We've published quite a bit on family caregivers in the past few years, ranging from opinion pieces to feature articles and a special supplement on how nurses and social workers can better support these caregivers. Recently, we've turned our attention to examining the issues that nurses themselves face as caregivers. In March and April, we ran articles that focused specifically on moral distress, which arises when one either cannot act in accordance with one's moral values or takes actions that conflict with those values. Both articles speak to the heavy toll taken when nurses face such dilemmas.
Although certain situations, such as end-of-life decision making, more clearly involve moral dilemmas, many nurses have told me that the “normal” institutional environment, fraught as it is with competing demands and expectations, causes them constant moral distress. For example, patients rightly expect and deserve high-quality individualized care that's provided in a safe environment conducive to healing. But although hospitals and other health care facilities may be overtly committed to that ideal, flawed policies and insufficient resources often preclude them from fulfilling these goals. Nurses—as patient advocates and as professionals committed to nursing's standards of care and code of ethics—are often caught in the middle, trying to live up to patients’ and their own expectations while being constrained by system inadequacies. We've all seen patients receive interventions that we knew wouldn't help them but were given per a treatment protocol. We've all gone home after an overlong, understaffed shift, knowing we hadn't managed to provide all the care our patients needed. Somehow, we must assimilate these experiences and return to the same conflicts the next day.
Extensive research has shown that chronically stressful situations contribute to various serious consequences, including medical errors and poor patient outcomes. For health care workers, workplace stress has been implicated in job burnout and high rates of absenteeism and stress-related illnesses. Even in the absence of moral conflict and in the best of workplaces, the work of nursing—coordinating care, multitasking of critical and often time-sensitive procedures, intervening in life-threatening events, and dealing with patients and families during some of the worst moments of their lives—is inherently stressful. It makes one wonder how most nurses are able to go to work every day and deal with everything that nurses deal with.
In this issue, Patricia Reid Ponte and Paula Koppel report on a pilot program they implemented in 2011 at the Dana-Farber Cancer Institute in Boston to help the nursing staff reduce stress (see “Cultivating Mindfulness to Enhance Nursing Practice”). The eight-week program aimed to teach nurses and other team members about mindfulness, a concept that can be defined simply as being fully aware of the present moment. As the authors explain, being mindful means “remembering to pay attention with care and discernment to what is occurring in your immediate experience.” It involves being aware of one's physical and emotional state and external surroundings, and focusing on whatever is immediately at hand. Research has linked mindfulness practice to reduced stress, improved communication and relationships, and fewer errors. Indeed, the 10 pilot participants found the program lowered their stress levels and helped them work more effectively. The institute now regularly offers its staff one-day workshops in mindfulness.
In recent years, countless companies from Fortune 500 industries to start-ups in many fields have embraced mindfulness as a means of enhancing employees’ well-being and thus improving productivity. I'm also a believer. I've found the STOP technique to be especially helpful in tense situations (the acronym stands for Stop and take a step back, Take a few breaths, Observe inside yourself, Proceed after you pause). It's a simple, easy method that I think most nurses would find helpful on a daily basis.
This month many new nurses will graduate and join our ranks. If they're lucky, they'll land in workplaces that support them in making the transition from student to professional caregiver. But many facilities don't have (or have cut back on) new nurse residency programs, offering instead just a short orientation and leaving it to coworkers to help new hires find their way. There will be trying and stressful days ahead. Mindfulness can help all of us—new and seasoned RNs alike—to find understanding for one another and better handle daily stress.