Fostering a Mindful Holding Environment in the Nurse ... Posters/33-Beirne-Streff.pdf · mindful...
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Fostering a Mindful Holding Environment in the Nurse-Patient Relationship: Using Mindfulness Based Concepts in Psychiatric Mental Health Nursing Practice Maureen Beirne Streff EdD, MSN, PMHCNS-BC & Elaine McGrane Olmstead MS, PMHCNS-BC Streff Associates Private Practice - Acton, Massachusetts Creating a Mindful Holding Environment in Individual Psychotherapy: Sitting Together Listening to A’s Story “Oh M you’ll never guess what my granddaughter wants me to do at her wedding ceremony” A continues… “The grandmothers and aunts are invited to come up to the altar and give a blessing at the podium. I’ll get so anxious. But I want to do it.” Would you like to talk about this? A softly begins to talk about the importance of faith, her “granddaughter is Catho- lic and her fiancé is Jewish.” “That could work out.” She was breathing softly and said “I feel more relaxed. I’m paying attention to writ- ing something to say.” “Would you like to bring your writing to our next session?” “Oh yes, I’ll bring it”, smiling “Yes, I’ll read it to you”. Next session A enters appearing anxious. She settles in her chair, feet on the floor. “Now I’m ready to read”. Then she hands the paper to me. “Please read it, I want to hear how it sounds”. I begin to read it. “Oh, your voice is calm, I hope I can be calm”. “You are reading calmly sitting in your chair, what is helping you to do that”? She says “We are sitting together.” “Would it be helpful to you if I was sitting in the back of the church during the cer- emony”? “Oh yes, would you do that”? “Yes I would.” Invitations to engage in Mindfulness practice are increasing, “The Art Of Being Mindful”, Pickert, K (2014, February3). Time, 183, 40-46. Integrating Therapeutic Mindfulness into our Clinical Practice is based on re- search and best evidence. Integrating mindfulness concepts in Psychiatric Mental Health Nursing interven- tions increases our present knowledge in psychotherapy and our ability to en- gage in our nurse patient relationships. To increase participants knowledge and use of mindfulness based strategies to enhance the therapeutic relationship and to provide psycho-education so that clients can better manage worry, anxiety, and depression. “Mental Illness, a leading cause of disability and premature mortality in America, contributes to the use of a significant portion of health care resources”. (Day, P. O., & Horton-Deutsch, S. 2004). “Mindfulness-based therapeutic interventions have been shown to relieve distress for individuals with medical and psychiatric illness”. (Day, P. O., & Hor- ton-Deutsch, S. p. 170, 2004). Advance Practice Psychiatric Nurses are increasingly seeking effective nursing interventions to promote a culture of safety and to increase the ability of staff to provide compassion and empathy for others. (Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. 2012). Objectives 1. Define 3 components of mindfulness based interventions such as aware- ness, acceptance, compassion, and attention. 2. Describe 3 benefits that mindfulness provides in the nurse-patient relation- ship, i.e. increased compassion, ability to stay present, and increased sense of safety. 3. Utilize mindfulness techniques for oneself to manage stress and to be able to increase compassion and empathy for others. What We Will Present We created a discussion forum in our clinical practice to review best evidence utilizing critical analysis and evaluation guidelines to create potentially ef- fective nursing interventions in our psychotherapy. We integrated the best evidence with our clinical experiences, our advanced psychiatric nursing education, our patients’ preferences and values in con- sidering a practice decision to foster a mindful holding environment in our nurse-patient relationships. Mindfulness Skills AWARENESS – “Ability to notice where attention is, how often it shifts and gen- tly bring it back to the focus”; thoughts, feelings, sensations can be noticed but do not have to be the focus of awareness. PRESENT MOMENT – Right here, right now, simple physical sensations and sen- sory experience; observe thoughts and emotions as they come and go but focus Background & Relevance for Psychiatric Nursing on the present moment. SELF-COMPASSION – Non-critical, non judgmental, of thoughts, feelings and ex- perience. One might notice self-criticism but have compassion for one’s struggle. BEGINNER’S MIND – Noticing and experiencing as if for the first time; “helps us to see things fully, as they are, instead of how we expect them to be.” ACCEPTANCE – Of things as they are – in this moment – not as we wish they were or fear of what they might become. The ability to accept one’s current state of mind as it is without evaluating it as good or bad can translate into being able to “accept whatever arises in daily life” (Orsillo, Roemer, 2011). Basis of Mindfulness in Nurse-Patient Relationship Mindfulness derived from the teachings of Buddha, (c. 500 BCE), “the great psy- chologist”, key component of Buddhist psycholo- gy. The Four Noble Truths: - Life includes suffering - Suffering is caused by desire for things to be dif- ferent than they are - Suffering can be reduced/eliminated by changing attitudes - The Eightfold Path – strategies to change attitude (Germer, Siegal, Fulton, 2005) Florence Nightingale (1820-1910) Interested in writings of Christian mystics and Eastern scriptures; believed spirituality is intrin- sic to human nature and is our deepest and most potent source for healing (Marcrae, 1994). “What nursing has to do is put the patient in the best condition for nature to act upon him.” Em- phasized that observation is the most important nursing skill (Nightingale, 1859). Hildegard Peplau (1909- 1999) Creating a Mindful Holding Environment While Participating in a Symposium, “Integrating Therapeutic Mindfulness and Compassionate Presence into Clinical Practice” Having sustained a median nerve damage in my right hand a year prior to at- tending the symposium, I had not yet experienced therapeutic mindfulness and compassionate presence as a tool to manage pain. During the symposium, Dr. Morgan a clinical psychologist introduced us to mindfulness by engaging us in exercises to experience that mindfulness can be defined as the learned capacity to maintain ongoing awareness of openness to a current experience. He invited us to take some slow deep breaths, relaxing with the exhalation breaths. I became aware of a decrease in the nerve pain in my hand. My experience of mindfulness meditation daily has enhanced my creating a mindful holding environment with a gentle in breath and with the next exhale imaging sending warm soothing energy with caring attention from the top of my wrist to my finger tips. - Interpersonal Relations in Nursing (1952) states empathy and rapport are the most important aspects of nurse-patient relationship. Emphasized empathic linkage and the interpersonal transmission of anxiety, panic, and other feelings. In a relationship with a patient, the nurse should pay attention to her own feel- ings as a means of gaining valuable observations about the patient’s feelings (Boyd, 2005). Mindfulness In Group Therapy For People With Metastatic Cancer PRIMARY FOCUS: Living with cancer and enjoying life now PMHCNS: Practices mindfulness in facilitating the group to manage own anxiety and distress to convey to group members that feelings are tolerable even when painful AWARENESS & ATTENTION: Members demonstrate ability to listen to content that family/friends may find difficult to hear; attends to affect behind the con- tent, encourages awareness of present experience in the group PRESENT FOCUSED: Members develop improved ability to live in the present moment which may be joyful, humorous, sad, or scary and will inevitably pass into the next moment. Even in the face of terminal illness they can laugh, experi- ence joy, cry, or experience friendship together. COMPASSION: Members offer each other support and caring and can empathize from their own experiences with cancer which in turn promotes self compassion NON-JUDGMENTAL: Members become better able to share feelings in non-judg- mental environment, show acceptance of each persons experience and wishes/ decisions regarding their treatment and end of life issues. ACCEPTANCE: Focus on living with cancer even though one may eventually die from it. Acceptance of the present moment differs from acceptance of eventual death from cancer but may assist in that process References: Boyd, Mary Ann. (2005). Theoretical basis of psychiatric nursing in Boyd, Mary Ann. (Ed) Psychiatric Nursing: Contemporary Practice, (3rd ed.) pp.74- 92), Philadelphia: Lippincott, Williams & Wilkins. Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. (2012). The im- pact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspectives in Psychiatric Care,48(3), 129-137. doi:10.1111/j.1744-6163.2011.00315.x Chiesa, A., Anselmi, R., & Serretti, A. (2014). Psychological mechanisms of mindfulness-based interventions. Holistic Nursing Practice, 28(2), 124-148. doi:10.1097/HNP.0000000000000017 Church, O. (2000). Hildegard E. Peplau’s leadership and achievements in the advance of psychiatric nursing: the right person in the right time and place. Journal of the American Psychiatric Nurses Association, 6(1), 16-24. Re- trieved July 14, 2014, from the Sage Publications database. Day, P. O., & Horton-Deutsch, S. (2004). Using mindfulness-based therapeu- tic interventions in psychiatric nursing practice -- part 1: Description and empirical support for mindfulness-based interventions. Archives of Psychi- atric Nursing, 18(5), 164-169. Retrieved from http://search.ebscohost.com/ login.aspx?direct=true&db=ccm&AN=2005021938&site=ehost-live Day, P. O., & Horton-Deutsch, S. (2004). Using mindfulness-based therapeu- tic 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. Retrieved from http://search.ebsco- host.com/login.aspx?direct=true&db=ccm&AN=2005021939&site=ehost-live Germer, C. K., Siegel, R. D., & Fulton, P. R. (2013). Mindfulness and psycho- therapy (Second Edition ed.). New York: Guilford Press. Hanson, R., & Mendius, R. (2009). Buddha’s brain the practical neuroscience of happiness, love, & wisdom. Oakland, CA: New Harbinger Publications. Hee Kim, L., Subramanian, P., Rahmat, N., & Phang Cheng, K. (2014). The ef- fects of mindfulness training program on reducing stress and promoting well-being among nurses in critical care units. Australian Journal of Ad- vanced Nursing, 31(3), 22-31. Retrieved from http://search.ebscohost.com/ login.aspx?direct=true&db=ccm&AN=2012567533&site=ehost-live Hirst, I. S. (2003). Perspectives of mindfulness. Journal of Psychiatric and Mental Health Nursing, 10(3), 359-366. Retrieved from http://search.ebsco- host.com/login.aspx?direct=true&db=psyh&AN=2003-05086-014&site=e- host-live Leininger, M. M., & McFarland, M. R. (2015). Culture care diversity and uni- versality: a worldwide nursing theory (3rd ed.). Burlington, MA: Jones and Bartlett. Macrae, Janet. (1995) Nightingale’s spiritual philosophy and its significance for modern nursing; Image: Journal of Nursing Scholarship, 27(1), 8-10. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: a guide to best practice (2nd ed.). Philadelphia: Wolt- ers Kluwer/Lippincott Williams & Wilkins. Morgan, B. (2014). Integrating therapeutic mindfulness and compassionate presence into clinical practice. New England Educational Institute. Nightingale, F. (1982). Notes on nursing and notes on hospitals (Special ed.). Birmingham, Ala.: Classics of Medicine Library. Orsillo, Susan M. and Roemer, Lizabeth. (2011).The mindful way through anxiety. New York: The Guilford Press. Peplau, H. (1965). The heart of nursing: interpersonal relations. The Canadi- an Nurse, 61(4), 273-275. Pickert, K. (2014, February 3). The art of being mindful. TIME, 183, 40-46. Pollak, S., Pedulla, T., & Siegal, R. D. (2014). Sitting together essential skills for mindfulness-based psychotherapy. New York: The Guilford Press. Segal, Zindel V., Williams, J. Mark G., Teasdale, John D. (2002).Mindful- ness-based cognitive therapy for depression: a new approach to preventing relaspe. NewYork: The Guilford Press. Williams, J. M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: freeing yourself from chronic unhappiness. New York: Guilford Press. https://www.ohio.edu/research/documents/templates Photo permission daughter, Anne Peplau Photo permission from: Margaret Koch, Executive Director of The Virginia Thurston Healing Garden Conclusion Our presentation demonstrating the process of fostering a mindful holding environment in our nurse-patient rela- tionships has prompted us to continue to examine the detail and depth of our work in order to prompt clinical and research questions. Purpose Summary of Evidence
Transcript of Fostering a Mindful Holding Environment in the Nurse ... Posters/33-Beirne-Streff.pdf · mindful...
Fostering a Mindful Holding Environment in the Nurse-Patient Relationship: Using Mindfulness Based Concepts in Psychiatric Mental Health Nursing Practice
Maureen Beirne Streff EdD, MSN, PMHCNS-BC & Elaine McGrane Olmstead MS, PMHCNS-BCStreff Associates Private Practice - Acton, Massachusetts
Creating a Mindful Holding Environment in Individual Psychotherapy: Sitting Together
Listening to A’s Story
“Oh M you’ll never guess what my granddaughter wants me to do at her wedding ceremony” A continues… “The grandmothers and aunts are invited to come up to the altar and give a blessing at the podium. I’ll get so anxious. But I want to do it.”
Would you like to talk about this?
A softly begins to talk about the importance of faith, her “granddaughter is Catho-lic and her fiancé is Jewish.” “That could work out.”
She was breathing softly and said “I feel more relaxed. I’m paying attention to writ-ing something to say.”
“Would you like to bring your writing to our next session?”
“Oh yes, I’ll bring it”, smiling “Yes, I’ll read it to you”.
Next session A enters appearing anxious. She settles in her chair, feet on the floor. “Now I’m ready to read”. Then she hands the paper to me. “Please read it, I want to hear how it sounds”. I begin to read it. “Oh, your voice is calm, I hope I can be calm”.
“You are reading calmly sitting in your chair, what is helping you to do that”?
She says “We are sitting together.”
“Would it be helpful to you if I was sitting in the back of the church during the cer-emony”?
“Oh yes, would you do that”?
“Yes I would.”
Invitations to engage in Mindfulness practice are increasing, “The Art Of Being Mindful”, Pickert, K (2014, February3). Time, 183, 40-46.
Integrating Therapeutic Mindfulness into our Clinical Practice is based on re-search and best evidence.
Integrating mindfulness concepts in Psychiatric Mental Health Nursing interven-tions increases our present knowledge in psychotherapy and our ability to en-gage in our nurse patient relationships.
To increase participants knowledge and use of mindfulness based strategies to enhance the therapeutic relationship and to provide psycho-education so that clients can better manage worry, anxiety, and depression.
“Mental Illness, a leading cause of disability and premature mortality in America, contributes to the use of a significant portion of health care resources”. (Day, P. O., & Horton-Deutsch, S. 2004).
“Mindfulness-based therapeutic interventions have been shown to relieve distress for individuals with medical and psychiatric illness”. (Day, P. O., & Hor-ton-Deutsch, S. p. 170, 2004).
Advance Practice Psychiatric Nurses are increasingly seeking effective nursing interventions to promote a culture of safety and to increase the ability of staff to provide compassion and empathy for others. (Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. 2012).
Objectives
1. Define 3 components of mindfulness based interventions such as aware-ness, acceptance, compassion, and attention.
2. Describe 3 benefits that mindfulness provides in the nurse-patient relation-ship, i.e. increased compassion, ability to stay present, and increased sense of safety.
3. Utilize mindfulness techniques for oneself to manage stress and to be able to increase compassion and empathy for others.
What We Will Present
We created a discussion forum in our clinical practice to review best evidence utilizing critical analysis and evaluation guidelines to create potentially ef-fective nursing interventions in our psychotherapy.
We integrated the best evidence with our clinical experiences, our advanced
psychiatric nursing education, our patients’ preferences and values in con-sidering a practice decision to foster a mindful holding environment in our nurse-patient relationships.
Mindfulness Skills
AWARENESS – “Ability to notice where attention is, how often it shifts and gen-tly bring it back to the focus”; thoughts, feelings, sensations can be noticed but do not have to be the focus of awareness. PRESENT MOMENT – Right here, right now, simple physical sensations and sen-sory experience; observe thoughts and emotions as they come and go but focus
Background & Relevance for Psychiatric Nursing
on the present moment. SELF-COMPASSION – Non-critical, non judgmental, of thoughts, feelings and ex-perience. One might notice self-criticism but have compassion for one’s struggle. BEGINNER’S MIND – Noticing and experiencing as if for the first time; “helps us to see things fully, as they are, instead of how we expect them to be.”ACCEPTANCE – Of things as they are – in this moment – not as we wish they were or fear of what they might become. The ability to accept one’s current state of mind as it is without evaluating it as good or bad can translate into being able to “accept whatever arises in daily life” (Orsillo, Roemer, 2011).
Basis of Mindfulness in Nurse-Patient Relationship
Mindfulness derived from the teachings of Buddha, (c. 500 BCE), “the great psy-chologist”, key component of Buddhist psycholo-gy. The Four Noble Truths:
- Life includes suffering
- Suffering is caused by desire for things to be dif-ferent than they are
- Suffering can be reduced/eliminated by changing attitudes
- The Eightfold Path – strategies to change attitude (Germer, Siegal, Fulton, 2005)
Florence Nightingale (1820-1910)
Interested in writings of Christian mystics and Eastern scriptures; believed spirituality is intrin-sic to human nature and is our deepest and most potent source for healing (Marcrae, 1994).
“What nursing has to do is put the patient in the best condition for nature to act upon him.” Em-phasized that observation is the most important nursing skill (Nightingale, 1859).
Hildegard Peplau (1909- 1999)
Creating a Mindful Holding Environment While Participating in a Symposium, “Integrating
Therapeutic Mindfulness and Compassionate Presence into Clinical Practice”
Having sustained a median nerve damage in my right hand a year prior to at-tending the symposium, I had not yet experienced therapeutic mindfulness and compassionate presence as a tool to manage pain.
During the symposium, Dr. Morgan a clinical psychologist introduced us to mindfulness by engaging us in exercises to experience that mindfulness can be defined as the learned capacity to maintain ongoing awareness of openness to a current experience. He invited us to take some slow deep breaths, relaxing with the exhalation breaths. I became aware of a decrease in the nerve pain in my hand.
My experience of mindfulness meditation daily has enhanced my creating a mindful holding environment with a gentle in breath and with the next exhale imaging sending warm soothing energy with caring attention from the top of my wrist to my finger tips.
- Interpersonal Relations in Nursing (1952) states empathy and rapport are the most important aspects of nurse-patient relationship.
Emphasized empathic linkage and the interpersonal transmission of anxiety, panic, and other feelings.
In a relationship with a patient, the nurse should pay attention to her own feel-ings as a means of gaining valuable observations about the patient’s feelings (Boyd, 2005).
Mindfulness In Group Therapy For People With Metastatic Cancer
PRIMARY FOCUS: Living with cancer and enjoying life now
PMHCNS: Practices mindfulness in facilitating the group to manage own anxiety and distress to convey to group members that feelings are tolerable even when painful
AWARENESS & ATTENTION: Members demonstrate ability to listen to content that family/friends may find difficult to hear; attends to affect behind the con-tent, encourages awareness of present experience in the group
PRESENT FOCUSED: Members develop improved ability to live in the present moment which may be joyful, humorous, sad, or scary and will inevitably pass into the next moment. Even in the face of terminal illness they can laugh, experi-ence joy, cry, or experience friendship together.
COMPASSION: Members offer each other support and caring and can empathize from their own experiences with cancer which in turn promotes self compassion
NON-JUDGMENTAL: Members become better able to share feelings in non-judg-mental environment, show acceptance of each persons experience and wishes/decisions regarding their treatment and end of life issues.
ACCEPTANCE: Focus on living with cancer even though one may eventually die from it. Acceptance of the present moment differs from acceptance of eventual death from cancer but may assist in that process
References:
Boyd, Mary Ann. (2005). Theoretical basis of psychiatric nursing in Boyd, Mary Ann. (Ed) Psychiatric Nursing: Contemporary Practice, (3rd ed.) pp.74- 92), Philadelphia: Lippincott, Williams & Wilkins.
Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. (2012). The im-pact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspectives in Psychiatric Care,48(3), 129-137. doi:10.1111/j.1744-6163.2011.00315.x
Chiesa, A., Anselmi, R., & Serretti, A. (2014). Psychological mechanisms of mindfulness-based interventions. Holistic Nursing Practice, 28(2), 124-148. doi:10.1097/HNP.0000000000000017
Church, O. (2000). Hildegard E. Peplau’s leadership and achievements in the advance of psychiatric nursing: the right person in the right time and place. Journal of the American Psychiatric Nurses Association, 6(1), 16-24. Re-trieved July 14, 2014, from the Sage Publications database.
Day, P. O., & Horton-Deutsch, S. (2004). Using mindfulness-based therapeu-tic interventions in psychiatric nursing practice -- part 1: Description and empirical support for mindfulness-based interventions. Archives of Psychi-atric Nursing, 18(5), 164-169. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2005021938&site=ehost-live
Day, P. O., & Horton-Deutsch, S. (2004). Using mindfulness-based therapeu-tic 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. Retrieved from http://search.ebsco-host.com/login.aspx?direct=true&db=ccm&AN=2005021939&site=ehost-live
Germer, C. K., Siegel, R. D., & Fulton, P. R. (2013). Mindfulness and psycho-therapy (Second Edition ed.). New York: Guilford Press.
Hanson, R., & Mendius, R. (2009). Buddha’s brain the practical neuroscience of happiness, love, & wisdom. Oakland, CA: New Harbinger Publications.
Hee Kim, L., Subramanian, P., Rahmat, N., & Phang Cheng, K. (2014). The ef-fects of mindfulness training program on reducing stress and promoting well-being among nurses in critical care units. Australian Journal of Ad-vanced Nursing, 31(3), 22-31. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2012567533&site=ehost-live
Hirst, I. S. (2003). Perspectives of mindfulness. Journal of Psychiatric and Mental Health Nursing, 10(3), 359-366. Retrieved from http://search.ebsco-host.com/login.aspx?direct=true&db=psyh&AN=2003-05086-014&site=e-host-live
Leininger, M. M., & McFarland, M. R. (2015). Culture care diversity and uni-versality: a worldwide nursing theory (3rd ed.). Burlington, MA: Jones and Bartlett.
Macrae, Janet. (1995) Nightingale’s spiritual philosophy and its significance for modern nursing; Image: Journal of Nursing Scholarship, 27(1), 8-10.
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: a guide to best practice (2nd ed.). Philadelphia: Wolt-ers Kluwer/Lippincott Williams & Wilkins.
Morgan, B. (2014). Integrating therapeutic mindfulness and compassionate presence into clinical practice. New England Educational Institute.
Nightingale, F. (1982). Notes on nursing and notes on hospitals (Special ed.). Birmingham, Ala.: Classics of Medicine Library.
Orsillo, Susan M. and Roemer, Lizabeth. (2011).The mindful way through anxiety. New York: The Guilford Press.
Peplau, H. (1965). The heart of nursing: interpersonal relations. The Canadi-an Nurse, 61(4), 273-275.
Pickert, K. (2014, February 3). The art of being mindful. TIME, 183, 40-46.
Pollak, S., Pedulla, T., & Siegal, R. D. (2014). Sitting together essential skills for mindfulness-based psychotherapy. New York: The Guilford Press.
Segal, Zindel V., Williams, J. Mark G., Teasdale, John D. (2002).Mindful-ness-based cognitive therapy for depression: a new approach to preventing relaspe. NewYork: The Guilford Press.
Williams, J. M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: freeing yourself from chronic unhappiness. New York: Guilford Press.
https://www.ohio.edu/research/documents/templates
Photo permission daughter, Anne Peplau
Photo permission from: Margaret Koch, Executive Director of The Virginia Thurston Healing Garden
Conclusion
Our presentation demonstrating the process of fostering a mindful holding environment in our nurse-patient rela-tionships has prompted us to continue to examine the detail and depth of our work in order to prompt clinical and research questions.
Purpose
Summary of Evidence
