June/July 2020 Mindfulness Effect on Stress Reduction & Empathy

My stress level has increased expedientially since March 2020 professionally and personally. In the past some of the coping methods offered to me seemed silly and now that I’m living in a pandemic they don’t seem so silly.

​What was the knowledge gained from the article? Dr Michael Kelly and Mari Tyson Staff RN reviewed with us the power of compassion and how it is essential to the practice of nursing. They also went as far as saying that it should be implemented with ALL nursing activities. They spoke of the evidence that supports improved patient care when empathetic and compassionate care is provided by the nurse. The article then goes on to state that the nurse is at risk for developing compassion fatigue.
According to Vaclavik (2018) moral distress is when a nurse performs duties that are contrary to what she or he believes is right but feels powerless to change actions.
Both articles identified reasons why a nurse could experience emotional distress due to their profession. They also give us suggestions on how to decrease emotional distress. According to Kelly (2016) mindfulness is a tool to combat stress and burnout because it enhances one’s self-compassion and empathy towards others. Vaclavik (2018) had several suggestions of stress reduction methods that were most successful were work–life balance events and the critical debriefs.
Will the research/information in this article change or influence your practice? If so how?​ I know that I’m personally going to need to focus on reducing my stress personally and professionally over the next year so I’ve found these articles to be very helpful. I also know from past professional experience the environment in which I work directly impacts my mood so it would be beneficial to me to be an active participant in any kind of stress reduction programs. Currently on my unit one of my colleagues Grace Chapman wanted to help by starting a book club with just this theme.
The book is The Miracle Morning.
What other questions does the article raise about current practice?​ Many of my friends and family are nurses and a common theme I’ve notice is that none of us are able to get a assigned 15 minute break in addition to our 30 minute lunch. Even more bothersome is many of the nurses I know aren’t even able to get a uninterrupted 30 minute lunch break. Is this the culture in which we live or is this just acceptable in healthcare in the United States? I’ve been asked many times by upper management why nurses aren’t staying at the bedside. How can we participate in debriefings and mindfulness therapy when many inpatient nurses don’t even get a 30 minute lunch. These breaks are even more essential when we are trying to wear masks and socially distance ourselves from colleagues.
Ohio State is wonderful place to work because they provide continuous education and process improvement but do they give us enough time to implement these self care practices.
Do you agree/disagree with the conclusions of the author, why? I agree these methods of stress reduction will work when implemented daily.

1.What was the knowledge gained from the article?
I have been aware of the general impact of mindfulness, but it was great to see the specific, measureable, and direct impact it has on nursing. Burnout and compassion fatigue have been problems in our profession since before Florence Nightingale. It is good to see that mindfulness has a statistically significant decrease on these negative impacts to the nursing profession. I was particularly intrigued by the section on self-compassion. Nurses are known to be a bit of perfectionists, so it was helpful to see that self-kindness counteracted the effects of “self-condemnation, self-criticism, and rumination.” (Kelly & Tyson, 2017, p. 15)
2.Will the research/information in this article change or influence your practice? If so how?
I have been practicing mindfulness for a couple of years through an app on my phone. It has hundreds of audio sessions and stories by a variety of authors and narrators with different styles and goals. I have never practice mindfulness specifically with the intention of increasing my ability for compassion before. I will now make this part of my regular practice to improve my empathy.
3.What other questions does the article raise about current practice?
The authors brought up the same concerns at the end of the article that I had, namely what type of mindfulness practice was used in these various studies and what format was used to present. Now that we have studies demonstrating that mindfulness produces measurable positive outcomes, we need further study to compare delivery methods and styles of mindfulness practice, keeping in mind that one style will not be effective for everyone.
4.Do you agree/disagree with the conclusions of the author, why?
I think mindfulness should be included in nursing school curriculums- I wish I had learned about it sooner and made it part of my regular practice. If not nursing school, then employers should certainly include it in their training. I am glad OSU offers mindfulness with the Whil app that is tied into our YP4H points- demonstrating the organizational policies and partnerships that the authors stated would be required to offer MBSR courses and opportunities to staff.

Kelly, M., & Tyson, M. (2016). Can mindfulness be an effective tool in reducing stress and burnout, while enhancing self-compassion and empathy in nursing? Mental Health Nursing. 12-17.

1. What was the knowledge gained from the article?
I am not sure that I learned anything new but both articles made me really stop and think about the stress and burnout that I feel and see around me. It validated that what we are feeling is real and not an isolated or personal issue.
2. Will the research/information in this article change or influence your practice? If so how? Admitting a problem is the first step in recovering and I think for those that are not already in any type of self-care program, they will be less reluctant to start something knowing that it is a real problem and it is not “just me.” Having the support of the articles, it will be easier to discuss and recommend attending our self-care group w/ Amy Rettig. In anticipation of having a big transition w/ construction and moving our offices and eventually having all clinics under one roof so we schedule a year of “Team Resiliency” meetings which started in February 2020.

3. What other questions does the article raise about current practice? We see the burnout all around us but how do we get those that no matter what you do for them, they just don’t have time? I feel if one is burned out and stressed then we all are because of the tension created in our environment. There are others that thrive on the stress of being so busy and feeling that things can’t go on without them – how do we get them to step back and care for themselves which in turn will help the care of those around them?
Also, for me personally, when I am overwhelmed it is just one more thing I have to think about and it’s hard to make myself not skip the meeting. It’s all so much easier said than done so how do we make it easier to do?
4. Do you agree/disagree with the conclusions of the author, why? Mindfulness article concluded: “It is known that the most benefits are to be found in those who practice mindfulness with a considerable amount of persistence and discipline” –
I totally agree as I stated in #3 it is hard to make myself not skip a meeting but I know the difference it makes so I force myself to put my work aside (or get up earlier) and attend. It really needs to be ongoing and not a onetime attempt.
I would like to think that regardless of my stress/burnout etc., that the care if give patients is 110% and does not vary based on my wellbeing. I do feel the strain of making that effort in an attempt to maintain a high standard of patient care when I am feeling stressed/burned out/tired etc. My motto is: “either show up like nothing is wrong or call off and don’t burden everyone else.” But again, it is easier said than done!

1. What was the knowledge gained from the article?
Personally I feel that burnout in the nursing field is quite common, no matter your specialty of practice. The information in these articles in not surprising or shocking, in my opinion. Speaking only from an oncology standpoint I have even found myself questioning if I was feeling burnout from this profession with only 8 years in the field. I imagine that those in this field much longer have too felt the same. I have known many nurses that have already left the bedside and are pursuing other types of nursing careers because of the feeling of burn out. I think that the recommendations in these articles to spend time focusing on self-care and ways to reduce stress can be helpful. The problem I think lies simply with time. We are busy caring for patients at work and then with different home lives it’s often difficult to decompress and fully relieve the stress that accumulates. I do feel that OSU offers services that should be taken advantage of but again, time. Do we have time to take a class, do we an extra 10 minutes in the day to practice some mindfulness, can we debrief after a critical situation, or do we have to continue to provide patient care to our other patients? Vaclavik, Staffileno, and Carlson all agree that something as simple a debriefing after a serious event, reduces moral distress significantly. Fortunately, I work on unit now that the staff provides a lot of support toward one another and during those stressful events we know that that there is backup. I feel this helps tremendously, but I am not sure other nursing units have this luxury.
2. Will the research/information in this article change or influence your practice? If so how?
By reading these two articles I do think it is very important to find that time throughout your work day to reduce stress and help prevent caregiver fatigue. Doing so could extend nursing careers and improve overall mental health of the nurse.
3. What other questions does the article raise about current practice?
As I said previously, I do think that OSU offers things that help reduce stress burnout for nurses. CNS’s do a great job of helping with RBC which can be refreshing and rewarding as well. I know there are other professions in the healthcare field that offer a certain number of paid days off a month to allow for employees to reduce stress and not use their own benefit time. How GREAT would this be?!!?!! Although, probably not going to happen here but what a great thing to do . I wonder if other facilities or nursing units practiced more RBC methods and encouraged nurses to focus on self, if retaining nurses for longer amounts of time would improve.

I think that teaching these things in nursing school is a great idea as well. It would be a great place to set a framework for these types of things. It will also be an insight to new nurses on what to expect throughout their career and ways to manage in order to have a successful and long career in nursing. Having a greater realization of what to expect in a profession I think is essential. Although, we cannot fully know until we have the experience at least there will be some knowledge on ways to navigate through. I think some nurses can become burnt out or have compassion fatigue much sooner than others.

Megan- I don’t think it matters how many years you have been an RN, you burnout quickly because of how focused and intense we are on patient care etc,.
Some nurses thrive on that negative energy and I don’t think we can ever change that – I once said, “Oh, its ok. Your going to have a heart attack worrying about stuff we can’t change.” Her response was, “No I won’t because I vent to you every morning!” Glad I could help but it was killing me! I never saw it that way and so I continued to be a good listener.

I also wonder about RBC making a difference in retention. What units at OSU/James have good retention and do they practice RBC? Do they focus on care of colleagues? Unfortunately, for many units it is just terminology thrown out there but never really used other than to check off that they talked about it and “have it” on their units.