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Department: On The Horizon

Six strategies to build resilience

Hegazy, Jameelah PhD, RN, PMCCT

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doi: 10.1097/01.NME.0000723412.89627.98
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A highly developed nursing professional requires caring, technical nursing skills, cultural competence, and the ability to think critically and make decisions with limited resources and increasing responsibilities. To prevent burnout, it's necessary to strengthen your ability to cope with work-related stressors. This article offers six simple activities gleaned from theoretical studies and research findings to help clinical nurses reduce work-related stress, increase positive insight, and improve job performance.

Nurses' lived experience

Clinical nurses experience a sense of fulfillment from caring for patients, but research findings reveal that despite improvements in workplace safety, nurses continue to experience burnout because of work-related stressors. Studies have shown that clinical nurses have a higher rate of anxiety, insomnia, depression, and cardiovascular disease compared with the general population. Although mental health resources are available, some nurses may resist medical interventions for reasons such as stigmatization by colleagues and management, fear of loss of employment, or their own beliefs about mental health.

Burnout, or mental exhaustion, is caused by multiple work environment stressors, such as coping with the COVID-19 pandemic and patients' complex disease processes, multitasking when managing a high nurse-patient ratio because of limited staffing, navigating peer conflict, dealing with a lack of equipment or poorly functioning/inadequate equipment, intervening in patient emergencies, and frequently skipping breaks. Work-related stressors are significantly associated with anxiety, insomnia, and depression among clinical nurses. Some nurses may resort to drugs or alcohol as a coping strategy; however, the band-aid solution of self-medicating can lead to a sleep disorder, irritability, lack of energy, decreased attention, altered cognition affecting decision-making, and poor psychomotor function, which can result in unsafe patient care. In contrast, practicing healthy stress-relieving strategies builds resilience against threats to mental and physical health.

Stress management and self-care activities

Private expressive writing. One approach to building resilience is writing about stressful work-related events during private downtime. In particular, expressive writing before bedtime can dismiss emotionally negative thoughts about stressful events. Focusing attention on positive insight can help you foster a caring attitude, discover ways to improve knowledge and nursing skills, and promote quality sleep. Positive thinking, such as why you entered the nursing profession and empathetic thoughts on the benefits of caring for patients and the community, reduces anxiety and aids in the development of self-confidence and empowerment to manage work-related stressors.

A randomized-controlled study revealed that expressive writing as a treatment adjunct reduces physiological stress. Studies have also shown that there's a significant correlation between a positive attitude and avoidance of behaviors that negatively affect job performance and well-being.

Social sharing among colleagues. Sharing positive events or accomplishments with your colleagues not only has short-term psychological effects, but repeated sharing of positive events no matter how small may extend positive feelings among colleagues and promote self-evaluation. To avoid negativity, commit to positive feedback. Informal sharing sessions can be implemented as often as the participants decide. A similar approach is for new nurses to observe and emulate successful experienced nurses. Make sure you understand your unit's environment and culture before implementing group activities.

Work breaks. Autonomous work breaks can offset burnout and the fatiguing effects of work. Physical and mental connection with activities of an individual's choice boosts cognitive vitality, flexibility, and energy. Similar to social sharing among colleagues, work breaks promote short-term psychological effects. Autonomous work-break activities that support personal recovery are crucial for replenishing nurses' mental resources and reducing fatigue.

Mindfulness interventions. By selectively paying attention to the present situation without judgmental thoughts and behavior, your attention becomes focused and your performance more efficient. Improving nursing skills, seeking peer support, collaborating with the team on patient care, and modeling leadership characteristics increase autonomous practice and self-efficacy and prevent burnout and compassion fatigue. In addition to attentiveness and awareness of your work situation, paying attention to and fully engaging in family and home events can serve as a distractor from work demands, reducing work-related stress.

Reshaping cognitive and behavioral habits. Engage in reflective thinking by listing three good or enjoyable things that happened during your day and practice gratitude to encourage emotional well-being. Consider kindness interventions—demonstrating acts of kindness toward others—and signature strengths interventions—identifying character strengths and practicing them daily. Time to identify strengths and offer positive feedback may be implemented during interdisciplinary team meetings.

Engaging in a positive psychological intervention specific for workplace settings can reduce stress, build resources, and strengthen positive thinking and behavior over time. For example, one study showed that listing good events while reflecting on being grateful for them reshaped cognitive and behavioral habits toward seeking the positive from both negative and positive experiences. Research has also shown that daily kind behavior toward others fosters immediate positive feelings and can change nurses' attitude about their colleagues, resulting in collaborative practice with shared decision-making for safe patient care.

Exposure to nature. The use of our five basic senses to perceive the natural environment builds up our psychological and physiologic reserves. During work breaks, spend time outside to promote a feeling of calmness. Research has shown a positive correlation between exposure to nature and positive affect.

#NurseStrong

The six practices discussed in this article can help you build the personal resources to manage work environment stressors, improve mental health, promote self-esteem, increase job performance, and foster pride in the nursing profession. Whether you're a new graduate or a seasoned nurse, make time for self-care so you can continue to have the strength to take care of others.

cheat sheet

Resilience strategies

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  • Private expressive writing
  • Social sharing among colleagues
  • Work breaks
  • Mindfulness interventions
  • Reshaping cognitive and behavioral habits (reflective thinking, kindness interventions, and signature strength interventions)
  • Exposure to nature

on the web

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American Psychological Association:

www.apa.org/topics/resilience

Mayo Clinic:

www.mayoclinic.org/tests-procedures/resilience-training/in-depth/resilience/art-20046311

Psychology Today:

www.psychologytoday.com/us/blog/how-be-yourself/201709/how-build-your-resilience

Very Well Mind:

www.verywellmind.com/ways-to-become-more-resilient-2795063

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