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Mindfulness Matters

Mindfulness Matters

Mindfulness for the Nursing Profession

“Today’s healthcare environment is turbulent, rapidly presenting nurses with stimuli, interruptions, and competing priorities. The stakes of success are extraordinarily high; nurses in all roles must cope successfully with numerous demands to make timely, accurate decisions affecting human lives.” (Pipe et al., 2009) 

Nursing professionals face enormous challenges. The work is difficult and demands full presence, energy, and commitment.  Stress is a pervasive fact of the profession, and it affects institutions and individuals, and even the caring relationship itself. 
Stress can impair the health care provider’s ability to observe, to listen, and to understand the patient. To practice safely, healthfully, and with compassion, nurses need to effectively manage stress. Taken to an extreme, when acute stress becomes chronic, impairments can be seen in immune system and cognitive functioning. One research group rang a note of caution that “unfortunately, breakdowns in attention raise the risk of serious consequences such as symptom recognition, medication errors, and patient safety issues” (Pipe et al. 2009). 
Mindfulness is a proven strategy that can help nurses to cope with the demands of their work and their lives (Baer 2003; Carmody et al., 2009; Grossman, 2004; Ludwig & Kabat-Zinn, 2008). Of the hundreds of clinical studies conducted on mindfulness-based interventions, 75% of them have been conducted in the past five years pointing to the mindfulness revolution sweeping health care. 
A wealth of different clinical interventions have been developed and researched that include mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), mindfulness-based relapse prevention (MBRP), and mindfulness-based eating awareness training (MB-EAT). 
 
Specific to nurses, Beddoe (2004) demonstrated that an 8-week mindfulness-based stress reduction intervention for nursing students significantly reduced anxiety. The students who practiced at home experienced additional benefits. These benefits spilled over into daily life and participants felt greater well-being and improved coping skills.  Mackenzie et al. (2006) studied a four-week mindfulness-based stress reduction intervention for nurses and nurse aides. The mindfulness intervention participants experienced significant improvements in burnout symptoms, relaxation, and life satisfaction. 
Pipe et al. (2009) studied nurse leaders with a 4-week mindfulness-based intervention (compared to a leadership intervention). The mindfulness group saw greater improvement in mood symptoms.
Neuroscience studies of meditation have demonstrated enduring and beneficial changes in both the function and structure of the brain that persist beyond the period of meditation (Davidson et al. 2003; Farb et al. 2007; Lazar et al. 2006; Luders et al. 2009; Lutz et al. 2008). 
Neuroscientist Daniel Siegel (2007) concludes that mindfulness produces a form of neural integration and coherence that leads to more adaptive functioning. The areas of the prefrontal cortex that show increases in grey matter are responsible for emotional regulation (including modulating fear) and an increased ability to be resilient in the face of stress. Other capacities affected include the regulation of body systems, attuning to others, responding flexibly, and exhibiting insight and empathy. 
For example, Lazar et al (2006) found that mindfulness meditation led to a thickening in areas of the prefrontal cortex linked to these functions, and that these changes were correlated with the length of time practicing. Lutz et al. (2008) conclude that:
Practitioners of mindfulness have recognized key benefits from cultivating attention in this way. 
By bringing ourselves into the present moment and away from future- and past-oriented narrative thinking (or critical commentary about the present moment) we shift our relationship to stress. We can think of the present moment as a vacuum chamber and that stress, anxiety, and depression-generating thoughts require an oxygen rich atmosphere to thrive. By being in the present moment we help ourselves as health care providers to moderate the challenges of stress, even having the opportunity to transform previously overwhelming situations into ones of challenge and mastery. 
This presence also helps us to be better clinicians. We are more present, more available, and better able to access empathy, compassion, and caring skills. The mindfulness teacher Sharon Salzburg noted, “the act of being completely present is truly an act of love.” Can we bring this love to our work? Mindful attention helps us to be wholehearted in our work and in full contact with both the joys and sorrows of patient care. When we are fully engaged we are devoting less internal resources to psychological and behavioral defenses and thus have more available for our patients. 
Cultivating the skills of mindfulness also gives us something to offer our patients. In any given moment we can encourage our patients to pay attention to their breathing, redirecting their attention away from painful narratives and into the present moment. The more we can embody mindful awareness the more we can give to our patients in this way.
In sum, mindfulness can help us to be the clinicians we aspire to be without paying the emotional cost of exhaustion and burnout. 
Whether nurses, physicians, or mental health providers we all endeavor to help our patients and we would like to provide this loving care in a way that does not damage our own health. We function within a highly stressful and often dysfunctional system of health care delivery. Mindfulness training can be a key component for coping with the demands of being a nurse today.
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Arnie Kozak, Ph.D. (http://exquisitemind.com) is a Licensed Psychologist and author of the recently published Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness (Wisdom). 

References

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Baer, R. (2003). Mindfulness Training as a Clinical Intervention: Conceptual and Empirical Review. Clinical Psychology: Science And Practice, 10(2), 125-143. 

Beddoe, A. E. & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43(7). 305-312. 

Carmody, J. et al. (2009). An Empirical Study of the Mechanisms of Mindfulness in a Mindfulness-Based Stress Reduction Program, Journal of Clinical Psychology, 65(6), 613-626. 

Davidson, R., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-70. 

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Day, P. O. & Horton-Deutsch, S. Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part I: Description and empirical support for mindfulness-based interventions. Archives of Psychiatric Nursing, 18(5). 164-169. 

Day, P. O. & Horton-Deutsch, S. Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part II: Mindfulness-based approaches for all phases of psychotherapy-clinical case study. Archives of Psychiatric Nursing, 18(5). 170-177.
Farb, N. et al. (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. SCAN. 

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Grossman, P., et al. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research 57, 35-43. 


Kang, Y. S., Choi, S. Y., & Ryu, E. (2009). The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Education Today, 29(5). 538-543 

Lazar, S. et al. (2006). Meditation experience is associated with increased cortical thickness. NeuroReport, 16. 1893-7. 

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Luders, E. et al. (2009). The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter. NeuroImage, 45, 672-8. 

Ludwig, D. S. & Kabat-Zinn, J. (2008). Mindfulness in Medicine.  JAMA, 300(11), 1350-52. 

Lutz, A., et al. (2008). Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PloS ONE 3, e1897 

Mackenzie, C. S., Poulin, P. A., & Seidman-Carlson, R. (2006). A brief mindfulness-based stress reduction intervention for nurses and nurse aides. Applied Nursing Research, 19(2). 105-109. 

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Pipe, T. B., Bortz, J. J., Dueck, A., et al. (2009).  Nurse Leader Mindfulness Meditation Program for Stress Management A Randomized Controlled Trial. Journal Of Nursing Administration, 39(3). 130-137. 

Shirey, M. R. (2007). An evidence-based solution for minimizing stress and anger in nursing students. Journal of Nursing Education, 46(12). 568-571.
Siegel, D. (2007). The Mindful Brain. New York: Norton.

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