Course:SOWK551/2021/Sample Project: Fostering Resiliency in Healthcare
Literature review of strategies for fostering resiliency in front-line healthcare workers.
Date: December 6, 2022
At first, I wanted to review literatures on resiliency specifically based on social work in healthcare in Canada; however, there was very little literature that speaks directly to my initial research query. I ended up having to look at literature that speaks to fostering resilience in healthcare from around the world within the last 10 years. The key topics from the literature I chose to discuss are embracing positive as well as negative emotions, practicing being rooted in the present, relationship building, social support, growing healthy lifestyle habits, and highlighting as well as supporting moral resilience.
Since the first covid-19 outbreak in 2019, there is an increased need to find ways to foster resilience for front line workers in healthcare settings. There has been a fair amount of new literature written that provides valuable tips that promote ‘integrative resilience’ in healthcare practice approaches. For this reason, I was able to search for related literature in a narrower time frame of 5-10 years. While most of the literature speaks to nursing and allied healthcare workers, the moral distress has weighed heavy on healthcare social workers as well. According to Wald (2020), during a public health crisis, healthcare workers experience “significant health risk and concomitant stress, fear, decreased sense of control, and uncertainty. Deleterious impact on both physical and mental health can result, including for healthcare professionals and health professions trainees” (p. 744).
The covid-19 pandemic has taken a significant toll on all healthcare workers due to increased demands of caring for patients with serious illness, the moral distress associated with having to make tough decisions involving patient care, and the potential risk to workers as well as their families. According to the American Psychological Association (2010) resilience is defined as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress— such as family and relationship problems, serious health problems or workplace and financial stressors. It means "bouncing back" from difficult experiences” (p. 1). This means that resilience to stress is complex and complicated.
One’s ability to bounce back from hardship and trauma depend on genetic factors as some are more naturally resilient possibly due to having better temperament than others or having learned better coping mechanisms from whomever helped to raise them. However, the good news is anyone can learn ways to foster resilience if they choose to learn how. Wald (2020) asserts the use of an ‘integrative resilience’ approach includes the “individual, learning environment, and organizational/systemic factors can ideally buffer negative impact, address ‘pre-traumatic’ and traumatic stress, elucidate strengths, and ideally reduce vulnerability to prolonged psychological distress” (p. 745). Some principles of wellbeing for coping
EMBRACING POSITIVE AND NEGATIVE EMOTIONS
When it comes to ‘integrative resilience’ Wald (2020) emphasizes the importance of not only embracing positive emotions or experiences, but negative emotions and experiences as well. It is common knowledge that positive emotions are ideal or more socially acceptable when we think of optimal mental health and wellbeing. However, it is also good practice to take a holistic view to emotions, thoughts, and feelings to nurture resilience as they are a natural part of the human experience. According to Wald (2020) it is perfectly normal to feel emotions “such as sadness, worry, anxiety, fear, irritability, and anger within significant life disruption and uncertainty” (p. 745). More, Virk (2020) conveys that unexpressed “emotions are often stored in our body in the form of muscle tension, tightness, and other body sensations” (para. 9).
Berinato (2020) encourages folks to be consistent in naming negative emotions because while it may not seem to help at first, it is important to be repetitious in naming emotions which is often grief or loss when it comes to experiencing a health crisis. There is something powerful about naming negative emotions because naming negative emotions are just as natural as naming positive emotions. Unfortunately, western society normalizes positive emotions and tends to stigmatize the expression of negative emotions. According to Berinato (2020), naming emotions is necessary for one to be able to move through the identified emotion to allow the emotion to flow through one’s body rather internalizing the emotion, which can be empowering and can free us from being fixed in a state of victimhood.
PRACTICING BEING ROOTED IN THE PRESENT
Wald (2020) further encourages frontline healthcare workers to practice being present in the here and now, to breathe, to ground oneself as well as letting go of the things we cannot control. Frontline workers can learn strategies that would be helpful not only to themselves but also to patients. These strategies can help facilitate to prevent or reduce stress and anxiety. They can also help one to shift from catastrophic thought patterns of expecting the worst to happen to a place of tolerance of feelings of uncertainty.
According to Wald (2020) the use of meditation and mindfulness is another helpful technique to foster resilience. Mindful awareness helps one to be calm, to feel reenergized, to bring clarity, to manage stress, to ground oneself, and to reduce moral distress as well as to release emotional grief. Being in the present helps one to move away from the overwhelm of ruminative or intrusive thoughts. Mindfulness strategies and being rooted in the present can also help with sleep disturbances and can improve concentration.
Holzel et al. (2011) advises that if mindfulness is felt deep within the body through breathing exercises and acceptance of what cannot be controlled can significantly improve one’s focus as well as concentration. More, Holzel et al. (2011) also indicates that when one practices mindfulness techniques for a long period of time it can have “long-term positive consequences on attention, body awareness, emotion regulation, and perspectives on the self” (p.2). Virk (2020) asserts the importance of “mindful body movements like stretching, yoga, and focused breathing, we can get in touch with how we’re feeling and ground ourselves in the present experience” (para. 9).
RELATIONSHIP BUILDING AND SOCIAL SUPPORT
To foster resilience the literature conveys the importance of social support where frontline healthcare workers connect purposefully and intentionally with others. Wald (2020) asserts that when it starts to feel like dooms day connecting with others is essential when it comes to stress resilience, which is “positively associated with active problem-focused coping, sense of control and predictability in life, self-esteem, motivation, optimism, enhanced immune function, dampened neuroendocrine and cardiovascular responses to stress” (p.747). The literature encourages one to connect with teammates to debrief and identify challenges with one another allowing the sharing of ideas or thoughts that helps one to cope with challenges. According to Wald (2020) focusing on challenges with teammates can reduce symptoms of post-traumatic stress disorder (PTSD), depression, and boosts resiliency.
Abu-Sharkia et al. (2020) upholds that when frontline healthcare workers are repeatedly exposed to mental and physical suffering, it can significantly affect them negatively, including “secondary traumatization, and positive consequences like posttraumatic growth” (p. 283). According to Abu-Sharkia et al. (2020) posttraumatic growth is connected personal growth which is defined as “positive changes that may occur as a result of psychological struggle” (p. 283). Even during the challenging times of a health crises requiring the population to adhere to physical distancing regulation, Wald (2020) says it is still important to encourage social connection as it helps front line healthcare workers not feel alone during times of adversity.
Social connection can be achieved in many ways. According to Wald (2020) this can be accomplished by checking in with colleagues and connecting to medical education groups for frontline workers by means of social media platforms. Kwok et al. (2016) asserts the importance of recognizing the power of frontline health workers having a collective sense of community during difficult times to cultivate “social well-being [and health], quality of life, sense of place and belonging, and civic engagement” (p. 198). Wald (2020) adds the need to respect that frontline “professionals will have narratives specific to those experiences; trainees at various levels will have their narratives as well” (p. 747). When necessary, it is essential that frontline workers come together to debrief and hold space to share the challenging experiences they are facing in supporting patients.
GROWING HEALTHY LIFESTYLE HABITS
Another way to foster resilience in frontline healthcare workers is to adopt healthy lifestyle habits. According to Wald (2020) the adoption of healthy lifestyle habits involves practicing relaxation, exercise, rest, healthy food choices, humour, and holistic wellness. Holistic wellness invites frontline health workers to look after their spiritual, emotional, physical, and social health.
According to Southwick and Charney (2012) improving physical health includes boosting one’s “quality of diet, amount of exercise, capacity to relax, and quantity and [sic] quality of sleep is important in determining how the body and brain respond to stress” (p. 81). Southwick and Charney (2012) assert a strong connection when it comes to fostering resilience through aerobic exercise and its ability to improve depression, brain function and cognition. According to Southwick and Charney (2012) “aerobic exercise is believed to induce the expression of genes associated with neuroplasticity and neurogenesis, as well as to regulate the HPA-axis response to stress” (p. 81). Cherry (2022) asserts neuroplasticity is “the brain's ability to change and adapt due to experience” (para. 1) which refers to the brain’s capacity to reorganize, change, and grow neural systems.
Some studies also indicate that exercise is just as effective antidepressants in treating as well as preventatively for general depression. Wald (2020) asserts that the physical activity can be “meditation in motion” as walking not only provides physical exercise and mindfulness at the same time, but also allows individuals to connect to nature by taking a simple walk outside (p. 748). Nature is well known to reduce stress and improve wellbeing as well as facilitate healing for folks. The knowledge keepers or Elders I connect often remind me to connect to the land to recalibrate balance and this has been easier to do since getting a puppy who also need to get out and release some energy, it works well for both of us.
HIGHLIGHTING AND SUPPORTING MORAL RESILIENCE
According to Wald (2020) part of fostering resilience includes bringing attention to moral resilience as it is important for frontline healthcare workers to know that experienced moral distress or grief comes from moral dilemmas, which can significantly reduce their sense of agency. During times of adversity, Wald (2020) asserts the need to support frontline healthcare workers and their ability to navigate moral distress, support their sense of integrity and strengthen moral resilience. According to Holtz et al. (2018) moral distress when there are conflicting views or values between healthcare providers, patients, and patients’ families on the best plan of action for healthcare delivery.
Although moral distress has primarily been studied in frontline nurses, it is now apparent that moral distress affects the entire interprofessional team. Holtz (2018) highlights that while moral distress has shown to be intensified during the Covid-19 pandemic as lifelong learners it is crucial to be open to navigating the muddy waters of adversity. Frontline work is important, and it is critical the work is done in a good and honourable way where workers can continue to try to strengthen their moral resilience.
According to Wald (2020) this can be achieved by validating “ethical uncertainties and complexities, feelings of powerlessness (should these be present), discussing any perceived threats to one’s sense of integrity” (p. 750). A great deal of distress can come along with the inability to give the level of care one should hope to provide especially when systems get in the way of achieving this as this can feel quite conflicting with one’s moral compass. Wald (2020) asserts support should be tailored to “individual needs including clarifying realistic expectations of trainees, colleagues, institutional leadership, and self within a crisis environment” (p. 750). It is important to be able to identify when were out of our scope of practice and encouraged to set boundaries by strong leadership.
APPLICATION TO SOCIAL WORK PRACTICE
The key topics from the literature I chose to discuss are embracing positive as well as negative emotions, practicing being rooted in the present, relationship building, social support, growing healthy lifestyle habits, and highlighting as well as supporting moral resilience. Social workers should be open embracing positive and negative emotions not only to become comfortable with talking through all feelings, but to allow the negative emotions to leave out bodies to decrease any chances of sickness or tension from building up inside their bodies. Social workers can practice being rooted in the present by practicing mindfulness like breathing exercises or deep relaxation techniques that help reduce stress, increase focus, revitalize us, and accept what we cannot change.
When it comes to relationship building and social support, it is crucial to have an outlet to talk about the challenges we faced in our day or week by debriefing with out team. It is also important that the people we debrief have a good understanding that debriefing needs to be a space free of judgment and non-hierarchical. When it comes to growing healthy lifestyle habits, it is important for social workers to tend to all areas of health also know as holistic health and wellness. It is also vital to be able to identify experienced moral distress to validate as well as foster resilience. Due the high likelihood of experiencing moral distress in the world of social work, I feel it is so important for social workers to see a counsellor especially when they are working in a setting that does not have strong culture of debriefing or coming together.
Abu‐Sharkia S., Taubman‐Ben‐Ari O., Mofareh A. (2020). Secondary traumatization and personal growth of healthcare teams in maternity and neonatal wards: the role of differentiation of self and social support. Nurse Health Sci. DOI:10.1111/nhs.12710
American Psychological Association. (2010). The Road to Resilience. APA Washington, DC. https://uncw.edu/studentaffairs/committees/pdc/documents/the%20road%20to%20resilience.pdf
Berinato, S. (2020). That discomfort you’re feeling is grief. Harvard Business Review. https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief
Cherry, K. (2022). What is neuroplasticity? Very well mind. https://www.verywellmind.com/what-is-brain-plasticity-2794886
Holtz, H., Heinze, K., Rushton C. (2018). Interprofessional' definitions of moral resilience. J Clinical Nurse. 27(3–4): e488–e494.
Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., and Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspective Psychology. Sci. 6, 537–559. Doi: 10.1177/1745691611419671
Kwok, A., Doyle, E., Becker, J., Johnston, D, Paton, D. (2016). What is ‘social resilience’? Perspectives of disaster researchers, emergency management practitioners, and policymakers in New Zealand. Int J Disaster Risk Reduction. 19:197–211.
Southwick, S., Charney, D. (2012). The science of resilience: implications for the prevention and treatment of depression. Science. 338(6103):79–82.
Virk, L. (2020). Social distancing not emotional distancing. Closler, April 13. http://closler.org/lifelong-learning-in-clinical-excellence/social-distancing-not-emotional-distancing
Wald, H. (2020). Optimizing resilience and wellbeing for healthcare
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