Maintaining wellbeing for nurses

(upbeat music) Well, welcome to the nursing standard podcast. What a crazy world we're living in at the moment. So you're very welcome as perhaps a respite from the activities of daily living. And in fact, in today's edition we're looking at wellbeing and self care. So we'll be examining burnout and how you can identify that in yourself and other people. And we're looking at burnout as a spectrum. So I think you'll find that quite interesting. We're looking at mindfulness and then finally, lecturer in sports therapy, Dan Martin, as well as hands full, because he's gonna try and teach me how to keep fit during these times. So there's hopefully a difficult one there, but hopefully it's some top tips. Those who listen to the podcast know that I'm Richard Hatchett, and I'm the senior nurse editor for nursing standard and RCNI, and I'm a registered nurse and my background is cardiac and intensive care nursing. Normally I'm joined by Flavia, the editor of nursing standard. But as you can probably gather, she's been pulled away onto other projects at the moment. So she's given me the keys to the podcast covered. So hopefully I'll do the program justice. But I'm not alone. I'm joined by my good colleague, the man with a fabulous name, Mr. Jason Beckford Ball. So Jason, how are you? - Hi everybody, yeah, welcome. Good to be here. - Well, good to have you Jason. And actually you trained a little bit after me, but when I trained all those years ago, your mental health wasn't really thought about. It was more a baptism by fire. You were dropped into it and told to get on with it really, and if you survived and did well, you were a strong and a good nurse. And I wanted in your training, whether mental health was thought about in the same light as my situation. - Yeah, it's interesting actually, because working in that field, you'd imagine that there would be a lot more care taken of the staff. But it didn't really feel that way at the time. I remember quite regularly myself and other students who were nearly qualified nurses. It was quite common to be told off in front of the whole hand over or disciplined in front of other people. And there was quite a lot of ex arm, ex services, ex prison officers, that kind of thing in the profession. So yeah, well being wasn't a huge factor. And even though workplace kind of rules and regulations and stuff didn't really feed into that, I mean, I'm not sure if this is still the case, but if someone didn't turn up for a shift and knew the nurse in charge, you just had to stay. So yeah, sometimes two or three shifts in a row, even. So I'm not sure whether that's changed a lot. I hope it has. But yeah, it's interesting to see. - Indeed, well that leads us nicely into our first guest, Dr. Daniel Madigan, who is a senior lecturer in performance psychology at York St. John University. And Daniel's also a member of the motivation, performance, and well-being research group at the university. Well, welcome, Daniel. I suppose the first question is, what actually is burnout? - Yes, thank you very much, Richard. And thanks for kind of giving me other chances to talk about this kind of important and pressing issue, especially in context of the situation we find ourselves in. So the way we view burnout is that it's a psychosocial syndrome that develops specifically in response to chronic stress that people experience. And so when we're talking about it as a syndrome, we're talking about its symptoms. So we're talking about three specific symptoms. And so the first of these is what we term a reduced professional efficacy. And so this is the idea that people kind of no longer feel like they're good at what they do. They no longer feel confident that they can be effective in their jobs. They can't effectively get done what they want to get done. So that's kind of the first symptom that we need to be aware of. And the second symptom is kind of increased level of cynicism. So cynicism normally directed towards the job itself. So individuals start to care less about whether their work is done well, whether it's done poorly. They divert the cynical attitude towards that kind of work. They do the environment that they find themselves in. We also, the final and perhaps most kind of key symptom and probably the most recognizable when we talk about burnout is this idea of emotional exhaustion. So everything appears to be harder than it usually is. Working feels like a strain. Working all day is much harder than it used to be. So these are our kind of three main symptoms that we talk about when we talk about burnout. And so one thing that's important to be aware of is that we don't necessarily talk about whether someone is burnt out or not. We talk about it kind of on a continuum of symptoms. So people kind of experience low symptoms to all the way to high it more, so they are symptoms. And so when we're looking at burnout in this context, we think about how frequently people experience these symptoms and are more frequently they experience them the more likely they are to be suffering from burnout. - Right, so you've touched on this, some of this already, can we look at it from the individual perspective and you've touched a little bit on that. If I said how can staff identify burnout, you've identified three things, but expanding that a little bit perhaps where they can go, et cetera. And then move on to an organizational perspective. What the organization, maybe the culture of the staff are doing to identify and support. So thinking from an individual perspective. - Yes, I think it's the most important place to start for me is to also think about the consequences of burnout. But specifically for nurses, but also people kind of in working situations, those supporting their staff, those supporting doctors. So there are a number of key kind of consequences, and that probably the most major is kind of a reduced well-being that can occur as a consequence of burnout symptoms. And so we also know that it's kind of a large amount of research suggesting that are kind of quite a strong link to depression and depressive symptoms that can occur as a consequence of burnout. We know that there is an increase in kind of potential for interpersonal problems, interpersonal conflict. This idea of kind of social disconnection. This idea we potentially feel less connected to others. We know that that can then lead to kind of this idea of loneliness, which is only going to be exacerbated in this kind of situation we find ourselves in. And in terms of thinking about how this might manifest for nurses at their jobs, we know that it increases absenteeism. So they may be less likely to actually turn up to some of these roles, and it can ultimately lead to nurses and other members of staff to actually leaving their jobs or leaving their profession in general. So there are quite kind of stark consequences that range from kind of individual wellbeing all the way to kind of what the consequences are for them and their job. So like you mentioned there, it's kind of awareness that's the first key issue in terms of prevention and understanding this for individuals. So knowing what those symptoms are is an excellent first step. So those symptoms of reduced efficacy, that cynical attitude develops in the exhaustion. So feeling more exhausted than one might usually feel. But I'm definitely going to be kind of that first step to understanding whether or not someone is experiencing this in your own. And I guess the next step then, if someone is worried they are experiencing these symptoms, is to seek help. So to seek out the help of the mental health law, wellbeing, professional to kind of provide them with support and care that would be required at that stage. So one thing I'll also add here is kind of this importance around overcoming potential mental health stigma in relation to burnout. Because we know that stigma can be a significant barrier to help seeking. So those who feel stigma towards mental health are less likely to actually help seek help when they experience these problems. And so kind of from our educational perspective, we need to make sure that the nurses are aware that this is not a weakness. This is not something they're showing it as a weakness. It's something that shouldn't be viewed by themselves or by other people as a weakness. And it shouldn't be viewed negatively in that manner. Instead, we should be trying to support one another in these situations and kind of aiming towards reducing those mental health stigma. So that will turn to be my overall summary in terms of from an individual perspective. Just pick up on, you talked about cynicism. How has that seen? And does that link to irritability? Because I sometimes find it's quite reassuring to hear there's a spectrum. I quite like that idea that rather than saying your burnt out or you're not burnt out, you might be traveling in that direction I suppose. but this idea of cynicism, can you just explore what examples that might be and is that the same as being short-tempered and irritated? I guess they're two different things. Yes, so I think from the burnout perspective it's kind of important to differentiate the actual symptom itself from the consequences of the symptom and so yes of the cynical attitude is more in relation to their job and so it's kind of not really no longer caring about performing well at their job role. No really not really the cynicism is directed towards what they're doing in their work whereas one of the consequences like you a new to there is kind of a development of interpersonal problems so it might it might result in kind of being short with people it can also affect communication so the way the ways in which people communicate and again in these in these situations and circumstances where communication is key in the nursing profession especially in the intensive care or those situations. You can see how it can have direct consequences for the care that's being provided to people. Yeah and from an organization of perspective because they are within an organization what an organization can do to identify and to help. I suppose a lot of that is just expanding out from what you're talking about. Yeah so the organizations and the way organization structure is definitely key in kind of providing the grounds for which burnout can develop but also for the way in which the consequences can manifest. Kind of like what we were talking about there if there are effects burnout effects kind of decision making there are definitely consequences for the performance of a team perhaps even a performance of an organization as a whole and so it's definitely worth considering how how the how workload is structured how workload is is divvied out but kind of yeah that workload issue is definitely key in terms of the demands that have been placed on individuals but I think what's important to know here is kind of that present in the present situation the demands are definitely excessive but they in a lot of the cases perhaps necessary and so we can kind of see that those demand being placed on this might make risks to burn out almost inevitable as a consequence of the the situations that the people are working in at the moment and these risks kind of can be kind of compounded by other expectations or demands placed on. So for example our group has done a lot of work on the role of perfectionism so not only kind of from an individual perspective so the standards that they set for themselves but also in context of sections that they they perceive other people to be particularly demanding. So for example those those people that they work with those people that kind of provide the word context if they are overly demanding of perfection or expect extremely and or excessive expectations and also the we know that these things are tied with kind of criticality when these expectations are not met so we know that the all of these things together from an organizational perspective can kind of lead to an increased risk of burnout symptomology. So I guess yeah I guess from that perspective it's important for nurses working with other people to ensure that they're kind of demands their requests from other people are should we say I don't know not excessive but yeah but essentially in line with what's capable of actually being done in those situations. Great there are any final thoughts Daniel for those listening and we've touched a lot on what the organization the individual can do research in this area particularly because I know you're very at the forefront of looking at these issues. Yeah again I think it's just about reiterating that there is a definite increased risk for burnout symptomology in the present context and being aware of those symptoms such as reduced efficacy, the exhaustion, the cynicism and ensuring that kind of you not only seek help from kind of your peers but also off the help to other people that you may think are experiencing these problems but also know that it is okay to seek help and that mental health professionals are there to support people and this is this is what they're here to do this is what they they're trained to do so that would probably be my kind of overarching overarching thought. That's brilliant. Josh Daniel Madigan thank you very much for joining us. Yes thank you very much my pleasure. So that was interesting Jason all about burnout. There any thoughts on that? Yeah I think it's I think it's really good actually that some attention is being paid to something that didn't seem to be a massive part of my in particular my nurse training and my life is a newly qualified staff nurse so I think it's pretty positive. So let's take the burnout and stress issue a little further and I'm joined online now by Dr Caroline Barrett from the University of Essex and Caroline is Program Lead for the MSC in Health Research and CPD Lead and we're looking at approaches to managing the whole issue of burnout and stress with a particular emphasis on Caroline's area of interest which is mindfulness. So welcome Caroline. What's your thoughts around this issue and particularly the role and benefits of mindfulness? Thank you very much Richard thank you very much for having me on today. So my experience in this area relates to my the development of a course called developing as a compassionate practitioner where I started to look at how my interest in meditation and mindfulness could be brought into the education of health and social care professionals and through doing that course I've gone through a lot of learning around you know how we can help to reduce people's stress, how we can help people to cope day-to-day with the challenges that they're facing and obviously at the moment things are particularly acute especially for our health and social care professionals. So a lot of what I I teach about is around mindfulness but obviously this is just one approach to managing stress of many and it may not suit everyone. The reason I think that mindfulness practice is particularly useful is that it can help create a sense of spaciousness particularly within our thoughts within the busyness of our minds that is very helpful for helping us take time out and resting and getting away from those day-to-day worries that can encroach very quickly when we're in very stressful situations. So can you just go through Caroline what mindfulness is for those of us who've heard a bit but perhaps don't know great deal about it and why particularly an advocate for mindfulness for health care professionals? Certainly so there are a range of definitions of mindfulness and there's a lot of debate in the research literature about what it is but a very common way of understanding it is the idea of paying attention non-judgmentally in the present moment and what this means is that being mindful is about taking time to be aware of our present circumstances without constantly judging thinking worrying about what's occurring but just being present with what is there in our experience in that moment and the reason this can be really helpful is because as human beings we constantly get caught up in wanting things to be different from what they are we might be doing the washing up for example and constantly thinking about we might be worrying about what happened at work that day or looking forward to what's coming in the evening but we're very rarely present with what's actually in front of us and the difficulty of this is that even when we're doing things that are quite nice like I don't know having our morning shower for example we can already be caught up in the stress and the worry of the day even though those events haven't started happening and physiologically this puts a lot of pressure on the body because the body doesn't know whether we're actually being exposed to that stress or not if we're thinking about it and we're worrying about it the body is already wired for stress and so when we're thinking about burnout burnout arises when we've been exposed to stress over a prolonged period and where we don't get the mental and physical break from that ongoing pressure and so by being mindful we can actually be aware of when we're not under stress when we're having a rest and so we can create greater spaciousness that's actually very nurturing both emotionally, mentally and physically. - I mean, it's an interesting point, isn't it, 'cause I kind of recognize that exactly what you're saying. And I wanted a number of points that, well, you know, quite a number of points. One is, can you do that alone without someone coaching by helping you do it? But also, I feel like I'm in a therapy session with you now, first, you're able to, there's a kind of comfort in the pain sometimes, isn't it, no, you know, I sort of think about all the things are gonna happen because I think somehow, probably in a futile way that you can control it, that you can, but actually, as you said, you just make yourself do some assaults, et cetera. So I'm wondering how easy it is, actually, to achieve mindfulness and do you need someone else to help you to do that? - So when we talk about mindfulness, we often talk about mindfulness practice because becoming more mindful is a constant practice, something that we have to be aware of and cultivate awareness of. Now, there are two forms of mindfulness practice or they can be grouped into ways. So on the one hand, we've got formal mindfulness practice, which people often associate with things like meditation. So for formal practice, it requires you to kind of take time out of your day to go and sit somewhere a bit quiet. So you have to do something deliberate, if you like, that actually takes you out of the flow of your everyday life. By contrast, informal mindfulness practice refers to small things that you can do within the flow of your everyday life to help to slowly introduce these moments of mindfulness, these pauses where we might take a breath and just become aware of our surroundings, allowing ourselves to drop out of the mental chatter and just give our mind just a few moments of rest. And when I teach mindfulness courses, I really emphasize the interplay of these two types of practice. So it can be quite hard to carve out these small moments. If you haven't first started to experience the value of more formal mindfulness practices, so there's a definite interplay between taking the time out to do some meditation, for example, contrasted with finding moments to pause within your everyday life. Now generally, I would advise people who are really wanting to explore mindfulness to engage in a course with an experienced teacher, someone who has sort of practiced meditation and mindfulness for quite a long time themselves, because there's a lot of value that comes out of those practices that they will be able to share. And particularly for people with underlying mental health issues, or for whom they've experienced recent trauma, I would certainly say that engaging in long-mind mindfulness practices or meditation, for example, longer than, say, 10, 15 minutes, it's really wise to have someone teaching you, guiding you through the process, because sometimes when we start to become quieter, when we start to really notice what's going on for us, sometimes there isn't always easy stuff. You've already hinted at the fact that we sometimes don't quite know what's going on for us, and when we start to tap into that, it can be quite challenging, so sometimes some guidance is helpful, but there's also an awful lot of online resources and books that provide a great introduction, that mean that a face-to-face course isn't necessarily essential to start. So what are the benefits that people are saying they're getting out of mindfulness? What does the research, for example, show as the benefits of this approach? OK, so I think where we have the firmest evidence around the impact of mindfulness practice, is around the impact of stress, with reductions of stress, and particularly improvements in mental health and anxiety. I think those are the key areas where mindfulness is consistent, not in every study, but fairly consistently showing a picture that engaging in mindfulness practices can lead to benefits for individuals. Now, we are seeing currently the research is developing to try and understand what is it about mindfulness that is causing impacts on stress, for example, and there's a few different theories out there. So one of the ways that it seems that mindfulness is affecting or helping to reduce people's stress is allowing them to gain a sense of perspective on their thoughts and their emotional experience. So what can happen when you engage in mindfulness practice is that you start to realise that your thoughts are just thoughts. You can actually gain some spaciousness from them and start to see the world in a slightly different way. So instead of when we're in a stressful situation, we can feel incredibly personal, particularly if someone's giving us a hard time about something. Mindfulness can give us the ability to notice how we're responding to a situation without being quite so caught up in it, and that can be a very powerful thing for helping to alleviate stress. Another way that mindfulness can help is by encouraging people to develop a greater sense of embodiment and sensitivity to what's going on in the physical body. And very often when we get stressed, the first warning signs that something harmful is going on in the body can be through tension that can be held in the body. And very often we get very stuck in our minds, we're very mental creatures, and so being reconnected with the body, the greater sensitivity to what's going on can be very helpful to help us tap in to what's going on for us. And the last area that I mean there are many things I could talk about, but I think another important thing to mention is that when we become more mindful and we're being able to be more present to what's going on, we can become less reactive in situations, and this can be very helpful not only for making better decisions, but also for improving our relationships, for example. And for people working in highly pressured teams in the health and social care sector at the current time, being able to relate positively, calmly, constructively with colleagues and with patients is really important. And the reason this reactivity reduces is because when we're mindful, we can be aware that someone has, for example, hurt or upset us by something they've said, and we can choose to respond differently instead of just having knee jerk reactions, which can sometimes be less than constructive, particularly when we're under pressure. That's very interesting Caroline, any final thoughts before we leave you? I think one thing I'd really like to say particularly at the current time is that actually it's really important with mindfulness practice that it doesn't become one more thing that people are putting pressure on themselves to do at this difficult time. If it feels like something that people want to engage with, that they think may be useful for them, then I would really encourage them to do so. But this isn't about problem solving, it's not about becoming a better person or self-development. And so particularly at times of stress, we need to identify things that also bring us comfort, that nurture us, that allow us to rest. And for a lot of people, that might not be mindfulness at the moment. It might be curling up and watching their favourite TV programme, calling a friend, and going for a run. But I hope that for some people that these ideas will be useful, but I certainly don't want it to become another thing that people feel bad for not doing. Dr. Caroline Barrett from the University of Essex. Thank you very much for joining us. Thank you. So that was an interesting, Jason. What do you think about that mindfulness? Yeah, that sounds really useful. And I particularly like the way that there's lots of different ways that you can apply it, so you can do it on your own, you can do it in a group or in books or. So I think that's really useful, yeah. From a day-to-day point of view. Keeping fit both physically and mentally is a clear challenge for nurses and all the work that we do. And of course it goes without saying at this challenging time. And my next guest, Dan Martin, who's a lecturer in sports therapy and a chartered physiotherapist at the University of Wales, Trinity St David, is here to discuss how nurses and other healthcare professionals may be able to maintain fitness at this time. So welcome, Dan. Do you think we should put on a new year's resolution to keep fit on hold at this time? I think Richard, now is a great time to potentially get fit. I think there's lots of opportunities out there at the moment. Obviously it is a challenging time. And I'm sure people will be feeling potentially a little bit fearful and stressed. But actually, that's just one of the many reasons to actually start undertaking an exercise programme and developing some habits around that. I suppose the question is, what do we mean by fit? Is it fitter? Because fitness is a bit subjective, isn't it? What are you thinking of when people get fitter? Fysterd? Fysterd yn cael y gallu ffordd o ffordd o ffordd a ffordd a ffordd a ffordd a ffordd a ffordd a fford Mae'r fawr yn ffordd o ffordd o ffordd yn ffordd o ffordd o ffordd o ffordd o ffordd o ffordd o ffordd o ffordd o Mae'r i'n gwybod yw i'n gweith i'n gweith i'n gweith i'n gweith i'n gweith i'n gweith i'n gweith i'n gweith i'n gweith i'n g ac mae'n gweithio. Mae'n gweithio'n gweithio, mae'n gweithio'r gweithio'r gweithio'r gweithio'r gweithio'r gweithio'r gweithio'r g I know a friend of mine who's working in social care. He kind of looks after that in the South Wales region and his wife's a nursing critical care so that they're a stretched family. But chatting to him the other day what he was talking about was incorporating exercise in between waking the kids up and making their breakfast. So managing to get a few exercises or a few stretches in in between those gaps and I think it's it's trying to fit in opportunities in and around that. Other people might well have slightly more time on their hands and maybe we'll be able to look at some of the online resources that are available on various websites to maybe develop new skills, maybe look at different types of exercise things like yoga, palates, look at some calisthenic type of exercise that they could potentially start and improve on. So there's almost a is that morphing into a physical fitness and a mental fitness because yoga right I maybe run I associate with relaxation and rather than hard exercise of I don't know lifting weights or running on the spot etc. So fitness is both mental and physical? Yeah definitely and I think the aspects in relation to physical and mental fitness are associated probably with the World Health Organization's view which is kind of looking at five times 30 minutes cardiovascular exercise and two lots of 15 minutes resistance exercise and that's kind of what people maybe perceive as fitness from that perspective but I think that the kind of holistic view and the view that is becoming more apparent over recent years is that actually people can get their fitness through a variety of means and as we mentioned there there's a few options in relation to different types of stretching those type of things you know are really useful actually enabling improvement from a physical and a mental point of view. So I think I think there's plenty of options there around you know you might even want to take up your Wix workout Richard. Maybe the other thing is do you think there are ones not one looking necessary to advertise but are there some online resources that are better than others then shorter programs longer programs how do you know what what is necessarily right for you is that does something that you have a gut feeling for? I think you can go to some some of the main sort of professional bodies so the child society does have some videos around exercises that you can potentially look at and they're they're free to view and free to access. Again the NHS actually has some good websites that are available and some good exercise programs I have another patient that actually pointed me towards some of the parties exercises so for somebody that's maybe just looking to get into a little bit more activity and maybe a different type of activity there's some beginner sessions on the NHS website so I think there's some of the bigger websites there I think if you go on to you know obviously the big wide sort of YouTube type forums and variety of sort of materials going to be quite quite vast so I think probably stick to professional bodies websites and and sort of main main areas from that perspective. Do you think you need to set personal goals is that overegging the pudding do you think you need goals that I was I was worried that people set goals and then get disappointed when they don't make them age you need to set personal goals and should they be flexible or would you just focus on it on what you're going to do that day is is personal goals a red herring? Yeah that's a good question actually I think a lot of people do focus on right I have to achieve this and they have a specific outline of what they want to do and they're like I'm going to achieve this in you know four weeks or five weeks I think personally that that is fraught with long-term issues and I think in my experience of sort of 20 years of dealing with people in relation to exercise I've always given patients generally a couple of exercises and allowed them to build on that and I think that's a pretty good principle if you give people a little bit of exercise and you encourage people to develop good habits in relation to activity then they can kind of be bedded in and utilise long-term whereas I think you know sometimes if we're if we're quite prescriptive and every kind of have these goals sometimes we get we can get a little bit too focused on that so I think my perspective on this is that I think it's it's better that we we kind of try and generate a culture a healthy active culture and that ultimately involves you know telling people that maybe you're doing a little bit of exercise at the moment ask somebody else are you keeping fit I think those type of things help promote that healthy culture and develop these habits yeah and it's a final point once we've moved beyond this dreadful time at the moment is there a place for personal trainers and joining groups and those sorts of things as you said that almost the motivation and the culture etc is this something that people should carry on doing on their own is that is once they get back into the big wide world how do they keep it going yeah I think there are lots of areas out there that are currently doing things online in relation to gyms or actually doing online sessions and trying to encourage people maybe through Zoom and another mode at other sort of video modalities trying to encourage people to stay in touch from that perspective and develop that sort of culture I think if you're that type of person then that's something that you may well want to do and have a level of accountability from that perspective I know some people do value that and and that's maybe something that down the line that people might look to invest in but I think I think if you can kind of develop some of these habits and some of these traits from a physical activity perspective whether that be going for a walk whether that be going for a jog whether that be doing some stretching calisthenics and kind of circuit activity whatever you've started to do during this time then I think there's lots of options to kind of develop on that in the longer term great Dan always good to talk to you thank you very much my goodness Jason that takes your breath away any final I know I know yeah I know I know I know I know so any final comments on well-being and self-care yeah I mean particularly at the moment with the lockdown we're going through I mean it's these things are just priceless aren't they so usual for you know morale fitness mental well-being all of all of those things I mean if you've a'r technych chi'n yw'r ymwch. It's really great. So yeah, I think it's been really useful and it's been great having you with this Jason. Thank you so much. Of course. Thank you. Well, I hope you enjoyed this episode and as always you can get more resources associated with the topic at rcni.com/podcast where you can also catch up on the episodes so far and do remember we're also on Eppel and Spotify podcasts if you want to leave a review and join us on Twitter of course at Nurse Standard. Thank you very much for listening. See you next time and take care.