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Theories of work-related stress

There are many theories of work stress and general stress theories. I have been trying to get my head around just a few, and so I thought I would share them here for future reference on work stress theory. Perhaps these will help you in your job and career?…or perhaps help you as a leader or manager to support your employees. In any case, please share your top workplace tips for working productively…. I would love to see these theories used to make your workplace a happier one ❣

worked

Transactional theories of work-related stress

The most commonly used transactional theory suggests that stress is the direct product of a transaction between an individual and their environment which may tax their resources and thus threaten their wellbeing (Lazarus 1986, Lazarus and Folkman 1987). Yet a more recent version of this theoretical model suggests that it is the appraisal of this transaction that offers a causal pathway that may better express the nature of the underlying psychological and physiological mechanisms which underpin the overall process and experience of stress (Lazarus et al. 2001).

In this sense, any aspect of the work environment can be perceived as a stressor by the appraising individual. Yet the individual appraisal of demands and capabilities can be influenced by a number of factors, including personality, situational demands, coping skills, pervious experiences, time lapse, and any current stress state already experienced (Prem et al. 2017). One multidisciplinary review provides a broad consensus that stressors really only exert their effects through how an individual perceives and evaluates them (Ganster and Rosen 2013).

As such, the experience of workplace stress according to the transactional theory, is associated with exposure to particular workplace scenarios, and a person’s appraisal of a difficulty in coping. This experience is usually accompanied by attempts to cope with the underlying problem and by changes in psychological functioning, behaviour and function (Aspinwall and Taylor 1997, Guppy and Weatherstone 1997). In order to recognise these external and internal elements of workplace stress, Cox (1993) outlined another modified transactional theory. This theory represented the sources of the stressor, the perceptions of those stressors in relation to his/her ability to cope, the psychological and physiological changes associated with the recognition of stress arising, including perceived ability to cope, the consequences of coping, and all general feedback that occurs during this process.

Yet, as with all transactional theories of work-related stress, it is the concept of appraisal that has been criticised for being too simplistic and for not always considering an individuals’ history, future, goals and identities (Harris, Daniels and Briner 2004). Additionally, in his later works, Lazarus stressed that his transactional theories of stress failed to acknowledge the outcomes associated with coping in specific social contexts and during interpersonal interactions (Lazarus 2006a).

cooperate

Interactional theories of stress

Interactional models emphasise the interaction of the environmental stimulus and the associated individual responses as a foundation of stress (Lazarus and Launier 1978). For instance, the Effort-Reward Imbalance (ERI) theory posits that effort at work is spent as part of a psychological contract, based on the norm of social reciprocity, where effort at work is remunerated with rewards and opportunities (Siegrist 1996). Here, it is the imbalance in this contract that can result in stress or distress. Yet in contrast to transactional theories of stress, this imbalance may not necessarily be subject to any appraisal, as the stressor may be an everyday constant occurrence.

The Person-Environment Fit theory is one of the earliest interactional theories of work-related psychological distress, suggesting that work-related stress arises due to a lack of fit between the individual’s skills, resources and abilities, and the demands of the work environment (Caplan 1987, French, Caplan and Van Harrison 1982). Here, interactions may occur between objective realities and subjective perceptions and between environmental variables and individual variables. In this case, it has been argued that stress can occur when there is a lack of fit between either the degree to which an employee’s attitudes and abilities meet the demands of the job or the extent to which the job environment meets the workers’ needs (French, Rodgers and Cobb 1974).

Yet the Job Demand-Control (JDC) theory supposes that work-related stress can result from the interaction between several psychological job demands relating to workload such as cognitive and emotional demands, interpersonal conflict, job control relating to decision authority (agency to make work-related decisions) and skill discretion (breadth of work-related skills used) (Karasek Jr 1979). The JDC model is concerned with predicting outcomes of psychological strain, and workers who experience high demands paired with low control are more likely to experience work-related psychological distress and strain (Beehr et al. 2001).

However, the original concept of job demand and control was expanded in 1988 to become the Demand Control Support (DCS) theory, describing how social support may also act as a buffer in high demand situations (Johnson and Hall 1988). As social support as a coping mechanism can moderate the negative impacts of job stress, another later version of the JDC theory was developed to suggest that it is those individuals who experience high demands paired with low control and poor support who are most at risk of work-related psychological distress (Van der Doef and Maes 1999). These later versions of the JDC theory were developed, as earlier versions were considered to be too simplistic and ignorant of the moderating effects of social support upon the main variables. However, the perceived job demands and decision autonomy outlined in the JDC theory have been acknowledged as being key factors in determining the effects and outcomes of work on employees’ health (Cox, Griffiths and Rial-González 2000).

Allostatic Load Model of the Stress Process

Early psychological models of stress may be suitable for describing how environmental events generate stressful appraisals for individuals. Yet another theoretical model, devised via a multidisciplinary review of Work Stress and Employee Health identifies the intervening physiological processes that link stress exposure to health outcomes (Ganster and Rosen 2013). This Allostatic load model of the stress process builds on earlier cognitive appraisal models of stress and the work of Seyle (Seyle 1983) to describe the developments of allostasis in the process of stress. Allostasis is the process of adjustment for an individual’s bodily systems that serve to cope with real, illusory, or anticipated challenges to homeostatic (stable) bodily systems. This model proposes that continued overstimulation leads to dysregulation, and then to poor tertiary health outcomes. However, the sequence of this model has proven difficult to validate empirically. Additionally, this research is concerned with the psychological rather than the physical outcomes of work-related stress.

Allostatic Load Model of the Stress Process

Allostatic Load Model of the Stress Process

Another model of work stress has been developed in response to the Health and Safety Executive’s (HSE) advice for tackling work-related stress and stress risk assessments (Cousins* et al. 2004, HSE 2001). This model, developed by Cooper and Palmer underpins the theory and practice advocated by the HSE (Palmer, Cooper and Thomas 2003). This model explores the stress-related ‘hazards’ or sources of stress facing employees in the workplace. The acute symptoms of stress are also set out, and these symptoms relate to the organisation, as well as the individual. The negative outcomes are outlined for both an individual’s physical and mental health, however beyond this, outcomes are presented as financial losses for both the individual and the organisation.

Cooper and Palmer’s model of work stress

Cooper and Palmer_s model of work stress

Another model of work stress developed by Cooper and Marshall sets out the sources of stress at work, factors which determine how an individual may respond to such stressors, go on to experience acute symptoms, and eventually go on to reach the chronic disease phase affecting one’s physical and/or mental health (Cooper and Marshall 1976). This model is concerned with the long-term consequences of work-related stress, as well as the acute symptoms of, sources of, and the individual characteristics associated with work-related stress.

Cooper and Marshall’s model of work-related stress

Cooper and Marshall_s model of work-related stress

The Conservation of Resources (COR) Model

The above models all outline potential stressors or hazards relating to the workplace. Yet work-related stressors cannot always remain separate from general life stressors. Illustrating this, the Conservation of Resources (COR) Model, an integrated model of stress looks to encompass several stress theories relating to work, life and family (Hobfoll 1989). According to this theory, stress occurs when there is a loss, or threat of loss of resources. This is because individuals ultimately seek to obtain and maintain their resources, loosely described by the authors as objects, states, conditions, and other things that people value. Some of these stressors may relate to resources such as one’s home, clothing, self-esteem, relationship status, time and/or finances. In this context, work/relationship conflicts may result in stress, because resources such as time and energy are lost in the process of managing both roles effectively (Hobfoll 2001). This may in turn result in job dissatisfaction and anxiety, although other resources such as self-esteem may moderate such conflicts and stress (Hobfoll 2002). Such a model would be useful in the development of resource-focused interventions which aim to make changes in employees’ resources and subsequent outcomes (Halbesleben et al. 2014).

Understanding the Role of Resources in Conservation of Resources Theory

Basic Tenets of Conservation of Resources Theory

Principle 1 Resource loss is more salient than resource gain.

Principle 2 People must invest resources to gain resources and protect themselves from losing resources or to recover from resource loss.

Corollary 1 Individuals with more resources are better positioned for resource gains. Individuals with fewer resources are more likely to experience resource losses.

Corollary 2 Initial resource losses lead to future resource losses.

Corollary 3 Initial resource gains lead to future resource gains.

Corollary 4 Lack of resources leads to defensive attempts to conserve remaining resources.

(Halbesleben et al. 2014)

A Sample of Psychological Resources

Objects/ Conditions: Job Security Constructive Rewards, Reinforcement Contingencies, Inducements

Constructive: Autonomy, Decision Authority, Skill Discretion, Control Participation in Decision Making Opportunities for Professional Development Resilience

Social Support: (supervisor, coworker, organization, spousal, customer, etc.)

Energies: Time Away from Work, Recovery Experiences

Key: Self-Esteem, Self-Efficacy, Locus of Control, Core Self-Evaluation Conscientiousness, Emotional Stability

Macro: Family-Friendly Workplace Policies

(Halbesleben et al. 2014)

The Revised Transactional Model of Occupational Stress and Coping

One model combines both Lazarus’ transactional theory of stress and coping (Lazarus 1986) and Karasek’s JDC theory (Karasek Jr 1979) is the revised transactional model of occupational stress and coping presented by Goh and colleagues (Goh, Sawang and Oei 2010). This model demonstrates how individuals appraise, cope with and experience occupational stress. This process involves an individual firstly encountering a potential stressor and appraising their experience of it. Subsequently, this model demonstrates how the individual then goes on to a secondary phase of risk appraisal, where coping strategies are initiated in response to the individuals experience of the initial stressor. The model also outlines how immediate outcomes and outcomes after 2 to 4 weeks are involved throughout this process of stress and coping.

In this case, the model demonstrates a direct link between the primary appraisal of the stressor and primary stress outcomes, and also a direct link between the primary and secondary stress outcomes. This process demonstrates how the appraisals of stressful events can significantly impact on an individual’s experience of stress and its associated outcomes. This model also provides support to the effect of emotions on a person’s choice of coping strategy (Ficková 2002). Notably, this model posits that the experience of stress, coping and the development of negative outcomes can occur at different points in the process of occupational stress and coping, and can be triggered by both psychological and behavioural coping factors.

The Revised Transactional Model of Occupational Stress and Coping

This model is my personal favourite as it explains the process and experience of stress and appraisal, along with the outcomes of stress. Here, we can also see how each component relates to one another. These are just a few of the stress models out there. Some can be applied to life, and some to areas of the workplace. Are the two ever really separate?…If you have any more you would like me to add then please let me know. I hope these few give us all something to think about in the field of work-related stress research and practice.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

References

Aspinwall, L. G. and Taylor, S. E. (1997) ‘A Stitch in Time: Self-Regulation and Proactive Coping.’. Psychological Bulletin 121 (3), 417

Beehr, T. A., Glaser, K. M., Canali, K. G., and Wallwey, D. A. (2001) ‘Back to Basics: Re-Examination of Demand-Control Theory of Occupational Stress’. Work & Stress 15 (2), 115-130

Caplan, R. D. (1987) ‘Person-Environment Fit Theory and Organizations: Commensurate Dimensions, Time Perspectives, and Mechanisms’. Journal of Vocational Behavior 31 (3), 248-267

Cooper, C. L. and Marshall, J. (1976) ‘Occupational Sources of Stress: A Review of the Literature Relating to Coronary Heart Disease and Mental Ill Health’. Journal of Occupational Psychology 49 (1), 11-28

Cousins*, R., Mackay, C. J., Clarke, S. D., Kelly, C., Kelly, P. J., and McCaig, R. H. (2004) ‘‘Management Standards’ Work-Related Stress in the UK: Practical Development’. Work & Stress 18 (2), 113-136

Cox, T., Griffiths, A., and Rial-González, E. (2000) ‘Research on Work-Related Stress: European Agency for Safety and Health at Work’. Luxembourg: Office for Official Publications of the European Communities

Cox, T. (1993) Stress Research and Stress Management: Putting Theory to Work.: HSE Books Sudbury

Ficková, E. (2002) ‘Impact of Negative Emotionality on Coping with Stress in Adolescents.’. Studia Psychologica

French, J. R., Caplan, R. D., and Van Harrison, R. (1982) The Mechanisms of Job Stress and Strain.: Chichester [Sussex]; New York: J. Wiley

French, J. R., Rodgers, W., and Cobb, S. (1974) ‘Adjustment as Person-Environment Fit’. Coping and Adaptation, 316-333

Ganster, D. C. and Rosen, C. C. (2013) ‘Work Stress and Employee Health A Multidisciplinary Review’. Journal of Management, 0149206313475815

Goh, Y. W., Sawang, S., and Oei, T. P. (2010) ‘The Revised Transactional Model (RTM) of Occupational Stress and Coping: An Improved Process Approach’. The Australian and New Zealand Journal of Organisational Psychology 3, 13-20

Guppy, A. and Weatherstone, L. (1997) ‘Coping Strategies, Dysfunctional Attitudes and Psychological Well-being in White Collar Public Sector Employees’. Work & Stress 11 (1), 58-67

Halbesleben, J. R., Neveu, J., Paustian-Underdahl, S. C., and Westman, M. (2014) ‘Getting to the “COR” Understanding the Role of Resources in Conservation of Resources Theory’. Journal of Management 40 (5), 1334-1364

Harris, C., Daniels, K., and Briner, R. B. (2004) ‘How do Work Stress and Coping Work? Toward a Fundamental Theoretical Reappraisal’. British Journal of Guidance & Counselling 32 (2), 223-234

Hobfoll, S. E. (2002) ‘Social and Psychological Resources and Adaptation.’. Review of General Psychology 6 (4), 307

Hobfoll, S. E. (2001) ‘The Influence of Culture, Community, and the Nested‐self in the Stress Process: Advancing Conservation of Resources Theory’. Applied Psychology 50 (3), 337-421

Hobfoll, S. E. (1989) ‘Conservation of Resources: A New Attempt at Conceptualizing Stress.’. American Psychologist 44 (3), 513

HSE (2001) ‘Tackling Work-Related Stress: A Managers’ Guide to Improving and Maintaining Employee Health and Well-Being’

Johnson, J. V. and Hall, E. M. (1988) ‘Job Strain, Work Place Social Support, and Cardiovascular Disease: A Cross-Sectional Study of a Random Sample of the Swedish Working Population’. American Journal of Public Health 78 (10), 1336-1342

Karasek Jr, R. A. (1979) ‘Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Redesign’. Administrative Science Quarterly, 285-308

Lazarus, R. S. (2006) ‘Emotions and Interpersonal Relationships: Toward a Person‐centered Conceptualization of Emotions and Coping’. Journal of Personality 74 (1), 9-46

Lazarus, R. S., Cohen-Charash, Y., Payne, R., and Cooper, C. (2001) ‘Discrete Emotions in Organizational Life’. Emotions at Work: Theory, Research and Applications for Management 4584

Lazarus, R. S. and Folkman, S. (1987) ‘Transactional Theory and Research on Emotions and Coping’. European Journal of Personality 1 (3), 141-169

Lazarus, R. S. (1986) ‘Folkman. S.(1984) Stress, Appraisal, and Coping’. New York 1

Lazarus, R. S. and Launier, R. (1978) ‘Stress-Related Transactions between Person and Environment’. in Perspectives in Interactional Psychology. ed. by Anon: Springer, 287-327

Palmer, S., Cooper, C., and Thomas, K. (2003) ‘Revised Model of Organisational Stress for use within Stress Prevention/Management and Wellbeing programmes—Brief Update’. International Journal of Health Promotion and Education 41 (2), 57-58

Prem, R., Ohly, S., Kubicek, B., and Korunka, C. (2017) ‘Thriving on Challenge Stressors? Exploring Time Pressure and Learning Demands as Antecedents of Thriving at Work’. Journal of Organizational Behavior 38 (1), 108-123

Seyle, H. (1983) ‘The Stress Concept: Past, Present and Future’. Cooper, CL, 1-20

Siegrist, J. (1996) ‘Adverse Health Effects of High-Effort/Low-Reward Conditions.’. Journal of Occupational Health Psychology 1 (1), 27

Van der Doef, M. and Maes, S. (1999) ‘The Job Demand-Control (-Support) Model and Psychological Well-being: A Review of 20 Years of Empirical Research’. Work & Stress 13 (2), 87-114

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Highlights from the 31st ICM Triennial Congress in Toronto, Canada #ICM2017 #ICMLive

toronto

My vacation is now over following a visit to the 31st International Confederation of Midwives Triennial Congress in Toronto, Canada (ICM). I think we would all agree that this was an emotional occasion, as thousands of midwives came together from all over the world to both celebrate our wonderful profession and share new research, knowledge and ideas about our exciting future.

I was personally in awe of our midwifery leaders, who certainly inspired a passion for change, strength and future thinking in midwifery practice. I would like to think that my work will go some way towards building a bright future for the profession, and one day I hope to stand beside those on the main stage of midwifery who are ultimately steering the ship. Yet for now, I am learning from a plethora of inspirational midwives about how to thrive and implement change. As I come to the end of my PhD, I reflect on how I might move forward in partnership with the most inspiring midwives I know. It was an honor to spend time with them in Canada….see all of those flags?…What a wealth of knowledge!

Naturally, we were flying the flag for the Brits…

Throughout the conference I naturally gravitated towards all of the midwifery workforce presentations, my favorite and most passionate area of workforce research…Here are some highlights from these sessions below:

I would like to thank all of these wonderful research groups for sharing their insights with me, and for helping my understanding of midwifery workplace wellbeing to grow. I would also like to thank those at Nottingham University and Elsevier for inviting me to their exclusive evening receptions. I felt very honored to be among the best academic midwives in the world!

Thank you also to those of you who came to see me present some of my own research (done in partnership with my wonderful colleagues at Coventry University and NHS England of course). It was really enlightening to hear your thoughts on the staff experience!…The best is yet to come!

Equally, I would like to thank the audience who came to discuss my PhD work following my presentation at this wonderful conference. Indeed, there was much interest in this work going forward, and whilst other interventions were presented for mothers and babies, it was clear that by following the MRC framework for developing complex interventions and by incorporating the Revised Transactional Model (RTM) of Occupational Stress and Coping, this intervention, being deeply rooted within an evidence base, is now ready for co-creation.

It was particularly interesting to hear the audience keen to invest in this project and disseminate it widely across the profession. As an online intervention designed to support midwives in work-related psychological distress, this intervention certainly has the potential to be widely adopted. This was music to the ears of a global midwifery audience, who may often see things developed in other countries, and yet be unavailable in their own area of practice.

Again, the theme arose here that midwives wanted a place to talk and seek help confidentially, away from traditional channels. I see such places growing organically in the online arena, yet none seem to be fit for purpose, evidence based or co-created on a large scale. To me this suggests that the next phase of my research (to build and test an evidence and theory based online intervention designed to support midwives in work-related psychological distress) will be well received by the midwifery community, especially if it has the support of larger healthcare organisations who can champion its implementation, dissemination and testing.

To spread and embed a large and complex intervention such as this across the midwifery profession would indeed be a legacy. Yet this work may also support excellence in maternity care, increase safety and support effective retention and recruitment strategies for maternity services around the world. As such, taking this work forward will indeed be crucial since it has been reported that reducing stress and fatigue among maternity staff is key to reducing baby deaths and brain injuries during childbirth, according to a detailed new analysis published by the Royal College of Obstetricians and Gynecologists. The challenge is to turn the vision for online support into practice.

icm

This was a wonderful, inspiring and thought provoking conference. To see a more detailed day by day summary, please see the wonderful blog by my dear friend @Dianethemidwife ….

Day One

Day two

Day three

Day four

Day five

Last day

It is sad that my time in Toronto is now over, but I have returned home with a new found sense of hope and enthusiasm for doing great things in the midwifery profession….

Until next time..🤚🇨🇦🇬🇧

 

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Mindfulness and Self-Care in Midwifery

As my main research interests are firmly rooted within supporting a positive staff experience for healthcare workers, especially midwives in work-related psychological distress, I am always looking for new opportunities to share knowledge with others in this area. …The Global Alliance for Nursing and Midwifery (GANM) is a joint project sponsored by the Pan American Health Organization (PAHO) and the World Health Organization (WHO) Collaborating Center for Nursing Knowledge, Information Management & Sharing at the Johns Hopkins School of Nursing. This blog post provides an overview of a webinar session hosted by GANM entitled “Mindfulness and Self-Care in Midwifery:  Review of Current Evidence and Guided Mindfulness Practice.

For a preliminary introduction to this topic – check out an earlier blog post on this topic entitled “Midwife Burnout: A Brief Summary“.

downtimes

Erin Wright, DNP, CNM, APRN-BC, led the conversation…Participants were diverse, and originated from Canada, Peru, US (Baltimore, Urbana, Birmingham, Atlanta, Buffalo), Ireland, UK (Coventry University and School of Healthcare Sciences Cardiff), Brazil, Montserrat, and Trinidad.

The full webinar can be accessed here.

Much of the research covered, has also been captured within my earlier narrative review: Pezaro, Sally, et al. “‘Midwives Overboard!’Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.” Women and Birth 29.3 (2016): e59-e66.

However, there were some new and interesting comparisons made with more recent research here…

“Four common themes have been identified that traverse the different models of care. The NZ study provides insight into how case load midwifery can be sustainable enabling long term sustainability. The UK study highlights healthy resilient practices that enable practice. What remains uncertain is how models of care enable or disable sustainable long term practice and nurture healthy resilient behaviours within the different models of care”.

comparisons

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking as the notion may be interpreted as expecting midwives ‘to toughen up’ in a working setting that is socially, economically and culturally challenging.”

Sources (Crowther, Susan, et al. “Sustainability and resilience in midwifery: A discussion paper.” Midwifery 40 (2016): 40-48.)

So we are now much enlightened as to how and why midwives are experiencing distress, we also have some insights into how they try to cope (or not)…and where this distress may affect maternity services…but what we are yet to learn, is what may be most effective in supporting midwives in work-related psychological distress…although a few clues are emerging….

Mindfulness is coming forward as a potential tool of support..stress management, education and clinical supervision may also be of benefit to midwives in distress…But how, why and how much is not yet clear.

After exploring the literature in relation to psychological distress in midwifery populations, we were all invited to join in some mindfulness practice..What is mindfulness?

Image result for mindfulness

 

Feeling overwhelmed?…TRY….R.A.I.N

RRecognize What’s Going On

AAllowing: Taking a Life-Giving Pause

I—Investigating with Kindness

NNatural Loving Awareness

Source: Mindful.org

relation-ships

Recommended further reading

Youtube presenters:

  • Jon Kabat Zinn
  • Elisha Goldstein
  • Tara Brach
  • Sharon Salzberg

Websites/Audio Links:

Books: 

  • A Mindfulness Based Stress Reduction Workbook (Goldstein and Stahl)
  • Everyday Catastrophe Living (Jon Kabat Zinn)
  • Wherever you go there you are (Jon Kabat Zinn)
  • Mindfulness for Beginners (Jon Kabat Zinn)
  • Real Happiness (Sharon Salzberg)
  • The Mindful Nurse (Carmel Sheridan)

For more mindfulness exercises, visit the UCLA Mindfulness Awareness Research Center.

book-mark

Thanks for a very insightful and informative session!

Until next time…Look after yourselves & each other 🦄💫🎓

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Reflecting on the #MaternalDeath report from @mbrrace as a midwife…💜

During the December of 2016, everyone involved in the provision of care for childbearing women (and the women themselves) began to reflect upon the findings of the latest Confidential Enquiry into Maternal Death. As a midwife, I am dedicated to supporting, protecting and caring for other midwives, childbearing women, babies their families. There is no doubt in my mind that these deaths have affected all of these groups profoundly, and society as a whole. But before we begin to reflect, let’s remember that the mortality surrounding childbirth (in the UK) is thankfully rare 

    

 

When we lose mothers…we also tragically effect babies…The Stillbirth and Neonatal Deaths charity (Sands) responds to new MBRRACE maternity report here

There is no doubt that we must learn from all of these  as the president of the explains here. Clearly there is much learning to do and many improvements to make. These key messages should remind us all to ask the question…start the conversation…notice the subtle clinical cues which alert us all to danger, react to risk and remain emotionally intelligent to the needs of childbearing women.

However, what struck me most was the sheer number of women who die from mental health related causes. The MBRRACE report found that “one in seven of the women who died during the period of review died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action”.

Image result for maternal mental health related deaths mbrrace

You can read the ‘expert’ reaction to MBRRACE-UK report citing mental health as main cause of perinatal death here. Maternal mental health matters – toolkit now available from for those developing a community perinatal mental health service.

Learning to save maternal lives and making change happen will not only improve the lives of mothers, babies and families. It will also improve the lives of midwives, as they will be better equipped to give the care they would like to give as their job satisfaction improves. When the psychological wellbeing of midwives is left uncared for, maternity services may see less safe maternity care. When we care for midwives, the safety and quality of maternity care may also improve. This will in turn contribute to a reduction in maternal mortality rates. So when we are looking to improve maternity care for women, their families and their babies, lets make sure that we also look to support those who are caring for them. It really is two sides of the same coin.

What can we promote?

= That it’s “OK to ask”

How can we support women & midwives? = With trust, compassion & respect

How can we improve safety?

= Evidence based care & excellent communication

 

Preventable maternal morbidity and mortality is associated with the absence of timely access to quality care, defined as too little, too late (TLTL)—ie, inadequate access to services, resources, or evidence-based care—and too much, too soon (TMTS)—ie, over-medicalisation of normal antenatal, intrapartum, and postnatal care.

Although many structural factors affect quality care, adherence to evidence-based guidelines could help health-care providers to avoid TLTL and TMTS.

TLTL—historically associated with low-income countries—occurs everywhere there are disparities in socio-demographic variables, including, wealth, age, and migrant status. Often disparities in outcomes are due to inequitable application of timely evidence-based care.

TMTS—historically associated with high-income countries—is rapidly increasing everywhere, particularly as more women use facilities for childbirth. Increasing rates of potentially harmful practices, especially in the private sector, reflect weak regulatory capacity as well as little adherence to evidence-based guidelines.

Caesarean section is a globally recognised maternal health-care indicator, and an example of both TLTL and TMTS—with disparate rates between and within countries, and higher rates in private practice and higher wealth quintiles. Caesarean section rates are highest in middle-income countries and rising in most low-income countries. Although researchers partly attribute the increase and variable rates to a shortage of clear, clinical guidelines and little adherence to existing guidelines, multiple factors—economic, logistical, and cultural—affect caesarean section rates.

Quality clinical practice guidelines need to be developed that reflect consensus among guideline developers, using similar language, similar strengths of recommendation, and agreement on direction of recommendations.

Strategies for enhanced implementation and adherence to guidelines need multisectorial input and rigorous implementation science.

A global approach that supports effective and sustained implementation of respectful, evidence-based care for routine antenatal, intrapartum, and postnatal care is urgently needed.

There is much work to be done. Until next time, take care of yourselves and each other 💜💙💛

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10 Tips for Success & Self-Care for Academics

cozy-dog

Another guilt trip about the importance of self care and being successful? That is why many people will read blog posts like this. We know we should be practising self care and succeeding, but do we really know how to thrive?

(I could not find a concept analysis for either success or self care – please let me know if you do)

We must presume that both success and self-care mean something different to each and every one of us. I am no expert on these topics…. is anyone?…But I think I am pretty good at caring for myself now and working towards success…having learnt the hard way. So I thought I would share some of my hints and tips. Feel free to adapt them, use them, completely ignore them, or ridicule them as ‘poppycock’.

Most people will expect to hear things like:

  • Take a bubble bath
  • Watch your favorite film
  • Curl up with a good book
  • Work hard
  • Network

But I am sure that you know about this kind of stuff already. So let’s look at self care and success for the academic, firstly by identifying the issues that some of us may face.

As an early career researcher, I am frequently told about the stereotyping and inequalities experienced by women in academia. I myself frequently worry about the insecurity of, and problems associated with being an early career researcher, especially a female one.…I worry about where I will find my next job, funding or co-author. I worry about whether I am making any impact at all and whether I will be able to reach my true potential as an academic in the current climate. Academic pressures are in no way restricted to those earlier in their career, many more established researchers are also feeling the strain. These experiences will undoubtedly result in some psychological distress for many academics. So what can we do both proactively and preventatively to improve the lives of ourselves and each other.

Research can seem like a lot of hard work for little reward.

Tip One: Keep your eye on the goal. Visualize yourself being happy, frequently. How would it feel to publish that paper? Get that fellowship? Collaborate on that project? Create your own self-fulfilling prophecy rather than focus on a possible spiral of doom.

How to do this? – Identify what makes you happy, or what will make you happy. Then do more of what makes you happy, or have a real go at getting what will make you happy. I personally love my research work. I know that many other academics feel the same way. Happiness to me is succeeding, making a difference  and making a real impact through my work. The stress I feel is associated with this not happening.

This stress and negative thinking serves no purpose unless it positively drives me towards my goal. Yet who wants to be whipped to the goal posts?  I use visualization as a driver for success. I see myself feeling and being the way I want to be…and I allow myself to believe that this vision will come true. This makes me much happier than thinking about the alternative. So I stick with it.

The practice of meditation may also assist you to work through your thoughts, direct them towards a more positive outlook and allow your goals to become meaningful and achievable.

As these tips continue, think about your own goals for happiness…whatever they may be…think about achieving them in relation to these tips and your own experiences.

I behave in the way I want to feel or be… Surely if I continue in this direction. Good things will come…

Tip Two: The problem of job insecurity for early career academics baffles me as Job security for early career researchers is a significant factor in helping research make an impact. Yet this seems to play on my mind recurrently. It is always a worry. However, worry really does nothing to resolve this issue, and only seeks to get in the way of my progress. In order to progress, I will need to ‘work smarter’ and embrace confidence in my own abilities. Worry and negative thinking has no place in this strategy.

Negative thoughts often lie, and so I swipe them away one by one by placing them on a train that is passing the station (Visualization) – I then sit for a little longer, and imagine the way I will feel and be once I reach my goals. My mood and stress instantly lifts once I do this. I am more confident and feel much stronger. I am ready to be happy.

 

Tip 3: Say No and be proactive – We need to look at what successful academics do. From my observations, they often say ‘No’ to anything that doesn’t suit their own focused agenda (they remove the ‘noise’ and toxicity), they ooze positivity, they are confident, they are assertive, they tell people what they need to succeed and they hang around with the most inspiring people. Therefore, the most obvious strategy is for us to do the same. Say ‘No’ to negativity, and to the people and things which do not enrich us as people. Let people know what you need in order to thrive. Embrace those you feel drawn towards as positive people.

Activity: Making the best of me…

1: Ask yourself how others can get the best out of you

2: Offer what you can realistically do

3: Communicate what inhibits your productivity with others

4: Actively describe what you need from others in order to thrive

Getting the best of me

Tip 4: Express gratitude and forgiveness for enhanced wellbeing. Not always easy, but worth investing in. This task not only unburdens your mind, but allows you to see all of the good things currently going on in your life. Regularly write down 5 things that you are grateful for. Also…try to forgive yourself, and others…often.

 

Tip 5: Address your work life balance as a fluid entity. I believe that the idea of a separate home and work life is changing. This is a good thing. It takes the pressure off and allows you to be a whole person, rather than one split in two…See yourself as a whole being, a working, living and family centred being. You cannot slice yourself into pieces.

See this blog -> ‘Work’ is a verb rather than a noun…it is something we do…not always somewhere we go…

Living in the ‘now’ rather than being at either home or work also allows us to enjoy more of ourselves and our lives. Notice where you are, what you are doing…Smell the flowers, look around you as you move, work, play and just allow yourself to ‘be’.

smell-the-flowers

Tip 6: Eat Sleep move, repeat. It really is that simple, but utterly essential for optimum productivity, stress reduction, health and wellbeing. Eat nutritious food regularly, sleep 7-8 hours a night and move…Exercise, walk, swim, run, cycle…Be outdoors as often as possible.

float

Tip 7: Write. Write your thoughts, your feelings, your ‘to do’ lists, your ideas, your goals down regularly. This not only means that they are out of your head, allowing your mind to be quieter, they are also made real…They are good to share..and worth addressing (when you feel able).

Tip 8: Talk about who you are. There is a tendency to talk about work first. What we do, what we are working on and what we are planning to work on. Start new conversations with how you enjoy your hobbies or your favourite music. This lets other people know that you are indeed human, and it also gives you an identity other than your work persona. Be authentic. It is healthy for you, and others to know the real and whole you. You are fab 🙂

Tip 9: Help other people and accept help yourself. Lift one another up, support colleagues, show gratitude, offer support and guidance where you can. Be a mentor. Be a positive role model. Be the change you want to see in the workplace and accept all of this in return. This will not only make you feel good, it will change the culture of your workplace, and bring about reciprocity for everyone’s success.

LiftEachotherUp_libbyvanderploeg

(Image via http://www.libbyvanderploeg.com/#/lifteachotherup/)

Tip 10: Celebrate the successes of yourself and others. Yes. Focus on the great things that you and your colleagues have achieved. However big or small, these feelings of success will snowball into a self fulfilling prophecy, where you feel valued, supported and part of a team that cares. Some people will feel uncomfortable about doing this, and feel icky when they see others wallow in their own brilliance. But what is the alternative? We all talk about how rubbish we all are? How will that make us feel?…

Spend time reflecting on what you have achieved. Write them down…use these achievements to inform your own vision of yourself…This is who you are. You are great.

As long as the feelings of celebration and success are reciprocated and directed towards others as well as yourself….Let the high fives roll.

Image result for the highest of fives gif

I do hope that these tips will resonate with some academics looking for something new to try. In the spirit of sharing, please feel free to add more tips below.

You deserve to be happy – Until next time, look after yourselves and each other ❤💙💜

 

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Why the health, wellbeing & engagement of #NHS staff matters..financially, practically & morally speaking…

wellbeing-of-nhs-staff-a-benefit-evaluation-model
I spend a lot of my time talking to clinicians, managers, commissioners, those outside of healthcare and leaders about the importance of promoting and supporting staff wellbeing within the #NHS workplace. Some are already on board with the reality that excellence in healthcare simply cannot happen in the absence of a workforce that is cared for and nurtured to thrive. Others feel discomfort at the thought of caring for staff when the ‘patient comes first’ and some simply don’t know what to do for the best. In any case, nobody seems to want to destroy the NHS workforce (correct me if I am wrong)!… and everyone seems to want to learn more.

A good staff experience where staff feel ‘engaged’ is critical to  achieving excellence in healthcare…What do we mean by ‘Staff Engagement’?

‘Institute for Employment Studies (IES), defined staff engagement as a positive attitude held by the employee towards the organisation and its values. An engaged employee is aware of business context and works with colleagues to improve performance within the job for the benefit of the organisation. The organisation must work to develop and nurture engagement which requires a two-way relationship between employer and employee (Robinson et al 2004, p 4).’
Recently, I was asked to provide some evidence as to why the wellbeing of NHS staff matters by someone else who was keen to make a difference in this area. They needed to make the case to others in order to make change happen. I imagine that lots of other change makers will be needing to provide evidence too, and so I have set out some arguments for the case below. I hope many of you will find it useful to have some of the arguments in one place.
Image result for staff engagement nhs employers

Please feel free to share this evidence widely with others…. If you have other evidence to add to this, please feel free to comment below…

(There can never be too much to share)!

Financial reasons to care for NHS staff:

Over 2014/2015, the NHS Litigation authority (NHSLA) paid over £1.1 billion to patients who suffered harm and their legal representatives, this coming year it will be c £1.4 billion and with accumulated provisions in our balance sheet of over £28 billion further significant increases are already in the pipeline. When staff are unwell, in psychological distress, communication is hampered by poor working cultures and there is a lack of staff engagement, NHS staff are more likely to make medical errors (Hall et al, 2016).

Good staff health, wellbeing & engagement = reduced medical errors = reduced litigation costs

Estimates suggest that recruiting a nurse from overseas costs between £2,000 and £12,000 and return-to-practice costs some £2,000 per nurse, while training a new nurse costs around £79,000. Additionally, recruitment costs to replace staff who leave owing to work-related stress and/or poor job satisfaction is estimated to be £4500 (More for senior posts). As such, in order to get best value for money, the NHS will need to work hard to retain and recruit a high quality workforce.

Good staff health, wellbeing & engagement

= Increased recruitment and retention = Best value for money

Staff sickness absence rates cost an estimated £3.3million annually per NHS organisation. When staff are absent, there is the added cost of agency staff to fill in gaps (The NHS Improvement team now expect the NHS to spend a total of £3.7 billion on agency staff by the end of the 2015/16 financial year).The Francis inquiry into Mid Staffordshire also exposed the consequences for patients and staff of not addressing this issue of staff morale and sickness. Typically, if an NHS organisation reduced staff sickness rates by a third,it would provide an additional 3.4 million working days a year for NHS staff, equivalent to 14,900 full-time staff, saving an estimated £555 million.

Good staff health, wellbeing & engagement = Decrease in sickness absence = reduced agency/sickness spend & therefore, improved patient care

Image result for staff engagement nhs healthcare
(Image source :http://www.slicedbread.co.uk/solutions/employee-engagement/)

Practical reasons to care for NHS staff:

Ultimately and practically, the NHS exists to provide high quality and safe care to patients. Evidence so far shows that better staff health and wellbeing is associated with improved patient outcomes.
Some of the many benefits to improved NHS wellbeing is that better staff health results in lower infection rates and lower standardised mortality figures. The Keogh review of 14 hospital trusts with high patient mortality rates found all these trusts also had higher levels of staff sickness, compared to national average.

Good staff health, wellbeing & engagement = Safer and higher quality patient care

When an NHS organisation invests in staff health, wellbeing and engagement, they improve their ‘Brand’. Branding is one of the most important aspects of any business, large or small, and its impact shouldn’t be underestimated when it comes to engaging staff with health and wellbeing initiatives.

Good staff health, wellbeing & engagement = Your NHS organisation looks good & therefore attracts more staff

A report from the Kingsfund suggests that job satisfaction, organisational commitment, turnover intentions, and physical and mental wellbeing of employees are predictors of key organisational outcomes such as effectiveness, productivity and innovation. Everyone wants more of these things..right? They all have the potential to save money and improve the safety and quality of care.

Good staff health, wellbeing & engagement = Higher productivity, staff effectiveness and innovation = Cash savings and better services

Image result for staff engagement nhs healthcare

Moral reasons to care for NHS staff:

Staff are entitled to a psychologically and physically safe professional journey. Caring for them is not an optional issue, it is an ethical one.

 

When staff are well cared for, they experience greater job satisfaction, improved morale and general wellbeing. Few aspire to be ill, and many feel great shame in letting others down or asking for help.
Where the emotionality of distressing work  remains unrecognised and void of support, distorted thinking, emotional distress, reduced productivity, increased sickness rates, poor decision making, and maladaptive patterns of behaviour may present. Physical symptoms can also result, where severe job stress evokes irregular menstrual bleeding patterns for female healthcare workers, poor sleep quality and bodily exhaustion.
The NHS workforce is one of the largest work forces in the world. They are patients, they are the public, as are their friends and families. As such, by caring for this group, we are also caring for a large part of society. Moreover, there is also a strong statistical link between the wellbeing of staff and patient satisfaction. This means that if we are failing to care for staff, we are also missing an opportunity to improve patient satisfaction.

Good staff health, wellbeing & engagement = A nice and decent thing to do for all.

Image result for staff engagement nhs employers

There are many more reasons for NHS organisations to care about the the health, wellbeing & engagement of their staff..Financially, practically & morally speaking… Please feel free to add these below.
I hope that these few facts and figures can be shared and used to convince everyone throughout the NHS of these facts. Many will say that it is the patient that must come first. However, I argue that excellence in health and social care may only be achieved if both the staff and patients are cared for equally, as they work in partnership to achieve the best outcomes.

Looking for ways to turn this vision into practice? See my blog on 20 ways to create a thriving NHS workforce here

Until next time, look after yourselves and each other 💛💙💜💚.
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Reflections from a session in the @empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn

One of the best things I experienced at this years NHS Expo 2016 was the @empathymuseum …where I was invited to #WalkAMileInMyShoes via the @HealthFdn. It was rather strange to be invited into a giant shoe box, but nevertheless… Just like Alice in Wonderland I found myself uttering….’curiouser and curiouser’..

As I wondered in to the cozy shoe box to sit on the sofa, I was asked to put on a pair of shoes.. Theatre shoes…(See below)…

I walked around and listened via headphones to the man who had kindly donated his shoes and his story to this project. He was a specialist nurse working in A & E. He spoke about how he had to face the reality of death at work every day. Not only did he have to do this, he then also had to engage loved ones and relatives in incredibly difficult conversations and help them to make the best decisions in the darkest hours.

This nurse was able to celebrate the incredible gifts people were able to give as organ doners, and see joy in how a family was able to see a part of their departed loved ones go on… All of this was very uplifting…and there was no doubt in my mind that this nurse was indeed a superb example of the profession. However…as I walked on…I found my self wondering whether anyone asked the nurse how he was? How long could he maintain this uplifting approach whilst dealing with death and emotional pain on a daily basis? Would cracks start to appear?

I often see examples of how we celebrate this service and self sacrifice…and to nearly quote Paul Simon… every generation throws healthcare hero up the award charts!.. and so we celebrate this eternal culture of giving. I certainly empathize with this nurse, and greatly admired his approach to his work… He is a hero..but he is also very vulnerable, both psychologically and physically as he continues to give all of himself to provide the best service possible.

My worry is that the more we place service and sacrifice upon a pedestal…the further our heroes have to fall…

 

As you can see from the film above…this really is an amazing and thought provoking project, as those who visit are asked to write messages to those they now share a new found empathy with.

I would have liked to have walked a mile in all of these shoes…and perhaps some day I will have time to…as you can soon also experience this project online here. So as a lasting thought on this amazing project…I would like to repeat my mantra…which is…always be kind to yourselves… and each other….

Until next time 💛💙💜💚❤