We are in an unprecedented time in history with the coronavirus (COVID-19) pandemic. Nurses and other crucial healthcare providers are at the frontline navigating uncharted and uncertain territory. There are limited supplies, including personal protective equipment, and little is understood regarding the pathway to healing with COVID-19. As such, the management team at Nursology.net has decided to dedicate a series of blog posts to COVID-19 using nursing knowledge as our framework. We hope that with these posts you become more informed about the unknown, and also find some stability during these shaky times. Our first post is dedicated to you, the nurses, and your well-being by PhD candidate Chloe Littzen.

Conceptual Framework for Young Adult Nurse Work-Related Well-Being

As a PhD student, I focused my studies on understanding the well-being of nurses, while specifically emphasizing young adult nurses. Over time, and with the guidance of my trusty advisor and committee, I developed a conceptual framework on the work-related well-being of young adult nurses. This framework and its development are based on my philosophical perspective as an intermodernist (Reed, 1995; 2019), nursing and non-nursing theories (Benner, 1982; Kramer, 1974; Baltes, 1987), salient knowledge on nurse well-being (Paatalo & Kyngas, 2016), relevant nursing knowledge (Fawcett, 1993; Newman, 1992; Parse, 1987; Terry, 2018), and my personal experiences as a young adult nurse. While this is in-process work, this framework has the potential of being a practical tool for nurses’ looking for a resource to help manage their well-being in these uncertain times. 

For a quick refresher, a conceptual framework is a type of theoretical thinking that is abstract, broad in scope, and uses general concepts (Reed, 2018). Within my conceptual framework on young adult nurse work-related well-being there are four main concepts: 1) generational differences in philosophical worldviews; 2) perceived co-worker social support; 3) resilience; and, 4) young adult nurse work-related well-being. The takeaway message is these concepts may all have a significant role in our well-being as nurses. Additionally, there may be things that we can do to sustain and enhance our well-being with these concepts in mind; especially now when our well-being is more vulnerable than ever. So below is a beginning theoretical how-to guide for you to sustain and enhance your well-being at work during this time of unease.

A Theory Guided Approach for Nurse Work-Related Well-Being

1. We All Don’t See The World The Same Way

This proposition is based upon my concept of generational differences in philosophical worldviews. What this proposition infers is that while we would like to think as nurses we see the world the same way we don’t always.

This is not a bad thing and is quite normal in diverse groups such as the discipline of nursing (there are over 3.8 million nurses in the United States alone!). That being said, it can be stressful when you are faced with a situation where you and colleagues have a disagreement. 

So what can you do to aid these disagreements, especially in crisis times like now? Try these five easy steps:

Stop and take a breath. Everything’s better when you breathe, and you have to breathe to do whatever it is you need to do, even critical situations. Acknowledge your colleagues’ perspective. Whether you agree with it or not, meet them with kindness and respect. Ask your colleague to explain, when appropriate, why they think about the situation the way they do. If you can’t do this when the event occurs due to the criticality of the situation, ask them to talk afterward even if it is uncomfortable. Whatever happens, don’t harbor negative thoughts because of disagreements. This can not only be harmful to you but also those around you. Ask yourself how you have grown from this interaction. What did you learn? Will you do something differently next time you interact during a disagreement?

2. Put Your Oxygen Mask On First

I think this is something we all know intuitively, but because we are nurses (there are some similarities among us I think), we are often more concerned about helping those around us than ourselves. While this is a wonderful character trait, this often leaves us depleted and burned out, ultimately negatively impacting our well-being. So this proposition is focused on building your resilience capacity, where every day you put your oxygen mask on before stepping out the front door.

How do I do that? 

First and foremost identify something that makes you happy.
Not your family member, not your friend, you. 

You can call this self-care, but whatever it is it has to make you happy and you have to take time out for it. Everyone is different but ask yourself, what works for you? Every day select an amount of time that fits your schedule, whether 5, 20, or 60 minutes, and block it off on your calendar. Treat it like an appointment with your boss, do not break it. Be bigger than your biggest excuse and show up for yourself. If you need to, talk to your family about how you are feeling and see how they can support you during this time. 

So to refresh, here are four steps for you to build your resilience capacity:

Identify what makes you happy. Alternatively, if you are so depleted that you can’t think of something that makes you happy, try something new! For Example: Start a daily yoga practice using an online platform (follow the link to a 14-day free trial). Try a daily meditation using an app. Read a non-work related book, even a page a day counts. Go outside (while practicing appropriate physical distancing) for a walk. Decide upon an amount of time you can dedicate to yourself every day. Schedule an appointment on your calendar Show up, every day, even when you don’t want to.

3. We All Need to Feel Supported

One of the biggest take-home messages about nurses’ I learned while pouring over the well-being literature is that we need each other, and we need to feel supported. Nurses seem to do better in every organizational outcome if they feel supported by their colleagues and management, which during times of crisis can easily crumble. So what can you do to help yourself feel supported, and simultaneously help your colleagues feel supported?

Find an accountability buddy!

What is an accountability buddy? This is a person that supports you in your well-being, while you simultaneously support their well-being. If you are currently working in the hospital or clinic, this should be a person at your place of work, and optimally each shift you work. If you cannot identify an accountability buddy at work, then identify someone outside of work that you can talk to after your shift. Lastly, if you’re in quarantine or physical distancing (otherwise referred to as social distancing, but more on that at a later time), identify a colleague who you can talk with throughout the day from home over email, texting, or a chat app such as WhatsApp or MarcoPolo. Just because you’re at home doesn’t mean you don’t need support. 

So what do I do with my accountability buddy?

Below are some suggestions to promote support during these uncertain times. But take the time to ask yourself what you need, and also ask your buddy what they need, and then revise as you learn more about each other!

In the Work Environment	Physical Distancing or Quarantining	After Work
Check-in with each other at the beginning, and throughout your shift. Ask each other how you are doing. Advocate for each other to take breaks and lunch, when appropriate. Promote a work environment where you both have someone to talk to if you feel anxious or overwhelmed. Look out for each other to make sure you’re not taking on too much responsibility. Give kudos to each other for positive well-being behaviors (e.g., you did yoga today, that’s so great!).	Send each other a daily message and ask each other how you are doing. Advocate for each other to take scheduled breaks and lunch. Promote a space where you both have someone to talk to if you feel anxious or overwhelmed. Share your daily goals with each other, both work and self-care related. Check in to see how you are both progressing through the day. Give kudos to each other for positive well-being behaviors (i.e., you went outside for a walk today, that’s great!)	Check-in with each other after work and share how you are doing over the phone, FaceTime, or Zoom. Reflect on how you took care of yourself today, did you take time for yourself? Did you take a break or lunch? Make a well-being goal for the next day at work. Ask your buddy if this is realistic and achievable, and reform as needed. Check-in daily regarding your well-being goals. Give kudos to each other for positive well-being behaviors (i.e., you asked for help when you needed it, that’s awesome!)

Where to start? 

We are all different, and one of these propositions may have spoken to you more than the others. Start there! Maybe you are already doing one of these suggested, if so, keep it up and try another suggestion to see if it help even more. Above all, just do something! As nurses, our well-being is a critical piece to making it through this difficult time, not just for ourselves, but for everyone on this planet. Change is never easy. We can’t go back and start a new beginning, but we can start today and make a new ending.

Stay safe and please take care of your well-being. 

References

Baltes, P. B. (1987). Theoretical propositions of life-span development psychology: On the dynamics between growth and decline. Developmental Psychology, 23(5), 611-626. https://doi.org/10.1037/0012-1649.23.5.611

Benner, P. (1982) From novice to expert. The American Journal of Nursing, 82(3), 402-407. https://doi.org/

Fawcett, J. (1993). From a plethora of paradigms to parsimony in worldviews. Nursing Science Quarterly, 6(2), 56-58. https://doi.org/10.1177/089431849300600202

Kramer, M. (1974). Reality shock: Why nurses leave nursing. The C.V. Mosby Company.

Newman, M. A. (1992). Prevailing paradigms in nursing. Nursing Outlook, 40(1), 10-13.

Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. A. (2008). The focus of the discipline revisited. Advances in Nursing Science, 31(1), e16-e27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

Parse, R. R. (1987). Nursing science: Major paradigms, theories, and critiques. W. B. Saunders Company.

Paatalo, K., & Kyngas, H. (2016). Measuring hospital nurses’ well-being at work – psychometric testing of the scale. Contemporary Nurse, 52(6), 722-735. https://doi.org/10.1080/10376178.2016.1246072

Reed, P. (1995). A treatise on nursing knowledge development for the 21st century: Beyond postmodernism. Advances in Nursing Science, 17(3), 70-84. https://doi.org/10.1097/00012272-199503000-00008

Reed, P. G. (2018). A philosophy of nursing science and practice: Intermodernism. In P. G. Reed & N. B. C. Shearer (Eds.), Nursing knowledge and theory innovation: Advancing the science of practice. Springer Publishing Company.

Reed, P. G. (2019). Intermodernism: A philosophical perspective for development of scientific nursing theory. Advances in Nursing Science, 42(1), 17-27. https://doi.org/10.1097/ANS.0000000000000249

Terry, H. (2018). Critical inquiry into philosophical perspectives underlying nursing research on acute coronary syndrome [Unpublished doctoral dissertation]. The University of Arizona.