Week 3 Discussion: Resilience and Change
Instructions: this is a 2-part assignment:
Part one: discussion board post which has instructions listed below.
Part two: reply to 2 discussions. Those need 1 scholarly reference each.
Required reading:
Access to book:
https://www.vitalsource.com/ OR. https://bookshelf.vitalsource.com/#/
book name: Nursing: Scope and standards of practice
Citation: American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed). Silver Spring, MD: Author.
Required reading:
- 21-24
Required Article
Garcia-Izquierdo, M., Meseguer de Pedro, M., Rio-Risqez, I., & Soler Sanchez, I. (2018). Resilience as a moderator of psychological health in situations of chronic stress (burnout) in a sample of hospital nurses. The Journal of Nursing Scholarship, 50(2), 228-236. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=29266720&site=eds-live&scope=site (Links to an external site.)
Required Website
The Joint Commission Center for Transforming Healthcare. April 23, 2012. Creating a Safety Culture [Video file]. Retrieved from https://www.centerfortransforminghealthcare.org/why-work-with-us/video-resources/creating-a-safety-culture (Links to an external site.)
Weekly lesson attached separately. Cite this as “weekly lesson” and I will fix it when I turn it in.
Initial Post Instructions
Change is part of our daily healthcare environment. Clinical nursing judgments based on quality and safety, as well as protocols and standards, reflect our patient-centered care values.
- What steps could you take to develop more resilience in your practice setting?
- How might you communicate a change in practice to patients and nursing peers?
Part two: discussion post replies, will require 1 scholarly source each, please reply to both, if the initial post takes away from the two pages I pay for, shorten it.
Follow-Up Posts
Compare your analysis with your peers. Examine how yours are similar and/or different. Build on their posts by providing additional information about the acts that you have not already noted in your own post.
Respond to two peers or one peer and the instructor. Further the dialogue by providing more information and clarification. PLEASE REPLY TO BOTH!
Follow up #1: Andrew
Simply put, resilience is the ability to tolerate and overcome adversity (Garcia- Izquierda, et al., 2018). It has become a topic of interest in nursing care as some nurses have an innate ability to tolerate a great deal of stress and shake it off where others do not. This presents on a continuum as opposed to an either/or talent. Resilience can further be defined as a nurse’s ability to adapt, problem-solve, find solutions under adverse conditions (Yu, et al., 2019). There is much that remains unknown about this ability, and a measurement tool still is not in existence. There is inconsistent data regarding personality factors enforcing resilience. While coping skills, self-efficacy, and social support are associated with its presence. Stress, burnout, PTSD, bullying, fatigue, anxiety, depression is associated with its absence (Yu, et al., 2019). What is not clear, is if the presence of resilience is the determining factor of the absence of the negative correlates stated above or if the absence of the negative correlates the determining factor of resilience. While the previous statement sounds naïve as these negative correlates exist in more nursing situations than it doesn’t, resilience is a human trait that needs more study and is not a nursing-specific ability. Resilience relies on the perception of the situation, the perception of the ability to handle the situation, and the interpretation of how this will affect an individual (Bennett, et al., 2018).
One potential measure of resilience on a biopsychosocial level is through stress habituation (Bennett, et al., 2018). Repeated exposure to stress under controlled lab conditions to measure and document resilience training. Evidence-based practice interventions have successfully demonstrated the development of resilient behaviors and with it, improved mental and physical outcomes (Bennett, et al., 2018). A stressful event is a necessary experience for resilience. This directly connects it to the body’s stress response (Bennett, et al., 2018). The activation of the sympathetic nervous system (SNS), releases catecholamines. This giving energy and also resetting the immune system to ensure survival. The stress response also directs interpersonal actions with the goal of maintaining homeostasis through physiologic and behavioral adaptation (Bennett, et al., 2018). In resilient individuals, this stress response turns off once homeostasis is achieved.
In non-resilient individuals, this response system has become less adaptive and responds poorly to these circumstances (Bennett, et al., 2018). There is either no activation of the (SNS) or hyperactivation of the (SNS). This dysregulation of the neuroendocrine-immune system has been linked to non-resilient individuals. Several neurotransmitters and neuro-regulators have also been linked to the differences in resilient and non-resilient individuals (Bennett, et al., 2018). Neuropeptide Y (NPY), regulate overactivation of the (SNS). Non-resilient individuals have lower levels of (NPY) and often fail to release it during times of overactivation of the (SNS). Levels of the neuropeptide neurotrophic factor (BDNF) have been associated with enhanced levels of resilience, while serotonin (5-HT) and its transporter (5-HTT) have been linked to enhanced levels of non-resilience (Bennett, 2018). There still remains much to research and understand about resilience, not just on a behavioral level, but a neurochemistry one as well.
Steps to become more resilient in my practice? I think I’ve spent the last six years of my life becoming more resilient at everything. The nursing care arena is just one environment. Resilience can be built in any, then used in another. From where I’m sitting, it’s more about the person and how they’re going to deal with a particular anything, than anything they’re dealing with. I guess, for me at least, its about mindset. If I could even call it that. There are a few things completely unrelated to nursing I believe I’ve learned the most about resilience than anything else. The program and being chronically ill. There just isn’t much out there worth getting me all worked up about. Now, I just don’t. I’m happy, so I know its not apathy, I am still involved so its not indifference. I do the best I can and know enough when I’m over my head to reach out for help. The formula works. Communicate a change in practice to patients and peers is something I don’t think would be an issue. Stay as objective as possible and simply tell them. My opinion about a change is a whole other ballgame and would need due consideration before giving it if I did at all.
Follow up #2: Stacey
Communication is the key component in all that we do. We use verbal communication, written communication, as well as actions as communication in everything we do as nurses. “The goals for each of us, especially in professional communications, are to always be conscious of both what we intend to communicate and what it may be perceived that we are communicating, and to be articulate, purposeful, and concise” (Ulrich, 2016). When dealing with changes in process, communication is a vital component. It is important to communicate effectively so that the information is conveyed accurately and succinctly with no margin for error. There have been many process changes in the past several months where I currently work. Since I float between three Freestanding EDs, with three different managers, there is always a chance of miscommunication or that one place is doing things just a little bit differently. I will give you an example. When I first started we were having to fill out a secondary slip of paper that went with the original EMTALA form when a patient got transferred. This slip of paper did not go with the patient, it stayed on site. Now, one site is not filling this out anymore. This can be confusing going from one site to another with things not being done the same. This was not conveyed from the manager, I was told by another co-worker. I did go to the manager and verify the information. This can be very frustrating. Most of the time information is passed on through e-mail updates and the managers are good about being on the same page. Having effective and cohesive communication across all departments is important.
With so many changes and updates in healthcare good communication is imperative. Especially no with the COVID-19 pandemic. Things are changing on a day-to-day basis. Where I live all of the schools statewide are closed, including college campuses. The emergency rooms are being overrun with patients and phone calls regarding the virus. Nurses are working longer hours and dealing with higher census everywhere, and it is only going to get worse. The ANA (2015) states that one of the nurse’s competencies is “maintains communication with interprofessional team and others to facilitate safe transitions and continuity in care delivery”. This is such a critical time for all of us. Burnout is a real possibility. Burnout syndrome is described as “a response to work stress determined by three dimensions: emotional exhaustion, cynicism, and professional inefficacy” (Garcia-Izquierdo, Meseguer de Pedro, Rios-Risquez & Sanchez 2017). These are all real challenges for the nurse. We work long hours taking care of not only the sick patient, but provide comfort to the family and friends. We are constantly bombarded with other peoples needs. Add on the needs of our own families once we get home (and the added stress of school). This often leads to not having time to care for our own needs. We often don’t realize we are on the verge of burnout until it is too late. Many seasoned nurses have built up resiliency to the constant bombardment of other people’s needs. “Resilience enables positive adjustment of the person and his or her environment, that is, maintenance of good health despite stressing circumstances such as those faced in the day-to-day work environment” (Garcia-Izquierdo, et al., 2017). We need to learn to watch out for our co-workers and ourselves better. We need to think of our co-workers and ourselves as patients and be aware of changes accordingly.
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