 you recite so if you please could could write what country you do come from you can see there's many european countries and also africa south africa and india and also australian receiving great thank you still more answers coming in okay i will end this poll and then we have another one just to say um here we ask you what uh what is your main occupation or role and as you can see there's many clinical midwives and also midwifery students and different kinds of occupations as well thank you just in this poll and then the last poll we will do just here to start would be this one where we are asking you from where you're joining from during this conference thank you thank you very much and i will end the poll and then i will hand over the microphone to you so again okay so welcome to session 12 my name is sarah bansak and i'll be your facilitator for this presentation and the next one and with me we also have a net who we've just met so um virtual international day of the midwife 2015 would like to welcome the fabulous sally presaro um sally started her career with a degree in communications media and popular culture and drama before studying midwifery with a masters in leadership for health and social care she's been involved in health care and charitable services since 2004 and she's interested in the well-being of health care professionals post-traumatic stress disorder mental health and well-being and has spoken at uk health care conferences about her experience and ideas for the improvement of health care services and sally is currently enjoying further phd study in this area welcome sally right thank you very much for that introduction i hope everybody can hear me they should be able to i see the green light is flashing um so that's a good thing um thank you very much for inviting me today uh it's very exciting to be here and especially on a day where they may be a royal baby born that we are all discussing midwifery and other babies being born but what i'm obviously put predominantly interested in is when babies are born and when things happen in midwifery and what happens to the midwife um what happens to the clinical staff when we do the job that's needed um okay i'm trying to put the microphone closer to my face because you're saying i'm quiet is that better much better great okay okay oh no too close right okay final adjustment good yep okay great then i shall continue if you are all sitting comfortably so my name sally pizarro i had that introduction there i'm a phd researcher at the center for technology enabled health research and that's at coventry university and i'm passionate about the mental health and well-being for health care professionals specifically midwifery um i'll explain a bit more about my project and how it works and how you guys can hopefully become a part of it to help me um what i'm trying to do is develop and evaluate an online intervention so an online platform um which is designed specifically to help midwives uh and midwifery professionals um who are experiencing psychological distress i'm just at the beginning of this project at the moment but i'm telling people about it because obviously i'm going to need lots of people on board to tell me what this thing should look like how it could help and what what else should be included um so i've got my supervisors ready dr wendy kline dr andy turner emi falton are all helping me design this and and get make it evidence-based and then i've also got dr claire jarada and elizabeth bailey now claire jarada i don't know if any of you know who she is but she is um immediate past chair of the uk um college of gps um so she's very high up in in the gp world and she's actually um design things um like the practitioner health program which helps doctors in distress and gps in distress some with substance abuse disorders or just mental health issues in general and there didn't seem to be anything um equivalent for nurses or midwives now my background is midwifery um and i definitely saw a gap for this so that is the reason i saw this opportunity to explore this area and um my blog is is there and if you'd like to follow all the research and all of the stuff i do in this area for interest you please follow that or follow me on twitter and hopefully you can join me in this journey so why is this project important well a safe high quality and cost effective health care is it intimately linked to good staff health and well-being now we all know that don't we really um whether there's enough emphasis placed on that is another matter um and traumatic work environments in maternity services may be associated with stress vicarious trauma and anxiety so we know that um maternity wards can be very busy can be short staffed and very emotional in terms of the roller coaster we go through um and how how kind of we we cope with that on a daily basis and currently there is a paucity of support for midwives who could be at an increased risk of psychological distress due to the fact that they are independent practitioners wherever they work um in a high area of litigation maternity services generally um accrue the highest litigation cost rates for whatever reason that might be so that stress is constantly there for us so what are we hearing from staff at the moment now this is other people's research i've drawn from rather than my own um but you know people are saying i suffer from a condition called being human now um i think midwives can sometimes you put on a pedestal as in they're perfect nothing ever goes wrong um for them and you know they they don't necessarily need the same help that patients do but they are human and there's reports that say some of some people are saying they're close to having a breakdown in mental health and just carrying on um or looking to leave the profession and a lot of people are saying i didn't come into the health service to be mediocre and fail that's not why anyone joins the health service it's not why anybody becomes a midwife you do that because you want to make a difference and do a good job it doesn't always work out the way you planned and then this important quote here blaming scolding and punishment really have no place in the treatment of any illness so when midwives are struggling i think it's really important that we don't have punitive systems in place that stop other people coming forward and get help so the current UK facts this is just in the UK poor mental health um is equitable to a quarter of staff sickness absence now that's quite high and it looks as though something should be really done to remedy that and 38% of NHS staff have reported um having suffered at work related stress and all been very unwell um as a result of work related stress so we know it's affecting them um and so inevitably they are going to need support for that um unfortunately only 57% of NHS trusts have a policy in place to support that support mental well-being of staff so we've got the problem but perhaps not the support there and 68% of staff report attending work at least once when they didn't feel well enough to do so now as we know that staff well-being and health relates directly to patient care if people are coming in when they shouldn't be um then that is going to affect our care our level of care and our quality of care unfortunately so the midwife as the second victim this is the concept of of this term in particular and dr albert woo coined this phrase and i've been looking a lot of about his work as i'm learning more about the subject uh and basically obviously that the patient is the first victim whatever they're going through however their um needs are at that particular moment um they are a victim of um something physically happening to them but where the health professional is involved and in an anticipated unanticipated adverse event they can come to become traumatized themselves when that happens they could then become the second victim of whatever trauma it was in the first place and there's lots of um reading you can be done around this and i've left all these links and references on so that people are coming back at a later date can just uh have a look at those in detail so what's the impact for the second victim well they often become professionally insecure um they don't have as much confidence which we know we need in practice to advocate for women challenge poor practice um we can have changes in professional attitudes so um you no longer become kind of compassionate about the certain things you used to or you you know you become angry or burnt out um in in that sense it can affect you um and then there's post-traumatic stress and post-traumatic stress disorder now these are really high up on the spectrum and they really do need to be properly diagnosed by a psychiatrist or mental health professional which i am not um but everyone thinks post-traumatic stress disorder is is just something that that kind of goes goes around whatever you know as a word we throw about but actually people can can suffer from just post-traumatic stress the stress by an event doesn't always go into a full blown disorder um because there's certain criteria that would need to be met for that diagnosis so we're looking at general stress symptoms anger they can have substance abuse disorders developed to cope with whatever's happening um and that can be a a symptom of the general distress um compassion fatigue they literally burn out of things to give even even though they want to care and that's in their nature they haven't got anything left in reserve to do that so they become perhaps have they they have the sleep patterns um altered so they get tired and and anxious um that can have an effect on their family life as well as depression and all these things can impair their conduct a lot of people forget the behavioral symptoms of mental ill health health and just think it's all internal but actually they could become um angry they can do things they wouldn't normally do um and there's those things that are really difficult to look out for and they have increased risk of both personal and professional adverse outcomes so they could lose their job they could be put on um a period of leave um and obviously the worst of these um impacts is death by suicide which is rare but it's on the rise and recently there was some data about some gps that unfortunately took their lives while they were being investigated um and no such data really exists for midwives so hopefully that's something I can address in my future future past down this course so what might be the cause of these um horrible horrible um inflections on on midwives well adverse patient incidents obviously we've got never events critical incidents and we all know our our obstetric emergencies that can occur anytime anywhere and they can go well they can go bad they can be managed well they can live with you in terms of the memory of it for a long time um medical error when people nobody goes to work to make a medical error they go to work to be good practitioners but this happens and when medical error happens it brings about a whole lot of emotions such as guilt shame lack of confidence again and they actually um need a lot of help and support to get through that um whistleblowing is a big area of concern where people are often victimized or isolated if they whistle blow it's a very kind of isolating brave thing to do and there are obviously problems in needing support to do that effectively workplace suspensions you know they're not supposed to be punitive when you are suspended you are supposed to be taken safely away whilst while some kind of investigation comes out or is investigated but actually you feel punished and punitive you know you feel punitive action against you because you can't speak to anyone you're on your own and you don't know what's happening and you're not kept in the loop people don't understand or necessarily prioritize your own emotional needs at that time and that's the same with regulatory investigations um the the research says that menaces and midwives are terrified of the nmc at times and don't want to self refer and they're so scared of being reported um for for misconduct or ill health that they they will often find that traumatic in itself if they do have to engage there obviously workplace bullying has come out within the francis report and midstaff's and the curcup report um has been a huge issue and that could be as a result of other people being stressed in the workplace and taking it out on others or you know the the narrative there are endless really we could talk about that as a whole other whole other um presentation and sometimes our patients are aggressive towards us and expect and demand more and more uh and if we can't deliver that or if we can't control that or or give them the care that we want that becomes a real traumatic experience for us and the negative and traumatic organizational cultures as well in terms of do you have empowerment at work do you feel that you can be promoted and be respected in your workplace um doing my advice feel they're being paid enough and valued enough well we know that they are still fighting that cause as we speak um so it's interesting to see how that could help that boost their confidence are they suffering in silence now i'm sorry there's so many words on this slide i know that's very bad but i just can't have all these things here so people could at least come back at a later date and have a proper read but basically lots lots and lots of midwives lots and lots of healthcare professionals are in distress and relatively few seek help they will often suffer their whole careers um with secrets and facts that they hide in terms of feelings of shame guilt distress um and it's ingrained in us that a person should shouldn't suffer is the patient so the healthcare professional will always do whatever they can to make the patients not suffer um patient comes first that's all the way through midwifery training the patient comes first and when you have that um it means that sometimes you can forget about your own needs and you don't want to admit that that you're not coping or you're not doing very well or you're suffering because you know you could lose your job you could be suspended um the punitive systems that say you know if you've had too much time off sick it becomes a disciplinary issue um and also people judging you know whether you are capable enough to do your job if you are suffering in these conditions um and and that's something most people would like to avoid um and because you are a health professional you know exactly how to mask um a a sort of mental health problem because you've seen it in everybody else and now you know the signs you would look out for you could hide from your colleagues and you might isolate yourself because you're feeling bad so again people can't see that you're in in in distress and struggling on your own so barriers to seeking help the words are very very small I apologize here um but we see the pressure from inside don't show um and until breaking point comes really so there's a lot of evidence to say that midwives will hold it in hold it in hold it in and it will come out in some kind of big outburst at some point whether that be anger or breakdown or um those kind of things and there's lack of service provisions for places for midwives to go to seek help especially if they feel that they can't go anonymously and their employer may find out or um if they're having severe problems with substance abuse disorder that they know they might be referred to a regulatory body so the stigma is there and they often can't recognize their own mental health problem it's difficult if you are ill to recognize that you are ill um and there's limited finances to provoke to provide counseling or whatever it is people may need poor accessibility and burnt out staff may have a distorted view of themselves so um if they feel that they aren't worth helping they aren't worth um looking after then they may just go deeper into depression and not address their own needs and issues which is really really sad um as I'm sure we all love our colleagues we want them to go through that so hopefully this phd project can help the title is the development and evaluation of an online intervention designed to support midwifery professionals experiencing psychological distress so every few seconds someone in the UK will search the terms depression stress and anxiety into Google now that tells us that people are looking for information on this online um that might be because they're suffering themselves and they're turning to an online platform to do that they may want confidential support um rather than go to their managers or go to someone else they may want to just completely go under the radar and speak about it openly there um the intervention I'm hoping to build can be tailor made to suit the needs of the healthcare professional away from patient centered services you know if you're suffering with a health professional you may not want to go to the same surgery that you work in because you may see your patient and you're in distress and and need to keep that professional boundary separate and then hopefully this um online platform can offer peer support midwife to midwife so um that that can be quite therapeutic for people we can also potentially add um evidence based therapies story sharing um talking and CBT therapies online are quite effective as well um and if we can use the online intervention to distribute support for those experiences psychological distress we can also hopefully promote help seeking behaviors in disclosure through an anonymity and amnesty so a place of amnesty as well where you cannot be judged I'm hoping we'll give people the confidence to seek the help outside that they do need whether that's a GP or drug and alcohol services so my project plan is basically at the moment I am doing literature viewing I'm telling people my plan to see if they think it's a good idea um please tell me lots and lots of feedback I need to know if this if this is something that you guys would find um important um I'm reading other literature which tends to be unfortunately a lot of it's done in the States um rather than a UK midwife so clearly I've got loads of work to do probably my lifetime won't be enough to to do what needs to be done um but looking into the literature it's so clear um that they are in distress the numbers aren't clear at the moment but they're there and something needs to be done we obviously have the Schwartz round I don't know if any of you guys in the UK know about Schwartz rounds um they're a kind of debriefing talking service where people get together in a hospital and talk about the emotional side of their work but as you can understand everybody may want to talk openly to their colleagues um at that point in time and so alternative an alternative platform online could be the best place for those people who don't feel able to talk openly so after I'm doing all my literature reviewing and telling you you lovely people about this I'm writing papers hopefully to get it out there as well I need to work out is this feasible what do midwives need um to do this and identify who who needs this and I think it's most midwives and midwifery professionals to be honest there's obviously ethical considerations to be explored if we're to do this um and we have a ethical responsibility to tell um to tell the NMC if somebody's not unfit to practice how can we do that um when they actually need to speak openly um about their problems so again the um ability to be anonymous and have amnesty is a very ethical dilemma that I'll need to look at in more depth so then my next step really is to do um a Delphi study now a Delphi study is where I get a a panel of experts and you guys are all experts because you know what you need and you know what you want um and I get a panel of experts and I get consensus on on things that should or shouldn't be included in this intervention so should it have online mindfulness should it have CBT online should it be anonymous should it be um peer support based and people telling their stories openly and anonymously and you guys can definitely help me with that if you'd like to become involved in that study then after I know from my Delphi study what people would want to see in this online intervention I can start to build it so that would be my kind of after that you know after this summer really I can start thinking about building and developing something and then obviously we pilot test it we ask midwives or who want to use it does it work can it help you um and those kind of things in a qualitative way really in a research sense so we can publish papers about it improve to people this is needed ongoing um and if this tool proves to be effective in supporting how can we take it forward with the with the NMC take it on as an important way to take care of itself with the NHS take it on um NHS employers we um need to basically have it funded so if this works it will be it will be lobbying really to say can we have the funding please to keep this moving forward because my phd is only three years long so I'm looking for people to get behind this so if it works we can keep it funded um by somebody going forward and then you know eventually if it works we can open it up potentially to nurses doctors and other professional groups so thank you everybody for listening to that and if you do want to make this happen I will be recruiting midwives academics yes student midwives I've just seen someone asking about student midwives um so I'll be recruiting all of those kinds of people to help me uh sort of synthesize what should be in this platform what you guys would need to make it useful to you um and again on my blog page I will be announcing when I'll be recruiting for that and I think it will be this summer and later on when it's all built I hopefully I can keep in touch with you via my blog via my twitter and get people together to test the intervention to see if it works properly or whether it needs um you know tweaking here or there um so that's how I want you to get involved that's how I want you to share my research and get excited about this because I'm sure it has a place for midwives in distress and we need midwives to be healthy so that our patients can be healthy you know that's the whole title of my blog healthy staff means healthy patients and that's what we're trying to get is it only in the UK I've just seen it will be initially um because I first have to make sure it works there's no point in spreading it across the world if it's rubbish I need to make sure this is evidence based and it works if it works then I can spread it out further in the UK and then if it works in the UK other countries may well um say do you know what this could work for us can we try that doing this in Australia doing this in New Zealand and midwives and midwives all around the world and I'm sure they share the same issues in the same psychological distress in some form or another so yes there is the possibility that it could go everywhere but this is a small pilot study to say does this or doesn't it work and if it works I'm hoping there are no limits to where it can go so um I'm sorry to talk about lots of difficult issues and suicide and distress and those kind of things and I understand that some of you guys may be struggling or in some kind of psychological distress in the workplace so I do actually have a link for support any support people may need may need from having this webinar discussion with me um so please access that if you feel you've been affected at all and I'm just saying about my presentation limitations I said before most of the studies unfortunately are based on American clinicians American doctors American midwives or nurse midwives as they're called there and I'm finding it hard to get the same kind of literature and research that I need in the UK but as I said I'd like to build on that and like to keep in touch with all of you so that any studies in this area or in the future I can bring you with me and use your expertise in making things happen for the better okay so thank you very much for listening I think that's about it and I'd love feedback and questions if possible so you've helped me to learn about how this can help you and what else it might need um right now as I'm building it and as I'm thinking about what what it should contain um it would be great to hear some of that I'm just reading through what you're writing very important wish it was running now do you know what I wish it was running now too Linda I actually spoke to NHS England and they were very keen to have this up and running as soon as you know soon if you could guess it but it does take time to research things and make sure they're evidence-based effects of a midwife's own birth experience as well yeah I imagine that if this was built lots of people would be wanting to talk about many different issues about their workplace their own birth experiences and those kind of things uh you can count on me to work in Iran as well this could be really useful for midwives working in conflict zones my experience of working with midwives in Afghanistan shows the trauma really impacts on midwifery practice that's very true but we also have to think about access if you're somewhere where there's no wi-fi no internet how you know if you can't use your mobile at work to get into the app if you you haven't got a computer at home there are going to be barriers to this unfortunately and yes there are a lot of hurting midwives Emma you love to be involved okay link with me on twitter link with me on my blog and I will make sure that you can have the opportunity to to become a part of the study have you considered how to maintain confidentiality and privacy for patients when midwives share things such as adverse outcomes of birth I have considered that um I think it's going to need that anonymity um clause uh in it very very strongly um I also think it's going to need a large amount of midwives to dilute the data obviously if I get a group of midwives from one labour ward talking about something they're all going to know exactly who they're talking about exactly about which patient and that's not really going to work and sometimes it is better to speak to a midwife you know hundreds of miles away to get a different perspective on what you've been through um so that that's going to be key in doing that and obviously not sharing hospital trust names patient names all of those things that are in the nmc code of conduct anyway um and the social media code of conduct that would need to be um a part of of that sort of the rules of the rules of use I hope that answers that question but yes ethically there's lots to think about that will be my next step I think there are many survivor midwives yes there are survivors not rather victims but survivors keep going through trauma and midwifery is common however as we midwives often expect to step up a lip yes I've witnessed this so many times and I'm glad this is now being considered for a research and I hope for the support of midwives yeah I know we have that a stiff upper lip culture perhaps that's British perhaps that's just midwives I don't know but definitely I think midwives are put up on a pedestal of being sort of angels of mercy never do anything wrong they are midwives oh my goodness you know you you looked at in such awe um and it seems such a privileged job it's almost you know how can I possibly complain I've got the wonderful job of being a midwife and sometimes people cannot you know often feel like they can't complain they can't whinge they can't whine and they can't sort of say how they are stressed with it because you've got this wonderful job of being a midwife and so you don't say anything you carry on because the patient comes first and sometimes we need to put ourselves first to care for ourselves so that we can make healthy patients got more questions coming in I think and more people joining in I think this presentation is going to be obviously recorded and I'll put it up on my blog and I heard it was going on YouTube I don't know if that's true or not but if so that's awesome because we can refer back to this conversation and hopefully extend the conversation onto social media or on the blog where we can you know if you guys have got any more ideas you want to contact me I'm very happy to sort of get your expert opinion on this true I'm I'm just reading all of that I don't necessarily have any more coming in or whether you're whether you guys are done bored with me talking this kind of ties with self-care that was discussed this morning yes self-care for me the wife is so important but do we do we give that um enough credit do we realize that's important when from student midwifery training we're told that the patient comes first at all costs I think that's it I think everybody's finished talking there's 45 of you now who have enjoyed this so I hope you found this interesting and I hope I've inspired you to get on board with something like this because me hearing you say how important it is makes me feel like yes I really am doing something worthwhile so thank you very much for being a part of this and I hope to see you in the stratosphere soon yes actually Maxine very good point midwives who are hurting and then hurt those around them cruel to women and to colleagues etc that's the sort of by by product of compassion fatigue they cannot give anymore and it turns out actually is poor conduct sometimes you know speaking harshly to people losing that compassion which hurts everybody and it's just because they're hurting themselves and they need help rather than punishment I think actually that's where the punitive doesn't come in someone who's behaving like that doesn't need to be necessarily disciplined they need to be helped is my personal view okay yes but bullying on other staff as well why are people bullying is it because they're nasty people I don't think so I think it's because sometimes they just feel so insecure and pressured themselves that if they remedy their own self you know self well-being and safe psychology that it could be turned around okay that's great oh everyone's typing now okay feel free to share it and show show it with your your colleagues and friends because the more feedback I can get the better and it would definitely direct the the path of my research going forward wonderful thank you Sally that was you welcome thank you that was a really good presentation and I'm and I think you really hit a nerve with it as well um by the looks of the chat box it's a much needed project so um we really appreciate your time and I think your passion for the subject is evident so thank you so much it's been lovely thank you for having me okay I