Nurses' stress is focus of meditation course at Suburban Hospital

Maryland Nurse, May-July, 2008 by Beverly Pierce

Over the past year at Suburban Hospital in Bethesda, an unusual thing began happening twice a week. Groups of 25-30 staff members came together to sit in silence. Then at random times of day, they would briefly stop whatever they were doing and pay attention to a series of three breaths. Or focus on 20 breaths, counting them from one to ten, and then backwards from nine to zero. Later on, there was homework that involved walking slowly for 20 minutes a day--a behavior almost unimaginable in nurses.

So what was that about? They didn't have enough to do? They were bored, wasting time? Annoying their managers? Actually a lot of their managers were right in there with them. In fact, not only a good number of nurses and nurse managers, but many of Suburban's executive staff took part in this strange activity. And from later response, it seems they were anything but bored, and considered this experience so useful that it may have changed their lives. What's more, there may be data to indicate they're right.

What these nurses were doing, with their focus and breath and slowed movement, was taking part in an eight-week program called Mindfulness-Based Stress Reduction (MBSR), with the strong support of Suburban Hospital administration and a gift from a generous donor who cares a great deal about nurses. The course instructor is Dr. Michael J. Baime, an internist, geriatrician, lifelong meditator and meditation researcher, who directs the Penn Program for Stress Management at the University of Pennsylvania. Dr. Baime drives down from Philadelphia weekly to teach the class.

The MBSR program is a carefully designed introduction to "mindfulness meditation," which can be described simply as the practice of paying close attention to our moment-by-moment experience, just as happens. This kind of focused attention is different from the way we generally operate in our multi-tasking, often distracted lives. Nurses especially find things coming at them thick and fast--patients with high acuity and multiple issues, distressed family members, the needs of other staff, rapid decisions and continuous new learning, day after day. In the face of complex demands, mindfulness is the ability to stay present, aware and relatively at ease, instead of escaping mentally or reacting emotionally. Mindfulness is a kind of day-in, day-out awareness that can be practiced and learned. The MBSR class (meeting two or two-and-a-half hours a week) and daily homework assignments 30-40 minutes a day) are the well-structured "gym" where this practice happens.

The first MBSR program was developed in the 1970s by Jon Kabat-Zinn, PhD, at the University of Massachusetts Medical School. Since then, the use of MBSR has been studied with a wide range of groups, including individuals with cancer, heart disease, chronic pain, AIDS, fibromyalgia, hot flashes and other conditions. It has been tested as an intervention for smoking cessation. It has also been taught worldwide to individuals who just want a healthy way to deal with the magnitude of stress they feel in their lives.

Several studies have looked at the use of MBSR specifically by nurses. In a small randomized trial, Mackenzie, Poulin and Seidman-Carlson (2006) offered a four-week MBSR course for nurses and nurse aides. The group taking the course showed significant improvement in burnout symptoms, relaxation, and life satisfaction, as compared to the control group, which was wait-listed for the course. Cohen-Katz et al. (2004, 2005b) implemented an MBSR program for nurses in a hospital system, finding that MBSR significantly decreased emotional exhaustion and increased feelings of personal accomplishment. The MBSR participants also reported improved relaxation, self-care, and better work and family relationships (Cohen-Katz et al., 2005a). Beddoe and Murphy (2004) described an eight-week MBSR course offered to 16 nursing students. Outcomes included a significant decrease in anxiety and a trend toward improvement in measures of stress and empathy.

At Suburban Hospital, Dr. Baime has asked all participants to complete a standardized questionnaire, called the Profile of Mood States (POMS), at the beginning and end of his eight-week class. The POMS tracks six conditions: anger, anxiety, confusion, depression, fatigue and vigor. Among Suburban participants, at the end of the MBSR class, all six measures showed statistically significant change in the desired direction. Results showed, for example, both decreased fatigue and increased vigor. According to course evaluations, 100% of participants felt the class had given them something of lasting value, and 94% said they have made changes in lifestyle as a result of the program. Typical staff responses include: "I have felt much support to give myself encouragement to STOP, breathe and not be reactive, to be more peaceful;" "I've noticed the effects most in my personal relationships, being more calm and less argumentative. I have definitely felt less stressed;" "I have become a better listener--calmer when in a period of conflict;" and "I am sleeping better whenever I use the techniques, and when I don't--back to old patterns."