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“Where does it hurt?” doctors and nurses ask countless times a day; and yet the answer may not match what’s on the patient’s chart.
“You can’t separate mental health from [physical] health,” said Tricia Gatlin, who holds a doctorate in nursing education and is the dean of the Wegmans School of Nursing at St. John Fisher University. “The body is not divided like that; although for a long time we thought it was. I think now it’s coming back together.”
Acknowledgement of the inextricable link between emotional and physical well-being is a major focus of training for future health care providers. At the same time, current providers realize that how they feel about themselves affects their work.
“Taking care of yourself is an important aspect of taking care of your patients,” said Dr. Richard Alweis, associate chief medical officer for education at Rochester Regional Health. “Denying your own feelings, denying your own situation may seem like a good short term thing … Actually, it’s a terrible strategy and hurts people.”
Integrating mental and physical health has been part of nursing curricula for many years and has been the foundation of the educational philosophy at the University of Rochester Medical Center since the late 1970s.
As with other aspects of life, the COVID-19 pandemic made educators think about how they teach and support providers’ emotional needs.
“COVID has made us all stop and take that step back and say, have we really been doing a good job of this,” Gatlin said. “What can we do? How can we do more? Should we do more? Let’s think about where we’re introducing some of this, let’s be more intentional … It’s just been more of making sure that we’re listening to our students and teaching our students to really listen to the patient.”
The pandemic arrived when the American Nursing Association had declared 2020 the Year of the Nurse. The celebration turned to a reckoning of the roles that nurses play and the importance of self-care.
“It really was this launch for us to start looking at when we think about the healthy nurse … we have to teach them to be holistic with themselves and holistic with their own care,” Gatlin said. “What we’re doing more of right now is making sure that we’re teaching that so (students) can be more resilient as they’re moving into the workforce.”
Gatlin said the St. John Fisher faculty are working nurses, so they understand and can model the balance between their work and professional lives and the need for self-care so they can be at their best with patients.
At Rochester Regional, medical students, residents and fellows are taught the importance of being “present.”
“If you’re sitting in the room patient while they’re talking to you and you’re paying more attention to the electronic health record and you’re typing and you’re not making eye contact … the patient isn’t getting the sense that you’re paying attention to them and their concerns,” Alweis said. “They’re not going to open up because they feel you don’t care. If you’re not present in the moment when the patient is opening their hearts, they’ll clam up, they won’t even go on tell you what’s really going on. So it all starts with presence.”
Something as basic as a provider reflecting on what brings him or her joy can affect their feeling of being present and build connection with the patient.
“It’s much less prescriptive and more like a mentorship, if you will,” he said. “It’s like from personal experience. These are the things that helped me maintain my joy and help me get through tough days. Let’s talk about what helps you maintain the joy in what you do and what will help you get through the tough days.”
As for how a provider’s mental health affects the patient’s overall well-being, Alweis said studies show that patients who are cared for by burned-out providers have worse outcomes than those that are taken care of by providers who are not burned out. “Taking care of yourself is an important aspect of taking care of your patients that will improve their outcomes.”
Medical educators said students are demanding attention to their mental health, which, in some cases, has led to intergenerational strife.
“The students are saying, ‘This is important, we’re paying a lot of money for our education, therefore it’s going to have to be important to you,’” Alweis said.
The University of Rochester Medical Center has built its curriculum around the biopsychosocial model pioneered in 1977 by George Engel, who held appointments in the UR departments of psychiatry and medicine. Engel paid attention to a person’s disease as well the social, emotional, cultural and environmental factors affecting the person’s health.
“The real importance is approaching the patient in their own experience of illness rather than just assuming disease is the only entity to focus on,” said Dr. Laura Cardella, who completed her medical degree at UR School of Medicine & Dentistry. After residency at Brown University, she returned to Rochester and now oversees psychiatric education at URMC.
Students are immersed in that style of learning throughout their four years. They are supported in their development though a program to bolster resiliency, which is led by Tressa Newton, director of Student Enrichment, Career Counseling and Wellness Programs.
“We’re trying to increase the dialogue and making sure we’re accessible,” said Newton. “Our students want to be connected. They want to know us.”
She said many first-year students visit frequently, possibly drawn by the chance to play with the therapy dog and enjoy a snack.
“That speaks to Rochester,” Newton said. “We really want you here. You’re ours. We want to take care of you, we want to help you. And I think that’s part of that relates all the way back to the bio psychosocial model. We’re here for all aspects of whatever is going on in your life; let’s help you get to your goal.”
Self-care is prominent in the curriculum of the Education and Human Services Department at Monroe Community College.
“We talk about self-care practices,” said Elizabeth Mandly, assistant professor in the department and coordinator of the addiction counseling program. “It’s hard work helping people and so you have to do something to sustain and replenish yourself … What I say to them most often is that you are the instrument of help. So you have to be the best instrument you can be.”
Mandly has been teaching for eight years but has been in the human services field for much longer. She said focus on self-care and counselor wellness has increased over the years. Some of it stems from ways to sustain the workforce.
She said that if students coming into the MCC program don’t grasp the importance of tending to their own emotional needs, they leave with the realization.
The benefit is twofold.
“There’s understanding how to stay in the field that you’re passionate about, so there’s career sustainability,” Mandly said. “I think that understanding more about yourself can make you a more effective counselor. It gives you the tools that you can use with your clients who need to think about their own wellness as they pursue their mental health or their recovery.”
Patti Singer is a freelance writer in Rochester. Contact her at [email protected]