Post on 26-Mar-2015
Looking After Yourself, Looking After Others
Jo Soldan Doc.Clin.PsyClinical Psychologist in Critical Care & Ko Awatea
Counties Manukau DHB.
Sue Dykes MSc Dip Clin PsychClinical Psychologist in Private Practice
Mindfulness Auckland
Date: Created by:
Illustration from ‘Quiet the Mind’ – Matthew Johnstone
Illustration from ‘Quiet the Mind’ – Matthew Johnstone
What is Mindfulness?Jon Kabat Zinn:
•Paying attention ‘on purpose’•Rooted in the present moment•Non judgmental
• Jon Kabat-Zinn and Saki Santorelli• University of Massachusetts• 8 week group programme, with one day silent
retreat• Various mindfulness practices• Strong research base• Modified programmes used in many areas
Mindfulness Based Stress Reduction
Efficacy of Mindfulness Based Stress Reduction
• Depression• Anxiety• Psoriasis• Chronic Pain• Cancer• Mindful Eating.
A Beginners Mind
Following the breath
• Accessible
• Regular
• Away from thinking
• Only ever in the present moment
• At the intersection of body and mind
• Innate capacities for calming
Why the breath?
Mindfulness restores the balance
• Too much sympathetic nervous system (fight or flight) leads to problems remembering, fatigue, lack of energy and frequent illness.
• Parasympathetic system (rest and digest) counteracts this
• Wandering attention “monkey mind”
• Fragmented attention, leads to mistakes
• Clinging/chasing after/ruminating
• Experiential avoidance – what we resist persists
The nature of the mind
Illustration from ‘Quiet the Mind’ – Matthew Johnstone
Facing the unpleasant When we bring full awareness....to the whole of
our experience....our relationship to the difficult emotions can shift dramatically
Williams et al. In The Mindful Way Through Depression( 2007)
Illustration from ‘Quiet the Mind’ – Matthew Johnstone
Outcomes of Mindfulness Practice
Focus, clarity and wisdom Interruption of autopilot (ruminating,etc) Metacognitive awareness Approaching rather than avoiding Responding rather then reacting Compassion
Matthieu Ricard
Increased gray matter in long-term meditators, and after 8 weeks of MBSR, in regions involved in:
Learning and memory
Emotion regulation
Empathy
Self-referential processing
Decreased gray matter density in Amygdala, correlated with perceived decreases in stress levels
Effects of meditation on the brain (Lazar, 2013)
Why - Mindfulness at Work?• Association with Emotional Intelligence
• More engaged in work, energised and less anxious. Reduced Cortisol, increase immunological response to flu jab (Davidson et al 2004)
• 70% reduction in sick leave
• American Army safeguards against distraction and emotional reactivity (reduced Depression and PTSD, clearer thinking in stressful situations)
"It's like doing push ups for the brain."
Why Relevant in Health Care
• Burn Out and Depression are known to be high in staff.• Increase Resilience to Nature of our Work.• Mirroring Neurons - A way of balancing brain activity.• Clearer Thinking – Patient Safety. Self Compassion PAFCC
Efficacy of Mindfulness Training in Health Care
Reductions in stress, depression, anxiety, burn out. (Krasner et al (2009) Shapiro et al 2005,Corey et al 2006,Britt et al 2009 )
Increased Empathy (Krasner 2009, Shapiro et al 2009)
Staff report increased ability to listen and be patient-centered (Krasner 2009)
Trainee nurses should be selected on compassion to avoid repeat of Mid-Staffs scandal:
Not Just Self Care - Compassion
Nurses told to focus on compassionate care
Three-year strategy unveiled to tackle 'crisis in standards of care' amid concerns over
treatment in NHS hospitals and care homes
How do we put the compassion back into healthcare?: Full round table discussion
In the wake of the Francis report, the BMJ gathered experts to discuss compassion in the health service.
Mindfulness at Work in Counties Manukau
• Abbreviated Courses 4 x 2 hours
• Intensive – 8 hour day followed by follow up at 4 weeks
• Lunchtime sits
• Integrated into work day
Mindful Minute
S stop what you’re doing T take a breath O observe your environment (int and ext) P proceed
www.impactednurse.com
Mindfulness Based Resilience in the Workplace at Counties.Quantitative outcomes
p value paired sample test
Brief Resilience Scale 0.02Maslach Burn Out Inventory :
Emotional Exhaustion 0.02 Depersonalisation 0.05
Perceived Stress Score 0.0003
Irene Zeng Research Office Ko Awatea
Mindfulness Based Resilience in the Workplace
CMDHB/Ko Awatea
Has the course impacted on you professionally?
100%
Have you noticed any positive change in your reactivity at work?
95%
Have you noticed and positive change in your ability to handle stressful situations
97%
Would you recommend the course to colleagues?
100%
Has the course impacted on you professionally?
100%
Have you noticed any positive change in your reactivity at work?
95%
Have you noticed and positive change in your ability to handle stressful situations
97%
Would you recommend the course to colleagues?
100%
Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
“I believe the course is a real gift from the organisation in terms of the cost and time commitment. However I do think this is more than
outweighed by the positive benefits that follow that can be taken into the participants personal and professional life”
“it has huge benefits for reducing stress levels and produce a more positive attitude which is noticed by others”
Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
Changes noticed in themselves
“more able to focus on the moment – I can do the work faster”
“Singing again”
“able to handle things differently, confident, better at making decisions, cope with stress better”
“I am much more relaxed and alert in dealing with stressful issues and concerns and people”
Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
Many reported colleagues noting changes in them over the 4 weeks:
“Not taking negative feedback so personally”
“Seems calmer” “More even tempered”
“Not getting overwhelmed by stressful situations”
“Much more present and confident”
“Less anxious and more positive about things”
“My manager attended the course last year and speaks very highly of it. There is also a noticeable change in his demeanour and stress response. I would like to see if I can obtain the same benefits from the programme”
Mindfulness Based Resilience in the Workplace
CMDHB/Ko Awatea
• “I have noticed that I am as present with the last patient on my list as the first
Mid Staffordshire NHS Trust 'should be dissolved'
Not just Self Care – Patient Safety
“Leaders and managers should actively support staff by excellent human resource practices, promoting staff health
and well-being” (Berwick Report 2013).
‘A promise to learn - a commitment to act’
Escape Fire – Don Berwick
There are a number of things we need to do in health care
“The first is the toughest: we need to face reality. This is very very hard….Our challenge is to have the courage to name
clearly and boldly the problems…we must find ways to do this without either marginalizing the truth teller or demoralizing the
good people working in these bad systems”
Mindfulness in Healthcare
• Staff Resilience – reducing Burn out, Depression, Anxiety.
• Increasing Joy at Work
• Supporting Compassion, Patient Centered Care
• Patient Safety – being present – ability to sit with difficulty
Resources• ‘The Mindful Workplace: Developing Resilient Individuals and Resonant
Organizations with MBSR’ Michael Chaskalson
• ‘Search Inside Yourself: The Unexpected Path to Achieving Success, Happiness (and World Peace)’ Chade-Meng Tan
• CALM.ac.nz
• www.smilingmind.au.com
• www.mentalhealth.org.nz - 5 ways to well being - take notice
• www.bemindful.co.uk - online courses
• www.compassionatemind.co.uk (Paul Gilbert)
• www.selfcompassion.org (Krisitin Neff)
• www.mindfulnessauckland.co.nz• www.openground.com.au
• Best resource - having a go! / developing a practice …….• Jo.Soldan@middlemore.co.nz