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So my name is Caroline Rollings. Um And I'm the wellbeing League for the National Association of Primary Care. I did my nurse training in 1976. A very long time ago, probably for lots of you. Um and spent a lot of time in primary care before doing a few other things. So becoming a psycho counselor and working in, in, in practice and also doing an MB A and becoming a managing part partner for a, a big, a big surgery. So um we employed 100 and 30 people, which is big for, for a general practice with an integrated nursing team. And I spend a lot of my time talking to nurses and doctors and all kinds of, of our colleagues across primary care and secondary care across the country. So I hear the heartbreaking stories that people, the struggles that people are going through. So self care is vital and I hope that this session will only give you a bit of a chance to look after yourselves, but also give you some ideas um of, of things that maybe you could do a a and some understanding if, if that's helpful. So we'll make a start. It's great to have you with us. So we're going to talk about in this session. There's two sessions in this series, the importance of selfcare and being kind to ourselves in, in, in a slightly deeper way. We're going to learn some techniques to help us. When we're feeling anxious. We're going to talk about overthinking because that can really affect our peace of mind. And then we're going to do a lovely little meditation on being kind to ourselves. I use a lot of Charlie Maxie. He knows I use him and, and he's inspirational and this is so true. I think the greatest in illusion said the mole is that life should be perfect. We often wait for kindness but being kind to yourself can start. Now said the mo and that's so important. So just ask yourself some questions like, how do you thrive and take control of your lives? What, what do you do as selfcare? And it's great to see some examples on the screen because practicing selfcare is actually vital and we need to give ourselves permission to step back and to practice it. And it is a skill that needs to be learned and that needs to become a normal part of our lives. And I think it's lifelong learning, I'm still learning how to do it and you know, still getting things wrong, but that doesn't matter. I'm still learning and still doing it. And that's how we grow and change. And also I think a really important thing to remember is that we're all role models as well. So even if you can't do it for yourself, think about your colleagues, think about maybe your family. Um because we are role models for so many people, our patients as well. So to be able to care for yourself, to be able to care for others, you have to care for yourself. And we forget that. So when we're under huge pressure where it, wherever it might be on a ward, when there's just not enough time and not enough staff, the same in general practice, when you're running a clinic, we just tend to think I'm just going to be put my needs aside. I'm just gonna keep going till I get there. And so many people say I'm gonna keep going till I get there. But the trouble is if we do that often, we, what is that? We don't get there because it is never ending. Um And, and that's when, I mean, there's really good evidence to show that care suffers when we're, when we're not looking after ourselves. And the culture at work isn't for us to look after ourselves. So try and provide yourself with times to disconnect, taking micro breaks can be really important. They don't have to be more than a few minutes. But maybe if you did some breathing like we're going to learn, you just bring your anxiety levels down a bit if that's how you're feeling. Um And try and look after your fitness. So enough sleep, enough exercise, good food. But I know that that all takes time and none of this stuff is without its challenges. So I thought we'd start by doing a check in on our body. So this is from Shout. One of the things I do is I volunteer with Shout, which is an online texting crisis service um 24 7 and we're talking to people who are struggling during the pandemic. Um The NHS used it and we still use it. Actually, you go in and type in front line, you go in through an NHS portal. So first of all, just ask yourself are my shoulders tense and maybe if they are just lower them and if that's hard, just gently bring them up and then lower them is my jaw tense. We carry a lot of tension in our, in our face and we don't realize that we do. Is your breathing short? What's it doing at the moment? Maybe if it is just take a deeper breath in with a pause and a longer, slower out of breath. The flight are you craving food or not feeling hungry? That can be a sign of what of some struggles within you? Am I feeling run down or exhausted and are having trouble sleeping? A lot of our colleagues ha haven't had trouble sleeping. Um And it's a sign that our brains, we're not getting any time to process stuff. So we're doing it at night. Do you have any wisdom for today? Said the boy, yes, said them all. What is it? Don't put off till tomorrow? The cake you could eat today. Now, the mole loves cake and cake I think is very important to you. But what that's telling us is don't always think I'm gonna do stuff in the future. Find a way to do it now to live the moment. During the pandemic, we did a big survey of general practice across the country. And these are the three top things that came back from our colleagues in primary care. So give yourself a break. You deserve one. Don't feel guilty, stop and acknowledge how you feel. That's quite important and don't pressure yourself. All we can do is do our best. And I think that that's really important. We can get into perfectionism sometimes too much. Society pushes us since childhood to be in a chronic state of fight or flight rush to school, compete for good grades, compete in sports, achieve perform. Our nervous system needs stillness, quiet and creativity because we are humans and not machines. And it's good to remember that sometimes I can't even see my next step. Said the boy, can you take a long deep breath? Yes and try. That said the horse because our breath is one of our most powerful tools and it's so easy to forget that and not to use it when we need to. So, what we're going to do now is we're going to do something called the emergency stop technique. Um And it's a very easy technique. I'm gonna teach it to you first and then we're going to do it together and you can do it. I've done it in meetings and nobody knows I'm doing it. You know, if you're sitting somewhere in a group, then all you do is is fix your gaze on a pen in front of you or whatever. If you're on your own, then you can do the whole thing aloud. So, what we're going to do is we're going to say stop to ourselves, stop fretting, stop getting so worked up. And then we're going to breathe in and hold our breath for a moment and then we're going to breathe out, slowly relaxing our shoulders and hands and then we're gonna pause again and then we're going to breathe in again. And as we breathe out slowly this time, we're going to relax our forehead, face and jaw. Now, it's important in any breathing exercises to always do a longer out breath than the in breath because that activates the parasympathetic nervous system. It's part of that feel good feeling that you get when you're doing deeper abdominal breathing. So I'm gonna talk it through and we're gonna do it together now. So I hope that you're in a place where you can do that. But if you're in a place with other people, then just do it and nobody will recognize you're doing it, just do it quietly to yourself. So what we do, first of all is we say to ourselves, stop, stop fretting, stop getting so worked up. And we breathe in, hold our breath for a moment and breathe out, slowly relaxing our shoulders and hands and pause again for a moment. And then you breathe in again, walls and as we breathe out slowly, this time, we relax our forehead, face and jaw and then we just stay quiet for a few seconds and then we go on with whatever we were doing, but maybe move a bit more smoothly and a bit more slowly. And if you have to talk, talk a little more slowly and a little with your voice a bit lower because actually when we're stressed, our voices rise and actually people listen more if you do that. So let's just do that once again together just because it's, it's a great thing to learn after this. You'll be able to um be sent some information and, and how to do this is written down for you as well because it's a really good tool to have. So we say stop to ourselves. Will you breathe in, hold our breath and breathe out, relaxing our shoulders and hands and we cause breathe in again. And as we breathe out slowly, this time we relax our forehead, face and jaw and then we're just quiet and then we move slowly and we talk slowly. I hope that, that you found that helpful because remember to use it, if it, if it would be helpful to you in difficult times, life gets busy doing, giving, helping, teaching, showing up loving caring. It's easy to run on fumes. But you must remember to fuel your own heart, your dreams, your passions, your health, you because you cannot give if you are empty and you matter too. And this is another thing to remember because so often as we go through life, we carry our past with us, all the things we regret all the losses, all the difficult times. Um And we also carry our future that we're worrying about, but actually, we really don't need to be carrying all that and it starts to affect the way we think, the way we feel and the way that we react to life, the way that we feel on an everyday basis. So when it all gets too heavy, it's ok to put it down. It actually, this present moment is what is really important. This present moment is all that's real. Um Because the past is a memory and the future hasn't happened yet. And if we don't really live this present moment, then we miss it. Um I'll come back to questions at the end. If that's all right. Thank you for asking. Ma so there are many types of selfcare and it's so easy to think that, oh, well, I'll just sit down and have a glass of wine or whatever. But actually it's way bigger than this. I'm not going to go through this in detail because you'll get it after the, after this session. But as you can see there, there's all those segments of emotional social, you can see them yourself, spiritual, whatever. And then the next bit of information takes all of those segments and gives you some some suggestions um of all the things that can actually be examples of self-care. And maybe you might have a look at that and think, oh, you know what that one appeals to me. I like the look of that one. So to have a look at it and think about it. So I want to go on and talk about what we call rumination, which is um negative self talk. It's the way that we think in our heads, the way that we talk to ourselves, it doesn't mean you're mentally ill and you're hearing voices, we all do it actually not everybody is aware of it, but we all do it. So rumination is actually overthinking. So it's as stressful as it is common and what it does is it takes a situation that has already caused stress and it magnifies it. Um So it magnifies both the stress and the importance of that situation in our minds and the signs and many of you will know because you'll do it too often like me, but some of you might not, not everybody's aware. So basically, as a general rule, the following can be indicated that you have fallen into the track of track of rumination. So if you're focusing on a problem for more than just a few idle minutes, if you're feeling worse than you started out, feeling before you started thinking and remembering if there's no movement towards accepting and moving on or if you're no closer to a viable solution, and that is probably rumination. So what I want to do is just share a few tips about it because it's something that really affects how we feel. And the heaviest burdens that we carry are the thoughts in our head. They are so powerful to how we feel. And it's, if you start to be aware, it, one of the good things to do is to stop, to be aware of the kind of voice you're using to yourself, the kind of words that you're using, uh the way that you are thinking to yourself, is that the way you would do that with friends or is it harsher? Maybe? Which for a lot of us, it is because you'll never speak to anyone more than you speak to yourself in your head. So be kind to yourself. Most of the old moles I know, wish they had listened less to their fears and more to their dreams. And I think that is very common that we, we do. We, we don't take much time to think actually, what are my dreams? What do I want to make happen in my future in the next year, in the next month or the next week or even today? Do I ever stop and think that and make that happen? Because now is the time we've got and it's very important and I think this has a real truth in it. So if you see that big balloon, the things that I worry about then actually the things that can happen and out of that, the tiniest circle of the things that do happen. I was talking to my daughter um, this weekend about something I was worried about and trying to work out, you know, what would I do? What this, that, and she said to me, mum, it might never happen. She's so right. But when we've struggled in our lives with um anxiety or some kind of trauma or whatever, it might be, what we try and do is we try and control everything because it feels safer and that can, can be overwhelming in our thinking and, and how we experience our lives. So it's worth just exploring that if that maybe resonates with you, your anger, it's telling you where you feel powerless your anxiety. It's telling you that something in your life is off balance your fear. It's telling you what you care about your apathy. It's telling you where you're overextended and burnt out. Your feelings are not random. They are messengers and if you want to get anywhere, you need to be able to let them speak to you and tell you what you really need and think about. Are you a people pleaser? I can, I can really fall into people pleasing because it makes me feel safe. Although actually in the end, it, it isn't helpful but the people we try and please compared to the people we actually can please and then maybe the people we decide we should focus on pleasing very different things. So I just share thoughts with you. Um And if something resonates with you, just have a bit of an explorer around it, there's so much support out there. Um And the NHS also has a lot of support and there'll be some information on that in your, in the information you get afterwards. Don't let anyone rent space in your head unless they're a good tenant and teams can be tough places, can't they? I remember coming home from work worrying about a relationship in a team, the nursing team I was working in. Um And just realizing that I in my head, I'd taken that person into my home into my evening, into my bed, into my shower in the morning. Um And, and it's not good for us trying to stop that though. Is a challenge. Um, and I want to talk a bit more about that. And also remember as part of being kind to ourselves that being successful in whatever it is you decide you want to be is not about reaching the top of the mountain. It's about every step. My granddaughter teaches me that. So. Well, she's, um, well, she was two at this time. Actually, she's three now. But whenever she, she's done something, whatever it might be, she goes, I did it. And one of the things I find a bit scary is driving places like a long way on motorways. Um And I did a drive with which involved three motorways recently and at the end of every motorway, I just said to myself, I did it and just supported me, whatever helps do whatever helps you. So how can we get ruminating, thinking under control? So the first thing is to hear it and to recognize your thoughts in the first place because often we get so used to this radio show that's humming in the background that we don't really realize the content and need to learn to tune in and be honest with ourselves. So some of the tools that can help you in that situation and mindfulness, really being in the present moment. Um And I can talk a bit more about that, but just thinking, where am I feeling it? Being aware and also journaling can help just capturing your thoughts and replace the why, why did I do that? Why I did I fail whatever it is with what and how, because why questions lead to endless evaluation but very little action. So when we learned, when we use how questions we tend to find ways forward. So why did I do that becomes, how can I do things differently in the future? And often our reactions come from our early experiences, sometimes traumatic and we continue to try and keep ourselves safe in this way, which is no longer helpful because the the the ways we learned to keep ourselves safe when we were Children, which is often when these things have happened are no longer so helpful. Now we're adults. So is awareness is the first step. Unless you have awareness, you can't do anything but then be kind to yourself and there's lots of help available out there. Stop assuming that you know, the answers. So ruminating is often based on the idea that there's a right or a wrong or a one way to do things or that each small thing that you do is connected to a big thing. So like if I hadn't said that they'd still value me and often we're trying to control a situation that we read is stressful. But in fact, what we're doing is causing ourselves harm through that reaction. So awareness and then questioning what's going on in your head and replacing overthinking with wellbeing activities can also be helpful because always distracting ourselves isn't necessarily a good thing in terms of mental health because sometimes we're trying to hide from processing our emotions. But with rumination, we're not processing anything, we're just stuck in it. So there's no chance of advancement because we're stuck in this cycle. So distraction is a positive intervention. Um Whatever that might be, exercise is great because when we're in this situation of stress, we're excreting adrenaline and exercise, burns up adrenaline. Um But also it could be any of the wellbeing activities we've talked about going and having a walk and really looking around you, whatever it is, but a positive distraction, not a negative. If you find yourself drinking a bottle of wine every night to distract yourself, maybe have a think about getting some support with that. Um Because it's so easy to try and escape from these difficult feelings and learn proper goal setting. I think that's important because sometimes when we get stuck in ruminating, we simply don't have a plan or even know how to take that first step towards less destructive thinking. So having a plan helps us feel empowered. We know how to find action steps forward and it does take courage to be aware and to admit these things to ourselves. And sometimes some brief therapy can be helpful. So if you look on the NHS people site or if you have a mental health hub set up where you can, sometimes your mind plays tricks on you. It can tell you you're no good but it's all hopeless. Remember this, you are loved and important and you bring to this world things no one else can. So hold on. What's your best discovery? Asked them all as I'm enough as I am said, the boy and what helps you to love others, loving yourself, said them all. I think that's quite an important lesson to remember. Sometimes we get it the other way around. So what we're going to do now is do a little meditation on being kind to ourselves. Um One of the kindest things you can do said the mole is to be gentle and patient with yourself. So what I'd like you to do for this um is to if I don't think anyone's got cameras on, if you've got cameras on, you might want to turn your camera off for this. So sit with your back right against the chair so that your lumbar uh spine is well supported. I hope you've got a chair that does that for you and lower your shoulders and relax your arms either onto the arms of the chair or on to your lap, have your thighs parallel with the ground and your feet flat on the ground and make sure that your head's well balanced. Our heads weigh a lot and if it's not well balanced, you end up getting neck problems. Um And so often um nurses end up with neck and back problems. So, really important to make sure that your body is safe for this. And then what we're going to do is just take a breath, um, just to calm ourselves down a bit more. So we'll just take a couple of deeper breaths. So breath in with the pros and a longer, slower out of breath and a pause and another breath in and to pause and a longer, slower out breath and just check through your body if you find there's anywhere that's feeling a bit tense, just take some breaths in your own time and imagine that tension floating out of your body as you do an out breath, just check that you're feeling in a comfortable position. So if you haven't already, just gently close your eyes and just continue to turn your attention to your breath. Now, just simply notice that you're breathing, not trying to change anything, just feeling the coolness of the breath as you inhale and the warmth of the breath as you exhale. So during this, there will be moments when I'm quiet and I won't leave you on your own for ages. So just stick with what we're doing. If your mind wanders and you're not used to doing this kind of thing, just gently bring it back to your breathing, no recriminations, nothing like that, just bring it back to your breathing. So as you breathe, just give yourself permission to leave your worries and responsibilities behind just imagine yourself stepping out of doing, stepping away from what's going on in the world, away from work or family away from all the things that are on your plate. So with your breath, you're carving out a space that's just for you, a peaceful space, a kind space, a space where you can safely let go. Just continue to focus on your breath in and out in your own time. So on each exhale allow yourself to release some of the tension that you've been carrying. Maybe just try and consciously soften your face, relax your jaw and let your shoulders drop. And as you release the tension, imagine your chest loosening and expanding, opening up the pathway for your breath just allowing it to flow free in no out nine. Bye. Now, how's your breathing in this space that you've created for yourself? You may find that certain thoughts or emotions arise, maybe worries about the world or things that are weighing on you, maybe regrets or self criticism or doubts. And when that happens, rather than trying to push that thought or feeling away, try and simply observe it without judgment. So not getting caught up in it, but acknowledging that's fair and then releasing it, letting it float away as you gently bring your attention back to your breath. So if you observe any thoughts or feelings, just observe them and then release them and bring your attention back to your breath for a minute. Of silence. So I'll, I'll come back and talk some more in a minute. Just concentrate on that. So as you're breathing in and out, see if you can kindle a feeling of warmth and kindness towards yourself. Some people find it helps to place a hand over their heart, just taking a moment to appreciate yourself just as you are in this moment. Many of us find it easy to love ourselves when things are going well. When we make mistakes, I feeling overwhelmed when we're not where we think we should be. We often fall back into patterns of negative self talk. We beat ourselves up for our perceived failings and shortcomings and we judge ourselves harshly. And in those moments, it can be helpful to stop and ask, what would I tell a loved one if they were criticizing and sounds like this? But so often we're much harder on ourselves than we would be on anybody else. We have to remind ourselves that we deserve kindness too. So when those negative voices start up, they encounter them with self-compassion, treating ourselves gently and kindly, just like we would a good friend just continue to breathe, allowing the warmth of compassion and acceptance and loving awareness to fill you up and infuse your whole body breath, my breath. Nine minutes, 59 minutes. As the self-compassion researcher and teacher, Doctor Kirsten Nes says, when we give ourselves compassion, we are opening our hearts in a way that can transform our lives. So just let your breathing come back to normal, maybe just eyes, maybe stretch your shoulders and maybe have a stretch up. And when you're ready, very slowly, take your time, there's no hurry, open your eyes and just see if you can bring that loving kindness for yourself with you as you go on about your day. So I hope that that helped, that gave you a bit of a moment of time out and time to concentrate on you. I always think relaxation and meditation is a skill. We don't expect people to understand, to feel comfortable doing it straight away. So if it's new for you, um there's lots of, of easy small steps that we can take and I'll be doing a different one next week. I'm talking about next week. Have a think about what you're going to do. Do you have any wisdom for today? Asked the boy, yes. Said the moll, what is it? Don't put off till tomorrow, the cake you could eat today. And what I mean by that is do some self care make it happen for you? So, in the next session, we're going to look at being kind to ourselves, talk about how self esteem affects us because it's big talk about what causes it and how we can improve it. And we're going to do a meditation on being kind to your, to our ourselves.