Stress Reduction Strategies for Nurses: Introduction (13:45)
Sara Lefkowitz describes her background and how she started examining stress reduction in the nursing vocation. Nurses are frequently devalued in challenging situations. Jean Bolte Taylor wrote about how the nurses made her feel safe by touching her while she was recovering from a stroke.
Training the Brain (10:29)
Lefkowitz describes literature by John Kabat-Zinn, Bob Stahl, Kristin Neff, Marshall Rosenberg, Rick Hanson, and Lama Tsultrim that helps explain the modern mindfulness movement; Dan Siegel coined the term "mental fitness." Practice self-care in the workshop and do not perform any exercises that make you feel uncomfortable. Learn quick stress breathers such as holding hands, breathing techniques, and self-affirmations.
Nurses are problem-solvers and tend to forget to listen. Lefkowitz leads participants in a meditation, based upon an exercise from Rick Hanson's book "Taking in the Good." Difficult meetings will be more productive if one practices meditation prior.
Group Exercise: Getting to Know Each Other (33:31)
Participants divide into groups, discussing their nursing specialties and what they would like to get out of the seminar. Spokesmen cites family members, patient ratios, physicians, nurse managers, low staffing, pain management, patient expectations, staffing, and patients sundowning as great stressors.
Understaffed and Overworked (10:46)
A spokesman describes how she and her fellow nurses provided evidence-based outcomes to the administration about why they needed more nurses and secured additional personnel. California has nurse to patient ratios. Lefkowitz leads participants in a meditation for nurses to perform prior to beginning work.
American Nursing Association has a healthy nurse program that focuses on weight, bullying, workplace violence, women's health, and flu. The Quality and Safety Education in Nursing recognizes mindfulness improves patient's safety and overall health. Lefkowitz demonstrates the four-square breathing technique to use under stress.
Manifestations of Stress (18:05)
Richard Lazarus describes stress as a reaction between the person and her environment that taxes her well-being. Physiological and psychological reactions occur under duress; Lefkowitz describes home, internal, and situational stressors and the fight or flight response. The body reacts in the same way to a stressful situation and an imagined scenario.
Coping Skills (10:24)
Lefkowitz describes positive and negative coping skills including, substance abuse, overeating, rehashing events, shopping, spacious awareness, and self-care. Recognize what triggers your stress response pattern. A strong emotion only lasts for eight seconds, count to ten to re-engage the pre-frontal cortex.
Immediate Stress Relief (07:15)
Nurses can experience learned helplessness. Suzanne Kobasa examined people in occupations that were under a great deal of stress and determined how optimism helps those cope. Lefkowitz describes that awareness of stress response, and adapting to stress can help the body not have as large a physiological response.
Habitual Stress Patterns (15:47)
Notice different types of muscle tension and internal stress reactions. Examine your stress reactivity pattern in order to combat negative coping skills. Participants write down what sensory details would help them calm down if feeling scared, angry, or frozen.
Mindfulness-based stress reduction therapies pay attention to present experience in a non-judgmental, kind way; set an intention or dedication daily. By focusing on the breath, meditation establishes a connection with the body and stops the mind from not concentrating. Lefkowitz describes how to live in the present moment.
Mindfulness of Eating (11:51)
Participants learn how to practice mindful eating. Notice how it feels in your hand, look at it, smell at it, listen to it, put it in your mouth, notice how it feels on your tongue, chew it, and swallow. Tips and techniques for performing this exercise at work include packing a lunch, taking meal breaks, and snacking during the commute.
Focus and Concentration (13:00)
Lefkowitz leads participants in a meditation for nurses to help calm the mind. As one begins to practice it becomes easier. Emotions cause a physical feeling in your body.
Mind Traps (14:47)
Lefkowitz acknowledges the underlying fear which gives her more freedom and confidence. Typical patterns include self-esteem issues, rejecting compliments, expecting perfection, feeling controlled by someone else, and catastrophizing; practice meditation, four-square breathing, give kindness, and naming and taming to stop repetitive thinking.
Meditation: Body Scan (23:55)
It is very common to fall asleep during meditations when you start practicing. Lefkowitz leads participants in a meditation for nurses to perform at night to help notice different parts of the body.
Movement: After Lunch (10:12)
Lefkowitz leads participants in exercises to help release stress and tension throughout the neck, shoulders, hips, face, and back.
Caring and Compassion (10:27)
Participants describe what they like about nursing include patients, co-workers, and corporate philosophy. Burnout causes emotional exhaustion, depersonalization, and lose the sense of personal efficacy.
The mirror neurons in the brain cause empathy. Nurses have difficulty balancing patient needs with their own self-care; Mindfulness training increases compassion in our self and others. Lefkowitz leads participants in a Tonglen Meditation to encourage empathy.
Kristin Neff describes it as having a sense of common humanity, being gentle and understanding, and mindfulness. If you are coping with difficult emotions be kind to yourself. Lefkowitz describes how to "soften, smooth, and allow" and leads participants in a visualization about a difficult emotion.
Afternoon Break (13:00)
After a difficult visualization, Lefkowitz gives participants a fifteen-minute break.
Non-Violent Confrontation (28:39)
Marshall Rosenberg writes about how people need to feel seen, heard, and their input count. Participants play a game describing how to effectively communicate with others in a workplace scenario using a formula describing feelings, needs, observations, and requests. Find a common ground; all nurses want to give excellent care.
Practicing Mindfulness (12:36)
Some businesses place profits above patient care; nurses want to work in a culture that makes them feel safe and secure to report a mistake. Google runs a program called "Search Inside Yourself" for its employees. Lefkowitz discusses how to incorporate kindness into medical fields and reduce stress.
Bullying, Violence, and Toxic Workplaces (10:52)
Lefkowitz provides suggestions of how to address confrontations in the workplace. Address and acknowledge issues to neutralize the situation. De-briefing after a bad outcome can help improve patient care.
Participants stretch to improve circulation and reduce stress. Name the emotion, meditate, communicate appropriately, and be empathetic to reduce stress levels. Create a self-care plan, ask for help when necessary, and develop a routine to close your workday.
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