Post 5 | The Transformation Essentials series
Building resilience and well being
The following blog is written by Jo Soldan, Senior Clinical Psychologist at Middlemore Hospital. Jo has a particular interest in resilience and psychological wellness and is currently working in the Critical Care Complex.
My background and passion is in the field of clinical psychology and for the past 20 years – the majority in Wales (my home city), I have been working as a Clinical Psychologist in physical health care – i.e. working with psychologically healthy people facing challenging life events. In 2010 my family and I moved to New Zealand and after settling into our new way of life I took up the role of part time Senior Clinical Psychologist – working with patients, families and staff in the Critical Care Complex.
Working in Critical Care, like other areas around the Hospital can be a demanding and stressful job and nurses, doctors and other healthcare professionals do a wonderful job delivering psychological care at the bedside every day – often in traumatic situations.
For the past few months I’ve been working with critical care staff on ways of building resilience and well-being. My aim is to provide staff with approaches, tools and support that they can use to maintain their own wellness and better prepare themselves to meet the psychological needs of their patients.
When you think about it we are sending staff, sometimes with little training in psychological skills or self care into stressful situations. We tend to expect ourselves to automatically handle these situations. It’s interesting to note that a study showed that while 77% of Critical Care nurses agreed it was emotionally exhausting to become repeatedly involved with families in need of support – 80% stated they would continue to do so regardless of the possible costs to themselves (Hickey & Lewandowski 1980).
When staff are asked how they cope with stressful situations, such as giving bad news or carrying out painful procedures such as burn dressings, many report that they distanced themselves, going into automatic pilot mode, while others connected in an emotional way, explaining what was going to happen and empathising with the pain. So is one way better than the other? While we can all see how distancing works, there is some research that shows that distancing (as opposed to engaging or seeking social support) as a coping method can impact on patient care (Nagy 1999) and reduce job satisfaction.
It’s the old familiar story that we tend to look after everyone else before we look after ourselves and even feel guilty if we consider our own needs. The ironic thing is that we find the time to regularly service our hospital equipment but what about our own health and well being? Studies on physical health, burn out etc. in health care staff make it abundantly clear that we need to take better care of ourselves, which is why psychological wellness and resilience (our ability to bounce back after stress and adversity) is becoming a hot topic of conversation – not just in NZ but around the world.
“Without a compassionate response to ones own distress, nurses may have a diminished capacity to respond to the suffering and distress of others” Rushton (2008)
Traditionally Psychology has looked at people who have had adverse outcomes – to people who develop depression, anxiety and post-traumatic stress and why and how these conditions can be treated. More recently however Psychologists are becoming interested in the people that go through disasters – through illness who don’t get depressed or anxious. They may do for a little while, but long term they seem to get back on track. So what was it about these people that make them bounce back quicker – i.e. more resilient?
To shed some light, studies have been carried out on groups of people who had gone through cancer and disasters, such as earthquakes and looked at what made these people different to the ones that had adverse outcomes. There are a number of key components. People who were more resilient have access to (and use) good social supports, maintain their own physical well being, have flexible thinking and are able to maintain some positivity and optimism. That’s not to say the resilient people don’t feel shattered – it just means they can recover more quickly
It’s human nature to focus on the negative side of things and avoid situations which may make us uncomfortable or afraid. While avoidance in some situations is warranted, are we affecting our mental health by spending a lot of time checking up on the risks and where the dangers are and then avoiding things? How can we create a healthier balance between our focus on the negative and positive thoughts?
One suggestion may be as simple as keeping a gratefulness diary. What this means is that at some point in our day – and I like to do it in the evening, we write down three things you are grateful for today. The main idea is if we don’t do this we tend to go to sleep thinking about the things that don’t go well. Research has found that within 3 months people’s self rating of well being and happiness goes up quite significantly when they keep a gratefulness diary. There is also growing evidence that we can actually change our brain chemistry by changing the things that we focus on.
In August 2012 we will be running a 4 week course on Mindfulness Based Stress Reduction, which aims to develop techniques for focusing our attention, as opposed to being absent minded, with our minds constantly elsewhere – when we miss much of what is inside us and around us. It’s about taking a step back and really focusing our attention on, and accepting what is – rather then wishing things were different.
Although mindfulness training is new to CMDHB, the idea has been around for many years. Large organisations such as Google have started offering mindfulness training to all of their staff and when mindfulness training was provided to a high-stress U.S. military group preparing for deployment to Iraq they demonstrated a positive link between mindfulness training, and improvements in mood and working memory. The study also found that the more time participants spent engaging in daily mindfulness exercises the better their mood, memory and problem solving. Mindfulness training in healthcare staff has demonstrated reductions in distress and emotional exhaustion and an increase in well-being and relaxation. Indeed some doctors, who have been on the training are reporting that not only is it making them more self aware it is helping them to be more able to listen to their patients. So it seems there may be multiple benefits for health care staff.
There is clearly a resurgence of interest in the area of resilience and positive psychology and it’s work that is pretty advanced in New Zealand.
I guess my ultimate wish is that resilience enhancing practices and skills training become embedded in the culture of our organisation and that we recognise the importance of psychological wellness, not only for the benefits it brings us, but the benefits it will bring our patients. Just like our equipment which has annual checks, maybe we could have an annual check on our psychological well being and resilience. What do you think?
- Martin Seligman
- Fish – A Remarkable Way to Boost Morale and Improve Results (Lundin S C, Paul H & Christensen J)