Chapter 1
SELF-CARE AND WELLBEING

LEARNING OUTCOMES

By the end of this chapter, you will have an understanding of the importance of self-care and wellbeing in healthcare to help with compassion fatigue, burnout, and post-traumatic stress disorder.

Different approaches to wellbeing techniques will be explored, including acupuncture, acupressure, yoga, Qigong, Tai Chi, and massage.

How are you feeling today? I ask this because we know the NHS is in a 'jobs crisis' with large numbers of healthcare professionals in the UK leaving the profession, citing as their reasons for leaving 'pay, working conditions and feeling under huge pressure'. Those leaving the profession often are not replaced, and the shortfall of healthcare professionals is reaching record levels, which puts more pressure on those still hanging on and caring for the vulnerable.

But who is looking after you? We do need to look after ourselves, as laid out by the Nursing & Midwifery Council document 'Future Nurse: Standards of Proficiency for Registered Nurses' (2018). This document states that at the point of registration, the nurse will:

1. 1.5 understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimize risks to health
2. 1.6 understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and wellbeing required to meet people's needs for mental and physical care.

In short, it is all about self-care and wellbeing. We need to care for ourselves and our colleagues, which may be easier said than done in today's healthcare climate.

Self-care
The actions we take for ourselves to remain fit and healthy and understand when we can look after ourselves and when we need to seek help from other healthcare professionals.

Wellbeing
Represents a broader bio-psycho-social construct that includes physical, mental, and social health.

The self-care process can start by reflecting on what makes us happy. When we are going through trying times, it can be easy to focus on the negative aspects of our lives - causing us even more stress and anxiety. Before we go down a negative spiral, it is important to focus on the things that make us happy. Moving from the negative to the positive is an important aspect of the healing process. And note that we may need help with this process (counselling, general practitioners, etc.).

COMPASSION FATIGUE

Unique to the healthcare sector is the occupational stressor known as compassion fatigue, whereby the carer connects with a patient and feels how they are feeling. This opens them up to absorbing and experiencing the patient's trauma, suffering, and pain - known as vicarious traumatisation. This exposure stimulates our fight-or-flight response, which we then continually suppress, leading to consequences for our physical and mental health.

The symptoms of compassion fatigue can be seen in Table 1.1.

If we ignore the body's response to vicarious trauma, the physical symptoms will only get worse. This is when we need to take steps to care for ourselves before we experience burnout.

Table 1.1 Symptoms of compassion fatigue.

Phase 1 Anxiety Vicarious trauma stimulates the nervous system into flight or fight, and you feel the effects of adrenaline on the body - raised heart and breathing rates, shaking, and muscle tension. It becomes harder to think clearly and concentrate and may be harder to sleep. It becomes more difficult to relax. Phase 2 Irritability Chronic stress may induce headaches, fatigue, and multiple minor illnesses as the immune system becomes compromised. The tension may affect your musculoskeletal system, causing chronic neck and back pain. You may eat more (or less) than usual. Phase 3 Withdrawal As you experience chronic fatigue and constant aches and pains, you may start to neglect your physical and emotional health. If you take time off from work, you do not feel any better on your return. Phase 4 Robot These symptoms are very similar to those suffering from depression and also include headaches, generalised aches and pains, digestive problems, and a feeling of low-level anxiety and very low mood.

BURNOUT

Burnout is a syndrome resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:

1. Feelings of energy depletion or exhaustion
2. Increased mental distance from one's job or feelings of negativism or cynicism related to one's job
3. Reduced professional efficacy

Risk factors associated with increased susceptibility to developing Burnout Syndrome can be seen in Table 1.2.

Table 1.3 shows some of the actions we can take to prevent Burnout Syndrome in the workplace.

Table 1.2 Risk factors in developing Burnout Syndrome.

Individual risk factors

• Poor self-esteem
• Poor coping strategies
• Idealistic world view
• Unrealistically high expectations
• Financial issues

Organisational risk factors

• Heavy workload
• Conflicts with co-workers
• Diminished resources
• Lack of control or input
• Effort-reward imbalance
• Understaffing
• Rapid institutional changes

Risk factors for nurses

• Variability in work schedules
• Rapid turnover of patients
• End-of-life events
• No breaks during shifts

Table 1.3 Action steps to prevent Burnout Syndrome.

Manage Understand that there are ways in which you can manage your work-related stressors that put you at risk of Burnout Syndrome. Engage Engage in the support of management, co-workers, friends, and family that may help you cope with stress - this is not a weakness. Breaks Take breaks at work and away from work. Go outside for a walk to get some fresh air during your breaks. Enjoyment Think about what you enjoy about your work, and focus your attention on your interests and passions. Techniques Gain techniques to be used at work when dealing with stressful work experiences and after work to relax and recharge.

STRESS-RELIEVING STRATEGIES

To effectively combat stress, we need to activate the body's natural relaxation response. We are all unique human beings, and stress-relieving strategies are not a case of 'one size fits all'. Each of us has preferred calming stress busters. The following bullet points show some of the strategies you may utilise to reach a state of calm and unwind after a stressful day or on a day off:

• Spending a day at a spa
• Eating chocolate
• Drinking a glass of wine at the end of the day
• Taking a walk in the country
• Going for a swim
• Going to the hairdresser/having your hair washed
• Going for a run
• Meditating
• Going somewhere for quiet time (stillness)
• Going to the gym
• Reading a book
• Undertaking some arts and crafts (hobbies)
• Watching a movie
• Listening to music
• Going to a café for a hot beverage (and a piece of cake) with friends
• Soaking in a warm bath
• Having a massage
• Gardening
• Playing with your pet animal
• Watching a football/rugby match (could be stressful if your team lose)
• Doing yoga
• Working on a jigsaw puzzle
• Modelling with LEGO bricks

I live in the West of England, and one of my favourite ways to destress is to go for a short walk in the Cotswold countryside and then stop in an Olde Worlde tea shop for a cup of tea and some cream scones (jam first, cream on top). Sometimes I forego the walk! (Several of my colleagues like to go to the gym after work - I can't think of anything worse!) My husband likes to snuggle up on the settee with a hot cup of tea, dunking his biscuits (yuk!) whilst watching a good movie on Netflix. In other words, it really is horses for courses. Also, everything in moderation: we should not become dependent on pouring alcohol down our gullets to 'feel better' as this could be a slippery slope.

The important thing is that we all need an outlet for our stress. Good health relies not just on the physical aspect but also the mental health aspect - a truly holistic...