Making time for me - NSW Nurses and Midwives' Association · 8 | Making time for me: the emerging...

NSW Nurses and Midwives’ Association PROFESSIONAL ISSUES | 5

MAKING TIME FOR ME: the emerging role of mindfulness practice

in self-care for nurses and midwives OCCASIONAL REPORT

2 | Making time for me: the emerging role of mindfulness practice in self-care for nurses and midwives

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The New South Wales Nurses and Midwives’ Association (NSWNMA) is the registered union for all nurses and midwives in New South Wales. Membership comprises of those who perform nursing and midwifery work at all levels including management and education. This includes registered nurses and midwives, enrolled nurses and assistants in nursing (who are unlicensed).

Eligible members of the NSWNMA are also deemed to be members of the New South Wales Branch of the Australian Nursing and Midwifery Federation (ANMF). Our role is to protect and advance the interests of nurses and midwives and the nursing and midwifery professions. We are also committed to improving standards of patient care and the quality of services in health and aged care services.

This paper is authorised by the Elected Officers of the New South Wales Nurses and Midwives’ Association.

Contact detailsNSW Nurses and Midwives’ AssociationAustralian Nursing and Midwifery Federation NSW Branch50 O’Dea AvenueWaterloo, NSW 2017

P (02) 8595 1234 (metro) 1300 367 962 (rural)E [email protected]


With its origins in Buddhism, mindfulness teaches

the art of self-compassion through a range of formal and

informal meditation practices. These include breathing

exercises, drawing attention to the present moment

and non-judgemental acknowledgement of thoughts,

feelings and emotions in both self and others.

As with any form of meditation, the more it is practised

the shorter time it takes to feel the benefit. Once skills are

developed, the art of mindfulness can easily be integrated

into the usual working day.

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Personal stress is increasingly being recognised as an emerging public health concern. Therefore the provision of workplace strategies to assist in the management of stress and burnout should be a top priority for healthcare employers.

From March 2018 nurses and midwives have a professional responsibility within their codes of professional conduct to maintain self-care. Section 7.1 of the Code of Conduct for Midwives and Code of Conduct for Nurses state that nurses must “act to reduce the effect of fatigue and stress on their health, and on their ability to provide safe care” 1.

Recognition that to provide safe, compassionate care it is essential that nurses and midwives first look after their own mental and physical health is long overdue. The inclusion of self-care as a requirement to practice is a welcome addition. However, one which will not only require personal strategies, but also organisational strategies to ensure compliance with professional codes.

Whilst the focus of this report is mindfulness, it should be implemented as one of many self-care strategies in the workplace. Provision of services such as life coaching, relaxation techniques, gym membership and physiotherapy can all prove beneficial for organisations and workers alike.

Healthcare workers are frequently exposed to workplace stress and violence which contributes to job dissatisfaction, high staff turnover, inefficiencies and poor health2. Nurses and midwives often experience burnout as a result3 and mental health has been identified as priority for remedial action in relation to work health and safety4.

Recent data shows that around 90% of workers’ compensation claims involving a mental disorder were linked to work-related stress or mental stress5. The impact of stress and burnout on healthcare workers is not only exhibited on a

personal level, but has the potential to adversely affect patient care3,6. Therefore the personal and economic benefit of implementing low-cost public health strategies to improve workforce resilience cannot be underestimated.

Mindfulness has only recently started to emerge as a strategy to maintain the physical and psychological health of workers. It has been implemented by organisations such as Google, IBM and Proctor and Gamble, to build resilience within their workforce. Yet it has only recently begun to make inroads in healthcare settings, where stress and burnout are major disrupters to workforce productivity.

Cultivating mindfulness allows healthcare professionals to examine the way they think and feel about their experiences, particularly in stressful situations, and seek understanding of how these experiences impact on their physical and mental wellbeing7. In turn, this self-awareness enables workers to be more intuitive to the needs, responses and feelings of the people in their care. As a consequence, mindfulness has

90%of workers’

compensation claims involving a mental disorder were linked towork-related stress or mental stress5


been found particularly beneficial for nurses working in: mental health8; drug and alcohol9; midwifery7,10 and child and family services11, where external psychosocial pressures influence patient behaviours, and a partnership approach is fundamental to building self-efficacy.

The practice of mindfulness and self-compassion may seem alien to many healthcare workers, who are conditioned to accept stress as part of the burden of caring. Many nurses and midwives who practice forms of meditation are often doing so out of personal interest, self-development, or have been exposed to mindfulness and have found benefit from continuing to practice the techniques. Very few are exposed to formal programmes within the workplace.

With stress now a major cause of staff absences, healthcare employers must seek out non-traditional methods to maintain a healthy workforce and reduce staffing costs. Safe Work Australia identify that psychological stress should be managed in the same way as physical stress, using a risk management approach12.

Work environments that do not adequately manage these risks can incur significant human and financial costs. However, few health care settings have a robust strategy to reduce the impact of occupational stress.

Stress for healthcare workers takes many forms. Workload and physical demands are often associated with this. Ultimately employers have a responsibility to manage these factors and reduce workplace demands on nurses and midwives. However, healthcare workers also have to manage the unique demands placed upon them due to their role as care giver. The ongoing burden of providing compassionate care is increasingly recognised as a major cause of mental fatigue and burnout, known as compassion fatigue13. This phenomena requires a different management approach and the use of mindfulness in negating the impact of compassion fatigue could prove invaluable.

Undertaking mindfulness based practices actually changes the physical composition of the brain, increasing cortical thickness in areas of the brain that are responsible for managing stress14,15. It has been found effective in building resilience, compassion and empathy10,16.

... the use of mindfulness in negating the impact of compassion fatigue could prove invaluable.

Undertaking mindfulness based practices actually changes the physical composition of the brain, increasing cortical thickness in areas of the brain that are responsible for managing stress14,15

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In my early nursing career I was very driven for 15 years. I was personally and professionally always putting everyone’s needs before my own until I could no longer sustain such a life. I was physically and emotionally exhausted. My life was chaos. I did not feel I could continue my nursing career.

Seeking solutions, I learnt lots of techniques, one of them being mindfulness meditation. I have returned to nursing as a mindful nurse for two years now and my professional life is so different.

I work in the operating theatre, it is busy and can be stressful. My mindful awareness of myself allows me to know intrinsically what I need to perform at my best. Sometimes that is simply focussing on my breath for a few seconds to calm myself down. Sometimes that’s simply understanding that my knowledge in an area could be better so I will seek out the information myself and ensure the learning. Sometimes it’s the knowing that I am not the best person for the job and being confident to speak up to the In Charge or the appropriate person.

With the introduction of Principle 7: Health and Wellbeing, in the latest Code of

Conduct for Nurses. We as nurses are personally responsible to be physically acting to reduce the effect of fatigue and stress on our personal health. I welcome this introduction to our Code. Taking the time to care for yourself will naturally promote feelings of well-being and increase job satisfaction without anyone else’s contribution. When we have self-awareness, we will naturally be more intuitive to our environment, our patients, and our peers. This in turn will lead to a more harmonious health care environment for all.

I do believe that healthcare facilities should provide mindfulness meditation and other relaxation techniques for staff, patients and caregivers and I would think highly of any organisation that offered the same. Through my mindfulness training, I now have true compassion for myself. I can only now, truly, have compassion for others. I simply do not believe, we can give something that we don’t have for ourselves.

The ultimate goal would be mindful healthcare where we have a mindful organisation that acknowledges mindful practices from both staff and patients which results in an optimum healthcare experience for all.

Lucinda Jones van Buuren is a Registered Nurse, Life Coach, Mindfulness Meditation teacher and NSWNMA member

www.themindfulnurseaustralia.com.au


Maintaining mindfulness exercises over a longer period enhances short term benefits and can significantly decrease heart rate17 providing long term health benefits.

Mindfulness has been proven to reduce job burnout in health professionals16,18 and more generally, can reduce susceptibility to illness, build emotional intelligence, increase productivity and facilitate innovation19. Increased job satisfaction in nurses and midwives has also been found as a result of short term workplace mindfulness interventions20, which will lead to retention of staff and better quality of care.

Studies of the impact of mindfulness on different ethnic and religio-cultural groups show it is effective in all populations21,22. Its proven benefits within diverse ethnic groups and healthcare disciplines means it has the potential to be a highly relevant and effective strategy for use within the nursing and midwifery workforce.

If nurses and midwives are trained to recognise signs of stress in themselves and use mindfulness to overcome issues, it will help build resilience19. Mindfulness programs improve learning effectiveness, attention and memory in student populations21 and reduce perceived and biological stress levels23. There is evidence to suggest mindfulness can not only assist students undertaking undergraduate nursing and midwifery education, but also

enable them to develop skills required to build resilience and prevent compassion fatigue. Teaching the art of mindfulness should be considered in undergraduate nursing programs. However, workplaces must provide ongoing support for nurses and midwives to practice their skills.

Little research has been conducted on the longer term productivity savings associated with mindfulness integration. However, it is a low cost-high value strategy that has the potential to enhance service provision. Most research has focused on short term intervention, including a 12 month programme run at the John Hunter Hospital in Newcastle, NSW24, which yielded promising results. However, to capitalise on mindfulness, this should be considered as part of a longer term strategy which is embedded into nursing practice.

Although mindfulness is currently achieving a high profile, unless it is intrinsically linked to workforce policy it runs the risk of being time-limited. Employers should seek strategies including the creation of mindfulness champions within the workplace to ensure longevity and as a means of acknowledging the challenging environment in which nurses and midwives work.

If nurses and miwives are trained to recognise signs of stress in

themselves and use mindfulness to overcome issues,

it will help build resilience19

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1. http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

2. Canadian Mental Health Association (2006) Sources of Workplace Stress. Richmond: British Columbia.

3. Hulsheger, U.R. et al (2013) Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion and job dissatisfaction, Journal of Applied Psychology, 98, pp. 310-325.

4. Safe Work Australia (2012) Australian Work Health and Safety Strategy 2012-2022. Available at: https://www.safeworkaustralia.gov.au/system/files/documents/1702/australian-whs-strategy-2012-2022.pdf.

5. Safe Work Australia (2015) Work-related mental disorders profile 2015. Available at: https://www.safeworkaustralia.gov.au/system/files/documents/1702/work-related-mental-disorders-profile.pdf

6. Moreno, B. et al. (2012) A study of physicians’ intention to quit: The role of burnout and difficult doctor-patient interactions, Psicothema, 24, pp. 263-270.

7. Warriner, S. et al (2012) A mindfulness approach to antenatal preparation, British Journal of Midwifery, 20(3), pp.194-198.

8. Raab, K., Sogge, K., Parker, N., and Flament, M. (2015) Mindfulness-based stress reduction and self-compassion among mental healthcare professionals: a pilot study, Mental Health, Religion & Culture, 18(6), pp. 503-512.

9. Marcus, M.T. et al (2009) Mindfulness-Based Stress Reduction in Therapeutic Community Treatment: A Stage 1 Trial, The American Journal of Drug and Alcohol Abuse, 35, pp. 103-108.

10. Warriner, S., Hunter, L. and Dymond, M. (2016) Mindfulness in maternity: Evaluation of a course for midwives, British Journal Of Midwifery, 24(3), pp. 188-195.

11. Becker, B.D. et al (2016) Mindfulness among Home Visitors in Head Start and the Quality of Their Working Alliance with Parents, Journal of Child and Family Studies, 25(6). Pp. 1969-1979.

12. https://www.safeworkaustralia.gov.au/system/files/documents/1702/preventing-psychological-injury-under-whs-laws.pdf

13. Figley, C.R. (1995) Compassion fatigue as a secondary traumatic stress disorder: An overview in C.R.Figley (Ed.) Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, pp. 1-20. New York: Routledge.

14. Hölzel, B.K., Carmody, J., Vangel, M. et al. (2011) Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry research, 191(1) pp. 36-43.

15. Pickut, B.A. et al (2013) Mindfulness based intervention in Parkinson’s disease leads to structural brain changes on MRI: a randomized controlled longitudinal trial. Clinical Neurology and Neurosurgery, 115(12), pp. 2419-2425.

16. Harker, R., Pidgeon, A., Klaassen, F., and King, S. (2016) Exploring resilience and mindfulness as preventative factors for psychological distress burnout and secondary traumatic stress among human service professionals, Work, 54(3), pp. 631-637.

References


17. Amutio, A., Martínez-Taboada, C., Hermosilla, D. and Delgado, L. (2015) Enhancing relaxation states and positive emotions in physicians through a mindfulness training program: A one-year study, Psychology, Health & Medicine, 20(6), pp. 720-731.

18. Luken, M. and Sammons, A. (2016) Systematic Review of Mindfulness Practice for Reducing Job Burnout, American Journal Of Occupational Therapy, 70(2), pp. 1-10.

19. Mars, M. and Oliver, M. (2016) Mindfulness is more than a buzz word: Towards a sustainable model of health care, Journal Of The Australian Traditional-Medicine Society, 22(1), pp. 7-10.

20. Steinberg, B.A. (2017) Feasibility of a mindfulness-based intervention for surgical intensive care unit personnel, American Journal Of Critical Care, 26(1), pp. 10-18.

21. Ching, H., Koo, M., Tsai, T. and Chen, C. (2015) Effects of a Mindfulness Meditation Course on Learning and Cognitive Performance among University Students in Taiwan, Evidence-Based Complementary and Alternative Medicine (Ecam), Vol.2015, pp. 1-7.

22. Thomas, J., Raynor, M., and Bakker, M. (2016) Mindfulness-based stress reduction among Emirati Muslim women, Mental Health, Religion and Culture, 19(3), pp. 295-304.

23. Beck, A., Verticchio, H., Seeman, S., Milliken, E. and Schaab, H. (2017) A Mindfulness Practice for Communication Sciences and Disorders Undergraduate and Speech-Language Pathology Graduate Students: Effects on Stress, Self-Compassion, and Perfectionism, American Journal Of Speech-Language Pathology, 26, pp. 893-907.

24. Ward, S. and Outram, S. (2017) Staff mindfulness sessions well received at John Hunter Hospital. The Australian Hospital Healthcare Bulletin, Autumn 2017 Ed. p. 82.

Further ReadingCarmel Sheridan (2016) The Mindful Nurse – Using the power of Mindfulness and Compassion to help you thrive in your work. USA: Rivertime Press

NSW Nurses and Midwives’ AssociationAustralian Nursing and Midwifery Federation NSW Branch

50 O’Dea Avenue Waterloo NSW 2017

PHONE 8595 1234 (metro)

1300 367 962 (non-metro)

www.nswnma.asn.au


NSWNMA/ANMF NSW Branch Legal Disclaimer

This publication contains information, advice and guidance to help members of the NSWNMA/ANMF NSW Branch. It is intended to use within New South Wales but readers are advised that practices may vary in each country and outside New South Wales.

The information in this booklet has been compiled from professional sources, but it’s accuracy is not guaranteed. While every effort has been made to ensure that the NSWNMA/ANMF NSW Branch provides accurate and expert information and guidance, it is impossible

to predict all the circumstances in which it may be used. Accordingly, the NSWNMA/ANMF NSW Branch shall not be liable to any person or entity with repect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out

of this information and guidance.

Publised by the NSWNMA/ANMF NSW Branch, 50 O’Dea Avenue, Waterloo NSW 2017, Australia.

© 2017 NSWNMA/ANMF NSW Branch. All rights reserved. Other than as permitted by law no part of this publication may be produced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or

otherwise, without prior permission of the Publisher. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is publised, without the prior consent of the Publisher.

ISBN: 978-1-921326-14-1 (Australia)

Issued April 2018. Authorised by Brett Holmes, General Secretary, NSWNMA and Branch Secretary, ANMF NSW Branch, April 2018



ISBN: 978-1-921326-14-1 (Australia) I Issued April 2018




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