key: cord-0734436-rp6jlv1t authors: Rosen, Benjamin; Preisman, Mary; Read, Heather; Chaukos, Deanna; Greenberg, Rebecca A.; Jeffs, Lianne; Maunder, Robert; Wiesenfeld, Lesley title: Resilience coaching for healthcare workers: Experiences of receiving collegial support during the COVID-19 pandemic date: 2022-02-22 journal: Gen Hosp Psychiatry DOI: 10.1016/j.genhosppsych.2022.02.003 sha: 12b88361ca9b5dd6eee413c9f4baa418e0e58dc3 doc_id: 734436 cord_uid: rp6jlv1t OBJECTIVE: To explore experiences of receiving collegial support from the department of psychiatry at an acute care hospital during the COVID-19 pandemic. METHOD: The Resilience Coaching program launched in April 2020, with the aim of offering a timely response to supporting psychosocial needs of healthcare workers (HCWs), leveraging collegial relationships and mental health training to offer support. Twenty-four HCWs were interviewed about their experiences receiving support from resilience coaches. RESULTS: Participants reported that Resilience Coaching offered hospital staff opportunities for connection, encouragement to attend to personal wellness, and avenues to learn practical skills to assist with coping. Coaching also assisted HCWs in accessing clinical mental health support when that was requested by staff. CONCLUSIONS: Resilience Coaching is a model for supporting colleagues in an acute care hospital during a pandemic. It is generally regarded positively by participants. Further study is warranted to determine how best to engage some occupational subcultures within the hospital, and whether the model is feasible for other healthcare contexts. HCWs with more work experience, and those who received training and support in managing stress (including attending to basic self-care) may show greater resilience (16) (17) (18) . Resilience can be defined in different ways; a core component is a person's ability to cope with adversity and carry on with facets of their lives (19) . The most effective interventions to support resilience tend to focus on bolstering a sense of personal control, coping skills, and access to psychosocial resources (20) . Folkman and Greer (21) describe a sequential approach to coping: Problem-focused, emotion-focused and meaning-focused coping. An important aspect of resilience may also be fostering a supportive workplace environment (22) . In occupational settings, burnout -a response to occupational chronic stress, characterized by emotional exhaustion, depersonalization and diminished professional achievement -is a threat to resilience (23, 24) . One framework for understanding burnout highlights three facets that protect workers from burnout: Control, Competence and Connection -the 3 Cs (25) . Control considers one's autonomy (the ability to self-govern) -to control schedules and do work in a way that makes sense for the individual. Competence is a sense of being skilled or welltrained, and proficient at work. Connectedness is a feeling of belonging and relating to other people at work, as well as the larger aim of the organization. Many support programs for HCWs have been described. Though they differ and may not be universally transferrable, some commonalities exist (4) : the involvement of mental health J o u r n a l P r e -p r o o f professionals and having flexible support mechanisms. A modular program developed by consultation-liaison psychiatrists in France featured a telephone hotline, onsite relaxation rooms, and a mobile team to visit staff experiencing difficulties (26) . "Battle Buddies," a program implemented in Minnesota, highlights the value of pairing staff to provide immediate, on-the-ground support. In addition to the peer support, areas of the hospital strongly affected by COVID-19 were also assigned a mental health consultant, who attended meetings, helped staff plan responses to change, and assisted in obtaining clinical assistance when needed (27) . A program called "CREATE," developed at an academic cancer hospital in Toronto, paired psychosocial coaches with unit managers to deliver adaptive support. In this model, coaches with interdisciplinary backgrounds work to address emotional needs of the team, promote calming, provide resources and assistance to advocacy where appropriate, and facilitate working through the Folkman and Greer model of coping (28) . Other examples of support programs include mobile applications with guided resources, online courses, and the creation of a dedicated research center that offers ongoing, multifaceted support (29) (30) (31) (32) psychiatry, including the importance of working closely with medical and surgical teams in providing patient care to complex patients. In contrast to C/L psychiatry, the focus of support is the team, rather than the patient or family. Although coaches are mental health clinicians, Resilience Coaching is distinct from clinical care. Coaches apply skills and training in psychotherapy to provide support to colleagues (5) . While most coaches are psychiatrists, the group here also includes a bioethicist, mental health nurses, and a social worker. In general, coaches try to provide support to a team with whom they had a pre-existing relationship when possible. Where no prior relationship existed, coaches work to rapidly establish a relationship by providing a consistent and supportive presence. Coaches provide dynamic support and are responsive to the group's needs (i.e. leading a mindfulness activity or discussing a challenge faced by the unit). Coaches lead unstructured sessions where staff explore feelings and provide mutual support; this promotes group cohesiveness. Coaches also facilitate access to clinical care for staff when appropriate; for privacy reasons, data is not kept about these facilitations. Coaches were oriented to the key model and principles of Resilience Coaching, and the program was launched and refined iteratively based on this model. Although there is no formal training program or manual, Resilience Coaches meet regularly to support one another, share best practices and identify priorities or areas of need. coaches expanded support to non-clinical teams, such as security and program administrators. Coaching was both offered directly and available on request. Requests corresponded with community infection rates, and other stressors such as government-mandated restrictions or school closures. In October 2020, a qualitative inquiry was undertaken to explore the experience of receiving Resilience Coaching. Qualitative interviews were conducted with 24 staff who had access to the intervention. There was no standard exposure for this study. A control group was not used in this study; in the face of limited time and human resources for research, the team chose to focus on collecting narratives about Resilience Coaching itself. The study was approved by the [name of hospital] Research Ethics Board. Participants were recruited via email invitation, from a range of disciplines and units across the hospital that had an affiliated coach. Interview participants were identified to achieve a maximum variation of participants across the units being coached. Hour-long, semi-structured interviews were recorded using the hospital's virtual meeting software. The interviewer asked questions about demographics and work history, work life before and during the COVID-19 pandemic, experiences with coaching, home-life during the COVID-19 pandemic, and whether J o u r n a l P r e -p r o o f and how Resilience Coaching should continue or should be promoted. The interviewer was responsive and allowed for organic discussions. Interviews were professionally transcribed, edited for clarity, and analyzed for themes by the team. Data collection and thematic analysis were conducted concurrently (33, 34) . The research team comprised a mixture of coaches and researchers with expertise in health services (initials) and education (initials). (initials) conducted all interviews. After each interview, (initials) identified themes and noted questions to discuss with the larger group. (initials) reported weekly to the research team, and adjusted topics in accordance with emerging themes in coaching discussions, and the evolving pandemic. Interview collection was completed when saturation of themes had been reached. A group of researchers (initials) coded a subgroup of transcripts to establish a working codebook. (initials) coded the remaining transcripts. To reduce coding bias, emergent themes were regularly discussed among the following researchers (initials) (33, 34) . Study participants included 4 physicians (17%), 10 nurses (42%), 8 allied health professionals (33%) and 2 other staff (8%). There were 4 participants who identified as male (17%) and 20 who identified as female (83%). The majority of participants (8 [38%] ) were between the ages of 30-39; the full age span of participants ranged from 20-29 to 60-69 years old. In the following sections, quotes from participants are labelled based on their occupation category: "N" are nurses, "MD" are physicians, "AH" are allied health professionals (other clinical staff, such as social workers and pharmacists), "OS" are other staff (includes non-clinical hospital staff, such as door screeners and research staff). Numbers that follow the label refer to the order in which a participant's quotation appears in the paper. Participant interviews revealed information about their experiences with Resilience Participants also reflected on how certain work relationships strengthened during the pandemic. One participant, who volunteered for redeployment to another clinical setting, commented: "We have to be like-minded people to decide to go into the fire willingly…. So…we're bonding in that way, and it feels good to have that support group…" (N1). Another phase" would be coming (N1). Another described colleagues as "hanging on by a thread," and that they were "going to explode" (N2). Participants consistently described Resilience Coaching as a forum to process these issues. Coaching offered a safe space where participants could acknowledge emotions, decompress, or brainstorm: "That space with the Resiliency Coach in my experience actually became a space to problem solve and feel that sense of agency for how you can effect change..." (AH4). Participants appreciated coaches' ability to create a safe space: "The Resilience Coach…brings a very calm energy to the space, it feels extremely safe, it really does feel like you could say anything and that you wouldn't have to be worried" (AH5 Another participant expressed that for them, Resilience Coaching was helpful because it provided "transparency with respect to information…questions that could be asked and information that was available" (N2). Another noted they learned ways to frame issues "in a way that could be beneficial to bring to management" from their coach, which made the staff team "feel advocated for" (AH5). Finally, one participant, who holds a senior position, noted sessions were a place to learn about their team: "I didn't realize…how much personal stress people were in, away from work…I was very glad to hear how supported they feel at work. And was helpful for me to reach out" (N4). This participant, noted "it makes a huge difference to know that…we can have a general conversation, but if something is really hurting you hard, you can reach out…" (N1). Several participants described appreciating that support took place directly on the unit where they worked, from a coach they knew well: "…with our coaches it's almost like peer support…for me personally…I could be myself more and not have to watch what I say" (AH2). Another participant also described that they preferred support in the unit because there was "an added layer of… relationship and trust" (AH3 Greer's model of coping (21) , staff reported greatest benefits in emotion and meaning-based coping. Participants described sessions as a safe place to regulate emotions, which resulted in feeling less alone; additionally, participants acknowledged emotional shifts towards being able to maintain work-life balance. Participants also described coaching as a safe, supportive environment, which is known to facilitate resilience (22) . Themes emerged about how coaching fostered connectedness and solidarity. Additionally, there was less participation from staff who identify as male, and as physicians (compared to nurses and allied health). Further research is needed to explore whether these factors are of significance. Further cross-sectional analysis of our data will reveal the degree to which Resilience Coaching was helpful for specific subpopulations of HCWs who are more or less prone to resilience. Another possible avenue for research would be comparative analyses between the experiences of staff who participated in Resilience Coaching and staff who chose not to access the intervention. Lastly, the majority of the research team are practicing coaches (except for (initials)). While there may be possibilities of bias, we believe the embedded status of the researchers enriches it through increased understanding of context and process. It is also methodologically harmonious with the goals of Resilience Coaching, which prioritizes connection. The presence of non-coaches (initials) (health services) and (initials) (education) on the team adds an objective perspective, as discussions regularly required clarification of concepts. Resilience Coaching is not unique in its provision of support for HCWs during this time. Worldwide, there are programs reported that range from peer-support to the development of smart phone apps (11, 14, (26) (27) (28) (29) (30) (31) (32) . These services answered global calls to action, issued at the start of the pandemic (2, 3) , where the immense challenge and risk of HCWs' burnout being amplified by the COVID-19 pandemic was highlighted. Where this paper adds to ongoing discussions is in highlighting voices of participants who experienced the intervention. This paper sits within a growing body of qualitative literature on working during the COVID-19 pandemic (12, 13, 15 ) that emphasizes the lived experiences of HCWs in their own words. A theme from our research is some HCWs find it difficult to communicate realities of their lives, creating barriers to accessing support, and potentially development of successful interventions (36). Therefore, we believe a key element of research in this area is to highlight voices of HCWs' to facilitate understanding, and better support. Resilience Coaching is a support program that has been well-received by staff during the COVID-19 pandemic. Analysis is ongoing with a focus on how to understand and support staff who did not readily access available coaching and how to translate Resilience Coaching to other contexts. 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