During the COVID-19 pandemic, a lot of the day-to-day things we take for granted have stopped. Returning to work as an Occupational Therapist in mental health services, Associate Improvement Advisor Andrea Boyd noticed that in a time of big challenges, it was often the little things that mattered.

It’s often the small things that mean the most in times of uncertainty. The everyday, ordinary things. The things you normally never notice, the things that you never miss until they’re not there.

Over the past few months I’ve noticed the absence of a lot of these small things and the difference they can make. A hug. A shared meal. A comforting pat on the arm. They all mean a lot.

Andrea on ward dressed in PPE and Andrea with family

Going back to work on wards

In my normal job, I split my time between working as an Associate Improvement Advisor in the ihub’s mental health improvement team, and working as a Senior Occupational Therapist (OT) at NHS Ayrshire & Arran. The focus of my ihub work is improving observation practice in mental health services, which is part of the Scottish Patient Safety Programme. I’ve built up a network of national improvement leads and I was looking forward to starting full time hours within the ihub from 1 April. But then everything changed.

As part of Healthcare Improvement Scotland’s national response to COVID-19, I returned to work as an Occupational Therapist at Woodland View, NHS Ayrshire & Arran’s acute mental health facility and community hospital at Ayrshire Central Hospital. I worked three days a week in older adult mental health wards, one day in acute adult mental health wards and one day a week in the community role I’ve continued to undertake. 

The impact of COVID-19

My community role as an Occupational Therapist has often been to act as a reassuring voice. I check patients’ symptoms and give advice on remedial actions they can take. During lockdown, the way I’d normally work has had to change, although, surprisingly, this was sometimes for the better.

For example, lockdown meant I was only able to make urgent visits to my community-based patients. However, as I kept in touch with them weekly on the phone, I ended up being in contact with them more regularly than I would in pre-COVID times. Some of my patients have been shielding and have particularly appreciated being in contact with me on this more regular basis.

Physical barriers can impede recovery

Working on the wards at Woodland View was, of course, a different story. Because of COVID, we’ve been aiming to reduce footfall in wards and make sure people get home as soon as possible.

The most challenging aspect has been to treat patients with complex mental health needs while wearing PPE. Some of our work involves working with patients in physically close situations, such as the kitchen, so we have to be careful to maintain a physical distance as much as possible, and to wear the correct PPE. It makes it a bit more difficult to get to know new staff and patients, and it affects building therapeutic relationships. Older adults in particular find it difficult to hear you through your mask.

Meal times in particular have been more isolated than usual as patients are eating alone in their rooms, rather than socially. Visitors have not been allowed inside the building, and while we facilitated some patient visits at ground floor windows, this lack of social contact has been hard for all of us.

Finding the positives

On the positive side, COVID has meant that we take every opportunity to get out in the fresh air, either for a staff break or with patients, where we can remove our PPE. There is a beautiful woodland walk on the hospital grounds.

Within the hospital foyer, Bramble Café is a bustling hub for coffee and cakes. When they removed the indoor tables and chairs and put out notices reminding us of the potential threat of COVID, the atmosphere changed. Thankfully, the tables and chairs are back now and I realise how much I missed them! It’s a small change, but it illustrates a bigger point about how much we all take for granted.

A piece of cake

One small thing we have been able to bring some cheer to the wards is to bake cakes for staff – we created ‘cake Friday’ to keep up team spirits. I do find not being able to hug anyone quite difficult, so giving out cakes is like sharing cuddles on paper plates. As a bonus, my youngest daughter has started baking with me at home – it’s something we enjoy together.

Next steps

I’m now back at Healthcare Improvement Scotland to start the work I should have begun in April, and I’m really looking forward to re-joining my colleagues in the ihub’s mental health improvement team. I’m particularly excited about a new video and case study the team have produced as part of our Improving Observation Practice programme, which gives an insight into how NHS Tayside improved the lives of mental health service users and staff through changes to their observation practice.

But my time back on the ward and in the community will stay with me. When we become overwhelmed with information and daily updates on the number of COVID-related deaths, we need to focus on the positives and what we can do, rather than what we can’t. And we should always remember that it’s the little things that count.

Andrea Boyd is an Associate Improvement Advisor who specialises in mental health within Healthcare Improvement Scotland’s ihub.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.