The Merriam-Webster online dictionary defines mindfulness as “bearing in mind” or “inclined to be aware”. While these definitions are helpful, Wikipedia provides a much more comprehensive entry, defining mindfulness as “a technique in which a person becomes intentionally aware of their own thoughts and actions in the present moment, non-judgmentally.”

One of the most famous proponents of mindfulness and “Mindfulness-Based Stress Reduction (MBSR) ” is Jon Kabat-Zinn , author of the books “Full Catastrophe Living ” and “Wherever You Go, There You Are ”. Kabat-Zinn directs the Center for Mindfulness in Medicine, Healthcare and Society at the University of Massachusetts Medical Center in Worcester, MA, where thousands of individuals have studied the techniques of mindfulness with astounding results, learning to live with chronic pain and other illnesses, not to mention simple garden-variety modern-day stress.

Kabat-Zinn defines mindfulness quite simply as “moment-to-moment awareness” in which we purposefully “pay attention to things we ordinarily never give a moment’s thought to”.

Mindfulness---or active awareness---can be cultivated through any number of means, from physical exercise to yoga to meditation to the act of work itself. According to the teachings of Kabat-Zinn, one could practice brick-laying with utterly perfect mindfulness if one were to fully attune to one’s breath, focus one’s awareness on the weight of the bricks in one’s hands, the soft pliability of the mortar, and the way the handle of the trowel fits one’s hand so perfectly. Why couldn’t a nurse translate that same set of sensations and patterns of awareness to his or her activities of nursing? How might even a handful of such moments throughout one’s day alter the trajectory of that day’s events and potentially stressful moments?

Through well-known and simple techniques involving conscious control of the breath and awareness of one’s self in relation to one’s environment, Kabat-Zinn maintains that stress can be reduced under even the most extreme circumstances, and that this net stress reduction can lead to improved quality of life, increased productivity, improved relationships, and increased levels of contentment and happiness.

Nurses, by and large, work in environments which require a great reliance on multi-tasking, the use of increasingly sophisticated technology, constant interpersonal contact with patients and colleagues, the use of finely honed clinical skills, and keen professional judgment in order to navigate any given shift. The challenges and stressors of any nursing position can be enough to send even the most seasoned nurse into the ranks of the burnt out and exhausted, and nurses often lose their love of the profession due to the vicissitudes and demands of nursing.

So, when discussing mindfulness, what is it about mindfulness that a nurse, for instance, would like to cultivate? What are qualities of being that would assist a nurse---regardless of clinical position---to be happier, more fulfilled, less reactive, and more productive? Would mindfulness improve patient outcomes or nurse-patient relationships? Mindfulness is, after all, by and large the opposite of mindlessness, wherein one engages in whatever one is doing with complete concentration, allowing extraneous thoughts to pass along the movie-screen of the mind like so many clouds across a clear blue sky.

For any nurse, simple practices of mindfulness offer techniques through which the nurse under stress can breathe through challenging moments (literally!) and decrease the negative effects of stress, mitigating the long- and short-term consequences on the mind and the body. Thus, a nurse who practices mindfulness techniques can be more aware of stress as it happens (in “real time”, as it were), and put into practice those techniques that can thwart the effects of stress on a moment-to-moment basis.

In terms of patient care, mindfulness can assist one in being more “present”, in allowing oneself to slow down just enough to listen more fully, to see with the eyes of compassion, and to have more authentic interactions with patients. Whether this can actually be quantified or not is beside the point. The nurse practicing mindfulness, and the patient on the receiving end of such practice, will doubtless both emerge from that interaction more satisfied and fulfilled.

Kate Loving Shenk , a nurse, writer, healer and musician, states, “nurses find the act of ‘being’ to be a difficult state to maintain. We often feel that we must be doing something for a patient at all times. The trick is to ‘be’ while ‘doing’. Do a task but practice conscious breathing, practice opening your heart, practice ‘being’ while ‘doing’, practice just being open.”

That said, how does one maintain one’s composure in the heat of the moment? How does one remain calm in the midst of the chaos when the call bells are ringing and the supervisor is calling for even more “productivity”? What does a mindful visiting nurse do when each of the eleven patients assigned for the morning wants to be seen by 8am and traffic is detoured at every turn?

During my own life, I have engaged in various practices that are said to increase mindfulness. Through explorations into yoga, Laughter Yoga, meditation, Qigong , Tai Chi and other techniques, mindfulness has been a somewhat elusive goal, but one that I continually strive to attain. Paradoxically, many teachers of mindfulness-based techniques state quite clearly that the striving for mindfulness in and of itself can actually be a deterrent to achieving one’s goal, since it is attachment to outcome that can thwart our ability to maintain our composure in the heat of the moment. Still, a calm awareness coupled with a modicum of detachment seems to be just what the nurse ordered, and modern techniques to achieve mindfulness are both well known and widely practiced, and could very well change the life of any healthcare provider or nurse who decides to learn them.

Despite being conversant with the literature and the practices themselves, I am as challenged as any other nurse in terms of remaining calm and centered when the proverbial feces hits the fan. Training in yoga, meditation and massage seems to make no difference. I still lose my cool. I become flustered, unfocused and scattered. I most likely miss many golden opportunities to be mindfully present with patients as I’m lost in the maelstrom of my own mind. It’s maddening to live in a world that seems to constantly battle against mindfulness, pulling and pushing us in too many directions at once, seemingly thwarting our desire to remain present.

Sisyphus vs. Hercules

It is a Herculean effort to be mindful, but we are even told by the teachers of mindfulness that too much effort will in and of itself thwart our progress. Rather than seeming like a Herculean effort, mindfulness might then seem more Sisyphean in nature (Sisyphus being the mythological character who was doomed to roll a stone up a steep hill for eternity, only to have the stone roll back down just before reaching the top).

Sisyphean or Herculean---or simply human---mindfulness techniques can truly be life altering, even if those changes are only experienced moment by moment. As Jon Kabat-Zinn is known to repeat ad nauseum, life is really not made up of days, weeks, months and years. Life is truly only made up of moments, and as each one passes, another presents itself for consideration. And consider those moments:

•    A patient looks you in the eye and says, “I’m afraid to die”.

•    You are about to give a child a vaccination, and you connect with her for just a second; aware not of the injection or the needle in your hand or the need to move to the next room----you are simply aware of this child breathing before you.

•    Your patient’s wife says, “I don’t know how to keep going. This is so hard.”

In those moments, the test is whether you can stay in the moment, see that moment for what it is and embrace it; or are you simply too lost to the magic of nursing that you can only see the task and not the person before you?

Mindfulness for nurses, in the end, is about presence, awareness, a compassionate ability to sink into the moment, ground one’s self in the present, and simply be---beyond the call bells, the patients, the orders, the phones and the scripts, it’s all about connection, and our ability to not only connect with our patients, but with ourselves.

If you are interested in mindfulness techniques, stress reduction, or any related topic, please feel free to email this author for further information. Below are listed the web addresses for several websites which may be of interest. A number of wonderful and gifted teachers of mindfulness and related techniques---including Thich Nhat Hahn, Jack Cornfield, and Pema Chodron----give retreats and publish books, websites, DVDs and CDs that may be of interest. Feel free to explore this limited but noteworthy list:

Center for Mindfulness at University of Massachusetts, Worcester
Sounds True
Thich Nhat Hahn
Pema Chodron
Mindfulness.com
The Mindfulness Bell
Parallax Press
Dharma.org

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NurseKeith is a writer, blogger, nurse, and consultant. Feel free to visit his blog, Digital Doorway . 

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