‘Five Ways to Wellbeing’ (New Economic Foundation (NEF), 2008) is a well-known evidence-based approach to creating wellbeing in individuals and communities.

Improving wellbeing can lead to improved physical, mental and emotional health, improved relationships, or getting into work and productivity (Department of Health 2014). I have discovered, through working with communities over many years, that there is a pattern to how the Five Ways to Wellbeing occur and I hope to explain that pattern and how nurses can enable it to occur within their own clinical practice.

For example, rather than telling patients to be more active, it is about enabling conditions within which the Five Ways will occur naturally. The approach is more social than clinical, but community nursing is about both. Nurses can catalyse wellbeing often via simple changes to their practice, rather than just providing clinical care.

Five Ways to Wellbeing

  • ONE. Connect – Connect to the people around you: with family, friends, colleagues and neighbours, in home, work, school and in your local community. Think of these as the cornerstones of your life and invest time in developing then. Building on these connections will support and enrich you every day.
  • TWO. Be Active – Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercising makes you feel good. Most importantly discover a physical activity you enjoy and one that suits your level of mobility and fitness.
  • THREE. Take notice – Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.
  • FOUR. Keep Learning – Try something new. Rediscover an old interest. Sign up for that course. Take on a new responsibility at work, Fix a bike. Learn how to play a favourite instrument or cook your favourite food. Set a challenge you will enjoy achieving. Learning new things will make you more confident as well as being fun.
  • FIVE. Give – do something nice for a friend or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look out as well as in. Seeing yourself, and you happiness liked to the wider community can be incredibly rewarding and create connections with the people around you. (NEF, 2008)

Two examples of how Five Ways to Wellbeing occurs

I will give examples from my work with two client groups: Being There, a Greater Manchester charity supporting people with life-limiting illness and Salford Dadz – a father’s group.

Being There

The first case study is my observation of clients of Being There, a charity that supports the emotional and practical needs of people with life-limiting illness and their carers.

The most basic wellbeing need we have is for social contact and so the first way to wellbeing is to connect. When you have cancer or you are bereaved, the isolation can be overwhelming. Being There coffee mornings and volunteer transport help reduce isolation and depression. As people start to make friends (often for life), the second way to wellbeing happens – clients become more active. For some, this means going on a coach trip to Fleetwood and for others a return to hobbies or fundraising.

Many Being There clients say that their focus shifts from being inward (focusing on their illness) to being outward looking. They take notice (third way to wellbeing). The introduction mentions noticing nature but in my experience, clients at Being There begin to notice things more broadly, such as how others are feeling, or how they cope. Over time clients learn how to listen and support others (fourth way), with some who have recovered from illness or losing a loved one after a long illness volunteering with the charity.

Through giving back (fifth way) they tell us they feel a tremendous sense of wellbeing. Here are some quotes from volunteers who are in remission from cancer:

‘I enjoy life to the full and am physically well.’

‘I feel buoyed up.’

‘I get a high…like being on a drug.’

Over time, illness may return and volunteers can again become clients and connect back to services. I describe this as Being There’s ‘virtuous circle of wellbeing’.

 

Virtuous circle of wellbeing diagram

Salford Dadz, Little Hulton

The second example is from working with a community of fathers called Salford Dadz, based in Little Hulton, Salford.

These fathers face multiple disadvantage including worklessness, mental health problems and associated poverty. They have undertaken action learning to understand how to improve their own wellbeing and, because they transmit their feelings into the home, they have found that their children’s wellbeing improves as well.

Salford Dadz’ members express that their primary problem is social isolation. When women have problems they get together and talk. When men have problems they tend to isolate themselves. Male ego plays a part and they have to overcome their pride to disclose what is troubling them. They rarely do this with a friend or family member. Salford Dadz are exceptional in that they speak openly about their problems and how they have overcome them. In that way these fathers give hope to others who are still isolated. Men also prefer to speak ‘shoulder to shoulder’ – that is, while they are occupied with doing something else, like fixing something or driving, rather than as women do, face to face.

So, as in the previous example, the first step is to connect, bringing fathers together in a non-stigmatising community setting such as a local cafe, which enables them to share common problems. After the first father breaks the silence to admit his worries, others reciprocate and the emotional healing begins (first way).

Men are mostly considered to be problem-solving, practical people so the second way – being active – means giving them a challenge to fulfil. It might be planting vegetables together in the children’s centre garden or mending the stage at the local church – it gives the fathers a sense of purpose and they begin to feel wanted and needed.

Just as the clients of Being There stop focusing on their illness, these fathers likewise move from talking about their own worries to listening to others (third way). They find that they take comfort by knowing that they are not on their own. They start to learn (fourth way) that they can get up in the morning and don’t feel as directionless as they did before. They come along to the dads’ and children’s Saturday Club to spend time as fathers and children together. They remark that ‘dads copy what they see their children enjoy’ and by spending time alone without the mother helps the dad and child to bond.

Rather like the Being There clients, many start to volunteer their time and other resources (fifth way). Worsley Rotary Club asked Salford Dadz for volunteers to fundraise when their Christmas float toured the streets of Little Hulton. Another man has just donated all his tools to the fathers and wants to teach them how to make simple things like bird boxes for their families. So, the fathers start to volunteer: having worked through their problems, they reach out to others.

The evidence suggests that you feel good when you do good (Action for Happiness), but most people don’t know where to start to help others, or even realise that they have the ability. Many are locked into a dependency culture, where they are used to receiving and not giving support. But in the two case studies above I show how wellbeing can be built from unhappiness.

Five actions that nurses can take to create wellbeing

So what does all this have to do with nursing? Community nursing caseloads, by their very nature, include vulnerable and socially isolated people. Twenty-first century community nursing practice can learn to flex between directly caring for patients, to building capabilities for patients to support each other. This is an unfamiliar skill set for most community nurses but there are some simple techniques that you can use to enable residents to connect, which is the foundation of the Five Ways to Wellbeing.

  1. Find the why
    The famous psychiatrist Viktor Frankl (1959), observing why some prisoners lived whilst others died in concentration camps in the second World War summarised this as, ‘he who has a why to live can bear with almost any how’. A nurse’s role can include rediscover meaning and purpose in patients’ lives. Ask ‘what would you like to achieve?’, ‘what does a good day look like to you’ and ‘what are/were you good at’.
  2. Make social isolation a clinical risk factor
    Consider how you might alter your clinical routines to address social isolation. An example of this is a ‘Leg Club’ – a tea party for people with leg ulcers that can be supported by the Lindsay Leg Club – helping people to get out of a lonely home, meet new friends and in the process learn how to self-care.
  3. Make social prescriptions
    Nurses can connect patients to community organisations that share a passion or reason to live. Make social prescribing part of your routine. For example, for Salford Dadz the reason to live was their children. Local clinicians now signpost fathers to the Saturday Dads’ and Kids’ Club. For others it might be a love of ballroom dancing or cooking for others.
  4. Make connections
    Where the primary aim is not clinical (such as managing leg ulcers) and there is no existing group, bring people with the same interests or problems together in a social context and see if they self-organize. Retired men for example may decide to start a chess club or ‘men’s shed’ (www.menssheds.org.uk).An organisation called Participle, in an experiment called MeetUp, connected isolated people in telephone groups. Here, a volunteer played much-loved music, hosted chats on current events or played Bingo using tele-conferencing. This allowed people to get to know each other and some decided to meet and form friendships, see www.vimeo.com/142485730 .
  5. Catalyse
    It is a nurse’s nature to help and solve problems, but one outcome from this is that it may create dependency, which inhibits the development of capabilities. So think of yourself as a catalyst not a care-giver. The local voluntary sector organisation will help people your might introduce to each other to organise themselves. By understanding the social needs of the caseload, the nurse can be the one to make that initial connection.One framework to aid success is EAST: events are planned to be easy, attractive, social and timely (Behavioural Insights Team, 2014). If patients need a room to meet in, offer one for free. If their ‘knit and natter’ group (www.tameside.gov.uk/museumsgalleries/knitandnatter) needs wool for knitting garments for special care babies, introduce them to a wool shop owner. Always enable the patients to take ownership and steer the direction they want to go in. Connecting people with similar problems or similar interests is not a frivolous add-on. It helps patients recover from illness (Department of Health 2014) and more importantly – it makes them happy.

 

References

Action for Happiness. 10 Keys to Happier Living www.actionforhappiness.org/10-keys-to-happier-living/do-things-for-others  Accessed 18/05/15

Behavioural Insights Team (2014) East: Four Simple Ways to Apply Behavioural Insights www.behaviouralinsights.co.uk/publications/east-four-simple-ways-to-apply-behavioural-insights Accessed 24/7/18

Department of Health (2014) Wellbeing: Why it matters to health policy www.gov.uk/government/uploads/system/uploads/attachment_data/file/277566/Narrative__January_2014_.pdf Accessed 18/05/15

Frankl, V (1959) Man’s Search for Meaning. Beacon Press

Friedli, L,  Jackson, C  Abernethy H and Stansfield, J, Social Prescribing for Mental Health – A Guide to Commissioning and Delivery. Care Services Improvement Partnership with North West Development Centre. www.centreforwelfarereform.org/uploads/attachment/339/social-prescribing-for-mental-health.pdf

New Economic Foundation (2008) Five ways to Wellbeing www.neweconomics.org/publications/entry/five-ways-to-well-being-the-evidence accessed 18/05/15

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