On the Frontline During COVID – Self Caring for the Carers

Professor Cynda Hylton Rushton and Rheanna Hoffmann recently engaged in a moving video podcast conversation that highlighted the scars and distress of what it means to be a frontline nurse during the COVID pandemic.  They covered not only the impact on nurses physical and mental health but also explored strategies that could be adopted by nurses to manage their distress.  Cynda will be a key presenter at the free, online Healing Healthcare Summit in early February 2022. 

Cynda is incredibly well-informed about nurses experiences during the pandemic, being a nurse herself and working with nurses to develop what she calls “moral resilience” – the ability of an individual to “restore or sustain” integrity in the face of the onslaught of challenges to their inner harmony and capacity to align their words and actions with their values and deep commitments.

Cynda, whose focus includes clinical ethics and contemplative practice, brings to the conversation penetrating insight and deep caring and compassion – characteristics that are manifested in her faculty work with the clinicians training program, Being with Dying.  Cynda is the author of Moral Resilience: Transforming Moral Suffering in Healthcare.

Rheanna is an emergency nurse who is also a meditation practitioner and teacher with extensive experience in mindfulness and its benefits.  During the worst of the pandemic in the US, she volunteered to work in New York City.  Her personal recollections of this experience can be found in an interview where she shares an intimate insight into what happened for herself and others during the overwhelming crisis.  Her presentation is part of the Mindful Healthcare Speaker Series which is readily available as a “resource for challenging times”. 

In her discussion with Cynda, Rheanna provided an expose of her emergency nursing experience during COVID that is raw and vulnerable but manifests her openness and courage.  I have previously reported on Rheanna’s interview about death and the dying process with Frank Ostaseski, Founder of the Zen Hospice Project.  Rheanna herself is the Founder of The Whole Practitioner designed to help nurses “to rediscover health, balance and their core values” after experiencing burnout, exhaustion and deeply personal frustration.

The distress of frontline COVID nurses

Rheanna recounted in telling detail the nature and extent of distress experienced by COVID nurses, especially those who were engaged in emergency wards.   She spoke emotively about the following experiences and sensations:

  • Reaching the limit of effectiveness of personal resources – whether that be yoga, friends or colleagues
  • Experiencing isolation and loneliness – tendency to withdraw physically and mentally to deal with the overwhelm
  • Feeling incredibly bare and vulnerable – the challenge of people dying and grief (that of relatives/friends and your own grief)
  • Physical exhaustion – tired beyond belief and suffering from lack of sleep, resulting from replaying adverse incidences
  • Feeling chronic hopelessness and helplessness – the challenges were beyond the capacity of individuals and the health system itself; exposure to personal limitations in the face of so much death and suffering.  Associated with this sense of helplessness are nightmares, flashbacks, randomly crying and insomnia.
  • Separation from self – the natural consequence of traumatic experiences.
  • Loss of a sense of balance –  impacting how time, health and relationships are valued or devalued (because of lack of time allocated to them)
  • Burnout – on physical, psychological and moral levels.  Rheanna described this as “acute burnout” reducing the energy for self-care and potentially leading to thoughts of suicide.

Rheanna pointed out that nurses, including herself, were normally able to “compartmentalise” their  adverse experiences and do so in a way that was healthy,  However, the adverse experiences from the pandemic were “unrelenting”, leading to chronic distress.  Part of the frustration was the inability of frontline nurses to help others at times when they were feeling so “fragile”.

Self-caring strategies for frontline COVID nurses

Cynda offered several self-care strategies for COVID nurses during her conversation with Rheanna.  Some covered ways of addressing negative self-talk while others focused on adopting a changed perspective and mindset or instituting a mindfulness practice: 

  • Mindfulness practice: Cynda offered a mindfulness practice that could be used by COVID nurses experiencing distress and burnout.  This focused initially on the breath with the out-breath being viewed as a release of stress.  In the exercise, the exhale stage was lengthened to accentuate and support release.  Participants were encouraged to rest in the gap between the in-breath and out-breath and, where possible, extend this gap between breaths.  A slow body scan was the next step with emphasis on identifying and releasing points of tension.  Participants were encouraged to focus on an anchor of choice to stop their minds addressing their extended to-do list or diverting into worrying.   Cynda suggested that nurse participants become conscious of how many miles their feet have travelled in pursuit of their daily caring and the level of support that their feet  have provided.  Lastly, she encouraged the nurses to employ statements such as:
    • May I trust the wisdom of this moment consciously and fully.
    • May I have the courage, honesty and openness to see things clearly and without judgment.
    • May I be willing to let go of what impedes me rather than helps me.
    • May I encounter a wise mentor to assist me to deal with these challenges.
  • Confronting your own limitations: Rheanna pointed out the sense of guilt and shame that she experienced that were driven , in part, by her self-talk – “you could have done more”, “if only you had acted faster”, “if you had paid attention more fully you could have saved more people”, “if only you had been able to convince people to make different decisions”, etc.  Our minds are very creative when it comes to self-denigration and negative self-evaluations.  It is important to acknowledge that no one could have handled the challenges for nursing presented by the pandemic and not experience their debilitating effects.  Cynda suggests that nurses need to “turn towards their limitations” and do so “with as much compassion “ as they extend to others.  There is scope here for loving-kindness meditation for oneself.
  • Changing your perspective: Cynda stated that the tendency in these crisis situations is to think that you are carrying the load by yourself because there is a natural tendency to turn inwards to cope with what is happening.   She argues that what is required is a change in perspective.  For example, she asked Rheanna to think about “Who else is carrying the load of the pandemic? “Who has your back? (e.g. friends, family, colleagues local and abroad & mentors).
  • Separate effort from outcomes: Cynda maintained that a form of self-care is to acknowledge that  the health outcomes are often beyond the control of a nurse.  She stated that In her own work she does the best she can in the circumstances to meet an identified need but recognises that the specific outcomes are not in her control – there are too many intervening aspects impacting the final outcome.  Cynda maintains that freeing yourself from expectations and outcomes is crucial for a nurses’ welfare.  In the pandemic, COVID nurses such as Rheanna attempted to “fix unsolvable problems”.  Nurses’ health outcomes were not the result of lack of effort or smarts but because the pandemic situation exceeded the capacity of individuals and the health system itself.  
  • Savour achievements – Cynda reinforces the view that the brain has a natural negative bias and is more likely to “mull over” what did not go well rather than “honour what we are able to do in the moment”, given the circumstances thrust upon us.  She stated that nurses need to focus on how they made a difference in people’s lives, e.g., holding someone’s hands as they were dying, gasping for breath or having a tube inserted to enable them to breathe.  This thought expressed kindly by Cynda precipitated a chain reaction from Rheanna who began to identify numerous moments when she “deeply showed up with people” and , in the process,  rediscovered “what it means to be a nurse” and gained insight into the very core of her being and who she was.  The other aspect that Rheanna savoured was her deep connection with people who were suffering – in spite of what was happening around her independently of her best efforts.

Reflection

Much of what Cynda proposed as strategies to help nurses deal with the extraordinary level of stress of frontline work during the pandemic can be incredibly useful for all of us to manage stress and resultant distress in our daily lives.  As we grow in mindfulness through meditation, reflection and other mindfulness practices we can reshape our perspective and expectations, savour the positive in our lives (including being alive), confront our grief and limitations and achieve the freedom of separating outcomes from effort in our chosen endeavours.

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Image by Gerd Altmann from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.

Building Resilience through Compassion Towards Others

In a previous post, I discussed Pema Chödrön’s ideas of developing resilience through self-compassion by “compassionate abiding” in our own pain and suffering during these challenging times of the pandemic.  This entails abiding in, or dropping into, the full depth of our painful experience through our bodily sensations and conscious breathing.  As we undertake slow, conscious breathing we hold our suffering with self-kindness and warmth.  Lulu & Mischka in their mantra meditation, Warriors of Light, remind us to “breathe into our hearts” because breath is our chariot enabling us to face the unknown and stand on our own.

In her interview podcast with Tami Simon of Sounds True, Pema extended the concept of compassionate abiding by moving beyond self-compassion to compassion towards others.  She maintained that embracing the pain and suffering of others particularly in these times, when everyone is suffering in one form or another, contributes to our resilience – we realise we are not alone and we are able to move beyond self-absorption and “panic storylines” to extending kindness to others.

Pain and suffering: a doorway to compassion for others

In these challenging times of the Coronavirus, we can be very sure that there are millions of people around the world who are experiencing suffering like we are.  People are experiencing all forms of loss – of loved ones, their jobs, their business incomes, their health, their financial security or their homes.  They may have become physically disconnected from their workplaces, their family and their friends, even stranded in a foreign country because of international travel restrictions.  They could be healthcare professionals working on the frontline and/or living away from their families for a number of months to protect their loved ones from cross-infection.  We can be very confident that there are people around the world who are feeling pain and suffering like we are.

Pema argues that abiding with compassion in our own pain and suffering is the doorway opening us to compassion towards others.  In experiencing fully our own suffering, not denying its intensity or pervasiveness, we develop a deep sense of connection with others who are also suffering at this time.  Pema spoke of the principle of Tonglen, a Tibetan word meaning “taking in and sending out” – taking in our own experience of pain and suffering and sending out desire for relief for others.  She suggests that once we become grounded in our own suffering (this may take 10-20 minutes), we can take in the suffering of others.  On our in-breath we can imagine others who are experiencing similar pain and suffering and on our out-breath, wish them relief and insight to enable them to move beyond their own discomfort, distress, grief or loneliness.  Connectedness and resilience lie in this mutual experiencing.

Pema maintains that we do not have to confine this compassion towards others to a time of extreme challenge, we can use our pain and suffering as the doorway to compassion and connectedness at other times.  We may be experiencing distress because a family member is suffering from Alzheimer’s or feeling panic and anxiety because someone we are carer for is experiencing the black dog of depression.  At these times, we can drop into conscious breathing, embracing our distress and anxiety with kindness, and gradually move beyond this abiding self-compassion to compassion towards others who are experiencing the intensity of our own emotions. 

Reflection

I think that Pema’s profound insight into compassionate abiding opens the way to develop self-compassion, compassion towards others and personal resilience.  As we grow in mindfulness through conscious breathing and extending relief to others, we can move beyond our self-destructive narratives, restore our inner equilibrium and peace, and develop the resilience to not only survive these challenging times but also be able to extend help and support to others. 

Compassion towards others can be expressed in many ways even in these times of social distancing – the virtual choir of women physicians singing “Rise Again” is but one example of many where people are moving beyond their own overwhelming challenges and distress to reach out to others.

Pema provides multiple resources including her many books, her free e-book titled, 5 Teachings of Pema Chödrön  and her online course, Freedom to Love, which expands on the principles and practice of compassionate abiding.

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Image by Evgeni Tcherkasski from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

How to Let Joy into Your Life

Diana Winston recently provided a meditation podcast on Opening to Joy.  She reinforced that mindfulness is about openness to the present moment in a curious and non-judgmental way.  Diana thought that this particular meditation is relevant in December when we are constantly being exhorted to be “joyful” – when many of us are experiencing emotions other than joy owing to anxiety, depression, or serious setbacks (physical, emotional or financial) at this time of the year.  It is also a time when we can experience extreme levels of exhaustion if we have been working intensely throughout the year or spending lengthy and stressful  days as a carer.  Diana offered this guided meditation as Director of Mindfulness Education at UCLA as part of the weekly meditation podcasts presented by MARC.

We can find that at this time of the year our negative feelings can be magnified as the pressure of family celebrations mounts, distressing memories of recent (or even long-past) adverse events well up or existing painful emotions such as loneliness become intensified because we are feeling left out or overlooked or misunderstood or marginalised.  Some people have very recently lost family members as a result of bush fires, car accidents, or other misadventures – while others experience recollections of these devastating events occurring at this time of the year in the past.  It takes a lot of time, focus and energy to heal the wounds of past trauma.

Diana encourages us to be kind to ourselves through self-compassion as well as to show compassion for others.  She encourages us to explore mindful approaches to equanimity to allow peace and joy to re-enter our life if we are experiencing negative emotions or distress.  To this end, she is offering an online course Cultivating Forgiveness as part of the many courses presented by MARC.

Encouraging joy in your life through mindfulness

When we practice mindfulness, we are opening ourselves to joy and contentment – to experiencing what is, in an accepting and kind way.  It does not have to be a laugh-out-loud happiness but can be something small and subtle.  Joy can range from something that is profoundly felt to a simple sense of being content with life at the present moment. It can be the sensation of mindfully taking a walk by the sea, drinking a cappuccino, being fully present and mindfully listening to someone – joy can happen just by being fully here and showing up in our lives.  The act of gratitude for the positive things in our life – savouring our child’s development, our achievements, our friendships – can release us from unease or resentment and let joy into our life.

A guided meditation on cultivating joy

Diana provided a specific guided meditation on how to cultivate joy in your life during the podcast.  The basic steps are as follows:

  • Begin by experiencing being grounded through your feet on the floor, your thighs resting on the chair, your back upright but not strained – developing a sense of stability and being supported.
  • Progressively scan your body and loosen any muscle that may be tight or tense including your feet, legs, arms, wrist, neck, shoulders, shoulder blades, lower back and your face and forehead – your whole body, opening to a sense of well-being and ease.  You can take deep breaths as you progress with your scan and use the outbreath as a way to release tension and let in ease.
  • Now focus on something that will serve as an anchor in the event of distraction – the sensation of your breathing in some part of your body or the sounds in the room (without interrogation of their nature, source, volume or pleasantness).  You can also use the dual process of focusing on the sensation of your fingers being joined while at the same time experiencing your breathing in some part of your body where your attention can focus.  When you experience distractions such as planning, thinking, evaluating or worrying, redirect your mind to the present and your anchor to stay with the sense of ease, rather than the experience of unease.  This process of redirecting attention builds your awareness muscle and increases the prospect of experiencing joy in your life.
  • While you are being anchored through your breathing or sound, be conscious of the peace or contentment you are experiencing.  Pay attention to the joy that arises from being mindful – being fully in the present moment with openness and curiosity and wonderment. 
  • Now focus in on a specific, recent experience of joy – e.g. being with a loved one, sharing an experience with a friend, enjoying company over lunch or dinner, walking in a rainforest, or enjoying the sense of competence when playing tennis or any other sport.  Try to recapture the moment, the sensations, feelings, thoughts and the resultant joy – stay with these feelings and positive thoughts.  You can express gratitude for being able to have such an experience and to have the capacity to recapture it.

The art of cultivating joy flows from our conscious efforts to develop mindfulness and live our lives as fully as we can in the present moment.

Reflection

We can cultivate joy in our lives through mindfulness practices, meditation, reflection and expressing gratitude.  A meditation specifically designed to cultivate joy can assist us to grow in mindfulness and, as a result, more frequently capture and savour the experience of joy in our everyday lives.  We can cultivate joy by being mindful in our words and actions.

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Image by Daniela Dimitrova from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.