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Eat, pray, love…yourself

ADA 2013Shari Liesch APNP, CDE

Abbot Speaker Bureau

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Disclosures

Health care providers care for others…do they look after their own needs◦ Eat = physical needs, energy balance ◦ Pray = emotional needs◦ Love = relationships (linked to well-being)

Goals: ◦ evaluate physical, emotional role risks◦ explore how relationships (professional and personal)

impact overall well being

3

What we will look at

4

EAT: the physical world

Think of a time that your role has impacted your health….◦ Illness◦ Injury◦ Rest/sleep◦ Demands, deadlines◦ Irritable clients◦ Administrative

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Health impact of your role

Physical demands Emotional demands

◦ Acute & chronic needs of others◦ Death◦ The unexpected

Personal trials (what is happening in own life) Lateral violence Administrative changes Governmental policy How do we handle it all?

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Risks for health care providers

1. Biological: viral hepatitis, TB, HIV2. Chemical: cytotoxic, anesthetic3. Physical: radiation, needle stick, patient handling4. Psychosocial: stress, shift work

Outcomes of exposureCancer, injuries, infectious diseases

2011 Nursing World: Health & safety top concerns: Acute/chronic effects of stress & overwork (74%)Musculoskeletal injury (62%)

Aiken et al 2002 ; Peipins, et al 1997

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Workplace hazards

Work:When controlled environmental factors: improved Satisfaction Retention Stress

Outcome measurement of job stress: mood

Full time & strains & sprains linked to turnover intent

Brewer et al 2011

Applebaum, Fowler, Fiedler 2010 8

Odor, noise, stress

Significant is:noise

percieved stress

job satisfac-tion

turnover in-tent

personal stress

Nursing shortage Increased work load Decreased support Retention/turnover issues Challenging work

environment: are new grads ready for the demands◦ Polled nursing schools…◦ New grad comments…◦ Family bathes, trays

passed by non nurses: Introduce Gloria...

◦ IV, meds, monitoring

Spence, et al 2009 9

Inpatient nurses

Job satisfaction mattersTime with patient & ability to care impacts satisfactionDavey, et al 2009

Working age nurse: Younger nurse◦ TB death small◦ No excess death r/t HIV◦ CA: breast & colon CA slightly higher◦ Chronic lympho-leukemia slightly higher

Older nurse:◦ Chronic myeloid leukemia◦ Malignant neoplasm◦ Slight increased kidney cancer◦ Slight increase brain & CNS CA—compared to total◦ Nurse health study

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Rate of illness for nurses

Work injury influenced by psychosocial & physical exposures (Australia)

^ stress 5% probability of injury

As # of health conditions increased, (3 & >6) chance of injury increased (5% & 15%)

Programs targeting modifiable factors (psychosocial & physical health) improved health & work productivity

Vecchio et al, 2010

Low back pain compared to personal/work characteristics

Korea: mean age 27 High prevalence of back pain

in ICU nurses Nurse w/2-4 years

experience had greatest probability of back pain and treatment◦ 90.3 % had back pain/monthly◦ 18.3% received treatment

If perceived staffing as inadequate (64%) and working >6 night shifts/month (48%) = increase in back pain

Ja June & Cho 201011

Injuries in the line of duty

Mortality due to diabetes = white collar workers Mortality due to heart disease: fewer compared

to all Working age nurse (vs retired): increased

accidental poisoning: drugs/meds Falls Slight increased risk: suicide No homicide or alcohol related increases Baer et al 2010

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Mortality of nurses

Last nurse study: 2012White rice activity

Protective gear matters◦Hockey “cup”

invented in 1874

◦Head helmet in 1974??

Infection control, universal precautions

Protective needles Remember finger

cots? Safety is improved

◦Masks◦Gloves◦Gowns

Attention to ◦Noise ◦Lighting◦Shift limits 13

Interest of safety…

It’s cumulative Linked to

◦ Illness ◦ Obesity◦ Heart disease/stroke◦ Hypertension◦ Diabetes◦ Cancer◦ Resilience problems◦ Grabbing “junk” food

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Risks of sleep deprivation

Increased ◦ Sleepiness: (subjective)◦ Mistakes

Decreased ◦ Alertness (behavioral)◦ Safety◦ Productivity◦ Attention & working

memory◦ Slowed thinking speed

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Sleep deprivation, cont…

Competence◦ Recognition◦ Ability◦ Strengths◦ Gifts

Autonomy: ◦ Choices◦ Voice◦ Make decisions◦ Feel supported◦ Longevity, ◦ Power, less hostility

Relatedness◦ Belonging◦ Connected to others

that are supportive◦ Support

Professional Personal Teambuilding

Self determination Theory, Mental Fitness16

Self determination Theory Basics

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Examine job related autonomy, relatedness and competence in a group of health care providers (AADE members attending AADE12 invited to participate)

Assess if there is a correlation between overall quality of life and perceived autonomy, relatedness and competence.

Hypothesis: improved job satisfaction and overall perception of health positively impacts quality of life and perception of well being.

Purpose of survey

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Survey group compositeRole

nurse

CNS

NP

RD

PT

Pharm

MD

industry

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Survey: years in role & profession

k

<2 2 to 5 6 to 10

11 to 15

16 to 20

21 to 25

over 25

0

10

20

30

40

50

60

70

80

90

roleprofession

20

AGE

<2626-4647-64over 64

practice location

inpatientoutpatientamb. Carecorp/oc-cupationalcom-munityother

Age & practice location

Lower competence <11 years in role(p= 0.027)

Greater competence:◦ Age >47 (p = 0.015)◦ >25 years in profession

(p= 0.015)

Increased autonomy :◦ >25 years in profession

Relatedness increased if >33 hours per week:◦ <33 hrs. per week less

relatedness (p=0.041)

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Summary

Sense of smell & taste decline over time

Decreased muscle massAfter age 35 we lose ½ #

muscle / year= a shift in type of cells even if

the scale doesn’t change Energy: 3500 calories = # 1

SittingChild 4-500 calories/hourAdult 80 calories/hour

Muscle burns 35-50 calories/pound; Fat burns 2 calories per pound

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The aging process

How do we?◦ Combat aging◦ Deal with gravity◦ Stop muscle loss◦ Deal with work demandsWhat about you and your

work environment…How about activity?Do you have play time?

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What is the plan?

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1. The leading cause of preventable death?

a. Smokingb. Obesity

2. When sleep deprived, what type of food do persons grab the most?a. fruitsb. veggiesc. cookie, candy, soda & donut like

stuff.

If you have a minute, use it wisely.

Get active30-60 min. most daysMore intense 45 min 2x/week

Monitor intake—journalEat breakfastFruit/veggie intake, fiber, portion

sizes, reduce fatCalcium, vitamin D, iron, etc.

Maintain a healthy weight No/reduce smoking Control health concerns:

CholesterolBP, weight, blood sugar

Zapka et al 2009 25

Heart Association guidelines

Quality, quantity of energy intake Food = socialization Liquid calories? Activity

miracle grow for the brainstress managementKaiser: healthy weight less likely to develop dementiaAmen clinics: dinosaur theory: smaller brain

What about your work team…..Lemon bars need lemon

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Eat = energy balance

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Emotions and spirituality

pray

Self & growth◦ Public self◦ Private self◦ Personal self

Nursing◦ Maker of meaning◦ Member of technology◦ Each a mystery◦ People are messy

Gallion & Stamp

Link between patient safety & nurse safety

Foley 2004

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Life journey

Think of a time when emotions were impacted◦ Elated◦ On fire◦ Dulled/numb◦ Hurting

Stress of diagnosis Loss of the known How was your life

journey impacted? The 5 minute call…

◦ Happy◦ Proud◦ Surprise◦ Excited◦ Calm/relaxed

Frustrated Anger Irritated

Keeping the poker face when stressed…

Erickson & Grove 2011 29

Impact on our emotions.

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Erickson & Grove Reviewed emotions & burnout Knowing emotional demand is

critical; how work stress translates to burnout & turnover◦ Influenced by organizational

practices governing work place more than the challenge of care

◦ How emotions are managed on the outside: surface acting Vs deep acting (how one feels on the inside) Younger nurse experience

more stress & burnout Increased burnout if more

surface acting & more masking of emotions

Does management of the emotion or the emotion itself cause burnout?

Burnout related to:◦ Older nurse: if low

level of + emotions◦ <30 yr old: if

experience agitation

Covering up true feelings lead to increased burnout than nurse who does not cover up true feelings

For practice: Positive emotions may

insulate us Mentoring needs an

emotional, supportive part

Emotions Matter

2/3 say job satisfaction same or slightly less than in the past

Listed professional development & recognition as motivators

Administrators goal: ◦ job satisfaction, ◦ decreased turnover ◦ less nurse shortage

Commitment of management in nursing:

Increased ◦ quality care ◦ professional

development◦ patient safety◦ + clinical experience◦ retention

Sammer & James 2011

All this helps weather health care’s economic storm

Ma, Samuels & Alexander 2003 31

Job satisfaction

If more satisfied Raise to challenge of

organizational restructure, need◦ Access to information◦ Support◦ Opportunity◦ Resources to do the

work◦ Certification and

magnetism matters◦ Pursuit of higher

education

Structural & emotional empowerment matter

Job satisfaction

Increased retention

Improved patient satisfaction

Personality traits do NOT matter

Erickson & Grove 2011 32

Satisfaction, cont.

Job satisfaction Job stress: leads to

◦ work burnout◦ emotional

exhaustion◦ work frustration

Autonomy—improved work environment, more control+ relationship to job satisfaction

Weston 2010; Zangaro & Soeken 2007

able to decide how I work

level 1234567

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Nurse meta-analysis

sense of ac-complishment

level 234567

feelings matter

level 1234567

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Survey: accomplishment & feelings

people care about me

1234567

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People at work care about me

Systemic problem Disenfranchisemen

t Marginalization Oppressed group

created by powerlessness of nurse health care system

McPhaul & Lipscomb 2004; Gates et al 2011; Jones & Argentino 2010 36

Oppressed group behavior

Emotionally challenged impacts ◦ performance, ◦ satisfaction,◦ retention, ◦ health, ◦ patient satisfaction

Does improved Emotional Intelligence (EI) impact group emotional competence ◦Constructive & appropriate behaviors :

decrease anxiety & nurse to nurse hostility

Feather 2009; Fuimano 2004; Zeidner, Matthews & Roberts 2004 37

Nurse to nurse hostility

Self aware: emotional feelings and reactionsEmotion = energy

Emotional resilienceMotivationInterpersonal sensitivity

Conscious of energy behind the words and interactions

InfluenceIntuitiveness ConscientiousnessBody receives/understands informationWickipedia accessed 8/15/2011

Mayer, Roberts & Barsade 2008 38

Emotional Intelligence (EI)

Learned Empowerment Increase autonomy,

locus of control, Intrinsic & extrinsic

motivators (individual) Recognition

◦ achievements ◦ desire to care

(intrinsic) ◦ receive appreciation

for care given (extrinsic)

Hyrkas & Dende 2009 39

Will enhancing EI matter?

Increased behaviors & habits that work vs. do not work for the group

Proactive skills speak up if out of line

100% valued– experience desired teamwork

Build EI in the individual it builds ◦ the group◦ team trust◦ effectiveness◦ networking

Zeidner, Matthews & Roberts 2004; Feather 2009; 40

EI as a group

Have space to experience own emotions Empower each other: ^ trust, caring, safety, EI Energize Encourage, respect Empathy: center to nursing role

◦ Improves outcomes, increases satisfaction with care◦ It can be learned through in-service educationWard, et al (2012) assessed empathy in undergrad programs:

found decline in empathy over the school year students with more clinical exposure had less empathy historically younger nurse, with less experience more empathetic

◦ Decline may be related to: time constraints, anxiety, lack of support, intimidating educational environment expanded roles increase in technical skills

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What can we do?

Increase trust, care, safety

Increase EI & Group Emotional Quotient (GEQ)◦ Modify, redirect actions

(based on assessment for the moment)

◦ Increase constructive outcomes

◦ Improved group member awareness, regulation, & interaction

◦ Encourage behaviors that seek awareness (+)

◦ Regulate emotions through personal growth increases group competence

Fuimano 2004; Mayer, Roberts & Barsade 2008, Laschinger et al 2009

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Empowerment

How are we doing? Nursing 93-95% women

◦ What about women?◦ Emotions◦ Hormones◦ Multi-task◦ Competitive◦ Internalize stress health

consequences◦ Stress eat◦ Lapse B/W knowledge and

ownership of behavior Women in survey CVD

prevention: assessed knowledge, intake, if smoked, exerciseHad knowledge, didn’t implement

Senior nurse down hill flow◦ Understanding the new

nurse isn’t easy Community vs. I approach

◦ Proper orientation◦ Mentoring◦ Buddy system◦ Teambuilding◦ Conflict resolution skills◦ Commonwealth◦ Hold each other

accountable

Hippeli 2009; Mills & Mullins 2008; Zangaro & Soeken 2007 43

Since 1960’s: Nurses eat their young

Belief in something greater than one-self ◦Offers renewal◦Soul nurturing

Connect with nature Where do you find

balance in your life?◦Floating down the

Menominee River VS rafting class 4 rapids

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Emotions

In business◦ Estrogen to

profit ratio is well known

◦ Women leaders mentor underlings

◦ Nursing is flooded with “estrogen”, yet we struggle

Stay or go?

Personal factors Marital status Childcare needs Greater chance at part

time employmentHigher education

◦ Males: enroll in non nurse role

◦ Advanced practice: decreased attrition

Nooney, Unruh & Yore 2010

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Other factors

Handling the curves in life Past experience Current perspective

(choices) Rested vs. fatigued Being vs. living

Think of a time you were tossed an unexpected curve ball—how was this handled Staffing changed

unexpectedly

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Resilience

Hope = #1 predictor in goal achievement

Faith = belief in future Air = deep breathing

Oxygen Calming

◦ RX: nature-play prescription Acorns, water, sun,

quiet Dr. Nan Strand and the amazing race

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Hope, faith, air

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Singing improves:◦ Immunity◦ Well being◦ Energy◦ Posture◦ Longevity◦ Decreases pain

What about music?

Muscles to smile = 22 Muscles to frown = 37-72

Smiling = anti gravitySmiling = contagious

May 2 = world laugh day Laugh for nothing: it’s heart

friendly Laugh at self—shift the

perspective No humor: emotional apathy

disease

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Of interest…

Does how you spend your free time impact your emotions?

What impacts your well being?

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Hobbies and free time

What keeps you grounded?

How do you keep your creativity alive?

What about work stress, how do you handle this?

How do you feed your inner child?

Is use of your hands important to you?

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Summing up emotions….

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Love Relationships: who is

in your circle

Who’s in your circle

Think of your relations

FamilyWork

FriendsNeighbors

Communities

Who makes up the strands that

help hold it all together for

you?

Wellcoaches, 2010 53

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Our survey on relationships

MOOD Color Chart

pressured at work

level 1 23 45 67

mood satisfaction

Very poor

poor

fair goodvery good

Life engagement Connections:

◦Help with personal development

◦Help us achieve our potential

Life bands: link or connect us◦Watch for

negativity55

Love = relationships

Veterans born: pre 1945 (>64) Baby boomers: 1946-1964 (47-64) Generation X: 1965-1980 (30-64) Generation Y: after 1981 (26-30) Millennium Era??

56Does the age of your peers matter?

AGE

<2626-4647-64over 64

Veteran nurse Hard work Respect authority Duty before play Sacrifice Follow rules Work is obligation Experience respected No news is good news Satisfied with job well

done Work & family kept

separate

Baby boomers Value family Job completion Do as told Commit to experience Accomplishments

matter Roles overlap Huge #; nursing is 2nd

career Focus on the big picture Workaholics Less appreciate

rewards, feedback Less balance

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What about generation gaps?

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Generation X Generation Y Less value on authority Personal touch matters Needs reinforcement Interested in work/life

balance Value flexibility, fun,

quality of life, & creativity

Technology abounds: look at monitor; forget the patient

Expect to be appreciated for their intellect

Like recognition Mutual support Trust in system Embrace new Multi-task?

BothCommitted to the teamLongevity less embracedAuthority less valuedManager: people focused: motivator, communicator

X & Y see baby boomers as self indulgent

Ruthless Uncaring

Baby boomers see X, Y as slacker, want a free ride

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How we see each other

Quality of relationships is reflected by the energy brought to the relationship◦ Increased purpose◦ Meaning to life◦ Respect & joy in each

other

I am lucky to have so many siblings…..

I am lucky to have_____on my team

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Relationships

Relationships: Key to survivalImpact overall well-being

In the DNA of well being: relationships are the strands that hold everything (us) together

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Research shows…..

Adult life ◦ 1st part: mind &

heart (doing)◦ 2nd part: body & soul

(being) Increase mindfulness

= attention to the moment

Story: shopping for furs in Chicago

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Love

Heart energy is vital Random acts of kindness:

filling the bucketForgivenessFriendshipOptimism

At the beginning of the day, what do I look forward to?

Look for reasons to say thank you…

List 3 things grateful for daily…

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Love shows in your being…

Stress impact◦ Foot on gas◦ Foot on brake◦ Foot on both

Antidote for stress◦ Laughter◦ Joy◦ Humor◦ Future focus◦ Connectedness◦ Confidence

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Love helpful in managing stress

Sharing a relationship or personal challenge……….◦ Even short term***

How did you overcome?

How did it make you feel at the time? Later?

Was there someone or something that helped?

How were you impacted long term?

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Sharing a story

Increases longevityConnections in your

circleRejuvenate soulBusy hands/mindIncrease humorFriendshipsMind stimulating—

never stop learning

ObstaclesLife is busyConvenience foods

Supersized?Stress eating?

Impact on activityStress:

Deadlines Perfectionist Other contributor’s

timelineHealth concerns

66

Support

67

Life balance

Friendship/relationships Helping profession Like to spend time Like to make a

difference Satisfaction in task

completion Happiness factors Stress antidotes Brain cell activation Goal setting

Stress Time management

strains Dead lines Sleep deprivation, shift

work Lifestyle choices (over-

commitment, sedentary, dietary habits)

Stuff accumulation The unexpected… Cutbacks.. How well can you juggle?

positives negatives

Gratefulness◦ Increased awareness◦ Satisfaction◦ Memories◦ + mindset, ◦ appreciative◦ + emotions = life

satisfaction, less depression

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Prioritize the positive

Brain socially connected

The potential to change, to learn, and to grow is in relationships

Have a sense of humor (must be mutually shared)

Are the persons in your circle nurturing for you?

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Never stop playing

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The Tipping Point By: Malcolm Gladwell

Ideas are spread like epidemics

Little things make a big difference3 rules of epidemics (agents of

change) Law of the few (80/20 rule)

◦ Connectors =gift for bringing togetherness

◦ Mavens = information specialist

◦ Salesmen = persuaders, charismatic, negotiators

Stickiness factor◦ Retention of content &

entertainment value Context: sensitive to condition

and circumstance at the time

Making a difference

We are inundated with messages: back to word of mouth: personal connections matter

Links to longevityHobbyHumorHappinessPositivitySleep

Think about:Eat (energy

balance), Pray (emotions), Love (life

engagement through relationships)

My first 30 years….Back to my friend Gloria

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Summary

Be the tipping pointMavenSalespersonConnector

Use positivity to fuel your life journey

Create a future that empowers

Find/post an image to help maintain your goals

What can we do to be part of the tipping point that transforms health care in a positive way?

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Look at

Pick 1 thing (personal or professional)Where are you now

(on a scale of 1 to 10)?Where would you like to

be?What does your goal

look like: visualize the dream…

What is the first step? **If we are emotionally

attached = increased likely to follow through & success

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Setting goals

Thank you!!

Shari Liesch APNP, CDE

CHW Fox Valley130 2nd Street

Neenah, WI 54956

sliesch@chw.org920 969 5302

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Daybreak calls. She gently takes flight; wings alive and aglow. Kissing each flower good morning, Bidding them to rise—decorating her world; Painting my world; with colors so magnificent. She tickles each blossom, soon they are singing; An enchanting choir fills the air. Our world is

alive! With all petals at attention, sweet sounds echo

about. Contented, she drifts down to her favorite rock, Peaking over the peaceful ripples of the bay. She rests, soaking up energy from the sun’s rays, Until gentle breezes call her, to come and play.   Today as I rested on the sandy shore, Peaceful breezes sang. The butterfly sat down beside me. My heart

swelled. I tried to reach out to her, But she flew away…eluding my touch. I was saddened she left me so alone, Yet, I thought I heard her whisper, “Today I celebrate, come and play!” By Shari Liesch RN, August 1996

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A Butterfly’s Birthday

http://Nurspiration.proboards.com

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Applebaum, D., Fowler, S., & Fiedler, N. (2010). The impact of environmental factors on nursing stress, job satisfaction, and turnover intention. JONA 40(7/8), 323-328.

Endicott, J. and Nee, J. (1997). Assessment letters for clinical studies. Psychopharmacology Bulletin 31(1), 13-16.

Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of life enjoyment and satisfaction questionnaire: A new measure. Psychopharmacology Bulletin 29(2), 321-325.

Feather, R. (2008). Emotional intelligence in relation to nursing leadership: Does it matter? with lifetime history of mental illness. Psychiatry Research 152, 45-54. Journal of Nursing Management Issue, 376-382.

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References

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Gates, D., Gillespie, G., and Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nurse Economics 29(2), 59-67.

Gladwell, Malcolm. The tipping point. Hippeli, F. (2009). Nursing: Does it still eat its young, of have we progressed beyond this?

Nursing Forum 44(3), 186-188. Jones, T. and Argentino, D. (2010). Nurse to nurse hostility, confrontational anxiety and emotional intelligence: An integral, descriptive pilot study. Journal of Peri-Anesthesia Nurses

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of Issues in Nursing 9(2), Manuscript 1. pages Ma, C. C., Samuels, M., and Alexander, J. (2003). Factors that influence nurses’ job satisfaction.

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Nooney, J., Unruh, L., and Yore, M. (2010). Should I stay or should I go? Career change and labor force separation among registered nurses in the US. Social Science & Medicine 70, 1874-1881.

Peipins, L., Burnett, C., Alterman, T., & Lalich, N. (1997). Mortality patterns among female nurses: A 27 state study, 1984 through 1990. American Journal of Public Health 87(9), 1539-1543.

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