The Concept of Self-Care and Personal Resilience

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INTRODUCTION

The purpose of this paper is to discuss the concept of self-care, personal resilience and its significance for experience of burn-out during my psychology training and work related practice. This reflective triangular paper will utilise an introspective methods designed introduced by Gibbs (1988) and in line with Bettney (2017) reflective approach during clinical training. I will review the theoretical as well as evidence based literature in collaboration with my personal encounter of those three phenomena's within my professional experience in acute hospital working as adult general nurse.

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Working as a nurse for fifteen years in different clinical setting made me aware that nursing profession face multiple challenges. One of them is global shortage of nurses and ageing population on local and global level (World Health Organisation, 2018) and building personal resilience skills was argued as one of the most effective way to retain nurses in the health profession (Ang et al., 2018). Emerging evidence suggest that healthcare especially in United Kingdom is heavily shaped by expectations from society demanding high?quality care with fewer resources (Frampton, Guastello & Lepore, 2013).

Burnout among front line services including nurses is a complex problem, negatively affecting both caregivers and healthcare organizations. As argued by Steffanina (2014) one of the ways to significantly improve the situation is by implementation of the knowledge that is filtrated from multiple sources. The wealth of information will act in dichotomous way; to improve the therapeutic alliance and act as a catalyst developing successful working relationship and as prevention from the burn out. On the other hand endorsement of character strengths may be a bridge between satisfaction from work and strategically implemented intervention effectively targeting work related burnout (Steffanina, 2014).

RESILIENCE

Resilience as a concept is a novelty and notoriously difficult to pin down not only in measurement (Vanhove, Herian, Perez, Harms & Lester, 2016) but in definition (Harm & Wood, 2016). It is important to look at resilience as learnable and adaptable skill allowing people to bounce back when they face adversity, conflict, failure and take responsibility for their own action (Imani, Kermanshahi, Vanaki amd Kazemnejad Lili, 2018). American Psychological Association (2014) defined resilience as adapting process when facing stress, adversity, trauma or tragedy. Narender and Joshi (2016) suggested that resilience could be used as a predictor of mental health. When looking at resilience it is important to look at it as a complex phenomenon derived from multilevelled interaction among cultural, genetic, demographic, social, developmental variables (Southwick & Charney, 2012). Research in field of neuropsychology provided striking evidence about neuroanatomical inheritance, people with more superior resilience skill have larger lateral prefrontal cortex (Shaw, 2016). As reported by Joslyn (2015) foundation of resilience is set up in childhood by focusing on positive and cognitively developed skills allowing to navigate effectively through life challenges and described as key factor for successful transition in life.

An early resilience?based approach may be the buffer and protective factors when facing workforce stress and improvement of job satisfaction not only for nurses (Ang, Uthaman, Ayre, Lim & Lopez, 2019). Current up to date research have found that resilience helps nurses effectively to reduce the effects of stress and burnout and was suggested that one of the most effective way to build resilient traits among health care professionals is by providing support and encouragement with courses or training allowing the skills to be build and most importantly stop people from leaving the care industry (Yu, Raphael, Mackay, Smith & King, 2019). Resilience was considered responsible for restoring emotional equilibrium, by intelligent adaptation to challenges of the workplace and positively predicting employee performance and well-being (Nielsen et al., 2017). Current research indicates that workplace bullying is one of the most harmful social stressors in organizations and can be the answer for the burnout of the people working in the care workforce (Tr?panier, Fernet, & Austin, 2013).

Resilience played a moderate positive role on psychological health and work related burn out (Garc?a-Izquierdo, Meseguer de Pedro, R?os-Risquez & S?nchez, 2018), because resources as resilience help to cope better with detrimental impact of stressful job by buffering the negative influence on health (Bakker, & Demerouti, 2017). Nurses who mastered the skills of resilience were able to maintain assertiveness at work with good sense of humour, positive outlook and ability to self-regulate (Cope, Jones & Hendricks, 2016). As suggested by Lin et al. (2018) dissatisfaction with the job within the nursing background is not a new one but in the recent years become more alarming as there is dangerously high turnover of newly qualified nurses and ageing population globally. They recommended that the changes improving the nursing experience should come from the institutional and human resources enterprise and should aim for comprehensive support system to enrich professional growth and commitment, work related enthusiasm, job satisfaction, solidarity and cohesion (Lin et al., 2018).

In the end of the day places like hospitals are managed as businesses; environment where unfortunately employees are not perceived as valuable enough part of the business. However, this is not consistent when looking across different wards; it is about the human factor, managerial skills and knowledge which makes such a difference not only on the morale of the team, but reflecting positively on job satisfaction, and resilience skills.

It is important to outline that most of the previous studies were conducted in homogenous populations and this create a general threat for generalizability to a multicultural and multi?ethnic country like United Kingdom.

That said, no single theory can captures all the nuances and provide full conceptualisation of the triangulated aim of the paper. As much as theory is useful in terms of providing information and effectively explain the nurturing problem there is still a big gap between real life application and main assumption of theory.

BURN OUT

Effect of burn out on employees within care setting is a serious problem manifesting in the form of anxiety, depression, insomnia, tiredness and in the worst scenario forcing highly trained staff to leave the job. Current data is alarming as burn out is effecting 21-67% of people working in health care sector (Dreison, White, Bauer, Salyers & McGuire, 2018). One of the most concerning issues in terms of hospital environment especially in acute setting is to understand the unpredictability of patient's conditions who will come for treatment to hospital, which will have tremendous impact on the resources and the service. These is why the idea of self-care of the health care professionals can be left on the doorstep in the moment nurses and other working colleges enter the hospital because they have duty to care after patient. ???

It is obvious that National Health Service (NHS) operating in United Kingdom is a public service and continue to strive for delivering the best services with fewer resources like staff and for less money allocated from the government into care effecting the health, well-being and fitness to practice and leaving no space for effective self-care and automatically employees paying the ultimate bill for it (Bettney, 2017). This is why at some stages nurses make decision to either leave the work or changing qualification to do something less detrimental to their general health.

One of the ways to explain the emotional and psychological disequilibrium of nurses and other health care professions come from Beck's (2008) cognitive schemas as representations of past experience, guides, rules to assist with future conceptualisation of the problem. This goes in line with Bettney (2017) highlighted the conceptualisation of 'putting others need before your own' as the most logical solution to why it is so hard to even encourage health worker to look after their own mental health as this never was a part of the main employment agenda. On the other hand, health care workers do not look actively for help, because they do not perceive they have a problem as they are at work to help, they do not think they are the one who need help neither and so on.

One of the way of explaining burn out will be by utilising self-determination theory (SDT) (Deci & Ryan, 1985) identifying basic human needs essential for psychological health with job demands-resources theory (JD-R) by Baker and Demerouti (2007) providing framework for understanding job burn out within the workplace.

SELF CARE

Self-care is a contemporary term relating to individual views and strategies aiming to improve own health by implementation of physical activity, home remedies, spiritual practice and medications (Arman & H?k, 2016). As suggested by Eriksson (2007) acts of compassions are the ethical building blocks of love and they are in the centre of caring profession and humans naturally quest for love in life. Caring profession more than others need attention on the balance as their ethical principles and code of conduct is more focused on self-sacrifice than self-care so they are more likely to running down their resources if they do not have the support and help available if needed. It is interesting how Buddhist philosophy and Christian ethics can be a valuable resources when managing self-care and preventing work related burnout (Pembroke, 2016) by offering universal and disinterested love, but difficult to achieve as most of caring jobs become regulated by external bodies as they are paid for delivering the service. However, there is a danger assuming that working in caring profession will produce self-caring individuals, emerging evidence suggest to be counter-productive.

One of the reasons for this to happen is simple by ignoring their own needs as working in demanding environment are a challenge to start with. One of the most striking conclusion emerging from this observation is that majority of people working in caregiving industry had knowledge about health but this did not lead reflect in their own health (Arman & H?k, 2016). Maybe this is why those kind of reflective papers are important in bridging the gap between theory, reality and expectations making space for successful relationship between those resources.

One of the way to effectively address the issue of sabotaged self-care as argued by Arman and H?k (2016) will be to create the thriving environment where self-care become a foundation and the expected experience of meaningful and good life within the caring professions.