The nursing profession presents unique risk factors that can make this group more vulnerable to poorer mental health
The nursing profession presents unique risk factors that can make this group more vulnerable to poorer mental health outcomes if they are not given the correct support. Providing awareness and useful tools to counteract the possible negative effects of such a rewarding profession is paramount.
Those in the caring profession are more at risk from autoimmune disease (where the immune system mistakenly attacks the body). This includes conditions such as psoriasis, thyroid disease, irritable bowels, rheumatoid arthritis and cardiovascular disease, which are reported to affect up to 80% more women than men (Invernizzi et al, 2009).
The exact reason behind this remains unknown. While genetics do have an important role, it is accepted that the immune system is responding to distressed brain signals. So, the body and mind must be viewed as one when considering mental health outcomes in aesthetic nurses. These stress signals are received and, in turn, weaken immune responses. For example, depression can increase levels of the stress hormones cortisol and adrenaline. Depression can then go on to affect the immune system, making it more difficult for the body to fight infection and inflammation, and this can lead to autoimmune disease. Aesthetic nurses may also be at a greater risk from neurological disorders, such as fibromyalgia. This debilitating illness is still largely misunderstood, but it is known that symptoms can occur after a stressful event or with emotional or physical trauma. This means that nurses are particularly susceptible due to the traumatic consequences experienced by many during the COVID-19 pandemic, as well as those on the NHS frontline. Recent studies have assessed several aspects of the mental health of healthcare workers and, specifically, the impact of the pandemic and COVID-19. Results showed an increase of stress, anxiety, depressive symptoms and insomnia, and suggest that contracting COVID-19 can be an independent risk factor for stress in nurses (Spoorthy et al, 2020).
Managing mental illness and wellbeing
Mental illnesses are not visible and often not communicated. Therefore, unmanageable stress must be regarded as a silent threat. Thankfully, there are creative ways to support nursing colleagues and reduce the potential risk of poor mental health outcomes. The Integrated Practitioners of Aesthetic Wellness (IPAW), a specialist community of psycho-aesthetic providers, has a wealth of services and combined experience and knowledge to support individuals and businesses to elevate mental health outcomes. For more information, please visit www.ipaw.org.uk. Regardless of what interventions are chosen, it is important to implement this without overwhelming anyone. For example, if someone feels that their privacy is being invaded or their boundaries are not being respected, this may risk triggering a downward and debilitating episode of poor mental health or illness. Despite good intentions, this would be the opposite of what was intended.
A committed and ongoing effort should be made to nurture an authentic workplace culture that emphasises the importance of psychological balance and mental wellbeing for staff, colleagues and patients alike by:
- Offering regular accessible health checks. For example, staff blood pressure monitoring (stress is well known to increase blood pressure). Ensure that there is a clear approach to psychoeducation, referral and intervention. This will also open up a protected space in which to speak openly. Talking about feelings can help with mental wellbeing and gaining support during times of troubled feelings. You do not have to wait to be in a crisis before becoming concerned about health outcomes, and these checks do not have to be scary. Prevention is always better than the cure, and practitioners could be missing out by not incorporating health checks at work
- Introducing wellbeing mornings/afternoons or full days for all who are dedicated to taking time to practise self-care within the working day. Activities can include group dog walking, cooking challenges, crafting, drawing, painting, outdoor photography challenges, seasonal scavenger hunts, guided meditation, dried flower arranging, baking and karaoke. You name it, and it does not have to break the bank. The objective is to build a workplace community that is compassionate and caring. One-off projects will not work, so make time to do these regularly. Wellbeing days can combat staff absenteeism (money, time and effort spent on sick days, rearranging the diary or cancelling/rescheduling patients and having other team members compensate for the workload) and presenteeism (a disengaged colleague who is just getting through the patients of the day). Other positive effects can include enhancing decision-making, improving memory, reducing irritability, reducing staff turnover and improving relaxation
- Demonstrating clear boundaries. This is an essential feature in self-care, and it is often missing from the discussion. List your non-negotiables: for example, do not miss lunch, finish work on time, do not respond to messages and emails after hours, do not give patients your personal phone number etc. Define what this means to you and stick to it, remembering that boundaries are not another's responsibility to uphold, they are yours. They may be tough to implement, but it is well worth it
- Deepening self-care practice by applying behavioural activation to a professional boundary. For example, washing hands with cold water at the start and end of lunch, taking your name badge off, putting a hoodie on during your break and changing your shoes immediately after work to walk or drive home. This will give you a psychological safety net to prevent burnout
- Reducing ‘team building or bonding sessions’ after work hours. This can put immense pressure on staff to commit to work outside of working hours and can threaten a healthy work-life balance, as well as professional and personal boundaries. While meeting a colleague for a coffee outside of work is perfectly reasonable, after-hours sessions can quickly become contentious, especially if alcohol is involved or social cliques develop. Some staff may feel left out, ostracised or even discriminated against, which can all have detrimental effects for mental health outcomes, staff conduct, disciplinary issues and confidence in the team
- Demonstrating commitment to mental health through responsible advertising and marketing. For example, World Mental Health Day was on 10 October 2021—did you acknowledge it? If not, it is not too late, you can get involved in key mental health awareness days yet to come throughout the year. The Mental Health Foundation (www.mentalhealth.org.uk) also has some great resources to help. You could even share your workplace wellbeing activities.
» Consider performance—not by the amount of work completed, but by the quality of work—as an insight to your psychological needs and closely monitor complaints, gripes and customer feedback «
Patient perspectives
Consider performance—not by the amount of work completed, but by the quality of work—as an insight to your psychological needs and closely monitor complaints, gripes and customer feedback. Note whether there are any recurrent themes or if they follow a pattern, for example, perhaps it is a particular treatment or nurse. Have training needs been identified and continuing professional development (CPD) opportunities provided? Are there any special circumstances? Perhaps performance is a consequence of unmet psychological needs. Integrating psychologically informed principles into the workplace will provide an opportunity to engage with oneself and colleagues in a more vulnerable and authentic way. Nurses must be equipped to respond to the challenges that may arise due to this. For example, issues around fitness to practise may come into view that were previously dismissed or hidden. Be prepared to protect public protection and revisit your internal policy and procedures that support your staff and/or colleagues when they may need to take time off. Be encouraged by this year's Olympic games that celebrated taking time off to focus on mental health, as this could also be a turning point in medical aesthetics. This self-care insight is an imperative safeguard to protect your pin, proficiency and registration, or this may quickly become an escalated matter for insurance if not adequately assessed, monitored and supported, which could have been avoided. Hamilton Fraser Insurance offers some insightful content, including podcasts and advice on mental health and medical malpractice to support aesthetic nurses through the intricacies in their practice.
» Nurses deserve to be cared for in the same way that they tirelessly care for their patients … allowing yourself time to process, rest and recover to reduce the consequences of long-term stress is your health right «
Patients can be offered a varied treatment menu that includes less invasive wellbeing treatments to demonstrate the importance of psychological balance and mental health in relation to the body. This also provides alternatives to patients who present in the clinic for first-time treatments, as well as those in clinic for their regular injectables treatment. A patient seeking treatment in a period of increased stress can increase the likelihood of treatment dissatisfaction. In other words, the treatment may leave them more vulnerable by enhancing their preoccupation with negative assumptions of their perceived flaws and attribution of self-worth. This may seem counterintuitive, but there is some fascinating emerging research to validate this (Brunton et al, 2014; Nuffield Council on Bioethics, 2017; Hosseini and Padhy, 2021). If deciding to treat at this time, this can make a patient hypervigilant to potential side effects, which increases the risk of, at best, complaints, complex case management and bad reviews due to ‘treatment failure’. At worst, this puts the practitioner at risk of secondary trauma, which may have a serious consequence to their own mental health or activate a period of mental ill-health as a consequence of being exposed to the patient's trauma. The patient's state of mind is likely to have been revealed in the consultation, as it is part of their motivation for treatment, or become apparent during the complaint process itself. If you feel uncomfortable saying no to treatment, suggesting alternatives is a gentle way of saying no without actually saying it. This means that patients can continue treatments, while reducing psychological risk to you and them.
Nurses should provide an undisturbed and confidential time away from the busy environment of the clinic to complete a full consultation that encourages patients to talk openly about their feelings without fear of treatment rejection. Be sure to let patients share as much or as little as they want to, but it is important that the nurse feels that they have assessed their needs correctly. Some open question examples to consider at consultation, which may invite an authentic mental health discussion, include:
- What things do you like to do to keep active?
- Do you follow a particular lifestyle or diet?
- Do you consume alcohol? If so, how much?
- Do you find it hard to keep in touch with friends and family?
- How often do you ask for help?
- Do you take regular breaks at work?
- Tell me something you are good at that is not appearance related
- What did you miss the most in lockdown?
- What comforted you most in lockdown?
Be aware of the red flags that suggest a patient is not suitable for treatment, as well as the language and words they may use to disguise this, and gain confidence in responding to them.
If you are not already doing so, offer free consultations. If this feels uncomfortable, try reframing this as a protective space for both you and the patient. I urge nurses to reconsider their ‘lost money’ or ‘wasted time’ narrative. This should be replaced with the belief that this is a necessary security system, knowing that, when patients choose you, they have done so out of choice and not because they are financially bound to do so. This should be met with gratitude and thanks and this trust will only grow and return as authentic patient engagement, improved treatment satisfaction and patient retention. This will prove to be less of a mental insult to you in the long run.
Again, if you are not already doing so, make detailed clinical notes of each patient interaction using the subjective, objective, assessment and plan (SOAP) model, which is simple, yet effective. This log will provide a useful tool for reliable patient reviews and mental health screening without fear of exceeding professional limitations. This will allow the practitioner to see whether the patient is engaging in short-term, temporary self-soothing or active long-term self-care. Once again, this will work to protect both patients' and nurses' mental health.
The capacity to cope
Coping with symptoms that are associated with poor mental health or mental illness, such as loss of memory, headaches, impaired mental ability, lethargy, lack of motivation, irritability, mood swings, compulsive behaviours, heart palpitations and breathlessness, can be overwhelming. Just reading this article shows that you are ready for change. You may not know what that looks like, but you are seeking something different. This is a courageous achievement. You are not alone; however, your experiences are unique to you. Nurses deserve to be cared for in the same way that they tirelessly care for their patients. The pandemic may have resulted in trauma for many, and other nurses may also be in survival mode. Allowing yourself time to process, rest and recover to reduce the consequences of long-term stress is your health right. Talk to a colleague, friend, family member or someone else who you trust. Take some time off. Perhaps consider what you would recommend to a patient if they were presenting with your symptoms and listen to your own advice. You have a voice, and it is okay to acknowledge your needs. The following self-compassion exercise can be used to help bring validation to any emotional pain that is being experienced. Find yourself a quiet moment, perhaps after a shower or bath, sit comfortably and ask yourself, where in your body do you feel the emotional pain? Place your hand gently over this area, feel the heat of your fingertips over your pain. Stay here for as long as you wish, taking a deep breath in and out, holding your pain, accepting that this is real and acknowledging your needs. Just this small action can provide comfort and compassion via the ‘cuddle chemical’ oxytocin. Trust yourself and your journey to improved wellbeing.