Wisdom

Think about a person whom you would consider wise. Who comes to mind? This might be your grandmother, a beloved teacher, a famous leader or author. Then ask yourself:

"What about them makes you think they are wise?" 
"What qualities do they have?" 

 

What Capacities Characterize Wise People? 

 

Wisdom researcher Monika Ardelt has done some very nice work delineating what characteristics exemplify a wise person.  She has separated these characteristics into three main domains.  

REFLECTIVE: Wise people can see things from multiple perspectives, rise above their own perspective.  This requires self awareness and self-insight.  

COGNITIVE: Wise people can see the deeper meaning, can apply knowledge and skill to right action, can deal with ambiguity and uncertainty, and they know what they don’t know.

AFFECTIVE: Wise people are compassionate.  And finally they have a focus on the greater good, and in their actions try to make the world a better place.

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Wisdom In Medicine
What Does It Mean To Act/Think Wisely As A Health Professional?

High levels of knowledge and skill, with the capacity to apply that knowledge and skill to a particular circumstance, Compassion, intellectual humility, learning from mistakes, seeing the bigger picture, these are all particularly important qualities in health care professionals. Maybe these are exactly the qualities that make us worthy of the trust that our patients put in us.

How Did Your Wise Person Get That Way?

One thing that comes out consistently when people talk about their wise person is that they are not perfect.  In fact, Becoming wise is really all about how one handles ones imperfections rather than about being perfect—a very very important distinction.  Wise people are humble, and VERY aware of their vulnerability to mistakes—but they also see their mistakes as an important window into how to get better.  So they look carefully at them, take them in, and learn from them.  So helping clinicians deal with imperfection is a big part of enhancing wellbeing and wisdom both. 

Back To Your Wise Person. 

Now, back to that wise person—how do you think they got that way?
It turns out that wisdom has a special relationship with adversity.  And it does appear from the 20 or so years of research into how wisdom is developed, that adversity is a particularly fertile opportunity for the development of these qualities that define a wise person.
It is what we bring to the table when adversity strikes?
Or is it what happens during and after—our social supports, what we do, the circumstances?
Maybe it’s a little bit of both.
There are likely predispositions (capacities, ways of seeing events) that predispose us to wisdom formation through experience (openness to experience, positive emotion, gratitude, forgiveness) (Gluck 2013, Plews-Ogan et al 2018, Jayawickreme et al 2017).
There are ways of reflecting on/processing experiences that are associated with wisdom gained (Gluck, Bluck and Westrate 2018, Plews-Ogan 2013, 2017).
 

Their findings demonstrate that “wisdom was positively associated with exploratory processing of difficult life experience (meaning-making, personal growth), whereas redemptive processing (positive emotional reframing, event resolution) was positively associated with adjustment.” (Gluck and Westrate 2017).

Redemptive processing: less psychologically risky.  Results in adaptation rather than growth. 

Exploratory processing: “This type of self-reflection is rare, probably because it is less pleasant than other processing modes. 

Dialectical integration (Linley 2003): a synthesis of regular life with trauma in which a person is able to “simultaneously hold in mind two opposite positions on the basis that they are but part of a wider picture in which the opposition is subsumed” 

This program is called Wisdom and Wellbeing for a reason: we have an intentional focus on helping people move through difficult experience (which is an inevitable part of life in the health care environment) with the best possible chance of doing well, of learning and growing through their experiences. 

This program is called Wisdom and Wellbeing for a reason: we have an intentional focus on helping people move through difficult experience (which is an inevitable part of life in the health care environment) with the best possible chance of doing well, of learning and growing through their experiences. 

So how does one go about fostering wisdom?
 
1. Assure that unnecessary stressors (insufficient supplies, inefficient or unsafe processes and environments) are given the attention they deserve and addressed quickly.
2. Help people to have a healthy internal set of resources, a platform of positive emotion, an openness for engaging with uncertainty.
3. Create a “wisdom atmosphere”—an environment that is supportive of growth, that brings out the best in people, that supports exploratory processing of difficult events, of creatively and courageously  engages with each other.
4. Help people to regularly touch down on the deep meaning of their work, and how their work connects to the larger picture.
5. And finally, pay attention to the critical events and how they are managed.  Assure that when a critical event occurs, people have the necessary and guidance to move through these experiences in the best possible way—these are situations like adverse events, mistakes, difficult conversations.
 

The Wisdom & Wellbeing Bundle
The capacity to act wisely is built through skills, practice, training, and experience. It is fostered in an environment that optimizes human performance.
 

 

 

Green zone interventions include ones to build both internal and unit or departmental positive emotion.I do believe, and the research is beginning to bear this out, that cultivating curiosity, forgiveness, compassion, gratitude, openness, these emotions, can set the stage for a wisdom-generating response to adversity. 
It takes work, and intentionality, to firmly establish these emotions.  At UVA, we have multiple partners  build this atmosphere including the Center for Appreciative Practice, Compassionate Care Initiative, FEAP, all focused on cultivating these emotions in our community, so that when challenges occur, as they inevitably will, we have the best chance of responding in a way that will generate wisdom rather than hate or further suffering.
 

Positive Emotion: The ‘oxygen’ of the Wisdom Atmosphere

Gratitude

What is so special about gratitude?

Two steps: 
1. Recognizing something good
2. Recognizing that it is because of something outside oneself

It is other directed (an “empathetic” emotion)
It is pro-social (builds trust)
It is associated with other positive emotions, including happiness, meaning, hope, optimism, connection, and helping people to positively interpret life experiences
It is incompatible with anxiety
It is easy to cultivate
 

Appreciative Practices = Positive Habits (That can change everything)
 

Assume positive intent
Compassion/empathy training
Foster gratitude
Appreciative gossip/use positive story
Foster curiosity (judgment-->inquiry)
Explore success as well as failure 
Appreciative check in
Mindful practice (including S.T.O.P.)
Change the narrative (we are the story we tell ourselves
Peer support 
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So this is what one of our team resources looks like
Notice the three positive practices worked into the stress continuum—helping people to see which practices can be used most beneficially in which stress zone.

We talked about gratitude and it’s a great green zone practice.

On using the breath:
Breathing has been studied now for a number of years as a means of self-regulation, of moving from an anxious state to a more calm, positive emotional state, and has been found to both reduce anxiety and enhance performance on cognitive tasks (Khng,2017, Brunye et al 2013, Chen et al 2017, Hyama et al 2012, cho 2016,). Taking a few slow deep abdominal breaths seems to help us calm both physiologically and emotionally.
So here are a couple of ideas to try with your teams
Encourage people to “gel in and breathe”—take that moment (literally it takes 2 seconds) to pause between patients, while donning and doffing, to calm, settle and prepare

S.T.O.P is another technique we teach people to gain control of their reactions in situations of high stress.

Does this Wisdom and Wellbeing Approach WORK in real life?

We did a pilot in the STICU—a highly stressed work environment that had struggled literally for years to try to maintain a good working environment.  It was in the lowest percentile for engagement and had one of the highest nurse turnover rates in the health system.  Our pilot demonstrated truly impressive improvement in engagement and staff turnover

We were also able to demonstrate, with a mindfulness intervention, a statistically significant improvement in professional quality of life among the STICU employees, improvement in compassion satisfaction, and significant reduction in burnout and secondary traumatic stress.

So yes, it works.  Beyond a shadow of a doubt.
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Peggy-Plews Ogan, MD MPH is a nationally recognized leader in Wisdom. She presented this material at the Medical Center Hour at the University of Virginia in 2019.