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Mindfulness for the Healthcare Professional

1.5 Contact Hours
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Athletic Trainer (AT/AL), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Respiratory Therapist (RT)
This course will be updated or discontinued on or before Thursday, September 24, 2026

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


BOC
CEUFast, Inc. (BOC AP#: P10067) is approved by the Board of Certification, Inc. to provide education to Athletic Trainers (ATs).
Outcomes

≥ 92% of participants will know about mindfulness principles, proposed mechanisms and mindfulness strategies to incorporate with self-use strategies and during patient care.

Objectives

By the end of this course, one will be able to:

  1. Outline how mindfulness can benefit the healthcare professional.
  2. Differentiate between formal and informal mindfulness practice.
  3. List one of the Attitudinal Foundations of mindfulness practice.
  4. Analyze the proposed mechanisms of mindfulness practice.
  5. Outline the physiological benefits of mindfulness practice.
  6. Analyze what changes in the nervous system are proposed through mindfulness practice.
  7. Describe at least one type of mindfulness practice a healthcare professional can incorporate for themselves or into patient care.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Mindfulness for the Healthcare Professional
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To earn a certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Attest that you have read and learned all the course materials.
    (NOTE: Some approval agencies and organizations require you to take a test and "No Test" is NOT an option.)
Author:    Andrew Manke (PT, DPT, TPS, PFiT)

Why the Healthcare Professional Needs Mindfulness

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.

What is Mindfulness?

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.

Mindful Moment

STOP!

Take a breath; what is being experienced in this present moment? Is it a sensation, a thought, a daydream, an emotion? What does the device or paper being held right now feel like? What are the senses currently relaying to the mind? There is no correct answer; only attendance at this present moment.

photo of man taking a mindful moment at laptop

Types of Mindfulness?

What are the basic types of mindfulness

Focused Attention

Focused attention involves bringing attention to a single object (Lutz et al., 2008). The object of focus is often one’s breathing sensation, mantra/intention, or even a physical object.

When the focus on that object shifts, a person notes that one’s focus is no longer attending to the object at hand. One then guides attention back to that object of focus.

  • Example/Practice:
    • Bring awareness to the breath, simply being aware of the natural movement of breathing without necessarily trying to change or influence the breathing pattern
    • Simply attend to the breath as it is in this moment in time
    • When sensations, thoughts, emotions, feelings, etc., interrupt the focus on breath, become aware that you are no longer attending to the breath
    • Guide attention back to the sensations of breathing
    • You are continually acknowledging focus shifts and becoming cognitively aware of this change in focus
    • Continue to guide attention back to the object or breath

Open Monitoring

Open monitoring involves becoming aware of each sensory experience as it arises in the moment (Lutz et al.,2008). These can often be physical or emotional sensations. Compared to focused attention, it often takes increased practice and experience to participate in open monitoring.

  • Example/Practice:
    • Take a drink of a beverage or a bite of a tasty snack.
    • Note the sensations that arise.
    • Do different flavors, textures, or aromas arise?
    • Can you sense the coolness or warmth of that drink?
    • Does the bite feel chewy or crunchy or taste sweet or savory?
    • Is there an emotion or internal sensation that arises as you sip this beverage or slowly savor this bite?

Formal Vs. Informal Mind

Formal

Formal mindfulness practice is the act of intentionally setting time aside to practice this skill (Kabat-Zinn, 2013). It is often practiced in the same location, time, and position. This repetition is to encourage habit formation and behavior change. It is often performed in a seated position. Seated practice is typically performed in an upright position, such as in a chair with the feet grounded through the floor. You can be sitting supported or unsupported but in an upright, relaxed position. It can be performed sitting on a cushion or elevated surface. It can even be performed lying on the floor. Find a position of comfort, but not quite so comfortable, that encourages you to fall asleep easily. Formal movement-based mindfulness, such as walking practice, includes focusing on decreasing speed significantly. This reduction in speed allows for attention to dwell on walking and the sensations of walking. Some prefer to incorporate an intention or mantra to help focus one’s attention during walking practice.

Informal

Informal mindfulness practice can be anything from washing one’s hands, performing routine hygiene activities, eating, employment tasks, washing dishes, performing yard work, knitting, or simply noting the subtle differences of a variation in the commute to work or school (Kabat-Zinn, 2013). Participating in informal practice allows for more routine practice and incorporation within daily activities of living.

Proposed Mechanisms 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.

Attention Regulation

Before you can begin to perceive yourself differently or better regulate your own systems, you must first be able to train your attention. Regulating attention can allow for this new “wiring” of the brain. Attention regulation is honing the skill of sustaining your attention on one object or task for longer and longer periods(Holzel et al., 2011).

Body Awareness

Where is the body in space right now? Where is it in relation to the room or the surrounding environment? Can you sense the surface that you are sitting on? What is the current state of your breathing? Can you feel or hear your heartbeat and note the subtle change in variability of the inhale versus the exhale? Where is tension being held, and where is there relaxation or openness? With mindfulness practice, you can better regulate attention and focus, which allows you to become more one with the body sensations that arise from the external to the internal (Holzel et al., 2011).

Emotional Regulation

Physical and bodily changes often occur before an emotion can even be perceived. So perhaps, if a person is in tune and attentive to the body, they can often start to name emotions and feelings sooner. This, in turn, allows an individual to have an emotional response rather than an emotional automatic reaction (Holzel et al., 2011).

Self-Regulation and Change in Perceived Self

With improved attentional regulation, improved body awareness, and improved emotional regulation, one starts to have a third-party or external view of the self. There can now be a sense of non-reactivity to the constantly transforming and fluctuating environmental stimuli all around and within the self. This change in self-perspective will ideally align and follow mindfulness's attitudinal factors and foundations (Holzel et al., 2011).

Attitudinal Foundations of Mindfulness

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

Non-judging

Throughout the day, a person automatically starts to categorize things and assign value to nearly everything experienced. This involves placing objects, ideas, emotions, and feelings into categories- positive, negative, good, bad, indifferent, irrelevant, etc. The practice of non-judging allows a person to free themself from dichotomization, by not assigning value to that experience of sensation and start to experience things as they are, and only as they are, at the moment (Kabat-Zinn, 2013). It is neither good nor bad, neither a positive nor a negative experience; it simply just is. Sometimes, starting to label experiences, particularly those in the physical realm or within the five senses, can be quite helpful with reorientating and grounding a person’s presence in this moment. For instance, try expanding the description rather than saying a sensation is painful or “this hurts” and therefore automatically placing it in the “PAIN” category. Is it a sensation of weakness, tender, firm, heavy, warm, hot, achy, cold, closed, restricted, tight, full, swollen, sharp, burning, shooting, etc.? This allows for a better understanding of this sensation. Rather than lumping it into the category of pain and viewing it as a negative sensation, it is perceived as an important mechanism for the preservation of self. Some of those words are probably perceived as being less threatening to the “fight or flight” regions of the brain, which might reduce the overall stress reaction. A reduced stress reaction allows for higher-level cognitive and executive functioning rather than a “fight or flight” reaction.

Beginner’s Mind

Have you ever noticed how a young child or animal often can become completely lost in an experience or struck with awe by an object that seems utterly mundane to the adult human? “It’s just a rock or stick,” “It’s just a bug,” “It’s just a paper bag,” “It’s just a big empty box,” “It’s just a boring work office,” or “it’s just a stethoscope and blood pressure cuff.” Imagine if a person could take a step back and view the world as if experiencing it for the first time. How wonderful that experience must be to see something for the first time. Recall the joy and wonder that occur when something is experienced for the very first time. This wonder and enthusiasm can be a part of everyday experiences because, in reality, it is the first time you have experienced the activity or object at this moment in time. It opens the opportunity to be truly curious about the world and the experiences occurring all around you at all times (Kabat-Zinn, 2013).

Patience

One of the many things most people in this high-paced world could benefit from is more patience. It can seem impossible to exercise patience in a world with such easy access to instant gratification and automaticity. How can one practice patience when nearly everything that is experienced can be done so instantaneously at the tap of a screen? Tap or click to pay, same-day delivery, social media videos, automatic notifications, binge television, automatic playback, the list goes on and on. Imagine a waiting room, a line of people, or even a lull in a conversation with a friend. How often is there an electronic device continuously present to prevent even a second of boredom? Being patient with the present moment and letting it unfold as it is in this moment in time takes practice and habit formation. With this practice, you can learn not to rush a reaction or outcome but rather wait patiently to respond.

Acceptance

Accepting the current situation as it is without judgment and without trying to skip to the next phase can be quite challenging. It can be even more difficult when others continuously encourage nonacceptance of the current state. There can be pressure to experience something specific or grand. People often push for more and more! Instead of trying to force feelings, emotions, sensations, and experiences, accept them for what they are and only what they are at this moment (Kabat-Zinn, 2013).

Trust

Being “in the moment” can be very difficult, particularly as it relates to trust. Can a person truly trust the sensations and feelings that are occurring now? Being vulnerable and trusting an experience for what it is most definitely does not come easily. This task is made more complex due to an individual’s preconceived ideas about how an experience should unfold (Kabat-Zinn, 2013). Past experiences and learned knowledge about how something is “supposed” to be viewed, felt, or experienced can create an environment of distrust. How can a person trust the now when the primitive “lizard” brain says, “Danger Will Robinson”? A person can never truly enjoy the experience- for the sake of the experience- if they are unable to trust the sensations and feelings that are currently unveiled.

Non-striving

Often, when individuals try mindfulness-based practice, they set some goals. This goal can be to reduce stress, pain, and anxiety, “clear the mind,” or find “inner peace.” People often initiate mindfulness practices in search of these things, but what can be counterintuitive is not striving to experience something profound or immediate. Sometimes, trying to accomplish something at that moment can be even more mentally challenging and fatiguing. The goal of not having a goal can be utterly frustrating for many. Non-striving is being okay with the current process and letting it occur as it is, not trying to influence the outcome, especially when the outcome really is not within a person’s control (Kabat-Zinn, 2013).

Letting Go

One of the hardest things to do is let go. Moving onward with the current moment rather than being preoccupied with past experiences or letting one’s worry not be enveloped by the fears of the future can be extremely difficult. Letting go and being present for this moment, right now, is not simple. With mindfulness practice, you can notice that focus or attention is not on the present. You learn to let go of those anchors that a person often drops. Rather than falling deeper and deeper into the preoccupation with ideas, feelings, emotions, sensations, etc., it is slowly bringing attention back to the now and letting go of what sometimes feels so important or urgent (Kabat-Zinn, 2013).

The Nervous System?

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.

Reaction Vs. Response

Can you start to see a pattern? Mindfulness is training a response-based system rather than a reaction-based system. Carolyn McManus, another expert clinician who utilizes and describes mindfulness so beautifully, often uses the metaphor of two arrows (McManus, 2024). It discusses the output of pain or stress. If you can, imagine two arrows. One is smaller, representing a stimulus. The other larger arrow represents a person’s response. The combination equals a person’s stress response or pain response. Why is the response arrow larger? It is because it represents an individual’s larger influence. A person cannot change the amplitude or magnitude of a stimulus, but a person can be in control of the response. Therefore, a person can have a larger influence on one’s stress or pain than the stimulus itself. Mindfulness helps encourage this practice of responding rather than having an automatically generated reaction to stress, pain, or other stimuli that occur throughout one’s day.

graphic with two arrows equaling stress or pain

So, how about a little visualization and scenario?

Imagine it is 7:05 am. You are 5 minutes past the time you need to pull out of your driveway/parking spot. You mentally curse the increased amount of traffic and red lights you will undoubtedly hit because of your 5-minute delay. You rush to put your shoes on while holding your freshly brewed coffee in one hand and your lunchbox in the other. Quickly, you step forward to slide into your shoe, but instead, you slam your foot onto a seashell that fell from the seascape diorama you told your 10-year-old to take to their room yesterday.  As the pain registers, you loudly yell out a few expletives, feeling like the bottom of your foot was sliced by broken glass. You hurriedly bend over to check the damage on your foot, just enough for the coffee to spill out of the “spill-proof” overly priced travel mug you are holding as it splashes the hot coffee onto your legs.

Now, how do you respond?

Contrast that to a different scenario.

Again, imagine it's 7:05 am. You and your family are walking on the sandy shores of your favorite beach. You have been saving for this trip for over a year. The past six months at work have weighed heavily on you physically and mentally. With each step you take, you feel the work stressors slowly begin to recede, just like the ocean falling away with the tide. You can smell the brine from the ocean water; a light breeze blows the hair from your eyes, and the waves crash loudly as they approach the shore. As you walk, the sand becomes firmer under your bare feet; the sand becomes less compliant and more rigid with each step. You sip the freshly brewed coffee that you made in the rental kitchen before starting your walk. You can hear your children laugh as they are splashed with the ocean spray. As you take another step, you feel a slight prick from a broken seashell that looks remarkably close to the one you stepped on that Tuesday morning several months ago. You continue walking towards your family while sipping your coffee, not bothering to check if the seashell hurt the bottom of your foot.

So, let’s recap.

There was a very similar stimulus to the bottom of the foot—a seashell on a firm surface. Yet there were two very distinctly different reactions/responses. The reactions and responses that people experience throughout the day are often automatic. Various stimuli can cause an overreaction or may not even register at all. The focus of an individual is often not on the body or the present moment; it is often contemplating something in the future or something that has already passed. This preoccupation is using up precious cognitive energy. Perhaps the brain is occupied with pain, either emotional or physical. When the brain is wrapped up in constant painful experiences, particularly for prolonged periods, the brain starts to change and shift. It becomes less efficient and significantly less accurate in processing the environment around an individual (Moseley & Butler, 2017; Louw et al., 2017). Mindfulness allows us to pause and re-assess what we are truly experiencing rather than let the nervous system be on autopilot.

Mature Organism

Louis Gifford developed and proposed the Mature Organism Model (Gifford, 1998). This model discusses pain as an output, with tissues and environments providing input to the periphery. This information is then carried up to the central nervous system. Here, the brain quickly processes the information and determines a particular output. That output can be pain, stress, movement, etc. This concept is similar to the two-arrow metaphor, in which a person cannot change the stimulus or environment but can tremendously impact the output or outcome. Beliefs, knowledge, memories, etc, often shape a person's reaction or response. However, the more a person allows a reaction to be habitual, the faster and faster the processing can become. Processes can become automated, which represents the Hebbian Theory. This theory suggests that less and less of a similar stimulus can cause an almost predetermined output.  In other words, “neurons that fire together, wire together” (Langille & Brown, 2018; ScienceDirect, 2018). With mindfulness-based practice, a person can develop the skill to learn to respond to stimuli rather than react automatically.

The Benefits

graphic showing steps of mindfulness

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)

Types of Mindfulness-Based Practices

Mindful Movement

Mindfulness does not need to always be practiced sitting on a meditation pillow, on top of a mountain, or in the middle of a tranquil forest. It can most definitely be enjoyed through movement. There are many movement-based activities and therapies that incorporate mindfulness strategies and principles throughout the actual physical movement. Yoga, Tai Chi, and Physical and Occupational Therapies are a few. However, with practice, day-to-day movements can easily be transformed into a mindfulness/meditative practice, such as slowed walking and any current exercise program. Taking time to attend to the breathing and the body movements sequentially can be a great place to start. Movement-based therapies have some evidence to suggest they can assist with decreasing pain/suffering and disability, improving body awareness, improving sense of control, and aiding in acceptance (Sengupta, 2012; Ward et al., 2013; Jahnke et al., 2010).

Mindful Breathing

From structured breathing techniques such as diaphragmatic, box, or nasal breathing to physiological sighs or simply slowly exhaling, there are many wonderful benefits of attending to one’s breathing. Many of the techniques can be quite simple and applicable to daily life and do not require a significant amount of time to be completed or incorporated. Mindful breathing correlates with various health benefits and can help bias the autonomic nervous system toward a sympathetic state(Russo et al., 2017; Zou et al., 2017; Ma et al., 2017; Saoji et al., 2019; Balban et al., 2023).

photo of woman using mindful breathing

Self-Practice

Physiological Sigh

  • Inhale maximally through the nose
  • Inhale again quickly/sharply through the nose
  • Exhale slowly and completely through pursed lips
  • Can be performed multiple times

Slowed nasal breathing

  • Perform breathing, both inhalation and exhalation, through the nose
  • Focusing on elongating the exhale

Single nasal breathing

  • Inhale through the left nostril
  • Exhale through the right nostril
  • Inhale through the right nostril
  • Exhale through the left nostril
  • Repeat the above

Mindful/Meditative Walking

  • Find an area that allows for ~20 steps
  • Slowly take steps forward
  • Exaggerate the length and time of walking; think “slow motion”
  • Note the sensation of walking as it is at this moment in time
  • One can pay attention to the feet, knees, hips, trunk, arms, etc.
  • Take this time to appreciate what each region of the body feels when walking
  • Be a third-party observer of the walking
  • If one wishes, focus on an intention with walking to bring focus and awareness to that particular intention

Focused attention on breath or object

  • Begin by sitting upright yet relaxed.
  • Settle into the sitting surface.
  • Start to become aware of the breath, potentially let it deepen as breath starts to take over the awareness.
  • Now, bring attention to the feeling of breathing
    • It might be the movement of airflow into the nose and out the mouth.
    • It might be the sensation of the air as it enters the nose, throat, or even sinuses.
    • It might be the sensation of the stomach or ribcage rising and falling.
    • Maybe it is the simple low audible sound of breathing.
  • Try not to attempt to change or influence the breath. Rather, sit and attend to it.
  • More than likely, the focus will shift to something else…
    • “Pay that bill after this.”
    • “Shoot, I forgot to send that email.”
    • “Pick up kids from after school program.”
    • “What is for dinner, and is there enough in the fridge and cupboard to make something?”
    • “What is that humming sound outside?”
    • “There is no way this is going to work.”
  • When the focus does shift, become aware that the focus shifted away from breathing/object.
  • The key is not emptying the mind or maintaining focus on the object the entire time.
  • The key is becoming aware that attention and focus have shifted away.
  • Notice that focus shifted without judgment, without assigning a positive or negative, good or bad, meaning to it. It simply is.
  • Now, more than likely, the focus will keep shifting and keep moving.
  • Each time one notes a shift, one can visualize it and take a third-party view.
    • Watch it and be curious rather than trying to interact with it.
  • Respond, attempt not to react.
  • Then bring awareness back to breathing or the object of focus.
  • Repeat, repeat, repeat.

Mindful Movement

  • Pick a movement, any movement.
  • It can be a simple stretch that one likes, it can be a mobility activity, maybe it is an exercise.
    • Maybe it is moving the dishes from the rack to the cupboard, throwing away a piece of trash, hugging a loved one, folding clothes, washing hands after patient care.
  • Now be curious about that movement, explore that movement, accept the movement.
  • What feels natural? What feels off? Where does one initiate the movement? Is it big, small, finely tuned, broad?
  • Experience movement for movement’s sake, take a back seat and observe.
  • Now observe breathing; when does one breathe with various aspects of the movement? Is one breathing or holding the breath?
  • Can the breath be timed with movement?
    • Try moving in one direction only as long as one inhales or exhales and then reverse.
  • Where is the breath felt with movement?
  • Does it feel better one way or the other breathing now vs then?
  • There is not necessarily a correct answer to these questions. It is about being mindful and curious about these questions.

Be Curious!

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

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.

Case Scenario 1

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.

Case Scenario 2

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.

Reflection

photo with text

  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?

Resources for Self and Patients

  • 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:
  • Self-AssessmentFive

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.