Looking After Yourself, Looking After Others

1. Looking After Yourself, Looking After Others Jo Soldan Doc.Clin.PsyClinical Psychologist in Critical Care & Ko Awatea Counties Manukau DHB. Sue Dykes MSc Dip Clin PsychClinical Psychologist in Private Practice Mindfulness Auckland Date: Created by:

3. Illustration from ‘Quiet the Mind’ – Matthew Johnstone

4. Illustration from ‘Quiet the Mind’ – Matthew Johnstone

5. What is Mindfulness? Jon Kabat Zinn: Paying attention ‘on purpose’ Rooted in the present moment Non judgmental

6. Mindfulness Based Stress Reduction • Jon Kabat-Zinn and Saki Santorelli • University of Massachusetts • 8 week group programme, with one day silent retreat • Various mindfulness practices • Strong research base • Modified programmes used in many areas

7. Efficacy of Mindfulness Based Stress Reduction Depression Anxiety Psoriasis Chronic Pain Cancer Mindful Eating.

8. A Beginners Mind

9. Following the breath

10. Why the breath? • Accessible • Regular • Away from thinking • Only ever in the present moment • At the intersection of body and mind • Innate capacities for calming

11. Mindfulness restores the balance Too much sympathetic nervous system (fight or flight) leads to problems remembering, fatigue, lack of energy and frequent illness. Parasympathetic system (rest and digest) counteracts this

12. The nature of the mind • Wandering attention“monkey mind” • Fragmented attention, leads to mistakes • Clinging/chasing after/ruminating • Experiential avoidance – what we resist persists

13. Illustration from ‘Quiet the Mind’ – Matthew Johnstone

14. Facing the unpleasant • When we bring full awareness....to the whole of our experience....our relationship to the difficult emotions can shift dramatically • Williams et al. In The Mindful Way Through Depression( 2007)

15. Illustration from ‘Quiet the Mind’ – Matthew Johnstone

16. Outcomes of Mindfulness Practice • Focus, clarity and wisdom • Interruption of autopilot (ruminating,etc) • Metacognitive awareness • Approaching rather than avoiding • Responding rather then reacting • Compassion

17. Matthieu Ricard

18. Effects of meditation on the brain (Lazar, 2013) • Increased gray matter in long-term meditators, and after 8 weeks of MBSR, in regions involved in: • Learning and memory • Emotion regulation • Empathy • Self-referential processing • Decreased gray matter density in Amygdala, correlated with perceived decreases in stress levels

19. Why - Mindfulness at Work? Association with Emotional Intelligence More engaged in work, energised and less anxious. Reduced Cortisol, increase immunological response to flu jab (Davidson et al 2004) 70% reduction in sick leave American Army safeguards against distraction and emotional reactivity (reduced Depression and PTSD, clearer thinking in stressful situations) "It's like doing push ups for the brain."

21. Why Relevant in Health Care Burn Out and Depression are known to be high in staff. Increase Resilience to Nature of our Work. Mirroring Neurons - A way of balancing brain activity. Clearer Thinking – Patient Safety. Self Compassion PAFCC

22. Efficacy of Mindfulness Training in Health Care Reductions in stress, depression, anxiety, burn out. (Krasner et al (2009) Shapiro et al 2005,Corey et al 2006,Britt et al 2009 ) Increased Empathy (Krasner 2009, Shapiro et al 2009) Staff report increased ability to listen and be patient-centered (Krasner 2009)

23. Not Just Self Care - Compassion Nurses told to focus on compassionate care Three-year strategy unveiled to tackle 'crisis in standards of care' amid concerns over treatment in NHS hospitals and care homes Trainee nurses should be selected on compassion to avoid repeat of Mid-Staffs scandal: How do we put the compassion back into healthcare?: Full round table discussion In the wake of the Francis report, the BMJ gathered experts to discuss compassion in the health service.

25. Mindfulness at Work in Counties Manukau Abbreviated Courses 4 x 2 hours Intensive – 8 hour day followed by follow up at 4 weeks Lunchtime sits Integrated into work day

26. Mindful Minute

27. S stop what you’re doing T take a breath O observe your environment (int and ext) P proceed www.impactednurse.com

29. Mindfulness Based Resilience in the Workplace at Counties. Quantitative outcomes p value paired sample test Brief Resilience Scale 0.02 Maslach Burn Out Inventory : Emotional Exhaustion 0.02 Depersonalisation 0.05 Perceived Stress Score 0.0003 Irene Zeng Research Office Ko Awatea

30. Mindfulness Based Resilience in the WorkplaceCMDHB/Ko Awatea Has the course impacted on you professionally? 100% Have you noticed any positive change in your reactivity at work? 95% Have you noticed and positive change in your ability to handle stressful situations 97% Would you recommend the course to colleagues? 100% 

31. Mindfulness Based Resilience in the WorkplaceCMDHB/Ko Awatea “I believe the course is a real gift from the organisation in terms of the cost and time commitment. However I do think this is more than outweighed by the positive benefits that follow that can be taken into the participants personal and professional life” “it has huge benefits for reducing stress levels and produce a more positive attitude which is noticed by others”

32. Mindfulness Based Resilience in the WorkplaceCMDHB/Ko Awatea Changes noticed in themselves “more able to focus on the moment – I can do the work faster” “Singing again” “able to handle things differently, confident, better at making decisions, cope with stress better” “I am much more relaxed and alert in dealing with stressful issues and concerns and people”

33. Mindfulness Based Resilience in the WorkplaceCMDHB/Ko Awatea Many reported colleagues noting changes in them over the 4 weeks: “Not taking negative feedback so personally” “Seems calmer”“More even tempered” “Not getting overwhelmed by stressful situations” “Much more present and confident” “Less anxious and more positive about things” “My manager attended the course last year and speaks very highly of it. There is also a noticeable change in his demeanour and stress response. I would like to see if I can obtain the same benefits from the programme”

34. Mindfulness Based Resilience in the WorkplaceCMDHB/Ko Awatea • “I have noticed that I am as present with the last patient on my list as the first

35. Not just Self Care – Patient Safety Mid Staffordshire NHS Trust 'should be dissolved'

36. ‘A promise to learn - a commitment to act’ “Leaders and managers should actively support staff by excellent human resource practices, promoting staff health and well-being”(Berwick Report 2013).

37. Escape Fire – Don Berwick There are a number of things we need to do in health care “The first is the toughest: we need to face reality. This is very very hard….Our challenge is to have the courage to name clearly and boldly the problems…we must find ways to do this without either marginalizing the truth teller or demoralizing the good people working in these bad systems”

38. Mindfulness in Healthcare • Staff Resilience – reducing Burn out, Depression, Anxiety. • Increasing Joy at Work • Supporting Compassion, Patient Centered Care • Patient Safety – being present • – ability to sit with difficulty

39. Resources ‘The Mindful Workplace: Developing Resilient Individuals and Resonant Organizations with MBSR’ Michael Chaskalson ‘Search Inside Yourself: The Unexpected Path to Achieving Success, Happiness (and World Peace)’ Chade-Meng Tan CALM.ac.nz www.smilingmind.au.com www.mentalhealth.org.nz - 5 ways to well being - take notice www.bemindful.co.uk - online courses www.compassionatemind.co.uk (Paul Gilbert) www.selfcompassion.org (Krisitin Neff) www.mindfulnessauckland.co.nz www.openground.com.au Best resource - having a go! / developing a practice ……. Jo.Soldan@middlemore.co.nz