Eat, pray, love…yourself

1. Eat, pray, love…yourself ADA 2013 Shari Liesch APNP, CDE

2. Disclosures Abbot Speaker Bureau

3. What we will look at • 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

4. EAT: the physical world

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

6. Risks for health care providers • 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?

7. Workplace hazards 1. Biological: viral hepatitis, TB, HIV 2. Chemical: cytotoxic, anesthetic 3. Physical: radiation, needle stick, patient handling 4. Psychosocial: stress, shift work Outcomes of exposure Cancer, 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

8. Odor, noise, stress 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

9. Inpatient nurses • 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 • Job satisfaction matters • Time with patient & ability to care impacts satisfaction • Davey, et al 2009 Spence, et al 2009

10. Rate of illness for nurses • 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

11. Injuries in the line of duty 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 2010 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

12. Mortality of nurses 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 Last nurse study: 2012 White rice activity

13. Interest of safety… • Infection control, universal precautions • Protective needles • Remember finger cots? • Safety is improved • Masks • Gloves • Gowns • Attention to • Noise • Lighting • Shift limits • Protective gear matters • Hockey “cup” invented in 1874 • Head helmet in 1974??

14. Risks of sleep deprivation • It’s cumulative • Linked to • Illness • Obesity • Heart disease/stroke • Hypertension • Diabetes • Cancer • Resilience problems • Grabbing “junk” food

15. Sleep deprivation, cont… • Increased • Sleepiness: (subjective) • Mistakes • Decreased • Alertness (behavioral) • Safety • Productivity • Attention & working memory • Slowed thinking speed

16. Self determination Theory Basics • 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 Fitness

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

18. Survey group composite

19. Survey: years in role & profession k

20. Age & practice location

21. Summary • Relatedness increased if >33 hours per week: • <33 hrs. per week less relatedness (p=0.041) • 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

22. The aging process • Sense of smell & taste decline over time • Decreased muscle mass • After age 35 we lose ½ # muscle / year • = a shift in type of cells even if the scale doesn’t change • Energy: 3500 calories = # 1 Sitting • Child 4-500 calories/hour • Adult 80 calories/hour • Muscle burns 35-50 calories/pound; • Fat burns 2 calories per pound

23. What is the plan? • How do we? • Combat aging • Deal with gravity • Stop muscle loss • Deal with work demands What about you and your work environment… How about activity? Do you have play time?

24. 1. The leading cause of preventable death? a. Smoking b. Obesity 2. When sleep deprived, what type of food do persons grab the most? a. fruits b. veggies c. cookie, candy, soda & donut like stuff .

25. Heart Association guidelines • If you have a minute, use it wisely. • Get active • 30-60 min. most days • More intense 45 min 2x/week • Monitor intake—journal • Eat breakfast • Fruit/veggie intake, fiber, portion sizes, reduce fat • Calcium, vitamin D, iron, etc. • Maintain a healthy weight • No/reduce smoking • Control health concerns: • Cholesterol • BP, weight, blood sugar Zapka et al 2009

26. Eat = energy balance • Quality, quantity of energy intake • Food = socialization • Liquid calories? • Activity • miracle grow for the brain • stress management • Kaiser: healthy weight less likely to develop dementia • Amen clinics: dinosaur theory: smaller brain • What about your work team….. • Lemon bars need lemon

27. pray • Emotions and spirituality

28. Life journey • Nursing • Maker of meaning • Member of technology • Each a mystery • People are messy Gallion & Stamp Link between patient safety & nurse safety Foley 2004 • Self & growth • Public self • Private self • Personal self

29. Impact on our emotions. • 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

30. Emotions Matter • 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 • 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

31. Job satisfaction • 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

32. Satisfaction, cont. • 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

33. Nurse meta-analysis • 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

34. Survey: accomplishment& feelings

35. People at work care about me

36. Oppressed group behavior • Systemic problem • Disenfranchisement • Marginalization • Oppressed group created by powerlessness of nurse health care system McPhaul & Lipscomb 2004; Gates et al 2011; Jones & Argentino 2010

37. Nurse to nurse hostility • 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

38. Emotional Intelligence (EI) Self aware: emotional feelings and reactions Emotion = energy Emotional resilience Motivation Interpersonal sensitivity • Conscious of energy behind the words and interactions Influence Intuitiveness Conscientiousness Body receives/understands information Wickipedia accessed 8/15/2011 Mayer, Roberts & Barsade 2008

39. Will enhancing EI matter? • 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

40. EI as a group • 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;

41. What can we do? • 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 education Ward, 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

42. Empowerment • 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

43. Since 1960’s: Nurses eat their young • 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, exercise Had 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

44. Emotions • 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

45. Other factors Stay or go? Personal factors • Marital status • Childcare needs • Greater chance at part time employment Higher education • Males: enroll in non nurse role • Advanced practice: decreased attrition Nooney, Unruh & Yore 2010 • In business • Estrogen to profit ratio is well known • Women leaders mentor underlings • Nursing is flooded with “estrogen”, yet we struggle

46. Resilience 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

47. Hope, faith, air • 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

48. What about music? • Singing improves: • Immunity • Well being • Energy • Posture • Longevity • Decreases pain

49. Of interest… • Muscles to smile = 22 • Muscles to frown = 37-72 • Smiling = anti gravity • Smiling = contagious • May 2 = world laugh day • Laugh for nothing: it’s heart friendly • Laugh at self—shift the perspective • No humor: emotional apathy  disease

50. Hobbies and free time • Does how you spend your free time impact your emotions? • What impacts your well being?