Creating an online peer based intervention for clinicians suffering with psychological distress: The challenge ahead Sally Pezaro*, Wendy Clyne, Emmie Fulton, Andy Turner, Clare Gerada. Coventry University, Coventry

1. Creating an online peer based
intervention
for clinicians suffering with
psychological
distress: The challenge ahead
By Sally Pezaro
Supervisors: Dr. Wendy Clyne, Dr. Emmie Fulton & Dr. Andy Turner
Official Advisor: Clare Gerada

2. Introduction
• The challenge ahead
• The project
• Case studies
• The current situation
• Epidemiology
• Aetiology
• The impact upon healthcare organizations
• Help Seeking
• Current sources of support
• Methodology
• The Challenges ahead
• Conclusions

3. The project
• To construct an online support programme explicitly designed to meet the
needs of clinicians.
• The goal is to facilitate and create a trusted online peer to peer support
network in an era where clinicians fear disclosure (Ullström et al, 2013).

4. Case Studies
• Margo – A 49 year old nurse with a reputation of being grumpy, rude
and uncaring. Disinterested in professional development and snaps at
students.
• John – A newly qualified A&E nurse. Easily startled, looks tired and
bewildered at times. John has recently made a medical error and
shows a marked lack of confidence.
• Emily – A midwife currently under investigation due to a patient
complaint following a critical incident. Her behaviour is markedly
changed, she is jumpy and avoidant of certain situations. She doesn’t
want to talk about it.

5. The current situation
• There is much research outlining widespread psychological distress in
health care professionals, yet scant attention has been directed
towards preventive interventions (Irving et al, 2009; Romani et al,
2014).
• Healthcare focuses upon providing support for patients, yet limited
attention has been paid to the ‘second victim’ (Wu, 2000).
• Clinicians report that they “are close to quitting or having a
breakdown in mental health” (McHugh et al, 2014; 106).
• There is a clear link between staff wellbeing and patient care quality
(Boorman, 2009; Black, 2008; DoH, 2014; Rassin et al, 2005).

6. Epidemiology
• The prevalence of second victims in health care has been estimated
to vary between studies from 10.4% (Lander et al., 2006)
approximately to over 30% (Scott et al, 2010) to 43.3% (Wolf et al,
2000)
• Studies in disaster response workers and routine based health
workers have returned generally similar traumatic stress incidence
rates (Laposa et al, 2003) ; Clohessy et al, 1999 ; Lin et al., 2007).
• In one survey of 2769 respondents in the UK, 80% of GP’s reported at
least one other practitioner in their practise is suffering from burnout,
(McHugh et al, 2014)

7. Aeitiology
• Psychological distress can occur in health professionals as a result of:
• Aggressive behaviour towards staff
• Workplace bullying
• Medical errors
• Traumatic ‘never events’
• Critical incidents
• Workplace suspension
• Whistleblowing
• Pre-existing long term mental health disorders.
(Strobl et al, 2014)

8. The impact upon healthcare organizations
• Emotional exhaustion, depersonalization, negative thoughts towards
others and a reduced sense of personal accomplishment (Maslach, 1986).
• Lack of empathy, poor concentration, working relationships,
communication, and decision making (Beddoe et al, 2004; Skosnik et al,
2000).
• Burnout has been linked to decreased patient satisfaction and longer
patient-reported recovery times (Vahey et al, 2004; Shapiro et al, 2005).
• People with post traumatic stress may experience changes in their
behaviours, cognitive function and emotions. symptoms can include
avoidance, hyper vigilance, paranoia, panic attacks, depression, anger,
guilt and substance abuse (Rogers et al, 2000).

9. Help seeking
• Many health professionals never seek help or do so after years of
suffering, especially during depressive episodes (Clark, 1999; Laposa
et al., 2003, Dewa, 2014).
• Healthcare professionals may not be aware that they need help or
may not think they need help (Dewa, 2014; Mojtabai, et al, 2011).
• Fear that they may lose professional reputation, be perceived as
inadequate or lose their careers, especially when substance abuse is
apparent also inhibits health seeking behaviours (Deuchert et al,
2013).

10. Current Sources of Support
• Compared to services provided for doctors, there is a paucity of support for
nursing and midwifery professions at this time.
• No support is provided directly by regulators; although the GMC commissions the
Doctor Support Service externally.
• Currently, there are indications that some organizational cultures remain
punitive and blame-focused. This is counterproductive to any support
• Range of internal and external support options offered by trusts, including
occupational health services, HR, unions, counselling, 24/7employee assistance
programmes, formal debriefing sessions, chaplaincy services etc.
(Strobl et al, 2014)

11. Methodology
• Literature and narrative reviews
• Delphi study or focus group
• Usability and needs assessments
• Develop a comprehensive evidence based intervention in readiness for
pilot work
• Beta testing
• Data collection and evaluation
• Evaluation of the impact of the intervention, delivery and outcome
measures.
• Write up

12. The challenges ahead
• Effectively moderate the online intervention
• To maintain data confidentiality and security.
• Navigate the ethical issues surrounding amnesty in cooperation with
regulatory bodies.
• To explore ethical issues in relation to confidentiality versus accountability
• To enable users to be private in a public space
• To facilitate storytelling whilst protecting the confidentiality rights of those
involved.
• To involve a range of stakeholders in facilitating private discussion whilst
acknowledging a duty of candour.

13. Conclusions
The hope is that this behavioural intervention will become a platform
for clinicians to heal through peer support and become able to seek
further medical attention in an era where clinicians fear disclosure
(Ullström et al, 2013).
“All clinicians suffer from a condition called being ‘human’” (Conway et
al, 2009:3).

14. Thank you – Questions?
Sally Pezaro
Email: pezaros@uni.coventry.ac.uk
Centre for Technology Enabled Health Research
Faculty of Health & Life Sciences
Coventry University
Priory Street

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