It has long been recognised that healthcare professionals are at risk of experiencing work related stress and, not unsurprisingly, it has been noted that “the quality of care dips if staff are not well or happy at work” (1).
As a senior nurse in palliative care, with many years of experience in the day care setting, I have facilitated many different types of groups; with patients, carers and colleagues. And, having worked in oncology and palliative care for over 20 years I have a thorough understanding of the pressures and demands of the field.
I am also well qualified in the wellbeing field, being trained in hypnotherapy and neuro-linguistic programming, mindfulness, yoga and herbal medicine. My main interest is in empowering others to have the best day they can, regardless of where they find themselves.
Identifying a need and gaining organisational support
The wellbeing programme for clinical staff at St Barnabas House began after inpatient nursing staff approached me during a wellbeing session for all hospice staff to ask if this ‘kind of thing’ could be made available to staff on a regular basis.
The team strongly believed that the strategies I was teaching would be very useful for them, acknowledging the pressures of hospice work.
Recognising that they were best placed to identify their needs, and had identified a proactive intervention, I discussed this with the ward sister, head of education and director of nursing and it was decided to trial twice monthly one-hour sessions for the team, entitled ‘Looking after yourself’.
These sessions would be prioritised as an opportunity for staff from all clinical settings to come together for guided wellbeing support.
There was a keenness to take on board the nurses’ thoughts, and recognition of the challenges associated with clinical work and the importance of maintaining staff wellbeing.
The importance of acting on staff feedback is one of the recommendations outlined in the report by Point of Care Foundation for Hospice UK, entitled ‘Resilience: A framework supporting hospice staff to flourish in stressful times’ (2). People are more likely to embrace change if they have been involved in it.
This report also cites Gilbert (3) as suggesting that a lack of compassion towards oneself is likely to lead to a lack of compassion towards others.
The Hospice UK report also recommends that staff have access to resilience training, and training in relaxation and mindfulness.
At the heart of mindfulness is developing an attitude of self-compassion. Neff (4) notes self-compassion is a powerful way to achieve emotional wellbeing in our lives, helping us avoid destructive patterns of fear, negativity and isolation.
Encouraging (self) care and compassion in staff also mirrors the language of two of the central ‘6 C’s’ – the principles which form the basis of the Compassion in Practice national nursing strategy (5). The hospice is part of a wider group that offers compassion training following on from the recommendations post the Mid Staffordshire NHS Trust Public Inquiry and this work fits well with that too.
Looking after yourself sessions
The one-hour sessions, held twice a month in the comfort of the education department, provide space for discussion in a relaxed setting.
The focus is on the session content, rather than an opportunity to talk about work specifically, making it more of an escape. The sessions aim to provide the team with a ‘tool kit’ approach to build resilience and manage stress.
Sessions are informally facilitated to encourage participation, encouraging all to join in. ‘Ground rules’ included confidentiality and respect for all to speak and be heard.
Sessions start with a short ‘settling in’ meditation, mindfulness being a theme that runs through the sessions and one of the interventions that the Hospice UK report recommends as accessible.
A key aspect of sessions is to help staff understand the nature of the mind, anxiety and how we experience stress. The power of knowing this is to normalise the response and allow a basis for education on ways to manage reactions to stress.
It is tempting for one to feel that once some external stressor stops, then they will be fine; these sessions seek to encourage ways to be OK. Most of life is beyond our control, and so bolstering our ability to manage our reactions can be very empowering.
“If you don’t like something change it. If you can’t change it, change the way you look at it.” – Maya Angelou in ‘Wouldn’t take nothing for my journey now’.
A sample of subjects covered included:
- Coaching tools such as ‘Wheel of life’ to offer the opportunity to look at the balance across our life and as a framework for making changes.
- Mental traps and how to work with them.
- Learning that our thoughts are not necessarily true.
- Developing resilience, what can we do?
- Relaxation strategies, prioritising self-care, healthy choices.
- Being our own best friend, encouraging self-compassion and kindness.
- Having fun….when did we stop doing this and how to restart.
- Gratitude, the benefits of counting our blessings.
- How to say no!
The initial six sessions were positively evaluated and so further sessions have continued. Next steps are currently under discussion with the ward team to see how best to develop this work.
In addition there has been recognition that the housekeeping and catering staff work closely with patients and their families/friends and may also find the ‘Looking after yourself’ sessions beneficial and therefore they have been invited too.
- Boorman S. NHS Health and Wellbeing: Final report. Department of Health; 2009.
- Goodrich J, Harrison T, Cornwell J. Resilience: a framework supporting hospice staff to flourish in stressful times. Hospice UK; 2015. Available from: http://www.hospiceuk.org/publications
- Gilbert P. The compassionate mind: a new approach to life’s challenges. London: Constable & Robinson; 2009.
- Neff K. Why self-compassion trumps self-esteem. Greater Good [Online] Available at: http://greatergood.berkeley.edu/article/item/try_selfcompassion Accessed 22 April 2016.
- Department of Health. Compassion in practice: Nursing, midwifery and care staff: our vision, our strategy. Department of Health; 2012.