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.

Welcoming the Richness of Our Life

Allyson Pimentel, psychologist and meditation teacher, often focuses on connection to overcome a sense of separation.   In her recent meditation podcast, her topic was Sit So You Can Stand – suggesting that through meditation we are better able to deal with life vicissitudes.  Her underlying theme was welcoming everything into your life – accepting “what is” with openness and curiosity.  Through openness and freedom from assumptions and stereotypes , we can truly appreciate the richness of our lives.

The richness of our life

There are so many things that we take for granted in our life.  Gratitude meditation and the mindfulness practice of savouring what we have, can enrich our life, develop positive mental health, and reduce negative feelings associated with envy or resentment. In the introduction to her meditation podcast, Allyson takes these considerations one step further.  She focuses on the richness and diversity of the people with whom we connect and, in particular, with those engaged in the virtual meditation practice that she was facilitating.

Allyson read a short anonymous piece called, Radical Welcome.  The text highlights the process of welcoming everyone and acknowledging the diversity and richness of all who are present – welcoming those who are child carers/elder carers/ mental health supporters; those who have a fast internet connection/ slow connection/ disrupted connection; those who bring greater diversity to the meditation through differences in ethnicity, race, or ancestral origin; those who are experiencing the ease of wellness together with those who are suffering from chronic illness.  The welcoming process was inclusive of gender and religious differences; of the young and not so young; of those who educate and those who are learning; of the doubts, questions, uncertainty and searching of people present; of the hearts, minds, and bodies of all who form part of the common endeavour.

To give some practical application of the welcoming process, Allyson encouraged everyone to look at the “gallery view” of those who were present and to wave to acknowledge others.  Looking at everybody opens our eyes and minds to the diversity of those present and this is enhanced if people have previously identified their location in the text box.  These practices in a virtual meditation environment help to make us more aware of the richness and diversity of people we interact with a on a daily basis – we are often too preoccupied with ourselves, our stories, our needs and our perceptions to appreciate what others bring to our lives.  To reinforce this connectedness, Allyson began the podcast meditation with an invitation to take a collective, deep breath while noticing the infusion of energy on the in-breath and the release of tension on the out-breath.

Guided meditation

 In the guided meditation, Allyson encouraged us to feel the support of the chair and the earth, to tap into our natural breathing process, and to progressively focus on the noises in the room – including their coming and going and the silences in between.  She stressed the importance of choosing an anchor that we can return to if we are distracted by our thoughts, e.g., by worries, negative self-evaluations, or planning our day. 

Most of the meditation was undertaken in silence – with a focus on the sense of connection with everyone  present, while acknowledging the richness of diversity.  

Reflection

Allyson’s podcast meditation offers us an opportunity to call to mind the differences we encounter in people we interact with on a daily basis.  As we grow in mindfulness through meditations such as this podcast, we can become more conscious of the differences in the people we encounter and the potential richness of the interaction.  Mindfulness also makes us more aware of our own perceptions, biases and assumptions that could act as barriers to truly acknowledging others, mindfully listening to them, and valuing their differences.   Creativity and innovation lie within diversity if we adopt openness and curiosity to learn about, and understand, differences.

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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.

Managing Yourself in Times of Crisis

Susan David was recently interviewed as part the Ted Connects© series of talks.  Susan spoke on the topic, How to be Your Best Self in Times of Crisis.  She maintained that “life’s beauty is inseparable from it’s fragility” and provided a number of ways to manage yourself in times of crisis.  She emphasised the importance of facing our difficult emotions, naming our feelings, being curious about what our emotions are telling us, developing our sense of agency and finding ways to help other people.  Susan stressed that underpinning her approach is the concept of “emotional agility” – the core of which involves “radical acceptance” of our emotions and self-compassion.

The fragility of life

Susan reminds us that the Coronavirus highlights the fragility of life. This fragility, however, is part of our everyday life experience. We love someone then lose them, we enjoy good health then experience illness, we savour time with our children only to watch them grow up and leave home.  The problem for us is that our social narrative, the stories we tell ourselves as a society, is so focused on the importance of always achieving, being fit and happy and appearing to be always in control.  There is an inherent denial of the reality of death and the fragility of life – we have to appear to be strong and deny our difficult emotions.

Facing our difficult emotions

Susan stressed the importance of overcoming our habituated way of responding to difficult emotions.  We typically deny them, turn away from them and, yet, end up stuck in them or “marinating in it” as Rick Hanson, in his Being Well Podcast, describes the resultant state of self-absorption.  Susan maintains the critical importance of facing our emotions and owning them, not letting them own us.  This involves naming our feelings not in a broad way such as “I’m feeling stressed” but in what she calls a “granular” way or fine-grained identification of exactly what we are feeling, e.g. disappointment, resentment, anger, fear or anxiety.  It is only by truly facing and naming our difficult feelings that we can tame them, stop them from owning us.  Susan points out that this self-regulation is a key facet of mindfulness.

Being curious about our difficult emotions

This is a form of self-observation and self-exploration. It’s being curious about what our difficult emotions are telling us about ourselves and what we value.  Strong emotions are indicators of what is important to us but, at the time, perceived as lacking in our personal situation.  Loneliness, for example, is experienced as disconnection from others and tells us how much we value relationships and connection.  Social distancing and social isolation, as a result of the Coronavirus, have compounded our feelings of loneliness.  So, it’s important to move towards ways of re-connecting, if not face-to face, by phone and online communication. 

Developing our sense of agency

Susan argues that in these times when everything seems out of control, it is important to develop “pockets of control” to enable us to develop our sense of agency – our capacity to control some aspect of our life and our immediate environment.  These arenas of control can be minute things like deciding what three things you want to do today, developing a menu plan for the week, setting up a daily routine (especially when you are working at home with children present) or changing the way you normally do things to adapt to changing circumstances.  It may be that you decide to master the skill of online communication – developing new capacities as well as gaining control.  Some people look to regain control and appreciation over their own yard or garden.  My wife and I have recently bought a coffee-making machine so that we can better control our expenditure on coffee, increase our control over how our cappuccinos or Piccolos are made and limit our time and social exposure by avoiding having to go out and queue up for a take-way coffee.

Sense of agency can extend to appreciating what we have and savouring it.  The Coronavirus attacks our respiratory system, quite literally taking our breath away.  We can begin to really value our breathing through various forms of meditation which can ground us in our body in these times of uncertainty and anxiety.  As we learn to control our breathing through meditation, we can develop ways to calm ourselves in times of crisis and stress.  Our calmness is reflected in our breathing, as is our agitation. 

Helping others in need

Besides showing compassion towards ourselves (in owning and accepting our emotions and what they tell us about ourselves), it is important to move beyond self-absorption to thinking of others and undertaking compassionate action towards them.  This may mean a simple phone call to an elderly relative who is in lock-down in a retirement village or contacting someone you have not spoken to for a while.  Everyday we hear about people showing random acts of kindness and generosity towards others.

For example, our weekend newspaper reported about the wife of a doctor on the frontline of the fight against the Coronavirus.  He has decided to live apart from the family for six months to protect them from contracting the virus.  Despite her resultant loneliness, his wife is creating homemade meals for him and his fellow health workers and enlisting the support of neighbours, friends and anyone else to do likewise so that these frontline workers don’t have to rely on unhealthy take-aways to sustain them during their very long hours of courageously caring for others.  Susan challenges each of us with the question, “How can we help in little and big ways?” – how can we demonstrate being part of a community and being “values-connected”?

Reflection

In times like the present with the Coronavirus impacting every facet of our lives, we begin to wonder how we will all cope.  Susan expresses great optimism that the crisis will enable people to be their “best self” and daily we see evidence of this.  Susan points to the history of people handling crises with courage, wisdom, compassion and mutual kindness (witness the recent wildfires in Australia).  As we grow in mindfulness and learn to face our difficult emotions through meditation and reflection, we can understand better what our emotions are telling us, regain our sense of agency and begin to show compassionate action towards others in need.  Mindfulness helps us to be calm, resilient and hopeful.  

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Image by ShonEjai 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.

Being Joyful for the Joy of Other People in Your Life

In a previous post I explored ways to cultivate joy in your life and provided a guided meditation on this practice.  The foundation for letting joy into your life is gratitude and the associated savouring of what is good in your life such as your achievements, friendships or your child’s development.  Genuine appreciation and gratitude displace the tendency to be envious of others’ success and joy.  However, we can work positively towards valuing and rejoicing in the good fortune of others, which in turn increases our own joy in life.

Diana Winston offers a meditation podcast, Taking Joy in Others’ Joy, designed to help us to be joyful for the joy of other people in our life.  This guided meditation is offered as one of the many weekly podcasts provided by MARC at UCLA and available through their online archive.

Barriers to being joyful for others

Diana points out that it is natural to experience barriers to being joyful for others.  These may take the form of feeling envious of their success, coveting what they have (whether a possession or a person) or feeling an inexplicable sadness when we become aware of another’s joy.  One way to address these blockages is to identify what we are feeling and to name the feeling so that we can control it.  What we will often find is that our sense of shame (for experiencing strong negative feelings) will cause us to hide these feeling from our self (not own up to them) and/or to camouflage them when interacting with others.

Michelle De Kretser, in her book The Life to Come, gives a very good illustration of this camouflaging of feelings of envy.  Michelle, when discussing the relationship between Cassie (a creative writing student) and her friend, Pippa (a successful, published novelist), highlighted how we can avoid confronting the unwelcome feeling of envy:

Cassie had hit on the strategy of dousing the envy that flickered up in her around Pippa with a stream of (fabricated) compliments.

While this approach may hide our true feelings from others, it does not address the underlying barrier to being joyful for the joy of other people in our life.  Being honest with our self about our true feelings, naming them and understanding how they reflect in our behaviour can help us to reduce the barrier.  Diana offers a supportive approach in her guided meditation podcast mentioned above.

A guided meditation on empathetic joy

In addition to addressing negative feelings that act as barriers to being joyful for others, it can be helpful for us to take a constructive approach through regular meditations designed to develop empathetic joy – appreciating the joy of others resulting from a specific accomplishment or the experience of good fortune.  The joy of others may arise through their concerted efforts to develop a skill, overcome a difficulty or achieve something that is important to them. 

The starting point of this meditation is to become grounded through your posture, mental focus and the process of using an anchor to maintain your attention and relaxed state of mind and body.  Once you have achieved this groundedness for a reasonably sustained period (e.g. 10 minutes), you can shift your focus to cultivating empathetic joy.

Firstly, you focus on the good fortune or enjoyment of someone who is close to you, with whom you have a strong relationship.  You can then picture their joy or enjoyment over a specific accomplishment or piece of good fortune and extend the desire for their joy to be increased and sustained, e.g. “May you continue to be happy and joyful and experience further success and happiness in your life.”

The next focus in your meditation is on a person with whom you experience some degree of discomfort over their success (avoid focusing on someone whom you are totally envious about) – you might have a twinge of envy that you do not entertain or dwell on to any significant degree.  In your meditation, you then apply a similar expression of good will towards this other person, moving beyond negative thoughts or feelings (as you bring them into focus), to a genuine expression of good will – wishing them increased, sustained joy and happiness.

Reflection

Being joyful for the joy of other people in your life, can be very challenging in some situations.  Where we have strong negative feelings towards them (e.g. envy or covetousness), we will experience barriers to rejoicing in another’s joy.  Being honest with our self about these feelings, their origin and strength, will help to remove these barriers.  The regular practice of the empathetic joy meditation can serve as a supportive practice to cultivate the capacity to be joyful for the joy of others and to experience vicarious joy.  As we grow in mindfulness through these types of loving kindness meditations and reflection on our behaviour, we can increase our self-awareness; develop self-regulation of our thoughts, feelings and behaviour; and build our connectedness to others around us.

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Image by Johannes Plenio 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.

Cultivating Healthy Confidence

Rick Hanson, in his podcast interview – Confidence or Narcissism? – reinforced the concept of a narcissism spectrum.  He indicated, from his clinical experience, that the extreme end of the spectrum – narcissistic personality disorder – is rare (less than 1% of the population).  However, narcissistic tendencies exist in all of us to a greater or lesser degree.  Rick provides examples, for instance, of what a 70% level of narcissistic tendencies in a person would look like behaviourally, compared to a level of 20%.  He suggests that at the 70% level, a defining characteristic is self-absorption to the point of harming others; while at the 20-30% level, a sense of entitlement is involved that results in others feeling subtly devalued.

Rick reinforced the view that there are ways to cultivate a healthy confidence to address our narcissistic tendencies.  In the previous post, I highlighted Ash Barty as an excellent role model to aspire to in developing the necessary traits.

Why do we need to develop a healthy confidence?

According to Rick, a healthy confidence involves acknowledging that you are “basically a good person with desirable traits”.  Fundamentally, the development of a healthy confidence requires “having and taking in positive experiences” (in contrast to experiencing childhood trauma in its many forms and playing out the trauma in narcissistic tendencies).   Rick suggests that deprivation in terms of normal “narcissistic supplies” in childhood, can lead to deficiencies in behaviour as an adult (including attempts to fill the void from childhood).  Normal “narcissistic supplies” take the form of physical and emotional availability by carers, accurate reading of signals and needs of a child and a genuine desire to respond in such a way as to cater for, not dismiss, the fundamental needs of the child – the needs for “comfort, soothing and affection” and to have a “sense that they are special”.

How do we cultivate healthy confidence?

Rick reinforced the importance of valuing and fully (mentally and bodily) feeling positive experiences whenever they occur throughout the day.  These can take the form of positive “narcissistic supplies” such as:

  • experiencing active listening (that affirms your worth as a person)
  • receiving an expression of gratitude for what you have done to help someone
  • being acknowledged for one of your own special traits such as wisdom, calmness, flexibility
  • experiencing sensitive understanding and appreciation of what you are feeling in a difficult personal situation (such as a relative who has a mental health issue).

Rick suggests that we should really savour these experiences, dwell on them and “replay the movie of a [positive] conversation” – and do so multiple times a day (as he did to redress his own narcissistic tendencies). 

Rick’s interviewer, Forrest Hanson – creator of the Eusophi (Good Knowledge) website – suggests that another way to develop healthy confidence is to work backwards from self-observation – observation of our own narcissistic tendencies at play, e.g. the need to gain others’ attention all the time.  He maintains that being aware of these tendencies and their negative impacts (e.g. people choosing to avoid us) can serve as a motivator for us to change.  Forrest’s mental frame on healthy confidence versus narcissistic tendencies is his suggestion that the former involves valuing oneself “from the inside out”, while the latter involves valuing oneself “from the outside in” – needing external validation to affirm your own worth.

Reflection

Most of us have experienced some form of deprivation of healthy “narcissistic supplies” in our childhood.  As we grow in mindfulness, we can develop the self-awareness and honesty to recognise and acknowledge how these deficits play out in our adult lives. By constantly savouring positive experiences, we can redress the balance and build towards a healthy confidence that can be a more effective guide of how to behave in our daily lives, in a work context and within our intimate/family relationships.

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Image by Евгения Кец 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.