Journal of Nursing

Hospital Treats Nursing Stress With Courses In Mindfulness


By David Templeton

Caring for patients can be “organized chaos,” nurses say. As the foot soldiers of health care, they function at the pressure point, the front lines of the war zone, where “you have to be flawless.”

“You can’t make one mistake,” said Daniel Griffiths, 47, of Greenfield, a nurse of Pittsburgh. “It’s physically draining. You’re on your feet for a 12-hour shift.”

It helps explain why stress levels in nursing can lead to mental and physical exhaustion, burnout, anxiety, depression, high blood pressure and sleep disorders. These occupational hazards, in turn, trespass onto one’s free time.

“When stress is high, it becomes difficult to make easy choices,” Griffiths said, noting his recent trouble deciding among loops, flakes or pops. “After work, if I go to get cereal at the grocery store, it’s hard to make a choice.”

Stress levels among its ranks have prompted one nursing school to sponsor training workshops in mindfulness meditation for regional nurses. About 50 participated in two day-long training sessions recently at a local facility.

Mindfulness, with roots in Buddhism, long has been accepted psychotherapy for stress, anxiety, pain and trauma. It allows a person to enter into the present moment by focusing on breathing and the senses, leading to insight and mindful action. The ultimate outcome can be acceptance and transformation of suffering.

The U.S. military, athletes, health care professionals and even corporate CEOs have adopted mindfulness meditation. And it’s no wonder. While benefiting mental and physical health, relaxation and keener focus improve decision-making, productivity, negotiating powers and conflict resolution.

Katie Hammond Holtz, a Pittsburgh-based licensed psychologist, conducts mindfulness retreats, including the recent sessions for nurses, nursing educators and leaders. Among other practices, she teaches mindful sitting, walking and movement, along with gentle yoga and deep relaxation. Participants during her retreats remain silent, with minds and senses alive to the moment.

“We come into the world with a breath and leave this world with a breath. But let’s not forget the breaths in-between,” said Hammond Holtz, a doctor of psychology and mindfulness-based stress reduction teacher.

As a starting point, she recommends putting one hand on the abdomen and the other over the heart. “We’re taking refuge in our in-breath and out-breath because it can change us, if we are fully present in our breath.”

Keep one’s appointment with the moment, she advises. Take refuge in one’s breathing. Respond to the challenge rather than react emotionally to the suggestion or assignment.

“Nursing is stressful,” said Mary Rodgers Schubert, the nursing school director of continuing education, in promotional material for the workshops. “There are too many patients, not enough time, and swiftly changing environments. The nursing profession can do more to help nurses take better care of themselves and, therefore, their patients.”

Hammond Holtz said research shows that the key issue for nurses is their ability to focus, with mindfulness helping to improve concentration. Stopping and pausing regularly to take mindful breaths fosters continuous awareness of your breath. In time, you become “your own vibrant portable mindfulness sanctuary,” with any activity involving mindfulness.

Studies show that nurses who practice mindfulness cope better with stress, reduce exhaustion, decrease rumination, enhance relaxation and improve life satisfaction, with measured improvements in patient care and satisfaction, she said.

Nursing school Associate Dean Susan Albrecht, who participated in the retreat, said it was extremely helpful in teaching her how to pause, focus and care for herself before trying to care for others.

“My stress levels dropped,” she said. “After the first half, I felt like a rag doll.”

Some psychologists have long used mindfulness to treat people with post-traumatic stress syndrome, attention deficit disorder, chronic pain and concussions.

When using it, a whole lot drops away, including judgment and commentary as you focus attention on your breath,” said Carol Greco, an assistant professor of psychiatry and a licensed psychologist. “The body just says ‘thank you’ and lets go of muscle tension. When muscle tension generally resolves, you have a sense of greater calm and relaxation.”

She teaches an eight-week mindfulness meditation course that includes homework. The center also offers a mindfulness yoga class and other programs. “Individually, I’m blessed to get to hear from patients and class participants about how it’s helping them,” Greco said, describing one patient who said mindfulness helped her withstand cancer treatments.

The center also uses mindfulness meditation to treat children, from grade-school age through 20, who’ve experienced trauma, domestic violence, sexual abuse and other problems.

“They are stuck in the past and are worried and scared about the future. They are afraid it will happen again,” said the center’s director, Anthony Mannarino. “When they connect with mindfulness, they disconnect their focus on the past and future. The focus is the here and now.

“We don’t tell them the bad stuff won’t come in, but we tell them to let it pass and try to focus on the present. If you try to get it out of the way, you’ve lost the moment. Let it pass through the mind.”

Laura Schubert, 23, took one of the recent classes. The maternity-ward nurse, described the time she was caring for two pregnant women who delivered their babies simultaneously. “I was like a ping-pong ball,” she said. “You can’t be at two places at one time as your patients progress through labor at the same rate.”

Such situations, she said, emphasize the benefits of the techniques she learned to preserve her mental and physical well-being.

“Mindful moments slow you down so you can breath and check in with yourself and hopefully prevent future burnout,” she said.


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