ‘Eureka moment’ happened whilst I was enjoying my morning dippy egg, and I shall translate my thoughts as follows:

In case you were unaware, Asimov’s laws were intended as a fundamental framework to underpin the behavior of robots in human society. These laws are intended to allow the safe use of robots as tools.

They were originally as follows:

  1. A robot may not injure a human being or, through inaction, allow a human being to come to harm.
  2. A robot must obey the orders given it by human beings, except where such orders would conflict with the First Law.
  3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws.

I shall now rewrite these laws based upon the analogy of this being applied to NHS relationships in my own mind.

  1. Clinical professionals may not injure a patient or, through inaction, allow a patient to come to harm.
  2. Clinical professionals must obey the orders or ‘needs’ of patients, except where such orders would conflict with the First Law.
  3. Clinical professionals must protect their own existence as long as such protection does not conflict with the First or Second Laws.

In essence, clinical professionals are programmed in this same way to put patients first. I am not necessarily arguing that this is wrong. But again, in doing this we may paradoxically be putting patients at risk if we fail to value clinical professionals as humans too.

Are clinical professionals the subservient robots of humanity?

If clinical professionals obey the needs or ‘orders’ of patients at the expense of their own well being, then this may not be conducive to safe clinical care.

Later, Asimov added a “zeroth law”, that preceded the others in terms of priority:

0. A robot may not harm humanity, or, by inaction, allow humanity to come to harm.

Which in this analogy would become:

0. Clinical professionals may not harm humanity or, through inaction, allow humanity to come to harm.

If the well being of clinical professionals is not properly valued or addressed, the quality of patient care may be reduced through “malfunctioning” or “Decommissioned”  practitioners. Therefore, humanity is harmed twice – once in the harm of patients and once in the harm of clinical practitioners. Humanity suffers.

The three laws are intended for robots, and we need to remember that clinical professionals are not robots. We also need to ensure that the well being of NHS staff remains an issue of equal salience in the provision of safe care. If both NHS staff and patients are of equal societal value, then we must value #StaffExperience as much as we value #PatientExperience.

Should this happen, then we may see better quality outcomes for all.

Please let me know your thoughts… Until then, I shall be burying my head in an ethics paper and literature review!

Be kind to yourselves, and each other x

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What is the Future of Psychological Support for #NHS Midwives? My interview with @MidwifeDiaries

This blog was originally posted by Ellie from www.midwifediaries.com on June 2, 2015. We spoke in May 2015 about my research project and the issues surrounding midwives (and student midwives) in psychological distress.

What’s The Future Of Psychological Support For Midwives? Interview w/ Sally Pezaro
She wrote :”Who is this researcher?”

This was me, a few weeks ago stumbling across a blog. This woman was sharp, driven, and had all her energy focussed on supporting the mental health of midwives.

She really got how unchallenged the assumption is that midwives are ok to keep going 24/7/365.

Sally Pezaro is doing her PhD on supporting midwives in psychological distress. Her project is exciting, and if it gets launched, will be something we can all use to keep healthy.

In this interview, we talk about why it’s so important to look after midwives, bullying in midwifery, and some strategies for mental wellbeing.

Most awesome quote from this interview: ‘Don’t give everything you have until your batteries run out. Yep – must put that on twitter.

Here are the links we discussed, ’cause I bet you’ll ask!

What’s Sally’s doing is so brilliant because she’s noticed something that is wrong in midwifery – and is doing something about it. Her project reminds me of that quote:

“Be The Change You Want To See In The World”

It’s so good to know that we do have researchers on our side, trying to make things better.

Now, Sally and I would love to hear from you. What’s your answer to the question I posed at the end of the interview?

“What do you find most challenging in looking after your mental health as a midwife, and what do you think could be changed to help with this, both on an organisational trust level, and on a personal level?”

Thanks so much in advance for all the kind, insightful and inspiring comments that are left. I’m excited to hear what you find hardest, and what could help you look after your mental health better.

As always, thank you for your time and attention, sharing and being so brilliant. MidwifeDiaries is turning into an incredible, supportive place for midwives, and I’m so grateful.

Ellie xxx

-> I would also like to add a link to the newest NMC Code (2015) as midwives can now use the power of the code to challenge psychologically unsafe professional behaviour in the workplace. The code now states that midwives must be supportive of colleagues who are encountering health or performance problems. Midwives also have a duty to care for themselves under this new code, so please do not feel guilty for giving self care. We must all work to create therapeutic working environments….

Five experiences are judged necessary for health. Primary emotional development, attachment, containment, communication, inclusion and agency. These can be deliberately recreated in therapeutic environments to form a structure for ‘secondary emotional development’. Failure to recognise the importance of these qualities of an environment can cause unhealthy, or frankly toxic, psychosocial environments in various settings (Haigh, 2013).

Haigh, R. (2013) ‘The quintessence of a therapeutic environment’, Therapeutic Communities: The International Journal of Therapeutic Communities, 34 (1): 6 – 15.

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#InternationalNursesDay celebrated during #MentalHealthAwarenessWeek… coincidence? #MHAW15

So… this will be a short blog for me today as I am working to get two new papers published so that I can do equally exciting, but different things next week 😀

I just wanted to sketch some quick thoughts down here about #InternationalNursesDay and  , as these events both fall within the same week and indeed #MentalHealthAwarenessMonth.

 celebrates self care and mindfulness this year, both extremely valuable tools (IMHO) to maintain ones own well being. The awareness week also brings our attention to the eternal war on stigma, which again IMHO is the biggest killer of all. This year was indeed an amazing #MentalHealthAwarenessMonth and I very much enjoyed reading and seeing the buzzing communities becoming involved on twitter.

Equally, #InternationalNursesDay  was celebrated with vigor, yet I saw this event in a different light.  saw those with mental ill health explain to the world how it feels to manage their mental health every day. They implore the world to take notice of their needs and  recognise mental ill health as being equal to physical health. They draw upon the importance of mental health awareness and the need for action. They are fighting for their rights and more. It was inspiring to see 😀

However, those celebrating #InternationalNursesDay seemed to share a different message. The main campaign which took my attention was the hashtag #whyInurse. This involved nurses from all over celebrating their work, acknowledging their privileged position and providing examples of the pride they share in nursing. It was really quite jovial. They were celebrating what they wanted to give, rather than anything they wanted to take for themselves.

This is seemingly a consistent pattern for health care professionals….they give all that they have….

Do they ever have time to look after themselves? Allow self care? practice mindfulness?

Many nurses celebrating their profession also celebrated #MentalHealthAwarenessWeek…Do they practice what they preach?

Although there is much to celebrate, I worry that health care professionals are placing themselves upon high ground. Through my research and the statistics I am seeing, I know that there are many health professionals who may be suffering in psychological distress. When these celebrations shout to the world that nurses are ‘having a ball’, it may make it that much harder for those in pain to speak out.

It may even make people think that health care professionals are much too happy in their jobs to be in psychological distress.

As it is #MentalHealthAwarenessWeek… I want to raise awareness about the healthcare professionals in psychological distress. They are dealing with horizontal violence, emotional and moral traumas, traumatic incidents, stigma, compassion fatigue and much more.

Remember that 1 in 4 people in the UK will experience a mental health problem each year. This figure also applies to health care professionals working within the NHS and all over the world.

I would like to bring #InternationalNursesDay and #MentalHealthAwarenessWeek together, so that healthcare professionals can become aware about their own mental health needs and the needs of their colleagues.

These are only my personal views. There is never any offence intended. Please see the support page of this blog if you have been affected by any of the content within this blog.

Thank you  for reading 🙂 

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#BringBackTheNHS Event – London 2015

So, yesterday I toddled on down to Westminster to attend the #BringBackTheNHS event and see what it was all about. The event was filled with great speakers, including some famous ones like: @IanMcKellen @charlottechurch and @marcuschown. This was set to be a ‘Non Political Event’ to celebrate the NHS. Nevertheless, there were some passionate words spoken.

I try not to get too political in my every day research, but it is so important that we all understand the healthcare climate in which we are working, living and healing. I also feel it is important for me to understand the continuously evolving health policies, rhetorics and visions if I am to contribute positively to the #mentalhealth and well being of Healthcare workers.

And so I came to learn about the The Campaign for the NHS Reinstatement Bill 2015 (  ) currently championed by @AllysonPollock among many others!

In a nutshell: The Health and Social Care Act of 2012, forced a commercialised model upon the NHS in England.

This new Bill aims to reinstate the founding vision for the NHS (Freee at the point of use, regardless of a persons ability to pay). A worthwhile cause to become involved with.

However, throughout the event and in listening to the speakers share some powerful NHS stories, I personally was struck by the stories involving NHS Staff. I would just like to summarise the key things I took from the evening.

– The NHS Staff will carry on giving every part of themselves to the care of others.

-The NHS staff do not go to work for themselves, but for the service of others

– NHS Staff are bound to protect/defend/obey the mother of the nation (ie. The NHS) –  as the well being of their family, friends, mothers, aunties, children etc….depend upon it.

– Front line NHS staff see the true nature of life and death. Their eyes see what others cannot comprehend or identify with. They then go back to changing beds….

-They work hard, despite being underpaid (and arguably undervalued).

-They work unsociable hours, any time, anywhere.

– Where resources are strained, they make sure that people still get what they need.

– They are still willing to give more.

The cultures of our healthcare systems and staff clearly show that ‘to give all’ is not enough. They will always give more…..Yet in times of strain, change and challenging circumstances, how will this effect the mental wellbeing of healthcare staff?

Who puts healthcare staff first?

Who makes sure that they are cared for?

Worryingly, this ‘carry on regardless’ mentality may put our healthcare staff on an even higher pedestal to perform and deliver. Will this make it even harder for those in psychological distress to seek help?

Does this ideology accept failure? – Healthcare staff are good people. They will give their all. I just hope there is someone there for them if they fall.