Self-Care for Nurses

Throughout human history the concept of quieting the busy mind has been celebrated as the art of the developed, wise person. The word meditation simply means to focus one’s thoughts, to bring the mind to a state of contemplation and reflection. The effects of setting aside time for contemplation range from calming of the physical body to awareness of our hidden emotions to increased mental clarity and new heights of spiritual enlightenment.

We begin with the physical effects of relaxation, which were described in detail by Hans Selye over 40 years ago (1956) and more recently by Herbert Benson at Harvard Medical School (1987). In Eastern traditions, meditation had been known to have positive physical and emotional benefits, but it was not until the effects were extensively studied in the West that the benefit of a meditative practice was fully appreciated. Consider the physiology of our response to stress, which activates a sympathetic system response that includes increased heart and breathing rates, increased blood pressure, peripheral blood vessel constriction, muscle tension, gastric hyperacidity, release of adrenaline, and over time the harmful cortisol, to name a few. In short, we have activation of the body’s fight-or-flight mechanisms that may be repeated hundreds of times until the body literally goes into overdrive and develops stress-related illness. The effects of calming oneself through meditative practice stimulate the neurons of the autonomic nervous system, which are oppositional to the stress response: Parasympathetic system response activation brings about decreases in heart and respiratory rates, dilation of peripheral blood vessels, muscle relaxation, lowered blood pressure, and increased flow of endorphins, the body’s own chemicals that increase a sense of well-being. Benson coined the term relaxation response to describe these extensive physiological shifts, which can be activated readily through our own willingness to learn ways of relaxing ourselves.

The activation of the relaxation response, then, is one of the most direct benefits of a meditative practice. Other benefits are the deepening of our relationship with our inner selves by connecting with suppressed feelings and thoughts on a regular basis. In working with emotionally disturbed persons, the need to experience our own center is even more crucial than in more mechanically oriented professions, such as working with computer technologies.

In the Miracle of Mindfulness Thich Nhat Hanh (1987, p. 11) describes mindfulness as “keeping one’s consciousness alive to the present reality.” If our minds are very cluttered, being present to our inner reality means to experience the clutter and acknowledge it. Mental overloading is well-known in the Buddhist tradition, in which it is called the state of the monkey mind. Observing the present state of reality, even one that seems unpleasant at first, opens a path to greater self-understanding.

Below are three examples of meditative practices that build on awareness of the breath, awareness of the body, and awareness of thought patterns. As you read the exercises, allow yourself to take time to recognize an aspect of yourself that may be new to you. Enjoy the discovery of meeting your own best friend!

EXERCISES

Focusing with the Breath

Sit or lie comfortably, stretching a few times to release any tension. Exhale fully, letting the breath flow out slowly, as if you are blowing out a candle. Repeat two more times, blowing out even more slowly and deliberately. Note that the inhalations are becoming deeper as well. Now count as you exhale, 1, 2, 3, 4. . . . Wait a moment before inhaling. As you inhale, count slowly, 1, 2, 3, 4. . . . Again, wait a moment as if wondering when the exhale will naturally come. Repeat several times until you get a sense of a natural flow, a cycle of bringing in and releasing—filling and letting go.

Just bring your mindful awareness to the breath, aware of the miracle of its flow. In 5 to 10 minutes of this gentle mindfulness practice you will feel calmer and more relaxed.

Learning from the Body

Sitting or lying down comfortably, relax a few times with the breath. Then, follow the path of your body’s circulation with your mind’s eye. Beginning with the lungs, feel the exchange of air as carbon dioxide is exhaled and fresh oxygen is taken in. Watch the nourished blood from the vessels in the lungs move to the heart pump and through it to

the aorta. Watch the flow of nourishing blood to the head, helping the brain to function well. See bright, red blood flowing to the arms and shoulders. Feel the flow in the internal organs, stomach, pancreas, liver, spleen, intestines, kidneys, bladder. Sense the flow of nourishing blood to the pelvis, thighs, legs, and feet. See the return flow through the tiny capillaries to veins and back to the heart. Feel the continuous flow of support and nourishment in the miracle of your own body. Bring your mindful attention to any part of the body that needs extra nourishment, oxygen, or love. Feel the area fill with the miracle of your mindfulness. Gently, come back to full present awareness so that you can move forward, feeling refreshed and replenished.

Learning from the Mind

Sitting or lying down comfortably, let your mind wander while you pay attention to its meanderings. As you have a pleasant thought, note to yourself, “This is a pleasant thought.” As you have an unpleasant thought, note to yourself, "This is an unpleasant thought." Without any judgment or criticism, just notice how your thoughts roam around--sometimes pleasant, sometimes unpleasant. Maybe you have a tendency to get a little stuck on the unpleasant thoughts, so as soon as you notice one, let youself move on to a more pleasing thought. Let yourself be both the mind and the observer of the mind--back and forth, just noticing, just bringing the quality of mindfulness to the experience. And, if you wish, imagine that you place the unpleasant thoughts on the back of a little monkey. Let it scamper around, perhaps running up and down a tree, as you feel more quiet and calm. After 10 to 15 minutes, let youself come back to ordinary awareness, noting what you have learned.

Any task that is repetitive gives an opportunity for activating the relaxation response. For example, if you wash dishes, or clean the house, you might do it in a hurry while you are thinking about your next task or you may take time to be fully present to the moment. Set aside a period of time for self-discovery. Pick up each dish slowly, hold it to the light, feel the water, the soap, and so forth. Experience joy and peace in every moment of this time. Most important, do not get overly ambitious or demanding of yourself: