The hardest thing was admitting that I was stressed at work...

To coincide with International Stress Awareness Week Annabel Gipp writes about workplace stress and shares her personal experience of working in the NHS.

Stress is something we all experience at some point in our working life, academic studies and at home. It’s almost become a standard for measuring how our day has been. I can recall many a time when I have exclaimed ‘That day was pretty unstressful!’, where this has really been code for ‘I’ve had a really great day’.

Being in employment has been found to have a beneficial impact on the health and wellbeing of a person, and helps to reduce workplace inequalities. Sadly however, being in low paid, insecure employment can actually contribute more to stress than being unemployed according to the National Institute for Health & Care Excellence. In non-manual workers, the most common cause of workplace absence was stress.

Workplace stress in defined as a harmful reaction people have to undue pressures and demands placed on them at work. Stress can manifest in a variety of mental and physical symptoms. Mentally, this includes:

• Trouble concentrating
• Negative feelings towards yourself, others and situation 
• Difficulty processing information or thinking logically 
• Constantly worrying something awful might happen 
• Forgetfulness 

This can also manifest in physical symptoms:

• Dizziness/ hyperventilating
• Trouble sleeping 
• High blood pressure 
• Chest pains 
• Tension and muscle pains 
• Fatigue 
• Digestive problems 

All of these can make it very difficult to focus on work or study, or even just keeping your home and socialising. This can result in a vicious circle which can worsen stress: 

A paper written by the Health and Safety Executive in October 2019 estimated that there were 602,000 workers across the UK suffering from work related stress, depression and anxiety. This resulted in 12.8 million working days lost and 54% of all working days lost to ill health were as a result of stress, anxiety and depression. The biggest cause of a build-up of stress was due to increasing workload, tight deadlines, too much responsibility and lack of managerial support.

It is also acknowledged that stress, depression and anxiety are more prevalent in public sector industries such as education, health and social care and public administration. Sadly, trends of reported workplace stress seem to be increasing slowly year-on-year, with 1,800 per 100,000 workers reporting work place stress in 2018/2019.

Stress has been linked with increased risk of many chronic health conditions, including heart disease, high blood pressure and depression. It has also shown to have links with immune system suppression, including in the progression of cancers, gastrointestinal disorders such as irritable bowel syndrome, skin conditions, neurological and emotional disorders.

So, stress is a very serious condition that needs to be reduced wherever possible, and organisations have a part to play to help manage it as much as possible.

Sadly it is not always possible to remove stress completely. I work in the NHS, and the nature of working in this organisation can potentially increase stress. Using this as one example, workers within the NHS are often faced with increasingly large workloads, stretched budgets, emotionally distressing situations or challenging patients - which can all increase stress.

I have had to take some time off work due to workplace stress. For me this was caused by a number of factors but what helped me return was a very supportive manager and team, and adjustments at work to help manage my caseload.

For me, the hardest thing was admitting that I was stressed at work. I felt guilty for letting the team down and that I should be able to manage. However, reducing the stigma around workplace stress is essential, as seeking support allowed me to return more quickly and stay in work.

So what can we do? The NHS Employers Website has a great tool to assess how you are feeling today, and it’s essential to check in on yourself. Having space to reflect and allowing yourself to voice worries or anxieties can help and give you time away from the stressful environment.

Trying to connect with people around you and with meaningful activities can all be helpful as well. But the key message is to seek support when you need it, from whoever you feel able to seek this from. Be it a colleague, friend, GP or charitable service, talking is essential and no-one is an island.


Annabel is a Floating Dietetic Clinical Specialist at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). Practitioner of Public Health, Faculty of Public Health, Trade Union Representative for the BDA (Association of UK Dietitians) and Staff and Dietetic Wellness Champion.


Good sources of information:

• Health and Safety Executive: http://www.hse.gov.uk/statistics/causdis/stress.pdf
• NHS Employers: https://www.nhsemployers.org/howareyoufeelingnhs
• NICE Guidance: https://www.nice.org.uk/guidance/ph19/chapter/1-Public-health-need-and-practice
• Psych Central: https://psychcentral.com/lib/the-impact-of-stress

Image:

1. "According to HR you haven't had any stress-related illnesses yet." by Grizelda Grizlingham via University of Kent, British Cartoon Archive (Reference number: GGD1406, Published by: Prospect, Sep 2017, with thanks to Copyright holder: Grizelda Grizlingham): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=GGD1406&pos=11

Policy, procedure, practice and plate-spinning - how to achieve a work-life balance

Posted by Susanne Nichol, Better Health at Work Award Programme Coordinator, Northern TUC

I regularly wish for an extra hour in the day, or a day in the week and I even more regularly feel like my frenetic movement from place to place whilst grabbing various coats, bags, children, laptops, papers and other extraneous articles is accompanied by the Benny Hill theme tune. And I know that I am absolutely not alone in this daily plate-spinning, multi-tasking blur that is reality for the vast majority of parents, carers – and well, everyone else!

However, I am fortunate to work for an employer that has a raft of measures in place to help me restore some balance. For example, having flexi-time means I can get a much needed hit of endorphins by going to the gym or out for a power-walk on my lunch hour, or before I have to sprint through the school gates lest my youngest child becomes an accidental boarder.

The Better Health At Work Award (BHAWA) is a regional flagship public health programme that is the result of a long-standing (currently celebrating a decade of making workplaces healthier), progressive partnership between 11 of the regional local authorities. This was evaluated in 2012 by Durham University, received a RAND Europe award in 2018 for its impact on health and wellbeing, and due to cross-organisational working between Local Authority specialist public health practitioners, academics and Fuse, was a featured element in the Prevention stream of the recently awarded regional NIHR Applied Research Collaboration (ARC) funding.

As BHAWA Coordinator I have contact with literally hundreds (currently over 400) workplaces across North East England and Cumbria, who cumulatively employ nearly a quarter of a million workers. One of the mandates of the BHAWA is that participants survey their staff biennially (at a minimum) and ask them what topics/ issues they’d like to see addressed or get more information/ support on and more often than not, work-life balance is ubiquitous in the top 5.

To me, this presents more of a challenge for both employer and employee than some of the other regular top 5 entries such as healthy eating, physical activity and mental health. Work-life balance encompasses all of those things and more, and whilst the application of all health topics is subjective, this even more so, as we all have our fulcrum in a different place – with a large measure of economics thrown in. Most of us would like to work less time for the same pay, but currently business demands and finances often make this unviable; conversely, whilst going to 3 days instead of 5 might give you perfect work-life balance, most of us wouldn’t be able to sustain a 40% reduction in salary.

Unfortunately, there is no quick fix or magic wand. However, there are multiple ways and means to mitigate work-life imbalance and to actively facilitate a redress in the right direction. The BHAWA takes a holistic approach to workplace health that emphasises making positive changes to all aspects of the workplace, from the infrastructure and logistics, to the pervading culture of staff and management engagement and interaction – and everything in between.

So, how do they do it and what does ‘good’ look like? Well, based on my six years of experience I can safely say that the best employers take a wholesale approach and embed health and wellbeing into the holy workplace triumvirate of policy, procedure and practice.

It all starts with having fit for purpose policies in place, specifically such as Flexible Working; one of our workplaces operates a best practice ‘Adult Working’ policy, which is uber-flexible, employee-led and based around a mutually trusting relationship, so if Costa is a conducive place for them to deliver their work in between school-runs or meetings, then so be it. More and more participants are also introducing ‘stuck not sick’ policies that allocate a bank of ‘reserve’ hours that people can use to deal with unexpected issues, such as an ill child or a flooded kitchen.

Then there are underpinning procedures like regular and supportive line management, meetings/1-2-1s that start with the question ‘How are you?’ which allows for an open dialogue and an easier conversation around any issues and hopefully a subsequent resolution. But, what is of paramount importance is the active implementation of policy and procedure. If an employer has the best policy in the world, yet nobody actually knows about it, then it’s not worth the paper it’s written on. Awareness, buy-in, good communication/training and a practical approach is imperative here.

Having managers who are properly supported to understand and apply the policy in practice is fundamental. They can do this in various ways; by advertising jobs as flexible from day one, supporting a range of flexible working options such as home-working, flexi-time, or compressed hours; reminding colleagues that they can (and should) take their lunch break/leave and can attend medical appointments or workplace campaigns or activities like on-site flu jabs, or a lunch-time yoga class, without it being detrimental to pay.

One thing is for certain - work-life balance is for life and not just for a week



Image:

1.  'plate spinning' by Clancy Mason via Flickr. Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0): https://www.flickr.com/photos/clancy123/1805082629
2. 'I'm working through my lunch hour. Work - life balance survey' by David Austin via University of Kent, British Cartoon Archive (Reference number: 84983, Published by: The Guardian, with thanks to Copyright holder: Janet Slee): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=84983

Actions bring risks

Posted by Llinos Mary Jehu, Research Associate with AskFuse, and Pat Watson, Research Fellow, Teesside University

We all know that. At a time when many of us are returning from holiday (or conference), we can reflect on the risks we took, like driving to the airport or eating sea-food.

So it’s no surprise that participatory action research brings risks. Co-researchers may be exposed to the risks that academics frequently anticipate, such as risks arising from lone-working or the emotional impact of data collection and reflection. There are also risks associated with research being carried out by people who have not been trained to the level of an academic, such as confidentiality, informed consent or interviewing techniques.

I’ve been involved in participatory action research at two universities, as well as within the NHS and local government. I’ve been through university ethics and NHS ethics, jumping through hoops as we’ve recruited and trained co-researchers, often re-submitting so we can finally start collecting and analysing data. I’ve also spent a fair amount of time getting to grips with systems for paying co-researchers expenses and honoraria. It’s amazing how complicated getting agreement to give out some supermarket vouchers can be, as both the ethical risks and financial risks are apparently enormous.

For all these projects, risk was removed, reduced or managed through our training and support systems. The training sessions allowed potential co-researchers to build their understanding of what the research involved, giving them an opportunity to opt-out should they choose. The sessions also built open, trusting relationships which, very occasionally, allowed us to identify and counsel people away from the project and signpost them to other opportunities. These relationships were vital during data collection periods. We may have drunk gallons of coffee and eaten far too much cake, but frequent, informal meetings with co-researchers ensured we kept a handle on what was happening in terms of ethics, finance and lone-working.

Consequently, I was a bit thrown when AskFuse - the responsive research and evaluation service run by Fuse - received a query from Pat Watson at Teesside University. Pat’s been commissioned by Sunderland City Council to carry out a piece of participatory action research involving pregnant mums in the design, development and implementation of a project looking at how expectant mums make decisions on how to feed their babies. The university Ethics committee had asked about insurance for co-researchers, and we had to admit that no one in the AskFuse team had any examples of formal arrangements. I also had a slight concern that, given the risk-averse nature of many large organisations, such a requirement might pose an insurmountable barrier for the research proposal. Undeterred, Pat went on the hunt, with a meandering email trail that eventually reached the University’s Deputy Director of Finance and the Liability Underwriter for the University’s insurers, UMAL. To my absolute surprise and delight, they confirmed ‘that the Teesside University Employer Liability/Public Liability/Public Indemnity covers apply to all University authorised research activity’. If Ethics approve participatory action research, then the co-researchers are insured.

It’s a huge relief that we now have a tick to put in the required box, and we have an example to cite should another researcher be asked the same question. I am really impressed with the approach of the insurance company: as their website states, they ‘never shy away from difficult risks’. However, managing risk in participatory action research requires far more than ticking boxes, regardless of how important these boxes may be. An equally important tool for identifying and managing risk is the strong relationships that successful co-research depends on. These relationships require time and investment, going to where people are and being prepared to share their space. They require trust and respect; possibly not asking people to show you a receipt before you pay their bus fare and not assuming that they’ll use their supermarket voucher to buy cider.

Research tools, data collection and analysis will be different, and often better, when the research process involves or is led by people who share the same standpoint, or even are, the research subjects. Hopefully universities will continue to recognise the benefits of participatory action research, recognise that the relationships it generates are a valuable asset and tool for managing risk, and not shy away from any ‘difficult risks’ it may present.


Image: 'victorian risk assessment cartoon' by John C Bullas BSc MSc PhD MCIHT MIAT via Flickr.  Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0):
https://www.flickr.com/photos/johnbullas/7788230372

Managing difficult conversations at work; ambulances, snow ploughs and submarines

Posted by Peter van der Graaf, AskFuse Research Manager / Fuse Knowledge Exchange Broker, Teesside University

We all face difficult conversations in our work; whether as a PhD student trying to tell a supervisor that they are not very helpful, or as post-doctoral researcher, explaining to your line manager that you really don’t want to take up any more teaching responsibilities. Or even as a practitioner having to point out to an esteemed researcher that their pet project is not relevant at all for your practice.

Like most people, I try to avoid these conversations as much as I can and prefer ‘flight’ rather than ‘fight’. Best to give in and avoid confrontation than have an uncomfortable row that will keep me up at night.

But could confrontations also be useful, and if so, how could you manage them in a way that they benefit you? This was the aim of the Courageous and Compelling Conversations Masterclass I attended in London as part of the NIHR Leadership Development Programme. Before starting the masterclass, I had to complete a self-assessment of my preferred response mode to confrontational conversations, which neatly confirmed my ‘flight’ status and gave me new labels for it: 60% Give In; 20% Run Away; and 20% Compromise.

What the masterclass taught me was that confrontation is not about preparing well for the other’s potential responses; for instance, by endlessly scripting clever and rational dialogues to counteract every accusation that a person could throw at me.

Instead, the course focused on better understanding my own response style in relation to other people. My light bulb moment was the realisation that you can’t control the response of the person you are talking to, but that you can manage yourself on how to respond, and take time to formulate this response during the conversation. Therefore, my nights (more preferably work hours) would be better spent understanding what I want to get out of the confrontation (outcome) and plan my conversations accordingly, instead of worrying what the other person will say and need.

During the course we were split into three groups, according to our preferred Motivation Value Style, with each group given its own emblem in the shape of a transport vehicle. Apparently, I am an ambulance, which is the symbol of the ‘carer’ group, who are motivated by the protection, growth and welfare of others. We prefer to ensure that everyone is happy, relationships are good and don’t want to be a burden to others. As an ambulance, I am responsive to other people’s needs and therefore go into conversations where I am needed (with blue lights if possible!).

In contrast, the ‘driver’ group (snow ploughs) - motivated by task accomplishment and achieving results - prefer to exercise persuasion. The third group, technicians (submarines) are different again in that they are motivated by meaningful order and thinking things through; they want to be practical and fair.

Although, these three styles feel quite stereotypical, I was surprised to see how much each of us on the course was conforming to these styles when explaining their behaviour in difficult conversations. We discovered that we incorporate elements of each style into our conversations but have a natural gravitas to a particular style. Realising your preferred style and working out the preferred style of your conversation partner, proved really helpful.

For example, someone who prefers to be a submarine (technician style), does not respond well to pressure to make an on the spot decision. Forcing them to agree to a solution at the end of the conversation will only escalate the confrontation. Instead, agreeing to give them time to mull the problem over and come back with a response later, will likely result in a much more favourable response and implementable solution.

Under stress, people tend to respond in either of two ways: they become more extreme in their preferred style (dig their heels in) or switch to a different style. What we were encouraged to do during the training course, was to play with different styles and practice switching during a confrontational conversation to a different style that would be more attuned to the person we were speaking to. In that sense, we are better able to manage ourselves and the responses we get from the person we are confronting.

A key part of this switching of styles was being assertive; not shouting over the other or ignoring what they say, but quite the opposite: taking more time to listen to the other and trying to understand what they say and where they are coming from. Are we really hearing what the other person is telling us or are we too busy trying to contain our emotions and constructing our next argument in our heads? Armed with this understanding, you will be better prepared to say what you think and feel, and, most importantly, what you want to happen.

As an ambulance, I need to be patient with submarines and focus on the practical, while being more competitive and assertive with snow ploughs, or team up with submarines to create new opportunities in joint conversation with snow ploughs.


Image:

1. 'Arguments' by Jeff Eaton via Flickr. Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0): https://www.flickr.com/photos/jeffeaton/7436909698