5/1/2018. The Role of Resilience and Mindful Leadership in Nursing. Learning Objectives. Common Terms Compassion and Compassion Fatigue

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1 The Role of Resilience and Mindful Leadership in Nursing Cindy Rishel PhD RN OCN NEA-BC Clinical Associate Professor Learning Objectives Describe the concept of resilience and identify specific attributes relevant to nursing Identify key tenets of mindfulness and relationship to nursing Explore research opportunities integrating mindfulness and resilience as key concepts in nursing leadership Common Terms Compassion and Compassion Fatigue Compassion Central value of nursing; described in ANA Code of Ethics Compassion Fatigue - Components Compassion Satisfaction meaning and joy nurses derive from providing care to patients Secondary Traumatic Stress feelings of despair; may elicit physical and/or psychological symptoms Burnout perceived demands outweigh perceived resources (Schmidt & Haglund, 2017) 1

2 Compassion Fatigue Combination of factors generally outside personal control External stressors High patient census Patient flow challenges Patient demands Focus on patient satisfaction Organizational financial goals Experience of critical incidents Interprofessional conflict Intraprofessional conflict Common Terms Burnout May be directly linked to job satisfaction; work environment Exhibited as Frustration Exhaustion Depression Hopelessness If not addressed may lead to compassion fatigue (Schmidt & Haglund, 2017) Resilience Defined as personal qualities that enable one to thrive in the face of adversity (Connor & Davidson, 2003, p.76). In healthcare, the ability of nurses to grow stronger from adversity Developing the ability to withstand and, ultimately, overcome adversity Characteristics Perseverance determination to carry on Equanimity balance perspective, roll with the punches Existential aloneness unique life path, some experiences must face alone Self-reliance self belief, strengths/limitations Meaning life has purpose, able to contribute to others (Meyer & Shatto, 2018) 2

3 Resilience Another definition describes as a multidimensional and learned ability that nurses may use to support functioning at a high level when facing adversity (Rutter, 1987). Mindfulness Described as awareness or personal understanding of how the mind works Work is needed to: Gain greater self-awareness that is intentional Integrate into practice Lead in challenging situations Receive feedback and group support Open and accepting Allows individual to respond rather than react (Halm,2017; Rishel, 2015) Mindfulness, Coping and Resilience Nurse shortage Aging workforce Enculturation of new nurse graduates Workplace incivility Increase in organizational mergers Healthcare as a business Research in field is growing 3

4 Scholarly Inquiry Mindfulness Based Stress Reduction (MBSR) Various strategies evaluated Short workshops Multi week programs Mindful attention to breathing, awareness of thoughts Yoga Intentional activation of self-compassion, kindness Results Increased relaxation states, fewer physical symptoms after MBSR Ongoing mindfulness practice and integration into routine of self-care is critical (Halm, 2017) Scholarly Inquiry Mobile Applications Supporting Resilience Study of Provider Resilience mobile application (PRMA) Oncology nurses Evaluate use of PRMA to support resilience/reduce compassion fatigue No significant difference in pre and post test scores of 3 groups in study Further investigation is needed for nurse use Numerous studies looked at use of mobile apps for patients (Jakel et al., 2018) Scholarly Inquiry Impact of Shift Work on Nurse Resilience Importance Shift work is necessary May affect physical/mental health; impact care delivery Key Findings Some studies reported negative psychological outcomes resulting from shift work Other studies found no evidence of poor outcomes Numerous measures used resulting in inconsistencies Impact Results may assist nurse leaders to support shift workers more appropriately (Tahghighi, et al., 2017) 4

5 Role of Nursing Leader Clinical experts Technology advocates Stewards of organizational finance Compassionate mentors Demands of the role Competing priorities Maintain quality outcomes (safety, satisfaction, nursesensitive indicators) Maintain fiscally productive workforce Need to compromise personal beliefs Scholarly Inquiry Self-Care for Nurse Leaders Stress linked to behavioral, emotional, cognitive changes Can compromise caring, limit leadership decisions, potential affect patient outcomes/satisfaction Successful nurse leadership incorporates self-care practices to reduce adverse events/potentially improve patient satisfaction Thrive on challenges/personal pride in accomplishment (Dyess et al., 2018) All Nurses Are Leaders Support emotional and physical journey of patients/families Strive to ensure that care delivery is of the highest quality As a result, all nurses are leaders at the point of care (not just nurses with organizationally delineated leadership positions) Each nurse must develop process of resiliency To become effective point of care leader Many lack true self-awareness/impact of actions on patients Effective leadership not intuitive Must be nurtured/developed Important to incorporate strategies to promote resilience 5

6 All Nurses Are Leaders Authentic nurse leaders Consistently incorporate personal values into practice Build trustworthiness in relationships Demonstrate personal discipline Establish balance between extrinsic and intrinsic motivators (George,2014) Leadership development Typically consists of training, some development programs, limited mentoring (formal/informal) Excluding significant percentage of nurses from exposure to leadership development strategies is counterproductive (Rishel,2015) Incorporation of Mindfulness Strategies to Support Resilience Various strategies may be used Meditation, prayer, reflective exercises, yoga, discussions with other that are introspective Incorporating one, or more, supports Improves effectiveness in navigating daily care environment Calm, thoughtful approach organizational issues, difficult care challenges Self-awareness Self-compassion Where Do We Go From Here? Future studies on use of techniques to promote resilience Which strategies are most beneficial? Planning a study focused on oncology nurse perceptions of current work environment, components of healthy work space Be clear on focus of research know what you are working with 6

7 Challenge to Nurse Leaders Future Studies Consider changing work environment Staffing patterns Care delivery model Incorporating Zen breaks into work shift Schedule regular debrief sessions In addition to adding mindfulness education/techniques to nurse s toolbox References Connor, J. and Davidson, K.(2003). Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC). Depress.Anxiety, 18(1), Dyess, S. ML., Prestia, A.S., Marquit, D-E., and Newman, D. (2018). Self-care for nurse leaders in acute care environment reduces perceived stress: A mixed-methods pilot study merits furthers investigation. Journal of Holistic Nursing, 36(1), George,B.(2014). Mindful leadership: Compassion, contemplation and mediation develop effective leaders. Retrieved from Halm, M.(2017). The role of mindfulness in enhancing self-care for nurses. American Journal of Critical Care, 26(4), Jakel,P., Kenney, J., Ludan, N., Miller, P.S., McNair, N., and Matesic, E.(2018). Effects of the use of the provider resilience mobile application in reducing compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 20(6), Meyer, G. and Shatto, B.(2018). Resilience and transition to practice in direct entry nursing graduates. Nurse Education in Practice, 28,

8 References Ray, M.A.(1989). The theory of bureaucratic caring for nursing practice in the organizational culture. Nursing Administration Quarterly, 13(2), Rishel, C. (2015). The role of resilience and mindful leadership in oncology nursing. Oncology Nursing Forum, 42(2), 1-2. Rutter, M.(1987). Psychosocial resilience and protective mechanisms. The American Journal of Orthopsychiatry, 57, Schmidt, M. and Haglund, K. (2017). Debrief in emergency departments to improve compassion fatigue and promote resiliency. Journal of Trauma Nursing, 24(5), Tahghighi,M., Rees, C.S., Brown, J.A., Breen, L.J. and Hegney, D. (2017). What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review. Journal of Advanced Nursing, 73(9),