Nurses experience stress and burnout at excessive levels, negatively impacting quality healthcare and patient safety.1,2 The COVID-19 pandemic complicated matters, increasing staffing crises and patient acuity. This has only heightened nurses' stress, and for many, making time for self-care was already challenging. As a nurse in high-stress EDs and ICUs for over 14 years, I have been guilty of foregoing meals and bathroom breaks while advising others to make healthy choices and prioritize self-care. Nurses have a responsibility to apply their skills and knowledge to care for themselves, just as they care for their patients. Self-care cannot be viewed as just another "task" on a list.
Mindfulness is one strategy that can be used to manage stress levels, reframe potentially overwhelming situations, and improve well-being.3 When the pandemic began, I was the educator for the Emergency and Inpatient Psychiatric Departments at a facility in Connecticut. In March 2020, I was asked to develop and execute a staffing and training plan for nurses who had never before used full personal protective equipment in order to open a COVID-19 testing site within a few days. One week after opening the site, the team had it operating smoothly, and I was reassigned as a direct care ICU nurse at a different hospital within the system 35 miles outside New York City. I had not been a direct care nurse for 18 months, and I felt anxious and powerless to save lives, support families, or even support the departments I served.
Stress has been cited as a top healthcare burden for many years.4 When external demands exceed internal coping resources, one can be overwhelmed, which can negatively impact one's health.1,5 Historically, I had been able to manage my stress with yoga, but at that time, self-care seemed frivolous; there were too many people, including staff, patients, and loved ones, who needed me. Even when I felt I did not have time for yoga, I realized that engaging in mindfulness improved my spirit and energy.
Mindfulness is one aspect of yoga, and in my experience, I found that it can be misunderstood. Mindfulness is not placing a positive spin on horrible situations or a state of detaching from the world; it is the practice of being willfully present in all experiences, even if they are not ideal. Mindfulness is a state of being aware of the present moment, no matter how busy the shift is or how many distractions there are.6 Unlike yoga, mindfulness can be done anytime, anywhere.
I found that focusing on my breath and movement in the moment helped prevent my mind from racing. I intentionally made space to focus on the moment at hand, leaving less space to despair over the many things still to be done.
Using several mindfulness strategies allowed me to be fully present with the person for whom I was caring. I asked myself what I felt, heard, saw, and even smelled. I felt grief from the loss around me in so many forms, but focusing on the control I did have over my actions and my mind made me feel more centered. As I expanded my focus, I realized the environment was not just full of the obvious suffering and unknown, it was full of humanity and hope too. We have all heard that story, but sometimes it is the story we tell ourselves in the moment that matters most.
Throughout the next days, I continued to focus on what I was doing in the moment, such as establishing venous access instead of anticipating upcoming tasks. I focused on my patient's eyes and the feel of their skin through my gloves to connect with the person in front of me and the humanity around me, realizing my hands could be the last touch this person remembered.
Using this technique, I felt more efficient, present, and much less overwhelmed with what needed to be accomplished. Helping others find a sliver of peace also gave me the peace I was seeking, and this still holds true despite families being back at the bedside. Mindfulness has been shown to decrease stress levels and burnout by allowing oneself kindness, acceptance, and the ability to objectively evaluate professional accomplishments, increasing overall well-being and patient safety.7,8
To foster resiliency in fellow nurses, I set up sessions to share how these strategies could be easily integrated into various situations. Since different strategies work for different people, I presented brief evidence-based mindfulness techniques to ED nurses, supplementing practice sessions with a handout and a 2-minute guided meditation exercise. These techniques included focusing on how something feels, such as performing hand hygiene, noticing sensations around you, labeling how you feel momentarily, even if it is negative; and breathing exercises. All of these techniques take less than a minute.
Another approach is concentrating on something to be grateful for. Sometimes the only thing I could identify to be grateful for was going home when my shift ended. While I looked forward to going home, mindfulness made me aware that I was creating my own guilt for leaving such sick patients and fatigued colleagues behind. I was able to label my emotion in the moment, and recognize my anguish over human suffering because of compassion and empathy, two key attributes of nurses.1 That led to the objective acknowledgment that making myself sick would not help the sick patients or fatigued colleagues. While that did not alleviate my guilt, it did help me cope.
These mindfulness techniques can help nurses manage stress levels, reframe overwhelming situations, and improve well-being. While these techniques can be done quickly, it takes time to train your brain to allow yourself the space to pause. This is especially true during a busy shift when nurses feel pressured to accomplish many things. I hope that by sharing my mindfulness story, I inspire other nurses to make space in their day to be self-compassionate, even if it is just for a moment.
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