Self-Care in Nursing Education

Abstract

Background:

The mental health of students and faculty has become a growing issue in academia. Faculty need to provide role-modeling early in nursing programs to enhance psychological well-being for future nurses that will have lasting effects throughout their careers.

Method:

A total of 29 faculty members participated in a descriptive study investigating types of self-care goals and how they could be achieved by College of Nursing faculty during their annual performance appraisal.

Results:

Seventy-three percent of respondents reported they anticipated that achieving these self-care goals would enhance their faculty role. Further, the respondents associated achievement of self-care goals as a way to improve their faculty performance.

Conclusion:

Since every individual has a unique perspective of the world, a self-care approach that works for one person might not work for another. Self-care goals should therefore be tailored to the unique needs and perspectives of each person. [J Nurs Educ. 2024;63(6):394–398.]

The term self-care recently became more commonly associated with stressors due to the coronavirus disease 2019 (COVID-19) pandemic. Simultaneously, improving mental health of students and faculty also became a more topical issue in academia, with self-care being used to describe routine practices that alleviate stress and improve scholarly performance. Faculty are called to provide role modeling early in nursing programs to enhance the psychological well-being of future nurses that may have lasting effects throughout their careers (^{Wei et al., 2020}).

The American Association of Colleges of Nursing (AACN) (²⁰²¹) defines self-care as “the daily process of being aware of and attending to one's basic physiological and emotional needs and the foundation for physical and emotional wellness to prevent mental health, occupational, or educational burnout” (para. 1). Domain 10 of the AACN's The Essentials: Competencies for Professional Education recommends that entry- and advanced-level students demonstrate a commitment to their personal health and well-being. The World Health Organization (WHO) (²⁰²⁴) describes self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker” (para 1). Self-care also includes activities that help individuals live well and improve their physical and mental health (^{National Institute of Mental Health, 2021}). Additionally, the American Nurses Association (^{ANA, 2015}) supports self-care initiatives. The literature also supports the core principle of Dorothea Orem's self-care deficit theory (SCDT) as serving as an appropriate theoretical framework that can guide self-care goals (^{Hartweg & Metcalfe, 2022}).

This study explored the types of self-care goals recommended by College of Nursing faculty during their annual performance review. A survey was developed based on the premise of Orem's SCDT that individuals freely and deliberately undertake actions to sustain their well-being and quality of life. Orem identified the following two steps: (1) identifying and prioritizing unmet self-care needs and deficits; and (2) selecting methods of assisting the individual to overcome identified self-care deficits (^{Hartweg & Metcalfe, 2022}).

Background

Psychological distress has been reported in higher education, with students indicating it can play a role in academic performance and adjustment (^{Charlton & Wofford, 2022}). Common reported sources of student stress include taking examinations, maintaining relationships with friends, engaging in clinical practice, and presenting reports (^{Fruh et al. 2021}). Increased psychological distress among nursing students may lower their academic performance, increase attrition and cynicism, and continue into their nursing careers (^{Gold et al., 2015}). Depression, anxiety, and insomnia can affect students' mental health, performance, and success—especially among those who experience higher levels of psychological distress and have personality traits of intro-version and neuroticism—leading to poor coping strategies, adjustment disorders, and withdrawal from courses (^{Kaur et al., 2020}). However, support from the institution and faculty has been shown to help ameliorate students' experiences of distress (^{Burleson et al., 2023}). Despite the available assistance, however, educators may not be fully aware of the extent of student distress and its effects on their lives and learning. To address these issues, nursing faculty must examine program curricula and integrate self-care strategies when possible (^{Charlton & Wofford, 2022}).

Provision 5 of the Code of Ethics for Nurses (^{ANA, 2015}) offers guidance regarding self-care for all nurses, stating that “Nurses should model the same health maintenance and health promotion measures that they teach and research” (p. 19). By learning skills for work-life balance, nursing students will have more opportunities to thrive in their future careers. The rationale for the current study was that self-care is essential to promoting balance in nurses' professional and personal lives. Nurse educators therefore must first role model self-care practices in their programs to foster a healthy learning environment and enhance the psychological well-being of their students (Wei et al., 2021). However, nursing faculty have identified distress in their own role, such as demanding course loads, multiple commitments, and the need to remain up to date with current practice trends and research. Successfully balancing these expectations can be difficult (^{Hosseini et al., 2022}); therefore, identifying and adopting self-care practices is essential to support competency, job satisfaction, and retention (^{Aquino et al., 2018}). Creating a supportive, positive working environment that promotes the well-being of faculty is vital. To address self-care needs, faculty in a university nursing program created a self-care goal for their annual performance and planning session with their department chairs.

Literature Review

Orem's SCDT is a well-known theory comprising three nested nursing theories (i.e., self-care, self-care deficit, and nursing system); the theory posits that all individuals are capable of self-care (^{Isik & Fredland, 2023}). Orem's assumptions include the following:

(1) Individuals are persons-as-agents needing continuous and deliberate actions to stay functional, healthy, and alive; (2) individuals must act deliberately to implement self-care action steps to meet their own needs and others'; (3) individuals must be in continuous connection with others and their environment; (4) individuals must learn, advance, and convey their needs to others and justify their actions; and (5) individuals in structured relationships must be responsible and accountable to group members (as cited in ^{Isik & Fredland, 2023}, p. 6).

Orem views human beings as the center of her nursing theory, stressing that human-to-human relationships by necessity precede nurse-patient relationships (^{Tanaka, 2022}). This premise transfers to faculty-to-student relationships, as faculty who implement self-care will be more equipped to teach self-care principles to their students. Intentional self-care goals based on Orem's theory can help faculty prioritize and improve skills leading to better self-care practices.

Self-care management is necessary for faculty and students. In the past several years, there has been a marked increase in both the number of students seeking counseling services and the number of students with serious psychological problems (^{Nair & Otaki, 2021}). In schools of nursing in particular, several classic studies have demonstrated that students experience high levels of stress and could benefit from learning to manage stress during their academic journey (^{Green, 2019}). For the next generation of nursing students, faculty must role model the importance of self-care.

Additionally, nursing programs must incorporate courses that promote student self-care strategies. Clark and Pelicci (²⁰¹¹) described an ideal nursing program in curricula that specifically addressed stress management and worklife balance as faculty were called to help students who encounter stressful circumstances. Fruh et al. (²⁰²¹) explored well-being variables, such as hope, healthy weight control behaviors, body satisfaction, sleep, depression, and anxiety, that were vital for predicting self-reported stress among nursing students. The study also investigated how stress in nursing schools could continue into the work environment. Green (²⁰¹⁹) detailed a self-care pilot project emphasizing the importance of self-care for prelicensure nursing students by teaching healthy eating, physical exercise, the value of sleep, and the use of positive affirmations and aromatherapy in a cohort of accelerated nursing students during a 5-week period.

Method

Research questions that explored types of self-care goals were developed by using dimensions of the wellness model from the United States Department of Health and Human Services (²⁰²³) that interconnects mind, body, and self-health. The dimensions included were physical, mental and emotional, spiritual, financial, social, and environmental. Survey questions used the core principles of Orem's model to link the theoretical framework.

Orem's universal self-care requisites include: (1) maintenance of sufficient intake of air, food, and water; (2) provision of care associated with the elimination process; (3) balance between activities and rest, as well as between solitude and social interaction; (4) prevention of hazards to human life and well-being; and (5) promotion of human functioning.

The research team and two nurse researchers reviewed the survey for consistency and clarity. Approval was received, and consent disclosure was obtained from the university's Institutional Review Board to survey current faculty. The initial survey was sent to 64 faculty members at a public institution in the southern U.S. in an urban setting. Faculty comprised those in the Bachelor of Science in Nursing (BSN), Doctor of Nursing Practice (DNP), and Doctor of Philosophy (PhD) programs. Faculty were asked to complete an anonymous survey during a 2-week period; a total of 29 faculty completed the survey.

Results

Both quantitative and qualitative analysis yielded the results of this descriptive study. The results from this initial pilot study may encourage future research on self-care needs and the development of self-care support programs, strategies, practices, and interventions at both the college and university level (Table 1). Faculty ranked the top three categories describing their self-care goals. Physical (n = 23) goals were ranked highest, followed by mental and emotional (n = 22), spiritual (n = 15), and social (n = 5) goals.

Table 1
Faculty Self-Care Results

Question	n (%)
How would you categorize your self-care goals?
Physical	23
Mental and emotional	22
Spiritual	15
Financial	2
Social	5
Environmental	3
What tools will you use to track your progress in meeting your goals? (n = 36)
Paper or journal	13 (36.1)
Activity tracker	13 (36.1)
Mobile or computer applications	7 (19.4)
Online resources or other	3 (8.3)
Did you choose a specific metric to use for evaluating your goals? (n = 26)
Yes	19 (73.0)
No	7 (26.9)
Have you set these goals for yourself before? (n = 26)
Yes	16 (61.5)
No, these are new goals	9 (24.6)
Maybe	1 (3.8)
Was choosing self-care goals simple, neutral, or difficult? (n = 26)
Simple	17 (65.4)
Neutral	4 (19.2)
Difficult	5 (15.4)
Do you anticipate that achieving these self-care goals will enhance your faculty role? (n = 26)
Yes	19 (73.0)
No	3 (11.5)
Not sure	4 (15.4)
Would you have set this goal if it wasn't required for your Annual Performance Review? (n = 26)
Yes	18 (69.2)
No	5 (19.2)
Not sure	3 (11.5)

Question	n (%)
Do you consider your self-care goals for 2023 contributing to long-term goals, daily goals, or both daily and long-term goals? (n = 26)
Long-term only	4 (15.4)
Daily only	0 (0)
Both	22 (84.6)

Tools Used to Track Progress in Meeting Goals

Based on the survey results of the participants (n = 36), most of the faculty mentioned using various tools to track their goals. Almost three-fourths (72.2%) of the respondents noted they used a tool to track their goals, either manually (e.g., paper or journal) or electronically (e.g., Fitbit, Garmin^®, or Apple^® Watch activity tracker). Some of the participants (19.4%) used mobile or computer apps (e.g., MyFitnessPal^™, Calm, I AM Fitness, Pacer, and Samsung Health). The remaining participants (8.3%) mentioned using online resources and other tools, such as spreadsheets and online Bible studies.

Metrics Used to Evaluate Goals

To evaluate the effectiveness of their goals, participants were asked whether they chose a specific metric to evaluate their goal. Nineteen (73.1%) participants indicated using a specific metric, and seven (26.9%) participants did not indicate a specific metric. Metrics used by the participants included exercising 1 hour daily, reading the Bible daily, attending therapy once a month, meeting with colleagues for lunch once a month, and reading a book monthly. Overall, the majority of responses focused on exercising goals. Participants were asked whether they had previously set these goals, with 61.5% (n = 16) indicating yes, 24.6% (n = 9) answering no, and 3.8% (n = 1) indicating maybe.

Choosing Self-Care Goals

Participants were asked whether setting self-care goals was simple, neutral, or difficult; 65.4% (n = 17) reported setting goals was simple, 19.2% (n = 5) were neutral about setting goals, and 15.3% (n = 4) reported setting goals was difficult. Participants were asked to describe why goal setting was simple or difficult. One participant noted, “I am not sure what my self-care needs are.” Some of the difficulties reported were integrating self-care with other responsibilities; one participant noted that it was “hard for me to think about caring for myself.” Of the participants who found choosing self-care goals to be simple, the most common theme was that setting self-care goals was “needed.” One respondent said, “I knew I had to do it for my health and well-being.” Although participants acknowledged that setting goals was important, they mentioned the importance of follow-through, motivation, and commitment. A few participants indicated they had already prioritized physical health, noting that “taking care of myself is important to me.” For some participants, setting goals in their annual review coincided with their routine of setting New Year's resolutions.

Effects of Achieving Self-Care Goals on Faculty Role

Almost three fourths (73%) of the respondents reported achieving self-care goals would enhance their role, with 17 (58%) participants providing more detailed responses. One participant said, “It will help me function and think clearer.” Connections also were made between balance and productivity. One participant noted, “More balance in my life leads to great productivity. Meeting personal goalsdrives me to succeed in all areas of my life.” Improved communication, more positive relationships, and better role modeling for students and peers also were noted as benefits of meeting self-care goals. In considering the stressors of a faculty role, participants noted that benefits included stress control, mental clarity and improved focus, and increased energy. One participant said, “A physical goal will help me to de-stress and provide endurance for those long physical clinical instruction days.” Although self-care goals were set in the participants' professional faculty role, the effects of achieving the goals also were anticipated to affect their personal roles, as well as improving their physical, emotional, and mental health.

Influence of Goal Setting on Annual Performance Reviews and Self-Care

Finally, participants were asked whether they would have set self-care goals if it was not required for their annual performance review. Almost three quarters (69.2%) of the respondents reported they still would have set self-care goals even if they were not required for their annual performance review. Participants also were asked whether their self-care goals for 2023 would contribute to long-term goals, daily goals, or both daily and long-term goals. The majority (84.6%) of the respondents reported their self-care goals were both daily and long-term (i.e., year-long).

Limitations

Results were limited in their generalizability as this small, single-site pilot study was conducted at a single public institution in metropolitan urban setting. The annual review process required faculty to set an annual wellness goal. However, requiring this goal may be a limitation. Including a self-care goal as part of faculty's performance planning was a new process for faculty and administrators, and faculty's self-care was documented as either being met or not being met. No demographics were obtained describing the unique needs of each faculty member.

Implications

Further inquiry is needed to discern whether the requirement of goal setting motivated faculty to meet self-care goals. Additional research is needed to identify the effectiveness of setting self-care goals to improve the health of faculty. The researchers plan to measure outcomes at the end of the year. The importance of self-care is not limited to the nursing profession. Therefore, other academic institutions and professions can use the survey and goal setting process.

Conclusion

Mental well-being of students and faculty has become a growing issue in academia. Individuals have a unique view of the world; therefore, a self-care approach that works for one person might not work for another person. Self-care goals should be tailored to the individual's unique needs and perspective. Nursing faculty associated achievement of self-care goals with improved faculty performance. An established action plan is important to remedy the effects of physical, emotional, and environmental threats on teaching effectiveness (^{Onubogu, 2021}). Thus, incorporating self-care in academic settings represents the first step in caring for those who will educate the next generation of nurses.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

Aquino, E., Lee, Y.-M., Spawn, N., & Bishop-Royse, J. (2018). The impact of burnout on doctorate nursing faculty's intent to leave their academic position:Adescriptive survey research design. Nurse Education Today, 69, 35–40. 10.1016/j.nedt.2018.06.027 PMID: 30007145

Burleson, S., Thomas, L., & DeBoor, S. (2023). Effective interventions for nursing student burnout:Ascoping review. Nurse Educator, 48(3), E85–E89. 10.1097/NNE.0000000000001348 PMID: 36729853

Charlton, A. C., & Wofford, L. G. (2022). Maladaptive coping behaviors in pre-licensure nursing students: An integrative review. Journal of Professional Nursing, 39, 156–164. 10.1016/j.profnurs.2022.01.011 PMID: 35272823

Clark, C. S., & Pelicci, G. (2011). An integral nursing education:Astress management and life balance course. International Journal for Human Caring, 15(1), 13–22. 10.20467/1091-5710.15.1.13

Fruh, S. M., Taylor, S. E., Graves, R. J., Hayes, K., McDermott, R., Hauff, C., Williams, S. G., Sittig, S., Campbell, M., Hudson, G., Hall, H., Melnyk, B. M., & Barinas, J. L. (2021). Relationships among hope, body satisfaction, wellness habits, and stress in nursing students. Journal of Professional Nursing, 37(3), 640–647. 10.1016/j.profnurs.2021.01.009 PMID: 34016325

Gold, J. A., Johnson, B., Leydon, G., Rohrbaugh, R. M., & Wilkins, K. M. (2015). Mental health self-care in medical students:Acomprehensive look at help-seeking. Academic Psychiatry, 39(1), 37–46. 10.1007/s40596-014-0202-z PMID: 25082721

Green, C. (2019). Teaching accelerated nursing students' self-care:Apilot project. Nursing Open, 7(1), 225–234. 10.1002/nop2.384 PMID: 31871706

Hartweg, D. L., & Metcalfe, S. A. (2022). Orem's self-care deficit nursing theory: Relevance and need for refinement. Nursing Science Quarterly, 35(1), 70–76. 10.1177/08943184211051369 PMID: 34939484

Hosseini, M., Soltanian, M., Torabizadeh, C., & Shirazi, Z. H. (2022). Prevalence of burnout and related factors in nursing faculty members:Asystematic review. Journal of Educational Evaluation for Health Professions, 19, 16. 10.3352/jeehp.2022.19.16 PMID: 35843600

Isik, E., & Fredland, N. M. (2023). Orem's self-care deficit nursing theory to improve children's self-care: An integrative review. The Journal of School Nursing, 39(1),6– 17. 10.1177/10598405211050062 PMID: 34636684

Kaur, G., Chernomas, W. M., & Scanlan, J. M. (2020). Nursing students' perceptions of and experiences coping with stress in clinical practice. International Journal of Nursing Education Scholarship, 17(1),1– 11. 10.1515/ijnes-2020-0005 PMID: 32804678

Nair, B., & Otaki, F. (2021). Promoting university students' mental health:Asystematic literature review introducing the 4M-Model of Individual-Level Interventions. Frontiers in Public Health, 9, 699030. 10.3389/fpubh.2021.699030 PMID: 34249852

National Institute of Mental Health. (2021). Caring for your mental health. https://www.nimh.nih.gov/health/topics/caring-for-your-mental-health

Onubogu, U. D. (2021). Strategies for promoting minority faculty self-care and support. Nurse Educator, 46(5), 330–330. 10.1097/NNE.0000000000001035 PMID: 34054067

Tanaka, M. (2022). Orem's nursing self-care deficit theory:Atheoretical analysis focusing on its philosophical and sociological foundation. Nursing Forum, 57(3), 480–485. 10.1111/nuf.12696 PMID: 35037258

U.S. Department of Health and Human Services(2023). Cultivating wellness:8dimensions of staff well-being. Head Start: Early Childhood Learning & Knowledge Center(ECLKC). https://eclkc.ohs.acf.hhs.gov/publication/cultivating-wellness-8-dimensions-staff-well-being

Wei, H., Kifner, H., Dawes, M. E., Wei, T. L., & Boyd, J. M. (2020). Self-care strategies to combat burnout among pediatric critical care nurses and physicians. Critical Care Nurse, 40(2), 44–53. 10.4037/ccn2020621 PMID: 32236429

World Health Organization. (2024). Self-care interventions for health. https://www.who.int/health-topics/self-care#tab=tab_