Nurses Test an Innovative Way to Care — for Themselves

Friday, November 9, 2018

Mariana Aviles, RN, a nurse who works in one of the outpatient cancer clinics at Rush, has a routine for managing stressful days. During her lunch break, she heads to a quiet, dimly lit room nearby for a 15-minute massage. It’s an important self-care habit she picked up after participating in a quality improvement project at Rush to evaluate a new way for cancer nurses to cope with the daily pressures of patient care.

As part of this initiative, Aviles rated her perceived stress level before and after using a mechanical massage chair in a room that was once a utility closet but now looks like a mini-spa, featuring pale blue walls painted with the words, “Renew, Relax, Refresh.” Behind a closed door with a “privacy please” sign, Aviles could program a 15-minute massage and have a cup of tea, listen to relaxing sounds, use aromatherapy oils or browse through a book or magazine. On days when she was feeling “super stressed,” she might rate her stress as a seven or eight out of 10 before getting a massage. But after using the chair for 15 minutes, her stress typically dropped to a two or three.

“I definitely felt more relaxed, like the day was going to be OK,” Aviles says.

In fact, this project, led by Mary Ellen Hand, RN, BSN, OCN, a nurse coordinator at The Coleman Foundation Comprehensive Chest Tumor Clinic at Rush, found that nurses who took a break in the massage chair cut their perceived stress level by 43.5 percent. Using the chair also significantly reduced nurses’ blood pressure and heart rate.

During a six-month data collection period, half of the nurses at the Rush University Cancer Center used the chair, especially younger nurses like Aviles. The project was so popular that nurses would often reach out to their stressed colleagues and suggest they “be sure to use the chair today.”

Reducing nurse stress could have powerful effects across an organization. Evidence shows that chronic, work-related stress can contribute to burnout and compassion fatigue, although the study did not measure these endpoints specifically. According to studies, burnout also can have a negative impact on nurses’ health and job satisfaction, as well as patient outcomes.

Testing a practical idea

Hand championed the simple self-care initiative and recently shared her team’s findings at the International Association for the Study of Lung Cancer 19th World Conference on Lung Cancer in Toronto.

“Many nurses stay in oncology for their entire career,” Hand says. Those like Hand who work in outpatient settings establish long-term relationships with patients and families that are tested by pain, disability, and sometimes death and dying. “We have to create coping mechanisms to be able to function and not be overwhelmed,” she says.

Not only are nurses under considerable stress, but they also get less sleep and are more likely to be overweight than the typical American, according to the American Nurses Association. For this reason, promoting better self-care and a healthier work-life balance among nurses is the focus of national initiatives like the ANA’s “Healthy Nurse, Healthy Nation” grand challenge. The initiative encourages nurses to improve their physical activity, nutrition, sleep habits, safety and quality of life.

Rush has a long history of promoting a healthy work-life balance and better self-care among nurses, including researching strategies like mindfulness training, pet therapy, and music and art therapy.

Like many nurses, Aviles says she tends to just “go, go, go.” Besides making time for massage breaks at work, Aviles nurtures herself by taking walks, setting work-life boundaries and getting plenty of sleep. She also knows when to ask her Rush colleagues for support.

“It helps to know you’re not doing everything by yourself,” she says.

Supporting innovation at the bedside

Beyond emphasizing the importance of self-care for nurses, support for this quality improvement project demonstrates how Rush provides nurses with opportunities to develop, implement and evaluate clinical phenomena and transform clinical practice, says Beth A. Staffileno, PhD, FAHA, co-director of the Center for Clinical Research and Scholarship.

The center, an 11-year-old partnership between the Rush University College of Nursing and Rush University Medical Center, pairs hospital-based clinicians with college-based faculty researchers who serve as mentors on research studies, quality improvement initiatives and other innovative projects across the health system. This allows clinicians like Hand to turn their ideas into formal investigations while building their research acumen and professional experience.

“Direct care nurses, whether they work in inpatient or ambulatory settings, always put patient care needs first,” says Staffileno, who is also an associate professor at the College of Nursing.

Yet with resources and support from the Center for Clinical Research and Scholarship, frontline clinicians receive the help they need to try out a potentially transformative idea in the real world, she says.

Currently other care areas at Rush are exploring how to add massage chairs for their staff. “There is a strong desire among nurses to promote a healthy work environment and support each other by fostering an opportunity for self-care,” Staffileno says, adding that the chair is just one example. “This is a reproducible project that can reach many nurses and health care professionals in different areas of practice.”