Case Notes on Self: The benefits of journaling as self-care

During the last lockdown, I gave myself a 30-day journal writing challenge. Initially to see if it would improve my writing skills, but also to see if journaling as a self-care strategy would have a positive effect on my wellbeing. 

I lost a close sibling the month before I started journaling. There was no shortage of personal material to write about. Not that I intended to use it for the sole purpose of working through my grief, but as it turned out, it was a vehicle for processing my loss. I also used it to reflect on the challenges and demands of my work, and as a springboard for initiating professional writing, poetry, and non-fictional pieces I was working on. I also discovered that writing regularly in my journal improved my writing skills. Moreover, over the weeks and months, I noticed the positive impact on my wellbeing. Through regular written reflection I came to a greater understanding of personal and professional issues. It gave me insights into some of the issues that lay beneath my frustrations with others, and I was able to find resolution with some of the problems I took to the page. This in turn helped me feel more at ease. 

Carry forward four months and journal writing has become part of my daily routine — now an intentional self-care strategy. The first thing I do most work mornings. With coffee in hand, after waking, I head straight to my desk and use the freshness-of-mind at the beginning of a day to write. Sometimes I start with leftover thinking or work experiences from the day before, or I return to a previous entry or piece I have been working on. Other mornings I have nothing to start with outside the day, date, my mood or the weather I see through the window above my desk — so that’s where I begin. 

On the odd occasion, my whole being is bursting to get to the keyboard from the moment of open eye. It’s as if an energy outside myself has entered the ideas space in my brain and my hands and takes over. These mornings, I let my fingers do the talking as they race to keep up with the words pouring through me. Whichever way I start on the page, it is a practice that generally sets me up for a good day, giving me a sense of achievement and quiet mindfulness. Journaling nurtures and develops my creativity through written expression and I carry this energy into the rest of the day. It’s also like morning exercise for my brain and soul and without exception, it makes me happy. And that’s got to be good for my wellbeing!

As nurses and midwives, we are trained to write about the health and wellbeing of our patients. Our case notes cover their daily status, treatment progress and recovery. Whether in a hospital or community-based setting our nursing case note documentations cover the gamut of our interactions and care. And, whether in a direct clinical role or that of a manager, academic or in the business of policy or service development, nurses and midwives are skilful and experienced writers. 

Also, because we are trained to observe with an acute eye for the subtle changes in a patient’s presentation (and we have highly developed attunement and assessment skills) we are good at picking up the nuances and variations in their mood, behaviour, responses to treatment, vital signs, and subtle changes to their physical, emotional, and mental states. Add to that our accumulated and intuitive knowledge of caring and we’re in a good position from which to write on what we know, hear, what we see, and what we intuitively know is going on for those in our care. 

Journaling gives nurses and midwives the opportunity to use the skills they’ve developed through the practice of daily patient case note writing as reflective tools to observe and process their own worlds. To come to a greater understanding of self in the workplace and the world and to use written reflection as a form of self-care and to improve wellbeing. 

The work we do as nurses and midwives and the contexts in which we work are diverse and rewarding but challenging — especially in the last few years. We know all too well the mental health cost of our work. We also know and understand the importance of debriefing, professional reflection and clinical supervision and how they help us process, make meaning of and gain insight into our work practices and what goes on in the workplace. Importantly too, we have come to see and value the need for self-care as a way to maintain our health and wellbeing and to prevent workplace fatigue and burnout. The use of journaling is one such way that nurses and midwives can practice the self-care. 

In a study to determine the effect of journaling on the degree of compassion fatigue, burnout, and trauma/compassion fatigue in registered nurses it was found that over time, journaling not only had a positive effect on the ability of nurses to handle stress but also improved their compassion satisfaction and decreased burnout, trauma and compassion fatigue. 

Secondary outcomes of the study demonstrated that regular journaling increased nurses’ awareness and expression of their feelings. Themes that emerged from the journaling process were 1) that it allowed nurses to unleash their innermost thoughts, 2) that it helped nurses articulate and understand their feelings more concretely and 3) that it helped nurses make more reasonable decisions.

Nurses in the study said that journaling:  

• “allowed me to unleash my inner thoughts, to use the journaling experience as a valve to release pressure”
• “helped me have a place to pour out thoughts or to rant by writing rather than getting the urge to do it out aloud when it is not always appropriate” 
• “has given me knowledge and tools to express my inner experiences”
• “made me more in touch with myself and created an awareness which helped me take care of myself and therefore better care for others”. 

And a last offering from a nurse in the study that captures the process and use of journaling: “when I feel stressed, I use free-flow writing to get my ideas down. It really helps get things on paper. After I finish writing and reread it, it helps me understand what I have been feeling, and makes it easier to deal with”.

Whilst I have titled this piece case notes on self, the journal entries we may make as nurses and midwives don’t have to be in written form. There are as many ways of keeping a journal as there are types. A Nurse Art Therapist I once supervised drew diagrams, figures and pictures with coloured pens, pencils, and crayons into a bound scrapbook. This was the medium that she used in her work with clients, so it was natural for her to use this method for her own reflective process. 

Many people use gratitude journals, with the focus on regular expression and development of thankfulness, wonder at the small and the cultivation of humility and gratefulness. Other people use journaling in dot points or bullet journaling as it is described. 

I have used the dot point listing for prioritising and planning at different times through my journal. This form of journaling can be a great way to get things out quickly onto the page, in short form without too much detail. The dot points or lists can then be used to refer back to and/or developed further at another time. 

Some people love journaling apps. There are a multitude available — some free, others at a cost and many available through health organisations. For those who prefer the ease and accessibility of smartphones, the app journals may be preferable. 

The message is: each to their own. There is no one ‘right’ type or way to journal. There are many mediums and it is worth finding a method and approach that works for you. I would say, however, that I do think it is a worthwhile and effective self-care strategy. Not the only self-care strategy in my toolbox, but now as a declared Nurse-Writer, I use it also to hone and practice my writing skills and maintain my wellbeing.

Here are my tips, based on the how-to literature I’ve read and my own experiences: 

Starting out: 

• Take one word at a time, one entry at a time. 
• Make an appointment with yourself, put it in your diary, and show up. Close the door behind you. Let others know not to disturb you throughout your ‘appointment’. 
• Start small. Begin with the date and the weather if that helps to get you going. 
• Yes, it can be like a diary to begin with. You are making the rules. Your rule might be there are no rules at all. 
• Ten minutes at a time might be enough to start with and build it up as you progress. As with most new things, if you’re new to journaling it will take time to develop your skills, but it is important to show up to the page and give yourself permission to be there. 
• It will get easier, you will get better at it, but unless you commit (even after writing only a few words some days), you can’t give yourself a chance to make it work.

Frequency and timing: 

• Journal as often as you can, but start small. Five minutes three times a week for the first month might be how you start. Your sessions can expand as you build your skill, enthusiasm, and commitment. 
• Choose a convenient time. I like mornings, but I don’t have to leave the house at 6 am for a morning shift. It might be at your lunch break or the finish of your shift. It might be better in the evening as part of your wind down. The key is regularity. It doesn’t have to be daily, but the more you journal, the more you’ll journal. 

Volume: 

• Write as little or as much as you like. If 5 minutes is all you have, see what comes out in that time. Trust that you will know when you’ve written enough or expressed what you need to. 

Most importantly: Remember who this is for. 

• Write for yourself. This is your journal. Your place to express and understand what you are going through. You don’t have to write for anyone else, so feel free to express it like it really is, and don’t let grammar and spelling slow you down. 
• In your reread (if that’s what you choose to do), you can edit and add anything you wish. Let your fingers speak what is in your head and heart. If you choose to share any of what you put down on the page, you are in control of that. This is your Case Note, nobody else’s.

Through a commitment to the practice of journaling on a regular basis, nurses and midwives as natural writers can employ this effective self-care strategy to decrease personal and professional stress, improve their understanding of self, develop, and nurture their expressive creativity and improve their wellbeing. 

If you uncover something in your journaling that you’d like to discuss further, Nurse & Midwife Support is always there. Call them a call on 1800 667 877 or reach out by email.