If It's Mentionable, It's Manageable: Building Resilience Through Connection and Reflection

Loneliness and isolation were declared an epidemic in 2023 by Dr Vivek Murthy, former U.S. Surgeon General. Researcher, Dr John Cacioppo states, “this condition [loneliness] is the emotional response to the painfulness of disconnection” (Singer, 2016). In recent years, this disconnection is said to do as much damage to our health as smoking fifteen cigarettes a day (Hold-Lunstad, 2009). As nurse educators, we are in a unique position to build compassionate resilience in our students by incorporating connection and active reflection into our curriculum.

Laying the Foundation- Connection

Classroom- day #1

When students enter the nursing program, they often feel overwhelmed, anxious, and alone. As educators, we set the tone in the classroom. As with any healthy relationship, establishing trust is a fundamental first step.

On the students’ first day of their first semester, I introduce a tool known as the Civility Index (Clark, 2017). This forty-question survey asks students to reflect on their own, and their classmates’, behaviors around civility. After calculating their score, students identify one specific area of strength and one area for growth.

As with most lessons, application is where true learning occurs. Upon completion of the questionnaire, we remove all physical barriers (desks, laptops, backpacks, phones etc.) and form a circle in the middle of the classroom. Voluntarily, students discuss their results. No one is required to share, but all will contribute by actively listening.

Often, one gift of this discussion is students committing to holding each other accountable for uncivil behavior. The very first time I completed this exercise, one student stated, “it drives me nuts when I see someone on their phone.” Immediately following this comment, another student admitted, “I’ve gotta be honest, I am addicted to my phone. Can we sit together? I think it will help me stay focused.”

This honest conversation, completed at the very beginning of their educational journey, establishes students owning their behavior and respecting one another in the classroom. Beginning with civility sets the stage for further exploration of connection and reflection as they move through the program. 

Building the Practice- Reflection Clinical- day #1

As students move into the clinical setting, asking questions that lead to a deeper understanding of self is critical to cultivating resilience (Walsh et al, 2020). In my experience, the more specific the reflection, the more universal the truth.

Asking questions such as, what inspired you today, what surprised you today, what challenged you today, and when did you feel most connected, encourage students to look beyond the day to day clinical tasks and explore how their experience impacted them emotionally. At the beginning of the clinical semester, I ask students to not only pay attention to what feelings arise, but also how they feel in their bodies, as they move through their day. Are there times when they tense their shoulders or forget to exhale? Do moments occur when their minds race or they want to run from the room? Paying attention to these physical and emotional reactions are key to understanding what situations are challenging for them.

Reflection Rounds- Resilience Clinical- last day

Though reflective writing is important, it is just scratching the surface. In order to more deeply process and move through our feelings, sharing them is essential. Engaging in a practice known as Reflection Rounds provides students a safe space to express their feelings and build resilience.

Reflection Rounds is a group exercise where students share about a patient experience that impacted them emotionally during their clinical semester. As with the Civility Index, the setting is an open circle, in the middle of a private classroom or conference room. Ground rules are set: students are each given five minutes each to speak- uninterrupted, strict confidence is respected (what’s said here stays here), and there is no crosstalk or advice giving. In addition, speaking is voluntary (though encouraged) and respectful, active listening is expected. We then sit in silence, until the first student is brave enough to speak.

Time and time again, when given space, students share on a deeply emotional level. It often takes several pauses, stops and starts of telling their story, before they reach the layer that reveals the truth about why they were so affected by a particular patient situation. Many times (honestly, every time) tears are present.

Throughout the near decade that I’ve engaged in this practice, several themes commonly arise: “I feel less alone. It’s like I feel lighter knowing that I’m not the only one struggling.” “I didn’t think of how much we are all going through and how much our patients affect us.” “It helped me see how important it is to connect with my patients.”“I was surprised how vulnerable we were when given the chance to open up. It was beautiful.” “I feel more connected to my classmates and more empathetic about what they’re going through.” “We need this in every clinical.”

In 12 step programs, there is a slogan, ‘we are only as sick as our secrets.’ Sharing openly in Reflection Rounds diminishes the power those feelings and fears have over us. This activity allows students to gain compassion and resilience by speaking their truth.

Going Forward

Today’s culture can feel very isolating and divisive. Incorporating reflection and connection into our curriculum lays the foundation for our students to not only be more resilient nurses, but more resilient people. As we navigate the struggles in this world, I feel strongly that we are better together. For in the end, my deepest belief is- when we connect, we heal.^TM

photo courtesy of Jacob Thompson

References

Clark, C. (2017). Creating and sustaining civility in nursing education. Sigma Theta Tau International Publishing.

Holt-Lunstad, J., Smith, T., & Layton, J.B. (2010). Social relationships and mortality risk: A Meta-analytic review. Public Library of Science Medicine 7(7).  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316

Murthy, V. (2020). Together: Loneliness, health & what happens when we find connection. Harper Collins.

Singer, E. (2016). New evidence for the necessity of loneliness. Quanta Magazine. https://www.quantamagazine.org/new-evidence-for-the-necessity-of-loneliness-20160510/

Walsh, P., Owen, P., Mustafa, N., & Beech, R. (2020).  Learning and teaching approaches promoting resilience in student nurses: An integrated review of the literature. Nurse Education in Practice 45.  https://www.sciencedirect.com/science/article/abs/pii/S1471595318301562