Your Well-Being as a Nurse and the COVID-19 Pandemic

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: 
  1. 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.
  2. Acknowledge your colleagues’ perspective. Whether you agree with it or not, meet them with kindness and respect.
  3. 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.
  4. Whatever happens, don’t harbor negative thoughts because of disagreements. This can not only be harmful to you but also those around you.
  5. 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

Nourish to Flourish

Image by @dlhamptom

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: 
  1. 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.
  2. Decide upon an amount of time you can dedicate to yourself every day.
  3. Schedule an appointment on your calendar
  4. Show up, every day, even when you don’t want to.  

3. We All Need to Feel Supported

Grow Together

Image from @dommaraju

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.

An Update from the Nursing Theory Collective

Welcome to Chloe Olivia Rose Littzen, who has now joined our
Nursology.net blogging team!
Chloe is a founding member of the
Nursing Theory Collective and
currently a PhD Student at the University of Arizona (Tuscon)

I. Introduction

In June of this year, a blog post was shared on Nursology.net by the Nursing Theory Collective, a group of scholars and students with a mission to advance the discipline of nursing/nursology through equitable and rigorous knowledge development using innovative nursing theory in all settings of practice, education, research, and policy. (Visit that post here). We are using the term nursing/nursology as at this moment in time as we continue to have discourse on the exact word choice we will use to characterize ourselves as a collective. 

To review, the Nursing Theory Collective was formed after the landmark conference, “Nursing Theory: A 50 Year Perspective Past and Future”, on March 21-22, 2019 at Case Western Reserve University. Since May, the group has met monthly to further discuss pivotal issues related to nursing theory and the identity of nursing/nursology, define their mission and vision statement, and to establish action items to drive their vision forward. Currently, the Nursing Theory Collective has 45 members from around the world including Canada, China, Colombia, and the United States, promoting a global perspective of nursing and nursing theory. 

To promote global connectivity, the Nursing Theory Collective created a WhatsApp (https://www.whatsapp.com) group for an easily accessible format that members in other countries can easily connect via their smartphones. In this WhatsApp group, members discuss pertinent issues related to nursing theory and the identity of nursing, sharing articles, actions in progress, or reminders for actions that evolved from previous meetings. Our meetings have been hosted via Zoom Video Conferencing (https://zoom.us) which enables access to participate in most countries, and has allowed us to record all meetings for future reference. A shared Google Drive was also created, enabling all members to have access previous document, to assist in the development of future action items, and to collaborate in real time. 

II. Updates 

To date, the meetings for our collective have revolved around discussions on actions items that can be taken to move the discipline of nursing and nursing theory into the future. In order to accomplish our collective goals, we have been working to define our mission, vision and values, and establishing logical action plans in the forms of scholarly writing and policy letters. In the following paragraphs, you will find a brief synopsis of all the action items that are in progress or completed. 

Mission, Vision, and Values. We have been working diligently on defining our mission, vision, and values as a collective. We recognize that this is a work in progress. We have been inspired by the vast body of prior nursing knowledge and theory work in the United States and abroad, as well as our individual philosophies of nursing. Guiding our mission, vision, and values is a concise definition of nursing theory first advanced by a working group of international nurse theorists, who proposed that nursing theory is simply “a description of what is going on” (Petrovskya, Purvis, & Bjornsdottir, 2019, p.2). Petrovskya, Purvis, and Bjornsdottir’s (2019), elegant definition, adopted from Rolland Munro, invites nurses to engage ideas beyond the theoretical paradigms most familiar to nurses educated in the United States. As this is an ongoing and open process, we invite you into the discussion and to add to our mission, vision, and values.

King Conference. In June 2019, the Nursing Theory Collective submitted an abstract that was accepted to the upcoming King Theory Conference in Washington, D.C. (King International Nursing Group, 2019). The topic of our abstract is, “Driving the Future of Nursing: A Collective Approach to Nursing Theory.” We look forward to being a part of this landmark conference. We plan to arrange a meeting of the Nursing Theory Collective at the King conference, and we welcome all members and non-members to join us for important discussions in driving nursing and nursing theory into the future. We will post details about the time and place for this get together as the date gets closer. One action item of this in-person meeting at the King Conference will be to continue the debate surrounding the adoption of the term nursology to characterize ourselves. 

III. Collaborative Efforts 

As we are a collective, we understand the importance of branching out and collaborating with individuals and groups to enable us to accomplish our mission and vision. To date, collaborative efforts have been placed into two categories: 1) Nursology, and 2) policy items related to nursing education and the future of nursing. Below is a brief synopsis of both of these efforts. 

Nursology. In 2015, Dr. Jacqueline Fawcett presented a case for changing the name of nursing to nursology (Fawcett et al., 2015). A variety of nursing scholars have echoed support for this change, but others have been questioning how this impacts on the discipline as we know it (Parse, 2019). To be mindful of all members views, we held an anonymous survey in June – July 2019 to adopt the term Nursology in our name, mission, vision and values. A total of eighteen votes were received, with 11 (61.1%) in support of adopting Nursology, and 7 (38.9%) in opposition. Members also had the option to write-in anonymously a rationale for their vote, and a variety of comments were received. For example, one member who was in support of the adoption asked “if there was an opposition for the collective to have an open discussion as to why this was.” Concerns that were raised by members in opposition included the marginalization of practicing and non-academic nurses, the validity and legitimacy of the term, and the belief that Nursology should be a term reserved for higher degrees in nursing such as the PhD. Supporters of the adoption argued that the term Nursology, while radical, would improve the strength of the identity of nursing, and has powerful implications for the general public and legislation.

Prior to the results being discussed, Dr. Fawcett kindly agreed to participate in our meeting where we discussed the adoption of the term Nursology, as well as the rationale for members in support or opposition. With this discussion, members had opportunities to further voice their opinion, and ask important questions related to the term and its meaning. For example, one member asked for whom the title nursologist should be reserved. Dr. Fawcett and other members designated the adoption of the term nursologist for all members, who have passed their licensing examination and are a registered nurse. At the end of the meeting, it was proposed as the group was undecided to adopt the term nursology into the mission, vision, and values, but also include nursing. We thank Dr. Fawcett for her involvement, and plan to keep the Nursology group updated as we move forward. Our next discussion on this topic will be in November at the King Conference in Washington, D.C.

Policy Items. In July, two members of the Nursing Theory Collective participated in a Zoom meeting with board members from the American Holistic Nurses Credentialing Corporation (AHNCC, 2019). The purpose of this meeting was to begin a discussion and collaborate on a campaign to express the need for nursing theory to be a core part of the current educational essentials, as they are being revised by the American Association of Colleges of Nursing (AACN) and the National Council of State Boards of Nursing (NCSBN). Action items from this meeting included the development of two letters focused on the educational essentials, as well as the revising of the National Council Licensure Examination for Registered Nurses (NCLEX-RN). To date, the letter to the AACN has been completed and is pending to be emailed out to key members of the essentials committee. After this, we plan to submit this letter for publication to spread the word of this important change that may impact the future of nursing. Our next step will be devising the letter the the NCSBN, we invite anyone who is interested in participating in developing this important letter. We thank the AHNCC for collaborating with us on this important project, and support them in their work as they promote a more holistic space for nurses to practice globally. 

IV. Future Efforts

While we have a significant to-do list as follow up from previous efforts, we continue to strive towards future actions in order to drive our vision for nursing and nursing theory into the future. We intend to remain vigilant about the AACN essentials, the NCSBN revision of the NCLEX, and will continue our activism aimed toward promotion of nursing theory at all levels of education. Our future actions include continuing our monthly meetings to have open discourse on the topic on nursing and nursing theory, we invite all members and non-members alike to participate. Additionally, we plan to write and submit manuscripts focused on demystifying nursing theory for practicing nurses and the educational environment. We welcome any and all ideas on how we can move forward with our goals, and hope that you would consider being a part of this movement. 

V. Conclusion and Invitation – Join us!

The next meeting for the Nursing Theory Collective is August 27th, at 2:00 PM Eastern Standard Time. We encourage all nurses and students, regardless of setting, experience, or educational level, to join us by contacting clittzen@email.arizona.edu to participate. If you are interested in joining the WhatsApp group, please email us to let us know and we will add you promptly. We also have a twitter handle, @NursingTheoryCo, and you are welcome to follow us as we plan future social media events. We plan to continue to update the community here on Nursology.net to keep everyone informed, as well as promote a movement of inclusivity to drive nursing and nursing theory into the future.

With gratitude,
The Nursing Theory Collective

References

American Holistic Nurses Credentialing Corporation. (2019). About AHNCC. Retrieved from https://www.ahncc.org/about-ahncc/

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., . . . Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28(4), 330-333. doi: 10.1177/0894318415599224

King International Nursing Group. (2019). Events. Retrieved from https://kingnursing.org/content.aspx?page_id=4002&club_id=459369&item_id=976945

The Nursing Theory Collective. (2019, June 18). Moving Towards the Next Fifty Years Together [Blog post]. Retreived from https://nursology.net/2019/06/18/moving-towards-the-next-fifty-years-together/

Parse, R. R. (2019). Nursology: What’s in a name? Nursing Science Quarterly, 32(2). doi: 10.1177/0894318419831619

Petrovskaya, O., Purkis, M. E., & Bjornsdottir, K. (2019). Revisiting “Intelligent Nursing”: Olga Petrovskaya in conversation with Mary Ellen Purkis and Kristin Bjornsdottir. Nursing Philosophy, 20(3), e12259. doi: 10.1111/nup.12259.