Some of the biggest barriers human beings have in dealing with each other are all the assumptions we make. Have you ever been shocked when a neighbor who seemed so pulled together with her beautiful clothes, nicely behaved children, fantastic job, and loving spouse has the most acrimonious divorce? Did you assume her life was perfect because it appeared that way to you?
Nurses, who see all walks of life each and every day, are less apt to assume each person has the life they appear to have. After all, nurses see people in what is often their most vulnerable and often most unhappy times.
But, according to Margaret Erickson, PhD, APRN, CNS, AHN-BC, executive director of the American Holistic Nurses Credentialing Corporation (AHNCC), there is one area where nurses’ assumptions can get in the way of caring for a patient on the level the patient needs.
Making assumptions about self care, she says, can be a problem for patients because self care means something vastly different for each of us. What fuels your soul might not be what makes your colleague happy. What makes you physically, emotionally, and spiritually whole is not going to be the same for your patients.
“I believe people know what they need,” Erickson says. “Our job is to be supportive of that knowledge. Don’t presume what self care looks like to you. Modeling isn’t showing them what to do.”
For some people, a 10-mile run, healthy eating, and getting a solid night’s sleep not only means they are taking care of their bodies, but also nourishing their souls. But for some people, it’s an afternoon of sappy movies or an hour reading People magazine. Are they the same on the health scale? Maybe not. But as a nurse, giving your patient permission to care for themselves in the way they know they need is part of figuring out how they will care for themselves when they leave your care.
The trick, says Erickson, is active listening. Listen without an agenda. Listen without waiting for your turn to speak. Listen without forming any comeback statements. You might be surprised at what you hear. Erickson practices using the Holistic Nursing Theory of Modeling and Role-Modeling (MRM; Erickson, Tomlin, and Swain) which gives guidance on combining both listening to the client’s story and using the art and science of nursing to facilitate the greatest well-being for the client, she says.
Erickson recounts the story of a man who for 15 years had been labeled as difficult and non-compliant. A diabetic, he was not following proper self care and had health complications because of it. Only through careful listening and noticing some nonverbal clues did Erickson find out some stunning information. For instance, the glazed look he got when his nurse talked about fruits and vegetables? When Erickson gently asked about it, he said he lived on a reservation and fruits and vegetables were delivered just once a month. If you were not there in time, you didn’t get any. So he had virtually no access to the fresh produce his care team said he needed.
He also mentioned that he tried hard to comply and use his insulin. But the medication had to be refrigerated and he did not have a refrigerator. For 15 years, no one knew that. No one asked about his living situation, and he didn’t mention it. But no one ever asked about how he took care of himself. They only told him what to do, says Erickson.
“When we are limiting with our world view, we put up a barrier,” she says. “We don’t talk about engagement with clients or colleagues.”
Instead of saying, “I am here to help you feel better,” nurses might consider saying, “How can I help you feel better?” says Erickson. “In order to plan interventions to be most effective, you have to see their world view,” she says. “We tell patients what to do for self care and then we wonder why they don’t participate in their own self care. It’s because it was never their plan.” With more focus on the person and less focus on the tasks at hand, the patient-centered care comes to the front. “Otherwise care becomes a cookie-cutter approach versus care individualized to each unique person,” Erickson says.
So when you find yourself wondering why a patient can’t seem to follow your instructions, seems uncomfortable with a plan of care, or seems puzzled, indifferent, or even resistant, dig a little deeper to find out what they think they need.
“Our goal is to facilitate clients to do self care actions,” says Erickson. “If we don’t plan care and engage the client in that care, harm can be done. Try to remember, ‘It’s not about me, it’s about them.’”
Well it has been a while since my last post, due to the “busyness” of life. Often times we let the things in our life take so much of our time, that we forget about taking care of ourselves. As nurses we are focused on taking care of others: our patients, our family, our friends, and sometimes even strangers. We have heard of the saying “Take care of yourself, so you can be there for others,” but how many of us actually practice this? This really hit home after hearing about the unexpected death of two colleagues over the past month. They both devoted so much time to their job and neglected to relax and take care of themselves.
Credit: Leslie McRae-Matthews
We have our plates so full with other people’s issues, cares, and needs, yet there is no room on the plate for us. There has to be a balance between work and relaxation. This is not new information for us—we just need to apply it to our lives. Many of us advise our patients about taking time to relax, meditating, and thinking about things they enjoy to decrease stress. These are some of the same principles that we can use.
When you start noticing that you are feeling anxious, moody, or depressed, these are signs that it is time to step back to refocus, recover, and renew. Many people relax by traveling, but you do not have to spend a lot of money to relax. Engage in simple activities, such as drawing, photography, taking a walk to enjoy nature, riding on a swing, or going for a swim. These activities are not an escape from reality or stepping into a “fantasy world,” but they will help you take your mind off of work or other issues, so that you can refocus. Take care of yourself and find that balance.
The financial challenges of those in the current “sandwich generation” (generally those in the GenX generation), can derail retirement plans and the emotional fallout of being stretched so thin also takes a toll. When you’re in the middle, self-care can help you manage all the demands.
Journalist Carol Abaya, who has studied aging and care giving, even went a step beyond the term sandwich generation. With a nod to the complex and complicated situations in so many families, she coined some new phrases for this kind of caregiving.
- Traditional: those sandwiched between aging parents who need care and/or help and their own children.
- Club Sandwich: those in their 50s or 60s, sandwiched between aging parents, adult children and grandchildren. OR those in their 30s and 40s, with young children, aging parents and grandparents.
- Open Faced: anyone else involved in elder care.
No matter where you fit, you are going to feel some additional stress in trying to take care of the needs of so many people. Here are some tips to help.
Talk to Others
You aren’t the only person going through what you are going through. Other people who are also juggling so many things will have some tips that will help you navigate these sometimes confusing paths. Whether it is a friend, a coworker, a faith leader, or a professional, talking with others and sharing experiences helps.
Getting help doesn’t always mean paying for help. Look for assistance by asking what’s possible. If they are old enough, get your kids to help with tidying up your parents’ home. Enlist coordinators to help set up driving help—those can come from senior centers, volunteer organizations, or even the medical community. If you can afford help, paying for someone to do yard work or clean the house can be a huge time saver, as can grocery delivery services.
Try to Care for Yourself
In the middle of so much caregiving, any time for you seems impossible. And sometimes, it will be impossible to take care of your own needs when so many others are depending on you. But if your tank runs dry, there’s nothing left for the people you need to help or for the career you love or for the relationships you want to nurture. Because burnout is damaging and pervasive, it’s important to recognize when you need a break and what that means for you. A break can encompass a whole range of experiences—figure out what will bring you relief. Even the smallest break can offer huge benefits in recharging your outlook,
The Usual Suspects
It is repeated so often because it’s important. The trifecta of nutrition, sleep, and exercise keeps you on an even keel. Look at your pillars on a weekly basis so you don’t feel like each day has to be perfect. Overall, try to fit in some more movement, more sleep, and nutritious food that gives you energy. Being aware is half the battle and the small efforts add up.
Being in the sandwich generation means you are taking care of the needs of many people all while trying to juggle your own family and work life. It’s not easy, but taking care of yourself is an essential part of managing this time successfully.
Are you like most nurses, filling your days with taking care of everyone else but yourself? That may seem heroic, but putting yourself last ultimately leads to a dip in on-the-job productivity and career burnout. But when you take care of your own needs first, not only do you benefit, and so do your coworkers and patients.
Is there a secret formula to boosting your health and happiness? Fortunately, there is no secret. It’s simple, though not easy, to make yourself a priority in your own life.
By attending to your own self-care, you’re more likely to head off the symptoms of overload which can cut your nursing career short. But where do you start, when there are so many components of a happy, healthy life?
Self-care is easier to establish if you know what’s most important to you at this particular point in time. You may want to focus on a major life activity—eating, exercise, sleep, or relationships—because they seem like obvious drivers of well-being. Improvements in any of those important areas can certainly yield major benefits, but they’re usually tough to crack.
Even if you highly prioritize self-care, it’s difficult to say “No” to that big slice of cheesecake, fit in workouts, or turn in for bed on-time. Especially when your schedule is already jam-packed, your shifts are long, or you work nights.
Why not try another tactic? Consider setting a self-care habit in motion by starting with baby steps toward your ultimate goals. Improvements don’t have to start in your “hot zones” either. Like dominoes, a shift in one habit or routine will cascade down to every other area of your life.
Here are two powerful ideas to spark your thinking:
1. You Need a Budget.
Who even uses a budget anymore? It sounds so old-school, like playing music on 8-track tapes and paying with paper checks at the supermarket. But sitting down to crunch the numbers, and getting a grip on your income and outgo, can be an effective stress-reliever. Your financial situation may remain the same, but seeing the actual facts can stop the free-floating anxiety that’s fueled by imagination.
Your budgeting system doesn’t have to be fancy, either—just use a notebook and pencil to note and track your household expenses and income. Some people like to allocate cash to specific purchases, using an envelope system popularized by Dave Ramsey. One envelope for cafeteria lunch money, another for…
And don’t forget to plan for seasonal outlays (holiday gifts or taxes) and emergencies. That way if you need to replace a dental crown, you’ll have a buffer fund to cover it, and won’t panic as much.
There are also many apps out there for budgeting, including the grand-daddy, You Need a Budget (YNAB).
2. Do a Digital Detox.
Are you always texting, Skyping, Tweeting, Facebooking, or otherwise deep in your digital stream? That’s the case for many “social media natives” and even for their oldest colleagues.
Even if you’re following social media guidelines for nurses in your workplace, you may find that digital is a distraction, always in the back of your mind, ringing, buzzing, or vibrating to get your attention. You could get relief from all sorts of social media ills, from text neck to FOMO, by choosing a set time to disable it, for hours or days.
Some people like to set aside long weekends to go away on formal retreats, like the ones offered by Digital Detox while others simply reduce everyday use. Digital refers to all smartphones and computers (sometimes TV’s too), so resolving to stay away from electronics and screens after 8:00pm could be enough to calm your down, and make it easier to get to sleep at a decent hour.
Oh, but wait, what if you ditched your alarm clock? There are all kinds of new devices for improving your sleep hygiene that you may want to check out. One example is the Philips Wake-Up Light Alarm Clock with Sunrise Simulation, which costs less than $50. The light on this clock slowly gets brighter over a 30-minute span, to gently awaken and welcome you to the new day.
It’s important for you (and your patients) that you engage in self-care every single day. So resolve to take a baby step toward making yourself a priority in your own life.
Why not start today?
The term “self-care” is a big umbrella that covers a ton of wellness topics, such as life-balance, stress relief, weight management, fitness, relationships, spirituality, and much more. It’s tough to pinpoint just one life arena you’ll want to make changes to in order to become happier and healthier. But it’s possible and may make your self-care journey easier.
Here’s a tip: Start with sleep.
Why Sleep Is So Important
This is probably the number one area where you can improve your health and well-being. Nurses are notorious for not getting enough sound sleep on a regular basis—odd shifts and rotating schedules don’t help the body to regulate rhythms. Fatigue is one thing but it’s worst when a sleep-deprived nurse actually nods off while at the bedside or on the road after a late shift. Obviously, that’s extremely dangerous—for you, your patients, and everyone near you.
Most American adults don’t meet the guidelines for sufficient sleep (seven to eight hours) and many of us consider it a luxury we can’t afford, or try to “bank” shut-eye by sleeping for 5 hours on work nights and 10 on days off. We like to think that getting along on little sleep is a sign of superhero strength and those who prioritize rest are weaklings. None of those beliefs are accurate. Here’s how you can take care of yourself, in spite of our hyperactive society’s mistaken take on rest and sleep.
The Basics of Sleep Hygiene
Chronic sleep deprivation and sleep disturbances, such as sleep apnea, can be improved by following good sleep hygiene protocols. Try these tips:
- Cut out caffeine later on in the day. (That includes certain soft drinks and chocolate, as well as coffee and tea.)
- Drink alcohol in moderation, or not at all, because it’s more likely you’ll wake at night after a drink or two.
- Another reason to stop smoking cigarettes: nicotine interferes with sound sleep.
- Finish your last meal of the day a few hours before bedtime so you’re done digesting.
- Don’t do heavy exercise late at night, though gentle stretching or yoga can be a restful entrée to sleep.
Setting the Right Environment for Rest
Digital sights and sounds make it harder to slow down and get ready for bed. Younger nurses, being social media natives, are especially prone to texting, tweeting, Pinteresting, and streaming movies in their bedrooms. Make it a rule to keep your smartphone, iPad, or other devices out of your bed. That way, you won’t be tempted by social media, news, or entertainment right up to the time you turn off the lights. Some nurses even set a digital curfew and power down devices two to three hours before bedtime.
When Your Mind is Too Busy to Turn Off
Some nurses find that the simple act of journaling before bed helps them quiet the worry, anxiety, and fears that may be keeping them awake. Nursing is an emotional occupation and there isn’t always an opportunity to process what happens during the day while on the job. That’s when a notebook and pen by the bed can be a curative. One of the principal researchers in the area of journaling and health is James Pennebaker, a psychology professor at The University of Texas at Austin and author of “Writing to Heal.” His studies have shown that expressive writing (journaling) is a simple and effective way to relieve stress while boosting both mental and physical health.