In Japan, nursing education has an emphasis on professionalism, clinical knowledge, efficiency and compassion. There is little provision for educating nurses to care for themselves and, after graduation, a good support system is rarely offered to nurses in the work setting.

Further, if nurses have not developed boundaries and do not have appropriate mechanisms to cope with difficult situations, they may react with primitive defence patterns such as fight, flight or freeze. An example of fight response may be when a nurse overly invests in ‘fixing’ the situation by offering advice or false reassurance. In a flight response a nurse may focus on technical tasks, and interaction with the patient and the family is kept to a minimum. A freeze response can be tricky in that the nurse may appear calm and unaffected but in reality has become dissociated from personal feelings. Some nurses become numb to any situation and appear cold or uninterested. These behaviours do not indicate a lack of compassion on the nurse’s part – they are simply unconscious mechanisms that ‘kick-in’ if the nurse does not have adequate tools to cope with the situation.

The Need for Self Care
I have been running workshops for nurses on Self-Care and Self-Healing in Japan for some time. This has revealed much. When workshop participants are assured of confidentiality and given permission – and encouragement - to express their emotions, some deep and long-held feelings rise to the surface. It is as if the workshop participants have been aching for an opportunity to share their inner struggles and pain. For some, an outburst of emotions is often a surprise because they have been detached from their own emotions for so long. Interestingly, no one mentions at which hospital they work or their job title. Each person wants to be seen and heard as a human being, without credentials or titles attached.

Some stories that emerge during the workshops are confronting. For example, one participant talked about leading a double life. Whilst she was admired by patients and colleagues and referred to as an angel at work, at home she took out her anger and frustration on her small children. She was devastated when her four-year old child told her that her face looked like the devil.

Another participant confessed that she had been mean and difficult to her staff because she was just so exhausted from work.
One participant (let’s call her Rose) revealed that she had not recovered from her close colleague’s death from cancer. They had shared a long history of working together in the same ward but when the colleague became sick. Rose could not bring herself to see her. colleague and iIn fact Rose did not see her before she died. Although Rose the colleague had been well respected and liked, her name thereafter was never mentioned again at the workplace. There was an unspoken code of silence. Days and then weeks rolled by as if nothing had happened. In fact, ten years rolled by until the workshop provided the first opportunity for Rose to release all her grief, guilt and anger. She sobbed uncontrollably. When I asked how she had handled working in the same department until now, she replied: “I have been numb. I have not felt anything toward patients or myself. It’s as if I became a shell. My body has just been going through the motions.” During the workshop she felt a huge burden being lifted and, a few months later, she reported that she was regaining hope and had begun to enjoy being a nurse again.

Although these participants were unhappy with their own behaviour, they had no other way to cope. They had not been educated in Self-Care.

Paradoxically, many nurses lead unhealthy lives because of smoking, excessive drinking, poor diet, emotional difficulties, relationship difficulties and other addictions. These behaviours often represent strategies for coping with the real stress and demands of nursing.

During our workshops, participants are introduced to practical tools for coping with overwhelming situations. These include meditation, simple breathing techniques, and creating effective support systems within the workplace. Feedback from incorporating these initiatives into daily experience has been positive. Once the person understands how stress and work demands have been affecting them, they can see how effective these tools can be. Many report improvement in both their professional and personal life. They really start to see what it means to be human and that it is OK to feel sad, angry and frustrated, so they feel validated. They also realize there is nothing wrong with them, which is often a revelation. They also find that by learning these healthier coping strategies, they are better able to fulfill their role and are better able to cope with their personal struggles.

Conclusion
Following completion of our workshops, many participants report improvements in both their professional and personal life. They come to accept that they are only human and therefore allowed to be sad, angry and frustrated. They realise there is nothing wrong with them when they express these emotions. This is often a revelation to them.

In order to be healthy and happy, humans need proper nurturing. Nurses know how to nurture and care for others. All they need is to apply the same skills to themselves. Nurses have a need to be cared for as much, if not more, than the care they give to others.

When the balance between caring for others and caring for oneself is not properly managed emotional, physical and spiritual well-being is jeopardised.

So, are nurses angels? My answer is no. Nurses are human just like everyone else, with a fundamental need for physical, emotional and spiritual wellness. When the illusionary image of an angel in white coat is let go, nurses are better able to get in touch with their authentic self. The authentic self is an invaluable resource for compassionate caring. Healing work offered by an empowered being, and authentic self, is much more genuine and profoundly effective.

Contributed by: Miyuki Yamamoto
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