So, you want to meditate?
Good. I am glad. You are taking time to put you first. You are doing something – committing time to overcome all that bullshit that bogs you down every day. I can share my experience and my methods with you, but remember at the end of the day, this is your exercise, your practice, your time. If you have made it this far, you are still interested in learning to meditate. Another congratulation is in order. Go you. Let’s get to it.
You just did your first meditation. Not so hard, huh?
Meditation is an awesome mindfulness activity to relieve stress, refocus your attention, and reacquaint your body and mind to this moment in space and time. I started with breathing exercises and would recommend you do the same for a number of reasons:
Hopefully, you now realize how achievable a meditation practice can be to establish. You don’t need anything, you don’t need to go anywhere or add another thing to your to do list. You just tie your mindfulness meditation practice to your breathing. If I haven’t scared you off yet, it’s time we establish some ground rules so this can go as smoothly as possible for you.
Rule 1: Leave your skepticism at the door
My middle name is Skepticism, but when I first discovered mindfulness and meditative practices, I set my preconceptions aside. I just tried it. And then I tried it again. You reading this means that you have already set aside some of your judgements, so toss any remaining skepticism aside right now.
Rule 2: There is no right or wrong
You will feel like you aren’t doing it right, suck at it, or any number of other self-degrading negative thoughts. STOP. Everyone feels this way. The whole point is to focus on the breath, not anything else.
Rule 3: Download a mindfulness/meditation app
A couple of good options are Headspace, Calm, and Insight Timer. Having someone to talk you through it is more helpful than just about anything else.
Rule 4: Start slow
Try 1 minute a day for a couple of days. Definitely not any more than 5 minutes. Just trust me.
Rule 5: Your mind will wander.
That’s OK! The whole point is to notice that, and then bring your focus back to your meditation practice. You’ll quickly realize how hard it is to focus on a singular task (like your breathing) and why learning to be fully focused in the moment is important and can be applied to basically any scenario in life where you need to be emotionally, mentally, and physically present.
Rule 6: Be kind to yourself
Forgive yourself for not being a Buddhist monk on the first try.
Rule 7: Remember the purpose.
We often forget that the purpose of our mindfulness meditation is to train our mind to be better adept at processing emotions from moment to moment. We are trying to handle our stress better and reestablish ourselves in the present – not meditate our way to Nirvana.
Rule 8: There are no actual rules
This is your practice, your time, that you are dedicating to self-betterment. Do what is most comfortable for you. Try different techniques, different styles. But most importantly, just try it and make it a priority. Schedule it. Put reminders in your phone.
Now try it.
I like this step-by-step guide from mindful:
Take a seat.
Find a place to sit that feels calm and quiet to you. Set a time limit. If you’re just beginning, it can help to choose a short time, such as five or 10 minutes. Notice your body. You can sit in a chair with your feet on the floor, you can sit loosely cross-legged, you can kneel—all are fine. Just make sure you are stable and in a position you can stay in for a while. Feel your breath. Follow the sensation of your breath as it goes in and as it goes out. Notice when your mind has wandered. Inevitably, your attention will leave the breath and wander to other places. When you get around to noticing that your mind has wandered—in a few seconds, a minute, five minutes—simply return your attention to the breath. Be kind to your wandering mind. Don’t judge yourself or obsess over the content of the thoughts you find yourself lost in. Just come back. That’s it! That’s the practice. You go away, you come back, and you try to do it as kindly as possible. Close with kindness. When you’re ready, gently lift your gaze (if your eyes are closed, open them). Take a moment and notice any sounds in the environment. Notice how your body feels right now. Notice your thoughts and emotions.
Check out the following resources from mindful.
Getting Started with Mindful Meditation How to Meditate Welcome back. We are one week into 2019. Maybe you made some New Year’s Resolutions: go to the gym, eat better, lose weight, get better grades, manage time better. Make a commitment to yourself this New Year and sign up for a Koru Mindfulness Class. These four one-hour sessions teach you eight skills in mindfulness. Originating from Duke Medical Center, Koru is a mindfulness-based stress-reduction training course created specifically for college students. Our Koru leader at UK, Ashley Hinton, is dedicated to providing this class for students. Keep your eyes peeled for registration for the new, interprofessional student organization, MINDS of Healthcare. Aside from cultivating self-care in all of the healthcare colleges, MINDS provides an abundance of leadership opportunities and interprofessional collaboration. Learn more here, or reach out to any members of the MINDS Executive Committee. Remember, breathe.
Missed a dose or need to increase your dose? https://adoseofmindfulness.weebly.com/content With finals looming, it’s easy to lose sight of the good things on our lives. We are worried, stressed, and give all of our attention to what’s not going right in our lives. When we are stressed, everything seems like a crisis. The smallest things tip us into an endless downward spiral. Soon enough a lost pen seems like the end of the world. The pen is completely insignificant, but it consumes us. The solution to these qualms is positivity and gratitude. I am grateful for all of you reading this. Find what you are grateful for each day, and most of all, Happy Thanksgiving.
Finish Strong. Anyone who has worked on the inpatient side of healthcare is familiar with the concept of a medication reconciliation. Med rec, for short, is the process of creating the most accurate list possible of all medications a patient is taking — including drug, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital. Studies have shown the benefits of completing a med rec for patients to avoid errors, omissions, duplications, interactions, etc.
What if we provided that same level of attention to ourselves? The analogy is rather striking when we break it down. We transition constantly as a result of multitasking, commuting, classes, work, and any of the millions of other attention-demanding things we face on a daily basis. We get spread so thin that we carry along things that we should have left in the past, forget to do things, and make errors. So what if we took time to reconcile our own mindset periodically throughout the day? I want to challenge you to try a meditation reconciliation exercise this week. When you are making a ‘transition’ in your day, maybe walking to or from class, before sitting down to catch up on studying, or prior to going out to do something fun, stop and reflect. Take a couple deep breaths. Breathe in the cool air, bringing in emotional purity. Breathe out the stress, tension, and negative emotions that stiffen your body. Go through the same steps you would when taking care of a patient. Ask yourself, What am I thinking about right now, what am I ruminating about that has already passed? Make mental note of these things, and then remove them from your med, rather, worry list. Then ask yourself, What am I doing now? How do I give my focus to the present? Update your focus to match your answers to these questions. This Meditation Reconciliation is another perfect example of adapting the skills you already use on a daily basis and repurpose them to take better care of yourself. You take the time to make sure your patient’s medications are correct and optimized for the current situation – not worrying about what has happened in the past, or worried about what will happen in the future when they leave the hospital. Take the same time for yourself. Keep Breathing. Missed a dose or need to increase your dose? https://adoseofmindfulness.weebly.com/content As part of the new emphasis on student wellness at the University of Kentucky, I was asked to introduce mindfulness to incoming first-year pharmacy students. One of my major focuses was to differentiate preconceived mindfulness imagery (where one must sit mountain side, perfectly still in a cloud of incense and experience some divine intervention) and actually integration of mindfulness into our daily lives as students. With homage to a recent post on mindful here are 7 ways to be more mindful as a student.
be present This is the first step in mindfulness at any point, place, or time in your life. You have to be there; be in it. The present moment is precious and always fleeting. Savor it. Capture it. Love it. start small Starting small keeps you from slipping into the anxiety pit of the future. Too many times I find myself telling others, ‘You are worrying about something that may not even exist.’ There is so much truth to this. We worry about things that haven’t happened yet - and may not even happen. We waste our time and energy anxiously planning out any possible path that may or may not come to fruition. Aside from all that wasted time and energy, we lose the ability to take the small steps necessary to tackle the large life challenges that actually may deserve a little worry. one thing at a time There is no such thing as multitasking. let something else do the thinking Google tasks, outlook invites, iCal events. Use them, just don’t let them become the only thing you focus on. break it up The Pomodoro Technique is the mindfulness concept applied to efficient workflow. It is a process of working without any distractions for a brief time (usually 25 minutes) and then taking 5 minute break. I like using Tide and Focus. accept what you can't change If being present is the first step in mindfulness, then accepting what you cannot change is the second, maybe third. To be mindful means to accept this present moment just as it is. And it that you accept YOU - whatever that may entail at this very moment. You will not be perfect. You may not always feel confident. You may hate things about yourself. Recognize those thoughts, and let them pass just as they came. In the medical context, you will be faced with an insane amount of flying colors and blaring sounds that constantly demand your attention and all of those things will be incredibly annoying. You will become infatuated with trying to avoid them - but learning to accept those distractions for what they are and moving past them will allow you to excel in the field. beginner's mind What is beginner’s mind? It’s dropping our expectations and preconceived ideas about something, and seeing things with an open mind, fresh eyes, just like a beginner. Shoshin (初心) is the word from Zen Buddhism meaning "beginner's mind." Basically, it means approaching each experience with an attitude of openness, eagerness, and lack of preconceptions when studying a subject. As we become experts in a field, our past experiences can often cloud our ability to see what is right in front of us. I’ve shared some of Leo Babauta’s other work on his blog, zenhabits, but he gives a nice overview of adopting a beginner’s mindset. Healthcare students are exposed to a constant barrage of stressors. Some stressors can be directly attributed to their education, while others are just the result of life. The reality is - Stuff Happens. We then attempt to cope with all of that chaos in some way and so we can move on handle the next thing that happens. The problem is that we don't really ever let go of it all. We carry it around like pack mules and then wonder why we are exhausted and emotionally drained. Before being thrust into the stressful environment of healthcare, I always found it so paradoxical to see our healthcare providers with self-destructive behaviors. Respiratory therapists that smoke. Dietitians that are morbidly obese. Pharmacists with substance use disorder. It seemed crazy that people who studied the very things they treat would choose to engage in activities that even they will tell you are bad. Now that I am here (in the hospital, in the clinic, in healthcare) I recognize how naive I was in my judgement. It easy to slip into habitual coping pattens to handle the ceaseless cluster of tasks, needs, metrics, and favors that are required of you as a clinician. Furthermore, these behaviors start when we are students. In a cohort of 4,402 medical students, 1,411 (32.5%) met diagnostic criteria for alcohol abuse or dependence. ONE IN THREE of our future physicians.... Just let that sink in… They also looked at the predictive factors that increased these students risk for alcohol abuse/dependence and not surprisingly, they were burnout, depression, and reported low mental or emotional quality of life. I want to share three more examples that are much more narrative and less data driven. These come from the book The Mindful Twenty-Something by Holly B. Rogers, MD. In one of chapters introducing mindfulness, she describes her interactions three (de-identified) students. I immediately empathized with these stories, having felt each of scenarios myself.
Why start now?I have heard all kinds of reasons not to try mindfulness, but one of the most common underlying themes is getting started. For some it’s a strange concept to focus on a contemplative practice. For others, there is no perceived need. Many express skepticism. These are all valid thoughts – so why should you start now? The short answer – you are in it. Whether you perceive it to be or not, you are on a pharmacy Spartan Race. You will be tired. You will get knocked down. You will be faced with obstacles that will convince you they are insurmountable. Graduate students are more than six times as likely to experience anxiety and depression... A review of graduate students revealed that grad students are more than six times as likely to experience anxiety and depression compared to everyone else (41% vs 6%). To add a bit of perspective, two University of Kentucky faculty helped with this review: L Todd Weiss from the Markey Cancer Center, and College of Medicine faculty, Nathan L Vanderford. You have three options: act like nothing is wrong and carry on (if you can do this, seriously, bravo), succumb to the challenges, or find methods to adapt and excel. Albeit biased, I would say option three is your best bet. While there are a million methods to choose from, our focus will be on the superpower available to all of us in every moment – Mindfulness. Mindfulness changes the way you react to the constant stressors of healthcare education. There is a growing body of evidence supporting the benefits of mindfulness within healthcare professions. Mindfulness changes the way you react to the constant stressors of healthcare education. It re-shapes your self-awareness to fight ruminating on mistakes or the angst of the unknown future. Through the practice, you are able to make better decisions, become more focused, and handle the day-to-day stressors that we all face.
You don’t have to take my word for it. Try it. Next time that frequent thought of, ‘omg… I’m so screwed. There is literally no way that I can <insert your favorite pessimistic mantra>,’ STOP. Try this technique from Mindful and Find Balance During a Moment of Panic. Welcome to the first weekly dose of mindfulnessWelcome to the first dose of your weekly mindfulness fix. The benefits of mindfulness in healthcare practice are well established. Other institutions have already been introducing practices of mindfulness and stress reduction to their healthcare students. This is a new column for The Weekly Dose focused on the benefits of mindfulness, providing opportunities to practice, and sharing resources to encourage student wellness and success. “Stressors Are Constant, Stress Is Not” This is a perfect time to bring this new content to The Weekly Dose. Some of you just finished your very first round of block exams. Others are counting down the number of blocks until the end. And of course, the fourth years have made blocks a thing of the past, but APPE rotations present their own set of challenges. No matter where you are in the curricular continuum, stressors are constant. Fortunately, being stressed doesn’t have to be. Watch this video from happify explaining the concept of mindfulness:
Check out these links:
An introduction to stress and mindfulness in healthcareAuthorJordan Potter, PharmD Candidate 2019 Objectives
This summer I had the honor of attending a mindfulness retreat with 9 of my peers in the various health colleges, the Center for Interprofessional Health Education Staff, and the fabulous Dean Janie Heath. During this retreat we broke down some of the major drivers of stress and burnout in healthcare and established a repertoire of tools and strategies to mitigate the detriments of chronic stress. Last year, 400 physicians take their lives every year and 82% of nurses in healthcare systems were evaluated to be excessively stressed. It is blatant that we need to be doing more.5 Now that I know a little bit about mindfulness, I wish I had known more about it during school. I’ll be the first to admit that four years ago, if someone told me that I should ‘be mindful’ I would have rolled my eyes. However, I think it would have been incredibly helpful to overcome the many challenges in both my personal life and pharmacy school. As such, I want to challenge and encourage those reading this work to keep an open mind. Some of the things may not seem relevant but in time, they will be. Stressors are constant, stress is not. Unfortunately, controlling every factor thrown at you is impossible. You can only control yourself and your reactions. Reporting feeling stressed is nearly ubiquitous for students. Education is demanding. Healthcare is demanding. In addition, the American Hospital Association (2018) reports 90 percent of health systems are addressing burnout and stress as a top strategic priority.5 A generation of health professionals are burning out and either leaving healthcare or struggling to manage high stress and the consequences that are the result of that stress. This field is more demanding than ever, both clinically and with all the paperwork, emails, and meetings we have to deal with. Keeping your mind healthy is just as important as keeping everything else healthy. Introduction to Mindfulness To lay proper groundwork for the concept of mindfulness, I recommend watching this short video from happify.
I like to keep it even simpler, and this is my kind of personal definition. “Mindfulness is when the mind and the body are in the same place at the same time.” I want to give you an example. We have all been driving and for some time not even been thinking about it. And you kind of wake up from it and go, ‘holy crap I was driving for 10-15 minutes and wasn't even aware of it.’ That’s what I mean when I say your mind and your body aren’t in the same place. This happens more than we even realize. We are doing one thing but thinking another, which can cause us to be disconnected from our experience. We go about our day from one thing to the next, often not mentally being in the moment but living in our thoughts, sometimes hours or days or weeks ahead, or rehashing things from our recent or distant past. I can remember times that I would have meetings that I had to go to and I would be so rushed and distant trying to just get out of there so I could get back to studying because I didn’t have enough time and I wanted to do well and all these things. I look back and I can see how I missed out on so many things - possible relationships I could have made, possible experiences I could have had, all lost because I was consumed with the future and the next thing on my to do list. Misconceptions. The idea of mindfulness on the court brings me to some preconceived notions that can be a major barrier to people experimenting with mindfulness. When I say, “let’s be mindful,” most of you are probably thinking of some serene environment, maybe on the beach, or mountain side, with a cup of tea and a sunset. While sure, this luxury would definitely fall into the category of mindful practice, we don’t have time for that. We have to take care of patients! Mindfulness doesn’t have to be some silent, spiritual excursion where you stand on your head and chant phrases with incense and tapestries. It’s not a religion, and it’s not a panacea for all that goes wrong. Mindfulness helps you develop the internal conditions that lead to resilience so that you are not so vulnerable to the constantly changing external conditions of your life, even during a busy workday, even with patients.6 Benefits of mindfulness in healthcare. Mindfulness can be incredibly beneficial for healthcare providers. Mindfulness helps sustain energy and productivity, leading to decreased levels of stress, anxiety, depression, and pain. When attention is rooted more firmly in the present and less on the past or future, research shows improved resilience and positive effects on health and well-being.7 Clinicians with a mindful practice also experience an increased sense of control.7 Mindfulness can reduce the sensation of time pressure or anxiety. With mindful practices, clinicians can also recognize their own habitual behaviors, coping patterns, and thought processes, improve their ability to make good decisions7. Likely the most important benefit for healthcare practitioners is a greater acceptance of what is beyond one’s control.7 Mindfulness helps clinicians handle the emotions associated with the upsetting situations that many of them encounter, such as deaths and dying.7 The benefits of mindfulness in healthcare are not limited to the provider. Our patients also benefit from a more mindful clinician. Mindfulness helps clinicians engage with people in a more meaningful and focused way, making patients feel cared for and increasing sense of trust.7 One of the most important benefits to our patients is the ability for mindfulness to provided increased safety. When clinicians pay close attention to patients, with a present state of mind, they’re more likely to detect early warning signs and make good decisions, resulting in fewer errors, omissions, and instances of harm.7 Formal Practices. Formal practice is when you set aside time — usually at least 10 minutes (on a mountainside or not) — and allocate your attention to building mindfulness. One example is meditation, which generally involves calming the mind and observing your own thoughts and feelings without judgment. Note that some people falsely believe that meditation is the same thing as mindfulness, but it is just one type of mindfulness practice.7 Try this example of a formal breathing practice. https://www.youtube.com/watch?v=c1Ndym-IsQg Others formal mindfulness exercises include yoga, guided imagery meditation, body scans, mindful walking, belly breathing, chakra meditation, dynamic breathing, Gatha meditation, mindful eating. Informal Practices and the utility in healthcare. Listed and explained here are three mindfulness techniques to try in your practice. First, the purposeful pause is a mindfulness technique conducted by intentionally pausing for 30 seconds or so. This pause consists of taking some calming breaths and feel your body – noticing any tension and allowing your body to relax with each breath cycle. Then establish an intention to come to the next activity or interaction with presence and care. This technique is best to provide a quick reset when you are stressed and allows you to bring yourself back to the present moment and helps realign your focus to the task at hand. During hand-washing, stand still and pause. Pay attention to the moment; reaching for the soap, spreading it on your hands; the motion, the feel of the soap, the temperature, the texture. Stay with the experience and not your thoughts. The escape artist, a second useful mindfulness technique involves physically removing yourself from a situation. When you recognize yourself in an overwhelming situation, step away from it. As you move away, acknowledge the emotions that you feel and then let them pass. Use your breathing or the sensation of walking as your focus point. This technique is especially useful for handling a high stress environment with many distractions. It allows you to escape and reconnect your body and mind. Try going for a short walk to get a drink of water or even walk to the bathroom. Lastly, the 45-second time out is a mindfulness technique conducted by pausing to acknowledge and process emotional experiences. This technique requires you to pause and reflect. Ask yourself, what am I feeling right now? Why am I feeling this way? Tell yourself, it’s normal that I have these feelings. Then let those feelings pass with each exhaled breath. Letting go of those emotionally charged experiences allows closure after an emotional experience and revitalizes the mind to give its attention to the current moment. Use this before class to focus your attention or after a stressful day to process and let pass the emotional burden of the day. Advice for your mindful practice. The goal of mindfulness is to bring your mind into the present moment. This is challenging and requires commitment to learn. When you notice your mind is adrift, first, take inventory of where your attention is. Then, let go of distractions. Retrieve any thoughts focused on the future or the past. Finally try to let go of present-oriented opinions, such as liking, disliking, or judgement. Keep it simple. Some tools will work better for you than others. Picking one or two to explore is plenty and will allow you to determine what works and what doesn’t while not being overwhelming. You may want to stick with just a couple for many months before trying others. Next, make it part of your routine. It can be helpful to link a mindfulness exercise to tasks you do every day. You might also look out for signs that your stress is building (e.g., muscle tension, stomach issues, or headache) and use them as cues to practice mindfulness. Let go of judgment. You are not doing anything wrong if you feel uncomfortable during these exercises. The goal is not to feel a particular way, but only to be present with what is actually happening in the present moment. Becoming aware of tension in your body and accepting it is part of developing mindfulness. Lastly, establish a formal practice. Formal practice makes it easier and more natural to apply informal mindfulness tools. Try to set aside ten minutes a day for a body scan or other formal mindfulness practice.
Conclusion. A quote from Sharon Salzberg really reiterates the simplicity of the concept of mindfulness; “Mindfulness isn’t difficult, we just need to remember to do it.” In and of itself, mindfulness is an incredibly simple concept. The challenge lies in recognizing the need for it and committing to integrating it into your everyday routine. In its most basic form, mindfulness is bringing the mind and body back to the same place and the same time. Mindfulness is not a goal, a task, or a burden and its definitely not something that you can fail. The key is to try. Keep it simple and make it a part of your routine. Finally, remember that mindfulness is available to us in every moment.
Acknowledgements Jenna Ferrante, PharmD Candidate 2019 Alex Nilges, PharmD/MBA Candidate 2021 Kent Brouwer, RN-BSN, DNP Candidate 2022 REFERENCES 1. Turner JC, Keller A. College health surveillance network: epidemiology and health care utilization of college students at US 4-year universities. Journal of American College Health. 2015;63(8):530-538. 2. Health NIoM. NIMH-Funded National Comorbidity Survey Replication (NCS-R) Study: Mental Illness Exacts Heavy Toll, Beginning in Youth. 2017; https://www.nimh.nih.gov/health/topics/ncsr-study/nimh-funded-national-comorbidity-survey-replication-ncs-r-study-mental-illness-exacts-heavy-toll-beginning-in-youth.shtml. Accessed September 13, 2018. 3. Daya Z, Hearn JH. Mindfulness interventions in medical education: A systematic review of their impact on medical student stress, depression, fatigue and burnout. Med Teach. 2018;40(2):146-153. 4. van der Riet P, Levett-Jones T, Aquino-Russell C. The effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review. Nurse education today. 2018;65:201-211. 5. Association AH. AHA Hospital Statistics. 2018. 6. Rodgers HB. The Mindful Twenty-Something: Life Skills to Handle Stress...and Everything Else. New Harbinger Publications; 2016. 7. Incorporating Mindfulness into Clinical Practice. 2017. http://www.ihi.org/education/IHIOpenSchool/resources/Pages/PFC-103-Incorporating-Mindfulness-into-Clinical-Practice.aspx. |
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