About a year ago, one of my graduating students gave me a fan with this Korean text 선생님 사랑해요, which translates to “I love you teacher.” I’m told that it’s customary in Korea to give the teacher a small token of appreciation for a positive educational experience. Another time, on the last day of school, a Thai student gifted me a lunch box with homemade coconut rice topped with mangoes. She told me that her mom prepared it, following a Thai tradition of presenting teachers with a gift at the school year’s end to honor the efforts of the teacher. Instances such as these, where I was the recipient of gratitude, which have been explored by positive psychology scholars, are often featured in newspaper articles, especially around November, a month when the 4th Thursday is considered a major holiday in the United States. Whatever the origins of the American brand of Thanksgiving, expressing thanks and feeling grateful has likely existed since the beginning of human history.
Gratitude arises from social interactions between helpers and beneficiaries, where beneficiaries, feeling thankful, attribute their positive circumstances to the efforts of helpers. Due the unique nature of nursing care, a “thank you” by a patient after being cleaned from their incontinence or feeling relieved from their post-op pain is not the same as thanking someone who has served us an overpriced venti macchiato. Whether the nurse is aware of it or not, being the recipient of a thank you triggers prosocial behavior in helpers.
Pro-gratitude equals prosocial
Prosociality refers to voluntary behavior intended to benefit others or promote social harmony. It encompasses actions driven by altruism, empathy, cooperation, and a general concern for the well-being of others, even when there might not be direct personal benefits. Prosocial behavior can include acts of kindness, sharing, helping, and cooperation, as well as contributing positively to social relationships and community welfare. Studies demonstrate that when individuals providing assistance receive expressions of gratitude from those they helped, they exhibit a greater willingness to assist those beneficiaries again. In healthcare, for instance, a nurse who receives appreciation from a patient may be more inclined to provide continued support and care (Answering that call bell promptly, anyone?).
Gratitude is a potent moral reinforcer for positive behavior. A nursing unit filled with grateful nurses likely experiences better teamwork, self-efficacy, and more positive patient outcomes than a unit with ungrateful workers or managers. In work environments with no meaningful recognition, the uttered thank you feels like a counterfeit platitude and workers feel devalued, which erodes trust and undermines productivity.
Put it in writing
Similar to a medical prescription, gratitude exerts more power when it’s written down. In a 2003 study, college students who documented five things they were grateful for each week reported more positive and optimistic life appraisals, increased exercise, and fewer physical symptoms over 10 weeks compared to a control group.
Positive psychology researchers conducted a study that involved a “gratitude visit,” in which participants wrote and personally delivered thank-you letters to individuals who had shown kindness but never received proper thanks. Those in the gratitude visit group reported increased happiness and reduced feelings of depression. These positive effects persisted during follow-up assessments conducted 1 week and 1 month later.
In the same study mentioned previously, participants who engaged in a week-long exercise of writing down three positive events each night along with their causes, offering a causal explanation for each, started experiencing increased happiness and reduced feelings of depression compared to their baseline. These positive effects were sustained during the 3-month and 6-month follow-ups. Wouldn’t it be great if every nurse’s station had a white board where the staff could write three things that went well for the shift with a causal explanation? I imagine we’d see less burnout among the staff and everyone would get a boost of team spirit and connectedness.
Cluster gratitude for greater potency
This Thanksgiving, I’ll continue my practice of reciting five things I’m grateful for each night simply because I can’t be thankful enough. For example, I’m continually grateful for the privilege to write this blog and for those who read my work. Each time I receive a thank-you email from my students, I’ll carry on the practice of telling them how grateful I am for their vote of confidence and how their gratitude gives me courage to continue to do my best.
I shall be mindful to take note of three to five good things that I encounter on my 12-minute walk to work. I’ll continue to remember some of my past patients who still teach future nurses as I retell their stories in my lectures. As an icebreaker, I’ll prompt my students, every now and then, to turn to the person sitting next to them in class and share two to three things they’re thankful for. In the week before Thanksgiving, I’ll bring blank thank-you cards to class and encourage my students to handwrite notes to those in their lives who haven’t received proper thanks.
There are two climate changes happening simultaneously—global warming ,which refers to the steady rise of the earth’s temperature, and global cooling, coined by the author Piero Ferrucci, refers to the loss of human warmth and genuine connection in our day-to-day lives. I would like to imagine that sincere gratitude expressions can help bring more interpersonal warmth and increase global prosocial behaviors, despite the tumult in the world.
Fidelindo Lim, DNP, CCRN, FAAN, is a Clinical Associate Professor at New York University Meyers College of Nursing.
