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Allocate spoke to Dr Marti Balaam, Senior Teaching Fellow in Nursing Studies and Lead for Professionalism and Wellbeing at the University of Edinburgh Medical School and Director/Founder of The Compassion Salon, to find out how nurses can practice self-compassion. 

This year has seen the NHS emerge as a national champion in its handling of Covid-19 and has gained untold respect from the whole country. We have clapped for carers, displayed rainbows in windows and raised millions for our amazing healthcare staff who have been confronted with unprecedented stress and uncertainty whilst caring for those impacted by Covid-19. So, six months on, how are our nurses fairing? The evidence is indicating that many staff aren’t just reaching but have, in many cases, already reached burnout. We were already aware of the intense pressure nursing staff were already under, prior to Covid-19, due to, amongst other things, staff shortages, increasing demands, mistreatment and lack of resource. Add to this the colossal weight of the pandemic requiring healthcare workers to dig even deeper and the result is that many are now running on empty.

How do we ensure nurses are re-charging their batteries?
Nurses are educated to put their patients first and are notorious for battling on in stressful situations under a virtuous ethic of self-sacrifice which is often detrimental to their own wellbeing. Stopping and recharging can be seen as a sign of weakness. But how can nurses be there to support and care for patients if they haven’t stopped first to care for themselves?
-So, it’s now vital that we give nurses ‘permission’ to recharge their batteries. The long-term effects of untreated stress and burnout are numerous and can be debilitating leading to distress, dissatisfaction, unhappiness and even the abrupt end of a career in healthcare if we don’t start to re-educate ourselves about the importance of self-care and self-compassion.

Prescribing Self-Compassion
What is self-compassion? And how can nurses prescribe it for themselves?
We know that as humans we are all wired to be compassionate and nurses are trained to offer care and understanding to those suffering – that is a given. We also know that the pressure nurses and care-givers are under day-to-day with the ongoing staff shortages and rising expectations in the NHS is relentless and over time can be debilitating. Add to that the uncertainty and disruption of Covid-19 throwing our normal, reassuring lives into complete disarray and the result is living with a constant sense of unease. For those in the caring profession, there is a requirement day after day for them to be resilient to provide reassurance and compassion to their patients, but how can that strong sense of compassion be turned on to themselves?

Compassion is defined by myself and Rev/Dr Harriet Harris as attentiveness to the suffering of ourselves and others, with the wisdom and steps taken to relieve it. Compassion then is incomplete if we do not include ourselves. However many nurses are been suffering with their own feelings of stress, anxiety and exhaustion without stopping to offer the same care they would offer to a patient, to themselves. Practising self-compassion means being attentive to our own suffering and being wise about how we can help ourselves. This includes being patient, kind and understanding when we fail or feel we are not doing the best we could. Recognising that we are not always perfect and that we are indeed human rather than getting impatient or angry is one of the first steps to practising self-compassion.

We need to consider therefore How healthcare workers can identify that they are suffering, that they need reassurance, care and compassion to bolster their own wellbeing? And on a practical level, how can nurses ensure that they are practising self-compassion day-to-day to ensure that they are not headed for burnout?
In order to start to practice true self-compassion, individuals need to be tuned into how they are feeling and responding to situations on a daily basis. Knowing when, how and what is required means we need to be attentive and tuned in to our own needs in the same way, as carers, we are tuned into the needs of others.



Six Steps to start practising Self-Compassion
Step 1: Practice Forgiveness
Accept that you are not perfect and be gentle with yourself when you are confronted with your shortcomings. Remind yourself, especially on a bad day, to be gentle and kind with yourself. Indeed, talk to yourself as you would to a close friend.

Step 2: Shared Humanity
It’s important to acknowledge that whilst we may be in different boats, we are in this storm together and we all have a shared need for love and acceptance. When we suffer therefore it is helpful to remember we are not alone. Everyone has feelings of loneliness and isolation but by accepting that many of us feel like this can alleviate these feelings.

Step 3: Employ a Growth Mindset
Changing the way you view challenges can help you adopt a growth mindset. By viewing challenges or obstacles as opportunities helps you see them as a path to learning and growing and is more constructive to getting through them with a positive outcome.

Step 4: Express Gratitude
Switching from wishing for what we do not have and feeling gratitude for what we DO have can be very powerful in our overall feeling of positivity and wellbeing. Writing a gratitude journal or going on a gratitude walk are ways of reinforcing and accepting all that is good in what we have.

Step 5: Find the Right Level of Generosity
For generosity to work in favour of your well-being, it cannot be selfless. Think about when you are being generous, make sure you are aware of your own needs before progressing. Consciously select the recipient of your generosity, the resources you have available, and your level of energy based on what will support your own well-being.

Step 6: Be Mindful
Mindfulness has been found to have a positive impact on self-compassion, as it has a tendency to lessen self-judgment. Try and always be in the moment and to be aware of what is happening right now, without judgment and labelling. Allow what you think or feel to have its moment and then dismiss it – let it go!



Compassionate Leadership
Its vitally important that we understand how to engage staff so that they recognise how to be compassionate with themselves, how to bring awareness to their own stress and wellbeing and also how to recognise it in others. Compassionate leadership is fundamental in creating a culture of improvement and innovation across health care. It enhances the fundamental motivation of NHS staff and reinforces their loyalty and determination. Compassionate leadership also helps to promote a culture of learning, opening up to risk-taking (within safe boundaries) and an acceptance that not everything we introduce or innovate will always be successful. It helps to create an environment where staff feel confident in speaking up about errors, problems and uncertainties and fosters a culture of trust and shared responsibility.

Cultural change post Covid-19
We have celebrated the work of the NHS over the past six months and have recognised how reliant we are on good healthcare, particularly through Covid-19 which has affected everyone in some way, shape or form. But in order for us to build a resilient future for our healthcare system, we have to put the people who work in it first and their wellbeing and mental health must be prioritised. Our healthcare system has been through a transformation this past six months and there will be good and bad experiences and lessons learnt from Trusts and healthcare organisations across the country. But hopefully, the one lesson healthcare workers will have taken from this experience is the importance of kindness and compassion to their colleagues, patients but most importantly to themselves. Learning to value the needs of our healthcare staff and prioritise them to help them build resilience and navigate this new normal is vital. We must learn therefore to put our own oxygen masks on first before attending to the wellbeing of others.


See Dr Marti Balaam Live

Catch Dr Marti Balaam presenting live at the Allocate and HPMA partnered webinar – Time for NHS Staff to Focus on Self-Compassion. 8 December 2020, 3.00pm – 4.00pm GMT – register today:

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