Running head: SELF CARE 1

Self Care of Nurses

Jordan Y. Mullauer
Ferris State University











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Abstract
It is widely known that nurses care for others on a daily basis and are often drawn to the
profession because of their desire to care for others. Although nurses are highly skilled in
the art of caring, they often lack self care practices for a number of reasons including lack
of time, demanding work environment, and lack of support. Dorothea Orems Self Care
Theory and Maslows Hierarchy of Needs are used to further explain the issue. To
improve self care of nurses, employee wellness programs, Magnet recognition, and
education are recommended. The Quality and Safety Education for Nurses institute
competencies of patient centered care and teamwork and collaboration are met through
the recommendations. The American Nurses Association standards 10, 14, and 16 are
also directly related to self care of nurses.












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Self Care of Nurses
Nursing is the nations largest healthcare profession at slightly over 3 million
registered nurses (Health Resources and Services Administration, 2010). These nurses
care for sick patients in need every day, and are often drawn to the job because they love
to care for others, not necessarily themselves. Nurses are often expected to care for
themselves, but for a number of reasons they do not always care for themselves in the
best way possible. This is a serious issue because nurses who do not care for themselves
are unable to care for others and provide safe and quality care. Although nurses typically
understand the importance of self care, they often lack motivation to do so. Explanations
for lack of self care will be explored as well as recommendations to encourage nurses to
improve these practices and ultimately improve quality of patient care.
Theory Base
Nursing Theory
To better understand the lack of self care in nurses, Dorothea Orems Self Care
Deficit Theory is useful (Nursing Theory, 2013). Orem was a prominent nursing theorist
in the twentieth century whose theory on self care deficit is widely used today. This
theory consists of three related parts including theory of self care, theory of self care
deficit, and theory of nursing systems. First, the theory of self care consists of four
different types of self care including self care, the self care agency, therapeutic self care
demand, and self care requisites. Self care are the actions needed to preserve human
functioning or activities of daily living (ADLs). The self care agency is the persons
ability to perform self care. Therapeutic self care demands are the total needs over a
period of time, and self care requisites include universal, developmental, and health
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deviation requisites. Nurses often possess the self care agency, or the ability to care for
themselves, but may have a larger therapeutic self care demand and less time to perform
these self care activities because of the strain of their job.
Someone who lacks self care (such as a nurse) would then progress to the self
care deficit theory, which determines when nursing is needed. Orem described five
different methods of help when someone experiences a self care deficit including acting
or doing, guiding, supporting, providing a positive environment, and teaching. Many
nurses who fail to care for themselves require all of the above methods to get them back
on the right track and understand the importance of self care and consequences of a lack
of self care.
Finally, the nursing systems theory determines the level of intervention needed for
someone with a self care deficit. They may require complete assistance, partial
assistance, or simply supportive assistance. Nurses need supportive assistance at all
times whether it be from their work environment or family and friends outside of work.
When self care is really lacking, nurses can fall to illness and disease where they will
require partial or even complete assistance, in which case their work is greatly affected.
Non-Nursing Theory
The non-nursing theory related to the self care issue in nursing is Maslows
Hierarchy of Human Needs (Simply Psychology, 2014). Maslow developed a pyramid
with five different steps or categories of needs starting with physiological and then
progressing to safety, social, self-esteem, and self-actualization. Every part of this
pyramid is quite relevant to self care of nurses. Maslow stated that each of the steps on
the pyramid motivate people and once one step is completed, they can progress onto the
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next step of the pyramid. Maslow noted only one in a hundred people become fully
self-actualized because our society rewards motivation primarily based on esteem, love
and other social needs (Simply Psychology, 2014, para. 1). Nurses who lack self care
abilities such as eating properly and taking care of their health often cannot progress to
the next levels of the pyramid and they may not be able to improve their self esteem or
work on other relationships outside of work. From an interdisciplinary perspective,
Maslows pyramid is also useful to understand that nurses need help from a variety of
different disciplines to help achieve optimal self care. For their physiological needs,
nurses can use other nurses to motivate them to stay healthy as well as pharmacists for
medications when they are ill. Moving up the ladder, nurses can utilize counseling
services to help meet their self-esteem and self-actualization needs.
Assessment of the Health Care Environment
Policies
Hospital policies to make nurses care for themselves directly could not be found,
and it is likely that there never will be because this would be against the nurses free will
or autonomy. There are, however, policies in place to help prevent a self care deficit in
other ways such as having a maximum amount of hours that nurses can work, and making
sure nurses have a long enough lunch period and breaks throughout their shift (Wood,
2005). These policies give nurses a time to relax and relieve some of the stress related to
work, which also gives them an opportunity to take better care of themselves. One study
also found that longer break periods were associated with less errors (Wood, 2005).
Thus, giving nurses adequate time to take a break from their busy work day also
improves quality and safety of patient care. The American Nurses Association (ANA)
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currently has a position statement that recommends that nurses do not work more than
twelve hours in a 24 hour shift, or sixty hours in a seven day shift (American Nurses
Association, 2006).
On the other hand, policies that do not encourage nurses to take care of
themselves involve mandatory overtime. The ANA (2014, para. 1) describes mandatory
overtime as the hours worked in excess of an agreed upon, predetermined, regularly
established work schedule, as identified by contract; usual scheduling practices; policies
or procedures. Right now, only 14 states have set restrictions on mandatory overtime,
while the majority of states still allow this. Overtime takes away from nurses free time
and gives them less time to properly care for themselves, leading to a multitude of other
problems.
Resources
The American Holistic Nurses Association (AHNA) (2014) focuses on the mind,
body, and spirit when it comes to healing, and promotes this not only in the patient but
the nurse as well. This organization encourages nurses to empower each other and learn
more about self care and self awareness to improve their physical and emotional health
and ultimately provide better nursing care. The AHNA is recognized as a specialty by
the American Nurses Association and is even accredited so that nurses can gain their
continuing education requirements for licensing by learning more about self care
practices and holistic nursing. Their website also suggests a variety of ways to relieve
stress specifically related to the demanding nursing lifestyle.
The Centers for Disease Control and Prevention (2014) is also a helpful resource
for nurses to assess their weight, lose weight, and prevent weight gain. Their website
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contains helpful tips for counting calories, eating healthy, and achieving optimal physical
activity in order to become healthier and feel better.
Quality and Safety
Nurses who are unable to care for themselves can greatly affect quality and safety
in the health care environment in a negative way. One study found that stress-related ill
health among nurses may cause sick leave or turnover and thereby limit adequate health
care staffing, reduce quality of care, and threaten patient outcomes (Hasson, Lindfors, &
Gustavsson, 2010, p. 54). If nurses do not take care of themselves physically and
emotionally, the stress of their job and home life can start to decrease their quality of
care. It is hard to care for others before one takes care of him or her self. Conversely,
nurses who take care of themselves and feel better can reflect their positive attitudes into
their work. In a study on nurses self rated health, nurses with healthier lifestyles
perceived that they were better able to engage in caring relationships with their patients,
use nursing knowledge, share information with patients and colleagues, and direct the
health care team (Hensel, 2011, p. 53).
Assumptions
One assumption when it comes to the health and care of nurses is that nurses do
not need help or do not need to be educated on the importance of self care because they
already have that knowledge. Generally, nurses have a great deal of knowledge
regarding the care of others, but one should not assume that a nurse does not need
encouragement when it comes to personal health. A nurse may not be aware of the
resources available or the consequences of a lack of self care. Nurses may also not know
qnursing school, students are taught how important it is to care for others and exactly
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how to care for others in need, but they do not have classes where they learn to take care
of themselves.
Another assumption is from nurses when they do not believe that their health and
well-being is as important as their patients health and well-being. This assumption is a
huge problem because if a nurse does not believe personal health is important, they are
much less likely to care for him or her self. Although the patients health is the nurses
ultimate responsibility, the nurse must also care for him or her self in order to provide
quality care to patients. This assumption is something that should be discouraged early
on in nursing school to teach students that although their patients care is very important,
having a lack of self care is not good for their patients either.
Inferences and Implications
If nurses continue to not focus on their own health and well being, several
negative consequences may arise. A serious problem nurses deal with today is burnout.
This condition is, characterized by a constellation of symptoms including emotional
exhaustion, depersonalization, and decreased perceptions of personal accomplishment
(Kravitz, McAllister-Black, Grant, & Kirk, 2010, p. 130). The lifestyle of nursing itself
can be considered risks for a lack of self care, which leads to burnout. Long work hours,
irregular meal schedules, the emotional costs of caring, and the physical activity involved
in nursing are just a few factors that lead to a lack of time and effort for nurses to put into
their own care (Nahm, Warren, Zhu, An, & Brown, 2012). These chronic factors coupled
with a lack of coping strategies can lead to burnout in nurses (Kravitz et al., 2010).
A nurse who lacks self care, coping strategies, and begins to experience burnout
may eventually end up quitting nursing all together and finding another job, which adds
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to the nursing shortage; another serious issue that nurses are faced with in the healthcare
field. The U.S. Bureau of Labor Statistics (2013) predicts that registered nurses will be
one of the highest growth jobs by 19% from the years 2012-2022. This would mean that
over 500,000 nurses would be needed. In addition to this need for new nurses, the baby
boomer generation is aging and reaching the age of retirement. The Association of
American Retired Persons (2014) also predicts that over the next 18 years, 8,000 baby
boomers will turn 65 years old each day. This information only adds to the need for
registered nurses in the acute and long-term care settings across the nation. Nurses who
do not take care of themselves can begin to burnout and eventually quit their job, which
will in turn increase the demand for registered nurses and make the nursing shortage an
even bigger issue.
Recommendations
What Healthcare Facilities Can Do
In order to prevent burnout and a larger nursing shortage due to a lack of self care,
recommendations have been made that both nurses and the facilities they work at can
utilize. Some hospitals and other healthcare facilities have employee wellness programs
that help promote health and wellbeing in their staff. One study with positive results used
a psycho-educational approach to improve self care in nurses by discussing nursing risk
factors, practicing relaxation techniques, and exploring different coping patterns (Kravits
et al., 2010). Another study that focused more on the physical health of their nurses
implemented a program called Nurses Living Fit (Speroni, Williams, Seibert, Gibbons, &
Earley, 2013). Several different physical health suggestions such as the amount of steps
per day and hours of sleep per night were recommended as well as nutrition education
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classes and diary completion where the nurses wrote down what they ate and how much
they exercised each day. After the implementation of this program, a significant decrease
in body mass index was seen. In addition, the nurses stated they felt better and even
asked for more classes and physical challenges for them to complete (Speroni et al.,
2013). A final employee wellness program explored was Spectrum Healths Healthy
Lifestyles program (Spectrum Health, 2008). This program gives employees incentives
to improve their health and stay healthy by offering monetary rewards based on body
mass index, cholesterol levels, and glucose levels among other guidelines. The program
has shown an increase in percentage of employees with healthy body mass indexes,
healthy cholesterol levels, and even healthy blood pressure ranges since its
implementation.
Self care education for students in nursing school is another resource that should
be investigated. Throughout nursing school, students are taught how to care for others
extensively, but most nursing schools do not have classes where they teach students how
to care for themselves or develop effective coping strategies. One study found that
although nurses have the knowledge to care for others, this knowledge rarely translates
into self care practices (Nahm et al., 2012). It would be a good idea to implement this
program and investigate how well it teaches students to care for themselves later on in
their nursing careers. It may be further beneficial to have the class be a requirement
rather than an extra credit class.
What Nurses Can Do
One approach nurses can do to promote good self care is to work at a hospital or
healthcare facility that is Magnet recognized. The Magnet organization, recognizes
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health care organizations for quality patient care, nursing excellence and innovations in
professional nursing practice (American Nurses Credentialing Center, 2014, para. 1).
Nurses who work for Magnet recognized hospitals can be sure their employer takes good
care of their nurses and promotes healthy working environments and advancing nursing
practice. All of these factors provide nurses a better opportunity to care for themselves
and provide a better quality of care.
The first step nurses can take in improving their self care practices is to be self
aware and recognize they have a problem (Sanford-Brown, 2014). Nurses should also be
open to help, keep their work and home life separate, attend counseling if needed, and be
proactive with their physical and emotional health. In addition to eating healthy,
exercising regularly, and getting the recommended amount of sleep each night, one study
found relaxation training, social support, cognitive techniques, exercise, and music to be
particularly helpful coping strategies for stress (Kravits et al., 2010).
QSEN Competencies
The Quality and Safety Education for Nurses institute (QSEN) (2014) has a set of
competencies every registered nurse must develop in order to provide safe and quality
patient care. Each competency also includes the knowledge, skills, and attitudes all
nurses should possess. Among these competencies is patient centered care, which is
directly related to self care of nurses. A study mentioned earlier pointed out that nurses
who felt better perceive that they are better able to care for their patients (Hensel, 2011).
Nurses who take better care of themselves physically and emotionally can pay better
attention to their patients and are more likely to recognize problems. Part of the quality
patient care competency says that nurses, integrate understanding of multiple
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dimensions of patient centered care (QSEN, 2014, para. 3). Healthy nurses can do this
by identifying physical and emotional needs of the patient and providing the unique care
needed for each patient.
Another QSEN competency is teamwork and collaboration, which states that
nurses, function effectively within nursing and inter-professional teams, fostering open
communication, mutual respect, and shared decision-making to achieve quality patient
care (QSEN, 2014, para. 4). Nurses who take care of themselves can contribute more to
a team when they are of optimal health and not distracted by other things going on in
their lives because they feel empowered (Hensel, 2011). An empowered nurse can
develop some of the knowledge, skills, and attitudes associated with teamwork and
collaboration including the ability to evaluate personal communicating skills and improve
those skills so that communication is improved with every discipline of the healthcare
team. In a similar manner, the nurse can develop better conflict resolution skills when he
or she cares for their health and uses effective coping strategies to make teamwork more
efficient.
ANA Standards
The ANA (2010) identifies 16 standards of professional nursing practice all
registered nurses are expected to perform. Three of these standards have been chosen
that directly relate to self care of nurses. The first standard, standard ten: Quality of
Practice, simply states the nurse contributes to quality practice. This standard allows
nurses to enhance quality of care, much like the study discussed earlier that shows nurses
who care for themselves and feel better both physically and emotionally perceive they
provide a higher quality of care (Hensel, 2011). This same study also found that nurses
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are more likely to teach healthy practices to their patients when they are active and
healthy themselves.
Standard 14: Professional Practice Evaluation also relates to self care of nurses.
This standard states, the registered nurse evaluates his or her own nursing practice in
relation to professional practice standards and guidelines, relevant statutes, rules, and
regulations (ANA, 2010, p. 59). Being self aware is a very important part of self care
for nurses. If nurses are self aware they can constantly evaluate their practice and make
sure they are following guidelines and regulations, as well as accept and utilize
evaluation by their peers. Self aware nurses can also identify when they need help and
ask for assistance before their nursing care starts to deteriorate.
The last standard identified, standard 16: Environmental Health, is another
important standard that is affected by self care. This standard states that the nurse,
practices in an environmentally safe and healthy manner (ANA, 2010, p. 61). Failure
to provide self care often leads to illness in nurses, and nurses who work while they are ill
are more likely to pass this illness onto their high-risk patients (Hensel, 2011).
Therefore, nurses who practice good self care provide a healthy environment for their
patients to heal. Not only are these healthy nurses concerned about their own physical
and emotional health, but they are focused on the health of the environment they work in
to provide better care for their patients.
Conclusion
Lack of self care is a serious issue nurses everywhere face today, and it should be
addressed by the nurses as well as the facilities where they work. Implementing
employee wellness programs and incentive programs can help improve self care practices
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among nurses from a broader perspective. From a more personal perspective, nurses
should focus on their physical and emotional health in addition to their patients to
ultimately provide a higher quality and safe care. Although nurses are skilled at caring
for others, nurses are people too, and they need help just as much as anyone else.



















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References
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