When the going gets tough(er) Developing resilience

Transcription

1 When the going gets tough(er) Developing resilience Dame Barbara Monroe DBE

2 A bit about me Length of contact Often younger with children Particular stresses for carers Especially feared illness 1991 Succession of losses Communication difficulties 2000 But MND is not totally unique

3 Stress Stress and challenge are inevitable in most jobs but health and social care professionals seem to suffer greater levels than those of the general workforce - 28% compared to 18% (Wall et al 1997) Two sources: the intrinsic nature of the work itself and the work context

4 Working with patients with incurable illness and with their families We need to find positive i ways of coping with the continuous interactions and managing the confrontation with our own vulnerability and mortality Working with such patients does not inevitably lead to greater stress. Hospice and palliative care nurses and doctors experience less than colleagues in other settings (Vachon 1995,Pereira et al 2011, Lepnurm et al 2008) Buffering effects of supportive environment and collective Buffering effects of supportive environment and collective sense of the meaning and satisfaction of the work?

5 The work context The quality of management of everyday organisational life and the organisation's approach to managing change. Lack of control, time and workload pressures,low autonomy, lack of feedback and social support (Vdipi et al 2008) Most studies indicate that organisational issues are a greater source of stress than patients It has long been known that there is a connection between patient and family functioning, although direction hard to determine (Hodgson et al1997) g ( g ) It is now also clear that patient care is linked to staff care. The way staff report their own wellbeing is closely linked to the way they care for patients (Raleigh 2009). Indeed it seems that experiences of healthcare staff are antecedent t to those of patients t (Maben et al 2012) It is very important that we pay attention to promoting staff wellbeing, competence and confidence Professional, patient and family, community, team and general organisational resilience are inextricably intertwined

6 How to recognise stress Individual: depression, loss of self esteem, irritability, over involvement in work, sleep disturbance, minor illnesses, rigidity, cynicism, apathy, persistent sense of being overwhelmed... Organisational: power struggles and rivalry, regular hostility towards managers, unrecognised conflict displaced onto convenient scapegoats, bullying, high sickness rates, rapid turnover, general lack of enthusiasm especially for new initiatives... Resource constraints increasing and changing demand and Resource constraints, increasing and changing demand and significant social change mean we must accept the challenge to do more, better/ smarter for less

7 What is resilience? A universal capacity which allows a person, group or community to prevent, minimise or overcome damaging effects of adversity. (International Resilience Project. Grotberg 1997) The capacity to do well when faced with difficult circumstances. (Vanistendael. BICE 2003) Resilience can be enhanced. (Almedon. J. Loss & Trauma 2005)

8 Starts with children but is relevant to all Research interest grown since child psychiatrists in 1970s realised that some highly disadvantaged, vulnerable children had much better than expected outcomes. (Anthony & Koupernik. Wiley 1974) Linked to : Self esteem and confidence Self efficacy Social problem solving approaches (Fonagy. Journal of Child Psychology & Psychiatry 1994 )

9 Growing understanding of psychobiology and the neurobiological basis of behaviour (Charney. Am.J.Psychiatry 2004) What turns on and switches off hormonal responses to crises. Importance of how we store memories of unpleasant experiences (McEwen. New England. J. Medicine 1998) (McIntrye. Eur.J. Neurosci 2002) Resilient e can find positive meaning in stressors s Greater access to stored positive information to offset or avoid being overwhelmed (Fredrickson. American Psychologist 2001) (Tugade. J. Personality & Social Pschol 2004) Attachment theory emphasises the importance of preparation and basic security in acquiring confidence (Bowlby and Ainsworth 1960/70s)

10 Childhood resilience promoted by : Strong social support networks Presence of a supportive adult Sense of mastery, belief own efforts make a difference Capacity to reframe adversity Ability to make a difference by helping others Opportunity to develop coping mechanisms - not pp y p p g sheltered from challenging situations (Newman. Barnardo s 2004)

11 Benefits of confronting adversity Adaptation following bereavement associated with self awareness, increased empathy, appreciation of family relationships, independence, re-prioritised goals and values, deepened spirituality and increased altruism. (Kissane OUP 2004) Optimism, not determinism; possibilities, not just problems (Rutter 2000s) Resilience emphasises the interaction between individual, family, social and cultural l environment

12 Review of resilience in health h care staff ( McCann et al 2013) "The results suggest that resilience involves the interactions of individual and contextual factors. These include demographic characteristics (age, gender, experience), personal characteristics (having a work-life balance, laughter, relaxation) and professional characteristics (continuing education, professional identity), and the contextual factors include partner or family support, clinical i l supervision i and the culture of the discipline. It is this interaction that t enables the maintenance of personal and professional wellbeing in the face of ongoing stress and adversity."

13 Sense of coherence Comprehensible e sbe understanding d the experience; e it makes cognitive sense Manageable having the resources to meet needs Meaningful finding emotional and spiritual meaning forgiveness, reconciliation, legacy, ritual (Antonovsky. 1987) Facilitate telling the story moving from chaos to a story that can be lived by and lived with (McLeod 1997, Chochinov 2005) Having the chance to give as well as receive maintains self esteem and realistic hope (Herth 1990) How do we organise services and environments to deliver these opportunities?

14 In the face of death (Papadatou 2009) Professionals need opportunities for: Information exchange to improve performance and collaboration Sharing personal experiences - the primacy of five minutes Reflecting on purpose and meaning Not all of these are always allowed. Mastery requires a coherent narrative not just ventilation. What does a supportive organisation look like? We need structures that encourage learning about coping with change and loss. You can catch confidence by observing others. Undergraduate training, placements and job exchange

15 What supports resilience? A realistic attitude towards caring for others Responsible "to" not "for" Partnering not paternalistic. Recognising that care is not a commodity Affirming capabilities as well as deficits. Staying curious and open to surprise Thinking about talking to more than one person, in reality and virtually. Help with sharing emotional pain and deciding what is important. Keeping people together whilst recognising differences of opinion and timing Honesty and reliability - avoid false reassurance Finding a way to be yourself- people recognise authenticity and can use it to develop trust Acknowledging mistakes and saying when you don't have an answer

16 What supports resilience? Communication centred on the individual What worries you most about your illness? What is the most important issue in your life right now? What helps you keep going? What is your greatest t problem? Is there anyone you are especially worried about? Would it help to go through the kinds of questions the children might want to ask? They may not do so out loud What else do you need to know to help you think about that?

17 What supports resilience? Self care Manage your energy not just your time. A rushed half an hour or an unhurried five minutes Don't confuse helping with rescuing. You don't havetobesuperman Acknowledge your feelings and get support for them ( Christmas and me) Manage endings- what's their s, what's mine? "How will it help you most to go from here?" The power of a pause. The importance of a buffer zone to de-role Find an opportunity to belong and not be alone. Create a team if you are single handed and build positive professional networks. These will help you lobby about the things you cannot change alone Pursue a passion in work or outside. Remember what you are good at and share it Think about ways to relax - physical exercise or creativity Manage times when personal pressures are acute e.g. a personal bereavement Cultivate optimism and a sense of humour Take treats seriously and be a little delinquent sometimes!

18 Balancing engagement and detachment Do you ever feel overwhelmed? No. It's about not being afraid of the situation or of the babies. I don't cry. I'm heartbroken every time, but it is their grief, not mine. I am an onlooker who is coming in to do something they don't even know they want at that moment in time. But doing it gives them pictures that they can look at in 10 or 20 years' time and remember their child. (Paula Brown Guardian July 2015)

19 What supports resilience? Good organisational hygiene Policies and procedures, competencies and standards, recruitment, induction and mentoring Appraisals and clinical i l supervision i Clinical review and Schwarz Rounds The chance to grow - opportunities for ongoing training and development Formal mechanisms for listening and consulting Management training for middle managers Well managed meetings with clear team objectives Support for innovation and legitimising g local action - the chance to own something and to have a good idea Sensitive support for return to work The chance to stay yourself and the possibility of disagreeing and sharing mistakes. "The most successful teams..can accommodate a broad range of views on important topics"(farsides 2006) Motherhood and apple pie - but.

20 What supports resilience? Strategic and personal leadership Leaders who recognise that no one profession or service can meet need and achieve success alone. A resilient service is an integrated service Leaders who engage g with the development of community capacity and new thinking about volunteering Leaders who deliver a more measured response to risk Leaders who recognise that change means something different to everyone Leaders who make clear decisions about what not to do or what to stop doing Leaders who have a commitment to quality and who know it is delivered by individuals and teams, not organisations Leaders who have eyes that see and who say thank you Leaders who ensure an adequate working environment

21 What supports resilience? A moral compass Not having to be right - thinking options not solutions Not beating yourself or others up Thinking about the worst regret you can live with Knowing that something is not the same as nothing

22 The research evidence thus far suggests that there is no magic bullet. We all need to take individual and collective responsibility for implementing a range of practices to create a positive support system. These will include personal and organisational mechanisms aimed at reducing stress and improving job satisfaction and a sense of personal competence.

23 Resilience. A Framework. (Hospice UK and The Point of Care Foundation 2015) Resilience in Palliative Care. Achievement in Adversity. (Edited Monroe and Oliviere 2007)