Research Associate in Public Involvement role at UWE
IMPACT BLOG
AMBULANCE STAFF WELLBEING RESEARCH
Integrating Mental wellbeing support in Partnership with Ambulance Clinicians, for enabling Time-to-talk (IMPACT): A co-produced multi-phase study – SWASFT/University of Oxford
Sasha is a Research Paramedic and Academic Support Lead who has worked for ambulance services in the UK and the Caribbean since 2002. She is completing the IMPACT programme of research for a Doctor of Philosophy (DPhil) in Experimental Psychology with the University of Oxford. Sasha has been awarded an NHSE stipend which supports her University fees and she is supported by South Western Ambulance NHS Foundation Trust.
Dr Jennifer Wild
Dr Wild is an Associate Professor in Experimental Psychology at the University of Oxford, a Consultant Clinical Psychologist, NIHR Oxford Health BRC Senior Fellow and the clinical advisor for The Ambulance Staff Charity. Her area of expertise is in the research, treatment and prevention of posttraumatic stress disorder (PTSD) and depression in emergency responders.
Any Concerns about this research
Please contact Sasha, Dr Wild or SWASFT’s Head of Research and Audit; Dr Sarah Black via email or via the SWASFT research team contact form
Overview
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Research title
Integrating Mental health support in Partnership with Ambulance Clinicians, for enabling time-to-Talk (IMPACT): A co-produced multi-phase study
Aim
To investigate whether it is possible and acceptable to offer ambulance staff dedicated ‘time-to-talk’ sessions at work to enable them to think about work-related stress, as well as support needs and determine whether this could help improve wellbeing.
Research background
In comparison to the general population, ambulance staff are more likely to experience mental ill health and to die by suicide. Several patient complaints involve staff attitude and poor decision-making due to poor mental health. Causes of mental ill health are complex, although repeated stressful and traumatic events at work typically experienced by ambulance staff, are known to increase the risk. If help is not sought for mental ill health, symptoms may get worse. This can affect physical health, result in a poor quality of life and affect how staff perform at work. Mental wellbeing support is available, although ambulance staff report feeling too exhausted to look for help after work and the most vulnerable may not seek help at all. Staff also feel stigma and embarrassment about asking for help.
This step-by-step research plan will design the content of a dedicated space for staff wellbeing and examine if ambulance organisations can provide such a space in working hours. These sessions aim to help staff to talk about how their work makes them feel and whether any support is needed. This approach is in keeping with current compulsory training practices that ensure ambulance staff are trained to manage patient needs.
Design and methods
The project will be built upon an ongoing review of all the available research about supporting ambulance staff wellbeing at work (completed by March 2023). The project team will then create the dedicated wellbeing session approach by:
- Using results from the ongoing review to work with staff and Patient and Public Involvement and Engagement (PPI/E) groups to discuss what the research says and what they think the sessions should look like. A team of experts will then review this information and agree upon a finalised session. The session will include a set format to ensure safety and confidentiality, alongside updates about current wellbeing support options and signposting to support services as needed.
- Carrying out a small study involving 64 staff at 4 ambulance stations to see whether the session is acceptable and whether carrying out such a study is possible. We will aim to find out:
- willingness to get involved with sessions and complete feedback questionnaires;
- views about the usefulness of the session;
- whether sessions improve wellbeing;
- whether the study went as well as planned and if anything could have been done better;
- whether a larger scale trial could be undertaken.
PPIE/Service user involvement
Regular meetings with a reference group of 20 Ambulance staff, 8 PPI/E representatives and a professional consultation with 6 senior managers helped revise this research plan, based on previous research. Staff/manager suggestions include:
- Non-uniformed peer-to-peer rather than manager-led sessions, due to worries about organisational stigma.
- Video study updates as well as written summaries to aid information sharing, especially for minority group staff.
PPIE representatives improved the plan by:
- Recommending video conferencing for communication.
- Suggesting PPI/E representatives share research findings as co-authors or co-presenters to highlight connections between patient care and staff wellbeing.
PPI/E groups will help complete the research during regular meetings by reviewing the work as we go, sharing decision-making, whilst helping to interpret results and share findings.
Sharing findings
Results will be published in medicine and psychology journals and presented at conferences. Findings will be shared worldwide through the Association of Ambulance Chief Executives. Press releases, social media and a dedicated website will share results with staff, patients, and the public.
IMPACT prototype
In terms of IMPACT development to date, a preliminary prototype model has been created from Masters work, literature searches and expert support. This model is framed by Clinical Supervision principles of providing a timed, structured, confidential, meeting at work. Mind’s Wellness Action Plan (WAP) (9 questions designed to support reflection about how to stay well at work) will be included to develop awareness of working style, stress triggers and responses. This will aid communication with a trained peer who will provide updates about available support and signposting if required. Initial findings suggest session frequency could align with current annual health and safety at work legislation, to normalise mental health discourse and help-seeking into organisational culture. Session frequency could be modified to meet individual needs and connect the most vulnerable staff with support designed to help them.
Project plan
1. SYSTEMATIC REVIEW
Download PDF for the protocol
2. QUALITATIVE INTERVIEWS
Download PDF for the thematic analysis data plan
3. CONSENSUS WITH EXPERTS
Download PDF for e-Delphi consensus reporting guidelines
4. FEASIBILITY TRIAL
The feasibility trial will be designed with ambulance staff and patient and public contributors based upon information identified during the systematic review, qualitative interviews and expert opinion. The following logic model demonstrates what this process looks like:
Project logic model
Exclusion of Clinical Trials Unit (CTU) support rationale
The planned feasibility trial will be co-designed with ambulance staff and patient representatives. The Bristol Trials Centre have reviewed the proposed trial plan and agreed to support this project. However, the quote for CTU support was £50,000 and as:
- This is a PhD project
- Sasha’s academic supervisors are experienced in leading Clinical Trials
- South Western Ambulance Service’s research team are experienced at hosting and delivering Randomised Controlled Trials in the prehospital setting and fully support the project
- As a student Sasha will have access Oxford University’s Clinical Trials Research Unit for advice if needed
- Sasha will be undertaking a short course about Clinical Trials to supplement knowledge gained during her Masters in Clinical Research
On balance, it was decided that a spend of £50,000 on CTU fees could not be justified. It would therefore be reasonable to decline the CTU’s kind offer of support and utilise the resources available to assist the delivery of the IMPACT feasibility trial.
“Patients and the public are interested in being part of and getting involved with health and social care research for a variety of reasons. Most of all, not only are they hopeful of benefiting from more treatments but they also want to help others who are experiencing the same condition as them” – National Institute for Health and Care Research (NIHR)
IMPACT Public Contributor – Diana Frost
Why I am involved as a patient representative in NHS research
Hi my name is Diana and this picture was taken during a PPI meeting I attended in London. I got involved with working with Sasha for her IMPACT research as I want to help others have a better experience in their health and wellbeing journey, that I sometimes didn’t receive. I want to help health professionals realise that as a patient we do have a voice and our experience can help to improve services. For me this is also an opportunity to learn about health professionals and how research is so vital in giving data and methods which help to save money in the NHS. I can honestly say in the last nine years i’ve witnessed a greater improvement in standards and attitudes to PPI.
Why am I involved in the ambulance staff IMPACT study?
I believe our ambulance services do struggle with their mental health and wellbeing. As they are a patient first contact when an emergency arises, they also need support to talk and get counselling when needed, as many don’t. To have a dedicated space where they can talk and contact for help is vital, as during the pandemic they worked tirelessly and saw some very distressing and sad calls leaving behind family and them never getting to say goodbye to loved ones. This study is a step forward for our ambulance service and other health professionals working to give a backup for mental health & wellbeing which will result in a substantial amount of savings in sick leave and staff shortages.
IMPACT Public Contributor – Lynn Tatnell
Why I am involved as a patient representative in NHS research
I do PPI medical research because my daughters care throughout her 24 years was poor and unhelpful. She was not diagnosed although a few tests were undertaken. We were left to muddle through especially the last 5 years of undiagnosed Epilepsy. She died from SUDEP (Sudden Unexpected Death in Epilepsy) one Sunday night and even her care before being admitted to A&E was questionable. Nobody contacted me after her death which I find appalling to this day. I want better care for the public and patients, carers and their loved ones in the future and so I have volunteered with PenARC (Applied Research Collaboration, South West Peninsula) as a PenPEG (The Peninsula Public Engagement Group) member since 2009.
Why am I involved in the ambulance staff IMPACT study?
I am involved with the IMPACT study as I think its important for ambulance services to make sure their staff look after themselves and stay mentally well so they can make good decisions for patients.
SWASFT Patient Involvement in Research Group (PIRG)
A group of 8-10 patients, relatives and members of the public meet with SWASFT’s Research and Development team on a quarterly basis, to be updated about, discuss and get involved with SWASFT research.
IMPACT staff reference group – Olivia Bond
As this study focuses on ambulance staff (although enhancing patient care by improving ambulance staff wellbeing is the ultimate aim), it is important to include staff in developing this work as they are the ‘service user’ this research aims to help. A reference group of 20 staff have co-produced the IMPACT research plan and will be involved throughout the project in the interpretation, management and delivery of the research.
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Get Involved: staff, patients and members of the public
A reference group of ambulance staff and public contributors from SWASFT’s Patient Involvement in Research group (PIRG) have been supporting the development of this research since 2017. To ensure we involve people from diverse backgrounds and different lived experiences and perspectives we are looking for ambulance staff (in any job role) to help us. The staff reference group will help to design an approach which will investigate whether dedicated time at work can be provided for staff to enable reflection about work-related impact and signposting to staying well services if needed. It would be particularly useful to hear from staff who are sceptical about this or other employee wellbeing approaches to ensure that we include those who wouldn’t usually get involved in this type of work.
We are also looking for patients and members of the public who have experience of using emergency ambulance services and have an interest in the mental wellbeing of ambulance staff. Your perspective about ambulance employee mental wellbeing and emergency ambulance care is important.
Both public contributors and staff will have opportunities to help with various areas of the research such as:
- Sharing perspective and opinions about how to plan and deliver the study
- Providing perspective and opinion about the study findings
- Helping to share study findings
- Support decision-making throughout this study and any plans for next steps
The ‘Get Involved’ flyer has been reviewed with an existing staff group and provides an outline of what each contributor can expect. Regular meetings will be held from October 2022 via video calling, such as Microsoft Teams.
For an informal chat about getting involved in the study please contact researcher email:
Sasha is currently applying to the National Institute for Health and Care Research (NIHR) for a Doctoral Research Fellowship which if successful, will fully support this research and enable Sasha to maximise all associated opportunities.
Please visit the website ORCID (Open Researcher and Contributor Identifier) for a list of Sasha’s publications.
