Correctional Nurse Self Care: Resilience

 

 

Peligro, cuerda rotaLast week’s commentary on the burden of moral distress brought forth the concerns and experiences of several more correctional nurses. Each of these courageous nurses described a turning point where they chose to act rather than stay silent and address the needs of their patients; each also paid a price, including termination, depression, failing health and so forth. I too, had to leave a position I had been in for 17 years because I was “in the way” of achieving the cost savings the organization had promised. This past year I witnessed a colleague being walked off the job because while she was trying to improve nursing practice she didn’t have the full support of the facility health authority. These are tremendous consequences for nursing professionals committed to quality patient care. One nurse commented that it is “easy to blame the nurses that are working with the inmates daily” rather than look up the chain of command to the organization itself and the managers responsible for the delivery of services. These experiences and the accompanying reality are the reason resilience has been identified as an essential quality to nurture as part of the caring practice of the nursing profession (Tusaie & Dyer 2004, Hodges et al. 2005, Warelow & Edward 2007).

Resilience refers to the ability to bounce back or recover from adversity (Garcia-Dia et al. 2013). Others describe resilience as the ability to grow and move forward in the face of misfortune or adversity; to adapt to adversity while retaining some sense of control and moving on in a positive manner (Jackson, Firtko & Edenborough 2007). Resilience has been suggested as a strategy for nurses to manage the emotional and physical demands of caring for patients as well as reduce their vulnerability to workplace adversity (excessive workload, organizational restructuring, lack of autonomy, bullying and violence).

The good news is that resilience is not a personality trait, that we either have or not, but instead consists of behaviors, thoughts and actions that can be developed and fostered to strengthen and adapt to our circumstances. Strategies that help build personal resilience include:

Professional relationships which are supportive and nurturing

A key component in the lives of resilient people is positive social support; having one or more people in the profession who are role models and can be called upon for guidance and support when needed. At least some of these individuals need to be from outside the immediate workplace so that support is unbiased and safe to receive, especially when the workplace is laden with tension. Another feature is that the relationship needs to be nurturing and one that fosters offers encouragement, reassurance, and individual professional growth; such as a mentoring relationship. In thinking about this, my professional network was developed among the members of the Oregon Chapter of the American Correctional Health Services Association. We meet twice a year and each meeting includes training, social time and the opportunity to discuss the workplace challenges we each struggle with. The relationships built through this local organization with other correctional nurses over the years have sustained me during many periods of crisis and change.

Maintain positivity

Positive emotions, including laughter, increase energy, change perceptions and help cope with adversity. Positivity comes from optimism or an ability to visualize potential benefits or positive aspects of an adverse situation. Considering a situation in a broader and longer-term perspective can build optimism. Indeed forcing oneself to think positively develops a greater range of resources and broadens the inventory of possible solutions in the midst of adversity (Jackson, Firtko & Edenborough 2007). The readers’ comments about their experiences with moral distress express an optimistic and positive view that reaching out to each other will create a collective voice to improve conditions in correctional health care. Techniques suggested to support positivity include visualizing what one wants rather than what is feared, identifying what brings joy to one’s life, maintaining hope for a positive outcome and laughter.

Develop emotional insight

Emotional insight is the capacity to identify, express, and recognize emotions; to incorporate emotions into thought; and to regulate both positive and negative emotions. When faced with adversity, emotion is inevitable, however we often are focused on the “who, how, what, when and where” of what is happening; unaware of how emotion is effecting us. When we can identify our emotional response to a situation we can switch our parasympathetic nervous system on and respond in a calm and rational manner and not suffer the effects of a “fight or flight” response. Understanding our emotional needs and reactions provides further insight into how we cope and may yield new ideas about how to improve our response in the future. Specific techniques suggested to develop emotional insight are relaxation exercises, guided imagery, meditation, deep breathing, journaling and reflection. See an earlier post about the use of reflection for professional growth.

Achieve life balance and spirituality

Highly resilient persons express existential beliefs, have a cohesive life narrative and appreciate their own uniqueness. This has also been described as having an anchoring force in life. In nursing, we often use the term achieving a work-life balance which is to engage in activities that are physically, emotionally and spiritually nurturing. This includes being clear about our mission in professional life, the reason for being a correctional nurse, so that we aren’t distracted in challenging times. Activities that support a balanced life include getting enough sleep, eating healthy, regular exercise, and maintaining a spiritual practice. You may want to revisit a recent post introducing self-care for correctional nurses. Another suggestion is to write and then send a letter to yourself recognizing your strengths and expressing gratitude for the work that you do.

Reflective practice

Reflection is a way to develop insight and understanding about situations so that knowledge is developed and can be used in subsequent situations. A concrete experience, such as losing one’s job or experiencing an ethical dilemma is used as a catalyst for thinking and learning. Journaling is especially helpful in adult learning because putting an experience into writing ascribes meaning to the people, places and events involved in the experience. Reflection is an opportunity for self-discovery; many people report better relationships, greater personal strength and self-worth, a deeper spirituality and heightened appreciation for life as a result of the self-growth that takes place after adversity. One of our readers said exactly that… “I have learned so much about myself, and systems change, and leaders vs managers.” I have to agree based upon my own experience; I am a stronger, more skilled professional than I ever was and have more to give others as a result of the self-discovery that took place after leaving, so long ago, a job I loved.

 

No one wants to experience workplace adversity and professional burnout and yet we know from our own experience and those of our readers, it is a reality in correctional nursing. Recognizing and building resilience personally and within our organizations is a strategy that is becoming part of the profession’s uniform. Below are several excellent resources for developing nursing resilience:

  1. Resilient Nurses: How health care providers handle their stressful profession. Written and produced for Public Radio. Consists of two ½ hour interviews with several leading nursing experts. The second segment includes techniques used to handle unusual strain as well as everyday stressors in nursing. It also includes a relaxation audio, a booklet, a CD and a list of resources.
  2. How can nurses build resilience and master stress? A summary of a 16 week series on Activating Resilience in Nursing and Leadership by Cynthia Howard. Links are included to other posts in her series on resilience.
  3. University of Virginia School of Nursing, Compassionate Care Initiative, is dedicated to teaching nurses resilience and compassion in health care. The site includes a link to “nurses thrive!” an online community of nurses dedicated to promoting resiliency. Also includes resources for building resilience through guided practice and exercise.

Do you recognize aspects of your own path to professional resiliency in these descriptions? What has helped you adjust or rebound from adversity? Please share your experiences or advice by responding in the comments section of this post.

References:

Garcia-Dia, , J., DiNapoli, J.M., Garcia-Ona, L., Jakubowski, R. & O’Flaherty, D. (2013) Concept Analysis: Resilience. Archives of Psychiatric Nursing 27; 264-270.

Hodges, H.F., Keeley, A.C., & Grier, E.C. (2005) Professional resilience, practice longevity, and Parse’s theory for baccalaureate education. Journal of Nursing Education 44, 548-554.

Jackson, D. , Firtko, A., & Edenborough, M. (2007) Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: A literature review. Journal of Advanced Nursing.

McGee, E. M. (2006) The Healing Circle: Resiliency in Nurses. Issues in Mental Health Nursing 27; 43-57.

Sieg, D. (2015) 7 Habits of Highly Resilient Nurses. Reflections on Nursing Leadership 41 (1).

Sullivan, P., Bissett, K., Cooper, M., Dearholt, S., Mammen, K, Parks, J., & Pulia, K. (2012) Grace under fire: Surviving and thriving in nursing by cultivating resilience. American Journal of Nursing, 7 (12).

Tusaie K. & Dyer J. (2004) Resilience: a historical review of the construct. Holistic Nursing Practice 18, 3-10.

Warelow, P. & Edward, K-l. (2007) Caring as a resilient practice in mental health nursing. International Journal of Mental Health Nursing 16, 132-135.

 

For more on moral distress and courage see Chapter 2 Ethical Principles for Correctional Nursing in the Essentials of Correctional Nursing. You can order a copy directly from Springer Publishing and receive $15 off as well as free shipping by using this code- AF1209.

Photo credit: Peligro, cuerda rota@alejandro dans- Fotolio.com

 

Caring in Correctional Nursing: Another Example

This guest post by Patricia Rolling, RN, is taken from her submission to the 2013 Correctional Nursing Celebration Essay Contest.

sunflowers grow in the prison in front of the barbed wireI remember on my first day of nursing school my classmates and me being asked what type of nursing we wanted to practice. I remember some of my classmates answering “pediatrics” and “mother/baby”; after all, babies are cute. The adrenalin junkies in my class answered “ER” or “ICU”. What I don’t remember is answering “correctional nursing”. That’s probably because I didn’t. I didn’t know what correctional nursing was. Fast forward to today and I can’t imagine myself doing anything else. All too often, nurses that choose to practice correctional nursing are viewed by their peers as misfits that somehow can’t make it anywhere else. This is so untrue!

It takes a special level of caring to be able to provide care for those people that society has deemed unworthy.   There is more to nursing, though, than just caring and the prison environment makes some of those other aspects a bit more challenging. Privacy is virtually impossible to come by in an environment where safety is and must be the primary objective. The nurse/patient relationship works best when it is one of equality and mutual respect. The inmate/correctional officer relationship by its very nature is one of inequality and hierarchy.  B. Jaye Anno states in her book Correctional Health Care   “The purpose of medicine is to diagnose, comfort, and cure; the purpose of correctional institutions, although sometimes rehabilitative, is to punish through confinement.” (B. Jaye Anno, 2001) In order for these two diametrically opposing concepts to coexist, a correctional nurse must have a strong, personal and ethical commitment to the patients she cares for. She must be committed enough to her patient’s welfare to be able to advocate for them when their needs and those of the correctional personnel are in conflict with one another.

The third element of Watson’s Transpersonal Caring states, “Care is authentic presence where the nurse honors the patient’s dignity and vulnerability.” Nowhere is this more evident than when working in the Receiving Room. In Delaware, where I practice, we have a jail/prison system. What that means is that because there are no county jails, when I see a patient in Receiving they have been in the custody of the State or local police for perhaps 6-8 hours. They are feeling scared, overwhelmed and very vulnerable. Within the few short minutes after their arrival and before they meet with me, they have been fingerprinted; strip searched and assigned a number that will effectively serve as their identity for the remainder of their stay in prison. In other words they have been stripped of their human dignity. Then I come along and ask them very personal questions such as have they ever been the victim of sexual or physical abuse, as well as asking whether they drink alcohol or do drugs. In order to get the honest responses that will allow me to render the appropriate level of care, I have to quickly establish a rapport that makes it clear that I can be trusted. I have a very short period of time to make it understood that I am NOT security and that what they say to me will be held to the same level of confidentiality as if we were in a hospital or a private doctor’s office. Since I am the first person from the medical department that they have any contact with, it is imperative that I set into motion a relationship based on honesty and respect that will last as long they are in custody. At the same time I have to make it clearly understood that I will not be manipulated or used by them to achieve their own personal goals. It is definitely a fine line to be delicately trod.

I have learned, and am still learning, how to give the level of caring, compassionate and medically appropriate care that I want to give and that my patients deserve to be given while also maintaining the necessary professional distance and keeping the necessary degree of personal safety. Which brings us back to the original question, “Do Correctional Nurses Care?” While I can’t answer for any other correctional nurses I can say unequivocally “This correctional nurse does”!

RollingPatricia Rolling, RN, is a relatively new correctional nurse having started at James T Vaughn Correctional Center in Smyrna Delaware just over a year ago. She has rotated through several positions at the facility and is currently the 11p-7a clinic nurse. She most enjoys working in intake where she is able to set the stage for the new inmate’s relationship with the correctional medical staff. Her next goal is to attain CCHP certification this summer.

Read more about caring in correctional nursing practice in Chapter 2: Ethical Principles for Correctional Nursing from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

Photo Credit: © vipatter – Fotolia.com

Reflective Practice: A Means of Professional Growth

Catherine snapping the Bean in Chicago 10 2008In last week’s post the use of reflection was suggested as a means to improve skill and competency in conflict management.  In this post we will take a closer look at this technique. Reflection is thinking about a situation, experience or event to gain insight that changes how you respond to the next situation.  Reflection is not a casual reminiscence or venting about an event; it is a deliberate assessment to identify problems and areas of improvement. Reflection is an excellent learning tool because it requires nothing more than an experience to analyze.

Take a moment to identify a conflict that you experienced recently. It should be an experience that you would like to have handled better. It could be a coworker’s attitude expressed at a staff meeting, asking for help and getting shrugged off by another nurse, arguing with the treatment team about a plan for a patient, an encounter with the on-call provider or a supervisor; the possibilities are endless. The following are three phases of reflective analysis. You can choose to write about the situation and your answers to the questions below or you can talk it through with a mentor or coach.

1. Describe the conflict situation. Identify and describe your relationship to each of the others in the situation. Your description should identify each of your actions but also what you were thinking and feeling at the time. The description also includes any biases, values, ethics or culture of the work setting that were a factor.  Stop here and wait a couple days before returning to complete the next two steps.

2. Examine your description of the conflict. Select a yardstick or reference against which to evaluate the situation. You could use the conflict management styles discussed in Chapter 17 of the Essentials of Correctional Nursing. You could also use the Corrections Nursing: Scope and Standards of Practice (American Nurses Association, 2007), particularly Standards 10-12 and 15 or another reference on conflict management. How did your actions, thoughts and feelings compare to the standard you selected for comparison?  How did the environment or other aspects of the situation influence you?  What intentions motivated each of your actions?

3. Identify gaps between what happened and what you would like to have happened.  In this phase you are looking for gaps between actual practice and the standard of practice you selected for comparison. Gaps can be in the area of knowledge, skill, attitude or belief. These areas become the focus for further professional development. Typical questions you ask yourself in this phase are:

  • Were my actions the most appropriate and successful ones possible?
  • What were the most important things that got in the way of doing well and why?
  • How could I change to better address conflict in the future?

At the conclusion of a reflective analysis of conflict you decide what you want to do differently in the next conflict experience. This may include changing the way you think or feel about a conflict or gaining knowledge or skill in a particular aspect of conflict management. At the very least reflection provides you with insight about the factors that influenced your feelings, decisions and actions during the conflict experience.

Have you used reflection to evaluate your practice in correctional nursing? Let us know how this technique works for you and any additional tips you have about the use of reflection to improve practice by writing in the comments section of this post.

Read more about reflective practice in Chapter 19 from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

Resources:

Asselin, M. E. (2011) Improving practice through reflection. Nursing 2011 April, 44-47

Freshwater, D. (2008). Reflective practice: The state of the art. In D. Freshwater, B. Taylor & G. Sherwood (eds). International textbook of reflective practice in nursing (pp. 1-18). Oxford, United Kingdom: Blackwell Publishing

 

Photo Credit:Catherine Knox 10/22/2008 at NCCHC in Chicago

Managing Conflict is Essential to Safe and Effective Correctional Nursing

picket fenceI live in a neighborhood of 36 houses that are built very close to one another. The neighborhood is surrounded by a beautiful landscape. The peacefulness and beauty of the setting was the reason I chose to live here. Last week the moving truck used by a new homeowner blocked the neighbor’s driveway for most of the day.  The neighbor raised such a ruckus that the whole community heard about it and the homeowner’s association had to get involved. The incident made me appreciate how important it is to a “healthy” community that conflict be addressed well by each of the members.

These skills are even more important in health care because they contribute to patient safety and retention of nurses.  Unrecognized or unresolved conflict in the health care setting causes a decrease in nurses’ morale, increases physical and emotional stress, as well as the likelihood that conflict will escalate (Longo, J., 2010; Almost, J., Doran, D., Hall, L., Laschinger, H., 2010; Johansen, M., 2012). “…conflict management skills have been identified as an essential competency for the professional RN to provide safe, quality care to patients…” (Johansen, M., 2012 p. 50).

Conflict is an inherent aspect of correctional nursing practice. Sources of conflicts that are unique to correctional nursing are detailed throughout the Essentials of Correctional Nursing. The American Nurses Association draft of the Correctional Nursing: Scope & Standards of Practice, which has been out for public comments the last month, also discusses conflicts experienced by correctional nurses. Two of the proposed standards explicitly address expectations of correctional nurses to assess and improve their skills in conflict management.

What are the sources of conflict in your day to day nursing practice? How often are these conflicts resolved satisfactorily? Do you wonder what you can do to better address conflict in the practice setting?  The following are some steps to assess and improve conflict management skills.

1. Explore your own emotional triggers and reactions. Nurses who have good self- esteem, perceive themselves as successful, feel they are in control of their life and are optimistic are also more constructive in managing conflict.

2. Identify and review the organization’s written directives related to conflict management. These may be in the code of ethics, rules for professional behavior, bylaws of the governing body or in the collective bargaining agreement. Know what is expected of staff, the methods to identify and resolve conflict as well as avenues for redress when conflict is not satisfactorily resolved.

3. Address conflict quickly, fairly and respectfully. Sometimes people are not aware that their behavior contributes to conflict at the workplace. Communicating in a way that increases understanding and resolves conflict among participants is not an easy task. It should always be done in private. Chapter 17 of the “Essentials” book provides resources and suggests that nurses build their repertoire of conflict management styles, especially those of collaboration.

4. Take care of yourself. Stress can contribute to increased emotions, particularly anger. Nurses who understand how emotions affect their behavior have less risk of burnout associated with conflict in the workplace. Take appropriate breaks; attend to personal needs for nourishment, relaxation and other self-care habits. Reflective journaling has been suggested as way to process negative personal feelings after a conflict. In addition to reliving the negative effects of a conflict situation, reflection can be used to build skills and competencies in conflict management.  We will take a closer look at this technique in a future post on this site.

5. Report abusive or disruptive behaviors through your chain of command. Many nurses opt to ignore or avoid conflict without knowing that if left unattended, it contributes to an escalation in conflict. Avoiding conflict at the worksite only reinforces disruptive, dysfunctional and unprofessional behavior. Knowing your organization’s policies regarding workplace conflict is an important first step.

This post was written from the perspective of the individual registered nurse. Nursing supervisors, managers and executives have an exceedingly important role in creating a workplace that supports the professional practice of nurses and safe environments for patient care. Going back to the example of conflict in my neighborhood, our community works best when individual homeowners address conflict quickly and well.  The same goes for the workplace; it is the everyday acts of individual nurses managing conflict that does the most to keep staff and patients safe.

To read more about conflict management order your copy of the Essentials of Correctional Nursing directly from the publisher. Use promotional code AF1209 for $15 off and free shipping. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

References:

Almost, J., Doran, D., Hall, L., Laschinger, H. (2010). Antecedents and consequences of intra-group conflict among nurses. Journal of Nursing Management, 18, 981-992.

Dombrowsky, T. (2012). Responding to verbal abuse. Nursing 2012, November, 58-61.

Hocking, B. (2006). Using reflection to resolve conflict. Association of Operating Room Nurses Journal, 84 (2) 249-259.

Johansen, M. (2012). Keeping the peace: conflict management strategies for nurse managers. Nursing Management, February 50-54.

Kupperschmidt, B. (2008). Conflicts at work? Try carefronting. Journal of Christian Nursing, January-March, 10-17.

Longo, J. (2010). Combating disruptive behaviors: strategies to promote a healthy work environment. Online Journal of Issues in Nursing, 15 (1) 3.

Siu, H., Laschinger, H., Finegan, J. (2008). Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness. Journal of Nursing Administration, 38 (5) 250-257.

Thomas, C. (2010). Teaching student nurses and newly registered nurses strategies to deal with violent behaviors in the professional practice environment. The Journal of Continuing Education, 41 (7) 299-308.

Photo Credit: © zimmytws-Fotolia.com