With heartfelt appreciation, we offer healthcare providers these practical tools for staying resilient. Preparing for the long engagement of healthcare service—both mentally and physically—means carving out whatever time we can to sustain ourselves.
Our hope at Mindful is to provide you with realistically accessible mindfulness practices during these physically and emotionally demanding times. The front lines for healthcare providers may feel overwhelming. Please use these practices freely, and often.
Stress Management for Healthcare Workers
Healthcare professionals have been going above and beyond in order to safeguard everyone’s health and well-being during the coronavirus pandemic. Many have been stretched to capacity—and it’s not as if all the pre-COVID pressures have magically disappeared. Mindfulness can help healthcare professionals look after themselves and their colleagues during this time and beyond.
8 Ways Healthcare Workers Can Reduce Stress
Dr. Reena Kotecha and Dr. Chris Willard offer a collection of quick tips to help other healthcare professionals rediscover moments of calm and self-care, even during a grueling work day.
- Breathe. Seriously, we know you’re breathing already—but checking in not only with your patients, but also with your breath, hits the reset switch on your brain and body, helping you head off the stress response. Try the 4-7-8 breath: Breathe in for a count of 4, pause for 7, then breathe out for 8.
- HALT. Don’t let yourself get too Hungry, Angry/Anxious, Lonely, or Tired. See if you can remember to check in with this quick acronym every so often to keep your physical and mental functioning at peak capacity.
- Focus on the good. We know it’s hard out there. Even when it’s heartbreaking, though, don’t forget to also reflect on the day’s successes at the end of your shift—whether it’s your hospital shift or your home shift with the family.
- Transition. Too often, we mentally and emotionally take work home with us. To help you release this lingering stress, create a transition ritual at the end of your shift before stepping into your home space. This may be a short internal dialogue to signal to yourself that you are transitioning from work mode to home mode, or it may be grounding yourself while standing outside your front door by taking a moment to feel your feet on the step.
- Laugh whenever you can. Think about the things that reliably make laughter bubble up inside you. Comedy podcasts on the drive home? Your kids’ corny jokes at the dinner table? Your favorite shows on the couch? Whatever it is, let yourself savor it. Laughing keeps our brain creative and resets our nervous system.
- Reach in. Lean into your faith, whatever it is you have faith in. Maybe that’s the spiritual, the scientific, or a combination of both. But so many people just like you, including your ancestors, went through hard times—maybe even harder times than this—and came out stronger than ever. What resources did they lean on to get through?
- Reach out. This applies when you are tired or down, but reach out when you’re up, too. You never know whose spirits you’re lifting, especially among colleagues. And even though it might feel like a thankless job, you can thank all your coworkers at the end of your shift, and thank your family and friends for their support. And if you ever forget, we all thank you.
- Remember, this too shall pass. It really will end: the shift, the week, the pandemic. And what will you do then? Talk with friends about the epic vacations you’ll take, or the staycations you’ll make if you don’t have the funds or energy. Research finds even planning a vacation lifts our mood and shifts our perspective.
A final tip: We know you may need to just do whatever you can to get through this time. We share this list to offer just a few ways to “disrupt” your brain and body from rewiring your nervous system for ongoing PTSD and trauma. You can always offer yourself gratitude for taking any step, no matter how small, to recenter your body and mind in the present moment.
Mindfulness for Healthcare Workers During COVID
There is no single practice that is going to change the fact that we’re all living under immense stress and anxiety right now. The intention of mindfulness is to help us develop the skills that will allow us to navigate through times just like this.
When our minds become exhausted and overwhelmed—as stressful thoughts lead to more stressful thoughts, and we get caught up in fear and anxiety (and we’re tired)—we create a mental state that has a lot of chaos to it. That’s when turning to mindfulness practice can help us settle, help us get out of all that thinking for a moment. We can try to settle down and maybe give ourselves a little rest or see a situation with a little more clarity.
A Mindfulness Practice for Healthcare Providers During COVID from Dr. Mark Bertin
A Breath Counting Practice For Stress
This is a counting practice, for those times when we’re feeling really unsettled and really off.
- Find yourself a comfortable posture (sitting or standing). Pick a place you can be still for just a moment and then lower your gaze. Shut your eyes if that’s appropriate and you’re comfortable with it.
- Begin to recognize that there is a physical motion with each breath. Tune in to that sensation of breathing, not because we’re trying to do anything with our breath. But just because it’s always there, so it can be an anchor for your awareness. Your thoughts will continue. Recognize that. It’s okay.
- Come back to your breath each time you’re aware of that distraction. And back to the next breath again. Breathing in and breathing out.
- You can count your breaths. Counting up to seven breaths. And then if you find your way to seven, starting over with one. So, breathing in, one. Breathing out, one. Breathing in, two. And breathing out, two. And if you lose touch with the counting, that’s fine, too, starting over wherever you last remember.
- For a few moments of practice, there is nothing to do, nothing to fix. And letting go of any sense of striving or trying to make yourself feel any different than you do. Just breathing in and breathing out.
- And when you’re ready, opening your eyes. Bring your awareness back to the moment.
A practice like that isn’t meant to make you feel anything in particular. It’s an opportunity to carve out a few moments for yourself, to bring yourself back from all the different places your mind has gone through the day. And hopefully, a practice like that can become something intuitive, something available to you anytime you need it. As you practice, it might be something you can do for a longer stretch of time once a day.
Certainly, the bigger premise with mindfulness practice is that by practicing regularly over time, it becomes part of our life. We develop almost a trait where we can fall back on it in moments of stress. But that practice is also something you can use multiple times in the day, no matter how busy your day is. Taking seven breaths, or you can do 15 breaths, can be a way to catch a moment and bring your awareness back.
Let your brain settle for just a minute. Give yourself a little rest. Even during the busiest day, fifteen breaths usually takes about a minute.
Mindfulness for Healthcare Workers
Our minds are never really still. And in moments of uncertainty or crisis, whether in life or in a clinical setting, our minds can complicate our emotional and practical responses with thoughts that make our experiences more intense. In this guided loving-kindness meditation, Dr. Mark Bertin invites us to work with our thoughts. This practice strengthens our intention to notice and label whatever may arise, as a tool to anchor ourselves. While you follow along, simply recognize where your mind gets caught up in thinking about the future or the past. Quite often we get lost in thought—even while meditating. When this happens, we can use an immediate sensation or a phrase to ground ourselves again.
What to do When Thoughts Arise While Meditating
We can’t wrestle with or suppress thinking. No matter how hard we try, thoughts will always come and go. Often, they’re like trains leaving a station, Bertin says. They sweep through our minds, we hop on the train of thought, and get lost.
Within any mindfulness practice, we can anchor our attention with something neutral, like the breath, and recognize that our thoughts are not inherently good or bad, useful or useless.
A Simple Compassion Practice
- Find a comfortable posture for yourself. You can sit, stand, or lie down, with your gaze lowered or eyes shut.
- Begin by offering yourself well wishes. At a comfortable pace, maybe timed with your breath, start by repeating the loving-kindness phrases to yourself.
May I be happy, may I be healthy, may I live my life with ease.
You can use any variation of the phrases that works for you.
- When your mind wanders, note or label your thoughts and bring your attention back to the phrases.
- Let go of any sense of striving or trying to make yourself feel anything. Approach whatever your experience is right now the way you would approach that of a close friend.
- Continue to repeat the phrases of your choice.
May I be happy, may I be healthy, may I live my life with ease.
- Remind yourself that you deserve well wishes, no more and no less than anyone else.
- Next, expand your awareness to the people around you. It may be people within the closest proximity to you, or your dearest friends or family members. Offer them the same well wishes.
May you all be happy, may you all be healthy, may you all live your life with ease.
- If you’re comfortable where you are, you can continue to offer well wishes to the people around you. If you’d like to go further, try expanding your awareness to all people, and all beings everywhere.
May all beings be happy, may all beings be healthy, may all beings live their life with ease.
- When you’re ready you can open your eyes.
Burnout in Healthcare Workers and Self-Care
Research suggests that if we attempt to repress how our work affects us—how our work affects our emotional health—it can lead to increased stress, less productivity, heightened depression and anxiety, and may even lead to a greater risk of heart disease.
To say the least, not metabolizing our emotions is making us sick. That’s not how we should be spending the 90,000 hours that we work in a lifetime. For example, it’s okay to feel offended when a coworker crosses a line—it’s the first step to developing healthy boundaries. It’s also okay to feel over-utilized and underappreciated—it can result in finding more empowering solutions. The important detail to recognize is that when issues crop up, you can find the root of the problem and address it in a way that you can feel good about, that allows you to thrive and find routes to well-being instead of becoming mired in obstacles.
How to Recognize Bottled-Up Emotions
One of the simplest ways to notice things aren’t alright is to note how you’re feeling Sunday night. Ask yourself the following questions:
- Do you dread walking into work the next day?
- Do you hate the thought of turning on your computer and getting started?
- Have you noticed that you aren’t motivated to work on projects or simply don’t put the same amount of time and energy into things as you once did?
If you answered yes to any of these questions, there’s a good chance that these feelings stem from attempting to stifle angry, upset, hurt, or other negative feelings.
But it’s not always this obvious, either. It’s entirely possible to love the work you do, look forward to Monday mornings, and find yourself in a slump midday or mid-week. When this happens, it’s a good idea to stop what you are doing and go through a quick body scan to see where you’re feeling physical pain or tension.
How to Tell You Have Reached the Point of Burnout
1. Emotional and physical exhaustion: People with burnout usually describe experiencing a complete lack of energy that manifests itself physically. Some are even diagnosed by their doctors with Chronic Fatigue Syndrome. Regardless, this troubled state results in a debilitating feeling of dread for what the day will bring, even on days when no major work or personal responsibilities loom. Basic tasks and, sadly, even things that would normally provide joy become chores. Surprisingly, though exhausted, people with burnout often have trouble sleeping to the point they develop chronic insomnia. This inability to rest and recharge makes it harder to concentrate and focus, which eventually shows up in physical forms, such as panic attacks, chest pain, trouble breathing, migraines, and stomach pains. These symptoms become so severe and disruptive that it becomes impossible to cope with the challenges (and even pleasures) of daily life.
2. Detachment and cynicism: Those suffering from burnout tend to become perpetual pessimists. They go well beyond seeing the glass as half empty. For them, the glass is totally empty and there’s zero reason to try and fill it. Feelings of worthlessness, hopelessness, and an inability to accept consolation from others or connect to the empathy offered by others is commonplace. They retreat into themselves and resist socializing. Eventually, fueled by a desire to shut everyone out, they move to a state of total isolation and justify their retreat with a cynical approach to life, family, friends, work, you name it. The feeling of hopelessness transitions into one of helplessness and creates a default response to every suggestion in the vein of “what’s the damn point anyway.”
3. Feelings of self-doubt and ineffectiveness, lack of accomplishment: Sometimes people experiencing burnout are still capable of going through the motions. They still make it to the office. They still get the job done. They still join the family for dinner and handle the household duties. However, they do it in an almost robotic manner. There is no zest, no pleasure, and, therefore, performance suffers. They find ordinary tasks take longer. They procrastinate and invent excuses as to why they’re less effective. They get frustrated at things that were once easy and now seem overwhelming. Sure, they’re physically present and functioning on some level. But emotionally and mentally, they’re a shell of their former selves and are keenly aware of their inadequacy. This, as you can imagine, only perpetuates those feelings of exhaustion and detachment.
A Body Scan Practice for Burnout
- Start by focusing your attention at the top of your head and slowly move down your body.
- Make sure to stop at every major intersection, from the head, face, neck, shoulders, fingers, and so on. Is your jaw sore? Are your neck or shoulders tight or hunched? Is there pain in your back or hips? Where else might you feel discomfort or tension in your body?
- Stop and investigate tension: its location, its texture (tight, hot, cold), and see if you can direct your breathing to that location in order to dissipate some of the stress.
Take Time for Self-Care with the P.A.C.E. Yourself Practice
We are all safer because of the work of healthcare providers. With deep gratitude, Dr. Reena Kotecha invites those working on the frontlines to take a moment to prioritize self-care.
- Permission: While healthcare providers are consistently advocating that their patients take time out to prioritize their health and well-being, we aren’t so good at doing the same for ourselves. I invite you to consider what would granting yourself permission look, sound and feel like? Might you use a phrase to encourage some self-care, such as, “I offer myself this opportunity for well-being.” FOr perhaps you’ll physically move into a space which signals to your body and brain that it’s time to take some time for yourself—this may be the corner seat in your clinical room, a spare room in your home, or stepping out into the garden. Consciously granting yourself permission to care for yourself in this way sets an intention to do so.
- Awareness and Anchor: Next, bring your awareness to your present moment experience. Notice any areas of tension or tightness in the body. Many of you have been donning PPE on shift and this may have left some residual constriction in your body. Observe any physical sensations you have, along with your thoughts and thought patterns in the here and now. If any unpleasant emotions arise as you are doing this, I invite you to anchor in the breath, breathing fully and deeply as you stay with your experience.
- Compassion: Now that you are aware of your present physical and mental state, consider turning toward yourself with kindness. What might you do in this moment to offer yourself kindness, just as you would offer to a friend or colleague who has been working tirelessly as a healthcare professional navigating a pandemic. Might you soothe yourself with an embrace? If you like, place your hands on your heart and sense care streaming through your fingers. Might you offer yourself some words of kindness or encouragement as you are doing this?
- Envision: When you feel ready to, consider yourself stepping into the next moment and all future moments with a sense of well-being, seeing and feeling yourself having energy and vitality, stay with your exploration for as long as you can and notice if there are any shifts in your mental and/or physical state. Keep in mind that well-being is an ongoing exploration. We can always test and try moments of self-care. When you are ready to come out of the Envision stage, consider what you might carry forward from this P.A.C.E. practice into the rest of your day.
Making sure our own needs are met is as important as taking care of those we love most. When turning your attention toward yourself feels challenging, there are simple ways to move through the discomfort. Explore our new guide for tips, practices, and reminders on how to engage in self-care.
Meditation for Healthcare Workers
Here are simple practices that healthcare workers can use in the middle of a chaotic time—or in the middle of serious challenges. These practices are not a Band-Aid or a fix for anything in particular. They’re an acknowledgment that when we’re knocked off balance and we’re caught up in stress, there’s some value to having tools at hand that we can use to settle ourselves in any given moment.
A Simple Breathing Practice
With each movement of the breath, there is a physical sensation and that sensation is always here. It’s a way to adjust and come back to what we are meant to be doing in the next moment.
Take the next seven breaths with that perspective.
- Start wherever you are—you can be sitting or standing.
- Breathe in one, breathe out one.
- Continue with this rhythm for seven breaths.
This is something you can come back to after a crisis, or before going into a challenging moment—it’s a way to ground yourself and settle down.
A Mindful Way to Wash Your Hands
Each time you wash your hands during the day can be an opportunity to catch a break for a few seconds. There’s nothing to do or fix or change. Instead, it can be a point of rest.
- Bring your awareness to the physical sensation of the hot water and soap.
- Acknowledge this experience as something that’s real and right now.
- Incorporate a counting exercise if you can by washing your hands for the recommended 30 to 40 seconds.
And again, we’re not trying to force ourselves to feel anything. There’s an aspect of mindfulness practice that’s simply acknowledging our experience.
The Doorknob or S.T.O.P. Practice
This practice starts with the assumption that if we can get out of autopilot mode, see with clarity, and practice being settled, then we’re going to understand what needs to be done or maybe that it’s not the time to be doing something.
S – Stop what you’re doing.
T – Take a few breaths.
O – Observe and check in with what’s going on around you.
P- Pick how to proceed. Ask yourself, “What’s the most skillful thing to be doing next?”
In medicine, it’s often called a doorknob practice because it only takes a few moments. Each time you put your hand on a doorknob to enter a room for the next experience with another human being, whether it’s a patient visit or an administrative meeting, you can take that S.T.O.P. practice and remind yourself: Stop. Take a few breaths. Observe and notice how things are. Pick how to proceed with intention.
The Stress Breath Practice
The stress breath can be used to help ground you in moments of stress or anxiety. This description of the practice comes from the Holistic Life Foundation (HLF).
The 3 Basic Elements of the Stress Breath
- Fog the mirror: The most important thing about this breath is that it’s audible. Take your hand and hold it up in front of your mouth and act like it’s a mirror that you’re fogging up. So, you’re exhaling with a haaaaaaaa sound as if you’re fogging a mirror.
- Make it audible: Now, do the same thing, but only have your mouth open for two seconds and then close your mouth while still pushing out the same way—but now push out through your nose. Practice making that same sound as you inhale, so the sound comes from the back of your throat (almost like a Darth Vader breath).
- Hold and lock: The HLF twist on the stress breath happens during the pause between the inhale and exhale. When you inhale, hold your breath, and then lower your chin to your chest. Hold there for a count of five and then lift your head as you exhale. Let’s put it all together…
An Easy Breath Meditation for Stress
- Inhale nice and deep, using the “fog the mirror” technique, so the sound is vibrating at the back of your throat.
- Hold your breath and bring your chin down to your chest.
- Count back from five.
- Exhale (audibly through your nose) while you bring your head up.
- That’s one cycle. Do twelve in a row, if you can, during the day and then again at nighttime.
A 20-Minute Body Scan Meditation for Stress
As we begin the body scan, guided by Dr. Mark Bertin, we’ll be slowly and systematically moving attention through the various regions of the body, from the feet to the top of the head, noting any physical sensations as we go along. Remember that, as always, there’s no need to strive to make anything happen. Simply observe what you find and practice letting things be for a while.
A 6-Minute S.T.O.P. Practice to Ease a Worried Mind
Creating space in the day to stop, come down from a worried mind, and get back into the present moment has been shown to be enormously helpful in mitigating the negative effects of our stress response. When we drop into the present, we’re more likely to gain perspective and see that we have the power to regulate our response to pressure.
A 3-Minute Breathing Practice in Response to Stress
Take a moment to hold a stressful event in mind—identifying who’s involved, identifying what happened. Then, when you have that in mind, allow yourself to practice the 3-minute breathing space in any way that feels comfortable.
Other Free Resources for Healthcare Professionals
We’ll be curating resources here specifically for healthcare workers. (If you know of anyone serving free mindfulness practices or mental health resources for healthcare workers, please let us know in the comments.)
1) The Center for Mindfulness, The Sanford Institute for Empathy and Compassion, and Compassion Institute
The UCSD Center for Mindfulness, The Sanford Institute, and the Compassion Institute are working together to provide daily streams and recordings of mindfulness and compassion sessions to provide resources and online support to those affected. Visit their Mindfulness and Compassion Resource page.
2) The Mindful Healthcare Collective
Mindful Healthcare Collective is a group of women physicians who are healthcare professional wellness experts. They are providing free online interactive and experiential Zoom sessions for debrief and mindfulness/compassion meditation offerings. Here’s an Awareness of Breath Practice from Dr. Ni-Cheng Liang, Executive Director of Pulmonary Integrative Medicine at Coastal Pulmonary Associates, Assistant Professor of Medicine at the University of California San Diego School of Medicine, and Advisor to the UCSD Center of Mindfulness.
3) Mindfulness for Healthcare Summit
Join Mindful May 20-23, 2021 for the Mindfulness for Healthcare Summit. This free four-day summit explores how mindfulness and compassion practices support high-quality patient care and the well-being of healthcare workers. Over the coming weeks, we’ll share exciting updates about summit programming and the healthcare industry leaders and mindfulness experts who will join us. Visit the registration page for summit updates.
VitalTalk is a nonprofit comprised of clinicians who empower clinicians to communicate about serious illnesses empathetically and effectively, enabling them to feel less burned out in the process. They’ve put together a COVID Communications Playbook to help healthcare workers handle difficult conversations that we never expected—or wanted—to have.
5) Greater Good Science Center
Greater Good Science Center produces a variety of resources and programs to help health professionals apply GGSC’s “science of a meaningful life” research to their vital work. These resources not only support the mental and physical health of their patients, clients, and colleagues; they also support their own well-being, helping them care for themselves so they can better care for others.
Riding a bike, lifting weights, sweating it out on a treadmill—each can be a mindfulness practice. Whatever the physical activity, instead of simply working out to master a skill or improve your condition, you can move and breathe in a way that shifts you from feeling busy and distracted to feeling strong and capable.