By Karen Murray Lead Midwife Education, Queens University Belfast
The work of nurses and midwives has been acknowledged as emotionally demanding. On a daily basis we deal with patients and their families during emotionally challenging times; we support them while they deal with anxiety, pain, fear and loss as well as joy and excitement. This ‘emotional work’ is often undervalued and goes unrecognised in the health care systems within which we work. In addition to this core element of nursing and midwifery practise we find ourselves working in increasingly busy and stressful environments; our patients are sicker, have more co-morbidities go home sooner, have greater social and physical needs and there never appears to be enough people to care for them.
These pressures create a potential legacy of problems for us personally, for our colleagues as well as for the patients and families we care for. The experience of increased stress and workplace adversity contributes to increased sickness rates and poor staff retention. Resultant staff shortages further exacerbates the pressures on frontline staff. Individuals who continue to work under this pressure will often develop self-protecting strategies to cope with the demands they face. For some, these may involve detachment and a reluctance to engage with the emotional aspects of caring, acceptance of the status quo and an inability to provide support for colleagues. Others develop more resilient strategies with allow them to adapt more positively to the increased stressors of their work. So what makes the difference?
Resilience can be defined as ‘the ability of an individual to cope with and adapt positively to adverse circumstances’ (Hunter and Warren, 2013). Resilience has been identified as comprising a serious of personality traits such as optimism, self-efficacy and hardiness which enable an individual to cope with increased adversity. Increasingly, resilience is viewed as the combination of internal and external factors, a dynamic process which develops over time and one which can be learned (Ungar, 2012; Neenan, 2009). If we begin to accept the view that resilience can be learned we then need to consider who has the responsibility to facilitate this learning?
It may be that each one of us has an individual responsibility to look after ourselves and develop resilient strategies. A literature review by Jackson et al. (2007) identifies that nurses can be active agents to positively adjust to workplace adversity and they propose ‘self-development strategies to facilitate resilience’. These self-development strategies include the building of positive nurturing professional relationships, maintaining positivity, developing emotional insight, achieving life balance, encouraging spirituality whilst also becoming more reflective. However, Jackson et al. (2007) proposes that the ‘self-development’ of nurses and midwives should not just be the responsibility of the individual but also of educators and the health care institutions. This is supported by Grafton et al. (2010) who, whilst acknowledging that individual nurses have a responsibility to ensure they develop ‘self-care’ practices, also recognise that healthcare institutions have an important role to play through the provision of supportive strategies which assist in the development of self-care through services such as education and counselling as well as work based facilities such as quiet rooms that enable staff to relax and reflect on practice. It is also suggested that policies and practices need to be implemented to promote reflective learning within teams. The government’s strategy for mental health (Department of Health, 2011) recognises the importance of building resilience for the health and wellbeing of individuals, it further encourages employers to recognise and promote these qualities. However to do this there is a need to have a clear understanding of what resilience is and how it can be fostered.
It is also suggested that predictors of resilience such as adaptability and positive identity can be strengthened through education and training (McAllister and McKinnon, 2009). These authors suggest that the educational implications of resilience research apply equally to undergraduate nursing and midwifery education as to education for registrants. McAllister and McKinnon (2009) specifically propose that that educational programmes should focus on enabling individuals to explore and develop their professional identity, as well as building their capacity for coping. They also suggest teaching leadership for change as a way to prepare individuals to better adapt to change. Finally McAllister and McKinnon (2009) suggest that ‘cultural generativity’ should be encouraged within teams. This is achieved by utilising the experiences of resilient practitioners, individuals who can act as role models by providing lessons and insights, as a mechanism to build resilience capacity within the professions.
It has been suggested that the development of resilience can occur at an individual level and can be mediated by education and work based practices. However, the research is limited and gives little direction as to the best way to help practitioners develop resilience. Yet, it seems to me, that resilience needs to be a fundamental element of modern practice. Given the challenges faced by both nurses and midwives with changes in the complexity of care being delivered, the pressures being placed on professionals to be more effective and efficient and an increase in autonomous ways of practicing our professions we need to develop healthy resilient strategies which will provide self-protection and ensure that we are able to meet the needs of our patients and their families.
Join the Evidence Based Nursing chat on Twitter this Wednesday 2nd April from 8-9pm GMT to discuss building resilience in Midwifery and Nursing staff #EBNJC
Department of Health (2011) No health without mental health. DH: London
Graften, E., Gillespie, B. M. and Henderson, S. (2010) Resilience: The power within. Oncology Nursing Forum 37; 698-705
Hunter, B and Warren, L (2013) Investigating Resilience in Midwifery. Final Report. Cardiff University: Cardiff
Jackson, D., Firtko, A. and Edenborough, M. (2007) Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: A literature review. Journal of Advanced Nursing, 60; 1-9
McAlister, M. and McKinnon, J. (2009) The importance of teaching and learning resilience in the health disciplines: A critical review of the literature. Nurse Education Today, 29; 371-379
Neenan, M. (2009) Developing resilience: a cognitive approach. Routledge: London
Ungar, M. (2012) Social ecologies and their contribution to resilience. IN Ungar, M. (ed) The social ecology of resilience