Mindfulness can positively affect how nurses feel and cope with the pressures of their work, thereby resulting in better self-care and improved patient outcomes
Mindfulness is becoming more widely recognised and increasing thought is devoted to how it, along with compassion, can benefit health professionals. This article explores the concepts of mindfulness and compassion and the positive effect they may have on staff and patients. It outlines how nurses can practise these activities, and presents a case study highlighting the benefits that have been reported.
Citation: Brass E (2016) How mindfulness can benefit nursing practice. Nursing Times; 112: 18, 21-23.
Author: Elaine Brass is PR manager, Breathworks CIC.
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It is increasingly common to encounter the words “mindfulness” and “compassion” in the contexts of healthcare and personal development but it is not always clear what these mean in these very different arenas. The need for nurses to be mindful and show compassion is stated in the literature and policy, but there is rarely any discussion of the importance of nurses practising self-care – thereby becoming more mindful and compassionate towards themselves – or of how this is done.
Mindfulness and compassion
Halliwell (2010) described mindfulness as:
“an integrative, mind–body based approach that helps people change the way they think and feel about their experiences, especially stressful experiences. It involves paying attention to our thoughts and feelings so we become more aware of them, less enmeshed in them, and better able to manage them.”
In short, mindfulness involves consciously attending to our experience – our thoughts, feelings, sensations, or surroundings – with interest and kindness. All too often we are swept along on autopilot, identifying strongly with thoughts or feelings, reacting impulsively to events and causing further difficulties by struggling with or resisting our experience.
Kabat-Zinn (1994) gave an operational description of mindfulness as: “Paying attention in a particular way, on purpose, in the present moment and non-judgementally”. This concept of paying attention “on purpose” involves a conscious attention to experience. For example, a few minutes of focused attention on the sensations of breathing can have a refreshing and restoring effect in the midst of a busy day. Paying attention “in the present moment” can give a respite from rumination on difficulties or sources of anxiety about past or future events, while observing “non-judgementally” allows space to evaluate experience afresh, to pause before going down well-worn patterns of thought or reaction, creating space for new choices.
While the practices to cultivate mindfulness originate from traditional Eastern meditation, over the past 40 years they have increasingly been applied in healthcare. This began with the work of Kabat-Zinn and colleagues at the University of Massachusetts Medical School in the 1970s.
Neff (2003) suggested that:
“Compassion involves being open to, and moved by, the suffering of others, so that one desires to ease their suffering. It also involves offering others patience, kindness and non-judgmental understanding, recognising that all humans are imperfect and make mistakes.”
Although genuine compassionate care is not a quantifiable skill or a technique that can be feigned, compassion has long been fundamental to nursing. As the NHS touches people’s lives under circumstances in which compassion and care are what matters most (Department of Health, 2009), being compassionate is an obligatory element of a nurse’s professional character: the Nursing and Midwifery Council’s (2015) code of conduct highlights that nurses should “treat people with kindness, respect and compassion”.
In recent years, however, an apparent lack of compassion in nursing has been a cause for public concern and national headlines. A report by the Parliamentary and Health Service Ombudsman (2011) on the NHS care of older people told of a dismissive attitude from staff and apparent indifference to deplorable standards of care, while Francis’ (2013) report into care failings at Mid Staffordshire Foundation Trust detailed a lack of care, humanity, compassion and leadership that created a situation in which essential standards of care were not observed and the fundamental right of dignity was not respected.
Mindfulness and compassion in nursing: the challenges
Being mindful and compassionate is not always easy in healthcare provision. The Royal College of Nursing (2013) says constant change, understaffing and relentless pressure erode staff’s kindness and compassion – thereby setting up good people to do bad things. The DH (2012) stated that it is important that nurses, midwives and care staff receive good care and feel supported themselves, to be enabled to support and care for patients. However, according to figures obtained by the BBC (2015) in 2014, 41,112 NHS staff were off sick with anxiety, stress and depression; when experiencing one of these conditions it is likely to be harder to practise mindfulness and show compassion.
A range of barriers can prevent mindfulness and compassion in nursing – some are specific to nursing and healthcare while others apply more generally:
- Lack of time;
- The qualities may not form part of organisational objectives;
- Showing compassion may leave nurses open to exploitation or harm;
- Having to keep busy – organisations and managers often expect nurses to keep busy, so the idea of stopping and just being still, of “doing nothing” is challenging – meditation is alien to nursing practice and may even make some feel guilty;
- Many people are more accustomed to taking care of themselves using other personal or social behaviour such as exercising or going for a drink;
- Individuals relate differently to self-kindness: some people are automatically kind to themselves while others struggle with it and give themselves a hard time;
- People who have never experienced mindfulness may be cautious about practising it;
- Despite being compassionate with others, nurses may not be as good at directing that compassion back onto themselves (Cullen, 2014).
The importance of self-care
While much has been written about the importance of compassion and being mindful in relation to nurses and the patients with whom they work, there is a growing consensus that nurses must initially be mindful and compassionate towards themselves for this to happen.
Self-compassion and mindfulness are intertwined: mindfulness reduces self-judgement, giving us an opportunity to reduce negative emotional experiences and make it easier to see ourselves with kindness rather than judgement. Greater self-compassion leads to more positive mental health outcomes, including reduced anxiety and depression (Neff, 2003).
Self-compassion has been shown to be closely linked to wellbeing; after following a mindfulness course, people tend to be:
- Less self-judging – they are understanding towards themselves in situations of pain or failure rather than being harshly self-critical;
- Kinder to themselves;
- Less isolated – they are more likely to see their difficulties as part of the larger human experience rather than things that separate them from other people;
- Less likely to be overwhelmed by painful thoughts and feelings (Neff, 2003).
Penque (2009) found nurses who incorporated mindfulness into their working lives were more likely to feel less stressed about work, and that mindfulness-based stress reduction (MBSR) programmes for nurses improved practice by enhancing the nurse’s presence. This could, in turn, improve patient care through improved satisfaction and safety (Penque, 2009).
Mindfulness training enables us to build up a “mental muscle” just as we would strengthen our physical muscles through exercise. Mindfulness is an innate human capacity and by learning it we are building up our mind’s capacity to respond to stress and suffering. Box 1 outlines a simple exercise that can be practised to build up mindful capacity.
A presentation at the 2015 Compassionate Mind Foundation conference (Henshall, 2015) suggested that having self-compassion and organisational compassion – the degree to which an organisation fosters a culture of compassion and participants are working with like-minded colleagues – are predictors of compassion for others, even in stressful situations.
The potential of mindful compassion
Although most people would see the alleviation of suffering as an important goal, it is particularly relevant in healthcare. Staff are specifically employed for this purpose and have extensive contact with people who are suffering, while health professionals themselves may struggle with their own wellbeing and health while caring for others (White, 2014).
Penque’s (2009) US study of nurses and MBSR stated that it was important for nurses to develop self-compassion to create a defence against the negative, stressful events occurring in the hospital setting, and the intense work that goes
on in a clinical setting with patients and their loved ones. Nurses who have nurtured the qualities of empathy, self-compassion, serenity and mindfulness in themselves, may contribute to improved patient outcomes and excellence in nursing practice, leading to higher levels of patient satisfaction and safer care (Penque, 2009). In 2013 one trust in England offered a series of mindfulness courses to its employees, which proved beneficial to their wellbeing. Details of the project are given in Box 2.
In nursing – perhaps the most caring of professions – nurses’ self-compassion is important; without it they may be ill prepared to show compassion for those to whom they provide care (Heffernan et al, 2010). When considering the relative lack of mindfulness and compassion training for nurses, White (2014) commented that:
“A wider issue of not addressing self-care and wellbeing in nursing, despite the challenging nature of the profession, may be behind the cause of mindfulness not being as integrated as other disciplines” (White, 2014).
Clearly there is room for much greater expansion of mindful compassion into the caring professions in today’s demanding workplace. Increasing a nurse’s self-compassion by undertaking a mindful compassion programme is proven to be important to nurses’ health and their ability to relate to others – a state of inner calm will help them connect more deeply with others (Cullen, 2014). As nurses are the largest body of caregivers in healthcare settings, it is important to recognise that the concept of mindfulness enriches their practice and ability to provide quality care (Cullen, 2014).
Burch et al (2013) recognised that in most areas of all of our lives, we try to block out or avoid feelings and thoughts we find uncomfortable. By practising mindful compassion we can gently face our difficulties and accept the things we cannot change, and reduce or change the impact of those that we can. There can be an enormous amount of relief to be gained from simply bringing an attitude of warmth, compassion and gentle understanding towards ourselves and the problems we face, in any of our daily situations.
Mindfulness and self-compassion are useful in helping any individual cope with the pressures of everyday life but may be even more useful in healthcare, where pressures are great and the ability to deliver compassionate care is fundamental. Courses to help health practitioners understand and engage in these practices have proven beneficial and should be considered for nurses across the health service.
- Mindfulness fosters a sense of wellbeing
- Self-compassion reduces feelings of negative self-judgement
- Accepting difficult situations without feeling negatively about them is an important skill
- Anxiety, depression and stress can inhibit the ability to be compassionate
- As with physical muscles, simple exercises can strengthen the “mindfulness muscle”
Burch V et al (2013) Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing. London: Piatkus.
Cullen G (2014) Realistic Evaluation of a Pilot Programme offering Mindful Compassion Training to Nurses.
Department of Health (2012) Compassion in Practice: Nursing, Midwifery and Care Staff – Our Vision and Strategy.
Department of Health (2009) The NHS Constitution: The NHS Belongs to Us All.
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry.
Halliwell E (2010) Mindfulness Report 2010.
Heffernan M et al (2010) Self-compassion and emotional intelligence in nurses. International Journal of Nursing Practice; 16: 366-373.
Henshall L (2015) The Relationship between Perceived Organisational Threat and Compassion for Others in for the NHS. Presentation at The Compassionate Mind Foundation 4th International Conference, Manchester, 21-23 October 2015.
Kabat-Zinn J (1994) Wherever You Go, There You Are. New York, NY: Hachette Books.
Neff KD (2003) The development and validation of a scale to measure self-compassion. Self and Identity; 2: 223-250.
Nursing and Midwifery Council (2015) The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives.
Parliamentary and Health Service Ombudsman (2011) Care and Compassion? Report of the Health Service Ombudsman on Ten Investigations into NHS Care of Older People.
Penque S (2009) Mindfulness-based Stress Reduction Effects on Registered Nurses.
Royal College of Nursing (2013) Mid Staffordshire NHS Foundation Trust Public Inquiry Report: Response of the Royal College of Nursing.
White L (2014) Mindfulness in nursing: an evolutionary concept analysis. Journal of Advanced Nursing; 70: 2, 282-294.