Be well and be a better critical care clinician. St.Emlyn’s

Be well and be a better critical care clinicianThis blog supports a recent podcast with Iain Beardsell on well being for clinicians. Although this is not the sexy resus end of  critical care or emergency medicine, it’s really just as important. You can only be a great clinician if you look after yourself. You can hear the podcast by clicking on the link below.

Working in critical care is challenging on us – physically, emotionally and spiritually. The work is mentally difficult, technically challenging and at times emotionally draining and incredibly sad. So how do we care for ourselves? Despite being incredibly clever very few people in critical care have a Wellbeing Plan. Strategies and tools in place to ensure that each day they are committed to their own wellbeing so that they can remain present and available to their own loved ones and also to their patients.

Critical care staff who are well across the three domains of physicality, emotionally and spiritually will provide higher quality and safer care to their patients, be better leaders and team members, more likely remain in their role and be happier – why would we not attend to our own wellbeing then with urgent attention?

What does a wellbeing plan look like then?   It has to cover all of the essentials and requires almost a painful awareness of self. It should be consistent enough that it is a lifestyle approach and a routine that you adhere to every day. Dynamic enough to change and be flexible depending on life circumstances and it has to work for YOU. A wellbeing plan must be something that works for you and your personality and life. We all know what we should do but know we have to integrate this into what we can do. Sometimes we have to be a little selfish to be better people – partners, parents, practitioners, friends.

Please do not construct an extreme wellbeing plan in the first instance that is unsustainable and will not work. Caffeine, chocolate, salt, comfort eating, alcohol, rest days, lazy days all should be included in any wellbeing plan in MODERATION.

Essential Components of a Wellbeing Plan:

ice-cream-cone-1274894_1280DIET: what we eat fuels our body. Food we consume impacts our energy levels, mood, sleep and even our brains. Many people in health who work shifts, weekends and changing rosters have unique needs when it comes to diet as a result. Unfortunately too many staff in critical care use sugar and caffeine for short bursts of energy and then alcohol to assist with ‘coming down’ and rest. Eating foods that sustain energy is important. Time constraints can also impact what we eat so bringing healthy food options from home will dramatically change the way we eat at work. Nuts, fruit and meals that can be eaten in small bites at a time can be important as people quickly grab mouthfuls of food in between important jobs.   Carry a bottle of water with you or leave it at the station at all times as hydration dramatically impacts how we feel and our cravings.

http://www.dietitians.ca/Your-Health/Nutrition-A-Z/Healthy-Eating/10-Nutrition-Tips-for-Shift-Workers.aspx

Neif-Sztramko et al 2014 Health-related interventions among night shift workers: a critical review of the literature Journal of Occupational and Environmental Medicine40 (6): 543-556

running-498257_1280EXERCISE: Exercise does not need to be a sport or related to a physical challenge. You should not be exercising for the ‘perfect body’ or for punishment for what you ate. Exercise for wellbeing should be something you really enjoy and look forward to rather than a chore. If you respond by saying you don’t enjoy any exercise you have not tried enough options. Walking the dog, swimming, running around with the kids, cycling, yoga, karate, boxing, dancing, acrobatics the choice today is limitless. This time should feel like a wonderful indulgence. Energy creates energy. So when you are feeling most lethargic try and move. Exercise will increase your capacity to cope with life, improve your overall health and give you some time to help your brain unwind. Using a pedometer to regulate how much you move is also helpful. We should all be aiming for 10 000 steps a day (7kms/4.5miles). Sometimes this is difficult to judge without using a prompt. If you haven’t met this goal a brisk walk around the block can help.

bed-945881_1280SLEEP: We all know sleep is important however having a regular sleep routine is very challenging when you work shifts. Try to maintain a routine. Be mindful of what you do as you prepare to sleep. Be careful what you consume. Importantly be mindful to stay off screens and social media in the 30 minutes before bed. Try instead to read, do meditation or mindfulness, have a relaxing shower all tasks that tell your body it is time to turnoff and sleep.

https://sleepfoundation.org/ask-the-expert/electronics-the-bedroom

BREATHING: The way we breathe can impact energy levels, stress and relaxation reactions and the state of our body. Next time you feel anxiety rising or energy depleting become aware of your breath.

Van Diest et al (2014) Inhalation/Exhalation Ration Modulates the Effect of Slow Breathing on Heart Rate Variability and Relaxation. Applied Psychophysiology and Biofeedback, 39(3-4) p171-180

http://www.forbes.com/sites/daviddisalvo/2013/05/14/breathing-and-your-brain-five-reasons-to-grab-the-controls/#3538a18b52aa

meditation-972472_1280BENEFITS OF STILLNESS AND QUIET: Each day try to find an activity that allows your mind to be still. This can happen while you are exercising, in the shower or as part of a disciplined mindfulness or meditation practice. Become more mindful about what you are doing, how your body is reacting, your behaviours related to this and what you want to achieve. This can be a very powerful practice.

Morgan et al (2014) Health Care Workers’ Experiences of Mindfulness Training: a Qualitative Review , Mindfulness Vol.6(4), pp.744-758 

QUALITY TIME: Be mindful of how you spend your downtime. Television, screens and even our beloved social media time can be an incredible time waster with little benefits for our wellbeing. Try to be outdoors and in nature regularly. Surround yourself with good people. If you are moving a lot because of training and career needs take the time to keep in touch with others and find one or two quality people every time you move and invest in these friendships as a priority.

FIND YOUR THING/S: Sometimes we have to fight for our own wellbeing and health. It rarely comes naturally. Prioritise yourself. Work hard at being well. Sanction time and do not let anything disrupt it. Your body and your mind will thank you for it, as will those that love you and your patients and colleagues.

 

EXAMPLE OF A WELLBEING PLAN– Liz Crowe (this is not a recommendation based on science or nutrition, nor is it advice, it is just an example)

Diet – I like to eat lots of protein, salad and vegetables, I don’t like hot drinks so consume lots of water. I have to eat breakfast in the car most mornings so I eat toast with protein – ham, egg, sausage etc. This fills me up and can be eaten on the run. I take nuts and an apple to snack on, if I have trained in the gym I will put peanut butter on my apple for extra energy. I take a sandwich for lunch full of salad, vegetables and a protein, I can eat it one bite at a time, doesn’t need heating, doesn’t spoil and can be re-wrapped as required. I try not to eat chocolates and biscuits that come into the unit but on the days I do I don’t feel guilty about it I see it as a treat. I drink loads of water and bring a bottle in with me each day and keep it available.

Exercise- my goal is to walk 10 kms/6.2miles each day. I love walking and it is my time to think. Walking is also my outdoor, be present with nature, look at the sky remember how insignificant I am time.   I try to have one walk on my own with music and the dog and one with either my husband or one of my teenage sons. They whine a lot for the first 5 minutes and then we both really enjoy it. I try to do a dance class once a week (dependent on my children’s sporting schedule) because dancing makes me very happy!! I try to get to the gym twice a week to do weights and strength training. I see a personal trainer once a week. Yes this costs money but I don’t drink coffee or wine so I figure this is my one indulgence. I always box with him which is a lovely way to punch out frustrations, anger, concerns and feel really tough at the same time. I find it works wonders for my stress. I used to cycle a lot but it became too time consuming though I hope to return to it one day. I also love swimming but it is also time consuming and means I have to wash my hair….

If I want to catch up with friends rather than just go somewhere and eat I usually organise a long walk followed by breakfast or a meal. That way you have exercised outside and been with a friend!

Screens: I watch little to no television during the week. I try to only be on social media when I am on the train on the way to and from work. I schedule my study time so that it is sanctioned and controlled.

Sleep: I am not a great sleeper and I have little time to sleep due to parenting life, study and work. I try to ensure quality sleep and have a strict routine going to bed each night. I shower just before bed, have a big glass of water and read a ficitional novel for 15 minutes or so to turn my brain off from the busyness of the day. I also try to organise a nap on days off whenever possible.

MY THING: Music and movement is absolutely my thing. When I am sad or low in energy music is my way to cathartically cry, reinvigorate myself, be foolish and exercise. Humour and finding the joy in life is also exceptionally important to my wellbeing. I have a very dark and sick sense of humour that erupts at the most inappropriate times. I surround myself with wonderful people at work and in my personal life who I can laugh and cry with and who I genuinely enjoy their company. My children are also a major source of wellbeing because I love them to bits and because they pull me back to life after a tragic or sad day by their own needs and demands.

RECOMMENDED READING:

The Essence of Health: the Seven Pillars of Wellbeing by Dr Craig Hassed 2008

 vb

Liz

@lizcrowe2

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9 Comments

  1. Simon Carley (Post author)

    Great work Liz. Emergency departments across the world are under significant stress at the moment and there is no doubt that it’s easy to forget to look after ourselves. There is great wisdom in your words and on the podcast.

    You inspired me to try a boxing class at the gym today. I now feel like I need critical care myself, but I’m confident it will be worth it in the end.

    vb

    S

    Reply
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  3. Iain Beardsell

    OK Liz, I accept your challenge. I thought to motivate myself even more of post my wellbeing plan here.

    I’ve taken on board the idea that little things are more likely to be successful (rather than buying the DVDs of the Insanity exercise programme) so here are my ideas for a few marginal gains in my wellbeing. This plan has to take into account my life as both a clinical lead (lots of office time), Emergency Physician doing nights and a Daddy to three shall boys.

    1, DIET- I’m going to try to sandwich diet. I’ll need to plan ahead to get the ingredients, but that shouldn’t be too hard. I’ll take fruit into work as a snack and I’m going to talk to our team about having a healthier option that biscuits (my nemesis at work).

    Caffiene- I’ve already reduced my Diet Coke intake. I’m having a cup of coffee in the morning (I’ve been doing this since my Dad used to make me one twenty years ago) and one later in the day. Otherwise it’s decaf or fizzy water.

    2, EXERCISE- I find this so dull! I’ve tried in the past, but really want to try again. I know I’m unfit and having small boys this is just not good enough.

    I’m going to try to use our work Park and Ride at least once a week, but Park and Walk instead. On office days I’m also going to take a 20 minute walk around the hospital at lunchtime. I’ve already started sit-ups and push-ups (but can’t do 50 of each yet!). I’ll try to get my bike out once a week and, in time, perhaps run while the boys cycle (the youngest can’t ride yet). And yes, I’ll try to run occasionally. I know that as I get fitter I’ll want to do all of these more.

    3, PSYCHOLOGICAL – As I said on the podcast I already see a coach/therapist and have found this really useful. I’m going to try the “Headspace” app again too. I need space in my brain.

    OTHER- More reading. Less screens. I’m going to try a different screen free bedtime routine to see if it helps my quality of sleep. Ideally I’d like to need to sleep less.

    WORK- The StEs team give me a lot of positive energy. My role as clinical lead has distracted me from the podcasts and other work I do with the team, which I really enjoy and find very rewarding. I’m going to try to make sure I am involved in producing at least one podcast a month (ideally two). Although time consuming, I know the value to me of doing this is huge.

    I need to make an effort to go out more. I like home comforts and need persuasion to stray out. I need to reconnect with friends who I may have neglected over the last few years.

    So, lots to do. I’m aiming for little things across the board. No time to write anything more now – I have sit-ups to do and a day out planned.

    Thanks again Liz for all you do. You are an inspiration.

    Iain.

    Reply
    1. gasdoc2857

      Thanks Liz and Iain. It was a great podcast and yet another reminder that we should be looking after ourselves better as we are not indestructible and to fail to do so damages ourselves and impedes our abilities to do the best for our patients. I’m a bit older than you and Simon Iain and now of an age where I am seeing colleagues burning out, suffering ill health and worse as a result of failing to address their unhealthy lifestyle.
      So I’m joining you in this quest for better wellbeing. I’m avoiding the hospital canteen and coffee shop (probably the worst bit so far) and coming to work with fresh salads and plenty of fruit as snacks. I’ve almost resisted the biscuits and sweets that lie around in the intensive care unit and am trying to cut back on caffeine during the day in theatre. Trying to increase my exercise again – been very inactive over last few months with a knee injury – but been back on bike this week, and thinking about joining a gym. Need to do a bit around my own psychological preparedness – I’ve had some CBT in past and think I have better insight into my psychology than I did but still not perfect so off to download some of the mindfulness Apps.
      And I need to learn to say “No”. I just can’t take on everything I’m asked to do at work so from now on will only do so by giving up something else!

      Reply
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