Life is what happens to you while you’re busy making other plans.Attributed to John Lennon, 1980,the song “Beautiful Boy”Originally in Reader’s Digest, 1957,cartoonist Allen Saunders
As we have mentioned in some of our previous editorials, practicing critical care can be stressful.1–4 During the American Association of Critical-Care Nurses’ 2016 National Teaching Institute and Critical Care Exposition (NTI), one of the major themes was how to reduce global life stress. Multiple keynote speakers focused on mindfulness and mindfulness meditation as ways to achieve inner peace and meaningful life balance. In this editorial, we describe the concept of mindfulness and how mindfulness meditation can be used as a technique to alleviate stress, enhance resilience, and put oneself on the path toward inner peace.5–13
There is no need for us to define stress. We all understand what stress is. As a species, we humans tend to be overly consumed with what has happened in the past and what might happen in the future. While we are ruminating about what didn’t happen exactly as we wanted it to in the past, and what might go wrong in the future, we are forgetting to live in the present moment. Let us provide you with some definitions of mindfulness from Jon Kabat-Zinn, a professor of medicine emeritus at the University of Massachusetts Medical Center who popularized the term “mindfulness” in the late 1970s:
…paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment. Simply put, mindfulness is moment-to-moment awareness. It is cultivated by purposefully paying attention to things we ordinarily never give a moment’s thought to. It is a systematic approach to developing new kinds of control and wisdom in our lives, based on our inner capacities for relaxation, paying attention, awareness, and insight.14
From our reading of the literature, our definition of mindfulness would be as follows: our thoughts, and ruminations on those thoughts, make us anxious and stressed. In our editorial on emotional intelligence,4 we discussed how important it is to not immediately react to your emotions in a situation (eg, being angry, anxious). Instead, you need to say to yourself, “I have emotional intelligence. I do not have to respond to this emotion I am having.” With the concept of mindfulness, we take this a step further. When we are being mindful, we are saying “my thoughts of what did happen and what might happen are making me upset, anxious, and stressed. I am mindful. These thoughts need to leave. I am going to quiet the mind.” The concept of quieting the mind is of the utmost importance when learning about mindfulness.
“Mindfulness meditation is a technique to help us quiet the mind.”
In their study of mindful meditation intervention for nurses in pediatric intensive care units (based on a shortened version of Kabat-Zinn’s traditional “Mindfulness-based Stress Reduction” model), Gauthier et al12 recommended 5-minute daily sessions that included the following:
Bring your attention to a primary object of focus (eg, your breath). Clear your mind.
Maintain a moment-to-moment awareness (eg, the feeling of your breath entering and exiting the body).
When your mind naturally drifts into thinking, just notice you are thinking, and then bring your attention back to your object of focus (eg, your breath).
When a strong sensation or emotion arises, again, notice the sensation or emotion and return to your breath.
As you gain confidence, you may practice maintaining this focus while observing thoughts flowing through your mind or sensations in your body while showing no concern for the content.
Thank yourself for your efforts and for taking this time.
As with other forms of meditation, the idea is to focus on your breath. You should sit somewhere comfortable, close your eyes, and focus on your breath. Just focus on your breath going in and out of your body. When you first start doing this, your mind will wander, and you will start to have thoughts. When you notice that, bring your focus back to your breath. Just get rid of all thoughts and focus on your breath. At first, this will be more difficult than it sounds. But with practice, it will become easier to quiet the mind.
In their mindfulness-based course for a pediatric oncology team, Moody et al9 listed some other parts of a formal meditative practice:
Body scan: a progressive movement of focused attention through the body, observing body sensations experienced as well as thoughts and feelings arising during the exercise
Sitting meditation: involving sitting quietly and focusing awareness on the breath and/or on the flow of sensations, thoughts, and feeling in the present moment
Mindful movement: consisting of guided gentle stretches and hatha yoga postures designed to enhance body awareness and balance through careful attention to sensations of the body in movement and associated thoughts and feelings
The STOP technique: a mini-meditation consisting of a pause; stop, take a breath, observe current state of mind and body, proceed
Loving kindness meditation: a mantra-based meditation intended to help participants develop greater compassion for themselves, their coworkers, and patients
For those of us who are not familiar with all of these techniques, the way to get started is to stay focused on how to quiet the mind. Mindfulness meditation is a technique to help us quiet the mind. By using mindfulness meditation, we can focus on our breath and allow stressful thoughts to leave our mind. As pointed out in the course by Kabat-Zinn, as we become more proficient at quieting our mind, we may allow ourselves to observe our thoughts flowing through our mind without being bothered by the content of the thoughts. This concept is key.
Don’t Sweat the Small Stuff
Using a similar approach to get “on the road to inner peace,” Richard Carlson created the extremely popular self-help book Don’t Sweat the Small Stuff… and It’s All Small Stuff.15 Carlson borrowed heavily from Buddhism and other religions focusing on meditation and acceptance as techniques for inner peace. Regardless of their historical context, the ideas in Carlson’s book are important and life-affirming: he created a book with important points of wisdom that we all need to be reminded of every day:
Accept life as it is.
Be accepting of what is. This can be difficult for critical care practitioners. We spend all of our waking hours not accepting things as they are. Being accepting of life as it is does not come easily for us, but we have to try.
Be grateful for what you have.
Do not always think of what you want.
Do not make being happy dependent on some particular goal.
Don’t say that you won’t be happy until you get a particular job or until you get a certain degree. This advice is also very difficult for critical care practitioners to follow. We tend to be a very goal-oriented bunch.
Live in the present moment.
Do not fill up your life with what has happened or what might happen. We tend to ruminate too much, and that isn’t healthy.
Think of your problems as teachers.
Transform your relationship with your problems.
Quiet the mind (a major theme of this editorial).
Be aware of your thoughts, but focus on quieting the mind.
Know that you do not have to react to every thought.
Beware of (and limit) your negative thoughts.
Cut yourself some slack.
Remind yourself that focusing on inner peace does not prevent you from pursuing your goals or having ambition to do great things.
“Do not fill up your life with what has happened or what might happen.”
Carlson expands on each of the aforementioned topics in his book, but as even a quick glance shows, the themes are very similar to those that we have been discussing. Although Carlson mentions quieting the mind, he expands on these ideas and develops them into a philosophy of being more at peace with the world as it is. It is the disconnect between the world as it is and the world as we want it to be that can lead to discontentment, anxiety, depression, and sadness.
Being a member of a multidisciplinary critical care team is never easy. By definition, if things were going well for our patients, they would not need our services. It is not surprising that all of our jobs are extremely stressful. Therefore, it is of the utmost importance that, as a group, we do everything we can to take a structured approach to reducing this stress so that we can continue to provide high-quality care when our patients need us the most. We think that the keynote speakers at NTI 2016 got it right and that an important approach to stress reduction and resilience training is mindfulness and meditation. We owe it to ourselves to take 5 minutes each day to quiet the mind. This technique could help us lead healthier, happier lives, filled with inner peace and loving kindness. Our patients will be the better for it, and so will we.
The statements and opinions contained in this editorial are solely those of the coeditors in chief.
To purchase electronic or print reprints, contact American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, firstname.lastname@example.org.