In late October, I attended the American Academy of Nursing’s Health Policy conference in Washington, DC. I also had the distinct honor of being inducted as a Fellow of the Academy, class of 2022. In the movie industry, being honored by the “Academy” epitomizes the crowning achievement of someone’s lifework. In nursing, a Fellow of the Academy is lauded for their impact on myriad aspects of healthcare. The festivities, the presents colleagues gave me, the FAAN mail I received, and the coming Thanksgiving holiday made me ponder gratitude as a moral virtue, or as a mindset that is essential to well-being.
Among the various social and academic definitions of gratitude, my favorite describes gratitude as “the willingness to recognize the unearned increments of value in one’s experience.” There is humility in this definition, a recognition that some of the great things that happened to us or were done for us were not necessarily earned or deserved. The acknowledgment that being the recipient of good deeds or accolades may be purely accidental or serendipitous might temper pride with the honesty to give credit where it is due.
Gratitude practice: Five a day
The practice of giving thanks is entrenched in many sociocultural rituals. Liturgical and ecumenical gatherings abound with appreciation directed at others (God, people, animals). It would be weird or outright immodest to thank the self. People also commonly give thanks for material blessings (the latest iPhone model) or the not-so-tangible, such as the internet. Marie Kondo, the master coach of tidy and organized living, has taught the world to say “thank you” as an incantation when letting go of stuff that no longer sparks joy.
Last year, a New York Times article about flourishing, the antidote for languishing, spoke about doing five acts of kindness daily as a well-being booster. The research showed that clustering good deeds in one day is better at making someone feel good than spreading them out over a week. Similarly, a study showed that intentionally identifying five things to be thankful for and writing them down as part of everyday practice led to a favorable life appraisal, higher ratings of joy and happiness, and optimism. In short, there is strength in numbers. I have incorporated the five-gratitude practice into my bedtime ritual. Somehow, deliberately appreciating the quotidian and the remarkable has a calming effect, and it gives me a balanced perspective. Sometimes gratitude is difficult, because life is difficult. I’d like to imagine that grateful thinking could be a balm for neuroticism.
To some people, saying thanks comes naturally; to others, it might require deliberate effort. Experts suggest starting with interior gratitude, such as giving thanks privately, then moving to exterior gratitude, the public expression of thank you. When a shout out is proclaimed in the presence of others, its value is magnified, and the recipient of effusive gratitude is doubly delighted. Before I forget, let me thank you for reading this far.
Thanking your way to health
In the same study mentioned above, subjects who wrote down five things they are thankful for daily for 10 weeks spent 1.5 hours more exercising than those who wrote five things that annoyed or bothered them. Those in the gratitude intervention also reported longer and better sleep quality, in addition to reporting fewer symptoms of illness. Given the health protective benefits of exercise and sleep, it could be that grateful people may live longer. Beyond the benefit to the self, it is also reported that thankful people experience a greater sense of optimism and connectedness to others, offer emotional support to others, and are more likely to have helped someone with a problem. In short, prosocial actions such as gratitude-giving may help optimize our collective well-being and reduce feelings of entitlement.
Is there a downside to gratitude?
In fact there is. Some people may resent the obligation to reciprocate and repay the kindness they have received, leading to negative emotions. But this should not discourage us from saying our thank you. A study demonstrated a glycemic side effect of gratitude. When primed to feel grateful rather than proud, subjects selected more sweets and fewer non-sweet foods. Notwithstanding awkwardness and hyperglycemia, one should still choose to be grateful because its benefits of enhanced psychological and social functioning outweigh the risks (though it might be sensible to hold off on the second serving of that pecan pie during Thanksgiving dinner).
Gratitude is the corollary of well-being, and is closely linked with reciprocal altruism. Given that the practice of nursing requires some degree of altruism, I’d like to imagine that in addition to being rated as the most ethical of all professions, nurses also are role models of grateful caring. I am sure there are many instances in my life when I have failed to properly express my appreciation for blessings received. But it is not too late. I shall attempt to thank out loud whenever I can, and continue the daily practice of five gratitudes.
As I have gone through three graduations, from my undergrad to my DNP, fortune has given me a handshake, while many hands helped me tremendously to get me to my destination. I don’t think of this destination as a physical place, but rather a state of being, of self-actualization. Nursing has not only given me a hand, but an embrace that gives me courage. For that I am forever grateful.
McCullough ME, Emmons RA, Tsang J. The grateful disposition: A conceptual and empirical topography. J Pers Soc Psychol. 2002;82(1):112-27. doi:10.1037//0022-3518.104.22.168
Fidelindo Lim is a Clinical Associate Professor at New York University Meyers College of Nursing