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2.0 CE Hours

Objectives:

1. Discuss how the caregiver’s level of self-care affects one’s personal health.

2. Identify signs that one is deficient in self-care.

3. Explore empathy in response to caregiving challenges.

4. Indicate how vulnerability affects a caregiver’s life and work.

5. Learn about coping strategies caregivers use to reduce their anxiety in dealing with both themselves and their patients

6. Understand holistic nursing views.

7. Define and list normal human needs.

8. Define and list normal human feelings.

9. Understand and the connection between human feelings and needs.

10. Indicate what the recognition of feelings can do to enhance the life and work of nurses.

The Caregivers’ Situation

The majority of nurses are working in highly stressful jobs, as well as being responsible for caring for their families. Birth, death, deformity, pain and suffering are realities they are expected to handle at work everyday. As one navigates these situations daily, the demands on one’s body, mind, emotions and spirit can certainly feel overwhelming.

As the saying goes, "You can't give what you don't have!"

Did you know that caregivers of seriously ill people often develop serious health problems themselves? Research shows that compared to non-caregivers, caregivers are more likely to:

• Be depressed or anxious
• Experience slower wound healing
• Sustain higher levels of obesity
• Suffer higher levels of stress hormones
• Spend more days sick with an infectious disease
• Possess a weaker immune response to the influenza, or flu
• Have higher risk for mental decline, including problems with memory and attention
• Develop a long-term medical problem earlier, e.g., heart disease, cancer, diabetes, or arthritis

 

Caregivers often have more health problems because of two reasons: 1) they are often handling more stress, and 2) they’re often less likely to take active and adequate care of themselves. For instance, compared with women who are not caregivers, women who are caregivers are less likely to:

• Get a mammogram
• Get medical care when they need it
• Fill a prescription for themselves, very often due the cost of the prescription

 

Also, compared with the time before they became caregivers, many caregivers report that they’re less likely to:

• Get enough sleep
• Eat a healthy diet
• Get enough physical activity

 

Signs that one is deficient in self-care include:

• Often feeling sad or numb
• Feeling constantly worried
• Often feeling overwhelmed
• Being tired most of the time
• Sleeping too much or too little
• Unable to focus or concentrate
• Gaining or losing significant weight
• Becoming easily irritated or angered
• Loss of interest in activities you used to enjoy
• Abusing food, alcohol or drugs, including prescription drugs
• Frequent headaches, bodily pain, or other physical problems
• Feeling you have “nothing left to give” emotionally, physically, mentally or spiritually

 

The last thing sick or dying people need is to learn that their caregivers are hurting or neglecting themselves through helping them, but this is often what happens. Throughout this course you will have an opportunity to learn why this is, and what you as a caregiver can do to avoid these pitfalls.

Tip: People who create and maintain strong self-care habits are more likely to continue honoring at least some of those habits when they experience times of extra stress. Even if these habits are modified, this prevents their health from slipping as much as it would if they did not have strong self-care behaviors in place.

Authenticity & Vulnerability in Response to Caregiving Challenges

People in most parts of our North American culture seldom talk about their vulnerability, yet we all feel vulnerable from time to time. Many addictions, including perfectionism, over-working and over-caretaking of others stem from our discomfort with feeling psychologically and emotionally vulnerable.

Brené Brown PhD, LMSW, author of two #1 New York Times Bestsellers: The Gifts of Imperfection (2010) and Daring Greatly (2013) studies feelings of shame and emotional vulnerability at the University of Houston in Texas. Brené believes it is vital for us to value and apply empathy and self-empathy in our interactions with others. She also believes in the importance of avoiding sympathy. Her stories on healing shame and honoring vulnerability have guided and inspired many people. Her 20-minute TED talks, The Power of Vulnerability has had more than 2 million views, and Listening to Shame has had over 600,000 views.

If you have chosen to take this course, there is a good chance you are an empathic person. This means you can imagine yourself in another person's place and imagine how they might feel. Because sick and dying people have strong feelings and needs, your first inclination might be to focus on those and not even notice you have lost track of your own feelings and needs. This is a common behavior of empathic people.

However, when we are helping someone prepare to die, our caring work must not be only about benefitting that person. If it is, then we lose an important opportunity to face our own emotional vulnerability, perceived shortcomings, mortality and the soul’s journey. “Exquisite empathy” is defined as being highly present, sensitively attuned and at the same time ‘well-boundaried’ in choosing how we engage in our empathy.

Being present with sick or dying patients brings profound gifts, but it is not easy work.

Many professionally-trained caregivers, including nurses and physicians, are challenged by facing their vulnerability, perceived shortcomings and mortality. They often have not been able to find a balance in caring for others as well as caring for themselves. Without strong, clear and healthy role models, it is no wonder that one will also struggle in this area.

So there is no reason for you to criticize yourself when you feel challenged by caregiving. In fact, here is a little peek into how many nurses (and physicians) have handled caregiving in the past. Fortunately, there is beginning to be some meaningful work done in learning how to correct these approaches.

The first study into the emotional vulnerability of health professionals was published in 1960. This classic study is Isabel Menzies’ A Case-Study in the Functioning of Social Systems as a Defense against Anxiety: A Report on a Study of the Nursing Service of a General Hospital.

The nurses that Menzies studied were assisting people who were physically ill or injured, often seriously. Assisting the patients who had incurable diseases were among the nurses’ most distressing tasks.

Menzies reported that the nurses’ contact with these patients aroused strong mixed feelings including pity, compassion, love, guilt and anxiety, along with hatred and resentment. Such strong feelings often had their roots in envy of their patients for the care they were receiving, while the nurses’ own needs for rest, care and support were not being met.

Menzies also found that the nurses reduced their anxiety by de-personalizing both themselves and the patients. Their coping strategies included:

• Using a ‘task-list’ system that absolved nurses from the anxiety of decision-making
• Talking about patients by disease instead of by name, e.g., ‘the pneumonia in bed 15’
• Accepting nursing uniforms because they allowed a measure of depersonalization and anonymity; one nurse being easily interchangeable with another
• Detaching from, and denial of, personal feelings of attachment, e.g., a ‘good’ nurse doesn’t mind being moved from one assignment area to another

 

How many of these same coping strategies happen in personal caregiving? ALL of them, and they happen often! This occurs even though these are not the ways personal caregivers may want to feel or behave. Disappointment in themselves results and adds to the challenges and sense of being overwhelmed.

Holistic nursing views everything as inseparable and interrelated – our mental, emotional, physical and social/relational aspects are all intertwined and interconnected. What affects one aspect of your self will influence all other aspects. For instance:

• The thoughts you think affect every cell in your body.
• The emotions that you feel affect your thoughts, and likewise, the thoughts you think affect your emotions.
• The way you care for your body: the foods you ingest; the type and amount of exercise that you engage in; the amount of rest and sleep that you get; the air you breathe... all of these practices have a profound effect on your thoughts, your emotions, and your relationships.
• The types and nature of the relationships that you engage in effect your overall physical health, your emotional health, your mental clarity, and your sense of well-being.

 

You will find it useful to develop a personal self-care plan to help you deal more effectively with stress and bring more health, vitality and wholesome behavior into your life. Since every aspect of who you are is interrelated, when you create health in one area of your life, the positive effects spill into all other areas of your life!

An Additional Note to Highly Sensitive People

You might be among the 20% of people who are naturally more sensitive than the other 80% of the population. If so, high-quality self-care is especially important for you because overstimulation can manifest quickly into imbalanced health.

Highly sensitive people need to be especially aware and responsible in managing their self-care because of their susceptibility to stress. So what looks like self-care for the other 80% of people might not be enough for the more highly sensitive people.

Our disadvantage is that sometimes we need to make lifestyle choices that others don’t understand. This can present problems to work through at home and at work.

The upside is that we have the potential to create great health for ourselves if we are able to be honest about our sensitivities and engage in real self-care. And since our sensitivity enables us to become aware of our imbalances earlier, we can correct them at subtler levels as well. The key is to honor and respond effectively to what we feel.

Regardless of whether you’re highly sensitive or normally sensitive, effective self-care doesn’t have to be hard. Let’s get started!

Honor Your Feelings & Needs

The first step in self-care is to honor your feelings and needs.Honoring means showing recognition, respect and admiration. Honoring yourself is an essential practice for stepping into right relationship with the stress that comes with life and death.

Most of us have been conditioned to ignore how we feel, but in order to honor your feelings and needs, you first have to be aware of them.

What Are Normal Human Feelings and Needs?

A need is something that is necessary for an organism to live a healthy life. Needs are distinguished from wants when a deficiency would cause dysfunction or death. Needs include the obvious visible things like air, water and food, as well as less visible things like peace and authenticity.

The following list of needs is meant as a starting place to help you recognize and honor your needs.* (This leads to better recognizing and honoring other people’s needs, too.)

Universal Human Needs

CONNECTIONacceptance affection appreciation belonging cooperation communication closeness community companionship compassion consideration consistency empathy inclusion intimacy love mutuality nurturing respect/self-respect safety security stability

CONNECTION (continued)support to know and be known to see and be seen to understand and be understood trust warmth PHYSICAL WELL-BEING air food movement/exercise rest/sleep safety sexual expression shelter touch water

HONESTYauthenticity integrity presence PLAY joy humor PEACE beauty communion ease equality harmony inspiration order AUTONOMY choice freedom independence space spontaneity

MEANINGawareness celebration of life challenge clarity competence consciousness contribution creativity discovery efficacy effectiveness growth hope learning mourning participation purpose self-expression understanding

 

 

Our feelings include our physical senses, our emotional senses and our intuitive senses. Our finest connection with our spiritual essence comes into our awareness through our feelings, not our thoughts.

When you pay attention, you’ll notice that your innate tracking intelligence always seeks ways to meet your needs. Your feelings are linked to your needs and they tell you when you’re on track or off. So if you’re not clear on what you need, start with your feelings for clues.

The next two lists are a starting place to support you in recognizing and honoring your feelings. The first list is feelings we have when our needs ARE being met, and the second list is feelings we have when our needs are NOT being met.*

Feelings When Our Needs ARE Being Met

AFFECTIONATEcompassionate friendly loving open hearted sympathetic tender warm ENGAGED absorbed alert curious engrossed enchanted entranced fascinated interested intrigued involved spellbound stimulated HOPEFUL expectant encouraged optimistic

CONFIDENTempowered expanded open proud safe secure EXCITED amazed animated ardent aroused astonished dazzled eager energetic enthusiastic giddy invigorated lively passionate surprised vibrant

GRATEFULappreciative moved thankful touched INSPIRED amazed awed wonder JOYFUL amused delighted glad happy jubilant pleased tickled EXHILARATED blissful ecstatic elated enthralled exuberant radiant rapturous thrilled

PEACEFULcalm clear headed comfortable centered content equanimous expansive fulfilled mellow quiet relaxed relieved satisfied serene still tranquil trusting REFRESHED enlivened rejuvenated renewed rested restored revived

 

* © 2005, Center for Nonviolent Communication.

Feelings When Our Needs Are NOT Being Met

AFRAIDapprehensive contracted dread foreboding frightened mistrustful panicked petrified scared suspicious terrified wary worried ANGRY aggravated annoyed disgruntled dismayed displeased enraged exasperated frustrated furious impatient incensed indignant irate irked irritated livid outraged resentful AVERSION animosity appalled contempt disgusted dislike hate horrified hostile repulsed

CONFUSEDambivalent baffled bewildered dazed hesitant lost mystified perplexed puzzled torn DISCONNECTED alienated aloof apathetic bored cold detached distant distracted indifferent numb removed uninterested withdrawn DISQUIET agitated alarmed discombobulated disconcerted disturbed perturbed rattled restless shocked startled surprised troubled turbulent turmoil uncomfortable uneasy unnerved unsettled upset

EMBARRASSEDashamed chagrined flustered guilty mortified self-conscious FATIGUE beat burnt out depleted exhausted lethargic listless sleepy tired weary worn out PAIN agony anguished bereaved devastated grief heartbroken hurt lonely miserable regretful remorseful SAD depressed dejected despair despondent disappointed discouraged disheartened forlorn gloomy heavy hearted hopeless melancholy unhappy wretched

TENSEanxious contracted cranky distressed distraught edgy fidgety frazzled irritable jittery nervous overwhelmed restless stressed out VULNERABLE fragile guarded helpless insecure leery reserved sensitive shaky YEARNING envious jealous longing nostalgic pining wistful

The point of all this focus on feelings and needs is: this is a secret to effective self-care!

Honoring your feelings and needs is NOT selfish. When you honor your feelings and needs, you will be more capable of honoring the feelings and needs of the people you work with, too.

While it is important to recognize our feelings and our needs, when we express our needs, we have a better chance of meeting them than when we express only our feelings.

The more directly we connect with our needs, the easier it is for us to meet them... and honor them as real until we can meet them.

Even when we recognize our feelings, most of us have a life-long history of ignoring our needs. That can end now. It might not be easy at first, but it gets easier with practice and the rewards are amazing! Here is a story to illustrate what we’re talking about.

“All my life, heard my mother complain about how hard she works to make nutritious meals and a pleasant home, and how all she receives from my father is criticism. A million times I’ve offered suggestions on how she can do things differently to change that experience, but every time she’s reacted with anger or hurt instead of taking my suggestions.

One day we were talking about feelings and needs. It seemed like we were having a comfortable conversation, when all at once Mom got up and walked out of the room. When she didn’t return after several minutes, I looked for her and found her in her bedroom. ‘Mom, are you OK?’ I asked.

‘Yes,’ she answered. ‘But I just realized that for 60 years I’ve been hurt and angry with your father for not honoring my needs, and now I realize I’ve never clearly told him what I needed.’

That was a major awakening for my mother, and it led her to the next step: to recognize how SHE hadn’t been honoring her needs, either. This was a much harder step because once she recognized her needs she saw she had responsibility for choosing how to respond to them. Even though it was painful to feel unappreciated by my father, it had been far easier than taking responsibility for meeting her needs.

I’m happy to share that my mom’s made a lot of progress in this area in the years since this conversation, even though she was in her early 80’s at the time! While she still struggles in this area, she’s now experiencing many more times when her needs for consideration and appreciation are met. When I see that she’s meeting her needs, it meets my needs for peace and joy in our family, too.”

Open to Recognizing Your Feelings & Needs

Since you’re reading this course, there’s a good chance you’re among the 20% of people who are naturally more sensitive than 80% of the population. Quality self-care is critical for highly sensitive people (HSPs) because overstimulation can manifest quickly into imbalanced health.

HSPs need to be especially aware and responsible in managing their self-care because of their nervous system's susceptibility to stress. So what looks like self-care for the other 80% of people might not be enough for the highly sensitive person.

There is an advantage to our sensitivity. That is that we become aware of our imbalances earlier because we are able to feel them. The disadvantage is that we sometimes need to make lifestyle choices that others don’t understand. This can present social and work problems.

The upside for HSPs is that we have the potential to create good health for ourselves if we’re able to manage our sensitivities and engage in real self-care.

Despite any conditioning you have received to the contrary, you do not need to be afraid of feeling your feelings and needs.

No matter what they are, your feelings and needs are vital parts of who you are, and they are intimately connected to why you are here. When we ignore or devalue our feelings and our needs, we are devaluing and undermining ourselves. This is actually a form of self-abuse... the opposite of self-care.

We encourage you to practice opening to your feelings and needs now so that it becomes a healthy habit. Start by giving yourself permission to feel your feelings and needs as a fundamental agreement with Life. This is about letting yourself sense and be consciously aware of all you need to know in each moment.

When you gently hold this self-permission in your Center, you can watch your inner landscape change so that your needs and longings are often fulfilled... sometimes in surprising ways!

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References

Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. New York, NY: Gotham Books.

Brown, B. (2010). The gifts of imperfection: Let go of who you think you're supposed to be and embrace who you are. Center City, Minn: Hazelden.

Burch, Sharanagati (2014) How to Be True to Yourself: Self-Care for the Caregiver. Awakening to Grace, Inc. www.AwakeningtoGrace.org

The Center for Nonviolent Communication, https://www.cnvc.org/

Fredrickson, B. (2013) Positive Emotions Broaden and Build, Advances on Experimental Social Psychology, 47, 1-53, University of North Carolina at Chapel Hill

Lawlor, D. (2009). Test of time: A case study in the functioning of social systems as a defence against anxiety: Rereading 50 years on. Clinical child psychology and psychiatry, 14(4), 523-530.

McElligott, D, Capitulo, K, Morris, D, and Click, E, (2010) The Effect of a Holistic Program on Health-Promoting Behaviors in Hospital Registered Nurses, Journal of Holistic Nursing, American Holistic Nurses Association

Menzies, I. (1960). A case study in the functioning of social systems as a defence against anxiety. Tavistock, London.

Pender, N., & Murdaugh, C., & Parsons, M. (2002). Health promotion in nursing practice (4th ed.). Upper Saddle River, NJ: Prentice Hall.

Pender, N., Murdaugh, C., & Parsons, M. (2006). Health promotion in nursing practice (5th ed.). Upper Saddle River: Pearson Prentice Hall.

Sears, M. (2010). Humanizing health care: Creating cultures of compassion in health care with nonviolent communication. Encinitas, CA: Puddle Dancer Press.

Ted Talks [TED]. 2011, January 3. Brene Brown: The power of vulnerability [Video file]. Retrieved from https://www.youtube.com/watch?v=iCvmsMzlF7o

Ted Talks [TED]. 2012, March 16. Brene Brown: Listening to shame [Video file]. Retrieved from https://www.youtube.com/watch?v=psN1DORYYV0

Thornton, Lucia. (2006) Beating the Stress: Treat Yourself Right. National Student Nurses Association (NSNA) Sept-Oct 2007, pp 60-65. www.NSNA.org

Walsh, K. D., Crisp, J., & Moss, C. (2011). Psychodynamic perspectives on organizational change and their relevance to Transformational Practice Development. International Journal of Nursing Practice, 17(2), 205-212.