PITTSBURGH — 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 at University of Pittsburgh Medical Center Montefiore. "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 the University of Pittsburgh School of Nursing to sponsor training workshops in mindfulness meditation for regional nurses. About 50 participated in two daylong 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," stated 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, states her website, www.katherineholtz.com .
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 A. 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."
A recent Time magazine story described how fourth- and fifth-graders who underwent mindfulness training improved their math scores by 15 percent.
UPMC and Allegheny Health Network 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 M. Greco, assistant professor of psychiatry and a licensed psychologist at the UPMC Center for Integrative Medicine. "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 for Traumatic Stress in Children and Adolescents at Allegheny General Hospital 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 at Magee-Womens Hospital of UPMC, 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.
By David Templeton
During training workshops on mindfulness meditation, Katie Hammond Holtz provides participants with a pouch of 10 practical items to serve as reminders to use the skills they have learned.
The chief skill is using one's breath "to keep in touch with the moment" while allowing thoughts to pass through the mind. But, in reality, the fits and starts of a stressful day can cause a person to restrict breathing and allow bad thoughts to seize the mind as stress wells up, resulting in anger and frustration.
Mindfulness provides methods to transform that, said Ms. Hammond Holtz who collaborated with University of Pittsburgh School of Nursing officials to custom-design a retreat for nurses to include a strong focus on the value of everyday mindfulness in the workplace.
During a Feb. 13 mindfulness workshop at the University Club in Oakland, nurses found a tin in the pouch containing 150 reminder messages that Hammond Holtz created, including such sayings as, "Enjoy a half smile in a meeting." The pouch also included a plastic bracelet proclaiming, "Nurses lead with each mindful breath."
As a tool to induce mindfulness, the Pittsburgh-based psychologist tolls a soothing bell to prompt clients to focus on breathing, which helps put the mind in the present moment to experience the senses. But a person can't always have a bell. So she recommends designating cues, including the bracelet, to serve as "bells of mindfulness."
Her booklet, "Going Home to Practice," helps people to use mindfulness from the moment they awaken until they go to bed.
Making mindfulness occur seamlessly and automatically are key goals. Cues can include every encounter with water, passage through a doorway, a trip on an elevator, or even every time you sit down. Birds chirping, a smudge on one's eyeglasses or the first touch of the computer keyboard can remind the person to improve posture, focus on breathing, embrace the moment and let troublesome thoughts pass out of mind on a soft breeze.
"You need a foundation, support and a nourishing community to support it, and you need to learn it from an experienced mindfulness trainer," said Hammond Holtz. "At first you have to pay attention purposefully to it. But over time it becomes so automatic that you take a peaceful breath whenever you enter the office or reach your desk.
"You need to stop and rest and take a Sabbath — 20 minutes, an hour or three hours — or practice five minutes of slow-walking in the office," she said. "Being aware of breathing, no matter what we are doing, makes us aware of what's happening inside of us and around us."
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