Although nurses, other clinicians, and healthcare leaders
take great care of others, they often do not prioritize their own self-care.
Burnout and depression now affect over 50% of clinicians in the United States and compromise the quality and safety of healthcare, as nurses and physicians who are experiencing poor mental and physical health are at greater risk of making medical errors. A recent national study of over 2,300 nurses from 19 healthcare systems throughout the country found that depression was the leading cause of medical errors. In this study, nurses who reported poor mental or physical health had a 26% to 71% higher likelihood of making medical errors. It is critical that healthcare leaders and clinicians prioritize their own self-care so that they can achieve optimal health and well-being for themselves, support a high level of wellness in their staff, and deliver the highest quality of safe care to others.
The Nine Dimensions of Wellness
Taking time each day to monitor and attend to your own well-being can have multiple rewards for you, from physical to emotional and financial health and well-being.
Presented here is an overview of the nine dimensions of wellness, designed to start you on your journey toward optimal well-being. Each dimension of wellness is vital and interconnected. Just as you are told by a flight attendant to place an oxygen mask on yourself first before you put one on your child, you cannot take good care of your family, your staff, or your patients unless you first prioritize your own health and well-being and engage in good self-care.
Physical wellness is not just limited to exercise; it includes healthy eating, engaging in regular preventive care and health screening, proactively taking care of health issues that arise, and sustaining healthy lifestyle practices on a daily basis. Focusing on self-care now will have lasting positive effects on your long-term health and well-being.
Emotional wellness includes the ability to identify, express, and manage the full range of your feelings. It also includes practicing techniques to deal with stress, depression and anxiety, and seeking help when your feelings become overwhelming or interfere with everyday functioning.
Financial well-being includes being fully aware of your financial state and budget, and managing your money to achieve realistic goals. When you analyze, plan well, and take control of your spending, you can make significant changes in how you save, spend, and feel. Almost three in four Americans surveyed in a recent American Psychological Association (APA) study (2015) said they experience financial stress. Financial stress can affect your physical and emotional well-being. According to the APA, high levels of financial stress are associated with an increased risk for ulcers, migraines, heart attacks, depression, anxiety, and sleep disturbance, and may lead to unhealthy coping mechanisms, such as binge drinking, smoking, and overeating.
Just as a flexible body indicates physical health, a flexible mind indicates intellectual health. When a person is intellectually healthy, he or she has a value for lifelong learning; fosters critical thinking; develops moral reasoning; expands worldviews; and engages in education for the pursuit of knowledge. Any time you learn a new skill or concept, attempt to understand a different viewpoint or exercise your mind with puzzles and games, you are building intellectual well-being. Studies show that intellectual exercise may improve the physical structure of your brain to help prevent cognitive decline.
Engaging in work that provides personal satisfaction and enrichment and is consistent with your values, goals, and lifestyle will keep you professionally healthy. After sleep, we spend most of our time at work, so ask yourself if your work motivates you and lets you use your strengths or abilities to their full potential. Burnout, stress, and dissatisfaction at work should prompt an evaluation of your career wellness. Even if you cannot change where you work right now, you can change your approach to the stressors and challenges you face at work.
Social wellness can be defined as our ability to effectively interact with people around us and to create a support system that includes family and friends. Evidence shows that social connections not only help us deal with stress but also keep us healthy.
A review of more than 100 studies of the benefits of the
arts (music, visual arts, dance, and writing) found that creative expression
has a powerful impact on health and well-being among various patient
populations (Jacobs, 2015). Most studies agree that engagement in the arts
decreases depressive symptoms, increases positive emotions, reduces stress,
and, in some cases, improves immune system functioning.
Creative wellness means valuing and participating in a diverse range of arts and cultural experiences to understand and appreciate your surrounding world. Expressing your emotions and views through the arts can be a great way to relieve stress. Do not let self-judgment or perfectionism get in the way. Allow yourself creative freedom without worrying about whether you are doing it well, and take time to appreciate the creative efforts of others.
Increasing awareness of your surroundings can improve overall well-being. Being environmentally well means recognizing the responsibility to preserve, protect, and improve the environment, and to appreciate your connection to nature. Environmental wellness intersects with social wellness when you work to conserve the environment for future generations and improve conditions for others around the world. Research has demonstrated that green space, such as parks, forests, and river corridors, is good for our physical and mental health. Your environment is not limited to the great outdoors though; it also includes everything that surrounds you—your home, your car, your workplace, the food you eat, and the people with whom you interact.
Spiritual wellness is largely about your purpose, not religion. You can seek spiritual wellness in many ways, including quiet self-reflection, reading, and open dialogue with others. A spiritually well person might explore the depth of human purpose, ponder human connectedness, and seek answers to questions like, “Why are we here?” Spiritual wellness includes being open to exploring your own beliefs and respecting the beliefs of others.
Protect and Cultivate Your Health and Well-Being
Changing your wellness habits is not easy; it typically takes 30 to 60 days to make or break a new habit. Setting goals for your well-being can make a significant positive difference in your life and in the lives of others. When trying to make changes, set SMART goals: goals that are Specific, Measurable, Achievable, Realistic, and Time-bound. Most people are not successful with their health and wellness objectives because they set goals that are unrealistic. For example, if you only exercise for 15 minutes, twice a week, do not set a goal to exercise for 30 minutes 5 days a week. A more realistic goal is 15 minutes three times a week or 20 minutes twice a week.
Evidence-Based Leadership, Innovation and Entrepreneurship in Nursing and Healthcare:
A Practical Guide to Success
This new book provides a clear path for readers to integrate innovation and leadership principles into their careers and daily practice. The text is enhanced by individualized quotes and first-person accounts from healthcare leaders. Chapters offer objectives and case studies, “Calls to Action” to help readers develop leadership skills, and “Key Takeaway Points.” Podcasts with top leadership figures in healthcare discuss how they meet challenges.
At any given moment working nurses are pulled in numerous
directions, as multitasking is the currency of the occupation. In many
instances, nurses are caring for high acuity patients on units with inadequate
nurse staffing. Nurses are trained in principles of documentation, the six to
of medication administration, and round regularly on their patients to maintain
Distraction can still wreak havoc on a shift if a nurse is not focused carefully on the immediate task at hand. A 2013 study revealed that “42% of healthcare-related life-threatening events and 28% of medication adverse reactions are preventable.” So how can nurses bring their full attention to what they are immediately concerned with?
Mindfulness Can Help
By embracing the practice of mindfulness. It’s a term that’s mentioned often in relation to relaxation and meditation these days, but it can be helpful during working hours as well as after hours. To be mindful, according to Merriam-Webster, one is “bearing in mind,” “aware,” or “inclined to be aware.” PsychologyToday.com states that mindfulness “is a state of active, open attention to the present.” Essentially, being mindful is being fully present and attentive to what is happening in the present.
Mindful over Multitasking
Nurses can incorporate mindfulness into their everyday
practice by making the effort to bring their focus to the present whenever they
are interacting with patients, which will improve work performance.
Save any multitasking for times not spent working directly with patients.
Before entering a patient’s room, pause briefly and take a breath. Bring the
focus to the specific details of the patient’s case and keep it there as long
as the interaction lasts. Actively listen when they speak.
Before entering a patient’s room, scan your body
for tension – look for tension in common places such as the jaw or shoulders
and relax those areas.
Be aware of feeling rushed or anxious, and
acknowledge these feelings without trying to eliminate them.
Take a couple of mindful breaths, dissolving
your tension and busyness on the exhale.
As you prepare to meet your patient, adjust your
mindset to be fully present.
Knock on the door and make eye contact as you
enter the room.
Introduce yourself and make a personal
Chat with your patient for a few moments before
moving on to your assessment or reaching for your computer.
Whenever you notice your focus has wandered,
gently redirect back to your patient and the task at hand.
Incorporating mindfulness into everyday practice can reduce reactivity to stress. By being more mindfully deliberate, nurses can implement their daily plans with less distraction. Adopting the mindful approach is considered much healthier than multitasking. And paying full attention to patients can only improve assessment skills.
Adopting the practice of being mindful and returning the
mind to the present whenever the focus strays can help keep nurses on task with
less stress and more efficiency. A mindful nurse is far less likely to make
mistakes. And that’s something from which everyone benefits.
Caring Science, Mindful Practice
This seminal work, based on the philosophy of Watson's Human Caring Theory, is designed to help students and practitioners of nursing to simplify Watson's complex teachings and integrate them into everyday practice. The revised second edition includes an abundance of new micro-practice examples for each of the 10 Caritas Processes®; practical exemplars from Dr. Sitzman’s research, enabling readers to cultivate Caritas and mindfulness on a daily basis; and new case studies demonstrating how others have implemented Human Caring Science into everyday life and work.
It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.
If you haven’t worked there, or haven’t for a long time, it could be that this lack of understanding is what leads hospital administrations to do one of the stupidest things imaginable. What is that thing? Banning food and drink from our work-spaces.
Now, this isn’t the case in my current job. But it is the case in all too many facilities. I talk to people. I hear things. And it’s usually justified with some unholy combination of infection control, Joint Commission and public health clap-trap, coalesced and refined, then circulated as a cruel policy.
When it’s enacted, clinical staff have their water bottles taken
away. Nobody is allowed to eat where they work. Dedicated, compassionate
staff members grow tired and dehydrated and hungry. (Maybe it’s a good
thing. They often don’t have time to urinate anyway, and water just
makes that happen more often.)
Mind you, the water bottles are sometimes kept in a nearby room, or on a nearby shelf. It’s an act of kindness, I guess. And the food? Well, all you have to do is take your break and go to the cafeteria or to the break room, right?
Those who come up with these rules don’t understand that a scheduled break is a great idea … that never happens. It’s an emergency department. It isn’t (technically) a production line; however, we try to impose time restrictions and through-put metrics. It isn’t “raw material in/product out.”
It’s “sick, suffering, dying, crazy human being in” and if all goes well, “somewhat better (at least no worse) human being evaluated, stabilized, saved, calmed, admitted, transferred, and sometimes pronounced dead” out of the other end of the line.
Those Herculean efforts can take anywhere from, oh, 20 minutes to 12 hours. During which time, it’s pretty hard to leave the critical patient in the understaffed department, with the “five minute to doctor” guarantee and the limitless capacity for new tragedy rolling through the door.
That setting makes it remarkably hard for breaks or even meals to happen at all.
As such, it’s nothing short of cruel and unusual for anyone to say to the staff of a modern emergency department, “you can’t have food or drink” — especially when it’s typically uttered by people who have food and drink in their offices and at their desks. People who have lunch meetings with nice meals or who have time to walk to the cafeteria or drive off-campus. And who feel so very good about protecting the staff from their deadly water bottles.
The argument, of course, is that the clinical staff work in a “patient care area.” Even when they aren’t at the bedside but are, for instance, behind a glass wall at a desk. If this is the case, then one could argue that the entire hospital (including administrative suites) is a “patient care area.”
They are afraid we’ll catch something. That it’s unsafe for us to eat or drink where we work. Of course, this is while we positively roll around in MRSA and breathe in the fine particulate sputum of septic pneumonia patients. This is while staff clean up infectious diarrhea and wear the same scrubs all day.
This is after we intubate poor immigrants who may well have tuberculosis and start central lines on HIV patients. This is after we wrestle with meth-addicts who have hepatitis C. And this concern for our “safety” occurs in places where physical security, actual security against potential violent attack, is a geriatric joke which is often tabled until the next budget cycle.
And as for our patients? Our food and drink are no danger to them. They and their families fill the exam rooms with the aroma of fried chicken, fries, and burgers, eaten at the bedside (often by the patient with abdominal pain). Their infants drag pacifiers across floors that would make an infectious disease specialist wake from bacterial nightmares in a sweat-soaked panic. In short, our food or drink are no threat to them and no threat to us.
But the absence of food and drink? That’s a problem. Because the ED is an endless maelstrom of uncontrollable events and tragedies, of things beyond our control for which we are responsible. It is a place of physical, emotional, and spiritual exhaustion where we rise to the challenge and manage (against the odds) to do so much remarkable good by virtue of our knowledge, our training, our courage, and our compassion.
In the midst of all that, a bottle of water, a cup of coffee, a glass of Diet Coke, a Styrofoam cup of iced tea is an oasis in the desert. And that sandwich, slice of pizza, cupcake, or salad is the fuel that helps make it happen.
More than that, food and drink are among the few pleasures we have time for each shift. They serve as bridges to the end of the day, small reminders of normalcy in a place where so little is normal.
Doubtless, one day someone will take away our music so that it doesn’t hurt our ears, or offend our patients. We’ll fight that battle when it comes.
But until then, depriving staff of food and drink proximate to where they work is of no health value and strikes me as just one more way of exerting control over the people actually engaged in the hard, grinding work of saving lives.
Thinking creatively about access to women’s health care has always been part of the job for Tracie Kirkland, clinical assistant professor in the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work.
Kirkland, a former program coordinator for Johns Hopkins Pepsi Beverages Wellness Center in Mesquite, Texas set up a mobile breast screening unit at the Pepsi plant so women could take advantage of mammography screenings without having to take time off work.
“Seeking windows of opportunity to access health care may not always be in a traditional setting,” Kirkland said.
Accessing routine care may be harder for some women than others, depending on individual circumstances and institutional barriers. Scheduling and attending routine health care visits can help women care for all aspects of their physical and mental health as they age.
Geography: People living in areas far from health providers may find it difficult to travel several hours for an appointment. In a 2017 report on social determinants, researchers found that geography contributed to differences in mortality and morbidity related to smoking, obesity, air pollution and several chronic illnesses.
Family obligations: Women who are parents of young children or caregivers for other family members may have to arrange for child care or other forms of assistance in order to make time for health visits. Data from a 2018 caregiving report from Pew Research Center indicates that women spend more time providing child care than men.
Transportation: In rural communities, women without a car or public transit options may be unable to access a provider. In urban areas, residents might not find care within walking distance or be able to afford costly public transit fares.
Even after women attend a health care appointment, social determinants can keep them from being able to understand and apply health information to their lifestyles. That includes knowing how to reach a provider for a follow-up conversation or how to fill a prescription at the nearest pharmacy. Providers like nurse practitioners can make use of one-on-one time to guide patients through next steps and counsel them on how to make appointments for other visits or needs.
“Know where to seek out services that may be free of charge, like the public health department or Planned Parenthood, where you can utilize a sliding scale in order to receive services,” Kirkland said. Sliding scale services use a variable cost to determine a fee based on how much the patient can afford to pay.
Providers can also look for innovative ways to reach patients for follow-ups or spread awareness about health information.
“We need to really be savvy in the way that we’re utilizing social media to disseminate information versus our traditional face-to-face visits,” Kirkland said.
Social media can help providers reach captive audiences by promoting health information during specific health awareness months. Patients can also use social media to find locations in their community to access health care and information:
Places of employment
Places of worship
Local and state departments of health
Local school district
Publicly funded clinics
Planned Parenthood and women’s health clinics
When using any of these venues to access care, it’s important that patients find a way to follow up with a provider or keep in contact.
“Once we create a connection through rapport, we generally are able to keep bringing [patients] back on a regular basis,” Kirkland said. “Depending on what we find in the clinical examination.”
Recommended Health Screenings for Well-Woman Visits
Even when feeling healthy, women have a lot to gain from routine checkups, including screenings for future medical changes, family planning, vaccinations and healthy lifestyle maintenance.
“Do you wait until your car breaks down to have it serviced, or do you maintain it by changing your oil and your tires?” Kirkland said. “Do you wait until your body breaks down, or do you maintain it?”
A well-woman exam is an annual appointment for women throughout the life span. As women age, their health needs evolve, so the visit may include different types of exams or interviews between a patient and provider.
Similar to an annual physical for children, a well-woman visit includes assessments of physical and mental health but also includes conversations about reproductive and sexual health.
An initial visit, often done when women are seeing their provider for a physical for the first time, may just be a one-on-one to discuss what would actually take place in a well-woman visit, Kirkland explained.
Depending on age and health needs, a well-woman exam can look different for each patient.
When Should Women Seek Reproductive and Sexual Health Care?
Women don’t have to be planning a family to need reproductive health screenings and care. They should start seeking care at the age of menarche — which is when they begin having menstrual cycles — or when they start having sexual partners. “It depends individually on their desire to be intimate, and where they are in terms of maturation,” Kirkland said.
STI and HIV testing: This screening can be a physical exam or a consultation from a provider to discuss sexual activity and test for sexually transmitted infections. The best time to get tested is before being active with a new sexual partner, and it can be done as often as a patient desires.
Breast exam: This is a physical exam that is done routinely on patients even if they have no other signs of developing breast cancer. Any abnormalities can be further tested with a mammogram, which is an X-ray screening for tumors that can’t be felt with a breast exam.
Pelvic exam: This is a physical examination of reproductive organs and is used to screen for ovarian cancer or other abnormalities that can develop as women age. The provider will inform the patient if they need to return for additional testing.
Menstrual health: A provider will ask about the regularity of a patient’s menstrual cycle, contraceptive use and any abnormalities with pain, bleeding or mood.
Pap smear: This is a physical exam during which a provider collects cells from the cervix to test for cervical cancer. This exam can also help find cells caused by HPV and is recommended every few years for women between the ages of 21 and 65.
Literacy about sexual health can be pivotal to women’s ability to control and plan for their future. Being able to afford contraception is one thing, but maintaining a treatment plan can be an issue — particularly when there is a lack of understanding about different types of contraception, their efficacy and how to use them. The more that providers can empower patients about seeking and understanding health information, the more meaningfully women can be engaged in their decision-making and health care.
When it comes to serious health conditions like heart attack and stroke, women are more likely to be misdiagnosed and receive delayed care.
When Andrea thought she was having a heart attack and called 911, the emergency medical technicians told the 35-year-old Nashville, Tennessean that she was likely just experiencing a bout of anxiety.
“They made me walk outside, down my driveway to the ambulance. They
never turned on the sirens or lights and stopped at every light on the
way to the hospital,” she told Today.
But Andrea was not having an anxiety attack. As it transpired, she had experienced a major cardiac event as a result of a spontaneous coronary artery dissection, an uncommon condition that can affect otherwise healthy individuals.
“The delay in my care caused me to have severe heart damage and heart failure that I am still living with” she said.
While Andrea’s condition is rare, her experience with emergency care is not.
How Are Symptoms of Heart Attack and Stroke Different for Women?
Myocardial infarction, more commonly known as a heart attack, occurs when the flow of oxygen-rich blood to the heart becomes blocked.
A heart attack can be caused by:
The full or partial blockage of an artery as a result of plaque buildup.
A coronary spasm, in which a coronary artery tightens and cuts off blood flow.
When people think of what a heart attack looks like, they might
picture a man grabbing his chest and describing severe pain that extends
to his arm. While chest pain is the most notable symptom of a heart
attack, many people— especially women—experience less common symptoms.
This can lead to misdiagnosis and delayed treatment among female
“Women worry about breast cancer or cervical cancer,” she said. “But
heart disease is the leading cause of death in women, not breast cancer
or cervical cancer.”
Symptoms of Stroke in Women
How Does Gender Affect Health Care?
The misdiagnosis of heart attack and stroke in women is part of the
larger issue of gender bias in health care. This stems in part from how
clinical research has been performed in the past, which informs how care
is provided to patients today.
In a research study on sex bias in clinical studies from the Allen Institute for Artificial Intelligence, researchers examined medical research from 1993 to 2018 and found that women were underrepresented subjects in the research of several health conditions, including cardiovascular health.
“Women worry about breast cancer or cervical cancer, but heart disease is the leading cause of death in women.”
The exclusion of marginalized groups, including women and people of color, may lead to a misunderstanding of the many ways a health condition can present itself and how it should be treated. “Medical bias,” a term for that disparity, refers to cases in which an individual may receive different care from a provider who is unknowingly acting on partial judgement.
The consequences of implicit bias in health care can be seen in how
women receive treatment in comparison to men in life-threatening
Additionally, in the aforementioned study from the American Heart Association, 53% of young women (aged 18 to 55) said their health care provider did not think their initial symptoms were heart-related, compared to only 37% of young men who said their provider got it right. These researchers also discovered a pattern in female patients who said they hesitated to seek help because they feared being labeled a hypochondriac.
Because of women’s experiences with the health care system, these biases may affect how women view their own health.
How to Advocate for Women’s Health
Women, their family members and friends, and even bystanders can take steps to help improve care for heart attack and stroke. From advocating for oneself in the emergency room to taking action when someone is in distress, the following resources are a starting point for women’s health advocacy.
How to Communicate With Your Clinician
Women sometimes express that they do not feel heard by their provider when sharing health concerns. Frisvold provided these tips for self-advocacy:
BRING A FRIEND OR FAMILY MEMBER
Another person can provide support, ask additional questions, and help navigate the treatment process.
If an individual believes he or she may be having a heart attack or
stroke, being prepared to specifically communicate all concerns to the
clinician can help.
Engaging in dialogue allows for an individual to push back in a way
that is specific and may help a provider check his or her bias.
DON’T LET SELF-BIAS GET IN THE WAY
“When you talk to somebody who had a heart attack, they [often] say, ‘I just knew something wasn’t right, but I just kept trying to downplay it.’ You’re better off going to the emergency room and finding out it was nothing than to err the other way,” Frisvold said.
How Bystanders Can Take Action in Health Emergencies
When another person appears to be experiencing a heart attack or stroke, there are steps you can take to help improve the chances of a positive health outcome:
DON’T HESITATE TO CALL 911
“Time is of the essence,” Frisvold said. “Those early moments are critical. Take steps early in the process to improve the health outcome of the person experiencing a heart attack or stroke.”
If a stroke is suspected and the person is conscious, the bystander should ask what symptoms the individual is experiencing so the information can be shared with emergency responders if the situation worsens and requires an advocate.
Whether buying as a nurse or for a nurse, there is a way to optimize the experience for both the giver and the recipient. One of the best ways to choose a gift is neither to spend extravagantly or try to find something unusual, but simply to know a little about the recipient. The most valuable gifts are either meaningful experiences or items that contribute to them. The key to gifting nurses is to thoughtfully find gifts that add ease or pleasure to their otherwise hectic life — and this holiday gift guide will help you do just that.
Experiences: Keep It Simple
There is no good reason to make gift-giving a complicated activity. In general, the simpler the better. The overwhelmed gift giver need not go further than giving a simple and relaxing experience. There are few nurses who wouldn’t appreciate a massage, for example. Similarly, a pedicure, facial, and aromatherapy will also delight most busy nurses.
For those less inclined toward spa treatments, access to other enjoyable experiences offers a much-welcomed reprieve from the life of a full-time nurse. This might include movie or concert tickets, yoga or fitness classes, cooking courses, or sporting events.
One thing to consider with gifting experiences to nurses is scheduling. So many full-time nurses supplement their regular work with per-diem, overtime, and continuing education. Furthermore, most hospital-employed nurses are mandated to work nights or weekends. With schedules like these, nurses may not want or be able to give up their precious free time for an activity chosen by someone else.
A Few Favorite Things
The best-gifted items are those that demonstrate the giver’s thoughtful understanding of the nurse’s preferences and personality. For example, the candle that is reminiscent of an experience or conversation is more valuable than a random scent, which may come off as an afterthought. Some nurses, especially those that are younger, may just be getting on their feet financially or living in smaller shared or urban spaces. These nurses probably don’t want something that’s going to jeopardize their already compromised space and storage.
Product purchases don’t have to be elaborate or expensive so items that support and simplify a healthy lifestyle are appreciated by most nurses. This might include cooking appliances, meal prep containers, a new yoga mat, foam roller, fitness subscriptions, or healthy recipe books. The nurse who dashes back and forth between school and work might appreciate an upgraded backpack or carrying case.
Nurse to nurse gifts might be the simplest kind because working in teams allows nurses to get to know each other well: individual tastes, goals, and work ethic. In this context, the best gifts might be those that are directly related to work. Nurses on their feet all day would probably appreciate new compression socks or a scrub cap with their favorite movie character. A nurse in neurology or neurosurgery would do well with a penlight that clips onto their ID badge. And of course, one can’t go wrong with a stethoscope.
The Thought Does Count
Gift-giving during the holidays doesn’t have to be overwhelming. A little attention to detail and creativity are all it takes to make gift-giving and receiving a positive experience. The old adage, “It’s the thought that counts,” proves true around the holidays.