Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond (2024)

1. Introduction

Viktor E. Frankl (1945, p. 165) declared, “The meaning of life is to help others find the meaning of theirs”. Arguably, the need for empathy, compassion and meaning in the lives of our patients, families, colleagues and ourselves has never been greater.

To care for others with compassion is why we became nurses (Vachon, 2016). The rapid spread of SARS-CoV-2, the virus that causes Covid-19, is an international public health event without precedent in any of our lifetimes. Not everyone will be affected physically by the virus, but every one of us will be affected psychologically. It is critical that nurses do not neglect their mental health during this pandemic. The global nursing and healthcare community is at the forefront of this unprecedented public health outbreak. The World Health Organization is one of many trusted public health organisations to provide comprehensive guidelines for the protection of front-line healthcare workers (WHO, 2020). But there are alarming reports of ongoing global shortages of personal protective equipment (PPE), for example: clinical staff in Chinese hospitals wore their raincoats or plastic garbage bags as protection (Smith et al., 2020). There are courageous stories, but also reports of resource rationing decisions, ongoing PPE shortages, and unrelenting pressure and grief. But nurses have experienced significant occupational stress, pressure and burnout prior to the Covid-19 pandemic.

To spark debate about these ‘contemporary issues’, we present a series of three papers for different audiences (i.e., nurse educators; front-line nurses; health system leaders and managers) to explain how empathic healthcare cultures and constructs such as empathy, emotion regulation, compassion, and self-care could sustain wellbeing, resilience and effectiveness in these volatile times. In this second of three papers, we explain how nurses, midwives and students can better care for themselves (e.g., self-care strategies such as kind self-talk; emotion regulation) so they can better care for others during the Covid-19 pandemic, and beyond.

First, we provide an overview of caring for ourselves and resilience in uncertain times. Next, we discuss empathy and compassion and explain why emotion regulation (‘self-other’ distinction) is an essential self-care strategy that nurses must learn so they can sustain care for others. Next, we explain how the practice of self-compassion can safeguard mental health, wellbeing, regulate emotions and reduce vulnerability. We then describe tips to support self-care and list trusted online resources that are providing regular updated information about Covid-19. Keeping strong in body, mind, and spirit to cope with ever-changing circ*mstances is vital.

2. Caring for ourselves so we can care for others

How do you talk to yourself when you are having a difficult time or have made a mistake? Are you kind and understanding and talk to yourself as you would talk to a good friend who is upset, or are you critical and judgmental? Studies show harsh self-talk and self-criticism activates the sympathetic nervous system that stimulates the stress response, so is harmful to our mental health and wellbeing (Singer and Klimecki, 2014). As nurses, we understand the importance of self-care strategies (e.g., adequate sleep, healthy eating, regular exercise, social connections, mindfulness) to foster our resilience (Mills et al., 2018; Cusack et al., 2016). Another important self-care strategy is kind self-talk which is a component of self-compassion (Neff, 2011). We must first practice self-compassion and be aware of our own needs, before we can help others with theirs (Vachon, 2016). When we talk kindly to ourselves, we strengthen our pro-social behaviours (e.g., altruism, kindness, empathy) toward others (Singer and Klimecki, 2014). When we are empathic, we communicate better with patients, families, and colleagues. This process can lead to a deeper understanding of what matters to patients, and how to act with kindness and compassion to relieve their suffering and distress (Vachon, 2016).

Nurses can use self-care strategies such as emotion regulation and self-compassion to lessen their vulnerability to caregiving fatigue and to improve their wellbeing and resilience.

3. Empathy, self-awareness, emotion regulation and compassion

Clinical teams are more effective, morale is higher, patient satisfaction is higher, and safety improves when empathy and compassion are present in healthcare cultures (Lown, 2018). Empathy is the ability to ‘feel with’ others and our empathic response is caused by the activation of neural networks in the anterior insula and anterior cingulate cortex that processes first person (our personal) experiences (Singer and Klimecki, 2014). Functional magnetic resonance imaging (fMRI) studies show that similar circuits of the brain are activated in both the person who is suffering and the person who is witnessing the suffering. It is vital we understand our empathic emotions are in response to seeing the other person suffering. In other words, it is not our suffering (Singer and Klimecki, 2014).

This understanding that the suffering is external to ourselves is called the ‘self-other’ distinction. The ability to distinguish between our own and the emotional pain of others firstly requires self-awareness and then regulating our emotions to develop a protective ‘self-other’ boundary (Vachon, 2016). The ability to regulate our emotions is key to avoid experiencing the distress of others. fMRI studies show that inadequate emotion regulation (i.e., blurring ‘self-other’ distinction) leads to individuals being unable to tolerate distressing emotions when confronted with another's suffering, so become overwhelmed. Nursing calls this debilitating condition ‘compassion fatigue’ which manifests as distress, emotional detachment from patients, feelings of isolation, and inability to care for self and others (Hofmeyer et al., 2019). However neuroscientists have proven it is ‘empathic distress fatigue’ (Singer and Klimecki, 2014, p. 875).

In sum, exposure to the distress and suffering of others can lead to two different emotional responses. Empathic distress results from inadequate emotion regulation that triggers detachment and personal stress. In contrast, compassion is characterized by empathic concern and motivation to relieve others' distress and suffering (Singer and Klimecki, 2014). Our ability to be self-aware and to regulate our emotions is key to our wellbeing and capacity to act with compassion. fMRI studies show compassion activates the medial orbitofrontal cortex related to positive affect, affiliation, maternal love, and reward leading to feelings of compassion for self and others (Vachon, 2016). Compassion training includes strategies (e.g., meditation) to ease distress and strengthen resilience and attachment (Vachon, 2016). Self-compassionate people are more likely to engage in ‘perspective taking’ which contributes to better mental health rather than ruminating about problems (Neff, 2011). Acting with compassion is predicated on self-awareness and self-care including emotion regulation and self-compassion.

4. Self-compassion

Psychologist Kristin Neff was the first researcher to define and measure self-compassion two decades ago. As illustrated in Table 1, self-compassion involves self-kindness, common humanity (understand that everyone makes mistakes and suffers), and mindfulness (Neff, 2011). On the other hand, uncompassionate behaviour toward ourselves is expressed as self-criticism: self-judgement, isolation, over-identification (Neff, 2011) as summarised in Box 1.

Self-compassion affects our everyday lives and is expressed in how we relate to ourselves in times of perceived failure, inadequacy, or personal suffering (Neff, 2011). Practicing self-compassion means we care with the same kindness and understanding toward ourselves when we fail, as we would care for a good friend (Neff, 2011). Examples of actions that constitute self-compassion and actions that constitute self-criticism (that we need to lessen) are explained by Neff (2011) in Table 1.

Learning to respond compassionately to our own distress requires self-awareness which, in turn, can strengthen our ability to activate our self-regulation systems so we feel safe (i.e., self-soothing activities stimulate positive emotions like contentment, more secure attachment) rather than feeling under threat (Vachon, 2016). Self-care practices to develop self-awareness include mindfulness meditation and compassion training.

5. Tips and resources for self-care

In this section, we list practical tips and online resources (i.e., organisations) providing regular updates to get you started so you can better manage in these uncertain times. However, this is by no means an exhaustive list. It is vital to be strong in body, mind, and spirit and courageously face the ever-changing circ*mstances of the Covid-19 pandemic. Self-care fosters greater self-compassion because it includes positive approaches to building resilience and regulating anxious emotions.

6. Conclusion

In the midst of the constantly evolving Covid-19 pandemic, it is vital that frontline clinicians have the support and essential resources they need to “reconnect with the purpose that drew them into healthcare so they can continue to experience, and offer, compassion” (Lown, 2018, p. 219). Knowledge and competence are as equally important as kindness and compassion in front-line nurses and responders to the Covid-19 pandemic. This unprecedented public health crisis is impacting every aspect of our daily life. Resilience, patience and kindness is needed to cope with the grief, distress and fear as we worry about the wellbeing of our patients, colleagues, our families and ourselves.

We have outlined tips and links to regularly updated information and self-care resources to safeguard our mental health, wellbeing and resilience as we work long hours caring for acutely ill patients and distressed families. Taken together, self-care and compassionate cultures are key ingredients to sustain wellbeing and resilience, contribute to nurses' career longevity, and compassionate practice now, and into the future beyond the Covid-19 crisis. In these moments of collective vulnerability and grief, let us all lead with hope and kindness toward others. As we continue to do the best we can in the days and months ahead, we can be encouraged by Ken Schwartz's words that simple acts of kindness can make the ‘unbearable bearable’ (Schwartz Centre, 2020).

CRediT author statement

Anne Hofmeyer: Conceptualisation, writing – original. Ruth Taylor: Conceptualisation, writing – review and editing. Kate Kennedy: Writing – review and editing.

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