In nursing school, we are taught the importance of observations. It is the start of our decision-making process, and all we do flows from there. Thorough observations are the core of our nursing assessments. We become nurses and, as time passes, we get better at it, and it can become almost second nature. We start to know what to pay attention to and what to ignore, as well as what to document.
After we accrue years of nursing experience, we are not even conscious of some of our observations. We start to have “feelings,” as in, “I don’t know why I suggested running that test to the doctor; something just didn’t feel right.” Or, “I feel like I need to keep a close eye on this patient; something is making me nervous.” This is often referred to as “instinct,” but in reality, it is our minds sorting through our observations so quickly we aren’t even aware that we are doing it.
All through our shift, we are constantly observing. In addition to observing our patients, we are observing each other, the workplace, the supplies and equipment, the patient care environment, and the management. There’s a lot to keep a watchful eye on.
Your Most Important Patient
Something that tends to escape our attention and observation is ourselves. Burnout and exhaustion are common but not necessary parts of nursing. We can take steps to care for ourselves in ways that will make our work more rewarding and make us mentally healthier and more resilient.
Let’s start observing ourselves! By which, I mean observing what’s going on in our minds. Just about everyone has a little “voice” in their heads that will keep up a running commentary all day long and sometimes even into the night or when we should be sleeping. This voice tends to excel at finding fault with us, and as a result it is sometimes called the Inner Critic, The Judge, or The Nag. We need to learn to sort out what is going on inside ourselves. With a little bit of practice we can start to pay more attention to the part of our brains that is watching us and noticing all we do.
Three Steps to Self-Care
There are many ways to get into the practice of using the power of observation as self-care. Let’s look at a few you can use:
If you only have a moment to spend on yourself, take that moment. Even if it is just ten seconds! You can do this anywhere and almost anytime. You can do this when you step into the clean utility to grab some supplies or while you are walking down the hall.
Take a breath, turn your mind inward, and check in with yourself. After you take that deep breath in, pause for a moment, and as you breathe out, ask yourself the question “How am I feeling right now?” and let the answers float up into your mind.
Sometimes I am surprised at what comes back to me. I could be feeling overwhelmed, anxious, distracted, happy, or any number of things. Then I can take a moment to see where that feeling might be coming from.
Sometimes there are physical needs. I may realize that I really need to eat, take some ibuprofen, or use the bathroom! Using this little exercise throughout your shift can help you know what you need to do next to take care of yourself mentally, emotionally, and physically.
The Head to Toe
If you actually manage to get off the floor, you can take a couple of minutes to do a head-to-toe assessment. Try to find a quiet place if you can. Sometimes I go and sit in my car just to get some solid alone time where I can focus.
Again, take that deep breath and focus on just your head. Are there areas of tension? Is your jaw clenched? Is your neck sore? Try to let that area relax. This is a really quick check in. It should only take a few seconds.
Next, move to your torso, notice what’s going on there, and let that area relax. Check your arms, your legs, and then your feet. That only took a minute! Again, ask yourself “How am I feeling right now?” and see what comes to mind. Make a mental note of the data you’ve gathered and get back to what you need to do.
Sometimes we are supposed to be sleeping, and we are lying there listening to the Inner Critic or rehashing our last shift. It seems like our minds do this on their own, and we can feel powerless to control it. Those are the moments that we can use our powers of observation to watch our respirations.
Next time you are lying there awake, or even while you are getting ready to go to sleep, try focusing on your respirations. Start with one big breath in and out. While you are doing that, try to notice if you have tension in your face, chest, or belly (that’s what we use to breathe), and then just breathe normally.
Now you want to just notice your breathing. Feel where it starts down in your belly, and follow it up and out using just your mind. Can you feel it in your throat or in your nose? Do you feel your lungs expand? Do you feel your chest rise and fall?
When your mind wanders (which it will) or The Inner Critic shows up, refocus your attention on the pathway that your breath is taking. You can even count as you would while assessing your patient.
These three techniques bring us important information, connect our mind to our body in a conscious way, and build the skill of observation of ourselves so that it can grow to become more instinctual.
Identify Your Needs
Just as our feelings influence our patient observations and help create our plan of care in our nursing, they can do the same for us. According to Marshall Rosenberg, the founder of Non-Violent Communication, feelings are basically indicators of needs that are being met or unmet. When we can better understand how we are feeling at any given moment, we can then begin to understand what we might need.
Feeling frustration can indicate that your need for respect is not being met. Feeling embarrassment may come about when your need for reassurance was not met. Disappointment can indicate that your need for celebrating an important milestone was not met. Feelings generally considered “positive” indicate when your needs are being met! Feeling optimistic could result when your need for autonomy was met in some way. Contentment can indicate that your need for safety is being fulfilled.
Once you get a better sense of those needs that are being met and unmet, you can find healthy and constructive ways to address those issues. You can set goals for yourself and work toward outcomes. Sound familiar?
Nurses are trained professionals in making, recording, and acting on observations. Let’s practice this core skill within ourselves and reap the benefits.
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