Sometimes when you are in practice you experience challenging situations, which can range from something quite small that 'niggles away at you' to something much bigger, and whatever it is, it can sometimes make you feel emotional.

During a pandemic, the practice you witness, and that you may be part of, will be different to usual. You, and many of the health care professionals you are working alongside, may experience wellbeing challenges that are different to the normal stresses and strains of practice. Your experiences in practice might feel relentless and exhausting.

Some issues will need to be managed through our usual processes, but others things might be centered on how you are feeling in the middle of what might be quite a daunting and chaotic time. You are important to us, and so, even if you feel like it's not a big enough practice problem to ask for help, you might still benefit from offloading or sharing your worries with someone.

Please ask for help if you need it ; whether you are 'just having a wobble' or your situation is more serious. There isn't a 'wrong' request for help. You and the person you make contact with can decide together whether the issues you raise need further action or support. It is intended that the support within this webpage compliments rather than replaces the other support that is available to you.

Look at other sections available on this webpage and see if any of the symptoms or concerns apply to you (e.g. work/life balance in a pandemic, witnessing trauma, early signs of fatigue, early signs of PTSD).

It’s really important that you look after yourselves and each other. It’s ok to be you, and it’s ok to not be ok.

There are all kinds of web pages, and other online resources springing up in response to the Covid-19 pandemic, and we wanted to try and put a website together that gave you links to some of the most relevant resources in one place.

The usual University support is still available to you, although it has moved online, and University staff can be accessed in a variety of ways including, phone, email, text and video calls (we use Google Hangouts).

Academic Advisers, Link Lecturers and Student Support Coordinators are still available to you, as is the University Wellbeing Service.

Brookes teams can arrange the best way to support you, whether that's via a phone or video call, or by texting or emailing.

This webpage is for specific professional practice related support. For more general wellbeing support please go to the Oxford Brookes Coronavirus Webpage. Your programme teams are also available for ongoing support.

The University of Nottingham have created a useful set of resources which we think you might find helpful.

Oxford Brookes has partnered with Fika to provide free access to an app which supports mental health and wellbeing for university students. Follow this link to the Fika page. Just download the app to your phone, select Oxford Brookes from the list of universities, set up and access initially via your normal Brookes email address, and then you are free to use the range of services provided for free. Remember to check your inbox for a verification email to activate your account.

Togetherall is an online service providing access to support for people with anxiety, depression and other common mental health issues.

Having said that we are here for specific professional practice support, we do want to draw your attention to a few small things that might make you feel a little bit better;

• If you are feeling anxious, overwhelmed and uncertain, plant both feet on the ground, take a few deep breaths and think about what you do know and what you can do today, even if it's something very small, it's still something

• If you are feeling guilty, remember it is because you are a compassionate and caring person and you simply want to help, remember we are all doing our bit to fight Covid-19, no matter how small and no matter what it is we do

• If you are experiencing grief, don't fight it, try to ride the waves of emotion, express them safely, be patient and kind to yourself, this will likely take many months to pass

• If you are feeling traumatised, connect with your loved ones more often, try not to avoid fearful situations, remember this is normal and will likely pass quite soon

• Try and place some limits on your less healthy coping behaviours (such as excessive use of alcohol)

• Please remember - you are not in this alone and help is available

We will get through this together

Occupational Health Services at the Oxford University Hospital NHS Foundation Trust (OUH) continue to be the service provided to Oxford Brookes University Health and Social Care students. There are many areas of vulnerability related to Covid-19 which require safeguards to be put in place and Occupational Health guidance outlines these. The Occupational Health Department have contacted students where they know they are in an at risk group, so if you have not declared a health condition and think you may be in an at risk group should seek advice from the Occupational Health Team at OccupationalHealthJR@ouh.nhs.uk

The guidelines issued by OUH Occupational Health are made available to you via your programme teams. We are issuing these when we receive them, and they are being updated frequently as the scientific knowledge around Covid-19 evolves. It is recommended that all students review the guidelines to establish what their vulnerability level means and the recommended reasonable adjusments are for you.

You will be able to access Covid-vaccination as a key worker. If you have not received this yet, please contact the national vaccination booking service

During the time of Covid-19, the Occupational Health regulations of the placement Trust may also provide guidance regarding occupational health risk assessments for the local area. When commencing placement, you should inform the Manager, of any occupational health issues or reasonable adjustments that you need. If you are in an increased vulnerability group for Covid-19 then you should liaise with the Placement Manager regarding undertaking the risk assessments relevant to the local Trust. All students will need to complete the Covid-19 induction checklist at the beginning of their placement.

If you require further support with this, please contact your Programme team.

The Covid-19 pandemic is clearly a marathon and not a sprint. You are likely to be juggling care delivery, learning and meeting university deadlines as well as coping with the issues that 'lockdown' causes. You may worry that keeping on keeping on may cost you personally.

There are many tips available for this within the general support site, links above, which will be useful to you eg mindfulness, breathing techniques, diet, exercise. Find the ones that work for you.

The key is to be aware of yourself and how you are managing...build positive self support measures within your clinical practice and within your home life.

Be kind and take care of colleagues and ask them to take care of you! - remind each other to eat, hydrate and take a break, even 3 minutes might have a positive impact if you use the time wisely!

Recognise when you are having a 'bad moment/day/week' -speak up and ask for support. STOP, BREATHE, then THINK- slowing your breathing slows the stress cycle and re-engages your frontal lobes - then you can think (Intensive Care society 2020). Utilise the local support services if this will be helpful to you eg. debriefing, chaplaincy, wellbeing support teams and apps. Recognise where you have control and influence. Know where you can seek support and guidance. If you are worried about yourself, seek support early.

Make space between clinical practice and home life eg. reflect on the way home and then have an activity that ends the working day and signals the start of home life, Going home checklist . Use positive coping strategies that have worked for you previously.

If you are living with other health care professionals work together to decide how you will ensure you have time for supportive and positive 'offloading of concerns' whilst ensuring you aren't talking about your clinical work 24/7. You need to have space for rest, relaxation and recharging your physical and emotional energy levels.

If you are feeling anxious about your programme of study in these uncertain times, this is understandable. It is important that you seek support.

Your programme team are the best source of information in relation to how your programme is being managed during the pandemic, including advice about what to do if your studies are disrupted.

You can make sure you stay up to date by watching your Moodle pages for updates, and checking your Brookes email regularly. As you will be aware, placements across all Health and Social Care settings have been affected by the pandemic, and so for some programmes there are special temporary arrangements in place to manage this. Programmes are working with the Faculty Executive Team and our placement learning partner organisations, to ensure that we monitor the ongoing situation carefully, and respond accordingly.

There is some information in the FAQs on the University Coronavirus webpages that might be useful for you.

Where this is necessary, information about redeployment will be made available on your programme Moodle site.

As the Covid-19 pandemic peaks and troughs, the response to it will also come in waves. Some health programmes may be offered the option of a paid placement. As the pandemic continues the likelihood of paid placements diminishes. The commonly held belief across the sector is that we will not be returning to paid placements however this cannot be guaranteed as it depends upon the course of the pandemic. During the pandemic, the usual ways of working have been challenged with the redeployment of staff and repurposing of placement environments. The clinical purpose of a placement may change rapidly due to the escalation of the Covid-19 response within an organisation, and therefore you will be required to work flexibly.

Thus your placements may not be what you had hoped for, but remember we are in a time of crisis, and the availability of the workforce to meet clinical demand is crucial and this will impact the placements available.

If required in the future those students who have the option for paid placements will be able to 'opt in'/'opt out' basis, but before you make a decision, you should look to your programme Moodle site for further information, and seek support from your programme team.

The key skills and considerations at this time include:

Teamwork is key to effective working at any time, and during a pandemic this becomes even more crucial. You will still have a vital place within the team, and you will still be able to contribute to its efficiency. This link (not specific for Covid-19) takes you to information regarding how civility within the clinical practice setting can help save lives.

Rumours abound during a time of crisis and it is important for you to think about how you respond to these. Consider the trustworthiness of the source of information, avoid speculation, stories and dramatic language, seek the truth whilst understanding that we have to allow time to make or receive a response. You remain an emerging professional, and should contribute positively using your professional knowledge, attitude and communication skills.

Resources and information regarding Covid-19 may change, be wrong or incomplete, this is how evidence is developed during a pandemic. As professionals we need to have a healthy sceptisicm regarding preliminary scientific findings and recognise that emerging information is useful, but our knowledge is a work in progress. For example, this is evident with the changes to PPE and Occupational health risks at the start of the pandemic. Public Health England and the royal colleges are providing their advice on the most up to date data and this changes frequently as the pandemic develops. Therefore you should keep yourself up to date.

Learning and Assessment - explore your programme moodle pages for advice regarding deadlines and any changes to the practice assessments. Be sure you understand who can assess you in practice during the Covid 19 emergency. When in your placement be clear about the rules and requirements of assessment. seek support form your link lecturers should this be necessary.

During the Covid-19 crisis you might find that you have moved into a student paid role, and this is new for everyone. Moving into employment in one of these roles comes with new duties, responsibilities and different levels of accountability. You should ensure that you understand the job description for your paid role and that you are clear about what is permissible within the role. Some of the things you could or couldn't do as a student in a supernumerary role may have changed. If in doubt ask for clarity and support.

Although you are not supernumerary you should still be supervised and offered appropriate guidance and support. You should be included in relevant staff training. If you are concerned about the level of supervision you are receiving then raise this with the paid placement manager, and if necessary, contact your programme team/link lecturer for further advice and support.

Other things to consider which will help you practice effectively;

• Use team briefings - actively listen and join in

• Be clear in your communication - be clear about what you are able to do, and about the areas where you don't have the necessary skills and will require additional support

• Use checklists and aide memoires

• Identify where you may be experiencing performance-limiting factors - look for safe and positive solutions - share these with colleagues

• Learn from your experiences and discuss them with the team

Guidance related to Personal Protective Equipment (PPE) and Occupational Health status are outlined on the Brookes Covid-19 webpages.

Unfortunately, during times of crisis, such as this, when things are not behaving 'normally' and people are under pressure, difficult decisions present themselves, and ethical dilemmas underpin crucial moments in professional practice, and often, without the time to make well considered choices.

We expect that during our response to the pandemic, there will be times when appalling hard choices will be made, and sometimes, practice will not be at the highest possible standards in a more ideal world. Sometimes you will witness practice that is traumatic, in a place where you would not necessarily expect to see trauma, or you might see something which creates significant ethical issues for you, and you may even be directly involved in situations where you are not able to practice in the way you would like to.

There are a lot of resources available which explore the challenges of ethical dilemmas in practice, and you have probably spent time on your course, thinking, talking, reading and writing about ethical issues.

You will have seen them come up in practice, and you may have sometimes felt a bit compromised and wanted to talk that through with a mentor, tutor or peer. We are aware that you might be exposed to more of these traumatic situations or ethical issues, without necessarily either the time, or the support structures around you, to help you work through what these mean for you.

Not only can you use the email address to send us a question or comment that we can support you with, help you pick over and perhaps understand better (and possibly advise you on whether or not it is something that should be taken up by someone else in the area where you are practicing), but you can also access resources online to help you.

You may come across the term, 'moral injury', which originates in the military, but which is increasingly being used to describe the potential effects of dealing with Covid-19 as a health or social care front-line worker. Moral injury occurs when an individual's moral conscience and/or their value set is ignored or violated, for example being forced to witness someone in distress or even dying, and not being 'allowed' to intervene due to rationing of medical aid. This experience can produce profound feelings of guilt and shame, and in some cases also a sense of betrayal, anger and profound 'moral disorientation', not knowing 'what is right anymore'. There is an interesting article on moral injury, published in the BMJ in March this year, if you want to read a bit more.

As we move through the pandemic and waves of crisis come and go, you will experience practice fluctuating. The moving from crisis to a more normal approach will bring with it, its own challenges. As reported widely there may be an increase in PTSD and fatigue and staff will be utilising resources to 'catch-up' service delivery over a number of months and years.

It's very important that you look after yourself during this time, and that is going to be all the more challenging when you are probably not resting as well as you would normally do, not sleeping, feeling anxious, and on top of this, probably also working very hard and in an unfamiliar way. We can all expect to feel more tired and generally 'out of sorts' at the moment, because this kind of disruption to our normal routines and daily activities can make us all feel that way. As the country goes in and out of lockdown according to the government's road map you may feel anxious. Recognising when you are getting too tired to carry on is an important part of being a professional who is aware of the boundaries of their safe practice. We know that you will be tempted to push on and on, especially when you are working alongside colleagues who are doing the same thing. We want you to take a break, regularly, in order to catch up with yourself, catch your breath and take time to offload and reflect and rest. You cannot possibly be effective in practice if you are running 24/7 or feeling ovewhelmed. Please be alert to signs that you are pushing too hard, and give yourself permission to hit the pause button. There is a useful NHS web page with information about tiredness and some of the causes, including how feeling anxious and stressed can make you feel tired.

Important signs that you are reaching your limits and need to pause are;

• headaches and dizziness

• sore or aching muscles and muscle weakness

• slowed reflexes and responses

• impaired decision-making and judgements

• irritability

• feeling unusually tearful

We are expecting to see increased numbers of people who are suffering a significant and very understandable reaction to the environment that they are living and working in, during and after the pandemic. We know that our mental health as a global community will be affected by these events and some people will need specialist support to recover from their experiences. Post-Traumatic Stress Disorder (PTSD) is a recognised type of anxiety which is caused by someone experiencing a distressing, traumatic and/or very frightening events. There is a growing belief that we may well see an increase in health and social care workers experiencing PTSD as a direct result of being exposed to high levels of stress in the practice environment, as we try to work within and and respond to, the pandemic environment. People react very differently to stress and fear and symptoms can come on after a few weeks or months, or can be delayed for much longer. We want you to be aware of this potential risk to your mental health, not to add to your worries, but so that you feel confident about asking for help straight away, if you need to.

Early signs that you might be needing to access specialist support because of the immense stress you are experiencing are;

• flashbacks to a particular event

• nightmares

• repetitive and distressing images or sensations

• physical sensations, such as pain, sweating, feeling sick or trembling

• intrusive and repetitive negative thoughts about the event or experience

There are lots of resources available to support people who want to have a better understanding of PTSD better, particularly during this global crisis.

It's important to remember that a certain amount of fear and trepidation, anxiety and even dwelling for a time on a stressful event, is completely normal, given the abnormal events we are currently experiencing and this will pass.

Try and stay focussed on the things that are within your control.

Remember the things that have gone well. Think about the small things that you have accomplished, because they matter.

Be prepared to feel anxious. There will be a psychological impact. Try and find time for things that are comforting, whatever that might be for you. It's simply not possible to be 'on it' 24/7. Remember to eat well, exercise and try and get some sleep. Stay in touch with friends and family, Remember to ask us for help, it's what we are here for.

In a pandemic, healthcare professionals may experience both fear and grief arising from their work contexts. There is a really helpful blog post here, by Holly Hughson, that you may like to look at that focuses on fear in crisis situations.

You might also be experiencing feelings of grief related to a range of losses, including “loss of life through bereavement, loss of job role, loss of income, friendship networks, childcare, work teams, sense of safety, certainty and predictability in life. Time and the support of friends and family and where needed seeking professional help can alleviate the symptoms and help us to process this grief” (Walker and Gerada, 2020).

Sarah Murphy, a Royal College of Nursing Counsellor, gives the following advice on managing the death of a patient;

• Discuss and reflect with a supervisor or a colleague

• Acknowledge your feelings, it is normal to feel sad, or wonder if any thing else could have been done

• Talk about your feelings to a friend or colleague for peer support

• Be kind to yourself

Nursing resources (however these may be helpful to all):

Look after yourself – see the RCN guide to a healthy you

Seek professional support if you feel overwhelmed– visit the RCN counselling service

(Murphy, 2019) More here.