Working Out & Mental Health

Last week was Mental Health Awareness Week in Canada so my timing with this post is a bit off…though, why should we only talk about mental health on “green light” occasions like MHAW and Bell Let’s Talk Day? Sure, they’re great events and I am thrilled to see more discussion about mental health but it’s not like mental health issues don’t happen all the time.

I don’t often talk about my own mental health challenges – partially because they don’t define who I am and partially because I don’t think what I’ve dealt with is particularly unusual. I was a shy kid with my nose always stuck in a book and thankfully, I also loved playing sports. I didn’t fit in socially very well and I wasn’t particularly girly (in fact, I was given the nickname “Butch” by the guys I played basketball with at lunch time). I have always kind of been a bit eccentric and although now I appreciate my creativity and different way of looking at things, back then, I just thought that there was something wrong with me. I thought that if I changed my body I would magically fix everything, fit in, and have everybody like me.

Long story short, I over trained and under ate and developed an eating disorder that went on for about 5 years of hell. I also started binge drinking to deal with my social anxiety and kill my feelings because I didn’t know how to deal with them. My weight went up and down, I was depressed and anxious, and not a very nice person to be around. Honestly, sometimes I think it’s a miracle that I got through high school (with a 91% average, nonetheless). Through it all, sports and fitness played an instrumental role in helping me not screw up my life completely. I wish I had done some things differently but I cared enough about my team to go to practice, eat, not drink the night before games and practices, and go to enough classes that I could still play.

Eventually in my third year of university I hit rock bottom and quit school. I stayed in London and worked at the city pool until the spring. My only reason for getting up in the morning was that I knew the aquafit ladies were counting on me to be there. I will spare the details of my eating disorder but suffice to say it was just miserable.

For me the journey to recovery started with a decision to move back to Nova Scotia to live with my parents in Wolfville. I made a pact with myself that I needed to get better and decided that trumped my fear of gaining weight. I gained a lot of weight very quickly which was really difficult to deal with because my body image was so bad. I didn’t have a job or school so for a couple of months I mostly stayed inside, afraid to go out in case “people” (who I didn’t know!) saw me. Writing this now it’s hard to believe that it literally took me 6 hours to get ready and have the courage to go outside and walk 2 blocks to the post office to pick up our mail!

That summer I worked at Camp Glenburn and met some of the most incredible fun people ever who loved nature and really didn’t care about superficial things. Despite being at my heaviest, it was one of the best summers of my life and made me realize that being happy and having fun isn’t about being a certain weight or size.

From there things kept getting better and in the fall of 2004 I went back to school at Acadia (super awesome choice!). I started going to the gym regularly and this helped my recovery in so many ways. First, it made me feel good about myself, mentally and physically. This is supported by lots of research too. When you exercise, your body produces chemicals that make you feel happy 🙂 Working out is also a terrific way to release stress and deal with feelings. Triple awesome. Second, working out helped me make supportive food choices. I realized that my workouts felt awful if I didn’t eat enough or too much. Since working out was something I like to do and look forward to, I was conscientious about eating regularly and not being extreme. It also made me care about getting enough sleep. Finally, working out helped me gain strength and muscle and take my power back. My goals shifted from “I want to be thin” to “I want to be strong and healthy”.

Of course, exercise and regulating my eating were not the only thing that helped my recovery. I also stopped polluting my brain with unhealthy ideals of beauty by not reading fashion magazines or watching TV. I went to counseling. I talked about my feelings and wrote poetry. I learned coping skills. I found things that were more important to focus on than how I looked. It’s a process and it’s different for everyone.

Today, 13 years later, exercise is still an essential part of my mental health and wellbeing.  I wake up at 5am to work out before my work day begins and it is my time to get focused and energized for the day.  My nutrition habits also play an important role in my mental health. I also eat mostly whole foods and gave up my food guilt when I eat something more rich. Being able to really enjoy and savour a delicious piece of cake (or a chocolate chip oat cake from the UNB library…) and not feel angry or guilty or want to eat the whole darn thing because I interpret a food choice as bad or making a mistake is HUGE.

I also realized that there is not enough cake or pizza or alcohol or anything else in the world that will really make me feel better or take away the feelings I don’t want to feel so my emotional eating has decreased a lot (though not entirely).  I think being a nurse has helped me with emotional regulation too because dealing with the depth and breadth of emotions of the human experience is unavoidable in our profession and self-reflection and awareness is something that we actively work on developing.

These days my mental health is very good, though I find the Canadian winter can get a little bit depressing (who doesn’t!?) and sometimes I still get a bit anxious about social situations and going to Costco (again, not all that unusual). I think because it’s not a problem anymore I tend not to talk about my mental health too much – I have so many other things to focus on instead! However, I do think that it’s important to share my experiences so that people know that they are not alone and that it’s okay to ask for help – EVEN if you are a health care professional or an academic. Stigma shmigma! Despite the silly pretenses that a lot of people put on, nobody is perfect – heck, what does that even mean anyway?!

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Relationship-building in a Task-Focused World

Increasingly, employees are asked to do more with less.  Arguably, this is the goal of Capitalism: to squeeze out as much work as possible for the least amount of money in order to maximize economic growth. I don’t think that this is a particularly helpful way to approach healthcare, as I believe that it is a basic human right, not a privilege, and that relationships with other people are fundamentally inefficient but extremely important.

In nursing the pressure to perform and maximize efficiency can be particularly difficult to cope with, as increased workloads leave less time to spend with patients and their families which is an important part of our job.  It may not seem like having a conversation is “work” but it is through conversations that patients communicate their needs, hopes, fears, and values (among other things).  By getting to know our patients, we are able to ensure that we provide care that meets their needs and treats each individual holistically, rather than as a list of tasks on our daily to-do list.

Building positive relationships with co-workers and leaders are also essential to creating a positive working environment where nurses and other members of the healthcare team can work together to deliver high-quality patient care.  Investing time and energy into these relationships is not efficient in the short term but pays dividends down the road in terms of staff retention, decreased voluntary absenteeism, decreased short-staffing (which leads to more sick time and burnout, etc.), and of course reduced time spent recruiting, interviewing, and training new hires.  It’s not rocket science that people who like their co-workers and their work environment are more likely to stay than those that dread coming in to work every day.  Strong relationships also facilitate good communication and trust among team members and generate shared understandings of work processes, as well as who knows what, and who to ask when you need help.

While we cannot ignore the tasks that need to be accomplished, as these are obviously important, we need to change how we think about relationships in the workplace.  Culturally, we have a tendency to judge relational work as “non-work” when in fact connecting to others in the workplace is very valuable (and sometimes extremely challenging) work.   Unlike patient care tasks that are easy to quantify and check off, it seems artificial and contrived to make a checklist that says “talked to each of my patients about their concerns”, “invested in my relationship with Susan by asking her about her son’s wedding”…etc.  I would also argue that most of us are naturally social and interested in other people so we do a lot of this work anyway and that trying to maximize relational “efficiency” by reducing these things to tasks is ridiculous (and insulting).

I understand that healthcare is expensive and many of the pushes to increase efficiency are driven by our aging population, aging workforce, government austerity, union wage increases, and the economic recession of 2008 (to name a few things).  It is complicated.  However, we need to invest in people and create healthy workplaces that foster a sustainable workforce and allow our healthcare professionals time to invest in relationships with patients. Pushing people harder and harder to produce more with less is not a long-term solution and will cost us more in the long-run – not just in terms of money, but in quality of life, happiness, and patient care.

Maybe the next time you see a nurse, doctor, or healthcare leader talking with a patient or a colleague, you should acknowledge that they are engaging in valuable work.  Just because we’re not doing a task like inserting an IV or giving a medication doesn’t mean that it’s not important.

 

Are nurses too fat?

The most recent issue of Canadian Nurse contains an article about the sad state of nurses’ health but I don’t think it provided the whole picture.  Although I am a nurse, my background is in exercise science and personal training so I have a few things I’d like to add.

1. Most nurses are middle-aged women.  This affects nurses’ health for a few reasons.  Physiologically women have higher body fat percentages than men because of our hormone profile which supports our reproductive role.  Having less muscle mass and high levels of estrogens in our bodies influence our metabolic rate and our body composition.

From a sociocultural perspective, women are still (!) bombarded with messages that they should be thin, rather than fit, making many prone to following fad diets and restricting calories.  This generally results in a “yo-yo dieting” pattern whereby the dieter loses weight while restricting, only to regain it all back, plus a little extra.  Over time, this can make you heavier than you were to start with and make it more difficult to lose weight.  Another thing that people often don’t think about is that the number on the scale does not tell you if you’ve lost fat or muscle. If you lose weight too quickly or are not eating enough calories you are likely losing muscle as well as fat.  As mentioned earlier, this reduces your metabolic rate and doesn’t help you over the long run.  As we age, our metabolism slows down naturally so keeping muscle is a good thing!

As if we don’t have enough on our plate, women generally take on the roles of caregiver, organizer, cleaner, cooker, etc. at home.  So after taking care of patients for 12-hour shifts women often take on their “second shift”, leaving little time for sleeping, let alone physical activity.  And yes, this can apply to men who take on these roles as well but generally speaking our profession is still dominated by women.

2. Most people don’t really understand exercise and nutrition.

Before I knew what a peer-reviewed journal article was, I sought out expert advice about fitness and nutrition from my local library.  While the information from magazines and books isn’t all bad, there is a lot of misinformation out there.  Just because some celebrity follows a certain regime doesn’t mean that it is healthy or appropriate for everyone!

I truly believe that there is no one-size-fits-all approach.  Individuals have different preferences, activity levels, genetics, and budgets to consider.  I am a big advocate of exercise and nutrition as medicine, unfortunately the fitness and nutrition industries are largely unregulated, making it challenging to find professionals who actually know what they are doing.

Which brings me to my next question: how much do most nurses actually know about exercise and nutrition?  Should we be providing advice to patients if we are not experts in this area?  I have mixed feelings about this.  On one hand, as nurses we are often asked to provide general information to our patients and we are readily accessed by the public. Our services are covered under our public health care plan.  On the other hand, we have lots of keen people graduating with degrees in kinesiology and nutrition who ARE experts in these areas but their services are largely available only through the private sector.  Yes, we have physiotherapists and dieticians working in hospitals and clinics, but the opportunities to use them are limited. If you want to hire a personal trainer and invest in healthy food, you are largely on your own.

Really this comes down to the current system’s general focus on disease management rather than preventative health care.  We spend millions on rehab, surgeries, cancer care, etc. and I’m not saying that we don’t need those things too but if we focused more on preventative health care and influencing the social determinants of change that affect people’s everyday lives we could save a lot of suffering and a lot of money down the road.  That applies to nurses too!

We need to create healthy work environments with the structure and culture to support nurses’ health and wellbeing.  Personal choices are also important, but there are real barriers to being able to take good care of yourself when you are a staff nurse working shifts.  Colleagues call in sick so you work short-staffed or work extra-hours to fill in for them – often this results in you becoming run down and getting sick, perpetuating the vicious cycle.  Patients are getting heavier, older, and sicker, adding to the workload we are expected to handle.  There are physiological effects of working nights, not getting enough sleep, and working in a high-stress environment.  To add insult to injury, the less fit we are, the lower our capacity to handle our workloads and the physical and mental strain from working.  Unlike machines, nurses do need time to rest and recover. Unfortunately working out is another stressor added to the mix. Sometimes what your body needs most is sleep.

I hope this doesn’t sound too negative.  There are nurses who manage to take very good care of themselves despite the obstacles.  I am one of them.  I’m not perfect by any means but after a few years of running around trying to be everything to everyone, I have found what works for me.  I have my road bike set up on a trainer in my bedroom and free weights kicking around so I can always do a quick workout at home if I can’t make it to the gym. I make my own food and bring it to work and I eat vegetarian most of the time.  I don’t have cable (but I do watch movies sometimes).  And yes, sometimes I choose sleep or a warm bath over exercise but I feel refreshed and ready to go the next day.  It is about finding balance and for each of us that is going to mean something individual.

Regardless of public perceptions, health is not about being skinny or having a certain BMI (according to which, almost every athlete would be considered overweight or obese!).  Are we role models for health because we are nurses?  Absolutely, whether it is fair or not.  But how is it that we define health?  Are we embracing the unrealistic body image ideals of our culture instead of a holistic view that appreciates multiple dimensions of well being?

While I think that we need to raise awareness of nurses’ health issues through articles such as the one in the current issue of Canadian Nurse, there are a lot of things to consider that were not brought up in the article.  I hope my thoughts contribute to the discussion and I would love to hear what others have to say on this topic!

Have a terrific day!

-Emily