Calling all Nurses: Improving well-being with positive psychology strategies
Michelle Deroubaix, Nurse Educator, University of Wollongong
While working in a complex and diverse workplace such as healthcare, nurses develop a plethora of skills to achieve positive outcomes for their patients, while delivering dedication to their craft of nursing on a daily basis. As workforce pressures escalate and job vacancies reach crisis point, as the baby boomers retire from the profession, utilising strategies to nurture and improve well-being is a crucial initiative to build a workforce of nurses with strong psychological capital instead of a workforce likely to experience burnout and leave the profession all together.
Nurses can instead, improve both psychological and physical well-being and flourish with increased knowledge and awareness of HOW to shift their focus to improve their experience.
The following article will discuss and present available strategies that nurses can adopt to improve their own well-being by utilizing positive psychology.
Background of Positive Psychology
The birth of positive psychology can be traced to 1998 when Dr Martin Seligman a well-know psychologist, was appointed as President of the American Psychological Association (2000). Mainstream psychology had lost focus on creating opportunities to nurture gifted and talented people and influence general well-being; instead the focus was on treating and healing people with mental illness and people in crisis. This proved to be very beneficial in categorising mental health illnesses, and also gave a consistent treatment method to use depending on their diagnosis. Psychologists have been focused on fixing disorders and diseases that focuses on the negative side of life instead of looking at how people can live a rewarding and happy life (Lyubomirsky, 2010).
The benefits of improving happiness in the nursing workforce are multiple and can be seen to improve both psychologically and physical well-being. The research available presents the view that it not only makes you feel better but energy levels increase, your immune system is boosted, relationships improve, productivity at work is increased and you live longer (Lyubomirsky, 2011).
Boosting happiness is not only important for nurse’s personal wellbeing but also has a flow-on effect to colleagues we work with, patients we care for and family and friends we care about. But be warned improving happiness isn’t going to land in your lap, in fact you need to be prepared to take some action and do the work.
Where does happiness come from?
The research from Sonja Lyubomirsky (2010) and her colleagues was intended to identify the cause of happiness and the strategies for influencing it. This research resulted in developing a pie chart that clearly showed there was a set point to happiness and what part of that set point could be influenced.
According to the study of 50 % of our total score originates from our biological parents, and this was discovered from expanding research with identical and fraternal twin studies. A further 10% is influenced by life circumstances, for example living in varying economic circumstances from wealthy to needy; having a chronic health condition or good health; being married or divorced; or even being beautiful or plain in looks.
The last 40 percent was found to be undefined but related to our behavior and what were our daily intentional activities; and in this they found the opportunity to maneuver and influence happiness scores through how we think and what we do. The value comes from scutinising what behaviors happy people engage in and understanding how we can tap into and increase our happiness score.
The Power of Negative Emotion
Although positive emotions initially were the focus for understanding how to improve and increase well-being, some experts also say that every emotion can be useful. Kashdan and Biswas-Diener (2014) hold the perspective that it’s important to have ‘the ability to tolerate psychological discomfort’, refereed to by psychologists as ‘distress tolerance’ (viii).
When we talk about the negative emotions such as anger, this can cause you to defend your rights or the rights of your patient. Embarrassment is a sign of humiliation but also signals a small mistake that we must correct, such as a medication error. To feel guilt is not comfortable but can signal a moral code being violated and this motivates us to question our standards of care.
The recipe for success here is not only utilizing the positive emotions but achieving a balance of both positive and negative states to achieve and reach a state of what the writers call ‘wholeness’ (Kashdan & Biswan-Diener, 2014, p.ix). Working in healthcare as tensions rise in emergency and acute situations, it is important that nurses can handle a balance of negative and positive emotions for survival in this environment.
Emotional agility in nursing is an imperative that will sustain the workforce for the future. The capacity to experience mixed emotions in life in general has shown to have the greatest gains in improving well-being (Kashdan & Biswan-Diener, 2014). As humans come from the primate family they crave social interactions and social connections. The nursing workforce is a network of connection always working in teams and needing to support each other through critical situations. It is this network we lean on when difficult situations arise and nurses step forward and excel.
The benefits also of working in a caring profession are that displaying kindness to our patients can mean you live longer, earn more and are better personally but also the drawbacks is suffering from compassion fatigue so need to be selective as our time, energy and resources are limited (Kashdan & Biswan-Diener, 2015).
Let’s now look at the different types of happiness and how they contribute to overall well-being.
The difference types of Happiness
There are different types of happiness and these all contribute to your subjective well-being. Keeping in mind that other variables such as personality, pathways and circumstances can influence this.
Hedonic happiness – the kind that says ‘eat, drink and be merry’ known as the ‘hedonic treadmill’ always searching for the next hit of happiness.
Prudential happiness – the satisfaction that comes from a life engaged in what you do best and a life of activities that stop boredom and feelings of emptiness.
Eudemonic happiness – includes psychological well-being that strives for excellence, authenticity, meaning and flow with a purpose or a concern for others. “Living in a manner that actively expresses excellence of character and virtue’ (Haybron, 2000 p.3)
Chaironi happiness – blessing, joy and a feeling of awe, gratitude and a oneness with a spiritual guide such as God or one with nature.
The pursuit of these types of happiness is a personalone, as we search for our purpose in life. Let’s look at the powerful influence that psychologists call hedonic adaptation (Wong, 2011).
Human beings have an amazing ability to quickly accustom themselves to sensory or physiological changes to their circumstances. This very understand can influence what we do and how we think and can have a profound affect on our happiness levels. By understanding that hedonic happiness can only last a short time we can extend the effects of that by thwarting it, by using gratitude and positive thinking and slowing the effects of the adaptation process.
I will share a personal example with you. When I bought the car of my dreams, a black sports convertible I used to look at my car and say to myself “wow this is my car, I can’t believe it”.. It had been a life long dream to own a car like this, yet within a year I was complaining about the boot space, my two daughters couldn’t fit in the car with me, and I even stopped even putting the top down as I adjusted to this happiness boost. I finally, understood how we can be tricked into thinking that buying things can have a long lasting effect to our happiness.
But hedonic adaptation is also a very positive process when life circumstances result in illness or accident, as after time we adjust to the circumstances we find ourselves in and revert back to our happiness set point (Lyubomirsky, 2011).
Some practical ways to Thwart Hedonistic Adaptation and social comparisons in nursing (Lyubomirsky, 2010).
Savoring and thinking of how grateful we are for positive experiences we have helping patients that are vulnerable and working effectively as a team, can bolster self-worth and self-esteem as a professional.
Consider how we value our career in nursing and how this consistent work-flow supports our families and us financially.
The gratitude around how helping our patients cope with stress and trauma to them physically and psychologically when given a diagnosis that is life threatening or life changing gives us an appreciation of our own life circumstances.
Grateful nurses are more likely to help others and encourage moral behavior.
Being grateful builds social bonds, strengthens relationships and creates the capacity to nurture new graduates and generously give our knowledge and skills to our profession.
Expressing gratitude tends to thwart comparisons with others and results in a genuine appreciation and thankfulness for what we have.
Improving positive thinking is obviously important to increasing well-being.
Let’s look at one of the theories available to us to explain why it is possible to change how we think.
Broaden and Build Theory
Frederickson (2001) who spent many years developing this theory suggests that when people experience positive emotions like love, contentment, interest and joy it not only affects their present experience but also improves well-being over time therefore having an accumulating effect. Her theory is that when positive emotions are available these experiences ‘…broaden people’s thought-action repertoires’, which results in building personal resources both physical and psychological. In nursing broadening our thoughts and actions is essential in being inclusive to critical thinking and problem solving. Being more creative and open we are to possibilities helps us to think of innovative ways of doing things with the resources we have. The best results occur when we are in this mindset.
In Frederickson’s (2001) research she also specifies that there are also long term effects to positive emotions as they broaden thinking, which also builds enduring resources. This is very beneficial to nurses as they need to recover from stressful situations they experience and use reflective practice skills so they can develop knowledge and improve patient outcomes. Building resilience is a key strategy to remaining psychologically and physically fit.
In the profession of nursing and working in a dynamic industry such as healthcare it is necessary to build resilience in the face of challenges. Using positive psychology strategies and developing associated skills, can be one way to build inner strength and be able to bounce back from situations that are thrown at us (Wong, 2011).
To be able to recognize the difference between coping effectively it is also important to nurture the spirit in the nursing profession instead of choosing maladaptive coping that can affect managing stress accumulation and overwhelming us. Duckworth (2013) in here research on grit and determination says that these skills help in the face of failure or adversity and can build resilience over time.
Another useful activity to develop in the quest to build well-being is physical activity.
The joys and benefits of physical activity
The writer’s personal favorite is maintaining the pursuit of physical fitness has had many benefits to help you survive the rigors of nursing and the toll of a rotating roster. Although we are well aware that, the boost to endorphins is a benefit from exercise there are also the other effects of boosting self-esteem when achieving a training program and this increases confidence in one’s ability. Deciding to reach a goal and challenge ourselves with a fitness regime makes us feel in control of our bodies and our health in general (Lyubomirsky, 2011). Other benefits can be to focus our attention away from our worries and negative thinking and can give us time away from the stressful environment we work in. Another reason why physical exercise makes us happy is the opportunity for contact with others and the possibility of building close relationships which has been seen to be a key factor in improving well-being (Lyubomirsky, 2011).
Strategies to Boost Well-Being
Martin Seligman in his book Flourish (2011) has suggested instead of analyzing bad events and trying to avoid them, try some alternative actions to encourage well-being.
What-went-well exercise – Write down three things that went well today and why they went well. Set aside 10 minutes at night and do this exercise for a week.
Research shows that writing down a positive event, boost happiness and decreases feeling of depression.
Understanding your strengths – Values in Action (VIA) signature strengths test. You can do this test online at www.authentichappiness.org . When understanding your top five strengths find opportunities to use them more frequently and this can have many benefits.
This is who I am
Feeling of excitement and motivation
Creativity of learning new ways to use them
Understanding the confidence this brings when knowing more clearly where your strengths lie
Renewed zest, enthusiasm and joy while using them
Gratitude Diary – Writing in a diary daily of what you are grateful for.
When looking at the nursing profession as a whole and thinking of how the use of Positive Psychology strategies can make a difference to the challenges and stressors in this vocation, the writer highlights many great examples of how the understanding of positive and negative emotions can have an impact on the way nurses think and act in their profession to be able to nurture and build well-being. Nursing uses mainly the eudemonic style of happiness as over time excellence is achieved as a mastery in this profession and reaches a level of appreciation that is experienced deeply in the experienced professional nurse and also in the novice nurse who comes to nursing with a background in grounded theory and different eyes to see how this profession can be improved with evidence based practice as the benchmark for clinical excellence.
In this article only some of the amazing strategies have been shared that have been proved to be successful in other fields and can be easily transferred to the practice of nursing. There are many other positive psychology strategies that can be used to facilitate an environment of increased positivity to assist nurses in their plight to grow and flourish in this challenging and fantastic profession that already gives so much reward and happiness to the staff who work in it. I hope by reading this article you will feel more enlightened about the growing body of research in this area and also feel motivated to find out more about what you can change in how you think and act in this very privileged position of nursing in healthcare to truly flourish.
Frederickson, B.L (2001). The Role of Positive Emotions in Positive Psychology: The Broaden-and-Build Theory of Positive Emotions, American Psychologist, Vol. 56, No. 3, 218-226.
Haybron, D.M (2000). Two philosophical problems in the study of happiness. The Journal of Happiness Studies, 1, 207-225.
Kashdan, T & Biswas-Diener, R (2014), The Power of Negative Emotion, Oneworld, London.
Lyubomirsky, S (2011). The How of Happiness: A Practical Guide to Getting the Life you Want, Pistkus, Great Britain.
Perkins-Gough., D & Duckworth., A.L (2013). The Significance of Grit: A conversation with Angela Lee Duckworth. Educational Leadership. Vol. 71 Issue 1, pp14-20.
Seligman, M.E.P & Csikszentmihalyi, M (2000). ‘Positive Psychology: An Introduction’, American Psychologist Vol. 55 No. 1 5-14
Seligman, M (2011), Flourish: A Visionary New understanding of Happiness and Well-Being, Random House Australia, North Sydney.
Wong, P.T.P (2011). Positive Psychology 2.0: Towards a Balanced Interactive Model of the Good Life. Canadian Psychology. 52(2), p69-81.