Head on: how Victorian nurses and midwives confronted COVID

To capture the authentic experience of Victorian nurses and midwives through the COVID-19 pandemic, every design decision was made with the emotional, physical and psychological experience of the nurses and midwives front of mind.

The design process was one of careful balance, with the designers taking great care to give each story the space, reverence and individual voice it deserved. In so doing, the stories became both written and visual elements, with each page typeset to emphasise the story’s unique theme – highlighting the repetitive donning and doffing of PPE, the overwhelming fear, the sense of loss, the great compassion, the joy in new ways of working or the deep sense of pride in a job well done.

The stories were ordered to create emotional peaks and valleys and blank pages were used to give the reader time to recover from the emotional lows and prepare to share in the highs.

The titles were styled to be intentionally uncomfortable to read. This approach was extended on the website where the titles blur on interaction, a reference to the obscured vision authors experienced when wearing glasses, masks and face shields.

The book and website draw directly from the muted colour palette of PPE equipment. These colours are also washed over many images, most of which are produced as close ups on black backgrounds to acknowledge the individual experience and challenging working conditions.

Produced in hardcover to ensure a long life, the book’s cover features a registered nurse in PPE, a visual synonymous with the COVID-19 pandemic. But this shot was taken post the pandemic phase to stand as a testament to resilience.

The book creates a deeply emotional and personal experience for the reader, offering highs and lows without becoming overwhelming. Told by real people in plain speak, they encourage readers to relate to the loss, the fear, the desperation to protect families, and the pride in finding ways to keep caring against the odds.

The design deliberately creates quiet moments, segmenting chapters with photography and creating visual rest so the reader can gather their thoughts before entering a new chapter. It concludes with an image of a midwife holding a newborn baby, an offer of hope and a demonstration that despite the trauma, work and life go on.

The companion website translates the book to the digital environment, with the potential to evolve the stories and grow the content in the future. It was developed in an accessible user format, so individual users can interact with the site as they wish, personalising the colour and controlling the way they read the content. The photography has been translated into a traditional gallery, with a passive parallax gallery scrolling autonomously behind feature quotes from the book.

The website allows more content to reach an even wider audience and presents an opportunity to grow the content without the expense of producing another book.

Both products raise the benchmark for self-published works and showcase the quality that is possible when a publisher chooses to honour the content by investing in professional design and curation. The design demonstrates that a book with nearly eighty different authors and more than 60,000 words can take readers on a unique and compelling journey of understanding, generating empathy and insight at the turn of each page, while also speaking directly to policy and decision makers about the impact of their decisions where the rubber hits the road.

The book and website are designed to speak to community members and decision makers –to ensure the voices of nurses and midwives who made health care possible throughout the pandemic are heard today and tomorrow.

The stories create images and raise questions that need to be answered. The design supports this approach – it never overshadows the story but works in harmony with the words to create an emotional reader experience and a deep empathy for the experience of nurses and midwives. It is deliberately simple but strong – the use of muted PPE colours and the capitalisation of titles bring a delicacy and power to the words, and the placement of images serves to amplify the messages, not usurp them.

The designers were also aware the content had the potential to be triggering for many people. This required a thoughtful approach and a gentle hand, with all design decisions considering the individual and collective experience of the contributors. How did they feel at the time they wrote their story? How might they feel about sharing their story? What message do they want the reader to take away? How might they like the reader to feel? How do we present their experience with the respect and gravity it merits?

Evidence of the emotional journey the book provides readers is expressed beautifully in the following review:

The stories in this book are at once haunting and inspirational. Haunting because the struggles, the pain, the loss and grief, the fear and anxiety are all too real and still too close. Yet inspirational because one cannot help but see the deep commitment to care, the dedication in the face of overwhelming circumstances, and the profoundly human responses to the devastating events that played out over months and then years. – Professor Brett Sutton, Chief Health Officer

A key element of the brief was to honour the contribution of nurses and midwives. Their feedback clearly shows this was achieved:

I just wanted to write and say that the book was very well put together and presented. I really appreciated the effort that all of you put into it. It was a real privilege to be published for the first time and to publicly present some insight into what we went through during a unique period. – Daniel

I am honoured to have my story told. It is history in the making. – Dianna

I was astounded at just how wonderful the book is and in hardcover! What a treat! – Amy

Another desired outcome was to ensure the experience of nurses and midwives would form part of the historical record and inform future policy making. It is too early to know whether this will be achieved, but the words of Victoria’s Chief Health Officer point to a lasting impact:

In public health, decisions must sometimes be made for whole populations in order to prevent catastrophic consequences. It’s clear that behind every critical decision are millions of people each with a human story. Nurses and midwives were at the heart of many of those stories, some of which are captured in detail here. I hope they help to inform policy and practice in future. But I truly hope that they stand as a testament to the incredible work that nurses and midwives did through this pandemic, and which they continue to do every day. I am humbled to read these personal reflections and remain forever grateful for the role our nurses and midwives played. – Professor Brett Sutton