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Nephrology Nursing Journal May-June 2021 Vol. 48, No. 3 261

Nephrology Nursing Journal May-June 2021 Vol. 48, No. 3 261

Nephrology Nursing Journal May-June 2021 Vol. 48, No. 3 261

We live in a tumultuous time with many competing demands, and COVID-19 has only heightened our emo- tional, physical, and financial stress. These immense stres- sors affect our emotional and behavioral responses, mak- ing it difficult to always ‘be our best self.’ As health care professionals who provide a life-sustaining therapy in the form of kidney replacement therapy (KRT) like hemodial- ysis, we like to think of ourselves as just that – ‘profession- al.’ However, we can all get pulled in many directions whether it be at home or at work, and authentically, we do not always show up as the best version of our self. At the heart of being able to identify patterns of behavior that ‘creep in’ or ‘explode out’ and are not aligned to being our best self is the concept of learning emotional intelligence. Researchers, psychologists, and sociologists have described the emotionally intelligent person as having the insight into one’s behavior and then being able to manage that behav- ior. Emotional intelligence is needed now more than ever in the clinical setting of nephrology. This article provides an overview of the concept of emotional intelligence, a brief overview of the brain science behind behavioral pat- terns, and why it is valuable to enhance skills in emotional intelligence. Practical tools will be highlighted for nephrol- ogy nurses to optimize bringing their best self to work dur- ing these challenging times.

Copyright 2021 American Nephrology Nurses Association. Lawrence, J.A., & Parkes, R. (2021). How do you be your best

self in a vexatious world? Nephrology Nursing Journal, 48(3), 261-265. https://doi.org/10.37526/1526-744X. 2021.48.3.261

How do we survive, let alone thrive, in health care? The complexity of providing care to patients and families on chronic kidney replacement therapy can be taxing for the most expert and resilient of health care professionals. Further complicating this by a global pandemic can pro- duce feelings of frustration and anxiety that can reduce our effectiveness in the everyday, yet we are compelled to prac- tice competently and professionally. Working on oneself is key to optimizing one’s resilience during volatile, uncertain, complex, and ambiguous times. This article introduces the concept of emotional intelligence and provides a brief review of the brain science behind behavioral patterns, highlighting how all health care professionals can engage in self-work to bring our best selves to the every day.

Key Words: Emotional intelligence, self-management, insight, managing emotions, brain science, hemodialysis, stress.

How Do You Be Your Best Self in a Vexatious World? Julie Ann Lawrence, MScN, RN(EC), CNeph(C), and Rebecca Parkes, BA

1.1 contact hours

N e P H r o l o g y N u r s I N g J o u r N a l

Health care is a high-stress, high-change environment on any given day. When you add in COVID 19 and the implications of a worldwide pandemic, it is no surprise that the stress on care providers has increased exponentially. COVID-19 has thrust us all into uncharted territory. It has stressed an already stressed workplace. For health care pro- fessionals, burnout is compounded, the risk of vicarious trauma has been magnified, and the additional burden of

Julie Ann Lawrence, MScN, RN(EC), CNeph(C), is a Nurse Practitioner, Kidney Care Centre, London Health Sciences Centre, London, Ontario, Canada. Rebecca Parkes, BA, is a Consultant, Life Coach, St. Thomas, Ontario, Canada. Acknowledgment: As the primary author, I would like to acknowledge the foundational work of Lianne Collins and Rebecca Parkes in develop- ing an Emotional Intelligence Strategy and experiential Emotional Intelligence workshop in 2018 for staff and leaders at London Health Sciences Centre. Statement of Disclosure: The authors reported no actual or potential conflict of interest in relation to this nursing continuing professional development (NCPD) activity.

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Nephrology Nursing Journal May-June 2021 Vol. 48, No. 3262

How Do You Be Your Best Self in a Vexatious World?

exposing ourselves to a life-threatening virus and potential- ly taking it home to our family has become a new tipping point.

The current health care arena can be described as a VUCA world: Volatile, Uncertain, Complex and Ambiguous. The concept of VUCA was first used by the U.S. Army War College in the 1980s to describe the chang- ing landscape after the Cold War (U.S. Army Heritage and Education Center, 2018). Who would have guessed at that time the terminology would move from the combat field into the boardroom and eventually health care (Gallo, 2010)? Volatile is unstable, unpredictable, and explosive. Uncertainty refers to lack of concrete trends or patterns that informs or allows prediction for the future. Complexity refers to interconnected parts that become more dynamic and/or increasingly unknown, thereby lim- iting past predictive outcomes as a framework for new changes. Ambiguity is about the present and turbid clarity for the future. The environment is unfamiliar and foreign to current expertise. Now let’s look at the VUCA world in the context of clinical environment. • Volatile: The vector of transmission and confounding

factors seemed to change daily in terms of what experts viewed as the means of infectability. At the beginning of the pandemic, opinion and evidence, along with instant messaging that was (or was not) evidence-based, brought about a rapidly changing and unpredictable clinical environment. Vectors of transmission (droplet, aerosol, fomite-mediated) were all documented at one point as being contributory.

• Uncertain: Look at how difficult it was to predict in the early stages how COVID-19 would evolve or unfold. As such, it was difficult to use past issues or learnings to predict future outcomes. For example, did you experi- ence arriving to your shift to have a patient assignment, then a cardiopulmonary arrest situation arises, and you are pulled to jump in and start resuscitation efforts, yet the process is to don personal protective equipment (PPE) according to procedure (as precious minutes pass by) until you are able to begin invasive or aggressive life sustaining measures? Couple this with the ongoing threat of inadequate PPE, and you can see and feel the uncertainty.

• Complex: What about the cohorting of patients to an area of isolation? How did your unit accomplish this? In hemodialysis units with close congregation of patients, were patients shuffled on entry to the unit if presenting with symptoms? Were patients in long-term care or residential/group living cohorted? Decisions and strategizing regarding the transportation of large groups, dialyzing in close quarters while also attending to your local health department standards, and mesh- ing them with your own facility standards makes navi- gating this daily quite a complex environment. The downstream implication is the minute-to-minute shift- ing of patient assignments and the chair position within the hemodialysis unit.

• Ambiguous: Recall the initial confusion regarding early information of vector transmission, availability of PPE, COVID-19 testing/treatment options, and/or determination of best practices that changed numerous times in a day. This challenged nurses, charge nurses, and nephrology teams to stay current to the realities of risk in a period that was turbid in clarity.

You can no doubt identify the impact this VUCA world

has had on your ability to bring the best version of yourself to each and every day. How do you manage when you are pulled in many directions at work and you have to spin on a dime? What is your reaction or ability to stay calm and optimistic when you show up for your shift, knowing you might be short-staffed or on a shift with a colleague who is constantly complaining?

When you feel exhausted, depleted, and unappreciat- ed, what is your mindset when you are driving home and someone pulls out in front of your car? Do you ever find yourself feeling sharp and impatient with the ones you love, only to climb into bed at night realizing in hindsight that you over-reacted in a number of situations? During the pandemic, have you noticed your feelings of anxiety and fear growing?

How do we begin to cope in this ever-changing land- scape and find a place of homeostasis, let alone bring our best self to each and every day? What we know is that because we are living in a VUCA world, it is unlikely we will go back to a slower, predictable, easier pace. Therefore, we are challenged to respond and adapt to this new normal and the next new normal each as ‘new nor- mal’ evolves and arrives.

We are moving through a world of problems that demand speed, deep thinking, and tolerance of unknowns to solve to a new reality that requires patience, sense-mak- ing, and an engagement despite uncertainty and ambiguity. If we are unable to control the world at large, the only piece we can control or manage is our inner world. Although not a quick fix, the good news is, it is possible.

The key to thriving versus barely surviving is found in the work we do on ourselves. If we build and enhance our self-awareness and self-management skills, we are more likely to be confident, an effective communicator, and resilient (Mayer et al., 2004). These skills are often consid- ered part of the cluster of skills known as emotional intelli- gence. A review of the literature searching emotional intel- ligence and nursing revealed a paucity of information with- in the context of providing direct patient care. There are certainly more numerous sources and studies found in the context of nursing leadership. Prezerakos (2018) reviewed qualitative and quantitative studies concerning the emo- tional intelligence of nurse leaders and the evidence-based composition of their results on the impact of job satisfac- tion and leadership effectiveness. The literature is rich in emotional intelligence as a key factor in optimizing or cor- relating with transformational leadership (nursing and non- nursing organizational outcomes). Notably, a smaller num-

 

 

Nephrology Nursing Journal May-June 2021 Vol. 48, No. 3 263

ber of articles referenced the emotional impact of kidney patients because of providers’ abilities to show empathy and communication linked to emotional intelligence as an important area for further study in the nephrologist popu- lation (O’Hare et al., 2018), but these did not focus on the development of emotional intelligence in this context. Hence, there is a paucity of literature related to the nephrology nurse and emotional intelligence. One article discussed the impact of emotional intelligence on educa- tion programs in hemodialysis. In this article, it was noted that renal nurses had improvement in quality of life when emotional intelligence was included in their education pro- gram for learning the skill of hemodialysis (Shahnavazi et al., 2019). As such, it is valuable to have discussions on how emotional intelligence can enhance our own personal development, while as nurses in nephrology, we can also increase our professional development.

Overcoming limitations of your beliefs so you are calm and composed versus fearful and anxious, and bouncing back more easily from unexpected changes or challenging situations are some of the benefits of developing our emo- tional intelligence. Emotional intelligence is needed now more than ever in the clinical setting of nephrology because there has been evidence of employees with higher emotional intelligence having high job satisfaction and higher organizational commitment. A meta-analysis of emotional intelligence and work attitudes by Miao and col- leagues (2017) found that emotional intelligence improved job satisfaction by reducing negative feelings, increasing positive feelings, and/or improving job performance. Hence, particularly during the VUCA world of a pandem- ic, why wouldn’t we want to cultivate these performance and work rewards?

Emotional Intelligence – What Is It Really?

There are many interpretations, definitions, and myths about emotional intelligence. Some people think having emotional intelligence is about being nice or giving full reign to your feelings or anything that is ‘warm fuzzy, touchy feely.’ It is often referred to as a ‘soft skill.’ Some people don’t even consider developing a new skill set because they erroneously think, “This is just the way I am!” Emotional intelligence is well researched and is a specific skill set that is the key differentiator between being average or not coping with life, and being a star performer and more resilient (McClelland, 1998).

One pioneer who studies the concept of emotional intelligence is Dan Goleman. Although there are many definitions of emotional intelligence, on a basic level, his working definition is simple, practical, and easy to under- stand, and can be applied to your personal and profession- al life. Emotional intelligence is the ability to recognize and understand your emotions and the emotions of others, and to use this awareness to effectively manage yourself and your relationship with others (Goleman, 2004).

The concept of emotional intelligence emphasizes two components. The first is having awareness, insight, and

understanding of one’s own emotions (and the emotions of others). If you understand the emotional background and foreground, this is the basis that leads to the second process, which is moving toward understanding one’s responses and behaviors. Therefore, the patterns of behav- ior can be managed in a more adaptive manner. By no means does this imply the making of an emotional intelli- gent person is two-dimensional and linear process. Deeply embedded in gaining awareness and insight into one’s emotions requires that you understand how each emotion was borne, harvested, manifested, reinforced, or dissuaded in our formative years.

During the pandemic, there are feelings of anxiety, fear, and uncertainty. These emotions may stem from feeling a lack of control in the current health environment. Further, one’s safety as a health care provider is essentially reliable upon the public maintaining their safety through social dis- tancing and other techniques that reduce the risk of viral transmission. For health care providers, nurses in particu- lar, who are caring for those with illnesses, the current health care arena can be more anxiety-provoking when entering work every day. Having the ability to recognize and manage one’s emotions, while also managing your response to the emotions of others, is key to an adaptive, calm, and constructive work environment, and ultimately, to enhancing team effectiveness. Moreover, developing this skill increases the likelihood that your resilience and homeostasis (in and outside the work environment) will optimize mental health. Who doesn’t want to optimize emotional balance and mental health in a vexatious period of health delivery history? To understand the concepts of emotional intelligence, one must first understand how the brain works. This is a starting point to understanding behavior patterns and emotional responses.

Brain Science

What is fascinating is that the recent neuroscience research is exploding, and it supports our understanding of emotional intelligence. Everything we take in through our senses passes through our amygdala, which is walnut-sized, and in the center of the emotional center of the brain. Everything passes through the amygdala before it gets to the prefrontal cortex, the thinking part of the brain. This is the part of your brain responsible for problem-solving, decision-making, and rational thought, which is why it is often referred to as the executive center of the brain.

The amygdala is hard-wired for survival. Nurses are familiar with the concepts of fight, flight, or freeze. These built-in reflex actions are why we have survived as a species. When the amygdala gets activated, it takes over. This neural hub does not differentiate between emotional and physical threat. Humans continue to be on the earth because we survived despite threats of physical harm, part- ly due to responses of fight, flight, or freeze. Practically speaking, these raw behaviors can be sourced to emotional threats as well. When triggered emotionally, does your amygdala knee-jerk to flight (withdraw, make excuses for

 

 

Nephrology Nursing Journal May-June 2021 Vol. 48, No. 3264

How Do You Be Your Best Self in a Vexatious World?

not attending highly emotionally charged meetings or par- ticipating in contentious projects), fight (move into a per- son’s space to confront, insist upon your way of doing things, using power and control over others), or freeze (making oneself small and unseen, quiet and passive in actions, fence-sitting in opinions)? Situations in which these responses (one or all) can be apparent in patterns of behav- ior when we are triggered emotionally. In this manner, we can refer to these reflexive responses as being taken “hostage” by our emotions because there is very little (if any) thinking involved. Rather, they are a very limbic, raw behavior.

Thankfully, we do not operate in the everyday being held hostage to our amygdala. The brain has multiple cog- nitive centers that contravene and bring about rationale thinking and behavior. One cognitive center is the pre- frontal cortex, or the thinking area of the brain. This pro- vides the day-to-day functioning in a non-threatening envi- ronment. However, bring about a stressful or a highly charged situation, and the prefrontal cortex goes offline as the amygdala and its limbic responses take over, and in essence, we can become hijacked toward emotional responses that we would otherwise not exhibit.

Have you ever found yourself in a situation at work or with a family member when you felt upset or felt strongly about what you had to say because you believed you were right? Then 30 minutes later, an hour later, two hours later when you have calmed down, you say, “Oh my gosh, what was I thinking?” From a brain science perspective, you weren’t thinking. Your amygdala took over and prevented you from accessing that thinking, rational part of your brain. Think of it as being triggered, flooded, or hijacked.

It is important to understand that we do not just have a hijacked moment when we are upset or angry. Have you ever found yourself in a meeting or out with friends for din- ner, when someone makes a comment that seems ridicu- lous? You may be sitting quietly and outwardly smiling, but inwardly thinking self-righteously, “I can’t believe she actu- ally just said that!”? In these moments, we are often trig- gered by patterns of behavior or belief. Perhaps more sub- tle than an angry outburst, these inward thoughts/judg- ments demonstrate an example of still not bringing our best selves in those moments, either. The patterns are “automatic” and seem to be driving us.

Take a moment to think of your own example when you may have been hijacked or you have responded in a manner that was not your best self, only to later feel regret and ask yourself, “What was I thinking?” or “Why did I do that?” Perhaps you acted out in an untoward manner (e.g., responded to a patient tersely/unprofessionally, became weepy/angry during a meeting, responded in text or email from a self-righteous stance, or vented loudly for the sake of hearing your own voice in the lunch room). In these examples, something triggered you, which opened the flood gates for your amygdala to spill messy, emotional responses that are not consistent with what your prefrontal cortex would view as professional.

From a brain science perspective, it is known that emo- tions are contagious (Hatfield, 1994). In particular, emo- tions seen as threatening (anger, hostility, hatred, defen- siveness, selfishness, jealousy, sarcasm, fear, or anxiety) can evoke negative responses in those working with a person exhibiting these. Becoming aware of one’s own triggers is a key component of awareness because then one can alter their own responses.

Often people will wonder how to bypass this emotional part of the brain. The answer is simple – you can’t. The goal of cultivating your emotional intelligence and becom- ing more effective is to understand what triggers you so it can be managed. Effective practice and contribution to a health care team is about staying connected to what is a trigger for ineffective and maladaptive behavior. More – over, keeping the neuropathways open between our pre- frontal cortex, and the amygdala is key in the development of skill in emotional intelligence. In those moments, we can bring all parts of our brain together to more effectively respond to a problem or difficult situation.

To change a previous pattern is to take what is unconscious and automatic and make it conscious. It is only in this place you can choose something different for yourself. Again, the good news is you can rewire your brain. You can create a new “automatic” that is healthy, constructive, and different from your current reactions and do so purposefully.

Rewiring Your Brain

Where attention goes, neural firing flows, and neural connection grows. —Daniel J. Siegel (Siegel, 2010)

Are any of these statements familiar to you? “Oh this is

the way I am,” “I can’t change,” or “Everyone knows I’m just loud, but I don’t really mean it.” Research shows you can change with practice (Boyatzis, 2006). Here’s how starting on the path of emotional intelligence development can lead to change.

Developing skill in emotional intelligence is about peel- ing away the layers of “that’s just me” to move to a place of knowing ourselves, and replacing the ineffective behav- iors and self-limiting beliefs with empowered ones. Think of it as an archeological dig. It is uncovering the condition- ing of your brain and amygdala through awareness. It does not matter if you grew up in a loving, caring family with both parents present or if you grew up with physical abuse or alcoholism. We all have an amygdala that has been con- ditioned by our early life experience. It is the result of neu- ral networks being formed and reinforced through repeat- ed use to the point where activation became automatic. We learned most of our primal and survival patterns of behav- ior when we were very young and reacting to what we per- ceived as threatening. This does not have to equate to physical threat, but also how, as young children, we tried to stay safe, loved, and met with approval. What we learned in our formative years impacts us for the rest of our lives – in our workplaces, homes, and all our interactions

 

 

Nephrology Nursing Journal May-June 2021 Vol. 48, No. 3 265

in the world. Truly, to have entered into the nursing profes- sion, much of what we learned was positive and served us well to complete school and gain employment. Yet some behaviors may be limiting our potential for success. However, we can change what we learned in the past and learn new and better ways of interacting with the world around us. We can literally rewire our brains for success.

Taking Stock

The quest for cultivating emotional intelligence begins with self and the deep dive within. Awareness is the first step to change. Each day for the next week, watch and observe yourself. Observe when you are triggered or feel reactive. Is there a pattern to when that happens? Is it with a certain per- son (someone you experience as bossy or in charge, some- one who is quiet and passive, or someone who is sarcastic)? Start to notice when you get reactive and notice what you do in response to that? How do you react (fight, flight, or freeze)? You do not have to change anything. Just pay atten- tion and make what might have been automatic and uncon- scious, and make it visible. What do you see?

The Conscious Leadership Group (2014) offers a tool (illustrated in their YouTube video) that can help you understand how you see the world and the manner in which you react by determining your “location” – by answering the question “Where am I?” They suggest that you envision a line – a simple black line. Do you see your- self as “above the line” – seeing things through a lens of opportunity (an optimistic outlook – open, curious, com- mitted to learning) or “below the line” – seeing things as a problem (negatively/pessimistic outlook – defensive, closed, committed to being right)? This tool can help a per- son identify where their patterns of behavior are located and then highlight behaviors the person may wish to focus on to change. For example, activities that include blame, denial, making excuses, waiting for others to act, finding fault, seeing failure, judgment with defensiveness, feeling no control, and seeing problems and obstacles are all exam- ples of actions that are “below the line” of effectiveness. As you observe your behavior in real time or reflect upon pre- vious instances when you may not have been at your best, ask yourself if your behavior was above the line or below the line? Take this awareness forward when continuing to be observant to how you operate day to day.

In Summary

In summary, we outlined the platform for understanding the concept of emotional intelligence and brain science as a foundation for understanding behavior patterns and emo- tional responses, and discussed cultivating self-awareness and emotional/cognitive resiliency with practical tools to bring your best self in these challenging times. This is partic- ularly relevant and current for the nephrology health care professional when providing care to those in need. We are relied upon to bring our best selves to work in the everyday

with the goal to provide safe and sensitive care to our clients and families to optimize their health and wellness. When caring for oneself, optimizing skill in emotional intelligence would ultimately facilitate success for the nephrology nurse to do so in a caring, yet consciously resilient manner.

References Boyatzis, R.E. (2006). An overview of intentional change from a

complexity perspective. Journal of Management Development, 25(7), 607-623. https://doi.org/10.1108/02621710610678445

Conscious Leadership Group. (2014). Locating yourself – A key to con- scious leadership [YouTube video]. https://www.youtube. com/watch?v=fLqzYDZAqCI

Gallo, A. (2010). Making your strategy work on the front line. Harvard Business Review. https://hbr.org/2010/06/making- your-strategy-work-on-t

Goleman, D. (2004). What makes a leader? Harvard Business Review, 82(1), 82-91. https://hbr.org/2004/01/what-makes-a-leader

Hatfield, E., Cacioppo, J., & Rapson, R. (1994). Emotional contagion (Studies in emotion and social interaction). Cambridge University Press.

Mayer, J.D., Salovey, P., & Caruso, D.R. (2004). Emotional intelli- gence: Theory, findings and implications, Psychological Inquiry, 15(3), 197-215. https://doi.org/10.1207/s15327965pli1503_02

McClelland, D.C. (1998). Identifying competencies with behav- ioral-event interviews. Psychological Science, 9(5), 331-340. https://doi.org/10.1111%2F1467-9280.00065

Miao, C., Humphrey, R.H., & Qian, S. (2017). A meta-analysis of emotional intelligence and work attitudes. Journal of Occupational and Organizational Psychology, 90(2), 177-202. https://doi.org/10.1111/joop.12167

O’Hare, A.M., Richards, C., Szarka, J., McFarland, LV., Showalter, W., Vig, E.K., Sudore, R.L., Crowley, S.T., Trivedi, R. & Taylor, J.S. (2018). Emotional impact of illness and care on patients with advanced kidney disease. Clinical Journal of the American Science of Nephrology, 13(7), 1022-1029. https://doi. org/10.2215/CJN.14261217

Prezerakos P.E. (2018). Nurse managers’ emotional intelligence and effective leadership: A review of the current evidence. The Open Nursing Journal, 12, 86-92. https://doi.org/10.2174/ 1874434601812010086

Shahnavazi, M., Parsa-Yekta, Z., Yekaninejad, M.S., Amaniyan, S., Griffiths, P., & Vaismoradi, M. (2019). The effect of the emo- tional intelligence education programme on quality of life in haemodialysis patients. Applied Nursing Research,.39,18-25. https://doi.org/10.1016/j.apnr.2017.10.017

Siegel, D.J. (2010). Mindsight – The new science of personal transforma- tion. Bantam Books.

U.S. Army Heritage and Education Center. (2018). Who first origi- nated the term VUCA (volatility, uncertainty, complexity and ambi- guity)? https://usawc.libanswers.com/faq/84869

Instructions for NCPD Contact Hours NNJ 2118

Nursing continuing professional development (NCPD) contact hours can be earned for completing the learning activity associated with this article. Instructions are available at

annanurse.org/library Deadline for submission: June 30, 2023

 

 

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