The power of self-care: An ENERGY model to combat clinician burnout

Author(s): Holly Wei, PhD, RN, CPN, NEA-BC, and Trent L. Wei, MD

It’s more important than ever for nurses to take care of themselves.

Takeaways:

  • Clinicians are experiencing alarming rates of burnout.
  • Self-care is essential to maintaining a healthy relationship with oneself and others.
  • The ENERGY model provides clinicians with practical self-care strategies to mitigate stress and job-related burnout.

Clinicians often experience considerable psychological distress related to work demands, and the COVID-19 pandemic has only added to that. Healthcare systems and organizations play an important role in promoting a healthy work environment to reduce distress, but changes coming from the top may be inadequate to meet individual needs. Nurses and other clinicians must take control of their own health, especially in a time populated with new challenges and obstacles. Self-care is vital.

A study by Wei and colleagues explains how clinicians can elevate six strategies into a self-care model using the ENERGY acronym: Energy source, Nurturing kindness, Emotional hygiene, Refocusing purpose, Germinating positivity, and Your uniqueness. (See ENERGY self-care model.) Consider incorporating these strategies into your daily routine to reduce stress and promote well-being.

ENERGY self-care model

Use this model to incorporate self-care strategies that can help reduce stress and mitigate burnout.

Energy source

To prevent feeling depleted, connect yourself to an energy source that helps you recharge physically and emotionally. Adequate sleep, balanced nutrition, and moderate exercise are fundamental for physical health, but you also must find sources of energy—such as family, friends, spiritual beliefs—to nourish your mind.

Social support and connectedness are critical to good health. People with strong social support and relationships have a lower risk of psychological issues than those who lack that support. Social support affects the hypothalamic-pituitary-adrenocortical system and central oxytocin pathways to help build resilience and mitigate detrimental events. People who are socially connected and supported have a heightened sense of companionship and belonging. These sensations can build your self-esteem and promote self-value, which, in turn, fuels the energy to love yourself and others.

Some of your social support and connectedness can come from your healthcare colleagues. The National Academy of Medicine reports that team-based healthcare is associated with improved patient outcomes and clinician well-being. A healthy work environment and amiable coworker relationships can help you reserve and fuel your energy.

During the pandemic, when many healthcare providers are isolated from family and friends, these positive relationships are even more crucial. Demanding patient care can easily drain your energy, but strong social connections and collaborative teamwork can foster trust, communication, and mutual goal-achievement, ultimately reducing burnout.

Nurturing kindness    

Nurturing kindness is fundamental to elevating your own happiness and brightening the mood of those around you. Acts of kindness help us create a caring-healing relationship with ourselves and others. The feeling of being kind not only increases life satisfaction and happiness but also promotes health. Reducing negative emotions—such as stress, anger, anxiety, and depression—improves the immune system. When we perform acts of kindness, our bodies release neurochemicals—such as dopamine, serotonin, and oxytocin—leading to a sense of happiness and well-being. Also, as more of our interactions are online, we need to ensure kindness—respect, caring, compassion, and em­pathy—within virtual communities and when providing remote care.

Emotional hygiene     

When we think of threats to our health, we frequently think about hazards that affect us physically, such as bacteria or viruses. But what about psychological hazards, such as rejection or loneliness? Emotional hygiene—practicing mindfulness, having a gratitude mentality, cultivating an optimistic attitude, self-valuing, shifting focus from adversities, and engaging in physical activities—can help you manage your feelings, handle everyday difficulties, and mend your psychological pain. (See Practicing emotional hygiene.)

Mindfulness practice and exercise can boost emotions and are powerful antidotes for psychological distress. Mindfulness practice can help you focus and reduce stress, anxiety, and depression and also help you release past negative or difficult emotions. Functional magnetic resonance imaging suggests that therapeutic mindfulness interventions may reduce the gray matter volume in the amygdala (the “fight or flight” center of the brain) and increase it in areas of the brain that are responsible for learning, memory, and critical thinking. During exercise, your body releases endorphins, which can activate the brain’s opioid receptors, making it a great remedy for emotional pain, stress, anxiety, and depression.

Practicing emotional hygiene

To alleviate the detrimental effects of the intense nature of healthcare, you must be diligent about your emotional hygiene. Here are some practical ways you can incorporate emotional hygiene into your daily routine:

  • Find opportunities during the day to relax the brain and soothe the mind with a simple breathing exercise: Close your eyes and take three to five deep breaths. These two techniques can help:
  • 4 × 4 breathing—Do a slow count of four for each inhale, hold, exhale, and hold.
  • 4-7-8 breathing—Do a slow count of four as you inhale, hold for a slow count of seven, and exhale for a slow count of eight.
  • Before going home, practice separation from work with purposeful and mindful handwashing. Use this practice to not only get rid of germs but also to “wash away” negative feelings and stress.
  • On the way home, focus on green space and enjoy nature.
  • Set aside 30 minutes each day to exercise outdoors for exposure to nature and sunshine.

Refocusing purpose   

Your life purpose is an inner compass that guides your actions during complex life situations; having a strong sense of purpose can positively affect your outlook and health. When you stray from your purpose and lose passion, you may need to pause, refocus, and reconnect with your purpose.

People with a strong sense of purpose show signs of better cognitive functioning, memory, mental health, and general well-being. Actively working and achieving a life goal creates a sense of fulfillment, which helps us feel satisfied. When we feel fulfilled, our brains can produce endorphins and serotonin, which are energizing.

For most nurses, the goal is to help others. When you face significant challenges, you may feel discouraged, stressed, or even burned out. However, if you can recall, refocus, and reconnect with your original purpose and passion, you may find joy and renewed energy.

Germinating positivity           

Geminating positivity is about cultivating a positive attitude and spreading it to others. Developing a positive attitude requires training your brain to focus on the positive aspects of events rather than the negative. Positivity training can help you change your behaviors and mindset to mitigate stressful situations and improve your well-being. Activities that can promote positivity include practicing daily gratitude (a gratitude journal or daily gratitude list), reframing the meaning of adversities, having a growth mindset, showing appreciation, and seeing difficult situations as temporary. (See Positivity research.)

In healthcare, promoting a positive work environment is vital for nurses and patients. You can promote gratitude and positivity at work in a variety of ways, including starting shift reports with positive events, recognizing and appreciating colleagues, and paying kindness forward. You also should try to view difficult situations as temporary and understand that hardships will pass.

Positivity research

Research shows that positivity and gratitude can change our brains. Wong and colleagues examined participants’ mental health and brain functions under three conditions:

  • psychotherapy with gratitude expression (writing letters of appreciation to others)
  • psychotherapy with expressive writing (writing about their deepest thoughts and feelings about stressful experiences)
  • psychotherapy alone.

Gratitude group participants showed the most significant improvement in their mental health and brain function. Practicing gratitude improves brain function in the regions such as the hypothalamus, which secretes dopamine, oxytocin, and endorphin. These hormones are beneficial to our mental health and help us feel happier and less depressed.

Your uniqueness        

Each of us is a unique individual. When you know your uniqueness, you can appreciate your strengths and limitations and will be able to unleash your inner power. Two kinds of power guide you, external (authority given to you) and internal (confidence that grows within you). Internal (inner) power helps you love yourself and shape who you are. People and events (such as workplace incivility and bullying) can’t make you feel bad without your permission. When you acknowledge your uniqueness, you can appraise your capabilities, an essential step for making peace with yourself and ensuring you don’t feel depleted.

Tending to your inner power requires valuing yourself as a distinct individual and setting realistic goals. How you think about yourself can affect how you feel. Thinking about yourself positively and using uplifting words to describe yourself can promote your sense of self-worth. Setting realistic goals helps you feel accomplished. When you get things done in the way you desire, your brain releases dopamine, which elevates your confidence and happiness and encourages your brain to seek out these sensations.

In the current pandemic, you can’t save every life, but you can work to the best of your ability to save some lives. You’ll need to make peace with what you want to do and what you can achieve. Setting realistic goals may help you feel accomplished, releasing the dopamine that will help you feel good and mitigate burnout.

Replenish your energy

Using the ENERGY acronym may help you replenish your energy. Practicing self-care can help you activate or deactivate certain brain regions to benefit your health. All healthcare providers shoulder a mission and responsibility for the health of our communities. We’re like lifebuoys; only when we fill up ourselves, will we be able to lift others.

Holly Wei is an associate professor, graduate leadership concentration, in the advanced nursing practice & education department at the College of Nursing, East Carolina University in Greenville, North Carolina. Trent L. Wei is a physician at Duke University Medical Center in Durham, North Carolina.

References

Baixauli E. Happiness: Role of dopamine and serotonin on mood and negative emotions. Emerg Med. 2017;7(2). longdom.org/open-access/happiness-role-of-dopamine-and-serotonin-on-mood-and-negative-emotions-2165-7548-1000350.pdf

Gelinas L. Promoting clinician well-being. Am Nurse Today. 2019;14(4):4.

Ghosh SK. Happy hormones at work: Applying the learnings from neuroscience to improve and sustain workplace happiness. NHRD Network J. 2018;11(4):83-92.

Harandi TF, Taghinasab MM, Nayeri TD. The correlation of social support with mental health: A meta-analysis. Electron Physician. 2017;9(9):5212-22.

Melnyk BM. Burnout, depression and suicide in nurses/clinicians and learners: An urgent call for action to enhance professional well-being and healthcare safety. Worldviews Evid Based Nurs. 2020;17(1):2-5.

Smith CD, Balatbat C, Corbridge S, et al. Implementing optimal team-based care to reduce clinician burnout. National Academy of Medicine. September 17, 2018. nam.edu/implementing-optimal-team-based-care-to-reduce-clinician-burnout.

Tabibnia G, Radecki D. Resilience training that can change the brain. Consult Psychol J. 2018;70(1):59-88.

Wei H, Kifner H, Dawes ME, Wei TL, Boyd JM. Self-care strategies to combat professional burnout among pediatric critical care nurses and physicians. Crit Care Nurse. 2020;40(2):44-53.

Wong YJ, Owen J, Gabana NT, et al. Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial. Psychother Res. 2018;28(2):192-202.

LEAVE A REPLY

Please enter your comment!
Please enter your name here