Rolling Hill nursing

A NEw tool for nurses to prevent burnout - interview included
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28

April, 2020

I recently had the pleasure of (virtually) meeting Dr. Christian Heim PhD, BMed(Hons), FRANZCP and his technique to PREVENT vicarious trauma, compassion fatigue, and burnout. Dr. Heim is a renowned and accomplished Australian clinical psychiatrist (and music professor) that focuses on preventative mental health.

Obviously, when I heard about his blog, I instantly checked it out, and there is so much amazing content for how to achieve optimum mental health. What gets me the most excited, however, is his new technique targeted specifically to healthcare providers and nurses. 

I love the idea of preventative mental health. 

Health care is currently undergoing a huge evolution to promote preventative care. Trying to prevent lifestyle based diseases like coronary artery disease, diabetes, and certain cancers, before they develop. I often tell my patients that it’s a lot easier to prevent a problem than trying to treat it once it’s out of control. 

As nurses, this is part of our training and a huge part of what we try to educate our patients on. It only makes sense to apply this preventative care to mental health – something that too frequently gets overlooked. 

As the nursing profession, we need to start prioritizing the needs of nurses, especially when it comes to our mental health. Too many nurses are feeling burnt out, losing hope, and leaving the profession all together. This is not good for patients, nor is it good for nurses! It’s also not good for our coworkers and can lead to the old problem of nurses eating their young – but that’s a discussion for another time. 

Dr. Heim has developed this technique that he calls WASH your WEB. This is an acronym and a description. He basically describes it as a technique to “washout the cobwebs” in your mind. 

You can find more information at Dr. Heim’s website:

A Psychological Tool to Help Prevent Vicarious Trauma (burnout): WASH your WEB

WASH your WEB: An Easy to Understand Guide

WASH your WEB: Rationale and Evidence

Watch the videos here and for more information check out the supplementary articles! They are short and give a great overview of the process.

I won’t go too in depth describing the process of WASH your WEB, because honestly, no one could explain it better than Dr. Heim himself! I will do a brief overview of how it works and my thoughts on it!.

Make sure to read to the end for an interview with Dr. Heim. 

WASH your WEB is actually an acronym for a process of steps that is supposed to be utilized before/during your shift (WASH) and then after your shift is done (WEB). 

Just prior to your shift and throughout your day use the WASH technique to help keep yourself focused and able to provide compassionate patient care.

WALL off empathy

ANTICIPATE strong emotions

SHELVE strong emotions (to deal with them later)

HOLD HOPE for HELPING compassionately

After your shift, but before you settle down and move on with other parts of your life, use the WEB technique to process and move forward from your crazy (and stressful) shift.

WALK through the day’s events in your mind

EXPRESS your shelved emotions

BILATERAL stimulation technique

Again, for full descriptions of each step, refer to Dr. Heim’s literature. It’s all a VERY quick read and super interesting. Also, watch the videos for a quick run down.

The WEB video also includes 40 different emotions to give you a reference to help identify some of those trickier feelings. 

Dr. Heim describes that the two main takeaways from the WASH your WEB technique should be:

Act with COMPASSION instead of EMPATHY

He details that empathy is feeling with someone whereas compassion is feeling for someone. The two actually activate different parts of the brain and according to Dr. Heim’s research empathy can actually lead to burn out. 

Throughout my career I always thought that empathy was the ultimate way to promote patient care. Honestly, because of Dr. Heim’s discussion, it makes total sense that compassion is really what we should strive for instead. 

If nurses and healthcare workers are constantly putting ourselves in the shoes of our patients going through trauma, cancer, surgery, catastrophe that’s going to weigh us down real quick. 

We see these horrible scenarios multiple times a shift. We have to protect ourselves and our mental health from being inundated with this vicarious trauma. 

Dr. Heim discusses many well-documented issues that can be caused by vicarious trauma including substance abuse, depression and anxiety, and difficulty sleeping. He also brings up that the DSM-V specifically lists healthcare workers who are constantly dealing with trauma as one of the criterion for post-traumatic stress disorder (PTSD). If difficulty sleeping is something you already deal with, read this post about quieting your mind to fall asleep.

While doing more research on the benefits of acting with compassion over empathy I found this study that found that while patients preferred both compassion and empathy over sympathy, they actually ranked compassion over empathy for how they preferred to be treated by nurses.

Dr. Heim developed incorporated the technique to wall off empathy to promote compassion instead. I love his idea of mentally visualizing a literal wall or a silver shield to protect our psyche.

In between patients we can anticipate strong emotions that we might encounter so that we can be better prepared and fortified against them. 

During the WASH phase, the last step is super important. We HOLD HOPE that we are acting compassionately and helping the patient. 

In nursing school, we are frequently warned not to provide patients with false hope. It’s true, because sometime’s (too often) our patients don’t get better. 

We are holding hope that the compassion we are giving to our patient is actively helping them – whether they get better or not. Dr. Heim recommends using a positive mantra that you silently tell yourself to validate that you truly are helping.

Read his list of affirmations and also refer to my previous post with over 20 positive personal mantras.

 

The second takeaway that Dr. Heim emphasizes is:

SUPPRESS strong emotions, don’t REPRESS

He describes repression as an avoidance technique which neither benefits you nor does it actually help process these strong emotions. Suppressing the emotions helps you temporarily shelve these emotions to be dealt with later

I really like this idea of having a mental shelf in your mind. During your shift when a strong emotion arises, instead of letting it affect you and distract you, you simply identify the emotion and then place it on the shelf. 

Suppression is a mature defence mechanism so that we can continue working and performing the tasks that our job requires. This is different from repression because instead of locking the emotion away and pretending it doesn’t exist, we are putting it on that shelf.

After the shift is when the WEB step happens and this is when we process those previously shelved emotions.

Dr. Heim recommends to do this pretty soon after your shift before you start moving on with the rest of your life. Personally, I like to do this in my car before I start driving home (especially if it has been a particularly difficult day). 

Otherwise, I will do it in the shower while I am scrubbing off whatever surprise bodily fluid I might have on me that day. Doing this in the shower is both a physical and psychological cleansing and scrubbing down. 

Start the WEB process by silently walking through all of the strong emotions that you had throughout the day. This helps prime you for identifying those emotions and processing them.

Saying the emotions out loud is where the real work happens. It allows you to address how you are feeling. If you need to cry or express your hard emotions, this is when you do it.

This is a form of exposure therapy which is a long-standing therapy tool to help process difficult emotions and experiences.

As shown in the video, the alternating, bilateral stimulation technique helps process these emotions by synchronizing the two hemispheres of the brain. See the interview below for more information on how bilateral stimulation works.

The WASH your WEB technique is quick and easy – also it will become easier to incorporate into your daily life once you get the hang of it. The thing I love most about this technique is that it is aimed at preventative healthcare to end nurse burnout. 

Dr. Heim warns that it is not for people who are at the brink of breakdown and burnout. When you start to use this technique if you begin to be overwhelmed by past trauma, then this is probably not the technique for you. Please, if you experience this, get personalized, professional help. If you need help finding resources, contact me and we can work together to find resources in your area. 

If you’re like me and you have a few additional questions for Dr. Heim about his process, read the interview questions below. Also, comment with any questions you have and I would be happy to pass them along to Dr. Heim.

Interview with Dr. Heim

Can you tell me a little bit about yourself? How long have you been working in psychiatry and the preventative mental health field? Do you have much experience working specifically with nurses?

I have been working as a doctor for 20 years and in psychiatry for 20 years and as a consultant psychiatrist for 12 years. Of course I have worked with nurses along every step of the way. They are, as you know, the caring core of the health care system. Particularly in mental health (but also elsewhere) I have come to really appreciate the value of good nursing and wish there wasn’t so much paperwork to get in the way of what you really do!

In your words, how would you describe “preventative mental health”?

Finding evidence-based ways of making sure that people don’t get to the stage where they need to see a doctor or a psychologist for mental health problems.

In your supplemental discussion of rationale and evidence I liked your description of the difference between empathy and compassion. As nurses we are frequently told to act empathetically towards our patients. A lot of us, including myself, pride ourselves on our empathy. Can you talk a little bit more about why we need to work more compassionately than empathetically?

Empathy will always be needed. It is the natural connection that goes on between human beings in our brains. But it is largely a limbic and feeling-based process whereas compassion is a frontal lobe process that moves us to helping and centring emotions on others. Empathy will always be there, but compassion is what is needed in the workplace as it helps prevent burnout. In the next month or so we will be posting a video specifically on this question.

How did you develop the technique of the bilateral tapping and how does it work?

The bilateral tapping technique was not developed by me, it is part of EMDR therapy, a therapy we commonly use to treat trauma. You can find out more about the bilateral tapping and EMDR through the references in my rationale.

Has the WASH your WEB process been peer reviewed? I know it is currently under ethical approval.

We are waiting to do a trial but Covid 19 has impeded our progress at this stage. However, a peer reviewed journal article on the tool so far is currently under publication consideration (we will let you know when published!), and we will be starting on a clinical trial as soon as we can.

What advice would you give to new nurses in terms of preventative mental health?

Get to know the difference between empathy and compassion and understand it really well, this subtle difference can be highly protective. During this viral crisis, do all that you can to sleep well, and keep contact with people you love to optimize your brain chemicals and keep meaning in your life.

Finally, how and where can people find you to learn more about your work?

I have a website and I do give public talks and I especially have a heart for young people that are going to be most affected in the long term by what we are going through at the moment. 

Links:

Website Home

Instagram

Youtube

Facebook

Make sure to find and follow him on his social media above. He has a lot of incredible knowledge and experience to share. 

I think WASH your WEB is especially important for new nurses. WASH your WEB is specifically targeted towards preventing vicarious trauma, compassion fatigue, and burnout BEFORE it happens. And that’s why starting early in your career can make such a beneficial impact in the long run.

If we can make a shift to help nurses proactively protect themselves from burnout then we will be in such a better place as a profession.

I hope you have an opportunity to try out the WASH your WEB for yourself. I think if we actively make an effort to preventatively take care of our mental health, we can reduce burnout and increase our career satisfaction. This in turn will help improve patient care!

Please share this technique with a nurse you know and love.

As always, I would love to connect with you on social!

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