Infusing Sustainable Happiness into
Nursing for Positive Work
Environments
Sheila Profit, BScN, MAdEd;
Judy Bailey, MN, RN;
Catherine O'Brien, PhD
Cape Breton University
Literature Review
• By 2022, Canada may have a shortage of almost 66,000
nurses (Tomblin Murphy, Birch, Alder, MacKenzie, Lethbridge, Little & Cook, 2009).
• Recommendations to address this shortage include
– developing strategies to improve retention of RNs,
– improve health and well-being of RNs
– improve the retention of nursing students
• Over the past decade research has emerged that investigates
the health benefits of positive emotions, subjective wellbeing (happiness) and life satisfaction.
Happiness Defined
• Definitions vary
• Often referred to as subjective well-being
– Judgments of life satisfaction
– Affect balance – positive feelings and few negative feelings
(Schimmack, 2008 cited in Fisher, 2010)
• Happy or good life involves
– doing what is right and virtuous
– Pursuing important or self-concordant goals
– Using and developing one’s skills and talents regardless of
how one feels at any point in time (Warr 2007 cited in Fisher, 2010)
Happiness Literature
• Research from the field of positive psychology is
being applied in many fields, including workplace
wellness.
• Positive psychology focuses on enhancing wellbeing through the study of happiness, subjective
well-being, and life satisfaction.
• Definitions of happiness may vary, but researchers
have demonstrated that one’s subjective
experience of happiness corresponds with
numerous positive health outcomes (Steptoe, Wardle, &
Marmot, 2005).
• Happiness is often referred to as subjective wellbeing
Happiness and Health
• Studies suggest that positive emotions are
associated with longevity, lower blood pressure,
and reduced risk of heart disease (Seligman, 2002; Steptoe,
Wardle & Marmot, 2005; Veenhoven, 2006).
• Research published in the European Heart Journal
followed more than 1700 Nova Scotians over ten
years:
– those who had experienced and expressed positive
emotions at the outset of the study had reduced
incidence of heart disease.
– Participants who had scored highest in terms of positive
emotions were also less likely to be smokers
– Preventive strategies could include increasing positive
affect (Davidson, Mostofsky & Whang, 2010).
Happiness-Related Constructs in the
Workplace
Job satisfaction,
Typical mood at work,
Thriving,
Engagement,
Job involvement
• All constructs re happiness in workplace have in
common:
– Pleasant judgments (positive attitudes) or pleasant
experiences (positive feelings, moods, emotions) at work
– These are stable over time
Research on Happiness and Workplace
Happy and satisfied people are relatively more successful in
the workplace
• There is a positive correlation between career
satisfaction, self-nurturance and life satisfaction (Nemcek,
2007)
• Business and health care organizations are recognizing a
connection between employee happiness and enhanced
productivity and improved outcomes (Scott, 2009).
• Happy people earn more money, display superior
performance and perform more helpful acts (Boehm &
Lyubominsky, 2008)
• Happy people are more satisfied with their jobs than
unhappy people (Boehm & Lyubimsky,2008)
Happiness and Workplace
• It has been assumed that the
accomplishments of success in the workplace
causes people to be happy.
• Instead the evidence suggests that happiness
preceded measures of success and that
induction of positive affect leads to improved
workplace outcomes (Boehm & Lyubomirsky, 2008)
Question
• Is it possible to teach happiness skills that can
lead to sustained well-being?
• Can individuals shift from a lower level of
happiness to one that is higher and thus reap
the health benefits?
• Could happiness skills be used as method for
fostering healthier lifestyles?
• Many models have been proposed for learning
“happiness skills” (Seligman, 2002; Foster& Hicks, 2000; Ryan, Huta, &
Deci,2008)
• Foster and Hicks have developed a “happiness
model” that has been used to train more than 5,000
nurses at the Mayo Clinic. Health professionals who
participated in their training program experienced
enhanced subjective well-being, both personally and
professionally. Participants also develop skills that
can be applied with clients.
• Research by Dr. Catherine O’Brien with
nursing staff and medical social workers using
the happiness model by Foster and Hicks
found a positive impact on:
– Participants’ attitudes
– A healthy work environment
• Nursing participants recommended that every
nurse and nursing student would benefit from
participating in a similar happiness workshop
What is Sustainable Happiness?
Developed by Dr. Catherine O’Brien(2005) to merge
principles of sustainability and findings from
happiness studies in order to draw attention to the
consequences, both positive and adverse, of how
individuals, communities and nations pursue
happiness
• Sustainable happiness is “happiness that contributes
to individual, community and/or global well-being
and does not exploit other people, the environment
or future generations” (O’Brien, 2009).
Foster and Hicks Happiness Model
The Nine Choices Towards Happiness (Foster &
Hicks)
1. Intention – the active desire and commitment to be
happy and the decision to consciously choose
attitudes and behaviours that lead to happiness over
unhappiness
2. Accountability – the choice to create the life you want
to live, to assume personal responsibility for your
actions, thoughts and feelings and the emphatic
refusal to blame others or view yourself as a victim
3. Identification- the ongoing process of looking deeply
within yourself to assess what makes you uniquely
happy, apart from what you are told be others should
make you happy
4. Centrality – the non-negotiable insistence on
making central to your life that which brings
you happiness
5. Recasting - the two-step process that
transforms problems and trauma into
something meaningful, important and a source
of emotional, energy
6. Options – the decision to approach life by
creating multiple scenarios, to be open to new
possibilities and to adopt a flexible approach to
life’s journey
7. Appreciation – the choice to appreciate
deeply your life and the people in it and to
stay in the present by turning each
experience into something precious
8. Giving – the choice to share yourself with
friends and community and to give to the
world at large without the expectation of a
“return”
9. Truthfulness – the choice to be honest with
yourself and others. And not allow societal,
workplace, or family demands to violate
your internal contract
Purpose of Research
Introduce nursing faculty and nursing students to the happiness literature,
outlining its significance for personal and professional well-being.
A workshop was done with the nursing faculty prior to doing the research
with the
The Foster and Hicks happiness model + the concept of sustainable
happiness= an intervention strategy which may assist students to
develop or re-connect to an intrinsic value system.
Intrinsic value orientations are associated with higher measures of
subjective well-being (happiness).
Research question =What is the impact of the Foster and Hicks
model and sustainable happiness on the intrinsic values of 1st
and 4th year nursing students ?
Ethics
• This research received approval from the CBU
Research Ethics Board
• Funding received from the Cape Breton Health
Research Grant Fund for $4034.00
Methodology
• This was a minimal risk study.
• Sustainable Happiness Workshops were
provided to 1st year and a 4th year
experimental groups
• No workshop initially for 1st & 4th year control
groups
• All students provided consent to complete an
Aspirations Index Survey & Sustainable
Happiness Survey
• Following survey completion a random
selection of students were interviewed
Workshop
• The aim of the workshop was to provide skills
to enhance subjective well-being
• Video
• Interactive exercises (listening)
• Relating personal experiences
• Reflecting on personality types
• Examine intrinsic vs extrinsic rewards
Example of Workshop Exercise
Self Reflection
• Think about the happiest person you know and
why you consider them to be happy?
• What makes you happy?
Risk
• The only potential adverse impact is that
through the process of reflecting on happiness,
participants may find that they become aware
of aspects of their life, personally or
professionally, that are not satisfactory
• The students were provided access to support
systems for dealing with any issues that may
have surfaced
Student Participation
• N 491: 1 and N125:1 designated Control
Groups
• Offered the workshop post research study for
Control participants
• N491:2 and N125:2 designated Experimental
Groups & were given the workshop
First Surveys
• Consents, The Sustainable Happiness Survey
and The Aspirations Index Survey were
distributed to both Control & Experimental
Groups
• The Aspirations Index was used with the
permission of the authors. It measures intrinsic
and extrinsic value orientations.
• Voluntary
• Coding for confidentiality and data collection
Second Surveys
• Completed by the Experimental Groups N491:2
and N125:2 in class 1 week following the
workshop
Third Surveys
• The Sustainable Happiness Survey and The
Aspirations Index Survey were distributed to
both Control & Experimental Groups during the
last class of the term (3 months following 1st
survey)
Interviews
• Student interviews conducted
• Random selection of students both control &
experimental
• 6-10 Interviews Experimental
• 2-3 Interviews Control
Results of the Research
Aspirations Index Survey
57 questions ( a & b), measured 11 domains
•
•
•
•
•
•
Money
Image
Popularity
Conformity
Self-acceptance
Affiliation
•
•
•
•
•
Community
Health
Spirituality
Hedonism
Safety
Sample of Questions for AI Survey
• Money Domain
– I will have many expensive possessions
a)
Importance 1
2
3 4 5
6 7 8 9
not at all a little moderate very extremely
b) Chances
1
2
3 4 5
6 7 8 9
very low
low
moderate high very high
• Self Acceptance Domain
– The things I do will make other people’s lives
better
a)
Importance 1
2
3 4 5
6 7 8 9
not at all a little moderate very extremely
b) Chances
1
2
3 4 5
6 7 8 9
very low
low
moderate high very high
Questions for Sustainable Happiness Survey
Prior to the Sustainable Happiness workshop I often engaged in the
following activities:
• __carpooling
•
•
•
•
•
•
•
•
•
•
__water conservation
__expressing appreciation
__walking
__composting
__purchasing fair trade
products
__energy conservation
__counting my blessings
__ using public transit
__physical exercise
__eating nutritious food
• __attempting to buy local
products
• __checking where products
are made
• __mindfulness
• __spending time with
friends
• __spending time with my
family
• __using the Foster & Hicks
happiness model
• __attempting to reduce my
consumption
• __Other (please describe)
Data Analysis of AI & SH Surveys
• 1st year Experimental = 33 students (198
surveys)
• 1st year control = 37 students ( 148 surveys)
• 4th year Experimental = 21 students (126
surveys)
• 4th year Control = 25 students (100 surveys)
• SPSS, Descriptive Statistics, Mean, Grand
Mean, Anova
Interview Questions - Experimental
• What was your experience of the workshop
while you were attending?
– realized the biggest thing I need to changerecycling & driving- I’m carpooling now and
recycling- less use of water bottles- I’m saving
money, that makes me happier- I remember the
animal types, I was in a big group of dolphins- the
surveys are what I remember most- I learned from
the surveys
– I wanted to do the natural highs more oftenexpressing gratitude-made a point of appreciating
parents-thought it was cool to think about
happiness
Interview Questions- Experimental
• Following the workshop, did you experience
any positive (or adverse) short term impact on
your life personally?
– Yes, I am someone who is stressed- found I started
to use “me” language rather than “you” in
relationships- take responsibility instead of
blaming-expressing appreciation more
Interview Questions-Control
• Identified experiences as a nursing student as
very stressful
• Indicated limited awareness of relationship b/t
happiness, health and well being
Ongoing Analysis of Results
• Need to integrate the concept of sustainable
happiness and happiness skills throughout the
program and not rely on just ½ day workshop
• Happiness literature has implications for
personal, unit and organizational level
• The concepts of Sustainable Happiness can
make a positive impact on at least 3 levels
– Personal
– Practice Work Environment
– Client Outcomes
References
Boehm, J. K. & Lyubominsky, S. (2008) Does happiness promote career
success? Journal of Career Assessment, 16 (1) 101-106.
Davidson, K. W. Mostofsky, E.. & Whang, W. (2010, February) Don't
worry, be happy: positive affect and reduced 10-year incident
coronary heart disease: The Canadian Nova Scotia Health Survey.
European Heart Journal.
Diener, E., Emmons, R., Larsen, J., & Griffin, S. (1985). The satisfaction
with life scale. J Personality Assessment, 49(1), 71-75.
Fisher, C. D. (2010). Happiness at work. International Journal of
Management Reviews, 12, 384-412.
Grouzet, F., Kasser, T., Ahuvia, A., Dols, J., Kim, Y., Ryan, R.M.,… Kennon
M. S. (2005). The structure of goal contents across 15 cultures.
Journal of Personality and Social Psychology,89(5), 800–816
Nemcek, M.A. (2007). Registered nurses’ self-nurturance and life and
career satisfaction. AAOHN Journal, 55(8), 305-320.
O’Brien, C. (May, 2010) Sustainability, happiness and education. Journal
of Sustainability Education. 1.
References
Ryan, R.M., Huta, V. & Deci, E.L. (2008). Living well: a self-determination
theory perspective on eudaimonia. Journal of Happiness Studies, 9,
139-170.
Schimmack, U. (2008). The structure of subjective well-being. In Eid, M.
& Larsen, R.J. (eds.) The Science of Subjective Well-being. New York:
The Guilford Press.
Scott, D.E. (2009). Happiness at work. The Alabama Nurse, 36 (1) p.9.
Seligman, M. (2002). Authentic happiness. Toronto: Free Press.
Steptoe, A., Wardle, J., & Marmot, M. (2005). Positive affect and healthrelated neuroendrocrine, cardiovascular, and inflammatory process.
Proceedings of the National Academy of Science,102 (18), 6508-6512.
Tomlin-Murphy, G., Birch, S., Alder, R., MacKenzie, A., Lethbridge, L.,
Little, L. & Cook, A. (2009). Tested solutions for eliminating Canada’s
registered nurse shortage (Canadian Nurses Association Rep.)
Veenhoven, R. (2006). Healthy happiness: Effects of happiness on
physical health and the consequences for preventive health care,
Journal of Happiness Studies, 15-11.
Questions