teach mindfulness meditation in hospitals!

I believe that we are in the midst of a changing culture within the NHS. At work, I see burnt-out staff, stress levels as high as ever and clinicians struggling at times to deliver the care they really want to give to their patients. At the same time I see a high demand of patients who are urgently in need of care, but are also sometimes not prepared to take ownership of their health. Some see that it is up to the NHS to "fix" them. This belief contributes to the pressures the NHS faces and so it sometimes appears to resemble a tug-of-war between staff and patients set within the political arena, stoked up by the media and fanned by disillusionment, thereby increasing frustration and stress within the workforce and fear and unrealistic expectations from patients. This has to change in order for the NHS to survive into the future. Notice I am not going to get into the politics, here - that's for another post! :)
For me, as a nurse and as a mindfulness coach, I want to help facilitate positive change within the clinical environment. I passionately believe that teaching staff to connect with themselves through mindfulness meditation will benefit not only the individual, but their colleagues and the patients, too. Teaching mindfulness meditation to patients to help them with anxiety, pain, phobias or other emotions in a clinical environment could have far-reaching benefits for them and create a different atmosphere at ward level, which will have a positive effect on others.
I have written a one-day course as part of my Connected Kids™ training for healthcare workers who work with children in the clinical setting (ward, outpatients, theatres). This course will teach staff about mindfulness, meditation, how to apply to their practice as a tool for implementing care and will teach them how to write and deliver their own scripts to their patients.
If you are interested, please get in touch with me at innerspaceproject1@gmail.com.
Please do share with your NHS friends, family and colleagues!

Mindful School

Me, speaking about mindfulness and getting students involved in mindful activities at the school

I've been teaching mindfulness to the year 11's in my local school, in preparation for their exams. Starting in February just before half term, I've been going in once a week to offer optional mindfulness sessions, given scripts and information to key staff for use during the week, and have been seeing students individually. I have also started lunchtime mindfulness to the teaching staff.
I have been auditing the sessions, which have shown improvements in the students. I am looking forward to going through the questionnaires the students and staff regularly fill in, but already there are significant improvements, particularly in anxiety levels - across both groups.
I am very happy to work in primary and secondary schools/colleges. Please get in touch to find out more!

Nikki Harman
innerspaceproject1@gmail.com
www.innerspaceproject.com

The Mindful Handshake

The Mindful Handshake is intended as a greeting to ourselves: it is though we are are shaking our hand to make contact with how we are feeling in a given moment. It can be used at any time, but particularly if fears or anxiety are becoming out of control.
To carry this out, please trace one hand with the index finger of the other, starting with the thumb, moving slowly and mindfully to each digit on the hand, using the following as your guide (remembering that the guide is within):


If you're unable to work through each digit, just pick one to focus on

Thumb: Think, "Am I becoming under the thumb (negative thoughts are beginning to take control of this moment)? Am I starting to become controlled by doubts, worries or fears?"

Index Finger: Point out the facts of the moment. What is true right now? Look for the good points as well (Look for the positives as well as seeing the negatives)

Middle Finger: Sit on the fence: observe what is happening to you, within you and around you

Ring Finger: Listen out for alarm bells - fears, doubts worries creeping in - see them, feel them, thank them, then "ringfence" them. Let these go

Little Finger: One little step at a time. Moment by moment

Palm: Palms up - what we give out, we receive. In other words, if we perceive everything in a negative light, then we are more likely to respond negatively to what's happening in any given moment.
Avoid "crystal-ball gazing" to predict an outcome, which we can do in times when we are anxious or worried about something. It can be easy to let the negative thoughts take control of our perceptions of an event. Be aware of this, so that you can check in with yourself and ask yourself what is happening right in the moment.

Fingerprints: What is in our nature? What are the habits we have learned? What can or cannot be changed?


Important: This is intended as a guide only. If you are experiencing anxiety or fears which feel like they are happening more often than you would normally experience; or if you are feeling that you cannot control these emotions, or yourself, friends or family are becoming concerned about your emotional well-being, please make an appointment with your GP. 

Enough Is Enough: knowing when to stop

Look at the photo above. Isn't it a beautiful view? I took it last week, during a walk with my two children. We were planning to go to Old Harry, on the Jurassic coast, then head into Studland to catch the bus back home.

We packed a picnic, lots of water (but as it turned out, not enough), a camera, and our sense of adventure. Seemingly intact, we left home and made our way along the beach.

We hadn't even made it to the bottom of the road before my 11 year-old daughter began to complain. Actually, we had had a morning of everything being not quite right in my daughter's world. I had tried to enter into her space, to try to help lift her out of her sense of irritation and negativity. She didn't want to invite me in, though, so she remained where she was, and I hovered around the outside, hoping for a free pass, or at least the offer of connection.

I kept things upbeat: "what a beautiful day it is!" (it is the SATs season: both children are sitting them this term and so I can almost confidently assume I have learned to use the recently-controversial SpAG exclamation mark correctly) I repeated, smiling, nudging and hugging both children. "We are so lucky to live here. Let's enjoy the day". My remarks were met with "I'm hungry and thirsty. When can we stop to eat?" We had only just left home, being fully watered before we set foot out of the door.
We decided to stop after we had walked for half an hour. In that time, we made one toilet stop, a water bottle refill, a rucksack adjustment and two shoe-lace re-ties, scattered with cries of "I'm hungry!", "My feet hurt" (what, already?), "When can we stop?" and "My eyes hurt". I confess that I uttered at least two of these statements. My 7-year-old was buying into the sense of adventure, but my 11 year-old was still in her own space, to which we were neither invited to join nor a party to, but rather the sounding boards for her irritation.

We enjoyed our lunch whilst admiring the view overlooking Swanage bay, on a bench which seemed to have jumped forward a few feet since we had last visited it; actually it was due to cliff erosion which had reduced the distance between the bench and the cliff edge. We had a lovely lunch, the mood lifted and we joked about being "hangry".

After a while we continued on the path up towards the top of the hills. Things were going well until my daughter felt she couldn't continue up the steep steps. I patiently encouraged her to carry on, one step at a time, but after another 10 minutes of complaining, bickering with her brother and getting cross with the steps, I felt it was time to stop. I tried to explain that it was OK to find it difficult...that not everything is easy nor intended to be, that the pain and difficulty we can experience can often end up giving us a completely new view and experience. After another round of sibling conflict I decided that enough was enough, so we turned round and walked back down the hill.

The lessons for me?
I have learnt that sometimes, it's easier to quit whilst I'm ahead. I learnt that the view we had on the midway point of the big scary hill will still be there to re-visit another day. Some days are meant for just climbing half-way up the hill, which is the successful point - that getting to the top of the hill isn't always the indicator of success.

I have learnt that my daughter was able to articulate her feelings because she felt safe and listened to, and because she is strong-willed in her own ways, which I am honour-bound as a parent and as a woman to listen to and respect. She is strong, fit, healthy and persistent: so the fact that she was telling me she couldn't do this walk to the top of the hill and beyond was an indicator of her own strength in admitting to herself and to the world outside her own space that "enough is enough".
I have learnt that my own projection of failure to meet my goal for the day (to get to Old Harry, walk into Studland and catch the bus home) to my children is not helpful for them or for anyone; and I have also learnt that I too felt that "enough is enough" when I caught myself spiralling into negative self-talk and buying into the cortisol-adrenalin mix that was swirling around me in the past week or so prior to this walk.

The view: oh what a beautiful view! The ability to see with clarity, to understand and gain an alternative vista had lifted me out of my head and into a beautiful possibility to turn things around from a negative into a positive.

To know is to understand, but to feel is to reach within the depths of empathy, compassion and sample the richness of experience from a higher perspective.

If we can accept that there is not always a right answer, a right way to do something, that things can go wrong; if we give ourselves permission to make the mistakes, then we can learn something beautiful from them.

Mindful NHS

A relaxing mindfulness session I led for NHS staff 

This week a report presented at The Mindful Nation launch revealed that if Mindfulness-Based Cognitive Therapy (MBCT) was practised by those suffering with chronic pain and depression, there could be a saving in the NHS of £15 for every £1 spent. The Mindfulness All Party Parliamentary Group (MAPPG) recommend mindfulness as a treatment for patients. This surely must be welcomed into a National Health Service at a time when so much change and disagreement is taking place? 

The thing is, that each time I read about the benefits of teaching mindfulness to patients I get a little frustrated (so I mindfully work through this, of course). To be honest, the crux of my frustration can be pin-pointed to these things:

1. I want to make people feel better. That's my job. That's my nature. I have seen the benefits of what I teach first hand, to adults and children. It seems that I am having trouble convincing the powers that be that I can have a positive influence on patient care and the well-being of staff. This is something I need to continue to work through in my own space. The whole process is teaching me more about who I am and how I react in my inner and outer worlds.

2. I want to be given the opportunity to develop a programme for staff to learn for themselves and then to teach with patients. I have it. I can do it. At the moment, nobody can hear me! I'm reaching out but the offers aren't forthcoming. What's going on? 

I feel that the NHS needs to change its culture in order to work forwards and make progress. In 2014-15, 39% of NHS staff had time off because of work-related stress. That's nearly 1 in 4 members of staff. I believe that before we can begin to teach patients mindfulness, we need to focus on staff well-being. I'm here. I have drafted a whole programme for NHS clinical staff to teach them mindfulness techniques. Hello!

As a nurse who qualified in 1997, I have seen many changes, and yet so much has stayed the same. It's time to look after ourselves, to give ourselves compassion, to listen to our inner fears and stressors, to learn how to adapt these into positives and reflect this in our professional relationships and in our delivery of care. I know what stress feels like, I work in demanding clinical areas, I've been in more senior roles in the past, so I get it. I now see things from an all-round perspective, so I do really understand the problems staff face. But I can also see ways to change the way the problems are perceived. 

I believe it begins with connection, what I call the seventh C of compassion in practice.The connection of human spirit within the nurse and patient relationship is what weaves the sometimes achingly beautiful compassion, care, courage and commitment into the art of nursing. Connection is the thread that holds everything else together. Without connection, the most basic, yet most complex circumstance is flawed. Mindfulness involves making that connection with ourselves, as well as with others. 

How many reports and recommendations will there be, in order to influence change? 

Nikki Harman, RGN, is a nurse working in an NHS trust. She is also a Connected Kids™ tutor and a mindfulness tutor to adults. Nikki is writing a book about mindfulness and teaching her new course, The Gem In The Dust. Contact Nikki at innerspaceproject1@gmail.com

The Nurse's Minute

www.innerspaceproject.com

The winter months increases the number of admissions to hospitals, leading to staff being put under huge pressures to see, treat and care for patients. During a busy shift, staff will often miss rest-breaks, opportunities to have something to eat and drink; and not even get time to go to the toilet. They may encounter a range of emergencies, challenges, emotionally-charged situations, verbal abuse, conflict and have to use many skills to deal with whatever they are faced with.
These shifts can last 12 hours or beyond, and be at unsociable hours when fatigue and tiredness can impact on the endurance of those in the middle of everything. Sometimes things can get overwhelming, resulting in not being able to do tasks effectively. I, like nearly every member of staff I've worked with over the years, get to a point where they're hungry, thirsty, tired, aching, have a full bladder, and yet are in the thick of stressful or busy situations with no sign of a let-up in proceedings to grab some time to refresh themselves.

Whilst the All-Party Parliamentary Group on Well-being Economics recommend Mindfulness as a treatment for patients, there is less focus on helping NHS staff using mindfulness. I am keen to utilise mindfulness techniques for staff to help overcome some of the problems faced each day. I believe it could have a significant positive impact on staff and on patients, too.

At a time when you feel relaxed, ask yourself what your stress symptoms are, even run a scenario at work where you felt overwhelmed and take note of what you feel in your body as you do. Then, during the course of your work, be aware of these symptoms being triggered, and give yourself one minute or so to just step away from the phone/bedside/bay or the area you are working (as long as it is safe), to run through the Red, Amber Green stress-relief points I have written. Remember that by slowing down and deepening the breath, you are helping to reduce your heart rate, which will impact on your blood pressure. When we are stressed, our heart rate, blood pressure and respiratory rate increase, reinforcing the stress response. Breaking the cycle can help to regulate your levels again, and allow you to feel calmer and more relaxed.

So, if you are an NHS worker, I invite you to print my Nurse's Minute (without altering it in any way; please retain my website details) to use whilst you're on shift.

I'd love to hear how you get on with this!

Nikki Harman, RGN, is a nurse working in an acute NHS hospital trust. Nikki is also a mindfulness tutor to adults and is a Connected Kids™ children's mindfulness tutor. Nikki is keen to work with NHS staff teaching mindfulness. Please contact The Inner Space Project: innerspaceproject1@gmail.com

Breathe your way to feeling better

In this video I describe a mindfulness breathing technique and explain how it affects body and mind to feel calmer

Mind Your Head

An article written by Oliver Moody for The Times recently, stated that mindfulness can be bad for you.  It seems that  two psychologists,  Miguel Farias and Catherine Wikholm have written in their book The Buddha Pill: Can Meditation Change you? that mindfulness and meditation have hidden risks which can include “mania, depression, hallucinations and psychosis”.

Mindfulness is hugely popular at the moment. It is being taught in schools, is recommended by the National Institute for Health and Care Excellence (NICE) as a treatment  for anxiety and depression, there are meditation retreats and courses all over the world, and experts making claims about its effectiveness. More recently, efforts are being made to reveal its “dark side”, including the profit-making abilities and how it can impact negatively on individuals.

There is growing evidence of the effectiveness of mindfulness, not solely on the mental health side of things, but physically and emotionally, too. There are numerous studies on the benefits of meditation, neatly and concisely summarised by Giovanni Dienstmann.   I have practised mindfulness for many years, as well as carefully taught it to adults, gained a qualification in teaching children meditation and then used the techniques with my own children; in schools; and with patients as part of my tool kit in my role as a registered nurse. I have seen great things arise from those who have used it.

Like many things, mindfulness isn’t for everybody. I have occasionally worked with those who haven’t benefited from the techniques and asked them to self-refer for further help with a psychologist – but these are the clients that haven’t wanted to or haven’t been able to explore the deeper connections within – and any good therapist would know when to signpost these clients for therapy and counselling, without leaving them unsupported and lost, which can lead to mental health issues like mania, depression or deepening anxiety.

Mindfulness requires discipline, time, connection and honesty with ourselves. In situations where we are able to see the deeper truth, of course it has the potential to bring up all sorts of emotional or mental imbalances. But it is important that the individual is supported to do this in a positive way, and for the therapist to know when to refer on, being mindful of the benefits and consequences for all. In short, then, “mind your head”.

Pressure

Imagine the scene: You are out shopping with your young children. You are in a busy shopping centre: it’s 2pm on Christmas eve; it seems as though the whole world is within the confines of the hot, crowded space. People are jostling around you; conversations heard between one person and the next as you pass echo the thoughts in your head: “I still need to buy 3 more presents, I also need to get sprouts and toilet roll and I’ve only got an hour before the stores close”.

You feel hungry and thirsty but you don’t have time to stop. Your children are over-excited, and aren’t listening to you as you instruct them to stay with you, so you are constantly keeping an eye on them. They frequently stop to look at shop windows, fully-laden with enticing-looking toys designed for maximum pester-power. One child points at something and asks if they can have it. When you say “No” a fresh round of questions and pleading ensues. Meanwhile, the swirl of shoppers around you distracts you from your other child, who has been swept along somewhere. You can no longer see them. Heavily laden with bags, you grab the child who is still pleading for a toy, as you feel the mounting panic reach maximum. You have lost your child in the busy shopping centre on Christmas eve.

How do you feel?

Imagine that…

…You feel hot and sweaty.

…You feel dizzy and your mouth is dry.

…You start shaking.

…You can hear a buzzing in your ears. Your head is throbbing.

…Your arms feel weak with fear and the weight of the bags you are carrying. Your legs seem to have turned to jelly.

You can hear yourself shouting your child’s name, but the noise around you and the sound of the buzzing in your ears begins to drown out other sounds.

You must find your other child.

You feel the panic rising in your chest and stomach.

As you look frantically around you, you catch sight of your crying child just ahead of you, being comforted by a stranger. You run to them, grab your child and hug them in relief. You thank the stranger, who leaves you to join the swirl of the crowd.

How do you feel now, and what do you do next?

OK, so this is an extreme scenario, but I designed it to give you a chance to really feel the physical effects of what you were asked to imagine. Did you feel any of the effects? Well, I can tell you that if you felt any of the panic or fear rising within you during the scenario, then it is possible that you can just as easily feel relaxed and calm if you were to imagine a different scenario:

Begin by sitting comfortably. Place your hand on your tummy. Close your eyes, or focus on something directly in front of you. Notice your breathing, and after a few breaths, take the breath deeper into your lungs, down towards your hand. Feel the hand moving outwards as you fill your lungs with air. As you let the breath out, don’t force it, just allow it to happen. Wait for the next breath to come in, slow and lengthen it as you take it to your tummy.

Now imagine It is a sunny day in the park or in your garden. You are standing barefoot on some lush, green, warm grass. You can feel the blades of grass between your toes. The warmth of the grass permeating the soles of your feet. The ground is supporting your feet as you are standing still, listening to the sounds of birds in the trees, the gentle rustling of leaves in the warm summer breeze, bees nearby humming as they pass from flower to flower. The warmth of the grass on your feet as you stand still and listen. The warmth of the sun around you gently blessing your skin with a relaxing touch that reassures you that all is well in this moment.

Imagine that warmth throughout your body. Sit quietly and soak it up for a few minutes.

Then, when you are ready, take a few deeper breaths and say to yourself “all is well with me right now” before you open your eyes. Smile to yourself.

How do you feel now? I must say at this point that if you found this harder than the stressful scenario, don’t worry! The chances are, that if you are affected by stress, it is because your brain expects stress and responds more readily than the measures you can take to feel the opposite.

That’s why regularly taking some time out to meditate can have a beneficial effect on the brain. When we feel stressed, our body releases stress hormones which causes our heart to beat faster, our breath to become shallow and fast, and our blood pressure to increase. Focusing on the breath and being “in the moment” has been shown to reduce blood pressure. Another study showed how meditating before a stressful event had a beneficial effect on stress levels, even in those who had never practised before. And if you are a multi-tasker, frequently changing tacks increases stress levels, but one study showed that meditating decreased stress and increased effectiveness of tasks with increased concentration levels, as well.

My post from yesterday explained how to differentiate between a healthy state of mind, to recognising the need to reset before reaching panic mode, or hitting the emergency button.

So here are just a few benefits of practising mindfulness and meditation. A key to success is finding what works for you, as there are so many different disciplines. As a nurse I am using meditation techniques with my patients in various situations to help them, with interesting and positive results. I can also vouch for myself as a practitioner of mindfulness and meditation – from boiling an egg, to running up a hill or overcoming insomnia, there is a place for these techniques in many aspects of life – with great results!

Nikki Harman is a nurse working in the NHS; and mindfulness and meditation tutor to adults and children. Contact innerspaceproject1@gmail.com for more information about courses or sessions either face to face or over Skype.