Friday, March 11, 2016

Being Present with Yourself and Your Patients

As nurses, we must juggle the varied needs of others throughout our shifts, and it continues when we go home. We hear about nursing burn out in the news, nursing journals, and within nursing social networks. There are many factors at play when nurses burn out, but I think much is related to the lack of human connection with our patients. Today's computer-centric, task-oriented, high patient loads and acuity world of nursing is causing us to lose sight of what brought us to nursing in the beginning. So how do we stay present and connected in this modern age of nursing? Being present. How can we be present in the midst of a chaotic shift caring for five or more patients? Practice mindfulness.
I have a psychologist friend, who introduced me to mindfulness. He encouraged me to practice mindfulness even when I was busy. I learned that I didn't need to sit for a meditation session to be present. Rather than just rushing down the hallway to the next meeting or next patient, I started paying attention to how my feet felt in my shoes as they were making contact with the floor and how the breeze felt while it blew my hair. I began to incorporate this attention to myself while I was sitting at my desk performing chart reviews or while I waited at a traffic light. 
Presence can be nurtured through mindfulness meditation. Meditation doesn't have to mean sitting in a room by yourself with music playing for an hour every day. I know that's what most people think of when they hear the term meditation. An easy introduction to mindfulness meditation is through a quick five minute body scan first thing in the morning or right before you go to sleep. You can do this while resting comfortably in your bed. Some nice relaxing music is helpful though.
Start by bringing your attention to your breath, not trying to change anything at this moment. Then you can move on to checking in with your toes, feet, legs, hips, hands, arms, stomach, shoulders, neck and head. How do each of those areas feel? Do you notice tension, cold, etc? Then go back to your breath. You may notice after only a couple of minutes of really tuning into your body that your breath is different. Perhaps it is slower, steadier, or deeper. You can then incorporate yogic or deep breathing techniques to further regulate your breath. Breathing in through your nose and out through your nose, gradually increase the length of your in-breath from a count of 3 to 6 and your out-breath from a 4 count to 7. Again, do as much as you are comfortable with at this time. You will increase your capabilities with each practice. I'll bet that you are feeling more relaxed and in tune with yourself at the end of your meditation.
The most important part of the nursing process isn't my skills or passing medications at a certain time. It's not performing the best dressing change or starting an IV in the first attempt either. It's the patient! We can become stressed about that balance though, causing our attitudes to suffer, and thus influence how we provide patient care. In our struggle to provide more patient-centered care, we can become so overwhelmed that our relationships with our patients suffer.
We can choose to be truly present while we are with each patient. While administering the IV medication or helping our patient bathe we are often thinking about all of the other tasks that are still to be completed. Instead, let's choose to be present. Choose to only think about what you are doing with that one patient at that particular moment. Engage them in conversation. Offer words of support. Seek to know more. Notice the coolness of the refrigerated IV antibiotic in your hand or your patient's soft voice. It really does make a difference, for the patient but also for us. By choosing to be present, we are nurturing a connection with our patients while nurturing our own compassion and spirit. Everyone benefits.
A quick example in practicing presence at the bedside...
I was caring for an elderly female with chronic pain and COPD. She became very anxious in the evening when her daughter went home. Upon completing vital signs, the student nurse came to me urgently to let me know that the patient had a very rapid respiratory rate and was complaining of difficulty getting her breath. Her oxygen saturation was normal though on her baseline 2L of supplemental oxygen via nasal cannula. The student was nervous and didn't understand why this was happening. When we re-entered the patient's room, I realized her daughter had left and we quickly reassessed the patient. Vital signs were all within normal limits besides the rapid respiratory rate. Sure, it was possible that the patient was in some sort of acute respiratory distress or having some other complication, but my intuition led me to believe that this was her anxiety. I could have simply told the patient that her vital signs were normal and to try to calm down, leaving her with the anxious feelings to address independently. Instead, I engaged the patient. I explained that her vital signs were fine but that I recognized that maybe she was feeling a little anxious without her daughter at her bedside and offered to be of some support. The patient readily agreed. I pulled up a chair, took her hand and coached her through a yogic breathing technique to promote relaxation. Within five minutes, her respiratory rate had returned to normal and the patient reported feeling much calmer. I was then able to further engage this patient and help her to see how she could easily go back to her breath when she noticed any anxious feelings. She was empowered. My student was exposed to this practice. And even I felt better after this interaction. 
Another example...
My family has a small dairy goat herd here in rural West Virginia. We feel very connected to all of our animals, but the goats in particular as they will provide us with fresh milk to nourish our bodies. We only developed this herd last fall, and this will be our first spring of milking. We are, by all definitions, novice goat keepers. When a young female delivered a baby unexpectedly in late January, we were less than prepared. Mama was young and did not know how to care for the new baby. She was very scared and confused. So were we! But we knew that if we didn't figure out how to help Mama and Baby quick, that Baby wouldn't live. We spent the entire day with that Mama and Baby, helping them to bond, but mostly just being present. We rested in the field with them. We cuddled the baby to keep her warm in the beginning when Mama was confused and scared. Our presence and mindfulness of Mama's and Baby's needs encouraged this mama and kept her baby alive. Mama eventually figured out how to let Baby nurse and to nurture her. We had a thousand other things to do that Saturday, but our priorities had to change to meet our farm family's needs, much like my priorities as a nurse often have to change to meet my patients' needs. This was the ultimate exercise in mindfulness and presence. These are practical tools that can be utilized with our families, animals, patients, and ourselves. 
Mama Reese and Baby Eka after some much needed TLC and presence from us. This was on the day Eka was born. We named her Eka because it means first in Sanskrit, and she was our first kid born on our farm.

When we practice this presence with our thoughts and physical selves, we are better prepared to bring that presence to our patients, even on our busiest shifts. Once comfortable, it is easy to introduce the practice of mindfulness or other relaxation techniques such as guided breathing exercises to our patients for their own personal use, encouraging them to be more active in their own care. 
So go forth and breath.
With love and gratitude,

April, RN 


  1. Great post, this is the answer for us all

  2. Awesome post, April! I enjoyed your examples of how we can bring mindfulness to our day... that we don't have to sit in a position on a block somewhere. This is accessible to us all of the time! Thanks for that reminder, sharing!

    1. Thanks for sharing. Another thing that I love about mindfulness is that my children are constant reminders of living in the present. They are always pointing out sounds in nature or new flowers as they pop up in the yard. These are things that I would overlook often as an adult in my busy mindset. They truly help to keep me grounded.