In these challenging times, healthcare leaders struggle with work compression, doing the same amount of work in fewer hours. Nurses and healthcare leaders are experiencing stress, burnout, and health issues at ever-increasing rates. The Covid-19 pandemic has increased the physical and fiscal strain on hospitals and healthcare organizations and companies. They expect their staff to deliver comprehensive, compassionate patient care to improve outcomes, satisfaction and engagement scores, and reimbursements. Yet, wise leaders know that caregivers cannot meet those expectations if they are physically, mentally, or spiritually exhausted.
With increasing demands on time, energy, and resources, health care professionals are experiencing burnout at increasingly higher rates, and staff turnover continues to rise. Burnout leads to lower levels of staff engagement, patient experience, and productivity, and an increased risk of workplace accidents. Lower levels of staff engagement are linked with lower-quality patient care, including safety. Burnout also limits a providers’ empathy, a crucial component of effective person-centered care. (1) Yet barely one-third (35%) of U.S. hospital workers said that current wellness programs encourage a healthier lifestyle. (2)
As leaders work long hours, tirelessly meeting the needs of their staff, they frequently neglect their own. To be fortified to manage effectively, we must nurture our own bodies, minds, and spirits every day.
The need for these practices is evidenced in the following table, identifying symptoms of stress and compassion fatigue:
| Symptoms of Stress and Compassion Fatigue |
| PHYSICAL
Appetite changes
Headaches
Fatigue
Poor sleeping
Frequent illnesses
Digestive problems
Pounding heart
Teeth grinding
Rash
Restlessness
Foot-tapping
Finger drumming
Nail biting
Smoking
Increased alcohol intake
|
MENTAL
Forgetfulness
Poor concentration
Dull senses
Lethargy
Boredom
Low productivity
Negative attitude
Anxiety
The “blues”
Mood swings
Anger
Bad dreams
Irritability
Crying spells
Nervous laughter
Loss of loving feeling
|
SPIRITUAL
Emptiness
Loss of meaning
Doubt
Martyrdom
Loss of direction
Cynicism
Apathy
Abandonment
Worry
Isolation
Distrust
“No one cares”
|
Copyright LeAnn Thieman, SelfCare for HealthCare ® 2012 Permission granted
Numerous studies suggest that work-related stress fuels burnout and job dissatisfaction among healthcare professionals. (3)
Drawing from my decades of work with healthcare leaders, I offer easily implemented tools for restorative self-care. This article will share strategies for balance of body, mind, and spirit, offering self-care for healthcare.
Physical Balance (Body)
Diet
We would never deprive nutrition or fluids to someone we care for, yet we often unconsciously rob ourselves. Keeping a dietary log for a week alerts us to our current eating patterns and allows us to change our diets accordingly.
Although evidence proves the importance of drinking 5-6 glasses of water a day, we too rarely consume that quantity. Seventy-five percent of Americans are chronically dehydrated, causing daytime fatigue, memory impairment, difficulty focusing, headaches, nausea, and poor metabolism. (4)
To get the recommended amount of water daily, fill a water container to consume throughout the day. Think about fluid balance, just as we do for patients. Applying what we know about fluid input and output for patients to our own bodies seems simple, but it is often ignored or under prioritized by us due to workload, inattentiveness, and even our own beliefs about self-sacrifice.
Sleep
Healthcare givers and leaders are becoming more and more sleep-deprived, yet studies prove the human body requires 7-9 hours of sleep in a twenty-four-hour period. (5)
Adequate sleep is important for mental focus, reaction time, attitude, learning, memory, decision-making, prioritizing, accuracy, conflict resolution, and communication, all key qualities healthcare givers need to deliver safe, compassionate patient care. Geiger-Brown & Trinkoff, who studied the impact of 12-hour shifts, reported that nurses sleep only 5.5 hours on average between 12-hour tours, even though a minimum of 7 hours is recommended for full engagement. (6)
Insufficient sleep has been associated with cognitive problems, reduced job performance, decreased motivation, and increased safety risks. Several studies have shown that failure to get adequate sleep contributes to medical errors. (7)
When sleep is inadequate, health deteriorates, resulting in lowered glucose tolerance, impaired thyroid function, fatigue, increased heart rate, decreased strength, increased blood pressure, stomach and bowel problems, pain, depleted immune systems, and increased fatty deposits. Sleep problems contribute to obesity, and obesity contributes to sleep problems. (8)
In today’s world of 24/7 connectedness, new issues have emerged that lure people away from sleep. Television, computers, and electronic devices have shifted from the family room and office into the bedroom, encouraging people to watch one more late-night show, or respond to another text or two. In my experience, many healthcare leaders report checking email after midnight in fear of missing something and feeling compelled to respond immediately.
Adequate sleep is an investment in our wellbeing. It’s a choice. Turn off technology, turn off the electricity, and get the recommended 7-9 hours of slumber.
Exercise
In our over-scheduled lives, it’s often challenging to set aside time for exercise. Yet research is showing that we don’t necessarily need a personal trainer or gym membership. A study of 334,161 European men and women showed that as little as 20 minutes of brisk walking a day could prevent us from dying prematurely. (9)
Exercise not only lowers the risk of heart attacks, diabetes, bone cancer, osteoporosis, arthritis, backaches, high blood pressure, depression, and stress, (10) but it releases endorphins in our brains and increases happiness too.
Be creative in finding ways to incorporate exercise into your daily activities. Park in the farthest corner of the parking lot. Make time to take the stairs. Have walking meetings. Take advantage of the exercise opportunities your employer provides.
Mental Balance (Mind)
Most self-care programs focus on nurturing our bodies with less attention to our minds and spirits, yet our physical wellbeing is dependent on our mental wellbeing.
Eighteen percent of nurses, twice the rate of the general adult U.S. population, have elevated depression symptoms. (11) Suicide rates of physicians exceeds the national average. To care for our minds, it’s crucial to take time throughout the day for mental rest. One of the best and easiest tools is simply breathing.
Breathing and Relaxation
Deep relaxation breathing is one of the most effective mental balance tools. This breathing technique relieves stress and tension and releases endorphins.
As a childbirth educator for thirteen years, I taught moms to breathe slowly, deeply, and easily to reduce stress and pain in labor. The same principles apply as we “labor” through life.
When laboring women get too stressed, they experience increased adrenaline, which shuts down the release of oxytocin and delays the delivery. Too much adrenaline results in longer harder labors for moms…and for us. Breathing and relaxing decreases adrenaline output and allows all our organs and body parts to work at their best.
For three minutes, several times a day, during stressful times or otherwise, breathe slowly in through your nose 1-2-3-4, then out through your mouth 1-2-3-4, repeatedly.
We schedule so many activities into our days, we must also schedule relaxation. Close your door. Take a break. Breathe deeply, and relax.
Laughter
A proverb that says, “Laughter is good medicine, but a broken spirit dries the bones.” Sometimes the demands of working in healthcare can nearly dry our bones.
I’ve been privileged to read thousands of true stories from healthcare givers when I authored three editions of the Chicken Soup for the Soul for Nurses series. Time and time again they shared how laughter helped them through their toughest times.
Humor is one of the most effective selfcare strategies. Laughter lowers blood pressure and heart rate, improves lung capacity, massages internal organs, increases memory and alertness, reduces pain, improves digestion, and lowers the stress hormones. (12)
Loma Linda University proved that laughter decreases the stress hormones, epinephrine, norepinephrine, and cortisol and improves immune function (13) Laughter has also been proven to reduce pain. (14) It offers psychological benefits, brings us into the moment, helps us transcend our problems, connects us closer to people, and helps us think more clearly.
Even smiling releases endorphins and serotonin, which boosts our immune systems and lowers blood pressure. (15)
Add humor to every agenda. Create laughter bulletin boards at work. Bring joy to your workplace.
Positive Thinking
There is tremendous power in positive thinking. Dr. Norman Vincent Peale wrote a book by that title (16) proving that we get what we expect in life. We bring to fruition our thoughts and visualization. We see this in our workplaces every day. Negative thinkers have negative contagious behaviors, resulting in negative outcomes.
It’s said that the average person has forty-thousand thoughts per day, of which 80% are negative. Every time we have a negative thought, our brains releases negative chemicals that make our bodies feel bad. When we combine positive thinking with positive visualization, remarkable changes occur.
Our bodies and minds don’t distinguish the difference between visualization and experience; they react as if both are real. Most of us have awoken from nightmares, sweating, our hearts racing. Although the scary event didn’t happen physically, our bodies responded as though it had. This phenomenon can work to our benefit, too. Recall your most successful moment and live it out again, visualizing it with all five senses. You can reclaim the same feelings again as your body releases the same chemicals as when you experienced it.
The growing field of psychoneuroimmunology proves that our brains can literally be “rewired” with positive thinking. Some neurological connections are strengthened while others are replaced. New thoughts and images stimulate new pathways and, when constantly repeated, have a great impact on behavior.
Our minds are like computers; we have sovereign control over the input.
Write a list of your personal positive affirmations. Create a vision board with words and pictures of things you want to achieve… personal goals, career plans, family desires, things to nurture your mind, body, and spirit. Post these where you can see them… and achieve them, improving your health, happiness, and workplace.
Forgiveness
After my presentations, audience members whisper two things to me consistently. “Thank you for talking about faith,” and, “Thank you for teaching the power of forgiveness.”
Forgiveness seems to be a universal chord in the hearts of people. There is an innate hunger to let go of the suffering and to learn how to release it.
We waste a lot of our energy, our health, and even our lives when we fail to forgive. People who won’t forgive have more illnesses, lower immune system function, and increased heart disease. (17) Those suffering from chronic low back pain found that anger, affective pain, and sensory pain were all lower after forgiving. (18)
A widely accepted definition of forgiveness is to pardon, to release from further punishment. Ourselves included.
The first step in healing is to forgive ourselves, for any past mistakes, indiscretions, or regretted decisions. What we did then was based on who we were and what we knew then. It’s not who we are today.
Next, we must forgive somebody else, no matter how horrific the offense. Refusing to forgive doesn’t hurt the offender, it only hurts us. Why would we give someone who wounded us so deeply the power to continue to harm us with sleepless nights, upset stomachs, high blood pressure, and headaches? We must forgive them, whether we think they deserve it or not, we do.
Forgiveness is an empowering choice. So, starting today, besides yourself, who are you going to forgive?
Spiritual Balance (Spirit)
Creating a spiritual balance is as crucial as mental and physical. Most medical schools today are tapping into ancient theories of holistic medicine, a healing of mind, body, and spirit. The American Medical Association requires medical schools to teach students to inquire about a patient’s religion. Ninety-percent have courses on spirituality and health. No wonder; 92% of patients say that spirituality is important in their coping and healing. (19)
Studies describing the association between prayer, faith, spirituality, and medicine are increasing. (20) Yet a study examining healthcare leaders’ perception of competence in providing spiritual care showed that while communication had the most favorable perception, improving the quality of spiritual care had the least favorable. (21)
In delivering care, healthcare leaders must recognize the importance of spirituality in the lives of patients, families, and loved ones, as well as in their own lives. All undergo tremendous stress and suffering. Spirituality offers a way to understand suffering and to cope with illness. By addressing spiritual issues of patients, loved ones, and ourselves, we can create more holistic and compassionate systems of care.
To nurture our patients’ spiritual health, we must first nurture our own. Polls estimate that over 92% of Americans believe in God. (22) If you are among that majority, I encourage you to be in touch with the Higher Power you believe in every day. Even if it is just for 15 minutes, take time for prayer, meditation, or reflection. So often we choose a way of life that best suits our bodies; let’s create one that also nurtures our spirits.
Summary
Selfcare is no longer a “soft” skill, but a culture shift, critical for transforming patient care and outcomes today. Hospitals that have implemented the year-long Selfcare for HealthCare® program have noted not only a 13% increase in retention, but 16% decrease in sick days, a 20% increase in engagement, 39% decrease in those considering leaving their positions, and 42% increase in agreeing their leadership cares about them.
A recent scientific research study with the Social Science Department at the University of Northern Colorado provides the evidence-based impact of Self-care for Healthcare. A partial list of those findings include: (the complete report available on request)
- A main finding that emerged from the pre- and post-test evaluation was a positive shift in workplace engagement
- A higher growth in resiliency and positivity.
- A positive impact on participants, specifically with identifying stress, building healthy habits, creating resiliency and positivity
- Identifying stress and creating healthy habits had the highest amount of positive growth.
- Participants agreed 13% more that they would recommend this organization as a good place to work, post-test.
- Participants agreed 14% more that their organization has a healthy workplace culture, post-test.
- Participants agreed 14% more that their organization has a healthy workplace culture, post-test.
- Participants were 11% more satisfied with the balance between my work and home life.
Evidence of the importance of caring for mind, body, and spirit was proven in a descriptive study exploring the self-care practices of healthcare leaders in a rural hospital setting. In the findings, the most prevalent self-care practices were humor, laughter, music, spirituality, prayer, healthy nutrition, walking, and healthy sleep habits. (23)
The duty of healthcare leaders is to be proactive, rather than reactive, to the stress they are facing. There are clear links between staff wellbeing and the three dimensions of service quality: patient safety, patient experience, and the effectiveness of patient care. When staff support services were proactive and prioritized, staff health, wellbeing, and performance were enhanced, patient care improved, staff retention was higher, and sickness absence was lower. Leaders are fundamental to creating a workplace climate that enhances staff wellbeing and delivers quality patient care. (24)
When staff participate together in wellness programs, engagement increases. Employees who feel they are personally cared for by their organization and that managers have higher levels of commitment, are more conscious about responsibilities, have greater involvement in the organization, and are more innovative. (25)
Every 1 percent increase in hospital employee engagement correlates with a 0.33-point increase in the facility’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) overall hospital rating. HCAHPS scores lead to a boost or reduction in a hospital’s Medicare reimbursement and can sway patients’ decisions in selecting a provider.
Also, a 1 percent increase in hospital employee engagement is tied to a 0.41-point increase in inpatient safety grades. Engaged employees are three times as likely as disengaged employees to earn top performance marks. Disengaged staff are twice as likely to leave their organization within 12 months of an engagement survey. (26)
Clearly, self-care is the best way to improve the quality of healthcare and reduce costs, by caring for healthcare workers, their patients…and ourselves.
As leaders, we are always role modeling. By nurturing our own bodies, minds, and spirits we will create cultures of caring for ourselves and those we lead and serve.
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LeAnn Thieman, LPN, CSP, CPAE is author of the Chicken Soup for the Soul for Nurses series and President and Founder of SelfCare for HealthCare, Fort Collins, CO. She can be reached at LeAnn@LeAnnThieman.com.
