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

S T R E N G T H

In the past year I have gone through a marriage break-up; launched my work as The Mindful Nurse; got into the knack of being a single parent; and continued my part time work as a nurse. I am taking on other responsibilities as well, and I am doing up bits of the house that needed attention, in between cooking; reading stories, going for walks, climbing trees, counselling and having loving cuddles with my children, taking them here, there, and everywhere for after school activities and taken them for various hospital appointments; writing the book I have been trying to get out of my head for a year; going through the process of divorce; unblocking my outside sewage drain in the pouring rain (several times) as well as self-taught a few other plumbing techniques to see me through the winter; started to collect tools for my own toolbox and can use confidently; and of course, very crucially, meditating.  I have pushed myself as far out of my comfort zone as I dare. I have tried to be as calm, compassionate, kind and as good a person that I could want to be during what has been a tremendous wrench out of where my life was a year ago, whilst still acknowledging my own sadness and confusion at the trauma which has unfolded.

It took me two years to build up the courage and the strength to be where I am, now. If I had been allowed a peak at myself now, back in 2013,  I could never have believed where my path has led to. Two years ago I was frightened, weak, dis-empowered and had some vision of what I wanted to do/be, but was too under-confident to pursue it. Although I was practising mindfulness and meditation, events in my life had somehow caused me to lose my way, like being in the deep, dark wood, unsure of which way to turn for the best. I knew I had to move in the right direction, but I had no idea of what it looked like.
I had to summon up the courage and strength to take brave steps forward. Things got really tough – heartbreakingly so -for all sorts of reasons. However, one baby step at a time, I gradually found a patch of brightness in these woods, which gave me some energy and power to take bigger, firmer steps which became strides.

Looking back at how things were one year ago, and who I am as a result, I can only put it down to the fact that, through using my mindfulness techniques, meditation, the odd glass of wine and a few amazing friends and family who have supported me through this whole process, I am nearly out of the woods and onto a clearer path. With flowers, birds, butterflies, fluffy rabbits and a merry tune that I can skip along to…

OK, that might be a bit far-fetched – but why not aim for that? One of my regular meditation techniques has involved powerful visualisations of what I want my life to look and feel like. I am therefore striding in that direction, in contrast to the deep, dark world that I am walking away from. Along the way I have encountered various and numerous events to trip me up; I have had traps I have walked into; I have walked into thick mud to pull myself out of. But I’m still walking towards the clearer path.

For me, being able to see that I am doing so much and trying so hard to get things right for myself and for everyone around me, shows me my strength. Two years ago I couldn’t see that, because I was simply too busy trying to fit a square peg into a round hole. What I thought was going on didn’t fit the bigger picture. Now I know that, so I  have given up trying to fit into the bigger picture. Instead I am creating my own.

When life gets tough, you may feel that you are not strong enough to handle it. But when you gather all the little bits of who you are, then fit these pieces together, you might be able to see that you are stronger than you thought you were. Strength brings structure; structure provides resilience.

The Code

Earlier this year,  new changes were made to The Code for nurses and midwives. The Nursing and Midwifery Council (NMC) has set updated standards that all registered nurses and midwives must apply to their practice.

There has been mixed discussion today from healthcare professionals and from the public, some of whom are in favour of the updated code of conduct and revalidation process; others who believe it to be somewhat condescending towards nurses and midwives. After the Francis Report and the Keogh Report highlighting flaws, concerns, dangers and poor practice across poorly-performing trusts, I find it puzzling that there is so much variation in care delivery across what should be a well-performing, unified organisation, theNational Health Service. Will updating a code of conduct for some of its workforce be enough to drive up standards of care delivery, or is there Something Missing?

I’ve worked in several different trusts as a nurse – both in primary care and secondary care – as well as in the independent sector for a while. Wherever I have worked, there have always been various issues ranging from money shortages, poor standards of care, mistakes, anger and disenchantment, to job dissatisfaction and stress with burnout. I’ve seen the best and the worst of care; with some incredible, caring staff who will go the extra mile for their patients. I’ve heard people say that the NHS runs on the goodwill of those who work within it. I’ve always done my best as a nurse to work to the best of my ability, for the benefit of patients. And if you were to ask any other nurse or midwife or healthcare worker, they would almost always say the same.

I have always said that if I ever stopped caring about my job or my patient, it was either time to change job or leave nursing. I often wonder if standards of care delivered by the NHS workforce reflect the standards of care delivered by the trusts and by the government…if as healthcare professionals we are expected to uphold standards and codes; if NHS Trusts are expected to comply with statutory regulations, targets and standards; what targets, standards and compliance are in place for the top governing bodies and government which control the NHS from the top down? Where does this drive for improvement, delivering high standards of care, behave compassionately and respectfully to the patients begin – the individual, the government – or both? Where does it begin for the staff? Why are staff bullied? Why are there failures in care? Will a code of conduct be enough to ensure that dreadful things don’t happen in the NHS, any more, or is there Something Missing?

I believe there is: one of the fundamental elements of mindfulness practice is based on connection. Connection with the Self. This connection, in the form of reflection or a moment to sit still and contemplate a situation or event that has taken place allows a more meaningful experience. Regular mindfulness practice and other forms of meditation, such as Metta meditation has a positive impact on ourselves: it makes us “nicer”. This connection within, when practiced regularly, can enable us to connect, empathise and act with compassion towards others. I would like to see this connection embedded with everyone, including patients, staff, trust boards, local and national government. The connection works both ways, though – even I struggle with that bit – I find it difficult to have compassion for the current political mess the NHS is faced with, at the moment.

So, this new code…I hear (and connect with) all those who have positive and negative experiences in their care delivery or as a patient; I understand and agree with much of the revised code; but  I also see that mindfulness deserves a high profile space in clinical care, starting with training student healthcare professionals. Influencing our thoughts towards ourselves and how we relate to others begins within. If this happens, who knows: perhaps others will begin to be influenced positively, too – including the public having a greater sense of trust and empathy for what NHS staff face on a daily basis.

Nikki teaches mindfulness and meditation to adults and children, and works as a nurse in an acute NHS hospital.

The Seventh 'C'

The more I embed my use of mindfulness into my nursing care, the more strongly I feel about how important it is that as nurses, we make a meaningful connection with our patients.

I started nursing back in 1993. I took a gap year before starting my training, to work in a nursing home. I wanted to develop my basic nursing skills, to begin to learn the art and science of being a nurse.

To me, nursing was about caring. I wanted to care for people. I wanted to make my patients comfortable. I wanted to understand what they were experiencing, as well as empathise with them. I wanted to know everything. I was an eager beaver, keen to do the best I could, but was still very wet behind the ears, completely naive, but full of enthusiasm.

Working in the nursing home was a shocking experience. Standards were poor: the home smelt awful. The residents were not properly looked after, but although I knew at the time the things I was witnessing was wrong, I did not know what to do about it. The company I worked for didn't pay us on time each month (once they arrived at the home to pay us by cheque at 5pm on Christmas eve); they didn't pay the bills on time, so at one point the phone line was disconnected and if we needed to make a call one of us had to leave the home and run 5 minutes up the road to the nearest phone box. The bill for incontinence pads was left unpaid for months, so the new orders were not delivered. We were told to cut up towels to use as pads, or dry the used incontinence pads on the radiators. No wonder the place smelled. No wonder, either, that most of the poor resident's pressure areas were breaking down. I, along with some others, refused to do either of these things, much to the chagrin of the company director.

It was a diabolical place to live and work. Most of the care staff did care about the residents, and wanted to make a real difference. We all knew of each individual resident's likes and dislikes (Betty loves cheese sandwiches, but Ethel hates cheese; Sam likes to listen to classical music in the morning with his porridge but Mabel prefers silence to eat hers; Rose always has to sit by the window, to see who is coming in and out of the front door - but everyone of us knew that she sat there each day in the hope that she would see her family walk into the home to visit her - but tragically, that event only took place a couple of times each year; partially-sighted Anne has to have her clothes laid out in a certain way each evening, so that she could find them in the morning). We all knew the routines and we followed them as much as we could, each day. But this did not take away from the fact that dreadful things were going on in that home, things that I could not bear to see. I felt a real connection with the residents, and that was the thread that weaved in the compassion, the care, the (attempted) competence, and the commitment, which led to the courage to communicate the terrible goings on to the authorities.
It was the connection with one or two in particular, that led me to write poems about the struggling, elderly bodies that tortured their fiery minds each day. One lady, on waking each day, would cry, because each night she prayed that she would die, rather than wake in pain each morning, her arthritic joints agonisingly taunting her heart, which longed to walk hand in hand with her husband on the beach, or hug the grandchildren she loved, who smiled at her from their gilded frames on the windowsill. I would try to be in her room before the others, to help her get dressed. Why? Because she insisted on wearing her tight-fitting satin blouses each day, which were almost impossible to bring her tense, creaking arms through. But I had found a way of being able to do so, unlike some of the other staff, who would take out their annoyance of the perceived inconvenience as they wrestled and tugged at the poor lady's arms, roughly pulling and tutting as she winced and cried out in pain. I couldn't bear to see it, so would try to get to her room first and gently, slowly ease her arms out as straight as I could, one at a time, apologising repeatedly, but knowing that the smart, pink blouse the lady wanted to wear, along with her matching lipstick, would make her feel just a little bit better about being alive, a little bit more "in the pink" than she really felt: quite simply, it made her feel human.
In the end, a good year or so after I left and started my training, the home was closed down after several serious complaints from relatives. There were staff there who were deeply caring and concerned about the treatment of the residents, as well as the living conditions and the mismanagement of the company (who subsequently found themselves in the position of being broke, forcing the closure of the other homes they owned, too), but 22 years later, I am still very saddened by the thoughts of the events I witnessed. I wish I could have done more to change the circumstances. I wish I could have stood up to the company and banged my drum louder for more to hear, so that changes could have been made. But I was green, I was naive, and I didn't know what I needed to do to make things better.
Ironically, when I started my training at a London teaching hospital, it was comparative luxury to be able to walk to the cupboard when I needed soap, incontinence pad, sheets or clothing, to see shelves full of everything I needed to be able to provide the basic nursing care required. It was bizarre to me that NHS staff were complaining of a shortage of equipment and resources. On reflection, it showed me just how bad things were at the nursing home I worked in.
On my first night in my nurses digs, I put up the poems I had written about the residents I had looked after on the wall next to my door. I read them each day, to remind me of the sorrow and pain these folks had suffered, in order to do the best for my patients. These and many, many more patients over the years are the connection within me to each one of those I have seen suffering, in pain or anguish, in fear or terror. 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.

So, 22 years later, I am no longer green or wet around the edges. I still love my job. I still make mistakes, each one leaving its mark for me to learn from and grow. I have seen so much heartache and pain, like other clinical staff; I have seen miracles, I have seen the fragility of the tiniest life to the vulnerability of the mightiest of men, anguish and grief in many; and joy, pride and acceptance in those too numerous to count.

But now is different. Now I am using my skills in mindfulness to help my patients across a wide spectrum of age, illness and diseases. I am discovering how best to use the connection I can make with my patients, to help them connect with themselves to understand that they can help to ease their discomfort. I am seeing results, sometimes instantly, just with a tweak to the way I work with each individual. So in my clinical practice the six 'C's have another recruit. Who wants to connect with me?

Mindfulness in hospital

Last week, I reached a milestone for my work. I ran a taster session for staff at the hospital where I work as a nurse, under my business as The Inner Space Project.
It was a seemingly small step, but I was so excited about it. For a start, more people than I had expected wanted to come along and find out about it. The session seemed to go down well with those who had come along, and crucially, they want more! I taught a series of activities based on focusing and visualisation, and ended with a relaxing meditation. I got some appreciative feedback, for which I am grateful for. It was a great session!

You see, I believe my role in nursing goes much deeper than the clinical everyday nursing stuff - this is important, don't get me wrong. But I want to weave the deeper stuff into my work, and I believe that others can do this, too, and have a positive influence not just on themselves or their patients, but within the department they work. I am full of ideas about how I can bring my clinical practice and my mindfulness into alignment, and use accordingly - and I am chomping at the bit to get it going!

The deepest thread amongst everything I do as a nurse (and in life) is to form a connection with others, and teach them to do the same, but also connect with themselves. I feel that our own inner voices often sabotage our good deeds to ourselves, and if that's happening on an internal level, it is being reflected externally, as well. At the centre of everything, the most important things to remember, are that we love ourselves, we are gentle with ourselves, and we forgive ourselves. If we can turn down the white noise, the noise that jeopardizes these kind and essential deeds, then we can start to influence others in the same way. What happens after that is connection, fulfilment and joy. A crazy, hippy ideology, maybe - but who says we can't try?!

If you'd like to find out more, please contact me at innerspaceproject1@gmail.com

pill-popping or hearts and minds?

Today's news has included an article about a new pill for men and women who drink excessively, to help them reduce their alcohol intake. It has made the headlines and induced discussions in the media, with the slant of being a new "wonder-drug" that will help many people.

That's great, isn't it?

Yes, it is great,

I don't think there is anything wrong with taking medication. I am a nurse, so I spend a great deal of my time administering tablets, medicines, drips and antibiotics to help make the people I look after, better. This is fine.

But...

I do also feel that as a society, we are easily swayed by medications to combat illness. We are conditioned to believe that a pill will make everything better, again. I find myself telling my children that "this medicine will make you feel better", or telling my patient, "this tablet will take the pain away", or "this antibiotic will kill the bug you have". Yes, they may well do, and invariably, that is what happens.

But...

Why do we think that we are only capable of fixing ourselves with a pill? What is it about our fixation with medicines to cure all ills? As a nurse, if I have a patient who is agitated, anxious or confused, the planned route would be to speak to the doctor to get a tablet to calm the patient down.

But...

With increasing frequency, I am using mindfulness techniques in my clinical practice to help my patients. I have had some surprising and successful results, from children to the elderly; from the scared and confused to the acutely ill, climbing-the-walls-with-pain patients.
For example, about a year ago I did a shift in A&E and was looking after a very scared, confused elderly lady. She did not know she was in hospital, and was desperate to go home. She had fallen at home and was very unsteady on her feet in the department, which was dangerous because she repeatedly got up from her chair to try to find her way into the cold, wet morning in her dressing gown and slippers. I sat down with her, did some breathing and focusing work with her, and then did a 5-minute meditation with her. As she relaxed in her chair, she settled, and then dozed off! In the time it would have taken me to either speak to a doctor about getting something to make her less agitated, or tried to get her to sit in her chair by telling her where she was, what had happened to her, and answered the repeating questions, thereby increasing her agitated state, I had simply taught her to relax her body and her mind for long enough for her to fall asleep.

So...

It works! So much so, that I am taking this further, starting with teaching mindfulness and meditation to my colleagues and other staff at the trust I work in.

Coming back to the news today, though, makes me feel a slight disappointment. Not because I don't think the tablet will work, as it sounds very effective; but because it compounds the all-round belief that we can only be fixed with conventional medicine. It reinforces the increasing belief in our society that the NHS can be relied upon to fix everybody, and it increases the "clinical" perception that society's health can only be managed "clinically". We are generally losing our ability to see things more holistically, that there can be some other frameworks that support an individual to take better care of themselves, manage their existing conditions as a "bundle" of care rather than singularly; and that by teaching people to connect within to understand why, for example, they feel the need to drink 3 pints of beer a night, they might be able to reduce their intake and feel healthier as a result.