Eat, pray, love…yourself
ADA 2013
Shari Liesch APNP, CDE
1
Disclosures
Abbot Speaker Bureau
2
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Health care providers care for others…do they look
after their own needs
◦ Eat = physical needs, energy balance
◦ Pray = emotional needs
◦ Love = relationships (linked to well-being)
Goals:
◦ evaluate physical, emotional role risks
◦ explore how relationships (professional and personal)
impact overall well being
3
EAT: the physical world
4
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Think of a time that
your role has impacted
your health….
◦ Illness
◦ Injury
◦ Rest/sleep
◦ Demands, deadlines
◦ Irritable clients
◦ Administrative
5
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Physical demands
Emotional demands
◦ Acute & chronic needs of others
◦ Death
◦ The unexpected
Personal trials (what is happening in own life)
Lateral violence
Administrative changes
Governmental policy
How do we handle it all?
6
1. Biological: viral hepatitis, TB, HIV
2. Chemical: cytotoxic, anesthetic
3. Physical: radiation, needle stick, patient handling
4. Psychosocial: stress, shift work
Outcomes of exposure
Cancer, injuries, infectious diseases
2011 Nursing World: Health & safety top concerns:
Acute/chronic effects of stress & overwork (74%)
Musculoskeletal injury (62%)
Aiken et al 2002 ; Peipins, et al 1997
7
noise
Significant is:
percieved
stress
job
satisfaction
turnover
intent
personal
stress
Work:
When controlled
environmental
factors: improved
 Satisfaction
 Retention
 Stress
 Outcome
measurement of job
stress: mood
Full time & strains
& sprains linked to
turnover intent

Brewer et al 2011
Applebaum, Fowler,
Fiedler 2010
8
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Nursing shortage
Increased work load
Decreased support
Retention/turnover issues
Challenging work
environment: are new grads
ready for the demands
◦ Polled nursing schools…
◦ New grad comments…
◦ Family bathes, trays
passed by non nurses:
Introduce Gloria...
◦ IV, meds, monitoring
Job satisfaction matters
Time with patient & ability to
care impacts satisfaction
Davey, et al 2009
Spence, et al 2009
9
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Working age nurse: Younger nurse
◦ TB death small
◦ No excess death r/t HIV
◦ CA: breast & colon CA slightly higher
◦ Chronic lympho-leukemia slightly higher
Older nurse:
◦ Chronic myeloid leukemia
◦ Malignant neoplasm
◦ Slight increased kidney cancer
◦ Slight increase brain & CNS CA—compared to total
◦
Nurse health study
10
Work injury influenced by
psychosocial & physical
exposures (Australia)
 ^ stress  5%
probability of injury
 As # of health conditions
increased, (3 & >6)
chance of injury
increased (5% & 15%)
 Programs targeting
modifiable factors
(psychosocial & physical
health) improved health
& work productivity
Vecchio et al, 2010
Low back pain compared to
personal/work characteristics
 Korea: mean age 27
 High prevalence of back pain
in ICU nurses
 Nurse w/2-4 years experience
had greatest probability of
back pain and treatment
◦ 90.3 % had back pain/monthly
◦ 18.3% received treatment

If perceived staffing as
inadequate (64%) and working
>6 night shifts/month (48%)
= increase in back pain

Ja June & Cho 2010
11
Mortality due to diabetes = white collar workers
 Mortality due to heart disease: fewer compared
to all
 Working age nurse (vs retired): increased
accidental poisoning: drugs/meds
 Falls
 Slight increased risk: suicide
 No homicide or alcohol related increases
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Baer et al 2010
Last nurse study: 2012
White rice activity
12
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Protective gear
matters
◦ Hockey “cup”
invented in
1874
◦ Head helmet
in 1974??
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Infection control,
universal precautions
Protective needles
Remember finger cots?
Safety is improved
◦ Masks
◦ Gloves
◦ Gowns
Attention to
◦ Noise
◦ Lighting
◦ Shift limits
13
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It’s cumulative
Linked to
◦ Illness
◦ Obesity
◦ Heart disease/stroke
◦ Hypertension
◦ Diabetes
◦ Cancer
◦ Resilience problems
◦ Grabbing “junk” food
14
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Increased
◦ Sleepiness: (subjective)
◦ Mistakes
Decreased
◦ Alertness (behavioral)
◦ Safety
◦ Productivity
◦ Attention & working
memory
◦ Slowed thinking speed
15
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Competence
◦ Recognition
◦ Ability
◦ Strengths
◦ Gifts
Autonomy:
◦ Choices
◦ Voice
◦ Make decisions
◦ Feel supported
◦ Longevity,
◦ Power, less hostility
Self determination Theory, Mental Fitness
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Relatedness
◦ Belonging
◦ Connected to others
that are supportive
◦ Support
 Professional
 Personal
 Teambuilding
16
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Examine job related
autonomy, relatedness and
competence in a group of
health care providers (AADE
members attending AADE12
invited to participate)
Assess if there is a
correlation between overall
quality of life and perceived
autonomy, relatedness and
competence.
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Hypothesis: improved
job satisfaction and
overall perception of
health positively impacts
quality of life and
perception of well being.
17
Role
nurse
CNS
NP
RD
PT
Pharm
MD
industry
18
90
80
70
60
50
role
40
30
profession
k
20
10
0
<2
2 to 5 6 to 11 to 16 to 21 to over
10
15
20
25
25
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AGE
practice location
inpatient
<26
26-46
47-64
over 64
outpatie
nt
amb.
Care
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Lower competence <11
years in role
(p= 0.027)
Greater competence:
◦ Age >47 (p = 0.015)
◦ >25 years in profession
(p= 0.015)
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Relatedness increased if
>33 hours per week:
◦ <33 hrs. per week less
relatedness (p=0.041)
Increased autonomy :
◦ >25 years in profession
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Sense of smell & taste decline over
time
Decreased muscle mass
 After age 35 we lose ½ #
muscle / year
 = a shift in type of cells even if
the scale doesn’t change
Energy: 3500 calories = # 1
Sitting
 Child 4-500 calories/hour
 Adult 80 calories/hour
Muscle burns 35-50 calories/pound;
Fat burns 2 calories per pound
22
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How do we?
◦ Combat aging
◦ Deal with gravity
◦ Stop muscle loss
◦ Deal with work demands
What about you and your
work environment…
How about activity?
Do you have play time?
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1. The leading
cause
of
preventable
death?
a. Smoking
b. Obesity
2. When sleep
deprived, what type
of food do persons
grab the most?
a. fruits
b. veggies
c. cookie, candy,
soda &
donut like stuff
.
24
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If you have a
minute, use it
wisely.
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Get active
 30-60 min. most days
 More intense 45 min 2x/week
Monitor intake—journal
 Eat breakfast
 Fruit/veggie intake, fiber, portion
sizes, reduce fat
 Calcium, vitamin D, iron, etc.
Maintain a healthy weight
No/reduce smoking
Control health concerns:
 Cholesterol
 BP, weight, blood sugar
Zapka et al 2009
25
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Quality, quantity of energy intake
Food = socialization
Liquid calories?
Activity
 miracle grow for the brain
 stress management
 Kaiser: healthy weight less likely to develop dementia
 Amen clinics: dinosaur theory: smaller brain
What about your work team…..
 Lemon bars need lemon
26
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Emotions
and
spirituality
27
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Self & growth
◦ Public self
◦ Private self
◦ Personal self
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Nursing
◦ Maker of meaning
◦ Member of
technology
◦ Each a mystery
◦ People are messy
Gallion & Stamp
Link between patient
safety & nurse safety
Foley 2004
28
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Think of a time when
emotions were
impacted
◦ Elated
◦ On fire
◦ Dulled/numb
◦ Hurting
Stress of diagnosis
Loss of the known
How was your life
journey impacted?
The 5 minute call…
Happy
Proud
Surprise
Excited
Calm/relaxed
 Frustrated
 Anger
 Irritated
Keeping the poker
face when
stressed…
◦
◦
◦
◦
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Erickson & Grove 2011
29
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Erickson & Grove
Reviewed emotions & burnout
Knowing emotional demand is
critical; how work stress translates
to burnout & turnover
◦ Influenced by organizational
practices governing work place more
than the challenge of care
◦ How emotions are managed on the
outside: surface acting Vs deep
acting (how one feels on the inside)
 Younger nurse experience
more stress & burnout
 Increased burnout if more
surface acting & more
masking of emotions
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Does management of the
emotion or the emotion
itself cause burnout?
Burnout related to:
◦ Older nurse: if low
level of + emotions
◦ <30 yr old: if
experience agitation
Covering up true feelings
lead to increased burnout
than nurse who does not
cover up true feelings
For practice:
Positive emotions may
insulate us
Mentoring needs an
emotional, supportive
part
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2/3 say job
satisfaction same
or slightly less
than in the past
Listed professional
development
& recognition as
motivators
Administrators
goal:
◦ job satisfaction,
◦ decreased turnover
◦ less nurse shortage
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Commitment of
management in nursing:
Increased
◦ quality care
◦ professional
development
◦ patient safety
◦ + clinical experience
◦ retention
Sammer & James 2011
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All this helps weather
health care’s
economic storm
Ma, Samuels & Alexander 2003
31
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If more satisfied
Raise to challenge of
organizational
restructure, need
◦ Access to information
◦ Support
◦ Opportunity
◦ Resources to do the
work
◦ Certification and
magnetism matters
◦ Pursuit of higher
education
Structural & emotional
empowerment matter
Job satisfaction
Increased retention
Improved patient
satisfaction
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Personality traits do
NOT matter
Erickson & Grove 2011
32
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Job satisfaction
Job stress: leads to
◦ work burnout
◦ emotional
exhaustion
◦ work frustration
Autonomy—improved
work environment,
more control
+ relationship to job
satisfaction
able to decide how I
work
level 1
2
3
4
5
6
7
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Weston 2010; Zangaro & Soeken 2007
33
sense of
feelings matter
accomplishment
level 1
level 2
2
3
3
4
4
5
5
6
6
7
7
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people care about me
1
2
3
4
5
6
7
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Systemic problem
Disenfranchisement
Marginalization
Oppressed group
created by
powerlessness of
nurse health care
system
McPhaul & Lipscomb 2004; Gates et
al 2011; Jones & Argentino 2010
36
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Emotionally challenged impacts
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performance,
satisfaction,
retention,
health,
patient satisfaction
Does improved Emotional Intelligence (EI)
impact group emotional competence
◦ Constructive & appropriate behaviors :
decrease anxiety & nurse to nurse hostility
Feather 2009; Fuimano 2004; Zeidner,
Matthews & Roberts 2004
37
Self aware: emotional feelings and reactions
Emotion = energy
Emotional resilience
Motivation
Interpersonal sensitivity
 Conscious of energy behind the words and interactions
Influence
Intuitiveness
Conscientiousness
Body receives/understands information
Wickipedia accessed 8/15/2011
Mayer, Roberts & Barsade 2008
38
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Learned
Empowerment
Increase autonomy, locus
of control,
Intrinsic & extrinsic
motivators (individual)
Recognition
◦ achievements
◦ desire to care (intrinsic)
◦ receive appreciation for
care given (extrinsic)
Hyrkas & Dende 2009
39
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Increased behaviors &
habits that work vs. do
not work for the group
Proactive skills speak
up if out of line
100% valued– experience
desired teamwork
Build EI in the
individual it builds
◦
◦
◦
◦
the group
team trust
effectiveness
networking
Zeidner, Matthews & Roberts 2004;
Feather 2009;
40
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Have space to experience own emotions
Empower each other: ^ trust, caring, safety, EI
Energize
Encourage, respect
Empathy: center to nursing role
◦ Improves outcomes, increases satisfaction with care
◦ It can be learned through in-service education
Ward, et al (2012) assessed empathy in undergrad programs:
 found decline in empathy over the school year
 students with more clinical exposure had less empathy
 historically younger nurse, with less experience more empathetic
◦ Decline may be related to: time constraints, anxiety, lack of support,
intimidating educational environment
 expanded roles  increase in technical skills
41
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Increase trust, care,
safety
Increase EI & Group
Emotional Quotient (GEQ)
◦ Modify, redirect actions
(based on assessment for
the moment)
◦ Increase constructive
outcomes
◦ Improved group member
awareness, regulation, &
interaction
◦ Encourage behaviors that
seek awareness (+)
◦ Regulate emotions through
personal growth 
increases group
competence
Fuimano 2004; Mayer, Roberts & Barsade 2008,
Laschinger et al 2009
42
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How are we doing?
Nursing 93-95% women
◦ What about women?
◦ Emotions
◦ Hormones
◦ Multi-task
◦ Competitive
◦ Internalize stress  health
consequences
◦ Stress eat
◦ Lapse B/W knowledge and
ownership of behavior
 Women in survey CVD
prevention: assessed
knowledge, intake, if smoked,
exercise
Had knowledge, didn’t
implement
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Senior nurse down hill
flow
◦ Understanding the new
nurse isn’t easy
Community vs. I approach
◦ Proper orientation
◦ Mentoring
◦ Buddy system
◦ Teambuilding
◦ Conflict resolution skills
◦ Commonwealth
◦ Hold each other
accountable
Hippeli 2009; Mills & Mullins 2008;
Zangaro & Soeken 2007
43
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Belief in something
greater than
one-self
◦ Offers renewal
◦ Soul nurturing
Connect with nature
Where do you find
balance in your life?
◦ Floating down the
Menominee River
VS rafting class 4
rapids
44
45
Stay or go?

In business
◦ Estrogen to profit
ratio is well
known
◦ Women leaders
mentor
underlings
◦ Nursing is
flooded with
“estrogen”, yet we
struggle
Personal factors
 Marital status
 Childcare needs
 Greater chance at part
time employment
Higher education
◦ Males: enroll in non
nurse role
◦ Advanced practice:
decreased attrition
Nooney, Unruh & Yore 2010
Handling the curves in life
 Past experience
 Current perspective
(choices)
 Rested vs. fatigued
 Being vs. living
Think of a time you
were tossed an
unexpected curve
ball—how was this
handled
 Staffing changed
unexpectedly
46
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Hope = #1 predictor in goal
achievement
Faith = belief in future
Air = deep breathing
 Oxygen
 Calming
◦ RX: nature-play
prescription
 Acorns, water, sun,
quiet
Dr. Nan Strand and the
amazing race
47
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Singing
improves:
◦ Immunity
◦ Well being
◦ Energy
◦ Posture
◦ Longevity
◦ Decreases
pain
48
Muscles to smile = 22
 Muscles to frown = 37-72
 Smiling = anti gravity
 Smiling = contagious
 May 2 = world laugh day
 Laugh for nothing: it’s heart
friendly
 Laugh at self—shift the
perspective
 No humor: emotional apathy
 disease
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49
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Does how you spend
your free time impact
your emotions?
What impacts your well
being?
50
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What keeps you
grounded?
How do you keep your
creativity alive?
What about work
stress, how do you
handle this?
How do you feed your
inner child?
Is use of your hands
important to you?
51
Love

Relationships: who is in
your circle
52
Think of your
relations
Family
Work
Friends
Neighbors
Communities
Who makes up
the strands that
help hold it all
together for you?
Who’s in your circle
Wellcoaches, 2010
53
mood satisfaction
Very
poor
poor
MOOD
Color
Chart
pressured at work
level 1
2
3
4
5
54
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Life engagement
Connections:
◦ Help with
personal
development
◦ Help us achieve
our potential
Life bands: link or
connect us
◦ Watch for
negativity
55
56
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Veterans born: pre 1945
(>64)
Baby boomers: 1946-1964
(47-64)
Generation X: 1965-1980 (30-64)
AGE
Generation Y: after 1981
(26-30)
Millennium Era??
<26
26-46
47-64
over 64
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Veteran nurse
Hard work
Respect authority
Duty before play
Sacrifice
Follow rules
Work is obligation
Experience respected
No news is good news
Satisfied with job well
done
Work & family kept
separate
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Baby boomers
Value family
Job completion
Do as told
Commit to experience
Accomplishments matter
Roles overlap
Huge #; nursing is 2nd
career
Focus on the big picture
Workaholics
Less appreciate rewards,
feedback
Less balance
57
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Generation X
Less value on authority
Personal touch matters
Needs reinforcement
Interested in work/life
balance
Value flexibility, fun,
quality of life, &
creativity
Both
Committed to the team
Longevity less embraced
Authority less valued
Manager: people focused:
motivator, communicator
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Generation Y
Technology abounds:
look at monitor;
forget the patient
Expect to be
appreciated for their
intellect
Like recognition
Mutual support
Trust in system
Embrace new
Multi-task?
58
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X & Y see
baby boomers
as self
indulgent
Ruthless
Uncaring
Baby boomers
see X, Y as
slacker, want
a free ride
59
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Quality of relationships is
reflected by the energy
brought to the relationship
◦ Increased purpose
◦ Meaning to life
◦ Respect & joy in each
other
I am lucky to have so many
siblings…..
I am lucky to have_____on
my team
60
Relationships:
Key to
survival
Impact
overall wellbeing
In the DNA of
well being:
relationships
are the
strands that
hold
everything
(us) together
61
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Adult life
◦ 1st part: mind &
heart (doing)
◦ 2nd part: body & soul
(being)
Increase mindfulness =
attention to the
moment
Story: shopping for
furs in Chicago
62
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Heart energy is vital
Random acts of kindness:
filling the bucket
 Forgiveness
 Friendship
 Optimism
At the beginning of the
day, what do I look
forward to?
Look for reasons to say
thank you…
List 3 things grateful for
daily…
63
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Stress impact
◦ Foot on gas
◦ Foot on brake
◦ Foot on both

Antidote for stress
◦ Laughter
◦ Joy
◦ Humor
◦ Future focus
◦ Connectedness
◦ Confidence
64
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Sharing a
relationship or
personal
challenge……….
◦ Even short term***
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How did you
overcome?
How did it make you
feel at the time?
Later?
Was there someone
or something that
helped?
How were you
impacted long term?
65

Increases longevity
 Connections in your
circle
 Rejuvenate soul
 Busy hands/mind
 Increase humor
 Friendships
 Mind stimulating—
never stop learning

Obstacles
 Life is busy
 Convenience foods
 Supersized?
 Stress eating?
 Impact on activity
 Stress:
 Deadlines
 Perfectionist
 Other contributor’s
timeline
 Health concerns
66
Life balance
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Friendship/relationships
Helping profession
Like to spend time
Like to make a
difference
Satisfaction in task
completion
Happiness factors
Stress antidotes
Brain cell activation
Goal setting
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Stress
Time management strains
Dead lines
Sleep deprivation, shift
work
Lifestyle choices (overcommitment, sedentary,
dietary habits)
Stuff accumulation
The unexpected…
Cutbacks..
How well can you juggle?
positives

negatives
67
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Gratefulness
◦ Increased awareness
◦ Satisfaction
◦ Memories
◦ + mindset,
◦ appreciative
◦ + emotions = life
satisfaction, less
depression
68
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Brain socially
connected
The potential to
change, to learn,
and to grow is in
relationships
Have a sense of
humor (must be
mutually shared)
Are the persons
in your circle
nurturing for
you?
69
The Tipping Point
By: Malcolm Gladwell
Ideas are spread like epidemics
Little things make a big difference
3 rules of epidemics (agents of change)

Law of the few (80/20 rule)
◦
Connectors =gift for bringing
togetherness
◦
Mavens = information specialist
◦
Salesmen = persuaders,
charismatic, negotiators

◦
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Stickiness factor
Retention of content &
entertainment value
Context: sensitive to condition
and circumstance at the time
We are inundated with
messages: back to word of
mouth: personal connections
matter
70
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Links to
longevity
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Hobby
Humor
Happiness
Positivity
Sleep
Think about:
 Eat (energy
balance),
 Pray (emotions),
 Love (life
engagement
through
relationships)
My first 30
years….Back to my
71
Be the tipping point
 Maven
 Salesperson
 Connector
 Use positivity to fuel your
life journey
 Create a future that
empowers
 Find/post an image to
help maintain your goals
 What can we do to be part
of the tipping point that
transforms health care in
a positive way?
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72
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Pick 1 thing (personal or
professional)
 Where are you now
(on a scale of 1 to 10)?
 Where would you like to
be?
 What does your goal look
like: visualize the
dream…
 What is the first step?
**If we are emotionally
attached = increased likely
to follow through & success
73
Shari Liesch
APNP, CDE
CHW Fox Valley
130 2nd Street
Neenah, WI
54956
sliesch@chw.org
920 969 5302
Thank you!!
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Daybreak calls.
She gently takes flight; wings alive and aglow.
Kissing each flower good morning,
Bidding them to rise—decorating her world;
Painting my world; with colors so magnificent.
She tickles each blossom, soon they are singing;
An enchanting choir fills the air. Our world is alive!
With all petals at attention, sweet sounds echo
about.
Contented, she drifts down to her favorite rock,
Peaking over the peaceful ripples of the bay.
She rests, soaking up energy from the sun’s rays,
Until gentle breezes call her, to come and play.
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Today as I rested on the sandy shore,
Peaceful breezes sang.
The butterfly sat down beside me. My heart
swelled.
I tried to reach out to her,
But she flew away…eluding my touch.
I was saddened she left me so alone,
Yet, I thought I heard her whisper,
“Today I celebrate, come and play!”
By Shari Liesch RN,
August 1996
http://Nurspiration.proboards.com
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