This simple tool can help staff change their outlook and improve care.
- As nursing leaders, we must recognize the importance of building staff resilience and improving the well-being of our caregivers.
- Three Good Things is a simple, yet powerful tool that can help us counteract our natural tendency to focus on the negative and change the way we perceive our reality.
“The negative screams at you, but the positive only whispers.”
— Barbara Fredrickson, PhD, positive psychologist
NEGATIVE EMOTIONS and events are more powerful than positive ones and are constantly vying for our attention. They also affect us more deeply. In the healthcare environment, nurses are surrounded by stress. ANA Enterprise’s recent HealthyNurse™ survey found that 60% of nurses who responded reported being “at a significant level of risk for workplace stress.” And 64% put their “patients’ health, safety, and wellness before” their own. If nurses don’t have the ability or personal resources to overcome the challenges and stressors they face every day, providing high-quality, patient-centered care at the bedside becomes increasingly difficult for them. Over time, this strain on their existing resources can lead to staff burnout and turnover and negatively impact patient outcomes.
Stress is an obvious part of an emotionally and physically demanding profession, but positive emotions and events—a nurse and a nursing assistant working together to bathe a patient, a patient smiling after achieving his daily ambulation goal, nurses sharing a laugh in the staff breakroom—occur every day yet frequently go unnoticed. Each of these moments presents an opportunity to highlight the goodness that exists around us while actively engaging staff in enhancing their own well-being and resilience to stress.
Counting your blessings
Robert Emmons, PhD, a leading expert in the science of gratitude, introduced the concept of “counting one’s blessings” as a gratitude-inducing exercise to improve well-being. Through his work and research by positive psychologists and neuroscientists, gratitude has been shown to have many benefits, including improved mood, better sleep, decreased depression symptoms, and enhanced social support. In the workplace, intentionally cultivating and accumulating positive emotions, such as gratitude, can broaden our minds and awareness and build lasting resources that result in an upward trend toward stronger, healthier individuals and higher performing teams.
Three Good Things, also referred to in the research as Three Blessings, is an extension of gratitude and a simple yet powerful tool that can be used to increase positive emotions and make positive events and moments more visible. Researchers have demonstrated that positive reflection can reduce burnout, build resilience, and improve the well-being of individual participants. Dr. Martin Seligman, considered the “father” of positive psychology, showed during a 1-week intervention that when participants took time at the end of each day to write down “three good things” (three things that went well) and why those good things happened, they experienced a significant improvement in both happiness and depression. This impact was sustained for 6 months after the intervention.
Dr. J. Bryan Sexton, director of the Patient Safety Center at Duke University, has pioneered the use of Three Good Things in healthcare and validated its benefits for frontline staff. A 2-week intervention with healthcare workers resulted in a 22% decrease in burnout that was sustained 1 year later. Participants also reported a 40% drop in depression, fewer delays, better work-life balance, and less conflict with colleagues. His team found similar results with neonatal intensive care staff at Duke University, University of North Carolina, and Stanford University hospitals.
The “power” behind Three Good Things lies in our increased ability to perceive positive emotions. Stress, anxiety, and burnout narrow our thoughts and focus, making it more difficult to see the positive and to view our reality through a rational lens. Intentional tactics to cultivate positive emotions and thoughts, including Three Good Things, can help us counteract our natural tendency to focus on the negative and highlight more of the positive that already exists around us. In the process, these positive emotions broaden our thoughts and awareness and begin to change the way we perceive and interpret our reality, including the adversities and stressors we face each day.
Implementing Three Good Things
Three Good Things is a simple, powerful, low-cost tool that can be used throughout a healthcare organization to help individuals, teams, and organizations counteract the natural tendency to focus on the negative. Nursing leaders can reap the benefits of Three Good Things in many ways. The key is to find the best way to implement it for your own work environment. Whether you implement it as a daily, weekly, or monthly activity, you’ll be able to realize the value of an intentional focus on the positive.
Anyone can start a Three Good Things intervention tonight. At the end of the day, before you go to bed, write down three good things that happened that day and reflect on why they happened. For maximum impact, repeat this daily exercise for 2 weeks. You may find it challenging at first to come up with three good things from your day, but the good news is that by day 4 or 5 remembering the good becomes easier. The brain begins to more effectively recognize and interpret the positive moments that we experience each day. This powerful tool can be used to improve your current levels of well-being and any time you begin to feel that your personal resources are being depleted.
Education on Three Good Things increases staff awareness of this tool, but ensuring staff adherence to the intervention outside of the workplace may be challenging. A little creativity can help engage staff in noticing the positive over a 2-week period. For example, pass around a sheet at the end of each shift on which staff can write down a good thing that happened that day. Then share three of those good things at change-of-shift report to start positive conversations rather than defaulting to our tendency to share stress and difficulties. (See Three Good Things in action.)
Incorporating Three Good Things in meetings can be as simple as asking participants to share something good at the start of each meeting. When you start on a positive note, you can change the meeting’s tone and enhance the engagement of staff in discussions of unit initiatives and challenges. Alternatively, ending your meetings by sharing good things allows individuals to leave the meeting with positive energy that they can bring back to the team.
Another option is asking staff to share Three Good Things and then one thing that can be done better. This approach can help remove the barriers that staff members face in speaking up about the challenges they experience at work. As a new nurse manager, I used this concept in my individual one-on-one meetings with each staff member. In addition to building connections with each employee, I garnered valuable insight into the existing strengths and opportunities for improvement on my new unit. (See More good things.)
Spread the word
As nursing leaders, we must recognize the importance of building staff resilience and improving their well-being. Three Good Things is a validated tool that holds the potential to enhance staff members’ lives and enable them to positively adjust to the adversities they face in the healthcare profession. Start using Three Good Things tonight and experience the benefits yourself. You might even find that it’s addictive—and contagious.
Paige Roberts is a nurse manager at the University of North Carolina Medical Center in Chapel Hill.
Adair KC, Sexton JB. Positively reflecting backwards and forwards is associated with improvements in well being. J Posit Psychol. Accepted for publication 2018.
American Nurses Association & Insight Consulting Group. Healthy Nurse, Healthy Nation™ Report. July 13, 2018. Unpublished.
Armenta CN, Fritz MM, Lyubomirsky S. Functions of positive emotions: Gratitude as a motivator of self-improvement and positive change. Emotion Review. 2017;9(3):183-90.
Emmons RA, McCullough ME. Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84(2):377-89.
Fredrickson BL. Positive emotions broaden and build. In: Devine P, Plant A, eds. Advances in Experimental Social Psychology. Vol. 47. San Diego, CA: Academic Press; 2013.
Korb A. The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time. Oakland, CA: New Harbinger Publications; 2015.
Roberts P. The power of the positive. Am Nurse Today. 2015;10(7). americannursetoday.com/the-power-of-the-positive
Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: Empirical validation of interventions. Am Psychol. 2005;60(5):410-21.
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