Brief evidence-based tactics that work

Even before COVID-19, rates of burnout, depression, stress, and anxiety in nurses, and other healthcare clinicians indicated a public health epidemic. Findings from multiple studies revealed burnout rates between 30% and 67%, with depression and anxiety affecting approximately one-third of clinicians. Research also revealed higher suicide rates in nurses and physicians than in the general population. The American Nurses Association took action by implementing Healthy Nurse, Healthy Nation to generate resources and evidence-based solutions.

Since the pandemic started, mental health issues in clinicians have escalated, resulting in compromised healthcare quality and safety as clinicians in poorer mental and physical health report more medical errors. In addition, Han and colleagues estimate that clinician burnout and poor mental health cost the U.S. economy approximately $4.6 billion per year in absenteeism, presenteeism, and turnover.

Nurses work hard to care for others, but they don’t always care for themselves. However, nurses who report that their worksites support their well-being have better mental and physical health outcomes. Many clinicians who aren’t experiencing burnout and depression may be languishing, a state between depression and thriving in which they lack energy and motivation. Urgent system-wide fixes for root causes of burnout (short staffing, long shifts, task overload, electronic health record issues) and individually tailored interventions within a sustainable wellness culture can help reduce its occurrence.

Clinicians also can practice brief evidence-based interventions that decrease stress and improve mood. A recent systematic review by Melnyk and colleagues found five brief interventions that may enhance mental and physical health outcomes and improve healthy lifestyle behaviors in nurses and physicians.

Deep abdominal breathing using the 4, 7, 8 method (breathe in to a count of 4, hold for a count of 7, and exhale slowly to a count of 8) can help decrease stress and lower blood pressure and heart rate. Catching, checking, and changing negative thoughts into positive thoughts reduces stress and improves mood. The next time you feel anxious, angry, or depressed, stop and ask these questions: Is this thought or type of thinking helpful? Do I have the evidence to back it up? If the answer is no, change that negative thought to a positive.

To reduce worrying and anxiety, refocus on the present moment with a technique called 5-4-3-2-1 grounding. Find 5 things you can see, 4 you can feel, 3 you can hear, 2 you can smell, and 1 you can taste. A daily gratitude practice (writing down the names of a few people or things you’re grateful for) also can help decrease anxiety and improve optimism, sleep, and cardiovascular health.

You can prevent chronic disease with just a few healthy lifestyle behaviors, including 30 minutes of physical activity 5 days a week (just 11 minutes a day has heart-health benefits), eating five fruits and vegetables per day, not smoking, limiting alcohol intake to no more than one standard drink a day, sleeping at least 7 hours a night, and practicing daily stress reduction. To reduce languishing, take a few minutes every day to focus on something that brings you joy.

It takes at least 30 to 60 days of daily practice to establish new thinking and lifestyle behaviors. To aid motivation, write down your goals. If you don’t meet your goal one day, start again tomorrow. Taking care of yourself isn’t selfish. If we don’t take a little time out of every day for self-care, we’ll need to take time for illness later.

Bernadette Mazurek Melnyk is an American Nurse Journal editorial board member. She’s also vice president for health promotion, university chief wellness officer, dean and Helene Fuld Health Trust Professor of evidence-based practice, executive director of the Helene Fuld Health Trust National Institute for Evidence-based Practice, and professor of pediatrics and psychiatry in the College of Medicine at The Ohio State University in Columbus. 

References:

ANA Enterprise. Healthy nurse healthy nation.

Centers for Disease Control and Prevention. How you can prevent chronic disease. May 13, 2022.

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Dzau VJ, Kirch DG, Nasca TJ. To care is human – Collectively confronting the clinician-burnout crisis. N Engl J Med. 2018;378(4):312-4. doi:10.1056/NEJMp1715127

Fleisher LA, Schreiber M, Cardo D, Srinivasan A. Health care safety during the pandemic and beyond – Building a system that ensures resilience. N Engl J Med. 2022;386(7):609-11. doi:10.1056/NEJMp2118285

Grant A. There’s a name for the blah you’re feeling: It’s called languishing. The New York Times. April 19, 2021.

Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170(11):784-90. doi:10.7326/M18-1422

Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician suicide: A call to action. Mo Med. 2019;116(3):211-6.

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Melnyk BM, Hsieh AP, Davidson J, et al. Promoting nurse mental health. Am Nurse J. 2021;16(1):20-2; 59.

Melnyk BM, Hsieh AP, Tan A, et al. Associations among nurses’ mental/physical health, lifestyle behaviors, shift length, and workplace wellness support during COVID-19: Important implications for health care systems. Nurs Adm Q. 2022;46(1):5-18. doi:10.1097/NAQ.0000000000000499

Melnyk BM, Kelly SA, Stephens J, et al. Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review. Am J Health Promot. 2020;34(8):929-41. doi:10.1177/0890117120920451

Melnyk BM, Orsolini L, Tan A, et al. A national study links nurses’ physical and mental health to medical errors and perceived worksite wellness. J Occup Environ Med. 2018;60(2):126-31. doi:10.1097/JOM.0000000000001198

Melnyk BM, Tan A, Hsieh AP, et al. Critical care nurses’ physical and mental health, worksite wellness support, and medical errors. Am J Crit Care. 2021;30(3):176-84. doi:10.4037/ajcc2021301

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