Making a Self-Care Plan

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Learning Scope #407
1 contact hour
Expires Nov. 8, 2014

You can earn 1 contact hour of continuing education credit in three ways: 1) Grade and certificate are available immediately after taking the online test. 2) Send the answer sheet (or a photocopy) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.

The work of nursing is caring for others. In addition, many of us also tend to our family and neighbors. Focusing on others and their welfare often causes us to lose sight of ourselves and our needs. If we disregard ourselves long enough, our emotional cupboards become bare and when we go there we find nothing to sustain us.

There is a quirky little contradiction we need to address about ourselves and our work - to best care for others we must first care for ourselves.

It is common knowledge among nurses that a care plan is a blueprint outlining the nursing care of any given patient. We write and more often think care planning as we go about our daily work. It starts when we walk into the presence of a patient. We automatically begin to make an assessment of the individual and move on to setting realistic goals for that encounter, whether it is a full day of care or a short ambulatory care visit. We follow up by checking how well our plan is working and realign our goals and interventions as needed.

Nurses find the nursing process and care plan useful in their work. So, how many of us use this method when addressing situations in our own lives? How often do we take the time to devote our expertise in systematic assessment and goal setting to write a plan of care for something in our lives we would like to change? Most likely, not often enough - if ever. However, if we did, we might see more goal achievement in our lives and enjoy ourselves more.

The major obstacle to overcome when setting out to take better care of yourself is the mistaken notion that taking care of yourself is selfish. It's quite the contrary. Taking care of yourself is self-nurturing. If your reserves are not renewed, you will come up dry and not be able to care for others.

Self-care is so important to executive recruiter Kim Richards, RN, that she started Self-Care Academy. Devoted to the care of nurses, Self-Care Academy addresses the issue of compassion fatigue, manifested by physical, emotional and mental problems, and most often the result of nurses not making self-care a priority in their lives. Richards maintains caring for self, using a systematic approach, reduces stress and reignites the caregiving spirit.²

Some other obstacles to self-care include the perception you lack time and/or personal private space, not thinking it is important, and listening to others who make negative value judgments on your attempts. All of these can be overcome. Just like we help patients overcome obstacles in their lives every day, we can certainly do it for ourselves.

Nurses know an accurate diagnosis only can be written after a systematic and thorough assessment. Some assessments are simple. For example, if you are not sleeping, assessing the conditions surrounding your sleep habits and other life events that impact your sleep can be fairly straightforward. Assessing other parts of your life might require a bit more work and soul searching. A variety of online self-assessment tools exist to help you. These include websites that measure your fund of knowledge and nursing competency in a wide variety of topics essential to nursing practice, measure your competence in collaborative leadership, help with career decision making, and give insight into your work values.^3-6

For your physical, emotional and spiritual health, you can use the same tools we use to assess your patients. Pick up any one of the numerous textbooks that address care planning and nursing diagnosis and complete a thorough systematic self-assessment. If you have trouble being objective, ask a trusted friend or colleague to help you by either interviewing you in an objective manner or by privately compiling their observations about you and then sharing them with you. Your diagnosis will flow from your thorough assessment, just like it does with a patient.

The more comprehensive your nursing diagnosis, the more direction you will have in goal setting and interventions. Here are some general nursing diagnoses that might fit:

• Altered nutrition - bad eating habits at work; not having enough time to prepare nutritious, balanced meals; using food as a self-soother; and the mentality of, "I deserve a piece of chocolate cake because I worked so hard today."

• Ineffective individual coping (losing temper at work) - lack of sleep; buildup of stress when taking care of difficult patients and their family members; internal conflicts of taking care of your own family members who do not always show their appreciation; and feelings of being taken for granted.

• Spiritual distress - not having enough time to help patients with pain issues; not being heard when expressing patient-centered concerns; and conflict with team members over patient care issues and concerns.

• Knowledge deficit (safe medication administration) - not enough experience to know about all commonly given medications on the unit; new medications being introduced all the time; and a large number of patients on multiple medications.

• Anxiety - partner losing job; children acting out in school; perceived lack of support from extended family members; and failing health of parents.

When it comes to goal setting, we need to use the same parameters for ourselves that we use for our patients. Goals need to be reasonable, attainable and measurable. Many goal-setting are worksheets available. Cigna Behavioral Health has a simple one-page goal-writing sheet that includes long-, intermediate- and short-term goals, a review of obstacles to completion, and a place to list who can help you in goal attainment.⁷

Deciding a date to begin working on a particular goal can be extremely important. For example, starting to volunteer at your child's school just before a family member's scheduled surgery may not work and may even cause you added stress. Wait until after the surgery.

Here are a few other helpful hints to aid you in writing personal goals:

• Write it down. Jotting something down on paper brings it into the physical world. It's not just in your head. Bringing it into the physical domain gives it substance and more power.

• Don't try to do too much at once. Work one or two goals at a time. For example, if your goal is to eat healthier, start out by having breakfast if you've been skipping it. You also can combine that goal with drinking more water throughout the day.

• Set aside time each day to review your personal goal(s), noting obstacles and how to eliminate them. Also, write yourself congratulatory statements when successful.

• Set a date on which you will re-evaluate your goal(s). This helps you to avoid quitting after one slip. How many times have you heard someone say she is going to make a change - for example, relax and read for 30 minutes before bed to help with sleep, and then quit when she messes up once? Give yourself enough time - let's say 40 days - to make a change in your life. Keep track of what happens each day and then on the 40th day see how well you did overall. In essence, start each day anew and don't make any value judgment until the 40th day.

• Recall goal setting and goal accomplish is a process. It doesn't just happen. You may need to tweak your goal a few times to make it fit and work for you.

• Get support from others. Stephen Covey, famous for his book 7 Habits of Highly Effective People, has a free online community that offers support to those who want to set personal goals and receive support from others.^8,9 Another alternative is to set up a small support group at work or among colleagues or friends. Remember, a group can consist of only two members.

To help with goal achievement, many people create a personal life mission statement and include a vision statement to help keep them focused on the big picture. Personal mission statements can be long or short, complex or simple. Personal mission statements, like institutional mission statements, state what you are about and what you can contribute with your life. Vision statements, on the other hand, state where you want to be and what you hope to accomplish. Personal values and beliefs also can be incorporated into mission and vision statements.

Numerous websites can help you write mission and vision statements, including WikiHow and the more career-focused Quintessential Careers.^10,11 An example of a mission statement on Quintessential Careers is: "To live life completely, honestly and compassionately, with a healthy dose of realism mixed with the imagination and dreams that all things are possible if one sets their mind to finding an answer."¹¹

There are advantages to working on a personal mission and vision statement at the same time as personal goals to address the nursing diagnosis you have identified. Among them is it helps you prepare a thoughtful and complete package of your personal characteristics and major qualities, as well as your hopes for the future, with steps to get where you want to be.

Remember, nothing changes without intervention. To wish it so does not make it so. As with other care plans, your self-care plan will work best if you write out specific actions that you will take to achieve your goal. For example, if your goal is to spend more time at the gym, you might use a calendar to plan out next week's gym schedule. If you want to spend more time with your daughter, make "dates" with her and include those on your calendar.

Viewing self-care time as an appointment or a meeting keeps you from allowing other things to get in the way. One nurse who did this explained that treating her personal care time as an appointment kept her on track and helped her avoid being swayed by others when conflicting activities came up.

• "I have an appointment" could mean an appointment at the gym or to get a manicure.

• "I have a meeting" could mean lunch with you daughter or with a friend you haven't seen for a long time.

And remember, you deserve privacy and have no need to tell others what your appointment or meeting is or whom it is with. A colleague shared she maintains her privacy when she thinks she is being asked an intrusive question by simply responding, "Why do you ask?" with a smile. If the response from the other person is one based in curiosity, she might respond with, "It's personal," again with a smile. This is usually enough to let the other person know that you do not want to share any details.

Taking action also requires some self-discipline. Giving yourself excuses for non-action will not get you to your goal. You cannot wait until conditions are just right. Put your plans into action now; that is, be a doer not just a planner. Respond to fear appropriately and refrain from allowing it to control you - recognize your fear or anxiety and move on.

Taking action also might include doing some things you have always wanted to do or trying some holistic self-care activities that you have heard work for others. Rachel Y. Hill, ARNP, gives a succinct and insightful account of many holistic activities you can use for self-care in her book Nursing From the Inside-Out.¹² Start with her book to learn how to use Kundalini yoga, reiki and hypnosis in your self-care plan.

Nurses are taught and become experts at taking care of others. We use our skills and knowledge every day to make other people's lives more fulfilling and joyful. We can take care of pain, lack of knowledge and physical inactivity. But what about ourselves?

Focus on the quirky contradiction that maintains we need to take care of ourselves to continue to take care of others. Take the time to make a through self-assessment and write out a self-care plan. Set your intention on working toward your goals with meaningful and strong interventions. Doing this helps us keep our cupboards full and helps us lead more balanced, fulfilling and joyful lives.

References
1. Lorenz, J.M. (2007). Stressed out about difficult patients. Marblehead, MA: HcPro Inc.
2. Self-Care Academy. Retrieved Oct. 24, 2012 from the World Wide Web: http://self-careacademy.com/sca
3. The Learning Nurse Resource Network. Retrieved Oct. 24, 2012 from the World Wide Web: http://www.learningnurse.com/index.php
4. Collaborative leadership: Self-assessment questionnaires. Retrieved Oct. 24, 2012 from the World Wide Web: http://www.collaborativeleadership.org/pages/pdfs/CL_self-assessments_lores.pdf
5. CareerOneStop. Retrieved Oct. 24, 2012 from the World Wide Web: http://www.careeronestop.org
6. University of Minnesota at Morris Career Center. Values questionnaire. Retrieved Oct. 24, 2012 from the World Wide Web: http://www.morris.umn.edu/services/career/career_planning/valquestion.php
7. Cigna Behavioral Health. Personal goal-setting worksheet. Retrieved Oct. 24, 2012 from the World Wide Web: http://www.cignabehavioral.com/web/basicsite/consumer/educationAndResourceCenter/articleLibrary/working_person11.pdf
8. Covey, S. (2004). Seven habits of highly successful people. New York: Free Press.
9. How to set personal goals. Retrieved Oct. 24, 2012 from the World Wide Web: https://www.stephencovey.com/personal-goals.php
10. How to write a personal mission statement. Retrieved Oct. 24, 2012 from the World Wide Web: http://www.wikihow.com/Write-a-Personal-Mission-Statement  
11. Hansen, R.S. The five-step plan for creating personal mission statements. Retrieved Oct. 24, 2012 from the World Wide Web: http://www.quintcareers.com/creating_personal_mission_statements.html
12. Hill, R.Y. (2011). Nursing from the inside-out. Boston: Jones and Bartlett Publishers.