Posted September 5, 2022
Nurses have a huge responsibility of taking care of different kinds of patients. This role, from a broader perspective, subjects nurses to several factors that lead to increased stress and there is a high chance for this stress to deteriorate their well-being. Hence, it is necessary to take preventative interventions before the damages happen rather than make band-aid solutions. It is collaborative work between the nurses, the organization, and the government.
This episode talks all about what preventive mental health is and what it looks like. It also talks about the problems and barriers that are inherent in the nursing profession and the things that contribute to someone flourishing at work and having an optimized sense of well-being.
KEY TAKEAWAYS FROM THIS EPISODE
Mental health is something that we all have. It’s not just something someone with a mental health problem has.
Well-being is when someone is contented, comfortable, and happy.
When we think about preventative mental health, we think of the factors and conditions that might make someone at risk of developing mental health conditions and intervene with them before the person struggles with mental health difficulties.
Several occupational factors lead the nursing work to have increased stress and increased stress most likely leads to burnout and other psychological difficulties.
Removing or reducing occupational hazards is important. People need to go to work feeling that they’re safe.
Supervisory or management relationships that are founded on trust, compassion, and respect are crucial.
A clear job description is important, but an opportunity for employees to express themselves and to be more flexible with their roles contributes to job satisfaction and well-being.
Understanding the role of compassion, self-compassion, and emotional intelligence for nurses will help you flourish in your work and prevent the deterioration in mental health.
There’s a psychological role of being compensated financially as well.
Having enough time and resources to do the job is also extremely important.
Social support is one of the biggest protective factors of people’s mental health and well-being.
Culture is the underlying principles and beliefs that guide behavior and actions within a team, a department, or an organization.
Well-being strategy is not about a single band-aid approach, it is about taking a broad look at the particular healthcare system, the organization, or the community and thinking about the particular needs of those individuals and ways their well-being can be supported over a long period.
Early intervention helps prevent more serious issues.
The Factors to Consider in Preventative Mental Health:
-Self-identifying their barriers before they start or during their training
-Proper funding for healthcare at the government level
-Building the right culture in the organization
-Having enough staff and resources in the workplace
-Meeting the employees’ basic needs
-Having the right conditions and environment
-Having social support
-Lifestyle interventions contributing to health
-Taking personal responsibilities
Facebook Group: https://www.facebook.com/groups/nursewellbeingmission
Nathan Illman 00:04
Welcome to the Nurse Wellbeing mission podcast. My name is Nathan Illman, and I’m a clinical psychologist who has a keen interest in preventative mental health for nurses and midwives. If you listen to the first episode, you would have got a bit of a background about me, I really recommend you go and listen to that and your short episode. But just in a nutshell, I’m someone who has had a number of personal experiences working with nurses and having received care from nurses that led me to really be quite shocked at how little support nurses and midwives get in their training and in their careers to manage the emotional side of the work or the emotional and interpersonal side of the work that they do. And I’m very interested in applying evidence-based practice and evidence-based methods to supporting nurses and midwives to help them flourish in their roles. And the more nurses and midwives that flourish, the more society flourishes. That’s my theory anyway.
Nathan Illman 00:56
So in this first solo episode, I thought it’d be a really good place to start to think about preventative mental health for nurses and midwives. And really just talk about what preventative mental health is, and what it looks like. So giving you a couple of definitions, and just talking about some of the things that we know from the literature around what things contribute to someone flourishing at work and having a really optimized sense of well being, and of course, discussing some of the problems and barriers that are inherent in the nursing profession. And thinking about the conditions, for example that nurses have to work under, and thinking about some of the factors that are often there’s so common in the UK and around the world that lead to nurses not flourishing.
Nathan Illman 01:45
And as we know, the moment the current context, following the peak of the pandemic is nurses are leaving the profession in droves, they are burnt out experiencing record high levels of mental health difficulties. And there really is a crisis in terms of the healthcare workforce. So I believe that this work, the things I’m going to be discussing in this podcast are really critical. And I hope you do too. If you’re listening to this, I assume you think it’s important, otherwise, you wouldn’t be listening.
Nathan Illman 02:12
So let’s just talk about mental health for a moment. So mental health is something that we all have. It’s not just something that someone with depression has, for example, I’ve heard someone in the past use this kind of expression, when talking about someone with a diagnosed mental health condition, oh, yeah, they’ve got mental health. But this isn’t a helpful way to look at it. Mental health is on a spectrum, obviously, at one end of the spectrum is optimized psychological functioning in which someone is probably experiencing a great deal of positive emotion in their life, they have a high degree of life satisfaction, and they are functioning very well in different areas of their life. So this, if it’s a nurse, they could be functioning very well in their nursing role, but also they could be functioning very well in their role as a mom or a son in different areas of life.
On the other end of that spectrum of mental ill health, of course, we have what ranges from mild psychological difficulties, so perhaps mild anxiety or low mood, which may have a minimal impact on someone’s day to day functioning, ranging to really quite severe and serious mental health conditions that have a very big impact on someone’s functioning. So for example, severe depression or psychosis. So mental health and mental health, this clearly overlaps with the term well-being or the concept of well-being, and well-being is is really all about, I suppose a dictionary definition of well-being is the extent to which someone is contented, comfortable and happy. Obviously, there are different definitions knocking about and in the research literature as well. But you’ll see that this definition takes into account the idea of well, a sort of optimized state of well being involving happiness or positive emotion, but also related to our physical health as also being comfortable and contented.
Nathan Illman 03:56
So when I mentioned, we’re talking about preventative mental health for nurses and midwives are what do I actually mean by that? Well, what we know is that there are certain conditions and factors that are more likely to lead to someone’s functioning going from one end of that spectrum. So being in a relatively optimized state of mental health and well-being and moving further down to the other end of the spectrum and developing mental health conditions. And when we’re thinking about preventative mental health, what we’re doing here is we’re applying what we know from the kind of scientific study of factors and conditions that might make someone at risk of developing mental health conditions. And perhaps, for example, the working conditions and environment that might make someone more likely to develop something like an anxiety disorder or post traumatic stress disorder. And we’re applying that and we’re intervening in some way as you will see, that could be at the organizational level or with individuals and we’re getting in early basically we’re getting in before the person has moved further down that kind of scale if you like it.
Nathan Illman 05:00
There’s point in which they’re really suffering, they’re really struggling. So these are kind of interventions that we know that can work to help mitigate against the unnecessary distress of individuals. And indeed teams and whole hospitals worth of staff now putting the additional pressures that the COVID pandemic placed on nurses putting that aside, I just want to talk about the context of Nursing and Midwifery the context which creates additional risk for nurses and midwives to develop mental health conditions and increased levels of stress. Because this is really important to consider because nurses and midwives have a different type of job to you know, somebody works in, for example, accounting or something, not to say that all accountants have an easy job. But there are just some things we know about the role and working in healthcare. So of course, you know, this includes doctors and other allied health professionals, but my focus here is just talking about nurses and midwives for the moment. So we know that the caring role that many nurses go into often involves being exposed to distress and things like physical disability, for example, and dealing with challenging environments, for example, with the public incivility in kind of aggressive behavior, or in roles in which there is challenging environments, working with families, for example.
Nathan Illman 06:26
So there are a number of kinds of specific occupational factors that lead the nursing role to have increased stress and increased stress. As we know, it is more likely to lead to difficulties with things like burnout, and people suffering from other psychological difficulties. Something else that’s really important. And this is a finding that perhaps not many people know about. But what I’ve actually had some sense of is that many nurses who go into the profession at the training level have experienced some degree of adversity in their own lives in the past, which might make them more at risk of actually developing some of these psychological difficulties.
Nathan Illman 07:08
So in a paper that was published a couple of years ago, the researchers took a sample of undergraduate student nurses across the United States. And we looked at the number of adverse childhood experiences that these prospective nurses had experienced or witnessed during their childhood. And these include things like being a witness or survivor of family violence, different forms of abuse, or neglect, having a parent or sibling who had died or attempted suicide, for example, and a number of other things that were either traumatic or highly stressful as a child. And what they found was that 40% of that sample of student nurses had experienced four or more adverse childhood experiences.
Nathan Illman 07:55
So just think about that, for the moment. 40% of that sample had experienced four or more of these terrible, stressful, potentially traumatic experiences when they were a kid, that’s in comparison to approximately 13% of the general population in a community sample. So only about 13% of people in the community have experienced four or more. So that means those nurses were over three times more likely to have experienced four or more adverse childhood experiences. What we know from the sort of other research literature is the number of adverse childhood experiences people have had, is a robust predictor of later psychological distress and psychological difficulties.
Nathan Illman 08:36
So this really creates a risk factor for many nurses. And this is not to say that it is absolutely determined that all nurses are going to struggle because of those experiences. There are many different factors that lead to different levels of resilience in people. So this isn’t, you know, I’m talking about these findings to try and rob people or deprive them of the riprap perhaps strengths that they’ve developed. It is just to say that it’s important to bear this in mind, and it’s something that we’re not really taking into account, from my perspective is that many nurses go in as what has been called wounded healers. So there is this unfortunate paradox that people who have been wounded in the past with psychological or potentially physical injuries are the ones who are more likely to go into a profession that is very demanding emotionally and more likely to lead to high levels of stress and psychological difficulties.
Nathan Illman 09:27
So that’s why from my perspective, my opinion, it’s absolutely essential that we start thinking about preparing nurses and midwives for the emotional work that they’re doing, especially because we know so much about preventative, mental health and preventative medicine. Of course, as we know, in society, there is much too much focus on a reactive approach. So my philosophy is about trying to shift that and I hope you will join me on my journey throughout this podcast as I delve further into the nature of preventative mental health and practice. ways we can support nurses and midwives.
Nathan Illman 10:02
Okay, so let’s move on to actually discussing some of those factors talking about the workplace, talking about what we know, that leads to nurses and midwives and other people flourishing in their roles. And I will give an overview of some of the ways that organizations government and individuals can work to prevent the deterioration in their mental health, and really to optimize wellbeing.
Nathan Illman 10:27
So let’s start by thinking about what we know from the organizational psychology literature, the occupational health literature about the factors that contribute to employee well being in general, so this stuff applies to really everyone, but you know, also nurses as well. So again, going back to basics, so just thinking about opportunities to be adequately fed, watered, and using the toilet. So the amount of times I hear or read about nurses saying that they just didn’t have time for their break, they basically didn’t really drink much water, they weren’t able to pee or poop on shift, you know, this is the kind of thing that is really basic, isn’t it. So everyone deserves the right to be able to do these things. And there’s, there’s laws in place, there’s policies that basically state that people should be given these basic kind of the ability to express these basic human needs. But often that doesn’t happen, and adequate time and place for rest on shift as well. So it’s not just about giving given time, it’s about where you’re given the opportunity to have that that rest. So we know that for an optimum kind of rest, it needs to be away from your place of work, there’s been research into this, it’s no good just saying, okay, just sit at the nurse’s station for 15 minutes. Because psychologically, our mind is still trying to process work related information when we’re in that same environment. And this goes for nurses, but it goes for, you know, people working at home, or if you’re, if you’re an academic nurse working in an office somewhere, if you’re taking a break, it really should be away from your computer.
Nathan Illman 11:56
So we need to be making sure that people are given the opportunity and the correct environment in which to have those kinds of risks, providing a safe physical environment with adequate equipment and staffing, for example. So removing and reducing occupational hazards is really important. People need to go to work feeling that they’re safe, that they’re not going to be physically injured. But also this goes for psychological injuries as well. So creating a sense of psychological safety for for nurses. So they know that when they go in the intersection, they’re going to be protected by whatever means possible from psychological injury.
Nathan Illman 12:33
So for example, harassment or bullying may be from the general public, and also that they’re going to be supported by senior staff, or when you know, for example, traumatic events or critical incidents happen in the workplace, we know that an environment that’s free from harassment and bullying and racism and blame and shame is really important. And I’m going to talk about the role of culture after I go through these other items. Having supportive management and supervisors who you can approach and be open about, that’s really important. We know that supervisory or management relationships that are founded on trust and compassion and respect are absolutely crucial. And most people have had an experience of a good supervisory or management relationship and a bad one. And we all know what impact it can have on our well being and mental health. When we don’t feel like our manager is supportive of us. We don’t feel that they understand us. We don’t feel that they care, for example, or we don’t just don’t feel like they respect us as another human being.
Nathan Illman 13:30
Having a sense of autonomy in your role with clear expectations and boundaries about what you’re doing. That’s really important. So having a clear job description, but also not just having completely kind of restrictive specified tasks. We know from the literature that when nurses and other sort of general kind of workers or employees are given opportunity to express themselves, they’re given an opportunity to be a bit more flexible with their role that contributes to job satisfaction, and of course, well-being and providing adequate skills training to manage the demands of a role. So for you this may look like upskilling on the job through a nurse educator or more senior colleague giving up being given opportunities for learning and development.
Nathan Illman 14:13
Obviously, this from the beginning, this has been given adequate training during your nursing education through your degree diploma, however, you’ve gone into nursing and something that I want to stress as a big part of the work I do this doesn’t shouldn’t just include being skilled to perform the technical aspects of the nursing. Well, there is also a role for being upskilled in the emotional and interpersonal aspects of the nurse and work so understanding about the role of compassion and self-compassion and emotional intelligence and emotional regulation for nurses that is going to help you flourish in your role and prevent the deterioration in mental health.
Nathan Illman 14:50
So being adequately compensated financially I’m sure many of you listening are probably thinking at one thinking, When’s he going to get to being paid enough? As I’m recording this the UK government is currently in the process of bother about to release a statement about public sector pay rises. And I know already that there is going to be much frustration and disappointment with this, because this is just it’s not going to be enough. And it tends not to be enough. And so nurses need to feel that they’re being compensated adequately, financially. So this is not just about being able to ensure they have an adequate standard of living, and that they can buy material things, there is a psychological role of being compensated financially as well. So we know that it just sends a message when people are given a pay rise and they’re being given a reasonable amount of money for the work that they’re doing. It sends a message from an organization or from a government that you’re cared about doesn’t make you feel valued, you feel that you’re being given enough for what you are giving to that organization or society.
Nathan Illman 15:49
Having enough time and resources to do the job that is specified is also extremely important. So this creates stress, if nurses don’t feel like they’ve got enough time, for example, to provide compassionate care to patients, which is a complaint a valid complaint that I hear a lot from nurses and the resources. I mean, this could just be staffing levels. So if you’re short staffed, if you’re relying on agency staff who perhaps don’t have the required skills, that is going to create a lot of lots of stress for individual, other individual nurses and teams in general, and lead to deterioration and well-being.
Nathan Illman 16:23
So the final point here I want to talk about is social support. So this is a massive one that people often don’t think about, or they don’t necessarily recognize the value of we know from the mental health literature that social support is one of the biggest Protective Factors of people’s mental health and well-being. So there’s some lovely research that shows that as we get older, the sort of the quality and number of close relationships we have with people, including family and friends, is predictive of our longevity and predictive of our physical and mental health and well-being. And obviously, we all spend a lot of time in the workplace. So of course, as a nurse, you probably want to try and keep some separation between work and home. But feeling supported socially at work is beneficial for nurses mental health. So lots of research has come out about the effect of COVID, the pandemic on nurses Mental Health recently, and one of the consistent findings from several different research studies is that when nurses feel that they had social support during their sort of family life or their home life, but also through organizations, this was protective against things like post traumatic stress disorder, anxiety disorders, and depression.
Nathan Illman 17:33
So organizations can provide social support both formally and informally. So this might be more structured social support. So you could see something like Schwartz Rounds, for example, being an example of social support within an organization, you’re able to attend those monthly meetings and be around other peers who are there with the explicit aim of kind of supporting each other, but more informal things could just be something that, you know, someone in your team has set up like a regular coffee chat, for example, or the you know, a group of you do a yoga class together or something like that. So many nurses would have had the experience in their organization of feeling like, okay, the management are trying to implement a particular intervention or thing here, but it feels a bit like a band aid, it feels like it’s too little too late. And that’s why it’s important to think about the role of culture, because culture is what binds all these things together.
Nathan Illman 18:30
Culture is the underlying principles and beliefs that guide behavior and actions within a team and department and the bigger macro level, an organization and the culture is really it’s sort of saying this is how things are done here. So a culture that is supportive and facilitative of well-being is kind of held by an underlying set of beliefs and principles that comes from the top right. So the executives and the higher level nurse leaders or other medical leaders, the medical director, for example, see the importance of the well-being of staff, and that is a priority. And they truly believe that working on that and helping to support that is of utmost importance. And then that’s demonstrated in small interactions and behaviors. So often this is guided by value and many of you would have come across some sort of organizational values, things like respect and compassion, for example, it’s very easy to come up with values, but really, it’s about how those values are demonstrated in day to day interactions.
Nathan Illman 19:37
So this comes between the micro interactions between nurse, nurse leaders and other leaders and their junior staff is represented in hospital policies, for example, to the policies support the well-being of staff. So a really great example something I read about recently was a lack of policies within healthcare system in hospitals around supporting women’s menstrual cycles, period policies, you know, this is something that if it’s available is could demonstrate a commitment to the well-being of staff, for example, and we also see culture embedded in kind of internal communications within the hospital as well to kind of promotional marketing kind of pictures and images that are displayed on the walls of the hospital, for example.
Nathan Illman 20:22
So a culture is really a feeling, it’s an embodiment of principles that are held and delivered by starting from the top of an organization, and then trickling down through the rest of that organization. So what’s really important is that a positive culture that supports the staffs well-being is established in your organization. And that is going to guide and drive all the other things with respect to improving nurse mental health and preventative mental health, for example. So all of those particular areas that I listed before, so what’s really needed is, of course, a number of different strategies to support nurses, but really a shift in mindset and priorities in both time and money to basically believing that it’s worth supporting staff. And this is what wellbeing strategy is all about.
Nathan Illman 21:12
There’s not that single band-aid approach. It’s about taking a broad look at the particular healthcare system, or the organization or the community or whatever kind of unit of analysis it is, and thinking about the particular needs of those individuals and thinking about different ways that their well-being can be supported over a longer period of time. So not just in the next two or three months, how can we react to staff sickness absence, for example, but thinking about a multi-tiered multi-pronged approach that is underneath as a philosophy that is around supporting well-being.
Nathan Illman 21:50
So I’m going to rudely interrupt myself at this stage of this episode of the podcast. If you’re enjoying this episode, and you don’t find my voice to repellent, then I’m going to invite you to come and join my free Facebook group. It’s called the nurse wellbeing mission Facebook group on Facebook, obviously, and in that group, I provide loads of free tips and resources, little videos of myself talking about self-care and how to improve wellbeing for individual nurses, but also some my thoughts and reflections around strategies for organizations as well. So if you’re interested in coming to join that group and joining part of a growing community, then just head over to Facebook and search for nurse wellbeing mission. And you’ll find our group there.
Nathan Illman 22:32
Okay, so back to the rest of this podcast. So what are some of the basic things that can be done to help nurses? This is a key question, isn’t it? So we’ve identified what are some of the vulnerabilities? What are some of the factors that are important to consider in what contributes to someone’s mental health and well being we’ve considered factors in the workplace that we know from the research literature. So let’s just go through some of the things that can be done to help with preventative mental health for nurses.
Nathan Illman 23:01
So let’s start with education and training, before people even qualified to become an RN, are in the UK, the new title of nursing associate, there is a period of formal training, a period of training that prospective nurses go through in which they’re learning technical skills to do the job properly. And we know that that actually does help with reducing stress and burnout if people feel highly, you know, if you’re skilled enough to basically do the role that they’re being asked to do. But this is an excellent point in which to intervene to screen and intervene to ensure those people who are most at risk are provided additional support to meet their emotional needs.
Nathan Illman 23:43
So as I said before, we know that a higher proportion of nurses have experienced challenging life events, and they go into nursing really often because they want to give back and they want to help in some way as expression, the wounded healer, which you may or may not like. But that’s something that’s been used in the literature, these people perhaps more risk of developing mental ill health and their well being suffering. And we know that and we also have an opportunity there to utilize evidence based strategies to support nurses who are in training to ensure that they don’t go on to develop more serious mental health difficulties or simply unnecessary levels of distress. So for example, we know that there are certain risk factors for developing anxiety depressive disorders and trauma, such as low levels of self-compassion. So people who are highly self-critical and find it very difficult to be kind to themselves and to regulate their own emotions.
Nathan Illman 24:43
We also know that people who tend to brood or ruminate a lot. So that’s really kind of overthinking things, playing things back in their mind over and over again asking lots of questions about why something happened and why didn’t it go this way? Why did it go that way? We know that that’s a risk factor.
Nathan Illman 24:59
So combined with our understanding of some of the historical things that can affect someone’s susceptibility to develop mental ill health such as those adverse childhood experiences, it would be reasonably straightforward for us to embed within nursing curricula ways of helping nurses to reflect themselves on their own experiences and themselves and their own strengths and weaknesses, and to be provided education and support and mentoring to identify perhaps whether they are someone who might tend to struggle with particular aspects of the nursing role. And once those people have essentially self-identified and have shown a willingness that they would prefer or would like to receive additional support, then we have lots of evidence based psychological strategies that can be delivered to those people with relatively low cost. And as we know from the health economics literature, assessing the cost effectiveness of early interventions, psychological interventions, we know that these can be highly effective.
Nathan Illman 26:01
So in helping reduce the later development of psychological injury and disorders and reducing the cost associated, for example, we ongoing health or psychological health care of those nurses. And of course, this means that more nurses are likely to stay in nurse training and probably in the nursing profession, as well. So just on that point about nursing curricula, as well as sort of identifying nurses who perhaps more risk also just embedding further robust education around emotional intelligence, and essentially an emotional curriculum, something this is something that has been called for by a number of different authors in the nursing research literature.
Nathan Illman 26:40
In one of my upcoming episodes, I’ll be talking to a researcher Yasna Schwind, who is argued for this argued for the cooperation of mindfulness and self-compassion into nursing studies. And she’s someone who’s written extensively about the role of teaching skilling nurses in compassionate and patient-centered care and focusing on the human aspect of the caring role, as well as the technical side of things. So these things are very likely to help prevent the later development of unnecessary stress, distress and psychological problems with nurses. And this is obviously in conjunction with things that are already happening within nursing education. So there is a role of peer support, there is already mentoring, there is obviously supervision, clinical supervision, there are obviously well being strategies that are developed by institutions.
Nathan Illman 27:33
So this isn’t to say that nothing is currently being done. These are just some additional ways that we know that would be evidence based, and that we could start incorporating. So obviously, it would be remiss of me to not mention the role of government and funding in essentially improving preventative mental health for nurses, depending on where you live. Obviously, this is going to be different sort of government funding structures look very different depending on the type of healthcare system you have.
Nathan Illman 27:58
In the UK, we have primarily a public health system, the National Health Service service, or NHS, so obviously, at the government level, increasing pay, for example, or providing more funding for nurse training and education, for example, to embed the kinds of things that I just spoke about, and of course, funding for healthcare in general. So funding for hospitals and equipment and that sort of thing. So these are essential in order to provide the right conditions that are going to support the mental health and well-being of nurses.
Nathan Illman 28:30
So the next and have extremely important role here is with the organization. So there are many things that organizations can be doing that would be seen as preventative mental health interventions. I’ve talked a little bit about the role of leaders and culture. And really, this is where you know, every organization needs to start. So that culture can be changed by coaching leaders to build a culture that is conducive to supporting staff well-being. So this looks like building their own emotional intelligence demonstrating an understanding of and caring about staff wellbeing and mental health.
Nathan Illman 29:06
So training people shifting their behaviors to create a culture of inclusivity and respect and candor, praising people’s strengths and reducing blaming and shaming. So actually celebrating when staff are willing to acknowledge and own mistakes that they’ve made in service of improvement for patients, for example, a set of necessary conditions to have an organizational culture that is felt to be supportive as well is one in which leaders are willing to receive feedback and take it on board. So taking a pulse on staffs, attitudes, and being willing to admit to mistakes and address feedback and essentially saying, you know, we’re not perfect, no one is perfect, and we’re willing to own the mistakes and things that we could do better as a leadership team, for example, and address staff concerns in a timely way, and one is done in a genuine sort of fashion, as well.
Nathan Illman 30:09
So these kinds of things, then create a culture in which staff who are lower down in the sort of a hierarchy, if you like, being shown that actually, alright, well, maybe people do care about us, and they’re willing to listen to us. And they’re also willing to admit when they’re wrong. And that makes it more of an open culture, which really helps to reduce the kind of stress that, understandably, many people would have heard of, is psychological safety. So this is the belief that one won’t be punished or humiliated for speaking up raising concerns, discussing mistakes, and essentially being able to be themselves. And this is a really important factor in helping to make people feel safe at work, and making them feel like they can fit in and that they’re supported by the immediate managers and team but also people who are higher up in the organization, and this contributes to employee well being.
Nathan Illman 31:09
So this next point is probably one of the most obvious that all nurses will resonate with, is it having enough staff, enough staff and resources and staff who are adequately trained to do the job, as many of you listening would have experienced this, when you actually feel that you’ve got enough people on your team, everyone knows what they’re doing in their roles, and they’re actually doing it well, everything goes much smoother, you probably tend to enjoy your job a lot more. And you have an enhanced sense of well-being, which is something that we can all get from work. Work often provides a sense of meaning for us. But when we don’t feel we’re able to do our job properly, then that benefit to wellbeing of kind of meaning making is reduced. If we’re just thinking that there’s actually too much on I just cannot meet the demands that have been placed on me, because there’s not enough staff here, it’s very unlikely that you’re going to be going home feeling very satisfied with your work.
Nathan Illman 32:04
As I mentioned previously, meeting basic needs is something that organizations need to do as well. So this comes through policies, but also through that aspect of culture as well. So creating a culture in which it’s okay to take your break, it’s okay to leave the ward to go for a break, it’s okay to go and use the bathroom, for example, and trying to eliminate cultures whether it’s organization wide or a micro level, we’re in a sort of ward or department where there’s this culture of bravado and people kind of being tough because they’re not taking care of themselves and their people essentially being belittled or made fun of because they want to go on a break, for example, or because they’re moaning or you know, quote unquote, moaning that they’re tired after having done three night shifts, so the right conditions need to be made available and the right environments. So for example, adequately spacious break rooms that are not on the wards, for example, but also the way policies are set up and the way leaders within potential kind of units or departments are communicating the importance of meeting those basic needs. And as all of you nurses and midwives who are currently or have done night shifts, you will also understand about the negative effects of this on mental health and well-being.
Nathan Illman 33:27
So from a preventative mental health perspective, organizations really need to be taking into account what is emerging from the research literature now about the detrimental effects of shift work and extended shift patterns with lots of extra overtime, for example, on the mental health of staff. So if this comes down to being adequately resourced, adequately staffed, having policies in place that limit the number of shifts or number of night shifts, for example, that individual nurses are doing managers and leaders being trained and again coached to shift their mindset around how they are using their staff. And again, how they are thinking all the time about proactively helping enhance people’s well-being and mitigating against kind of mental health problems through an understanding of how sleep loss, for example, and overwork are going to going to lead to a kind of deterioration in people’s well being. And of course, all of this needs to be supported backed up with the correct kind of funding in place from the government and through organizations themselves.
Nathan Illman 34:31
So much of what I’ve just discussed, there are things related to the conditions that are set by an organization, including its culture and aspects of the specific nurse role and how that can be improved to help prevent mental health deterioration enhance well-being. Of course, we also know that there are specific targeted well-being and mental health strategies that can be put in place that are not just reactive. So this isn’t just an employee assistance program with counseling that you can call up when you’re experiencing significant levels of burnout, depression or anxiety, for example, this is things that can be put in place ahead of time in the knowledge that they can help prevent those significant or clinical levels of mental health symptoms.
Nathan Illman 34:31
So as I’ve mentioned previously, one of these which is probably under utilized a lot in organizations is the role of social support. Social support, has that really protective factor that can mitigate against distress and development of problems for people. And again, it can be formal or informal. So again, that example of Schwartz Rounds is a really lovely example of social support for colleagues and peers who can come together and share stories and support each other a lovely example of social support that I can think of comes from a previous hospital that I used to work for, where there were so many different events that were designed to bring staff together in aid of some kind of cause. So it might have been for a charity event it might have been for, for example, pride in London, going together on that March. So really kind of unifying and bringing people together for a cause there was socially nature, there was a fun element to it, there wasn’t a pressure around work, it may have been held on the hospital grounds at times. But often this led to people kind of socializing, making genuine friendships with people at work, and then deciding to do things outside of work as well, that served a really lovely purpose of just connecting with each other and would absolutely have had a benefit on people’s mental health. And that was something I benefited from as well. I loved hanging out with these people at some of these events at the workplace, but also outside of the workplace to.
Nathan Illman 36:47
Another thing that has been researched within organizations is the role of lifestyle interventions for nurses specifically. So looking at, for example, helping nurses to change their nutrition, their dietary habits to reduce smoking, or give up smoking to increase exercise to help with managing stress to improve sleep, there was a recent review on lifestyle interventions for nurses by Staniel, which at all I hope I’ve pronounced that correctly. So this was done a couple of years ago in 2020. And it showed largely positive support for the role of these kinds of interventions in supporting a range of different outcomes for nurses. So what they found was the strongest evidence was for improvements in stress, anxiety, and burnout. So actually, kind of some of their emotional outcomes tended to have the best outcome with some of these lifestyle interventions compared with some of the more kind of physical outcomes like BMI, for example. And this was through targeting behavior change in particular. So not just education, we’ve all had education about what we should eat what we shouldn’t eat. Most people know that they should be exercising more for interventions that really support nurses to shift their behavior in some way, for example, to help them exercise more, to learn skills, to manage stress, to manage skills to enhance their sleep, for example.
Nathan Illman 38:09
So this is a great preventative mental health kind of intervention that can be embedded within organizations. There’s also a role for other psychologically oriented interventions, which I’ve kind of alluded to already a little bit with nursing education, we know that there are specific psychological skills that people can learn that will help mitigate or prevent things like post traumatic stress disorder can prevent depression, for example. And in future episodes, I will be talking more about that and talking to other researchers who have looked into that specifically, but just to give you a sort of brief overview that we know that even sort of online, largely self-guided interventions can be helpful for nurses as well as the general population. But this has been looked at with nurses in particular. So we know that organizations can actually take on more of this kind of stuff, and and provide that to staff and where it is provided in a way that’s a bit more targeted to those at risk people, it tends to have the most beneficial effects.
Nathan Illman 39:09
So the final thing to consider with preventative measures to avoid preventative mental health is with individual nurses and midwives. And I’ve purposely left this to the end, because I want to stress the importance of getting all the other stuff right first. So from the educational level, to the organizational level, and at the government level with policies and funding, all of that stuff is arguably more important, and these are things that they should be doing. And of course then after that we have individual nurses and we all have a personal responsibility to take care of our health and well being so just like anyone else, there are lots of things nurses can be doing to help prevent later mental health difficulties or experiencing burnout. For example, I think one of my main recommendations is around getting in They’re early and seeking help before things start spiraling out of control. So if someone is experiencing high levels of stress, and they feeling a bit burnt out, and I’d always recommend trying to find that social support to begin with people that you trust in your immediate social circle, who you can talk to about things, and then seeking more professional support, whether it be could just be a line manager at work that you trust, it could be going to your Employee Assistance Program, or it could be going to your GP, for example, and seeking support, because we know that early intervention really helps to prevent against more serious issues developing.
Nathan Illman 40:35
And then of course, we’ve got things like those lifestyle factors and lifestyle interventions that I mentioned that organizations can do. So in all my work as a clinical psychologist, I think, something that is often overlooked, or that it’s becoming a bit more commonplace now is really getting right the building blocks of sleep and rest, nutrition, and hydration, and Exercise and Movement. So when I work with individuals or organizations, anyone, I always highlight the importance of these. So are you getting enough sleep, if you have trouble with sleep, there are ways to improve that. So of course, night shifts can interrupt with your sleep pattern. And that’s quite a specific problem related to nurses. But for example, if you struggle to get off to sleep in general, if you find yourself lying awake at night, if you think you’ve got bad habits related to sleep, there are absolutely ways that that can be improved. There’s online programs, there’s books, there’s more formal psychological support, and we know that those kinds of things can massively improve someone’s well being and can help prevent against depression, for example.
Nathan Illman 41:37
Nutrition is another massive one. So I’d recommend anybody who’s interested in learning about more, learning more about the role between what you eat and your mood and your well being there’s a fantastic free course offered by Deakin University in Australia, I believe it’s called the food and mood course I took that last year. And it’s fantastic outlining the current state of the art and evidence around how what we eat, and specifically the types of foods that we contribute to our mental health and how we can basically prevent against developing mental health conditions from our diet. And just to give you a snapshot summary of what that could look like, or the the what’s called the Mediterranean diet is one that’s been studied and is found to be beneficial for health, mental health and well being. And of course, that involves eating lots of fruits, vegetables, legumes, nuts, seeds, low amounts of red and processed meat, and adding in little things like olive oil, for example, exercise and movement, again, is absolutely critical.
Nathan Illman 42:34
So another recommendation in mind for individual nurses looking to really kind of improve their mental health and well being is to explore different forms of movement and exercise. So there’s not a one size fits all approach. You don’t have to go out and bash a 10k run. You don’t have to go to the gym or do sit ups. There are so many different ways you can exercise and it’s about finding what works for you something else that was really interesting. We came up with some of the COVID literature and nurse wellbeing and mental health was I saw a few studies that nurses that said that they had been exercising regularly throughout the pandemic, again, we’re much less likely to develop things like post traumatic stress disorder. So it’s like a serious mental health condition. And this is a consistent finding.
Nathan Illman 43:17
So getting exercise in regularly, even just for short bouts, and finding something that you enjoy is really going to help you and be beneficial. And then finally, there are other particular skills that individuals can learn that are going to help them navigate the emotional aspect of the work that they’re doing. So learning some key psychological skills and skills to work with and transform stress, for example. So learning to meditate and using mindfulness learning other emotional regulation strategies.
Nathan Illman 43:50
Self-compassion is another skill set that can be developed that can help to mitigate against mental health difficulties. And learning ways to problem solve in one’s personal life, for example, or even things like time management can be a helpful skill that will reduce stress and reduce your chances of going on to develop sort of high levels of distress and mental health conditions.
Nathan Illman 44:15
Okay, so there are many more things I could have talked about here. And I’ve already been talking for 50 minutes or so hopefully, you’re still with me, and you found this interesting and informative. I’m not going to go into any more details. I’m going to leave that for future episodes of this podcast where I’m going to delve into these things and really break down the particulars of particular interventions, different ways to support your well-being as a nurse and and get other people’s perspectives and stories about their own well being and what’s been helpful or not been helpful for them. I think if I had to leave you with one final message to distill everything in the past hour that I’ve been talking about, it’s that a really multi-tiered and multi-pronged approach is necessary to optimize nurse well-being. It comes from different layers and levels. And it’s a set of responsibilities that lay not just with individual nurses, but with organizations, educational institutions, and ultimately the government or making policies to support our health care workforce.
Nathan Illman 45:16
I’ve really enjoyed discussing this stuff. I’m really excited to bring you the next episode of the podcast. I really hope you’ll join me back for those. As I mentioned before, if you’re a nurse or midwife, and you would like to join a community of like-minded people who are interested in improving their own well-being and supporting each other, then head over to Facebook and find our group Nurse Wellbeing Mission or you can head over to our website, nursewellbeingmission.co.uk and sign up to the newsletter and you can receive some of those same kind of tips and resources that I’ll be providing over there.Okay, well, thanks so much for your attention. And for listening to me. I’ve got a dry throat now from talking so much. I’m gonna go practice some self-care and rest my throat and my voice and drink some water. I’ll see you next time for the next episode of the Nurse Wellbeing Mission podcast.