by Stephanie Stemmler • March 10, 2019
Pat Nellis, OTD, OTR/L, (standing), helps a participant complete her well-being map at Cardinal Ritter Senior Services.
In a senior living community outside of St. Louis, a group of women, ages 55 to 70, are making goals for themselves focused on improving their sense of well-being and their overall ability to manage life’s transitions. In the midst of laughter and conversation, they each create a web-like map of their strengths and challenges in the areas of physical activity, nutrition, sleep, positive emotions, their sense of purpose, social connectedness, and serving others.
“Well, it’s no secret that I need to work on nutrition and exercise after looking at my map,” laughs Carol Grant, one of the participants, as she shows off her results. Others in the group point to sleep or creating a sense of purpose as other potential challenges in their lives.
The maps the group has created are visible tools that highlight the long-recognized indicators that can promote— or hinder—a sense of well-being.
“Well-being is a subjective sense of being content and happy with your life,” says Patricia Nellis, OTD, OTR/L, director of the Division of Clinical Operations in the Program in Occupational Therapy at Washington University School of Medicine. “But it’s critical to teach people to focus on their well-being because when a person is negative, depressed, not involved, not coping well, eating or sleeping badly, they end up in a state of social and functional decline.”
Nellis and colleague Lisa Carson, OTD, OTR/L, want to develop actual functional tools that can help individuals enhance their sense of well-being. They are piloting a new public health and community education program that focuses on proactively identifying and addressing potential negative factors of well-being. Called “Map Your Path to Well-Being,” the 9-week program was initially piloted in a group of adults with disabilities. Nellis is now working with seniors and hopes soon to develop a similar education tool to use with children.
“There are few, if any, comprehensive tools that evaluate areas such as meaningful occupation, social connectedness, mindfulness, and joy through helping others,” says Nellis. “We want to help people develop an action plan to improve their quality of life and a sense of well-being and then share those proven strategies with community groups, physicians and others, as well as incorporate them into our occupational therapy clinical practice curriculum.”
The World Health Organization defines overall health as a state of complete physical, mental and social well-being, and not merely the absence of illness or disease. For physicians, then, it is more than focusing on disease prevention and treatment; it is taking a holistic view of an entire person and prompting them to take action to reach and maintain a positive sense of well-being.
The process has its roots in the evidence-based field of positive psychology, which is the scientific study of the various strengths that enable individuals and communities to thrive. In 2008, the British New Economic Foundation noted that there were five actions to improve personal well-being:
It is those five actions that are embedded in the new occupational therapy well-being program. Step one for participants is to complete a global health assessment and create their “map” of strengths and challenges.
Once challenge areas are identified, participants then are asked to identify small, achievable goals that can potentially turn a negative into a positive. At Cardinal Ritter Senior Services, where the group of women volunteered to participate in the pilot program, all are single and living in independent living apartments. For some, says a Cardinal Ritter services coordinator, winter months often are times when it’s difficult to cope with aspects of daily living, which, in turn, can lead to anxiety, stress, or even medical decline.
Carson, an occupational therapist with a particular interest in healthy aging and the management of life transitions, hopes the well-being program encourages older adults to identify and continually implement small actions that optimize a positive outlook on life.
“Part of this course is that we want you to make a positive change in your life,” Carson tells the women. “And it starts with an action plan. We want you to set a goal to improve one thing and then write down how confident you are about achieving this goal and in what timeframe.”
At first, the women talk about broad goals—eating better, exercising more. Carson and Nellis encourage more details to create actionable goals. Carol Grant, for example, wants to try eliminating one favorite food from her diet as her first step toward eating healthier. “I’d like to stop eating chips, but I have them around for my grandchild when she visits, so I eat them all the time,” she says. But with encouragement, she agrees to hand over the chips after her grandchild leaves to Patricia Redeker, a friend in the group. “This accomplishes two things,” applauds Nellis. “You are taking a concrete step to improve your eating habits and you now have a stronger social connection with Patricia, because she’s going to help you with your goal.”
After the weekly session, Carol Krews, 73, notes, “I like to learn, so this process of goal-setting is interesting. Especially since we all live alone, we need to remember to keep doing these self-assessments and think about well-being more often. It’s made me realize that this is, in fact, a lifelong process.”
Nellis, who previously was director of inpatient rehabilitation services at Barnes-Jewish Hospital, says she firmly believes that health care doesn’t always need to be reactive. “We can be proactive and preventive,” she stresses. “Well-being needs to be part of the prescription for health, and, as occupational therapists, we want to teach others proven strategies that will keep people healthy out in the community for as long as possible.”
As she and Carson finalize the assessment and action tools to enhance well-being, Nellis adds, “I feel we are making a difference at the front-end of care. In that way, occupational therapists are the icebreakers. We’re breaking up the ice and modifying care delivery practices so that we are at the forefront of helping to improve quality of life for individuals and communities.”
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