Mindfulness for the Healthcare Professional

Mindfulness has become quite the “buzzword” among healthcare professionals from social media, nursing, psychology, rehabilitation, counseling, and gurus alike. Because it is becoming so popularized, normalized, and evidence-based, it is apparent that healthcare providers should have at least a basic and practical understanding of its use and application. Some societal shifts often distract one’s focus and self-awareness, in which mindfulness practice has a wonderful place to ground and reorientate to the present moment.

Healthcare providers are experiencing a growing number of individuals suffering from burnout(Link et al., 2021; Venturini et al., 2024). Those in this field suffer from the demands of direct patient care, the pressures from employing organizations, and the continual needs of the healthcare system. Mindfulness offers a revitalizing approach and a means of coping through these trying periods.

What about societal attention span and the ability to focus one’s attention? The Microsoft organization performed a study that found that its employees had a reduction in their ability to pay attention to a particular task. The average focus maintenance was only eight seconds (McSpadden, 2015). Mindfulness training is a means of improving an individual’s ability to maintain focus on a task or activity with better ease. It encourages refreshing viewing of the same or similar tasks.

What about the cost? Besides the time spent practicing, it is free to implement as a daily routine. Mindfulness has been compared to cognitive behavioral therapy with comparable results for treating various conditions (Sverre et al., 2023). Mindfulness may be a more cost-effective strategy for many as it requires no equipment or significant cost to practice.

So, What is mindfulness? Mindfulness has deep and historic roots in ancient Buddhist teachings (Kabat-Zinn, 2003), but mindfulness is not a religious or spiritual practice. However, it most definitely can incorporate these aspects. Research supports the use of religion and spirituality in healthcare settings when it comes to coping and even pain modulation (Brasileiro et al., 2017; Chin et al., 2021; Illueca & Doolittle, 2020; Najem et al., 2023; Simonovich et al., 2022). Jon-Kabat Zinn is considered to be one of the leading experts in mindfulness. He developed the Mindfulness-Based Stress Reduction program at the University of Massachusetts.

Zinn defines mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment and non-judgmentally to the unfolding experience, moment by moment.”

When learning any subject, it is good to reflect on the standard definition and one’s own definition. This allows you to become aware of personal biases and understand what mindfulness is and means to you as an individual. You must also be willing to truly listen to others who may have a different perspective or understanding.

Despite its roots, mindfulness does not have to be “Hippy-Dippy.” It has broad applications in numerous practical settings that do not require a meditation cushion, yoga mat, sound baths, or monk robes. It requires no equipment at all, which makes mindfulness such a versatile and effective tool. However, mindfulness utilization is a skill that requires behavior change, habit formation, and self-reflection. It is a way of being responsive to everything going on around you.

What are the basic types of mindfulness

There are four proposed mechanisms related to mindfulness. These include (Holzel et al., 2011):

1. Attention Regulation
2. Body Awareness
3. Emotional Regulation
4. Self-Regulation and Change in Perceived Self

Each will be discussed in the following sections.

The following seven attitudes are considered the attitudinal foundations of mindfulness  (Kabat-Zinn, 2013):

1. Non-Judging
2. Beginner’s Mind
3. Patience
4. Acceptance
5. Trust
6. Non-Striving
7. Letting Go

What is going on in the nervous system? Research suggests that expert mindfulness practitioners/meditators engage regions of the brain differently than those who are novices or nonmeditators when holding attention or focusing (Tang et al., 2015). Why does this matter? It demonstrates that with practice, the brain can make changes and “re-wire.” It becomes more efficient in processing sensory stimuli. The sensation is the same, but there is a response rather than an automatic reaction. The brain can adapt to be less reactive, and one can dampen connections to the “lizard” brain and the limbic system, where there are heavy ties to fear and emotion (Tang et al., 2015; Taren et al., 2013). How fantastic to know that an individual can train the brain. This is neuroplasticity at its finest. The more regularly you can practice, the more automatic this processing can become with better ease of tuning into your attention. There is often an automatic reaction to stimuli, whether it be stress, pain, or other “fight or flight” sympathetic experiences. However, with practice, you can begin to change to a more rational, thought-out response rather than an impulsive survival reaction.

Mindfulness is a skill that can be learned and developed with practice and has numerous benefits. Below is a list of the numerous benefits of practicing and participating in mindfulness-based activities.

• Improved focus/concentration (Ma et al., 2017)
• Improved regulation of emotions (Shields et al., 2016)
• Decreases muscle tension (Kapogiannis et al., 2018)
• Reduced stress/anxiety (Kapogiannis et al., 2018; Ma et al., 2017; Grossman et al., 2004)
• Reduced pain (Doran, 2014; Veehof et al., 2016; Burns et al., 2022)
• Reduced anxiety and depression (Teasdale et al., 2000; Roemer et al., 2008; Hofmann et al., 2010)Decreased substance abuse
• (Bowen et al.,2006)
•  
• Improved management of eating disorders and weight loss (Ruffault et al.,2017)
• Improved physical function (Grossman et al., 2004)
• Improved sleep (Grossman et al., 2004)
• Improved mood (Balban et al., 2023)
• Improved immune function (Carlson et al., 2007; Davidson et al., 2003; Jacobs et al., 2011)
• Reduced blood pressure (Carlson et al., 2007; Zou et al., 2017)
• Decreased cortisol levels(Carlson et al. 2007)

Was a theme starting to become more apparent? Be curious, observe, respond, non-reactive, and non-interactive. What was hopefully conveyed is that mindfulness can be nearly anything, from the most basic movement of breath to the most complex and intricate artistic creation, performance art, or athletic event. It can be the most exciting or the most mundane. It is the simple art of becoming aware and finding ways of viewing the world from a wider vantage point. In turn, it allows one to truly be present in the world and in life.

Trauma-informed care training is outside the scope of this class. However, it is vital to know that it is not uncommon for patients to have a history of a wide variety of traumas. Whether it is emotional or physical. Adverse child experiences (ACE) are also very common and can significantly impact a patient’s health and well-being in the future (Herzog & Schmahl, 2018; Swedo et al., 2023). According to one study, about 64% of adults in the United States reported they had experienced at least one type of ACE before age 18, and nearly one in six (17.3%) adults reported they had experienced four or more types of ACE (Swedo et al., 2023). Mindfulness practice is often quite safe, but always ask for informed consent before interacting with an individual. With trauma-informed care, the goal is not to retraumatize. Being informed and aware of past medical history can be very helpful in deciding if these intervention strategies may or may not be helpful. Consent is very important before proceeding. Be sure to inquire about any concerns the person may have before proceeding. Again, the goal is not to retraumatize an individual, and sometimes, it is wise to approach every individual as there may be a history of trauma. Doing this ensures one can be sensitive to each patient’s needs. This can be as simple as being aware of your own verbal and nonverbal communication in relation to the individual. Trauma-informed care aims to facilitate and promote an environment of safety.

A 53-year-old woman injured her left shoulder when skiing approximately three months ago. She sustained a non-displaced greater tuberosity fracture. She reports hitting her head, though she did not lose consciousness. She reports brief vision loss and having difficulty with her memory and occasional word finding. However, she was told due to no loss of consciousness, they did not perform any imaging at the emergency department. In addition, she was initially told that there was no fracture at the emergency department. She was more recently evaluated by orthopedics with clarification and diagnosis of a fracture. However, there was still no referral for a concussion assessment. Rehabilitation screened the patient for a concussion, and the patient was finally referred to sports medicine for a concussion assessment. Based on that examination, she was then referred to speech, occupational, and physical therapy services for continuation of shoulder care as well as a new diagnosis of post-concussion syndrome.

The patient has regained her shoulder's full range of motion but has some continued strength loss secondary to nonsurgical lifting precautions. Her pain has been persistent despite significant improvements in function. The patient also recently had an abdominal hernia surgery that was initially postponed, allowing her to participate in a full skiing season. She had no shoulder pain for a few days post-operatively, but her pain has since returned. With further discussion of her rehabilitation progress, it is learned that there is a high-level life stressors involved. She is a stay-at-home mom with four children heavily involved in competitive travel sports and recent family concerns. Throughout your conversation, you learn that she trained as a massage therapist and worked in a holistic chiropractic clinic before becoming a stay-at-home mother and her corporate employment role.

Biopsychosocial Variables for Plan of Care:

Biological:

53 years of age, healed humeral fracture, post-concussion syndrome with difficulty with focus/attention/memory, lifting limited secondary to abdominal hernia repair, near full range of motion of the shoulder, no further precautions set by orthopedics, vitals within normal limits but her blood pressure was elevated to 138/90mmHg (typically ranges <120/<80 mmHg)

Psychological:

History of anxiety and depression

Social:

Family concerns/issues, recent prolonged family visit, inability to ski for the last half of the season (her coping strategy), inability to work due to requirements as role as a stay-at-home mother, inability to participate in previous self-care activities

Intervention Strategies:

During her most recent visit, she reported increased fatigue from not sleeping well due to family concerns and her children. She reported reduced pain in her shoulder since her abdominal surgery and doing much less. However, with the return of reduced sleep and return of activity, she is having increased pain. During the session’s initial warm-up for physical therapy, there was a discussion that explained how pain, concussion symptoms, and increased and prolonged physical and emotional stress all significantly impact the nervous system. Typical stimuli can be perceived as threatening or dangerous. The body and nervous system’s reaction can become hypersensitive. Neurological load from the post-concussion syndrome, having prolonged pain, and having a prolonged stress response can all impact an individual’s appropriate sympathetic and parasympathetic regulation. These less appropriate responses further tax various brain and nervous system functions.

The therapist and the patient then discussed the potential benefits of mindfulness or focused attention training to give the nervous system a “break.” The therapist explained that this allows present-moment processing to reduce overall neurological load and sympathetic reactivity. The patient agreed and initiated supine-focused attention training emphasizing awareness of breathing. The patient was occasionally cued to note or become aware when her attention shifted from focusing on her breathing. She responds with nonjudgement to various stimuli such as sensations, emotions, sounds, lighting, etc., then guides her focus back to the breath and attends to the sensations of breathing.  The therapist then reassessed vitals, and blood pressure was now 118/78 mmHg post-focused attention breathing. The patient was surprised that simple breathing could have such an effect on her blood pressure. She then stated she would like to continue incorporating it throughout her day between various stressful activities.

A 45-year-old female with breast cancer presents for her fourth session of weekly chemotherapy infusions. There are some outward signs of frustration and fear. Upon taking vitals, she has an elevated heart rate and blood pressure higher than the last three weeks before today’s visit. With further questioning, she states due to the chemotherapy and her breast cancer diagnosis, she has been unable to work or participate in her artwork. She states that her children often want to play outside now that the weather is improving, and they want to walk more often to the local park. Until recently, she was at least able to walk beside them, maintaining their pace, but now chemotherapy has significantly reduced her physical capacity. There are days she has trouble even getting out of bed, both from a physical and an emotional standpoint. She becomes quite tearful and is anxious about this infusion because the last one really “wiped” her out for the entire week. She notes that her focus and attention have been significantly worse as well due to “chemo brain.” She has been so wrapped up in this diagnosis for the last year with so many appointments and medical providers that she is forgetting even the simplest of things.

Biopsychosocial Variables for Plan of Care:

Biological: 

Breast cancer with bilateral mastectomy with reconstruction and a history of right upper extremity range of motion deficits and strength deficits. She is currently on her second round of chemotherapy and her fourth weekly infusion of twelve. She is having cognitive function deficits. Her vital signs are occasionally variable, but she typically has low blood pressure. Her physical activity capacity has significantly reduced over the last month.

Psychological:

High PHQ-2 Score (Depression Screen)

Social:

She is unable to work. She has limited tolerance for physical activity when playing with her young children. She is often home alone when her spouse is at work and her children are at school.

Intervention Strategies:

Over the last several sessions of infusions, a therapeutic alliance and a patient rapport have been built. The patient has developed trust in the attending nursing staff. The patient is asked if she is familiar with mindfulness. The patient states that she is somewhat familiar with the topic, but she knows little about it. She is asked if she would be interested in doing basic focus training with her breathing. The nurse explained the benefits and how they might be helpful for her current situation. She consented to try a basic sequence of awareness of breathing. While monitoring heart rate and blood pressure, it is noted that both have already begun to decrease.

1. What actionable step will one take after completing this course to incorporate mindfulness for self-practice or when interacting during patient care?
2. What theme can one take away for further self-reflection following this course?
3. What is one thing you learned, and why does it resonate with you?

• Apps:
  • Calm, Headspace, Oak, Insight Timer, UCLA Mindfulness, Mindfulness Coach, Down Dog – Meditation, Heart Math
• Books:
  • Full Catastrophe Living
    • Outlines the Mindfulness-Based Stress Reduction program developed by Jon-Kabat Zinn
  • Meditation for the Fidgety Skeptic by Dan Harris
• Websites and Scripts:
  • Mindfulness Exercises
  • Hubermanlab
• Self-AssessmentFive
  • Facet Mindfulness Questionnaire

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