Liaison psychiatry nurses have a tough job. They are based in the Emergency Department and work with individuals experiencing acute distress; these patients may have recently self-harmed or attempted suicide and could be at high risk of further harm. Liaison psychiatry nurses contact gatekeepers to other services while under the pressure of national waiting-time targets. They usually have no continuity with patients after they are discharged and may be left wondering how their patients’ situations turned out in the end. Both mental healthcare staff and emergency department staff are high risk groups for burnout (Johnson et al., 2018; Potter, 2006); liaison psychiatry nursing combines each of these elements and so these nurses may experience particularly elevated stress.
In order to provide liaison psychiatry nurses with more support, one hospital introduced reflective practice groups. The groups were a protected hour: the liaison psychiatry nursing team left the department to go to a quiet room in another building where they could not be contacted. The groups were facilitated by a clinical psychologist already employed by the hospital. I particularly liked this feature; too often I hear about outside consultants being paid hefty sums to deliver wellbeing packages with hazy evidence bases, when most healthcare organisations already have a group of highly trained professionals employed in their psychology department who can do this work. The psychologist enabled dialogue between the team members and facilitated their conversation but did not impose an agenda.
When I was invited to contribute to the evaluation of this intervention I was delighted. We interviewed 13 liaison psychiatry nurses who had attended the group. They identified four main benefits of participating:
- Sharing and learning. Participants found that sharing their experiences in the group helped them to feel less alone. They realised that other people in their team were experiencing similar challenges and they left the group sessions feeling clearer-minded and lighter.
- Grounding and perspective. Participants said the group allowed them to take a step back and gain perspective on the difficulties of their work and the risks involved. It reminded them of the value their work has.
- Space. Participants described the group as a safe space; they felt able to ask for help or to say they were unsure of things and seek advice from their colleagues.
- Relationships. Participants said the group supported some positive interpersonal experiences between team members. The fact that they had an external facilitator and were guaranteed to be free from interruptions led them to feel they could raise difficult issues with their colleagues, in the knowledge they would be able to resolve these before the conversation ended.
It should be noted that not all nurses found the group beneficial. Some felt that the types of discussions they had during reflective practice were already happening elsewhere and they believed a protected space was not necessary. However, these nurses recognised that some of their colleagues benefited from the group, and were willing to participate in recognition of the overall team benefit.
We weren’t able to quantitatively evaluate the group as the number of participants in the study was too small. However, our qualitative data suggested that overall these groups provided a range of benefits which would have been hard to get from another forum, and some participants believed that sickness absence in the team would have been higher without them.
Practical tips for running reflective practice groups
For anyone wanting to run reflective practice groups, our study suggested a few things should be considered:
- Groups shouldn’t include managers. The presence of managers changed the nature of the group and inhibited open discussion.
- Protected time is key. Nurses stated that the groups were the only time they were guaranteed to have a conversation at work without interruption, and this was an absolute necessity for helping them feel able to discuss sensitive issues.
- The facilitator must be external to the group. Previous research suggests nurses trained in reflective practice can supervise these groups and there can be benefits to having someone of the same discipline provide this facilitation. However, experienced clinical psychologists should be sufficiently trained to offer this in the absence of trained nurses. Our study suggests this is acceptable to nurses and the important thing is that the facilitator works in healthcare but is external to their team.
A practical and cost-effective solution
Further research is needed to establish the effectiveness of reflective practice groups for supporting staff wellbeing. However, the evidence base for burnout reduction interventions in general is still small (see my previous blog on this here), and the best methods for supporting staff are not yet established. While we wait for evidence-based recommendations, reflective practice groups are a cost-effective form of support for liaison psychiatry nurses: they require no special equipment, no long periods of staff absence from work and can be facilitated by in-house psychologists, so no expensive outside consultants are required.
To read this study please see here.