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Guidance will aim to boost psychological support given to first response nurses

Effects of daily exposure to distress can take a toll on pre-hospital clinicians

Effects of daily exposure to distress can take a toll on nurses and other pre-hospital clinicians


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Guidance on how to improve psychosocial and mental health support for first response nurses is being developed.

The guidance to employers is part of a two-year project to improve detection, prevention and alleviation of psychosocial and mental health problems among first responder nurses, paramedics and doctors.

It will be developed by a working group at the Royal College of Surgeons of Edinburgh’s Faculty of Pre-Hospital Care. Mental health nurses working at ambulance trusts will be among the clinicians involved in the early stages of the project.

The guidance will highlight the nature and effects of distress among clinicians in the pre-hospital setting.

The daily toil of the job

Faculty chair David Lockey said high-profile events such as the Grenfell fire and terrorist attacks showed the emotional toll first responders face. But he said there is ‘day-to-day toil’ from more common emergencies too.

Professor Lockey said: ‘We want this project to provide a sound basis for delivering high-quality, evidence-based care for practitioners in pre-hospital environments.’

A team that supports and is supported

Nurse Emma Kennedy manages the Grenfell Outreach Team, set up in the immediate aftermath of last June’s fire, which killed 71 people.

The outreach workers aim to reach the estimated 11,000 people who may have been affected by the tragedy in west London to offer them screening for post-traumatic stress disorder.

Time out to reflect

She said reflective time was mandatory for the team.

‘In jobs where there is potential for staff to become traumatised, it should be mandatory to attend a facilitated reflective space at least once every two weeks.

‘Construction workers have to wear hard hats to protect themselves, yet we have a system where staff can become traumatised, and we do little to prevent it.’

The Grenfell outreach team continues to support emergency workers such as police and firefighters, traumatised by the tragedy.

Project lead Richard Williams, a disaster management adviser to the Royal College of Psychiatrists, said: ‘The project, which is based on current scientific evidence, best clinical and managerial practice and emerging guidance, will learn from recent emergencies.

'We are keen to engage practitioners in contributing their knowledge and experience.’

Employers' responsibilities

RCN professional lead for acute and emergency care Anna Crossley said it was incumbent on employers to create good working environments. ‘There are issues that individuals cannot solve alone, such as the burn out caused by overworking in resource-constrained or trauma-centred environments. Organisations need to have a “healthy workplace, healthy you” mindset that facilitates open discussion, support and debriefing.’

A second piece of guidance will be published to help staff in a pre-hospital setting support patients whose behaviour is causing concern, such as those who are threatening to harm themselves.

The faculty aims to complete the project by autumn 2020.


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