Running head: IMPORTANCE

The Importance of Implementing Self-Care in Nursing Curriculum

Kami Alexander, Michelle Carrillo and Lilia Murashov
Western Washington University

IMPORTANCE

The Importance of Implementing Self-Care in Nursing Curriculum

Introduction
When I was in nursing school, we had a group meeting in the staff lunchroom at the end
of every clinical day. When one of my fellow students complained that she did not have time to
use a bathroom, one of the nurses from that floor shared a joke with us. Did you hear about the
body found alongside the road? They dont know her name, but they know she is a nurse because
her back is broken, her nerves are frayed, her ankles are swollen, and her bladder is full.
Although we all laughed, the sad reality is that many nurses care for others at the expense of
their own health. The population focused on in this paper are students currently in the nursing
program at Bellingham Technical College (BTC), as well as new nurses in the residency program
at PeaceHealth St. Joseph Medical Center (PHSJMC). The American Nurses Association (ANA)
defines a healthy nurse as one who actively focuses on creating and maintaining a balance and
synergy of physical, intellectual, emotional, spiritual, personal and professional wellbeing
(ANA, 2016, p. 1).
Although self-care is important in nursing education, these skills are often neglected and
the curriculum is usually focused toward care for others. How can we change the culture around
poor self-care in nursing? It is often forgotten that healthcare providers must be healthy
themselves to provide safe and effective care to others. During nursing school students appear to
experience an increased level of stress. Ashcraft and Gatto (2015) found that students slowly stop
practicing self-care as the intensity increases.
When nursing school curriculum incorporates the importance of self-care, students can
see the value in it instead of as just another cumbersome requirement. Nurse educators are in a
perfect position to assist their students in developing a foundational understanding of self-care.
Implementing self-care curriculums into nursing programs will provide several benefits. First,

IMPORTANCE

students will improve their own health and will know how to deal with stress at an earlier point
in their career (Blum, 2014). Second, caring for oneself will prepare students to be better nurseeducators for their patients because nurses who practice positive self-care behaviors become
better role models, educators, and patient advocates (ANA, 2016, p. 1).
Change theory
Prochaska and DiClemente's six stages of change best informs our recommendations for
change because the stages allow for an assessment of readiness for change and provide
recommendations for implementation. Prochaska and DiClemente suggest that there are six steps
involved in change. The first stage, pre-contemplation, describes an organization that is not ready
to make change within the next six months. The next stage is contemplation and represents an
organization planning to make change in the next six months. At this point, the organization is
aware of the positive aspects of change, but also the negative impact of change. The following
steps are preparation, action, maintenance and termination. BTC is in the preparation stage
illustrating an organization preparing to make an intentional change within the next three
months. This model will help nursing instructors to transition from the current EBP curriculum
into the proposed self-care curriculum. After implementing change, an organization in the
maintenance phase can assess outcomes and make necessary refinements to meet the needs of the
population. The proposed changes to the curriculum include flexibility in assignment topics
based on student feedback from the survey data. Gradual increase in assignment complexity is
proposed as part of the new curriculum implementation to allow for enhanced learning. Current
BTC students and faculty will experience an adjustment during this transition and this model
addresses resistance to change, which is common in nursing. As with any transition, adjustments

IMPORTANCE

to the curriculum will be necessary based on the needs of students and faculty while in the
maintenance phase of change.
Lewins Force Field Analysis
Implementing new curriculum comes with barriers and challenges as well as positive
change. Implementing changes in the curriculum can be a difficult transition for students. Based
on survey results, BTC nursing students expressed dismay in implementing additional self-care
topics and do not wish to work in groups. Students were unhappy with unclear directions and
expectations in the rubric guiding the assignments. This is a second challenge that applies to the
nursing faculty. Our proposed solution includes consistent grading among instructors across the
program. One positive aspect of this change is that each assignment focuses on a component of
self-care that builds on the previous assignment which allows students to practice self-care
techniques. We intentionally placed occupational well-being as the final assignment to prepare
students for the transition into the workplace. The proposed change in assignments allows
students more freedom in selecting topics that relate to their personal experience or interest.
BTC is highly likely to implement our proposed additions to the curriculum. The nursing
program faculty at BTC have expressed continued interest in changing the EBP projects based on
current research supporting the necessity of self-care in nursing. We have been working
collaboratively with the instructors to provide interventions that are relevant to the current
curriculum taught in each quarter.
Recommendations for Implementation
Once BTC and PHSJMC begin implementing self-care in their curriculum, the influences
on health and well-being will likely be positive. The first step to implementing our proposal is to
develop new curriculum that meets the educational requirements of the program. Teaching

IMPORTANCE

healthcare professionals to engage in healthy behaviors early on is beneficial and will better
prepare them for a lifelong career in healthcare. The second step will be to ensure that the
nursing faculty reaches a mutual consensus of expectations, and that their needs are met as well
as students. Nursing faculty will also need to ensure that the assignment expectations are clearly
defined for nursing students. After implementation, it will be crucial for students and faculty to
remain open-minded and collaborate as a team to make necessary adjustments.
Conclusion
After a review of the literature, there is strong evidence supporting the need for self-care
curriculum in nursing programs. BTC is supporting the implementation of self-care in their
nursing program because there is a need to support nurses in developing self-care skills early in
their career. If health promotion and self-care strategies are included in the nursing curricula, it
will enhance nursing students understanding and value of self-care, which in turn will help them
to provide high quality and safe care for their patients when they start their practice.

IMPORTANCE

6
References

American Nurses Association (2016). Healthy nurse. Retrieved from

http://www.nursingworld.org/healthynurse
Ashcraft, P. F., & Gatto, S. L. (2015). Care-of-self in undergraduate nursing students: A Pilot
Study. Nursing Education Perspectives, 36(4), 255256. http://doi.org/10.5480/13-1241
Blum, C., (2014). Practicing self-care for nurses: a nursing program initiative. The online
Journal of Issues in Nursing, 19(3). doi: 10.3912/OJIN.Vol19No03Man03

IMPORTANCE

7
Appendix A
FOCUS PDCA

Find a Process to Improve- Through research we identified a need for improved self-care
curriculum in the nursing program at Bellingham Technical College and PeaceHealth St. Joseph
Medical Centers new nurse residency program. We are making recommendations for change in
EBP projects each quarter and in the residency based on the current research to improve
satisfaction and retention in the nursing profession.
Organize a Team that knows the process- We have organized a knowledgeable team including:
Kami and Michelle who are recent graduates of Bellingham Technical Colleges ADN program
as well as Diana Davidson, current nursing faculty and Julie Samms who is a former instructor
and graduate of BTC. Another member of our team includes Lilia who has six years of nursing
experience and knowledge of importance of self-care and also mentors new nurses. We are also
working with Jane Sloane who is a nurse educator in the residency program at St. Joseph
Medical Center.
Clarify current knowledge of the process- Access to current self-care EBP projects at BTC and
in the residency program. Knowledge of gap in needs based on survey results gathered from
these populations. Survey covered existing self-care techniques used and suggestions for
improvement in future EBP projects as well as residency program recommendations.
Understand causes of process variation- Through our meetings with Diana Davidson and Jane
Sloane we identified a growing need for improvement in self-care among students and nurses.
While research supports the need for improved self-care curriculum for student and new nurses,
we found through our survey results that only 35% of nursing students were interested in

IMPORTANCE

implementing self-care into EBP projects. Only a small percent of nurses in the residency
program recalled having education regarding self-care in their undergraduate programs.
Select the Process Improvement- In the first quarter BTC will emphasize importance of
developing an effective self-care routine and resilience in the nursing profession. This knowledge
will prepare students for progression in the curriculum, in the workforce as well as in their lives.
The EBP projects will build upon knowledge learned in the previous quarter. In the sixth and
final quarter students will research topics related to occupation such as lateral violence. This will
assist them in their transition from student nurse to practicing nurse.
Plandraft a plan- Six self-care topics will be introduced in each of the six quarter with topics
building upon each other. Projects will gradually increase in complexity throughout the program.
Recommendations for the residency program will include continuation of the same self-care
topics introduced in ADN programs.
Doexecute the plan- Collect and analyze survey results. Synthesize current research regarding
importance of self-care. Collaborate with instructors to develop recommendations for changes in
EBP projects.
Checklessons learned? There is a lack of interest and emphasis on self-care in nursing and
residency programs based on our survey results and current research. There is a need for further
education regarding the role of self-care in the nursing profession. Early implementation of selfcare provides a foundation for success throughout nursing education and career.
Evaluate Actto continue improvement- should our recommendations be adopted, evaluation
would include student and instructor feedback. Future WWU BSN students can further develop
the self-care curriculum and assess current data regarding individual implementation of self-care
techniques via survey.

IMPORTANCE

9
Appendix B
Logic Model

Statement of Need: Implementation of self-care techniques into EBP at Bellingham Technical

College and PeaceHealth St. Joseph Medical Center
Resources/Inputs- In order to accomplish our set of activities, we will need the following:
Diana Davidson, Nursing Faculty, BTC
Jane Sloane, Nurse Educator in Residency Program
Self-care related evidence based research
Information gained from BTC and residency program surveys
Nursing books/existing curriculum
Activities- We expect that once we have accomplished these activities will produce the
following evidence or service delivery:
Working with Diana to implement the self-care components into each quarters EBP project
Used survey monkey website to distribute survey to nursing students and residents
Correlating self-care EBP project recommendations to current nursing curriculum
Outputs- In order to address our problem or asset we will accomplish the following
activities:
Larger emphasis placed on importance of self-care throughout education and career
Received data related to current self-care knowledge and recommendations
Building on established nursing curriculum to expand self-care knowledge
Outcomes- We expect that if accomplished these activities will lead to the following changes
in 1-3 then 4-6 years:
Nursing students and residents understand importance of self-care throughout education and
career
Utilize current evidence based research to inform project recommendations
Survey results identified gaps in current EBP projects and residency curriculum
Logical progression of self-care EBP projects for ADN program and residency

IMPORTANCE

10

Reduced stress level and burn out

Impact- We expect that if accomplished these activities will lead to the following changes in
7-10 years:
Nursing and residency programs utilize and expand self-care curriculum based on feedback and
current evidence
Nurses practice self-care throughout career
Increased retention of new nurses

IMPORTANCE

11
Appendix C

Force Field Analysis

Driving Forces
Restraining Forces

Proposed Change

Reducing stress level

and burnout through
nursing school

Developing a
Preparing students
for
Self-Care
work experience
Curriculum
for BTC
Nursing
Students and
PHSJMC
Better role models,
residency
educators and patient
advocates
program

Increasing retention of
new nurses

Only 35% of students

are interested in EBP
project

Limited peer-reviewed
research for some topics

Will students continue

practicing self-care
behaviors through their life?