Peri-Shift Mindfulness #WILTW

This is the 179th #WILTW

Mindfulness, compassion and burnout

Three words which have only recently become accepted as legitimate terminology in medicine.

We need to work towards tighter universal definitions to ensure the terms are not mis-used, or become consigned to leadership “buzz-word bingo” status. There is something inherent in the word ‘burnout’ that implies the driving factor is the individual themselves. While clearly some people could improve their own coping strategies or mindsets, it shouldn’t be a process where resilience (itself a term that implies some may be weaker than others) is the sole responsibility of the individual.  It’s good to see organisations are already introducing initiatives to help staff, and one might hope that there is a shared strategy between individuals, departments and hospitals in the future.

One of things I’ve become increasingly conscious of is “of the moment‘ personal awareness.

Clearly long term strategies to ensure that you remain healthy and engaged in work are vital. However the concept that an individual shift can challenge your resolve is familiar to all, regardless of speciality or profession. As winter arrives I realise there are a number of approaches to consider (acknowledging very easy to promote “do as I say not as I do” thinking)

Pre-Shift Preparation

I aim to have a quiet ‘period’ 15 minutes before the beginning of any clinical shift. Trying to avoid last minute e-mail replies or phone calls stops you coming on shift distracted about events you then can’t control or respond to. The ideal is listening to music (easier when driving into work on a late shift) as this tends to clear my head. The team at St. Emlyn’s have suggested some tracks to listen to.

In-Shift Awareness

This is the most difficult to prepare for as the more challenging the clinical environment becomes, the more it feels you are less able to take care of yourself when it in fact is increasingly important that you do so. Even 5 minutes of head space is vital if you have been constantly focused for a prolonged period.

Take other’s hints about this, if someone asks you (especially the nurse in charge) whether you have had something to eat or drink, it’s not just your stomach they are inquiring about. They may well be noticing your behaviour is changing and giving you a gentle nudge.

Another important insight is knowing the difference between when you are truly processing information and when you are procrastinating. The former is the natural passage of time used to maximise available information and determine treatment plans appropriate to the patient’s trajectory of illness. The latter is not acknowledging either cognitive overload or tiredness (both normal issue regardless of your experience) and delaying inevitable interventions as you work out what to do.

Post-Shift Practices

Your reflections on your shift will have consequences for your attitude to future shifts. An emotionally demanding shift will will be remembered more negatively  if you finish late and are rushing home or to another appointment. The stress that this causes combines with the stress of the shift. This isn’t the easiest thing to counter-act but it’s important to separate the two. One may cause the other obviously but the resultant emotional impact it has on you is multifaceted and needs to be acknowledged as such.

Cold debrief with a hot drink (a chat with a colleague over coffee in the canteen days afterwards) may alter your internal perceptions about what went wrong or was frustrating to you. This is vital to avoid long term build up of resentment about a particular situation.

I am sure there are other things that are important to consider, react to or reflect on. The key is awareness of your own awareness as it were…

What have you learnt this week? #WILTW

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