Infusing Sustainable Happiness into Nursing for Positive Work Environments

1. Infusing Sustainable Happiness into Nursing for Positive Work Environments Sheila Profit, BScN, MAdEd; Judy Bailey, MN, RN; Catherine O'Brien, PhD Cape Breton University

2. Literature Review • By 2022, Canada may have a shortage of almost 66,000 nurses (Tomblin Murphy, Birch, Alder, MacKenzie, Lethbridge, Little & Cook, 2009). • Recommendations to address this shortage include • developing strategies to improve retention of RNs, • improve health and well-being of RNs • improve the retention of nursing students • Over the past decade research has emerged that investigates the health benefits of positive emotions, subjective well-being (happiness) and life satisfaction.

3. Happiness Defined • Definitions vary • Often referred to as subjective well-being • Judgments of life satisfaction • Affect balance – positive feelings and few negative feelings (Schimmack, 2008 cited in Fisher, 2010) • Happy or good life involves • doing what is right and virtuous • Pursuing important or self-concordant goals • Using and developing one’s skills and talents regardless of how one feels at any point in time (Warr 2007 cited in Fisher, 2010)

4. Happiness Literature • Research from the field of positive psychology is being applied in many fields, including workplace wellness. • Positive psychology focuses on enhancing well-being through the study of happiness, subjective well-being, and life satisfaction. • Definitions of happiness may vary, but researchers have demonstrated that one’s subjective experience of happiness corresponds with numerous positive health outcomes (Steptoe, Wardle, & Marmot, 2005). • Happiness is often referred to as subjective well-being

5. Happiness and Health • Studies suggest that positive emotions are associated with longevity, lower blood pressure, and reduced risk of heart disease (Seligman, 2002; Steptoe, Wardle & Marmot, 2005; Veenhoven, 2006). • Research published in the EuropeanHeart Journal followed more than 1700 Nova Scotians over ten years: • those who had experienced and expressed positive emotions at the outset of the study had reduced incidence of heart disease. • Participants who had scored highest in terms of positive emotions were also less likely to be smokers • Preventive strategies could include increasing positive affect (Davidson, Mostofsky & Whang, 2010).

6. Happiness-Related Constructs in the Workplace Job satisfaction, Typical mood at work, Thriving, Engagement, Job involvement • All constructs re happiness in workplace have in common: • Pleasant judgments (positive attitudes) or pleasant experiences (positive feelings, moods, emotions) at work • These are stable over time

7. Research on Happiness and Workplace Happy and satisfied people are relatively more successful in the workplace • There is a positive correlation between career satisfaction, self-nurturance and life satisfaction (Nemcek, 2007) • Business and health care organizations are recognizing a connection between employee happiness and enhanced productivity and improved outcomes (Scott, 2009). • Happy people earn more money, display superior performance and perform more helpful acts (Boehm & Lyubominsky, 2008) • Happy people are more satisfied with their jobs than unhappy people (Boehm & Lyubimsky,2008)

8. Happiness and Workplace • It has been assumed that the accomplishments of success in the workplace causes people to be happy. • Instead the evidence suggests that happiness precededmeasures of success and that induction of positive affect leads to improved workplace outcomes (Boehm & Lyubomirsky, 2008)

9. Question • Is it possible to teach happiness skills that can lead to sustained well-being? • Can individuals shift from a lower level of happiness to one that is higher and thus reap the health benefits? • Could happiness skills be used as method for fostering healthier lifestyles?

10. Many models have been proposed for learning “happiness skills” (Seligman, 2002; Foster& Hicks, 2000; Ryan, Huta, & Deci,2008) • Foster and Hicks have developed a “happiness model” that has been used to train more than 5,000 nurses at the Mayo Clinic. Health professionals who participated in their training program experienced enhanced subjective well-being, both personally and professionally. Participants also develop skills that can be applied with clients.

11. Research by Dr. Catherine O’Brien with nursing staff and medical social workers using the happiness model by Foster and Hicks found a positive impact on: • Participants’ attitudes • A healthy work environment • Nursing participants recommended that every nurse and nursing student would benefit from participating in a similar happiness workshop

12. What is Sustainable Happiness? Developed by Dr. Catherine O’Brien(2005) to merge principles of sustainability and findings from happiness studies in order to draw attention to the consequences, both positive and adverse, of how individuals, communities and nations pursue happiness Sustainable happiness is “happiness that contributes to individual, community and/or global well-being and does not exploit other people, the environment or future generations” (O’Brien, 2009).

13. Foster and Hicks Happiness Model

14. The Nine Choices Towards Happiness (Foster & Hicks) • Intention – the active desire and commitment to be happy and the decision to consciously choose attitudes and behaviours that lead to happiness over unhappiness • Accountability – the choice to create the life you want to live, to assume personal responsibility for your actions, thoughts and feelings and the emphatic refusal to blame others or view yourself as a victim • Identification- the ongoing process of looking deeply within yourself to assess what makes you uniquely happy, apart from what you are told be others should make you happy

15. Centrality – the non-negotiable insistence on making central to your life that which brings you happiness • Recasting - the two-step process that transforms problems and trauma into something meaningful, important and a source of emotional, energy • Options – the decision to approach life by creating multiple scenarios, to be open to new possibilities and to adopt a flexible approach to life’s journey

16. Appreciation – the choice to appreciate deeply your life and the people in it and to stay in the present by turning each experience into something precious • Giving – the choice to share yourself with friends and community and to give to the world at large without the expectation of a “return” • Truthfulness – the choice to be honest with yourself and others. And not allow societal, workplace, or family demands to violate your internal contract

18. Purpose of Research Introduce nursing faculty and nursing students to the happiness literature, outlining its significance for personal and professional well-being. A workshop was done with the nursing faculty prior to doing the research with the The Foster and Hicks happiness model + the concept of sustainable happiness= an intervention strategy which may assist students to develop or re-connect to an intrinsic value system. Intrinsic value orientations are associated with higher measures of subjective well-being (happiness). Research question =What is the impact of the Foster and Hicks model and sustainable happiness on the intrinsic values of 1st and 4th year nursing students ?

19. Ethics • This research received approval from the CBU Research Ethics Board • Funding received from the Cape Breton Health Research Grant Fund for $4034.00

20. Methodology • This was a minimal risk study. • Sustainable Happiness Workshops were provided to 1st year and a 4th year experimental groups • No workshop initially for 1st & 4th year control groups • All students provided consent to complete an Aspirations Index Survey & Sustainable Happiness Survey • Following survey completion a random selection of students were interviewed

21. Workshop • The aim of the workshop was to provide skills to enhance subjective well-being • Video • Interactive exercises (listening) • Relating personal experiences • Reflecting on personality types • Examine intrinsic vs extrinsic rewards

22. Example of Workshop ExerciseSelf Reflection • Think about the happiest person you know and why you consider them to be happy? • What makes you happy?

23. Risk • The only potential adverse impact is that through the process of reflecting on happiness, participants may find that they become aware of aspects of their life, personally or professionally, that are not satisfactory • The students were provided access to support systems for dealing with any issues that may have surfaced

24. Student Participation • N 491: 1 and N125:1 designated Control Groups • Offered the workshop post research study for Control participants • N491:2 and N125:2 designated Experimental Groups & were given the workshop

25. First Surveys • Consents, The Sustainable Happiness Survey and The Aspirations Index Survey were distributed to both Control & Experimental Groups • The Aspirations Index was used with the permission of the authors. It measures intrinsic and extrinsic value orientations. • Voluntary • Coding for confidentiality and data collection

26. Second Surveys • Completed by the Experimental Groups N491:2 and N125:2 in class 1 week following the workshop

27. Third Surveys • The Sustainable Happiness Survey and The Aspirations Index Survey were distributed to both Control & Experimental Groups during the last class of the term (3 months following 1st survey)

28. Interviews • Student interviews conducted • Random selection of students both control & experimental • 6-10 Interviews Experimental • 2-3 Interviews Control

29. Results of the Research

30. Aspirations Index Survey57 questions ( a & b), measured 11 domains • Money • Image • Popularity • Conformity • Self-acceptance • Affiliation • Community • Health • Spirituality • Hedonism • Safety

31. Sample of Questions for AI Survey • Money Domain • I will have many expensive possessions • Importance 1 2 3 4 5 6 7 8 9 not at all a little moderate very extremely • Chances 1 2 3 4 5 6 7 8 9 very low low moderate high very high • Self Acceptance Domain • The things I do will make other people’s lives better • Importance 1 2 3 4 5 6 7 8 9 not at all a little moderate very extremely • Chances 1 2 3 4 5 6 7 8 9 very low low moderate high very high

32. Questions for Sustainable Happiness SurveyPrior to the Sustainable Happiness workshop I often engaged in the following activities: • __carpooling • __water conservation • __expressing appreciation • __walking • __composting • __purchasing fair trade products • __energy conservation • __counting my blessings • __ using public transit • __physical exercise • __eating nutritious food • __attempting to buy local products • __checking where products are made • __mindfulness • __spending time with friends • __spending time with my family • __using the Foster & Hicks happiness model • __attempting to reduce my consumption • __Other (please describe)

33. Data Analysis of AI & SH Surveys • 1st year Experimental = 33 students (198 surveys) • 1st year control = 37 students ( 148 surveys) • 4th year Experimental = 21 students (126 surveys) • 4th year Control = 25 students (100 surveys) • SPSS, Descriptive Statistics, Mean, Grand Mean, Anova

34. Interview Questions - Experimental • What was your experience of the workshop while you were attending? • realized the biggest thing I need to change- recycling & driving- I’m carpooling now and recycling- less use of water bottles- I’m saving money, that makes me happier- I remember the animal types, I was in a big group of dolphins- the surveys are what I remember most- I learned from the surveys • I wanted to do the natural highs more often-expressing gratitude-made a point of appreciating parents-thought it was cool to think about happiness

35. Interview Questions- Experimental • Following the workshop, did you experience any positive (or adverse) short term impact on your life personally? • Yes, I am someone who is stressed- found I started to use “me” language rather than “you” in relationships- take responsibility instead of blaming-expressing appreciation more

36. Interview Questions-Control • Identified experiences as a nursing student as very stressful • Indicated limited awareness of relationship b/t happiness, health and well being

37. Ongoing Analysis of Results • Need to integrate the concept of sustainable happiness and happiness skills throughout the program and not rely on just ½ day workshop • Happiness literature has implications for personal, unit and organizational level

38. The concepts of Sustainable Happiness can make a positive impact on at least 3 levels • Personal • Practice Work Environment • Client Outcomes

39. References Boehm, J. K. & Lyubominsky, S. (2008) Does happiness promote career success? Journal of Career Assessment, 16 (1) 101-106. Davidson, K. W. Mostofsky, E.. & Whang, W. (2010, February) Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey. European Heart Journal. Diener, E., Emmons, R., Larsen, J., & Griffin, S. (1985). The satisfaction with life scale. J Personality Assessment, 49(1), 71-75.  Fisher, C. D. (2010). Happiness at work. International Journal of Management Reviews, 12, 384-412. Grouzet, F., Kasser, T., Ahuvia, A., Dols, J., Kim, Y., Ryan, R.M.,… Kennon M. S. (2005). The structure of goal contents across 15 cultures. Journal of Personality and Social Psychology,89(5), 800–816 Nemcek, M.A. (2007). Registered nurses’ self-nurturance and life and career satisfaction. AAOHN Journal, 55(8), 305-320. O’Brien, C. (May, 2010) Sustainability, happiness and education. Journal of Sustainability Education. 1.

40. References Ryan, R.M., Huta, V. & Deci, E.L. (2008). Living well: a self-determination theory perspective on eudaimonia. Journal of Happiness Studies, 9, 139-170. Schimmack, U. (2008). The structure of subjective well-being. In Eid, M. & Larsen, R.J. (eds.) The Science of Subjective Well-being. New York: The Guilford Press. Scott, D.E. (2009). Happiness at work. The Alabama Nurse, 36 (1) p.9. Seligman, M. (2002). Authentic happiness. Toronto: Free Press.  Steptoe, A., Wardle, J., & Marmot, M. (2005). Positive affect and health-related neuroendrocrine, cardiovascular, and inflammatory process. Proceedings of the National Academy of Science,102 (18), 6508-6512. Tomlin-Murphy, G., Birch, S., Alder, R., MacKenzie, A., Lethbridge, L., Little, L. & Cook, A. (2009). Tested solutions for eliminating Canada’s registered nurse shortage (Canadian Nurses Association Rep.) Veenhoven, R. (2006). Healthy happiness: Effects of happiness on physical health and the consequences for preventive health care, Journal of Happiness Studies, 15-11.

41. Questions