Discovery, Dream, Design and Destiny in intensive care
As part of the sWell project, which is focused on examining staff wellbeing in the PICU at Birmingham’s Children’s Hospital (BCH), I have been interviewing healthcare professionals to find out their definitions and personal experiences of wellbeing. ‘What does wellbeing mean to you?’, I would ask. No two answers were the same.
Wellbeing is often thought of as the state of being happy, healthy or comfortable but this is subjective and personal to each individual. Healthcare professionals working in paediatric intensive care units (PICUs) are continuously exposed to traumatic experiences and with long tiring shifts, staff often have little time to do the things that make them content. The lack of space for contentment can reduce people’s ability to be resilient and have a detrimental impact on their wellbeing. In such a high-pressure work environment, people are highly susceptible to burnout and compassion fatigue.
The sWell project, funded by Birmingham’s Women’s and Children’s Charity, is a collaboration between Aston University and Birmingham Children’s Hospital with Dr Rachel Shaw as the Chief Investigator and Advanced Nurse Practitioner (ANP) Sr Rachael Morrison, Sr Sarah Webb (ANP) and Paediatric Intensive Care Consultant, Dr Heather Duncan as the co-investigators based at BCH. There are several workstreams, but all focus on and explore definitions, practices and interventions concerned with wellbeing. I worked as the Placement Research Assistant on this project from September 2020 to May 2021 under the supervision of Dr Isabelle Butcher, the project manager, and Dr Rachel Shaw.
A deeper insight
One of the ways we talked with healthcare professionals was through a group activity using appreciative inquiry. Appreciative inquiry (Cooperrider et al., 2003) is an open-ended approach that focuses on the positive and follows the 4-D process: Discovery, Dream, Design and Destiny (Jones et al, 2019). Participants were presented with 24 picture cards and asked to choose the card/s that represented wellbeing to them.
The more popular cards chosen by staff typically depicted family and friends or nature. Using the 4-D cycle, staff were able to: discover what wellbeing meant to them and identify what works to improve their wellbeing; dream about (or imagine) being in that state of wellbeing; think about how they might design (or introduce) scenarios into their lives and how their work environment could be adapted to offer that sense of wellbeing; and think about their destiny, in terms of their future wellbeing aspirations.
This was a crucial step to the sWell study as it focused on staff’s experiences, giving us deeper insight into their wants and needs on the unit. Paediatric Intensive Care Unit at BCH has a number of wellbeing initiatives that are available to staff, but there is still a clear gap between the wellbeing needs of the staff and the initiatives provided on the unit.
The pandemic played a large part in the responses – the study ran between October 2020 and February 2021, in the peak of the second and third UK Covid-19 lockdowns. Overall, 46 healthcare professionals took part. The themes that we identified in analysis included the importance of being nurtured and supported at worked. Staff often spoke about how much they valued being listened to by the peers at work and being able to have a strong support system within their team. Another theme we identified was social support independent of work; several staff emphasised the importance of spending time with friends and loved ones, something that has unfortunately been very restricted in the past year and a half.
Knowledge into practice
Conducting the appreciative inquiry wellbeing card activity sessions online using Zoom was an unusual but exciting experience. Prior to my placement on sWell, I never really had great interest in conducting psychological research, yet I found myself excited to work on this project as it had theoretical links to both clinical and health psychology, two fields I wished to further my studies in. My placement experience allowed me to gain a deeper understanding and appreciation of the importance of psychological research, over and above what my degree programme has taught me in the previous two years as I was able to experience it first-hand working as a research assistant.
The placement was also an opportunity to put some of the knowledge and skills I learnt in my degree programme to practice. For example, I was able to learn practically by working on my qualitative methods of data collection. I was also able to obtain consent, create topic guides and more.
I was also able to see the limitations in my knowledge and skills – there is a significant difference in being shown and taught certain skills compared to performing them in practice. For example, I had conducted interviews before during my degree programme, but I had never used this specific appreciative inquiry technique to elicit information. Although I had the basic skills required to conduct the interviews, there were still aspects that I had never experienced, such as in-depth interviewing. I was able reflectively learn by conducting mock interviews and gaining feedback on my interview techniques from fellow researchers at the hospital and apply this to the interviews I conducted with staff.
I have also created connections with Psychologists in the field that have supported me in gaining further experience. For example, during my placement I applied for the British Psychological Society’s Undergraduate Research Assistantship Scheme with Dr Rachel Shaw as my supervisor and was awarded funding for my own project this summer titled ‘The impact of professional clinical psychological input in the form of one-to-one staff support sessions on staff wellbeing in a Paediatric Intensive Care Unit (PICU)’.
Overall, my placement provided me with great experiences that have positively shaped my attitude towards conducting psychological research. I would recommend taking the opportunity if you are given it!
- Omobolanle Balogun
Rachel Shaw, Chief Investigator
"Bola took the project exceptionally well. It required her to meet with a range of healthcare professionals of differing levels of seniority and Bola conducted herself with confidence and professionalism. I could see how this developed over the course of the placement. Bola was also asked to get involved in a host of research methods that she hadn’t learned about on her degree so far. She grasped them really well and has contributed to some excellent data collection. Staff were incredibly candid in their accounts. Bola helped to generate a really rich data set which is providing fabulous insight to the challenge of improving the wellbeing of healthcare professionals working in paediatric intensive care."
Rachael Morrison, Principal Investigator
Cooperrider, D. L., Whitney, D. K., & Stavros, J. M. (2003). Appreciative inquiry handbook: The first in a series of AI workbooks for leaders of change (Vol. 1). Berrett-Koehler Publishers.
Jones, A. S., Isaac, R. E., Price, K. L., & Plunkett, A. C. (2019). Impact of positive feedback on antimicrobial stewardship in a pediatric intensive care unit: a quality improvement project. Pediatric quality & safety, 4(5).
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