In addition to patient safeguarding, another crucial issue in delivering arts in health interventions relates to occupational health. Occupational health is a multi-disciplinary activity that aims to protect and promote the health of workers, develop healthy and safe working environments, enhance the wellbeing of workers, and enable workers to contribute positively.
The World Health Organization has produced a manual that explores some of the key topics in occupational health, entitled Occupational Health: a manual for primary health care workers (2011). This is available on its website www.who.int.
Working in healthcare, whether in a healthcare setting, in the community, or in a private space, can be demanding, so it also important that those involved in the delivery of arts in health interventions safeguard their own wellbeing. There are various types of negative impact that an environment could have on an individual, including:
- ? Physical stressors—e.g. poor lighting, noise, and physical exertion
- ? Environmental psychosocial stressors—e.g. work overload, witnessing distressing events, and emotional stress
These stressors may affect people differently depending on their personality type, individual susceptibility and the level of support they receive from their team.
Responses to these stressors in the short term can include fatigue, anxiety, dissatisfaction, and psychosomatic symptoms (such as headaches, backache, and disturbed sleep), with potentially higher absenteeism, reduced productivity, and decreased group cohesion. In the long term, they can lead to depression, aggression, and burnout. As such, it is important to try and prevent stressors occurring or, where they are unavoidable, put in place systems to provide support. There are three main ways this can be undertaken:
- 1. Primary prevention—prior to an individual (such as an artist, project manager, or researcher) becoming involved in a project, steps should be put in place to ensure that the individual receives appropriate preparation for the type of work they will be undertaking. In Chapter 7 we discussed the value of shadowing a project to become accustomed to the environment, having a supervisor to help provide support while a project is under way, and using diaries or feedback sessions to allow individuals to discuss what they have experienced, ask questions, and receive advice on how to manage different situations. Having this structure in place at the start of a project can be an effective way of making sure an individual feels supported and is prepared to deal with the environment. Including stressors within the general risk assessment can also help to identify them in advance, enabling advance planning
- 2. Secondary prevention—if an individual identifies that they are beginning to find any aspect of the project demanding, there should also be a system in place for them to raise this before it becomes a bigger issue. For small projects, having a main point of contact for those involved in the delivery of an intervention can help to provide continuous support. For larger projects, having drop-in sessions on a regular basis for people to come and discuss any issues can help to identify problems before they become too big. Once the problem has been identified, it may be possible to put in place more support for the individual, to plan a change in rota to provide them with more time off, or to refer them to somebody who can provide further support for them. Team away days, social events, and project celebrations can also help to bring those involved together to relax and appreciate the positive impact of a project too
- 3. Tertiary prevention—there should also be a plan in place for what happens if somebody needs immediate support, for example, if there is a distressing incident that occurs during a session, or an individual is affected by something they have witnessed while in a healthcare environment. If there is a counselling service in the organization, individuals could be provided with the details of how to access this for confidential support. Often identifying tertiary support will involve working closely with the healthcare organization involved to see what is offered to other staff and whether this can also be made available to those involved in the project. If an incident does occur, it is important to review the situation and assess whether anything could be changed in the future to minimize the chance of the situation occurring again
The European Union Programme for Employment and Social Solidarity
(PROGRESS) developed a guide entitled Occupational health and safety risks in the healthcare sector: guide to prevention and good practice (2010), which identifies a wide range of individual risks including psychosocial risks and considers how to manage them.(2)