HSE Library: Covid-19 HSE Clinical Guidance and Evidence: Guidance for Staff on Calls

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The following is a general guidance for staff when engaging with individuals on calls. It is understandable that individuals may be experiencing heightened levels of stress if they are receiving a call in relation to possible or confirmed cases of COVID-19.
When people are fearful, they are more likely to spiral into an emotional mind state where their fight/flight response will is activated. It is important to remember that when an individual’s emotions are running high that it is not about us personally. It relates to their own ability to regulate or turn down the volume on their emotions and ultimately their anxiety and fear of having a COVID-19 diagnosis and being given unwanted news.
All staff are doing the best they can in a difficult situation to both gather and provide information to patients and at risk members of the public.
There are a number of things that we can do to help bring down the emotional volume for an individual in the context of these calls. We can remember some key skills using the acronym GIVES.

Be gentle with the person. It can be difficult for people to get a call either identifying them as a close contact or as a casual contact of someone who has been diagnosed with COVID-19, or indeed someone who has been diagnosed with the virus.
Individuals may experience a range of emotions ranging from complete shock to thanking you for the call right through to being really angry at the bearer of bad news. Remember to use a gentle tone, and be mindful of your volume and pace of speaking. It is important that you are conveying a sense of being in control and ready to answer their questions to reassure them as much as possible in this difficult situation.
It is also important that we are gentle with ourselves. Regardless of their emotional response it is important that we take steps to ground ourselves before each and every call. It will be easier for you to have a gentle manner and be calm and reassuring if you are managing your own levels of stress and wellbeing.
- Are you getting enough rest?
- Are you taking regular breaks?
- Are you getting fresh air?
- Are you taking some time in between calls to process your own emotions?
- Who do you speak with after a difficult call?
- What helps you to keep your emotions in check?

Be interested in what the person has to say. It is important that you hear what they have to say and communicate that you understand that these calls can be difficult for people, in particular if unexpected. Explain that it is important that you learn as much as you can about their recent contacts so that you can minimise the risk of other members of the public becoming unwell. You are interested in understanding who their close and casual contacts are. You are just gathering facts with no judgements.

It is important that we validate the person’s thoughts and emotional responses. To validate is to communicate that you acknowledge and understand why they are thinking and feeling the way they do.
It is empathy plus the communication that the person’s perspective is valid in some way, or that their perspective makes sense.
Even in difficult situations, or with very problematic behaviour, something valid can be found.

Why is validation important?

How we validate?

Key phases:

I understand/I know………. this is hard, it scary, was unexpected
Of course……………you would think that, worry about that, feel this way given the circumstances
That makes sense
I can hear you are upset…….do you need to get a glass of water, tissue, take a moment

It is important that you provide people with accurate information so that they are clear about what you require of them and what will happen next. Bear in mind information given verbally over the phone in the context of someone being upset or caught off guard is likely not to be fully heard, understood or processed. We need to advise people to avoid Dr. Google and taking guidance from social media. People should be guided to follow official guidance via the HSE website.

Make sure that you have covered the following:

What accurate sources of information are available to them
- https://www2.hse.ie/conditions/coronavirus/coronavirus.html
- www.yourmentalhealth.ie
That we can link them with a member of the COVID-19 Self Care team if they wish (verbal consent to referral), explaining this is a call back service provided by trained psychologists and counsellors

If you are concerned about the mental health and wellbeing of yourself, a colleague or a person whom you have been in contact with, please do consider the option of seeking support from the COVID-19 Self-care team. Members of the team will be available on site or by phone daily and can consult with individuals, or are available to consult with the team. We are keen to support staff in managing challenging calls, and offering to follow up with patients as required.
You may wish to refer if:
- A person is very distressed on the contact call and has not regulated themselves by the end of the contact
- If the person indicates they have a mental health history
- If the person is elderly and living alone
- If the person is distressed in light of being in or asked to quarantine/self-isolate
- Is distressed about having spread the infection to others- family/friends/colleagues
- Is expressing high levels of unwarranted guilt/shame/stigma
- Is very agitated or angry on the phone or is calling back frequently but cannot be soothed by this contact