Sometimes we find better ways of doing things under pressure. That’s why it’s important to discover what worked well, and what didn’t work, for healthcare teams during the Covid-19 pandemic.

For Professor Martina Hennessy, exploring how healthcare workers fared during the pandemic has pointed to key factors that affected their psychological health and wellbeing, and she now wants to see the learning applied to improve the practices and wellbeing of healthcare teams.

“The acute intensity of the pandemic may be over, but the healthcare system is still very much under pressure,” says Professor Hennessy, who is Associate Professor in Medical Education at Trinity College Dublin’s School of Medicine.

She was involved in a series of surveys during the pandemic that explored how healthcare workers were supported around three basic psychological needs – autonomy, competence and relatedness.

“We asked to what extent were these recognisable for doctors, mainly early-stage practitioners, during the pandemic,” explains Professor Hennessy. “ The pandemic provided a living laboratory to understand the relationship between psychological needs and care provision, because in effect the crisis was “standardised” across countries and hospitals and healthcare settings.

Much of what the research found seems intuitive, like the importance of factors such as giving people more time for handovers, allowing people time to reflect and ensuring that people are making decisions at an appropriate level. But it is more than simply common sense, says Professor Hennessy.

“The research shows that we need to recognise the power of these factors and make them work to improve healthcare.” 

Making decisions in ICU

One of the pieces of research looked at teams working in intensive care units in acute hospitals in Dublin, New York and Utrecht. These surveys were carried out towards the start of the pandemic, a time when there was no vaccine and healthcare workers were being applauded publicly but working under unusually stressful and disrupted conditions.

The cross-sectional survey found that respondents generally felt while the quality of care and supervision were lower than usual, they were acceptable, in this period, and there was a strong spirit of collaboration.

“We could see that under these conditions having a strong mix of experience and training levels in the healthcare team was really important for their psychological wellbeing, as was the stability of the team, that people were not being switched in and out,” says Professor Hennessy, who is a practising clinical pharmacologist at St James’s Hospital, which featured in the study.

One of the standout findings was that the availability of senior staff made a huge difference.

“Senior individuals being on site was key, there was a robust culture of informal consultation,” says Professor Hennessy. “This meant that advice from experienced people at the right time helped things to move smoothly, and people were not needing to make decisions at a level above their capacity, that there was autonomy-supported supervision.”

Interns need time to reflect

Slightly later in the pandemic, another survey learned from interns who were moving from their expedited graduation to the frontline in acute hospitals.

“Your first year of practice in medicine is a time of uncertainty and enormous change even at the best of times, and interns who went into this phase in Covid-19 faced even bigger challenges and interruptions,” says Professor Hennessy, who is Director of Internship at Trinity School of Medicine.

Supported by HRB Covid-19 Rapid Response funding, she led a survey in Ireland from July 2020 to June 2021 that looked at how confident the new cohort of interns felt to be able to carry out their duties, and their sense of becoming connected into the healthcare community.

“What seemed to help this group develop their autonomy and relatedness included things like having a longer overlap period, so outgoing interns could hand over and help the incoming interns, and that being given an appropriate level of responsibility helped people to develop their belief and confidence in their abilities,’ says Professor Hennessy.

“We also saw that the ones who could park the feelings of worry and sadness and create a separation between their home and work life tended to process their feelings better and it helped them to cope with the stresses and the grief of losing patients,” she adds.

Worrying signs

The burden of coping with the pandemic was more than evident in a separate survey with a range of healthcare workers – doctors, nurses and radiographers – in acute hospital settings in July 2021.

“We looked at psychological stressors and mental health in the third phase of the pandemic, and what we saw concerned us,” says Professor Hennessy. “Several respondents reported moderate to severe post-traumatic stress, including mood disturbance, moral injury – where they felt they could not help others – and worryingly some had features of suicidal ideation.”

The study found that among those who answered the survey questions, doctors were the least likely to report the more severe aspects of psychological distress, and a substantial proportion of the nurses who responded said they had felt a sense of moral injury, where they were unable to help patients in the way that they wanted to.

Translating findings

Professor Hennessy would like to see the findings from the studies incorporated into hospital systems and that they inform medical education and help to support healthcare workers to deliver the best for patients as they develop their skills and careers as clinicians, managers and researchers.

“The healthcare system is still under huge pressure,” she says. “And many of the lessons we learned from studying how people were coping on the frontline of the pandemic still need to be heeded today.

Ultimately what patients need, whether it’s in a pandemic or in an Accident and Emergency department today, is healthcare workers who are enabled and supported to make the right decision in the right place at the right time for the best outcome.”

You can read more in the studies linked to this article.