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Caring for the Caretaker: A Nursing Process Approach

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Abstract

Problem: Nurses begin their careers infused with a passion for making a difference in the lives of their patients. However, patients’ needs and the demands made on their time can cause nurses to become desensitized to their own needs. The resulting dissonance between values and actions increases stress levels, which, if left unchecked, lead to burnout and compassion fatigue. Method: The nursing process is a dynamic and efficient problem-solving technique used by nurses in their approach to caring for their patients. This approach can help nurses who are experiencing stress and burnout to define their core values, develop goals, implement a plan of action, and realign their focus. Reflection and journaling bring insight and understanding to the process and promote growth. O-utcomes: This process develops a stronger sense of self that leads to a solid foundation from which to act. The individual makes mindful choices from an integrated state based on positive goals. This leads to a sense of well-being and balance, which can decrease stress and promote satisfaction and a return of passion for our profession.

As new nurses, we enter our profession with enthusiasm and the desire to make a difference for our patients. However, the cumulative effects of stress cause many nurses to lose their passion. It is the nature of nurses to respond to the needs of others before their own, but habitually putting off our own needs can cause us to become desensitized to them. Over time, we feel less vital and less energetic. Eventually, nothing satisfies us; and finally, we burn out. When our needs are pushed aside, so are desires, dreams, aspirations, and our selves. “Expert at caring for others, nurses are novices at caring for themselves, as reflected in the high rate of burnout that are endemic to nursing” (Hernandez, 2009, p. 129).

One factor that differentiates nursing care from other disciplines is our use of the nursing process. Practiced throughout nursing school, it becomes so ingrained in our thinking that we use it automatically. However, this dynamic and efficient problem-solving technique need not be reserved only for patients; it can be a way for nurses to approach problems in our lives as well. By following the steps of the nursing process with flexibility, curiosity, and critical thinking, we can map out a plan of care for ourselves to return balance, enthusiasm, and satisfaction to our careers.

The first step begins with self-assessment. Self-care is personal; no one else can tell you what you need to do for yourself. Some will advocate therapies such as yoga, aromatherapy, and/or meditation. These are certainly helpful adjunct therapies. However, we cannot improve the stress in our lives until we face the sources and cultivate new responses. Sources of stress can be internal or external. Reconnect with yourself through reflection. Give a name to your desires. Look at your dreams; it is possible to make them happen.

Journaling works well to organize your thoughts and feelings. Use it to increase awareness of individual preferences, emotions, spiritual needs, and growth. If you find you are stuck, Kathleen Heinrich (2008) describes a free-write exercise in her book, A Nurse’s Guide to Presenting and Publishing, that can help you get started. Specify a certain length of time between 1–2 minutes, put pen to paper, and let your thoughts flow without editing. Have a specific question in mind, and keep your pen moving, even if it starts with doodling (pp. 9–10).

Define your core values. It is important to operate from these values—-otherwise we experience dissonance or dis-integration. This dis-integration can be a strong source of moral distress. When you function from your values and beliefs, you feel on track and you respect yourself. The value of self-respect may be something we take for granted (Dillon, 2009). However, whether we respect ourselves determines how we live our lives. When we respect ourselves, we model how we want to be perceived (Vollman, 2010).

Take a look at your physical health. Are you doing all you can to take care of yourself? Short-changing yourself through an unhealthy diet, lack of exercise, and insufficient sleep adds to your stress level and undermines your physical well-being. Be familiar with the symptoms of chronic stress and burnout—these include feelings of powerlessness, high levels of frustration, and feeling overworked and undervalued (Goran, 2010).

Even healthy work environments can be stressful. However, you should feel that you are supported and respected, that your contribution is valued, and that you have what you need to care for your patients.

Then, look at your work environment. Even healthy work environments can be stressful. However, you should feel that you are supported and respected, that your contribution is valued, and that you have what you need to care for your patients. Is the mission of your institution in line with your values and beliefs? Do your coworkers have similar values? Signs of disrespect, unfairness, and lack of autonomy, as well as poorly maintained equipment and/or inadequate staffing and other resources, are warning signs of unhealthy workplaces. According to Silence Kills (2005), a study by the American Association of Critical Care Nurses (AACN) and VitalSmarts, lateral violence is one of the major reasons nurses leave the profession. What is your role in your work environment? Are you a positive or negative influence? For the assessment step to work, you need self-awareness and accountability. This step can be hard work, but it is good work. It can be gratifying to become reacquainted with yourself, give voice to your dreams, and focus on possibilities.

PLANNING

Analyze the data from your assessment and develop a plan to address the areas you have identified as issues. Working from the information you have gathered sets you on a solid base from which to make decisions in both your personal and professional life. Define your goals. Decide what can be changed. Be realistic. You cannot tackle everything at once. Use your critical thinking skills and set priorities: What can be fixed quickly? What will be more involved? What needs to be considered urgently? If you are already having symptoms of burnout, that is where you need to focus. Because burnout is associated with the cumulative effects of the routine hassles of work, the remedy is change (Goran, 2010). Consider a vacation to fully get away, and plan to return refreshed and willing to try some new approaches.

Maybe you discovered that you need a more permanent change: a different unit, a new specialty, or another venue. Look at what you need to accomplish your goals and break it down into manageable steps. One of the great things about nursing is that if you do not love what you do, there is always something else to try. If you are feeling stressed but are not at the burnout stage, plan strategies to prevent burnout from happening.

IMPLEMENTATION

Once you have identified your stressors and have plans in place, it is time for action. Be proactive, not reactive. When we react, we are at the mercy of the situation; proactive, we function more from our choices and less from our emotions. Stay focused on your goals. Be cautious of old habits when it comes to taking care of you. Take your breaks, do not work so much overtime, and do things that nurture you on your days off. Use your allotted vacation time; schedule regular vacations throughout the year to renew and rejuvenate.

You have more influence in your workplace than you are aware of; a positive attitude produces positive influences.

Every day you have a choice: You can grumble and be negative, or you can use your voice to change situations for the better. You have more influence in your workplace than you are aware of; a positive attitude produces positive influences. Join a committee that deals with your practice. You will gain a systems perspective on practice issues, and you can help participate in decision making. Join a nursing organization to gain a more global perspective. How involved you become is up to you. You can start slowly, read material, get a feel for what a group does, and decide whether you want more involvement. Become certified in your area. Continue to learn.

EVALUATION

Evaluate your progress. Are you staying in touch with your core values? Are the plans you implemented helping you reach your goals? If they are, keep going; if not, then go back, read through your journal, and see what you need to change. Stay in balance. Evaluate which actions are most appropriate and which ones need to be revised. Celebrate your successes. This is a dynamic process with no mistakes, just learning opportunities. Evaluate changes and reactions at work. When we are recognized for the contributions we make and our input into the workplace is respected, we develop greater confidence and want to be a part of our work community.

REFLECTION

While evaluation looks at the relevance of what you are doing, reflection is the opportunity to elicit meaning from your experiences. As an analysis of what you see, think, and feel, reflection enriches your knowledge by offering a depth of insight that is not apparent during the unfolding of an event. It is this mindfulness that gives us strong awareness of our participation in the events of our lives. At the end of the day, reflect on what went right or wrong, where you can improve, and how you felt. Reflection helps us look at situations in a new way; it keeps us connected to our selves. This practice is a good debriefing activity that can help put your work experiences into perspective before you bring undue stress home. Once home, a few minutes of journaling records the important points to follow up on or remember.

Mindfulness gives us a strong awareness of our participation in the events of our lives.

CONCLUSION

Nurses enter the profession with the desire to help others, but without self-awareness, we can easily find ourselves drained of energy to the point of depletion, becoming ineffective. The nursing process is a reliable framework for decision making. Engaging in each step can help nurses maintain self-awareness and develop a core of balance and well-being. We can then achieve relevant goals based on our own needs assessment, and regain the passion we once had.

REFERENCES

  1. R. S. Dillon (2009). Respect. In The Stanford Encyclopedia. Retrieved April 11, 2010, from http://plato.stanford.edu/entries/respect/
  2. S. F. Goran (2010, April). Compassion fatigue: Just too tired to care. Session conducted at the AACN Region 1 Horizons2010 Critical Care Symposium, Burlington, VT.
  3. K. T. Heinrich (2008). A nurse’s guide to presenting and publishing: Dare to share. Sudbury, MA: Jones and Bartlett.
  4. G. Hernandez (2009). The heART of self-C.A.R.I.N.G.: A journey to becoming an optimal healing presence to ourselves and our patients. Creative Nursing, 15(3), 129–133.
  5. K. Vollman (2010, April). Vitamins for nurturing the nursing soul back to health. Keynote address conducted at the AACN Region 1 Horizons2010 Critical Care Symposium, Burlington, VT.
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