The ‘ED Spa’ is designed to be a safe space within an Emergency Department, a place that is completely non-clinical and separate from the coffee room. A place where any member of staff can go for a time out, a cry, a rant or just a bit of space to ‘be’. Our room in Virchester, looks and smells completely different to the rest of the department, you can walk in and know you are in a non-clinical area. Everything in the room is based around the ‘5 ways to wellbeing’. We have been open since 28th July 2017, it has been an absolute joy to see the Spa in action.
It took Kirstin (aka Dr Ballantyne) and I over 6 months of planning to get up and running. I wanted to share why creating the SPA became a passion, and the theory behind it. Most of all my heart behind this blog is to share how we all could have an ‘ED Spa’ in our lives, and explain why I believe we should use these tools while we are well, to help us in the tough times.
The need for a physician to look after themselves to feeling good and function well (wellbeing) is not a new. An engraving found on a monument dated to 22 AD says this:
“ These are the duties of a physician: first….to heal his mind and to give
assistance to himself before giving it to anyone (else)”1
So how did the ED SPA even become an idea?
I personally did not take the need to look after myself seriously until I was very broken, events stacked up and I was left wrestling with the idea that I did not want to be and was not ‘strong’ enough to be a doctor any more. My identity was crushed. In this time, I was loved well by family, friends and colleagues, I picked up tools to help me process the issues that had arisen. I came out of this period as a very different person and clinician. My eyes had been opened to the effects work can have on not just me, but also my colleagues.
This lead me to design a qualitative research project exploring “How Events in Emergency Medicine impact doctors’ psychological wellbeing”. The full results of this project will hopefully be published soon. This project involved conducting narrative style interviews from emergency physicians, we reached data saturation at 15 interviews however performed a total of 17. The data was then analysed using framework analysis, from which several themes emerged. Every clinician that I spoke to had a story to tell, of a case or situations at work that had profoundly affected them. These quotes sum up why I was passionately moved from research into action. One interviewee said this “ I have been a very well person, and I am actually very confident. I am very outgoing and it absolutely broke me”, another said this “ The net result of all that was, I certainly didn’t sleep properly for 3 and a half years. I thought about it every day except for a few days on holiday and it had a huge impact on my life”.
What is the ED SPA and what is the evidence behind it?
First of all, there is no one size fits all approach for this, you need to find your ‘thing’. The fabulous Liz Crowe explained this here: http://stemlynspodcast.org/e/wellbeing/
The UK governments Foresight program together with the New Economics Foundation created five Evidence based actions to improve personal wellbeing (5 ways to wellbeing). This is the bases of the ED SPA, everything done in this room and from this room, encompasses one of these 5 ideas.
Invest in relationship, as Liz Crowe explains in her SMACC talk, have a work husband or wife. Strong meaningful relationships will encourage and support you.
Feeling valued by other people is a fundamental human need, both at work and in your personal life. Creating a community at work is something we do well in EM; working in an Emergency Department is true team work. That feeling of community gives a sense of familiarity and increased self-worth. If you’re a team leader, make sure you spend time encouraging and supporting your team. Mary Freer gave a really inspiring talk about compassionate leadership at the recent Don’t Forget the Bubbles conference about compassionate leadership. As a leader you have the privilege of setting the tone and culture in your department.
Connect with your family and friends. There is a link between the total number of close relatives and friends (primary group size) and the risk of developing common mental health problems. A primary group size of three or less is a predictive factor for the development of common mental health disorders in the future.2
Get together over coffee and cake or a few drinks after work (all in moderation!) to create and maintain meaningful relationships. Set time aside to invest in relationship with those around you. Get outside and connect with nature. Parties and nights out, did not need any help to be arranged by us, these are already plentiful! We have used coffee cups planted around the department to try and promote connection. We also have had the guide dogs in the SPA to allow the staff to connect with nature and each other, this was very well received.
2. Be Active
Find the thing that you enjoy that gets you active
Participating in physical activity lowers rates of anxiety and depression, as well as preventing cognitive decline.3,4 In terms of mental wellbeing, the exact recipe (type, duration and frequency of physical activity) needed for positive effects is not clear. It is known that engaging in physical activity reduces negative thoughts whilst giving a sense of empowerment and self-mastery.5 As little as ten minutes exercise, 3-5 times per week, is known to improve mood and reduce symptoms of depression. Here in Virchester there is a well established running club, for novices to experts. We have taken our team out for activity days, climbing, rafting, and team challenges all free to the participant and facilitated by a local scout club. These were a fantastic success, taking time to invest in our staff, help them get connected in a setting out side of work as well as getting active. Try running similar days for your department. Not everyone will enjoy this sort of thing, not everyone will sign up to the days, but it’s important to promote and offer a range of opportunities for the diversity of staff in your team.
Liz Crowe has established a walking club in her critical care unit, whatever your passion is find it. Before starting a “Netflix and chill’, spend some time getting your heart rate up first (Ed – we have subsequently discovered that the phrase ‘Netflix and Chill’ is not quite what we thought it was, but it’s funny so we are keeping it in).
As well as getting active, think about what you eat and drink and impact of nutrition on stamina, concentration and decision making during a shift. Get off the sugar roller coaster of caffeine and biscuits. Shift working can make it very difficult to do this well, we have looked at this here at St Emlyn’s.
There is a lot of research showing kindness and gratitude have many positive affects on wellbeing. Neuroscience research has found that the neural response to social co-operation is rewarding.6 Kindness and gratitude increase your serotonin, and oxytocin levels have been shown to increase your energy levels and give you pleasure.
Creating a culture of thankfulness, performing random acts of kindness, creating gratitude lists. These are simple and effective tools.
Download a random acts of kindness calendar, for yourself or your department, try and follow it. Create a gratitude board in your staff room, integrate gratitude lists into your handover structure.
We have a gratitude tree in the SPA which you can see in the photo. The idea is that staff members record things that went well and where people have been kind. All to often we spend lots of time ruminating and investigating when things go wrong, it’s important that we celebrate when things go well as a balance to our work. The gratitude tree is one means of doing this. Colleagues are welcome to leave any messages they like there and also to read what others have written.
We’ve also createda wall in the SPA that demonstrates our gratitude towards the staff and shows them how thankful we are for all they do. You might think this is obvious and that you do this anyway, but there is no harm, and arguably lots of benefit to clearly stating it.
4. Keep Learning
Every day in health care is a school day, in a medical career is that we will never stop learning, from every day, from every patient. Evidence shows that continual learning increases optimism, efficiency and satisfaction 7.
Make a list of the things you had always dreamed of being able to do, how could you learn some of those skills, are there classes you can take. Can you carve out a protect time to pick up that hobby you love.
The SPA contains a bespoke library, the books here promote reading for pleasure, healthy eating cook books, books that teach a wide range of wellbeing tools, and books about decision making. All these books were from recommended sources such as books on prescription.
5. Take Notice
Paying attention to the things around you in the moment, and how you are feeling.
While the idea of mindfulness will fill some of you with dread, please remember this is a tool kit, find the ones that work for you. Being present in the moment, taking notice of how you feel and what is going on around you. Training yourself to be aware of sensations thoughts and feelings has been shown to increase your sense of wellbeing8.
Beyond this, allowing yourself to feel your feeling is vital, sadness, anger, frustration are all perfectly valid emotions, and can often be felt working in emergency departments. Its normal. Self-awareness, will allow you to address and move through these feelings. Try reading ‘The Upside of your Dark side by Todd Kashdan’ for more on this.
For those who want to give it a try, the Head Space app is a fantastic place to start, or if you like books, ‘Into the Magic shop‘ is written by a neurosurgeon about his experience of the practice of mindfulness.
Creating a culture within your department, where feeling and emotions can be expressed is invaluable.
Although we advertise the SPA throughout the department, including spaces seen by other teams, patients or relatives there are some notices that we keep to staff areas only. If you work in the ED there will be days when things don’t go well. We’ve all found colleagues in tears following a bad patient outcome or when they have been poorly treated by others. Those days are tough and we need to know that colleagues feel safe and that there are places and people to contact. That’s where the ‘What the £&$K just happened’ posters came from. These are in the SPA, but also in the staff toilets and staff rooms. These posters have contacts and ideas for what to do on the dark days. It’s not all rosy in the ED and we need to make our teams feel as if there is support out there when they need it.
The bottom line
I believe passionately that investing in your self is the most valuable thing you can do. It doesn’t always mean being ‘happy’, it means looking after your self and finding the things that make you the best version of you. Doing this will help you flourish, and will improve your patient care. There is no one size fits all answer to do this, I hope this blog has give you some ideas for you and your department
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