Enhancing positive psychology in wellbeing of clients

With careful cultivation, the flowers of positive psychology can bloom in every region of the Earth so we may see one enchanted global garden. (Yang & Lu, 2007). Literature states “Positive psychology can be regarded as that discipline in the psychology that focuses on positive experiences, positive emotions, positive personality traits and positive social interactions”. (Pietrowsky & Mikutta, 2012).Additionally, positive psychology is “A science of positive subjective experience, positive individual traits, and positive institutions promises to improve quality of life and prevent the pathologies that arise when life is barren and meaningless”. (Seligman & Csikszentmihalyi, 2000). In nursing practice it’s applicable as it focuses on providing various techniques like counseling sessions which encourage clients to explore and develop positive emotions, positive behavior and characteristics which lead to wellbeing.

The purpose of choosing this topic is to address the application of the new branch of psychology i.e., positive psychology in clinical setup.  The interventions of positive psychology are helpful in maintaining subjective wellbeing. It’s the responsibility of nurses for providing holistic care to patients and she must focuses on all three components of health. According to WHO these three major components include physical, mental and social wellbeing. If any of the components is ignored health of individual may deteriorate e. (WHO, 2011). In health care settings nurses focus on medical management to recovery, alleviate suffering and prevent diseases but unfortunately they ignore the set of human strengths that are the most likely buffers against illness. Optimism, interpersonal skills, work ethic, hope honesty and perseverance play a key role to wellbeing (C. Snyder & S. Lopez 2002).

positive-Pschology

Positive psychology focuses on three areas of human experience, these dimensions include, subjective level, individual level and society / group level. At subjective level it focuses on positive emotions like, happiness, joy, love, satisfaction with life and confidence. (Snyder., & Lopez, (2007).I encountered a 13years old male patient in my pediatric rotation that became mute on hearing a bad news of her mother’s death.  We tried our level best to make him vocalize through encouragement, care and love through attention. At individual level positive psychology focuses on positive individual traitsthat are core values in individual behavior pattern such as courage, honesty and wisdom. (Snyder, & Lopez, 2007).Muslims have the believe that they are answerable to their deeds, virtues and sins on the Day of Judgment. In Pakistani literature it’s been supported that we adopt honesty, wisdom and perform good deeds for spiritual and religious wellbeing.”Positive psychology, therefore, opens up new vistas for interaction between science and religion” (Watts, Dutton, & Gulliford, 2006, p. 281). A research was done to prove the association between religion and positive psychology among Pakistani university students. They showed positive results that are religious and spiritual wellbeing are connected with healthier self-functioning. (Khan & Watson 2006). In my opinion the purpose behind providing pray areas at most tertiary hospitals  are to provide opportunities for patients and families to practice religion in improving illness. At Society/Group Level it provides positive institutions where it addresses issues and develops healthy families and communities. (Snyder, , & Lopez 2007)

“Positive psychology adopts an Aristotelian view that human nature is innately good. According to the Aristotelian model, humans should exercise their many virtues and live their lives at their best.”(Yung & Lu 2007). Here the ethical principal autonomy is highlighted. In the health care settings we provide consent form to patients to decide for his or her own treatment modalities and we respect patient’s decisions and care patients based on patient’s decision. In this situation individual becomes an active agent in his cure and treatment .Self aware, self chosen and self determination can further be explained in Dabrowski’s Theory of Positive Disintegration as the theory describes a process of personality development – the creation of a unique, individual personality. (Dabrowski, 1995)

The significance of positive psychology is enlightened in perspective on positive aspect of human nature, and flourishing individuals, societies and community’s wellbeing and recovery. The positive aspect of human nature includes the human potentials, motives, capacities and happiness. Happiness is the key aspect in human nature which leads to wellbeing. A construal theory of happiness explains that some people are happier than other depends upon cognitive and motivational processes that enhance happiness and transient mood which leads to wellbeing. (Lyubomirsky, 2001). Experiences of positive emotion signal well-being and perhaps guide behavior in the moment. Positive emotions in daily life and in health care setting play important role in wellbeing. The broaden-and-build theory suggests that capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing. The balance between positive emotions such as joy, happiness, love and negative emotions such as anger, anxiety and sadness judges wellbeing. Hindering negative emotions and expressing up positive emotions ensure wellness. “Positive emotions are worth cultivating, not just as end states in themselves but also as a means to achieving psychological growth and improved well-being over time”. (Fredrickson, 2001).  Subjective wellbeing depends on satisfaction, controlling negative emotions and experiencing pleasant emotions. According to Fredrickson.B (2001) Positive emotions facilitate the creation of important skills and resources. For instance nurses help clients to improve self esteem, encourage them to participate in different activities which improve their interest in daily activities. In addition, positive psychology is helpful for resilience in people. Majority of people around world are happy although they have various difficulties and problems. (Meyers, 2000). Nurses help patients to cope successfully with various medical conditions through counseling and therapeutic communications. For instance at the initial stage of diagnosis of any chronic illness patients get worry, anxious and depressed. At that time nurses reassure the patient. Reassurance and enabling patient to ventilate feelings become helpful to cope with the stressful condition. In this regards nurses help clients, families and communities to build thriving.

Positive psychological wellbeing directly influences favorable outcomes in the form of survival. “Positive psychological well-being has a favorable effect on survival in both healthy and diseased populations”. (Chida & Steptoe 2008). Positive psychological wellbeing is associated with health. It includes positive effect, happiness and cheerfulness.  Positive affect can is a state of pleasurable engagement with the environment eliciting feelings, such as happiness, joy, excitement, enthusiasm, and contentment. (Chida & Steptoe 2008).  In clinical setting we come across different patients with different diagnoses and every individual has different level of anxiety related to the prognosis of disease. Patient become helpless and thinks negatively about themselves and having negative thoughts about their surroundings. If nurse become able to lessen the anxiety level, decreases depression and distress than she helps patient to decrease morbidity and mortality. Our positive and negative affective states have close linkage with central nervous system loci and mechanisms involved in the regulation of cardiovascular and neuroendocrine systems. (Critchley 2005). So persistent positive affect could lead to down regulation of psychobiological responses implicated in disease risk (McEwen 2007). Using positive psychology in nursing practice nurses can identify high risk population and individuals who are prone to get stress, and anxiety which later leads to cardiovascular diseases. Effective nursing intervention like improve positive affect like joy, emotional wellbeing happiness and positive traits like disposition i.e., hopefulness, life satisfaction, sense of humor optimism are linked with reduced cardiovascular mortality. (Chida & Steptoe 2008). ). In communities nurses encounter patients having chronic diseases like hypertension, and cardiac disease. Nurses focus on behavioral and physical components of patient to achieve cardiac outcomes. Individuals with hopefulness and positive physiological states may have grater cardiac outcomes as they are highly involved in healthy behaviors healthy eating, physical activity, smoking cessation, and medication adherence which are associated in enhancing cardiac outcomes. (Dubois, Beach, Kashdan, Nyer, Park, Celano & Huffman, 2012)

In several studies it has been evident that positive psychology alleviates depressive symptoms in patients having major depression. A randomized controlled study was done to implement two intervention i.e., best possible self, three good things. The results showed that patient’s well-being and resilience increased and depressive symptoms declined. (Pietrowsky & Mikutta, 2012). During our mental health clinical rotation a patient was provided a pen and notebook to write moments of his life where he became happy. After three weeks it’s observed that patient was able to list down the joyful moments in his life. And he developed positive thoughts about his future and insight improved regarding treatment.

There was a debate whether positive psychology was embedded in culture or free. (Jorgensen and Nafstad 2004). According to Peterson and Seligman (2004) survey on influential traditions, including Taoism in China, Buddhism and Hinduism in South Asia, ancient Greece, Judeo-Christianity, and Islam in the west proved that in every tradition some personal characteristics and virtues like wisdom, courage, humanity, justice, temperance, and transcendence are present which grows its root in positive human nature. Scholars generally agree that a core group of positive traits and processes exist across cultures and that these dispositions can be modified by cultural environment across time (Jorgensen and Nafstad 2004). Trans cultural nursing provide holistic care to individuals from different cultural backgrounds. It respects patients believes, norms, languages, and provide a constructive environment where patients can practice their rituals which harmonize their mind to get recovery and wellbeing. In Pakistani context)

The scope of nursing is not only confined to hospitals, it also comprised of community health nurse, school health nurse etc. In these areas nurses play a role of counselor or teacher. School health nurses can guide teachers to practice positive psychology in class room to improve the behavior and learning of pupils which further improves self concept. If student are treated positively it results in seeing themselves in more positive terms. The self concept develops through the feedback individuals receives from others i.e., social approval and social experience is crucial in the development of self concept. Additionally positive reinforcement plays a key role in developing self concept. Being a nurse if we address the positive psychology in different institutions like schools we develop our youngsters and youth to lead the nation in a different way which focuses more on our positives attributes, and positive deeds. (Swinson & harrop, 2012).  In another study it’s evident that through participation in positive psychology course students reported gains in hope, self-actualization, well-being and pathway hopefulness, purpose, and mission in life. (Maybury, 2012)

In conclusion positive psychology deals with positive emotions, positive experience, positive traits and positive social interaction. It consists of subjective, individual and societal /group levels. In subjective levels it majorly discuses about positive emotions like, happiness, joy, love, satisfaction with life, and confidence. In individual level it focuses on positive deeds, harmony, honesty and wisdom. In societal level it deals with positive institutions. Positive psychology adopts Aristotelian view that human nature is innately good, and humans can decide best for themselves. The significance of positive psychology influence positive perspectives, positive aspect of human nature, and flourishing individuals, societies and community’s wellbeing and recovery. In nursing practice positive psychology enhances wellbeing recovery, decreases depressive symptoms, enhances cardiovascular good outcomes, enhances self actualization in students through facilitation of positive emotions which creates important skills and develops resilience. Positive psychology is embedded in cultures. In every culture there are some important traits like wisdom, courage; humanity, justice, temperance, and transcendence are common. Tran cultural nursing effectively deals with different patients from different cultural backgrounds and having different languages. It focuses on wellbeing, recovery; alleviate suffering and deals with different life events successfully. Positive psychology is a new field which is applicable in nursing practice to improve patient’s wellbeing.

By: Nusrat Nadir Khan

Aga Khan University School of Nursing.

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