Mindfulness—paying intentional attention to the present moment, with an attitude of nonjudgment, acceptance, and awareness. Mindful practice has clear implications for nursing leadership, workforce resilience, and health promotion, which benefits both patients and the healthcare team. In the first part of this series, we described “In the Moment: Stories of Mindfulness in Nursing,” a visual narrative of nurses presenting real scenarios of when they used mindfulness and compassion in their professional and personal lives (https://drive.google.com/file/d/0B4DSpdC0BRYEOUNETGpJQ0hod2M/view?usp=sharing). This work is aimed at elevating the importance of mindfulness, compassion, and presence as key competencies for professional nurses across the career span in all healthcare settings.
The authors are participants in the 2014 cohort of the Robert Wood Johnson Foundation Executive Nurse Fellows program (www.executivenursefellows.org/). We're all executive nurse leaders from a variety of practice settings, working in broad-based geographic settings across the country (Maine, Vermont, Virginia, Nebraska, and Arizona). An action learning team component is part of this 3-year intensive executive leadership program, focused on the team process, individual leader growth, and completing a project to effect positive change with national impact. The topic of leadership development and mindfulness emerged as a theme during our action learning team's brainstorming session to identify an overall project focus. Despite the diversity in our roles and settings, each of us had a compelling interest in mindfulness, driven by pressing issues observed in our leadership roles.
When forming our team, we created a team name (True North Leadership); charter; ground rules, including integrating mindfulness practices into each of our team sessions; and a framework for our work and individual/team learning. The timeframe for our project was 18 months. An action learning team coach was assigned to our group to facilitate processes and guide us in reflective practices along the way. As nurse leaders, working with a team of equally expert nurse leaders presented interesting challenges that we were encouraged to “lean into” and learn from.
One of the first challenges was narrowing our focus to a project that was timely, relevant, and feasibly completed within 18 months. We used human-centered design principles and “yes, and...” thinking to explore possible approaches. Typically in the change process, teams tend to focus on the reasons why ideas won't work. This generally manifests in a “no, but we can...” type of thought process. The “yes and...” approach allows for one idea to build on the other and doesn't dismiss ideas that are generated during the brainstorming process. Using this tool took a fair amount of practice and added significant value and richness to our discussion as we narrowed the project focus.
Early on, we discussed creating a learning platform to teach mindfulness to nurses and nursing students. However, we ultimately decided that, given all of the emerging resources in the field, a better approach was to ask nurses to tell stories of how they use mindfulness, compassion, and presence in their work and personal lives.
Although mindfulness, compassion, and presence are often successfully taught using workshops or classroom teaching approaches, we felt it would be powerful to use a storytelling approach in which nurses verbally share a time when being mindful made a positive difference in their experience with patients or colleagues. Using narrative as a tool for self-reflection can inspire others and is a creative way to effectively reach nurses and nursing students.
Our project purpose was to launch a national-level campaign to engage nurses in enhancing the human experience through stories of mindfulness, compassion, and presence. As we consider national-level impact through distribution of the stories, we'll also engage in local distribution through our organizations. We believe that there will be applicability at all levels of practice, from the bedside and beyond. As we look to the next phase of our distribution, we'll be engaging colleges of nursing and healthcare organizations to utilize “In the Moment: Stories of Mindfulness in Nursing” as a resource.
Navigation despite distraction
One of the unanticipated events that impacted our team's course was the energy and controversy generated by the 2015 Miss America pageant. During the pageant, Miss Colorado, an RN, used her talent segment to tell a story of connecting with a patient and the power of that connection on both her and the patient. The aftermath of this event in the popular press and media created an opportune moment to name what Miss Colorado talked about in her monologue; essentially, a visual narrative about mindfulness, compassion, and empathy. This event also highlighted the lack of understanding about the power of the nursing profession and the role and influence of nurses on health and healing.
Based on this event, we developed a social media page titled “Share Your Nursing Story,” inviting nurses to share their narratives about how they use mindfulness in their practice. However, other competing social media pages emerged and we discovered that our page wasn't going to draw the impact we intended. We ultimately decided that this avenue wouldn't achieve our goal of increasing awareness of the impact of mindfulness in nursing practice.
This experience helped our team learn about our process, as well as identify that we needed to generate alternative strategies for collecting and disseminating narratives of mindfulness in nursing. It was with some humor that we realized our attention had strayed from our original purpose, due in part to the allure of the media attention surrounding the Miss Colorado story. In short, we needed to refocus and use the experience to become more mindful as a team.
Logic model adoption
Our team defined specific outcome and process measures that we wanted to achieve with this national project. The outcome measures included increased understanding/awareness of mindfulness among nurses and how to apply strategies that support mindfulness in nursing practice. The ultimate end result we're driving toward includes nurse resiliency, self-worth, patient connection, and deep commitment. Process measures included the number of stories captured, the venues of shared stories, the nurses exposed to the concept, and the importance of mindfulness as demonstrated through the nurses' stories. The logic model depicts process inputs and outputs, and short-term, intermediate, and long-term outcomes. (See Figure 1.) This model guided our work and provided structure to our emerging efforts.
Although each of our team members is skilled in nursing leadership, different talents were necessary to actually do the work required to collect, record, and disseminate the narratives. We recognized that we didn't have the requisite skill sets to create and disseminate the video using high-quality production approaches. Thus, we enlisted the assistance of a sponsor, project manager, videographer, and graphic designer. The sponsor is an expert in a given field who's responsible for helping the team explore ideas, challenge assumptions, and facilitate introductions to other industry experts. For our project, we chose professionals in high-level communication roles to inform our work in terms of design, development, and distribution. The project manager served to keep our team on track with regards to deadlines, deliverables, and budget. This role helped ensure that key milestones and tollgates were established and met, the team had a robust process for budget tracking and performance, and the logistics of a busy team working from five different physical locations ran smoothly.
Each of the team members recruited one nurse from our organizations to participate in the video narrative. Nurses consistently recognized by their patients and peers as truly connecting with others and making a difference in their lives were selected for participation. These nurses were identified with input from the chief nurse executive leader and via programs such as the DAISY Foundation's DAISY Award.
Nurse invitees were given a brief summary of why they were selected and a general overview of the project. We used a portion of our project budget to support the interviewees' travel to and lodging in Washington, D.C., for the nurses to meet each other and our team. We arranged for a video studio for the videographer and interviewer to capture 1-hour interviews with each of the participants.
Questions used to guide the interviews, included:
- You were selected to participate in this video because your patients/supervisor/coworkers use you as an example of someone who connects with and impacts those for whom you care in a remarkable way. Why do you think others feel this way about you? What makes you different?
- If you were teaching another nurse to be mindful and present in his or her daily activities, what pointers would you share?
- When you leave your nursing position after a busy workday, how do you know your focused mindfulness or presence made a difference in your patients', coworkers', or your own life?
- Can you share a story about a specific time when you knew your focused mindfulness or presence made a difference for a patient or family? What specifically made you aware that you made a difference?
One of the most challenging pieces of our work was the editing process for the final video series. Each participant generated about 45 minutes of amazing dialogue, which needed to be edited down to 3 to 4 of the most impactful minutes. Each team member viewed the raw footage for each participant. Using a spreadsheet, the significant quotes, stories, and examples were noted for each interview. The videographer then took the spreadsheets and created a first-round edit for each of the stories. The team then reviewed the first-round edits and, using the same format as with the raw footage, made minor changes. The final edits were then set to music and graphics were added. The final cut was then shared with the team.
At the conclusion of our project, the nurses indicated that the interviews were a positive experience for them:
- “It was nice to remember some of those situations where I felt I made a difference, kind of a feel good moment...These memories are the inspirational ‘cup filling’ moments that keep me going back to work every day and restore my faith in humanity.”
- “This opportunity was definitely enlightening! It encouraged me all the more to pursue a career that truly resonates with me and brings out the best version of myself.”
A rewarding journey
Through the action learning team process, we learned how to leverage tactical and strategic approaches to implement our project. Equally important, if not more so, we also discovered that it's vital to attend to the processes of team learning with mindfulness and compassion. We grew both as a team and individually during the course of the project. It was rewarding to see the immediate impact on the five nurses who provided their personal stories, and it's hope-inspiring to consider all the ways in which the video narratives may be used.
In the final installment of this series, we'll explore the leadership implications of this project. For example, how do nurse leaders recruit nurses who have the capacity for presence and understand its importance? How do nurse leaders provide nurses with tools to use in the moment? How do you as a nurse leader use mindfulness to keep you resilient and performing strongly?