Well-being is as much part of an oncology nurse’s personal protective equipment as gloves and gowns are, Lisa Blackburn, MS, APRN-CNS, PMGT-BC, AOCNS®, from The James at the Ohio State University Comprehensive Cancer Center, said in a session during the ONS BridgeTM virtual conference on September 16, 2021. Just as a construction worker needs a hard hat, safety vest, and harness, oncology nurses need equipment to protect themselves from the hazards of their work, and “it’s more than manis, pedis, and massages,” Blackburn said.
Oncology nurses and social workers have the highest rates of anxiety, depression, and post-traumatic stress disorder of all healthcare providers from the COVID-19 coronavirus pandemic. Blackburn already knew that burnout rates for nurses were high from research conducted before COVID-19, which led her and a colleague to develop the THRIVE Program at the James. THRIVE entails an eight-hour in-person retreat followed by six weeks of private group study and a two-hour wrap up session, and it’s designed to help oncology nurses improve their resilience.
“There is strong evidence that the program works by increasing resilience and decreasing compassion fatigue and burnout for participants for at least six months after program completion,” Blackburn stated.
Prior to COVID-19, Blackburn often encouraged nurses to do anything they considered a well-being activity to build their resilience. However, today Blackburn urged the audience to consider the distinction between well-being and self-indulgence, such as taking time to get a relaxing pedicure.
“I’m not saying that there is anything wrong with self-indulgence once in a while,” Blackburn said, “but it won’t build resilience. Well-being for resilience requires some effort on your part, and you come away from it having learned something.”
Blackburn’s technique for monitoring resilience is similar to monitoring vital signs, and she bases the steps on temperature, heart rate, respiratory rate, and blood pressure. Taking your own temperature means assessing your resilience and what and when you need to do activities to support your own well-being. When looking at your heart, Blackburn encourages you think about what you love to do. Whether it is at work or outside of work, what is your passion? Monitoring your respiratory rate involves considering what helps you breathe, what relaxes you, and what helps you be still. Measuring your blood pressure is an assessment of whether your resilience practices work or if you need to explore new options.
As Blackburn summed it up, “The significance of taking these resilience vital signs regularly is to identify what you need early, before someone calls a code blue on you because you are too depleted of resilience!”
Blackburn also encouraged attendees to think about doing short exercises that have a big impact or “micropracticing” her concepts to build resiliency in harrowing times. Ideas include meditation, vision boarding, playing, chair yoga, stretching, and breathing exercises.
Finally, grief is an important concept to address for resiliency.
“We can’t talk about resilience in oncology nursing without discussing grief,” Blackburn said. “No matter what success we have had over the years with increases in survival rates and newer targeted therapies, our work is also inextricably linked with death and loss of many different kinds.”
Remembrance and renewal are important parts of the grieving process, and Blackburn shared examples of spaces for remembrance and calming images. Journaling is another helpful technique for well-being, and Blackburn closed the session by reading one nurse’s writing about a meaningful patient experience.