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Nurses: To care for others, we must FIRST care for ourselves (Part Two)
 
Do you have a self-care toolkit?
By Kim Richards
Barbara Dossey, PhD, RN, AHN-BC, FAAN, has identified six pathways of self-care—physical, mental, emotional, spiritual, relationships and choice—and I’ve found that they offer an effective framework for my self-care practice. As Dossey has so effectively illuminated, the natural interweaving of each path serves to boost the other paths (Dossey & Keegan, 2013). The undeniable and interrelated dynamic of body, mind and spirit presents me with choices—choices I make multiple times each day. For me, the key is finding effective practices that allow me to push the reset button as needed to realign my thoughts, restore harmony and get back in balance.
 
These tools, together with making time to proactively fill my reservoirs before a significant challenge (such as a hectic travel schedule), inject me with a prophylactic bolus of resilience that shores up my foundation and gives me flexibility to adapt while riding the roller coaster of life. Filling my own bucket enhances my work-life balance and, when consistently dosed, prevents me from hitting the wall, throwing in the towel or generally becoming a calloused victim of the very full life I have chosen as a healer.
 
Joan Z. Borysenko, PhD, distinguished pioneer in integrative medicine and world-renowned expert in the mind/body connection, teaches that tending to ourselves is healing for others. The inner experience we create for ourselves changes our physiology and creates a safe place for others that helps bring forth their potential. Borysenko (2012) states, “Nothing happens to us that doesn’t affect others.” Could this foundational truth be profoundly useful for nurse administrators wanting to improve staff resiliency while leading a culture change, seeking to increase employee and patient satisfaction, or trying to lead a successful Magnet journey?
 
My treasures
My self-care toolkit is the product of many years of learning how to essentially “mother” or nurture myself and thereby improve resilience. While my toolkit is, physically, a small, store-bought treasure chest made up of symbols, small items and paper clippings, I have extended my self-nurturing, memory-evoking, calming environment to include my office, as well as my home.
 
Although most of the items I collect tend to be inexpensive, they are deeply significant to me. My late father’s cell phone and comb and a small key chain from a volunteer mission to Ethiopia will always be cherished. A dirty, worn bracelet given to me by a patient in Uganda engages deeply personal, private and visceral emotions that serve to snap me out of any funk I may be experiencing and instantly create a shift, opening my heart and relaxing my mind. I breathe deeply in the reflective moment and allow myself to be bathed in positive emotions, transported back to laughter, love and renewed connection to the meaning and purpose of my life.
 
Although most items in my toolkit are insignificant to anyone but me, I sometimes find that items or symbols that have provided sweet solace to me call to be passed along to someone I meet. Filling another soul with self-compassion creates a boomerang effect, whether it’s offering a collected stone from Africa, a picture from a fabulously fun vacation or a clipping of a quote that resonates with me.
 
Sometimes, positive emotions are like atrophied muscles. First, you have to remind yourself how to move the muscle. Only then can you build it up and come to rely on it. Negative emotions can be an easy place to land, yet even three to five minutes of self-care intervention interspersed throughout my day have a cumulative effect on my mood and serve to raise my energy level in the evening. Those moments, strung together, along with a physical environment that is clutter-free, restful and void of noise pollution, such as loud, violent TV, rock me to sleep, making me less distracted by events of the day and unfinished business I will need to face tomorrow. The work will always be there, and I will be at peak performance after a great night’s sleep.
 
Facebook is not my best friend
Living in a society that is addicted to being electronically wired at all times, I am a firm believer in a clear separation of work and personal life. Therefore, I never, ever allow my laptop or cell phone in bed with me. The boundaries of separation I set for myself serve to honor me, as well as my family, friends and colleagues. If Facebook ever becomes my best friend, I need major intervention—and a life!
 
My toolkit also includes a sleep mask from United Airlines—remember pillows and blankets, too?—reminding me of the vital importance of sleep to restore and renew, a must for me to be on top of my game. I once heard a sleep expert say, “Sleep like your life depends upon it. It does.” Consistent sleep deprivation is associated with a plethora of negative outcomes, including cognitive impairment, depression, hypertension, obesity, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents and a significantly diminished quality of life.
 
With the demands of travel, my sleep patterns may be interrupted, yet I quickly return to my bedtime routine when home. If I have a particularly hectic travel week, I will typically arrive at my destination early to prevent as little disruption as possible. The days of rushing in at breakneck speed are over! I have also learned the importance of short naps and don’t hesitate to close my eyes for about 20 minutes should my body, mind or spirit start to wane.
 
I never, ever allow my laptop or cell phone in bed with me. … If Facebook ever becomes my best friend, I need major intervention—and a life!
While there is no shortage of tools and rituals that serve to nourish my emotional, mental and spiritual pathways, some of my favorites include reading, dancing, yoga, fly-fishing, meditation, prayer and journaling. (It’s wonderful to look back and be reminded of past progress when facing a challenge.) But my favorite, easily accessible and “in the moment” tool is music.
 
Music is like a drug for me. I use it to pump me up, give me courage, motivate me, cool my jets or relax me to sleep. It is no surprise that music evokes such emotional and physical shifts; volumes of studies in various clinical environments cite music as interventional therapy for a myriad of applications. Yet my grandmother inherently knew the power of lullabies light-years before music therapy was studied.
 
Mirror, mirror on the wall
My toolkit also includes the essential mirror for personal reflection, expanding the bandwidth of resiliency with positive self-talk and the affirmation that I am a catalyst for health care change. Thinking and acting like a resilient person may not feel natural to someone listening to an endless loop of negative self-talk, so I purposefully try to catch my reflection often, mothering myself with kind, compassionate and encouraging words.
 
Some may confuse self-care with vanity. I do not. Affirming myself is critical to my self-care. For example, as I start my day and pass a mirror, I pause to catch my reflection and offer, “Good morning, Kim! I love you!” Sometimes I say it out loud; sometimes I don’t! Wacky? Whatever! I resist the temptation to criticize puffy eyes, new wrinkles, root grow-out—you get the drift. I give my clients a mirror for their emotional toolbox and ask that they bring it every session. I want them to get familiar with speaking kindly and compassionately with themselves, just as they would to a best friend.
 
A recent self-care workshop participant openly admitted her daily self-flagellation as she critiqued her body in the mirror after stepping out of the shower. Not only did this assault affect her self-perception and become a sad routine, her colleagues commented on her consistently negative, worn-out loop of self-effacement. They had a message for her they had been holding back, saying. “When you talk so badly about yourself, it puts the burden on us to keep you pumped up and change the subject. It’s a downer, and it’s getting really old. We’d appreciate it if you knocked it off!” The honesty caused her to pause, reflect and commit to positive change, previously unaware of her effect on her colleagues.
 
At times, I have failed to intervene in one of my personal downward spirals. As a result, I found recovery and catch-up more elusive, requiring more time and energy than if I had consistently complied with my self-care routine. I remind myself often of that fact when I am hurried and pressed for time.
 
Linda Q. Everett, PhD, RN, NEA-BC, FAAN, executive vice president and chief nurse executive at Indiana University Health in Indianapolis, Indiana, recalled a difficult, challenging time in her career: “I had a million reasons why I couldn’t just step away, even briefly. In retrospect, I can clearly see the steps that exacerbated my stress and anxiety. What I have learned over time is that failure to care for yourself makes any bad situation worse. If you’re not taking time off, getting away and focusing on something other than work, you’re doing yourself a disservice and, ultimately, setting yourself up for failure. As you strive to meet goals related to patient satisfaction and patient expectations, ask yourself what matters most. And then do something for yourself to help you get there” (Everett, 2011, p. 56).
 
Functional nutrition
After completing the International Nurse Coach Association’s Integrative Nurse Coach Certificate Program and having the opportunity to delve deeply into functional nutrition, I started drinking a morning shake, full of antioxidants, essential vitamins and minerals, essential fatty acids, flax meal and probiotics for optimal gastrointestinal health. I am a firm believer that food is medicine. It can kill me or heal me. I really am what I eat, and I have numerous opportunities to choose whether to boost or diminish my health. I have found success in eliminating empty, fatty calories by being mindful of that fact, but a seductive magnetism still attracts me to a fabulous brownie or a slice of cheesecake. Do I eat it? Yes! And here’s the kicker: I don’t feel guilty and beat myself up. I enjoy every mouthful and savor the taste. Then I go back to my routine.
 
Self-care does not mean denial of favorite things but practicing a more mindful way of looking at what is fueling or draining. I suggest to my clients that they make simple diet changes they can easily stick to, such as choosing more vegetables than meat, drinking water consistently and eliminating soda pop and most processed foods.
 
Awareness of the relationship pathway with regard to self-care is an important key to success. He who roams with wolves learns to howl! Translated, it means, “He who roams with paunchy pals becomes plump.”
 
Christakis and Fowler (2007) followed 12,067 subjects from the Framingham Heart Study over the course of 32 years. Their findings were surprising. A person’s chance of becoming obese increased by 57 percent if a friend became obese. They learned that the type of friendship is also important. Between mutual friends, a subject’s risk of obesity increased by a whopping 171 percent if the friend became obese. It seems that, among friendship groups, social modeling may play a significant role in the spread of obesity (Herman, Roth, & Polivy 2003; Hetherington, 2007; Hetherington, Anderson, Norton, & Newson, 2006). This research has clear implications for choosing a positive relationship pathway when it comes to self-care, and it brings meaning to the saying “Sometimes, you have to weed your garden of friends.”
 
Speaking of exercise
While some routines will become a self-nurturing sanctuary, successful self-care journeys provide dynamic change, adaptation and flexibility. For instance, I have been a lifelong athlete. I was a high school cheerleader, took dance lessons for 12 years and have taught fitness classes for more than half my life. I had been a big fan of the Western model of pushing the limit on intensity and strengthening: Kick higher, harder, faster; never enough, go, go go! Now, biking, hiking and skiing serve my need for a heart pumping, challenging and sweaty oasis, along with a new practice I’ve adopted, hot power yoga.
 
My exercise regimen has continuously evolved throughout my life. About 12 years ago, as I was struggling with significant life challenges, I discovered the profound power that yoga practice has not only to sculpt my body, but align my mind and breath with movement. Inviting vulnerability, harnessing my inner warrior and allowing my self-expression to push beyond my typical comfort zone—while improving my physical and mental flexibility—have made me an unlikely champion of this ancient Eastern practice.
 
One of the many benefits of yoga is the rinsing and elimination of a toxic cocktail of physical, mental and emotional sludge. This release, as well as the camaraderie the class offers, serves to create my foundation for resilience, and I am naturally more mindful of healthy choices—both small and sometimes life-changing. I have never felt healthier, stronger or more conscious of my mind, body and spirit, and I have grown almost an inch in height! As I carry my practice off the yoga mat, my world may be chaotic, but I am able to tap into my breath and my mindfulness and respond more calmly. I admit my addiction to a good daily rinsing! The melding of East and West modalities is now a daily part of my self-care.
 
A wealth of research funnels down to one undeniable conclusion: Exercise equals happiness.
 
When I first engage with coaching clients, I ask them to imagine various forms of self-care, including physical exercise, that they could commit themselves to practicing daily and to describe how they would feel after being successful. Without exception, they report feeling an improved sense of well-being after the first few days. Self-direction, choice and sustainability are key elements when modifying lifestyle to enhance wellness. The impact of engaging nurses in changing their personal and individual daily habits to do something a little healthier tomorrow than they did yesterday is pivotal to creating a culture of health and an optimal healing environment.
 
Return-on-investment expert Ron Goetzel, PhD, notes that, “Employers are realizing that it’s not just about getting employees not to be sick. It’s also about going beyond that so employees are at their physical and mental best” (Goetzel, 2012, p. 41). Other desirable objectives include:
  • Being viewed as caring about employees
  • Providing competitive or exceptional benefits to attract the best employees
  • ncreasing employee satisfaction and retention
  • Having higher employee morale
  • Improving productivity
  • Motivating employees to think they are part of a higher purpose—not just “cogs in a wheel” but people who contribute individually and are viewed as important
  • Being recognized as a healthy company
To summarize, my friend Roxane Spitzer, PhD, MBA, RN, FAAN, editor-in-chief of Nurse Leader, voiced a wise call to action in the February 2012 issue of that journal: “We are entering a totally new era for care delivery. Applying bandages and work-arounds will not suffice. Let’s open our eyes and minds and realize that the status quo is intolerable. Nurse leaders are one of the major drivers in preparing for a real health care system. This will be different from what we have ever known. We not only have to prepare, we must lead it” (Spitzer, 2012, p. 6).
 
Let’s start by harnessing the power of self-reflection and building our self-care toolkit with proven wellness practices and tools that boost resilience. Oh, and you’ll also need some comfortable shoes to navigate the cobblestones on the rocky road to drastic and sustainable change. It is ours for the taking! RNL
 
 
Kim Richards, RN, INC, CYI, founder and owner of Self-Care Academy and president of Kim Richards & Associates, Inc., is a certified integrative nurse coach and yoga instructor.
 
References:
Borysenko, J.Z, (January 2012). Presentation at Integrative Medicine Conference, New York, NY.
 
Christakis, N.A., & Fowler, J.H. (2007). The spread of obesity in a large social network over 32 years. New England Journal of Medicine, 357, 370-379.

Dossey, B.M., & Keegan, L. (2013). Holistic nursing: A handbook for practice (6th ed.). Burlington, MA: Jones & Bartlett Learning.
 
Everett, L.Q. (2011, December). Knowing when to refuel and renew. Nurse Leader, 9(6), 56.
 
Goetzel, R. (2012, May). Health is wealth: The rise of workplace wellness. Idea Fitness Journal. Retrieved from http://www.ideafit.com/idea-fitness-journal/2012/may
 
Herman, C.P., Roth, D.A., & Polivy, J. (2003). Effects of the presence of others on food intake: A normative interpretation. Psychological Bulletin, 129(6), 873-886. doi: 10.1037/0033-2909.129.6.873
 
Hetherington, M.M. (2007). Cues to overeat: Psychological factors influencing over-consumption. Proceedings of the Nutrition Society, 66, 113-123. doi:10.1017/S0029665107005344
 
Hetherington, M.M., Anderson, A.S., Norton, G.N.M., & Newson, L. (2006). Situational effects on meal intake: A comparison of eating alone and eating with others. Physiology and Behavior, 88, 498–505.
 

Spitzer, R. (2012, February). Lessons from the housing bubble. Nurse Leader, 10(1), 6.

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