Aggie Stewart: The Essence of Self

We are very sorry that our last live contributor, Aggie Stewart, won’t be able to share her live session with you today. We wish her the very best and hope she feels better soon! To ensure that she is still part of the Summit, we share a short extract from Aggie’s new book, ‘Yoga as Self-Care for Healthcare Practitioners‘. We do hope you enjoy it.

 

Self-care is never a selfish act—it is simply good stewardship of the only gift I have, the gift I was put on earth to offer others. Anytime we can listen to true self and give the care it requires, we do it not only for ourselves, but for the many others whose lives we touch.

Parker J. Palmer

 

This is a challenging time to be a healthcare professional. Whether in education and clinical training or in professional practice, major aspects of the healthcare education and delivery landscape present inherent and well‑documented risks to the health and well-being of students and practitioners.

Currently, the effects of the epidemic of burnout and self-harm, blunted empathy, compassion fatigue, absenteeism, and attrition are being felt across the health professions. Research into the factors underlying the current state of practitioner wellness indicates that, for many, signs of burnout and its related consequences emerge during the education and training period and go unattended as graduates step into professional life.

As the healthcare professions grapple with the range of environmental and cultural issues that contribute to the current state of practitioner wellness, self-care has emerged as a pressing need for both students and practitioners. Broadly defined, self-care encompasses the ability to recognize and respond in an appropriate and positive manner to one’s needs on all levels: physical, energetic, mental, emotional, and spiritual. Increasingly, health professional schools, healthcare settings, and health professional associations are providing education on the importance of self‑care on all these levels along with training on specific aspects of selfcare, such as diet, exercise, finances, and activities that support self-care, such as yoga and other mind–body–spirit practices.

Greater awareness of the need for enhanced self-care practices among students and practitioners acknowledges the profoundly human foundation of healthcare delivery. It is a system of humans caring for other humans—humans who are subject to the very same health and wellness challenges and goals as the humans for whom they provide care; humans who are affected by those they care for and with whom they work; and humans who are affected by the environmental conditions and circumstances of the delivery settings in which they work along with the myriad pressures that bear on those settings. Special knowledge of how health and pathology manifest in the physical body and the mind does not make healthcare practitioners or students immune to health issues, particularly those associated with work‑related stress, fatigue, and burnout.


Challenges to Resilience, Empathy, and Compassion

Managing the work-related stresses faced by those dedicated to supporting the health and wellness of others is nothing short of heroic. Across healthcare disciplines, practitioners and students face similar pressures. Some of the most difficult include:

  • the rising cost and debt burden of education and training
  • the effects of the “hidden” curriculum—that is, the conflicting expectations for professional behavior between what is taught in the formal curriculum and what is experienced in the clinical environment, including continuing stigma around mental illness
  • constraints on care delivery imposed by healthcare financing and regulation
  • reliance on cumbersome information technology of varying quality that further decreases meaningful time with patients and clients
  • the impact of sleep deprivation due to long hours, shift work, and call schedules
  • the hierarchical organization of the work environment and the clinician–patient/client relationship that rewards power imbalance, self-sacrifice, and stoicism in the face of complex health issues and at times of tremendous human suffering.

Each of these conditions makes its own contribution to the multifactorial work-related stress equation. Individual disciplines working in a range of delivery settings from private to public and locations from urban to rural face further demands uniquely configured to their patient and client demographics. Additional pressures often include conditions such as:

  • high staff turnover and clinician shortages
  • increased workload and decreased allotted time with patients and clients
  • exposure to patients’ and clients’ emotional needs and suffering related to their health issues along with the associated secondary trauma
  • exposure to workplace violence.

When we combine stresses in our personal life with the resulting mix of work-related stress, the impact on our health, well-being, and resilience and the potential for eroding our ability to act from our innate capacity for empathy and compassion become readily apparent. The evolving science of stress gives us a more nuanced way of understanding how consistent, prolonged stress affects our overall health, well-being, and resilience along with our ability to act consistently with empathy and compassion.

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”5 Well-being can be characterized as a state of comfort, contentment, or happiness. Broadly defined, resilience is the ability to recover from adversity, to meet the challenges of difficult situations and “bounce back,” not merely surviving but learning and growing from them. Resilience reflects the core of our health and wellness. Its strength influences our innate capacity to act with empathy and compassion, two related but different inherent human faculties. Empathy is our ability to be sensitive to and emotionally share or resonate with the emotions of others. Compassion is the ability to recognize the suffering of others, to feel their pain coupled with a genuine desire to alleviate their suffering. Compassion includes feelings of kindness for those who are suffering along with the recognition of the vulnerability and imperfection that underlies our shared human condition.

The unique stress-related challenges to resilience, empathy, and compassion that we face as healthcare practitioners necessitate that we view self-care through a different lens, one that helps us create a sustainable foundation for how we care for our self while we provide care to others.

Creating a Sustainable Foundation for Self-Care

How we do and don’t take care of ourselves involves some of the most deeply rooted, longest-standing habits we have. While great work is being done to educate, expand awareness, and create opportunities for self-care to be actualized across healthcare disciplines, these very positive messages and actions can inadvertently convey and reinforce a sense of shame or blame around not taking better care of ourselves or striking a healthier work–life balance. This can become amplified if organizations are not invested in creating space for self-care during the workday.

Too often the idea of self-care and ways of acting on it become one more thing to do in a professional life already crowded with pressing demands and responsibilities within a larger personal life also crowded with pressing demands and responsibilities. Paradoxically, even simple self-care actions such as taking a stretch break every hour, eating meals away from our work, or remembering to breathe mindfully during moments in a busy, hectic day can feel like putting a band-aid on an open wound that requires stitches. Like New Year’s resolutions, self-care actions embarked upon with the best of intentions become abandoned when the demands of our organizations and the strength of our habits overpower those intentions. These habits include the way we perceive stress, our self, the needs of others, and the environments in which we interact.

When viewed as a “to do,” self-care becomes too easily relegated to the “may do” or “nice to do” category of activities in an already chock-full daily schedule, which makes self-care easy to drop or put off when time grows short and external demands assert themselves. This usually has nothing to do with how important we believe these activities are or even how much we enjoy doing them.

Viewed as an expression of our relationship with our self, however, self-care takes on different resonance and meaning. It elicits more positive commitment, motivation, and efficacious behaviors that support health, well-being, and resilience. When viewed as an expression of our relationship with our self, self-care can begin to become a way of life, part of personal hygiene, so to speak. This view supports self-care becoming regular and sustainable.

When I first mention to healthcare students and practitioners the idea of self-care being about our relationship with ourselves, I often get a deer-in-headlights response, visible stiff squirming, bemused hmms. Indeed, the idea may feel strange at first and may even set in motion a stream of harsh judgments about it being selfish, egocentric, and self-centered, encouraging self-absorption, and leading to a lack of consideration or caring for others. All these negatively charged associations can elicit deeply uncomfortable feelings.

Consider, however, that this negatively tinged perspective fundamentally pits caring for our self against caring for others. This perspective is not often evident during education, training, and professional life, much less the larger culture that forms and prepares us for entry into the healthcare professions. Nonetheless, the message comes through in subtle and powerful ways, with perhaps the most subtle being little real opportunity to act on self-care, not to mention being rewarded for toughness, stoicism, self-effacement, self‑denial, and unquestioned adherence to hierarchy during both training and professional life.

Developing a conscious relationship with our self, however, one that is positive, kind, and loving, is aligned with current research on the positive effects of self-compassion. Human development researcher Kristin Neff, PhD, and clinical psychologist Christopher Germer, PhD, define self‑compassion as “simply compassion directed inward” towards one’s self.

They point to a large body of research demonstrating that self-compassion increases coping skills for dealing with difficult emotional experiences and enables people to thrive and experience less anxiety and depression in the face of challenges. They note that self-compassion decreases cortisol and increases heart-rate variability, markers of our ability to regulate emotions through actions such as self-soothing when stressed.

Neff and Germer also point out that rather than encouraging complacency and laziness, self-compassion has been linked to positive motivation, perseverance, and growth, as self-compassionate people retain an inherent sense of worth regardless of success or failure. This increases theikelihood that self-compassionate people stay on track with and meet their goals. Neff and Germer further note that, contrary to commonly held beliefs, self-compassion does not lead to insular and narcissistic behavior—in fact, just the opposite. Self-compassionate people show more compassion for others, demonstrating an ability to act on empathic concern while being less likely to experience personal distress in the presence of another’s suffering.

Seen in this light, self-compassion becomes a fundamental aspect of the foundation for self-care. Our relationship with our self determines just about everything we do in our day along with how we do it. It affects the way we wake in the morning; our morning rituals; what and when we eat; what activities we do; how we interact with others and go about our work; how we schedule our day; our evening rituals; and how we sleep. When we make this relationship conscious, we have a much better chance of making informed and deliberate choices that safeguard our health and well-being. These kinds of choices enable us to better serve and care for those around us, whether peers, patients, clients, and colleagues or family, friends, and community. They support cultivating and maintaining the health, well-being, equanimity, and presence necessary for working in a challenging healthcare delivery environment, and they deepen and nourish our natural ability to act with empathy and compassion as we care for others.

Personal yoga practice facilitates developing a conscious, compassionate, and loving relationship with our self, one that helps us maintain our health and wellness while keeping our energy and enthusiasm strong for doing our chosen work of supporting the health, well-being, and resilience of others.


Yoga as Self-Care for Healthcare Practitioners
Cultivating Resilience, Compassion, and Empathy
Aggie Stewart

An introduction for healthcare practitioners on using yoga to help manage stress and reach one’s full potential. The importance of self-care to prevent burnout and stress is increasingly recognised within healthcare professions, and is being incorporated into education and training programs. This book gives students and practitioners across healthcare disciplines the tools they need to face various challenges on a multitude of interrelated fronts and help process the stress that these bring. It covers the foundations of yoga practice, and how the different building blocks can be combined to develop resilience, compassion and empathy. Read more

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