When your job involves taking care of others, it’s important not to forget about your own health and well-being. All too often, nurses and other health care workers are so focused on helping their patients that they neglect their own self-care needs. Unfortunately, if your own needs aren’t met and your mental health declines, it can affect your work and your ability to properly care for others.
The health care industry is often fast-paced and chaotic, meaning health care workers often don’t even realize that their own well-being needs attention until they hit a breaking point. Minority health care workers are especially at high risk of experiencing burnout and emotional distress due to the added struggles they face. It’s important to take breaks and listen to your body as a health care worker to identify potential mental health conditions the same as you would use your knowledge to help your patients.
How to Improve Your Mental Health and Well-Being
Finding ways to maintain your mental health is a must for nurses and other health care workers. To continue delivering quality care to your patients, you have to take care of yourself as well. The following are ways you can help maintain your mental health or work to improve it if you are already feeling low:
Get Enough Sleep
This one should go without saying, but resting and getting enough sleep is essential. It’s common for health care workers to lose sleep when they work long hours, especially those who work night shifts, but it’s important to find time to sleep when you can.
Process Your Emotions
Working as a nurse can be psychologically draining. Dealing with patients and their families can be challenging, especially when you lose a patient. Often, health care workers will try to brush it off as simply being a part of the job, but it’s important to acknowledge and process your emotions when you have time to yourself. Just because losing a patient or dealing with other emotional and stressful situations is part of the job doesn’t mean you can’t feel sad or angry. It’s essential to find healthy ways to process the stressful things you deal with as a health care worker on a daily basis.
Create a Relaxing Home Environment
When you’ve had a rough shift, coming home to a calm and relaxing environment is crucial to maintaining your well-being. The environments we spend our time in can have an impact on our mental health. Understandably, there are things at home that may need attending to as well, but it’s important to create a space where you can get away from distractions and relax.
Find Ways to Disconnect
Many nurses struggle to find time to themselves because when they do have days off, they have other things that require their attention, like family, social engagements, and other responsibilities. However, it’s important to find time to get out and disconnect to give yourself a break. Getting outdoors, for example, even if just for a short walk every day, can help you feel refreshed and re-energized.
Eat Healthy Foods and Exercise
Another part of maintaining your mental health and feeling refreshed is getting physical exercise and eating healthy, well-balanced meals. It can be difficult for nurses and health care workers to find time to stop and eat, but healthy meals and snacks throughout the day are important to keep you energized and feeling your best. It’s also important to find time outside of work to move your body and get in some exercise when you can. Physical activity can go a long way towards boosting your mood and helping you get better sleep.
Practice Mindfulness and Gratitude
It’s easy to forget about appreciating the good things we have in our lives when we are tired and stressed, but practicing mindfulness and gratitude can positively influence our mental health, especially for health care workers. The more joy we can find in our lives wherever possible, the easier it is for us to maintain a positive state of mind. A great way to practice mindfulness is to journal or write down things at the end or start of your day that you want to work on or that you are grateful for.
Though you may feel that your work and your patients should always come first, you can’t give them the quality care that they need if you are struggling with your own mental health. It’s important to remember to take time to focus on your needs. The stigma around mental health can often lead to it being neglected, but there is nothing wrong with prioritizing your well-being and speaking up when you need help.
Dealing with mental health conditions and asking for help is not a sign of weakness. As a nurse or other health care worker especially, you must advocate for yourself and your needs. Maintaining your mental health can ensure you continue to deliver quality care and avoid feeling overwhelmed and burnt out.
Nurses, like other health care professionals, have been hearing the buzz about mindfulness. Technology corporations, like Google, are instituting mindfulness programs, as are health care and wellness-related workplaces. Lifestyle magazines like Oprah and Yoga Journal are covering the topic, but surprisingly, so are Harvard Business Review and other business publications.
Perhaps you’re wondering what the term actually means, and whether it’s been proven effective in treating patients and those who want to be proactive in warding off illness and disease.
In this article, nurses and mindfulness experts will explain their unique approaches and how they help patients with health challenges. You’ll learn about the evidence behind the practice, so you can comfortably introduce it to your patients. You might even want to incorporate it into your own work and personal life.
What is Mindfulness?
Simply, mindfulness means that you direct your mind to the present versus having it wander aimlessly. You practice an awareness of your thoughts, and a focus on the here and now, not the past or future.
The opposite state, “mindlessness,” is what happens when you drive home at the end of a 10-hour shift, suddenly arrive at your front door, and can’t remember how you get there.
Are You Interested in Trying Mindfulness for Yourself?
The mindfulness and health site,DrJud.com, offers a free online course for health care professionals. The seven-module video course answers common questions about the practice and the evidence supporting it.
Continuing medical education (CME) credits are available through Brown University.
Though mindfulness meditation is thousands of years old, with its roots in Buddhism, today’s mindfulness practices are often not spiritually centered. Scientifically-based mindfulness programs are meant to be used by patients of all faiths (or none).
That awareness may help boost patient emotional well-being and help strengthen their immune system. One example of the benefits of mindfulness, the Cleveland Clinic reports that 20 randomized trials reviewed in 2011 show improvement in overall mental health.
Mindfulness is a drug-free tool that can help optimize neural processing, boost immune system function, address the epidemic-level of chronic pain, reduce insomnia, and even caregiver burnout.
In new research, mindfulness shows promise in reducing the incidence of physical diseases or managing existing conditions. Examples are diabetes and hypertension. Mindfulness can also be an aid in breaking unhealthy habits, such as smoking, and averting the associated risk of disease.
One Nurse’s Research on Mindfulness and Hypertension
Eunjoo An, MSN, RN, a PhD candidate in nursing at UCLA, studied ways to reduce hypertension, which is the number one risk for stroke, she says. As a nurse, An knew that simply telling people what to do—eat right, exercise, etc.—wasn’t enough. She suspected that mindfulness training along with a health promotion program could have beneficial results.
Earlier research showed that mindfulness has a calming effect on the fight or flight response, leading to blood pressure and heart rate reduction, An says. “The difference in my research is that it’s looking at not only blood pressure but habits; most patients have difficulty changing diet and exercise,” she explains. “Mindfulness brings focused attention to body. During those times you’re more likely to say to yourself: ‘I should eat better,’ and then that translates to that behavior. No study has taken that to the next step.”
An used the UCLA mindful awareness program beginner’s course, which is not as extensive as some approaches, but more approachable than others, she says. The mindfulness group was told to practice at home. She hoped that the training would help calm patients and that reduced stress would translate to behavior change.
Her research was applied to hypertension in an independent living facility that is primarily African American. She was the instructor for the health promotion group, using the six-week program modules on a government website. Both groups received information about healthy diet and the importance of exercise.
The results? “The mindfulness group, with stage 1 hypertension, reduced their systemic blood pressure to normal range at the end of the 12-week study,” she says. While blood pressure did go down in both groups, “in the mindfulness group it dropped into the normal range whereas in the health promotion group it stayed in the high range.” Mindfulness practice was beneficial in helping patients to eat and exercise in such a way that their blood pressure dropped 40%.
To learn more, watch An’s three-minute presentation about her research on the benefits of mindfulness available on YouTube.
Beyond Mindfulness for In-Patient Care
Menna Olvera Feder
The Urban Zen Integrative Therapy (UZIT) program brings mindfulness plus yoga, Reiki, essential oil therapy, and contemplative end-of-life care to patients and providers. Started in 2009 by fashion designer Donna Karan in New York, it soon expanded nationwide with the launch of the UZIT teacher training program.
“UZIT-trained therapists provide a variety of care, in a wide range of settings, to patients, staff, and caregivers, plus the community,” explains Menna Olvera Feder, UZIT acting program director.
Services can be accessed through a number of hospitals, rehab centers, senior-care and hospice facilities, as well as yoga studios offering drop-in stress-management class.
Research has been conducted at multiple facilities, including Beth Israel Medical Center in New York City and Wexner Heritage Village in Columbus, Ohio, showing significant health benefits. Patients experienced fewer symptoms of pain, anxiety, nausea, insomnia, constipation, and didn’t require as much medication for relief from those conditions.
When a UZIT-trained nurse “sees a patient isn’t breathing well, or is in pain, or is exhausted, they have what they need in their toolbox to address it,” says Olvera Feder. The UZIT protocol “adds a level of care to nursing that drew the nurse to be a nurse to begin with.”
The holistic program is used in health care environments with a diversity of patient populations. “We want to attract people of different cultures and those who are bilingual. We’re always looking for nurses who are Spanish-speaking or who speak Chinese,” says Olvera Feder.
Simple, clear terms are used to introduce the care modalities to patients and their families. For instance, “yoga,” is explained as “mindful movement to address respiration, digestion, and circulation,” Olvera Feder says. “Because when you’re in bed, you’re not doing downward dog.” Mindful movement in that case may mean that pillows aren’t stacked too high, and the patient is positioned in simple supported postures to bring them into a more comfortable state.
The UCLA Health has a number of UZIT trained health care professionals, among them is Anna Dermenchyan, RN, MSN, CCRN-K. An Armenian American, Dermenchyan was an ICU nurse before transitioning to a quality role in 2013, with the aim of improving patient care. She is also pursuing her PhD in nursing at UCLA School of Nursing.
“Urban Zen is meant for patients who feel pain and anxiety—that’s pretty much any patient in a hospital—they feel so much better after,” she says. One of the moving examples of UZIT’s effectiveness was when Dermenchyan sought to help a family say their final farewells to a brain-dead patient. “We provided Reiki and essential oils to them and a sad experience was made less painful,” she recalls.
Though always aware of stress in the health care workplace and how it affects nurses and patients, “I realize now how stressed everyone is, including physicians and administrators, and how vulnerable they are to fatigue and burnout,” she adds.
Mindfulness Class in Your Pocket
Not every organization has a mindfulness program available for patients, and not every patient has the money or time to attend formal training sessions. That’s where digital mindfulness apps come into play.
“We consider ourselves the leader in evidence-based, digital therapeutics for mental health,” says Mark Mitchnick, MD, CEO of MindSciences, Inc. “It’s pretty easy to put an app out in the health care space, especially in mental health, but do they have evidence behind them? We get grouped with some very scientific, rigorously researched” companies, and some that are not.
Currently the company offers three apps: Eat Right Now to address emotional eating, Unwinding Anxiety to relieve anxiety and stress, and Craving to Quit for smoking cessation. They are based on the work of Judson Brewer, MD, PhD, a leading mindfulness researcher, $11 million in funding from the National Institutes of Health (NIH), and input from thousands of users in clinical trials, and later as subscribers.
Many users first learn about this brand of apps because their health care provider recommends them. “It’s offered to individuals through organizations and insurance providers, such as Humana,” he explains. “We wanted to offer [mindfulness] as something scalable and very affordable—and today that’s an app.”
For example, MindSciences is “working with coal miners in Appalachia, using our smoking app in a pulmonary clinic,” says Mitchnick. “Folks are enrolled in a clinic but still smoke.” Using a hybrid model of delivery—digital app plus the participation of health care professionals—they aim to help patients kick the smoking habit.
Similarly, they’ve started working with bariatric surgery clinics to help patients avoid regaining weight lost after surgery. “We’re not a willpower-based system,” he says. “In the case of eating, you have to separate out ‘I’m feeling hungry’ from ‘I’m feeling anxiety,’ and find a more appropriate behavior for that.”
Interested individuals can independently download the app, try it out free for three days, and later subscribe. In the case of Craving to Quit, the program is $24.99 a month, which includes the mobile app training modules, an online support community, and weekly live expert video group coaching sessions. The program has been shown to be twice as effective as a leading smoking cessation treatment, and it’s backed by a limited money-back guarantee.
Mindful Yoga-Inspired Tools for Patients
Oregon Health & Science University (OHSU) in Portland, Oregon, offers a number of mindfulness programs to its patients and staff members. Kimberly Carson, MPH, C-IAYT, E-RYT, is a mindfulness educator and yoga therapist. She is considered a leader in the therapeutic use of mindful yoga for people with medical challenges.
Carson offers an ongoing drop-in class, Breath by Breath, as an introduction to mindfulness-based stress reduction methods. The class is free of charge to OHSU patients and any interested members of the community.
“Breath by Breath is a combination of mindfulness practices and yogic tools,” she explains, for cardiac, oncology, chronic pain, and other patients, plus their caregivers. “Sometimes people come once, sometimes a few times, or sometimes for years.” The class is held twice a week, for hour-long sessions, in conference rooms offered by participating departments.
Along with instruction in a variety of relaxation and mindfulness practices, Breath by Breath incorporates yoga-inspired adaptive movement, “We don’t take people to the floor,” explains Carson, “these movements are appropriate for most people—the postures are skillful to a medical or aging physiology.”
Group discussions and sharing make up an important component of the session. “At the beginning of the class, “I use what I call the ‘quickening question,’ which is totally spontaneous, such as ‘What inspired you today?’” she says. “The question helps give voice to people’s experience.”
She also facilitates Mindful Yoga for Chronic Pain, a five-week, drop-in series, “which is more asana heavy,” she explains. Gentle postures help patients develop mindful awareness of bodily sensations, thoughts, and emotions in this evidence-based intervention.
Beyond classes, Carson offers “bedside mindfulness” in the Bone Marrow Transplant Unit to address pain, agitation, insomnia, and existential distress. “I go in and lead patients through a mindfulness process,” she explains. “It quiets the nervous system, so they get relief right then. We do a body scan and breath awareness exercise. That’s the face-to-face introduction to the skill, to give them a taste of what’s available.” Later, patients can access more training modules on “the mindfulness channel” via OHSU’s digital education platform.
Mindfulness for Minority Communities
Jeffrey Proulx, PhD, is a Native American who has been studying mindfulness as a way to reduce psychological stress and improve physical health in underserved communities. A K99/R00 award from the NIH National Center for Complementary and Integrative Health is currently funding his contemplative-based program to reduce diabetes in Native communities. He has also done culturally based mindfulness research with other ethnic minority communities.
Proulx believes that psychological stress needs to be viewed in a wider context that includes historical oppression. “They wanted to wipe Native Americans off the face of the earth, and African Americans were enslaved,” he explains. “So, for these populations, daily stress is compounded by historical stressors.” But instead of focusing on cultural trauma and the associated poor health behaviors, he works with communities to explore their resiliency and strength.
Mindfulness-Based Stress Reduction [MBSR] is the landmark evidence-based program developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center in 1979. Many health care mindfulness programs and health apps are based on this intensive, eight-week training series. Proulx has facilitated these classes for patients and health care providers at OHSU, as has Carson.
“But MBSR isn’t really geared to address cultural trauma, intergenerational trauma, people getting sicker from generation to generation,” he explains. “I’m approaching it from another way. The bigger, overall issue is how people carry on.”
One way Proulx makes sure his offering is culturally competent is by using the term “stress reduction” rather than “mindfulness.” That only goes so far, he warns: “You can call it different things to sand down the edges,” but it doesn’t change the basic shape, and what he’s trying to create “is a program to get at stress in your community, not just the upper class white community.”
The development process is long for his years-long studies in these communities who may be suspicious of him or medical professionals generally. To head off prejudice, he enlists the endorsement of community leaders (e.g., the tribal council or church pastor) and forms a small advisory group for guidance and assistance.
Proulx aims to create a safe, open, and accepting environment among community members. “You do that by learning about the history of the community, the culture, and becoming part of the neighborhood,” he says. “It’s an effort to develop trust, show trustworthiness, and embody trustworthiness.”
Their own culture then informs how these involved community members experience his mindfulness and stress reduction training. “‘Oh, it’s like Proverbs,’ I often hear,” says Proulx. “Or ‘It’s like Christian charity and compassion.’”
Underserved populations can also be a source of future trainers and greater diversity in the mindfulness field. “I encourage people in those communities to become teachers,” he explains. “Brown University is paying for that training.”
The practice of meditation is used in many cultures to reduce stress and anxiety and to maintain optimal psychological and spiritual well-being. Meditation has been extensively studied as a treatment for not only improving cardiovascular health, but also anxiety disorders as well. Since burnout and anxiety are common conditions plaguing health care professionals around the world, nurses must understand the healing power that meditation has in assisting them maintain physical, mental, and emotional balance. By learning how to incorporate the complementary practice of meditation and mindfulness into their lives, nurses have the ability to learn advantageous coping skills to handle potentially stressful situations.
The Art of Meditation and Mindfulness
The ancient art of meditation and mindfulness was derived from ancient Buddhist and yoga practices around 1500 BCE. Mindfulness refers to a process that guides individuals in maintaining a mental state characterized by nonjudgmental awareness of the present moment. The basic premise underlying meditation and mindfulness centers on how experiencing the present moment nonjudgmentally and openly can effectively counter the effects of stressors, because excessive orientation toward the past or future can be related to feelings of depression and anxiety. It is further believed that by teaching nurses to respond to stressful situations more reflectively rather than reflexively, meditation can effectively counter experiential avoidance strategies, which are attempts to alter the intensity or frequency of unwanted internal experiences from the outside realm.
Mindfulness-Based Stress Reduction
Due to the incredible health benefits that meditation and mindfulness possesses, Kabat-Zinn conceptualized a highly effective and integrative approach for reducing the physical, emotional, and mental consequences of chronic stress and anxiety. Mindfulness-based stress reduction (MBSR) is an innovative therapy that blends various elements of different Eastern meditation practices with western psychology. MBSR is a formal eight-week evidence-based program that challenges the patient to cultivate a greater awareness of the unity of the mind and body as well as the unconscious thoughts, feelings, and behaviors that can influence their overall health. During MBSR therapy, the individual learns various coping skills and techniques aimed to reduce the physiological effects of stress, pain, or illness by participating in experiential exploration of stress and distress to develop less emotional reactivity.
Since the mind is known to play an influential role in stress and stress-related disorders, MBSR has been shown to positively affect a range of autonomic physiological processes, such as lowering blood pressure and reducing parasympathetic arousal and emotional reactivity. In addition to mindfulness practices, MBSR also utilizes yoga to help promote wholesome physical activity and prevent unhealthy complications associated with living a sedentary lifestyle.
Due to the many health benefits it possesses, MBSR has been shown to relieve pain and improve psychological well-being across the health care spectrum. Because of this realization, nurses should make a more concerted effort in incorporating mindfulness meditation practices into their daily lives to not only improve their own stress reactivity, but also imbue resiliency to stressful and arduous psychological challenges associated with working in the health care setting.
Does your mind easily wander? Do you find yourself performing tasks at work without much thought? Research shows that people spend almost half of their waking hours thinking about something other than what they’re doing, which weakens their performance, creativity, and well-being, according to Harvard researchers.
If this behavior describes your mindset, you belong to a club where membership only requires habitual ways of thinking, doing, and feeling. The bad news? It’s not a great place to be. Mindfulness – with all its benefits – is where you want to head.
Mindfulness, which means being focused in the present moment, can strengthen your job performance as well as your mind, body, and spirit. Mindfulness engages your senses to allow you to participate fully in daily tasks.
So how do you achieve it? Here are six steps to practice moment-to-moment awareness at work.
1. Reflect and plan.
Start the workday by focusing on your organization’s purpose and how you contribute to it by being present and engaged. End each day by preparing for the next to help avoid anxiety or procrastination.
Slow down. Set aside five minutes daily to breathe. For a minute or two, breathe deeply. Focus only on inhaling and exhaling. Consider adding a few minutes of stretching, which allows more oxygen into your body and encourages blood flow.
3. Walk more.
Concentrate on the sights, smells, and sounds that accompany your movement. If you can, spend a few minutes walking outside to observe nature.
4. Feel thankful.
Once a day, take a few minutes to think about an accomplishment or something else that fills you with gratitude. Practice finding joy as doing so you can change the direction of your day.
5. Enjoy your meal.
This sounds simple, but how often do you think about what you consume? Try to taste each ingredient or observe how thoroughly you chew. Pay attention to your food and how it makes you feel.
6. Breathe when there’s a ring or ping.
Instead of instantly reaching for a ringing phone or pinging computer, take several breaths before responding. Emails and calls raise stress levels, research shows. It’s important to pause and calm down before reacting.
Mindfulness is the antidote to multitasking and possible burnout. With practice, you can build your mental muscles to keep your mind from wandering and engage in what’s happening right now. That’s a win for you in and out of the workplace.
When nurses talk, there’s no doubt they share some humor or stories that someone who’s never been a nurse just won’t get. But nurses don’t always have a chance to talk shop and swap stories. Even rarer are the times when they can dig more and share their deepest thoughts about this unique profession.
A nurse retreat offers all that and more. Nurse retreats are a professional development course, therapy session, and spa weekend rolled into one.
According to Jan Landry, co-founder of The Sacred Art of Nursing, nurse retreats can help nurses refill their well. “Our hope in retreats is to give nurses a mindful approach to nursing care,” says Landry. “Retreats offer skills and self care.”
Retreats are for nurses of all practices. Whether they have been nursing for one year or 40 years, have been an ER nurse or in management, retreats are a way to come together and be with like-minded people. “There’s something that happens when a group of nurses get together and share deeply from their hearts,” she says.
What can you expect at a nurse retreat? All retreats are different, but many share the same goal of talking about the journey of nursing, and what that means to personal and professional growth. The experience of talking with nurses from so many different backgrounds helps normalize what many nurses feel about their jobs. It’s not always easy being a nurse and it’s certainly something that is life-changing on a day-to-day basis. Although many outside the profession don’t “get it,” fellow nurses do.
“Nurses talk about the inspirations and challenges,” says Landry. “They talk about the things we all experience but never talk about. There is the safety to name some of that and share the humanity of nursing.”
And, like any retreat would suggest, there’s time to just rest. “One thing we noticed when we had our retreats is that nurses were really tired when they arrived,” says Landry. Being able to come together with other nurses away from a professional environment gives the conversations about nurse bullying, the generations of nurses working now, or even the challenges of certain types of nursing an opportunity to expand to everyone present.
“Some of our sessions are lighthearted and poignant,” says Landry, “and sometimes something only a nurse could understand.”
And Landry hopes nurses who go on retreats are able to take away a new perspective and a sense of renewal. “It’s a real honoring of the incredible work nurses are doing,” she says. “I hope they are taking away a deeper respect for themselves, other nurses, and the nursing profession.”