Chapter 19: Self‐care and wellbeing
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Source: Adapted from NHS ([51]).
Source: Adapted from Hinton ([32]).
Evidence‐based approaches
The British Dietetic Association workplace initiative ‘Work Ready’ highlights that it is essential to the wellbeing of staff that they can take breaks to refuel and hydrate. What we eat can affect how we feel, our energy levels, our concentration, our decision making and how we deal with stressful situations. Most people feel better when they have had a healthy balanced meal. It is important to have adequate carbohydrates to eat.
The ability to concentrate and focus comes from the adequate supply of energy – from blood glucose – to the brain. The brain uses 20% of all energy needed by the body. Glucose is also vital to fuel muscles and maintain body temperature. Blood glucose comes from all the carbohydrates we eat, including fruit, vegetables, legumes, wholegrain cereals, bread, rice, and potatoes, sugars and low‐fat dairy (Arens [1]) (see Boxes 19.12 and 19.13).
Box 19.12
Daily reference nutritional intakes for adults
- Total fat: less than 70 g
- Saturated fat: less than 20 g
- Carbohydrate: at least 260 g
- Total sugars: 90 g
- Protein: 50 g
- Salt: less than 6 g
Box 19.13
Ideas for healthy meals at work
- Wholemeal or seeded roll with lean meat, fish or egg, and a salad
- Wholemeal wrap with fish, avocado, humous and/or chicken
- Jacket potato with toppings such as beans, tomato ragu or tuna
- Sushi
- Fresh soup and a roll
- Salad with pasta, rice or cous cous
Eating from each of the four food groups
The British Nutrition Foundation ([6]) recommends that everybody regularly eats from each of the four main food groups: starchy carbohydrates, fruit and vegetables, protein and low‐fat dairy.
Starchy carbohydrates
Choose wholemeal options and aim for at least 260 g per day. Example foods include:
- bread: for a sandwich or with soup (approx. 12 g carbohydrate per slice)
- rice: 100 g cooked (approx. 28 g carbohydrate)
- pasta: 100 g cooked (approx. 31 g carbohydrate)
- potatoes: 100 g baked with skin on (approx. 22.6 g carbohydrate).
Fruit and vegetables
Aim for at least five different types per day. Example foods include:
- watermelon: 100 g (approx. 8 g carbohydrate)
- strawberries: 100 g (approx. 8 g carbohydrate)
- raspberries: 100 g (approx. 10 g carbohydrate)
- cucumber: 100 g (approx. 9g carbohydrate)
- broccoli: 100 g (approx. 7g carbohydrate)
- tomatoes: 100 g (approx. 3 g carbohydrate).
All fruits contain natural sugars and the water content in them supplements your daily recommended fluid intake as well.
Protein
Aim for 45–55 g per day (Public Health England [58]). Example foods include:
- chicken breast: 100 g grilled (approx. 32 g protein)
- lean beef steak: 100 g grilled (approx. 31 g protein)
- salmon: 100 g grilled (approx. 24 g protein)
- tuna: 100 g canned (approx. 24 g protein)
- eggs (chicken): 100 g (13 g protein)
- chickpeas: 100 g (approx. 8 g protein)
- kidney beans: 100 g (approx. 7 g protein)
- almonds: 100 g (approx. 21 g protein)
- walnuts: 100 g (approx. 14 g protein).
Low‐fat dairy
Aim for two or three portions of low‐fat dairy per day (Public Health England [59]). Example foods include:
- semi‐skimmed milk: 100 g (approx. 3 g protein)
- low‐fat cheddar cheese: 100 g (approx. 26 g protein)
- yogurt (plain, low fat): 100 g (approx. 5 g protein).
Snacking
Many people snack, and these can be a useful energy source when working a long, busy day on the ward. Hignett ([31]) suggests the following helpful hints relating to snacking:
- Snacks that are high in protein, fibre and wholegrains help to fill us up.
- Choose snacks that contain cereals, fruit and vegetables.
- Take care not to overindulge in snacks high in sugar.
- Choose low‐fat snacks.
- Keep portions small.
Box 19.14 provides some ideas on snack choices, and the next section suggests snacking approaches that may help to sustain a positive mood.
Box 19.14
Ideas for snacks
- Fresh fruit
- Dried fruit mix with seeds and nuts
- Low‐fat or 0% fat yogurts and fromage frais
- Cereal bars (wholegrain)
- Baked or popped crisps
- Chopped raw vegetables with dips such as humous
Food and mood
When you work in an emotionally demanding job, being very mindful of what you are eating and drinking is essential, as food and hydration have a significant impact on how you feel. Eating well and staying hydrated will help you to cope better psychologically and physically, and will affect your concentration, energy levels, and ability to give compassionate and thoughtful care.
Food literally affects your mood. Under stress, the body craves rapidly acting carbohydrates to fuel the fight‐or‐flight response, which is why we favour sweet or starchy foods during times of stress. These foods temporarily give us an emotional lift but then add to our feelings of anxiety. This is because as they are quickly absorbed they cause a ‘crash’ in blood glucose, lowering mood and leading to further ‘sugar fix’ cravings. Fruit is good for you, but some is very high in natural sugar, so it is best to avoid eating it on an empty stomach and better to eat it with or after a meal. Controlling blood glucose levels during times of stress is therefore essential to avoid this swinging effect and subsequent mood changes.
To avoid this swinging, it is advised to choose foods with a low glycaemic index; they are harder for the body to absorb the glucose from. This means their glucose is released over a sustained period, preventing the rapid highs and lows that affect mood. As an example, choosing a wholegrain cereal, porridge, yogurt, smoothie or eggs for breakfast and avoiding white bread or very refined and sugary cereals will control your blood glucose better. Similarly, at lunch time, picking sandwiches made with brown bread over white, or choosing a jacket potato rather than chips, can make all the difference. After a long shift, it is essential to eat, but if a meal high in carbohydrates is eaten too close to bedtime, it may keep you awake. Therefore, it is better to choose smaller portion sizes that are high in protein if you are planning to go to sleep within 2 hours.
Snacks are important and can ‘keep you going’ until you are able to take a break, but avoid sugary sweets, chocolate and fizzy drinks as the glucose in these will be rapidly absorbed and have a negative effect on your mood. Nuts and seeds will give you energy without affecting your blood glucose, and both bananas and dark chocolate with a very high percentage of cocoa contain natural sources of serotonin, which can lift your mood. A good snack to make up at home and carry with you to work is the ‘good mood mix’ (Box 19.15).
Box 19.15
Good mood mix
Make up a mix of the following as a snack to lift your mood:
- mixed nuts
- dried banana chips
- dark chocolate chips.
You could also add other nuts, fruit and seeds that can help your mood, for example:
- Sunflower seeds are a natural source of norepinephrine, which can raise your mood.
- Pumpkin seeds contain magnesium, which is known to help alleviate anxiety.
- Dried cranberries can improve immunity.
Hydration
Water and good hydration are essential for life. Water has a number of roles within the body. For example, it:
- is a major constituent of the body
- transports nutrients and compounds in blood
- removes waste products, which are passed in the urine
- acts as a lubricant in joints
- regulates the body's temperature (Gandy [27]).
Dehydration affects concentration and cognitive function, and it also triggers fatigue. As a result, just like missing rest breaks, being inadequately hydrated is not just a wellbeing‐at‐work issue but an issue of patient and staff safety.
A study of the hydration levels of clinical staff at an NHS hospital found that 36% of participants were dehydrated before they started their shift. Using urine samples and short‐term memory tests, the study also found that 45% of participants were dehydrated at the end of their shift, and that cognition was significantly impaired in dehydrated participants (El‐Sharkawy [21]). Physical activity (such as being on a busy shift for 12 hours) and environmental temperatures can increase the need to keep hydrated. Nurses frequently complain of not being able to access drinking water while at work. In a survey of RCN members, 25% of respondents reported that they were not allowed to have water on the wards or at the nurses’ station while at work (RCN [61]). Members who responded to this survey also reported that the pressure of work can lead to the inability to drink, go to the toilet or eat (RCN [61]).
Thirst is part of the way that the body regulates the body's hydration. However, it is important to note that people tend to stop drinking when their thirst subsides, but this normally occurs before true hydration. The colour of urine is the best indicator; if you are drinking enough fluid throughout the day, then your urine should be a straw or pale yellow colour (Figure 19.3). If it is dark, you must drink more. If you do not drink enough fluid, you may experience a variety of symptoms, such as tiredness, poor concentration, headache, and dizziness or light‐headedness.
Figure 19.3 Am I hydrated? Source: Reproduced from RCN ([62]) with permission of the Royal College of Nursing.
How much should I drink?
Men need a minimum of 2000 mL per day and women need a minimum of 1600 mL per day. The amount increases for women who are pregnant or lactating. It also increases in warm weather or in warm and dry environments, such as air‐conditioned offices or wards. Additionally, centrally heated homes increase the need for water as they speed up the evaporation of sweat on the skin. The amount you need will also increase if you are busy with manual duties or engage in exercise (Figure 19.4).
Figure 19.4 How many cups should I drink on a 12 hour shift?
What should I drink?
There are many options available. In the UK, drinking plain tap water is a good, cheap way to get enough to drink, and the water can be chilled or filtered depending on taste. Bottled water has the same hydrating abilities as tap water. Tea and coffee will also provide water. Fizzy and still drinks contain a lot of sugar and should only be drunk in small amounts; ideally choose sugar‐free versions. Fruit juices provide water and other nutrients but contain sugar so only have one small serving per day; this counts towards your five servings a day of fruit and vegetables.
Caffeine
It is important to remember that caffeine is a stimulant, which means that although it will give you a quick burst of energy, it may then make you feel anxious and depressed, disturb your sleep (especially if you have it before bed) or give you withdrawal symptoms if you stop suddenly (Mind [46]). Caffeine‐rich sources of liquid include tea, coffee, cola and other manufactured energy drinks. If you decide to drink less caffeine, you could try switching to decaffeinated versions of these drinks.
