For Students, Lessons in Mindfulness

December 10, 2019
Mindfulness in the classroom
Meghan Viveiros, an instructor of physician assistant studies, begins her class by guiding her students into a state of relaxation.

Techniques taught by faculty take a holistic approach to help students focus better, relieve burnout, and improve empathy.

On a hot Monday morning in late July, Instructor Meghan Viveiros is preparing to teach a class of aspiring physician assistants. Putting on a wireless microphone, she begins speaking in a calm, serene voice. The classroom grows quiet as the students close their eyes and focus on Viveiros’ words, intended to guide them to a state of relaxation.

It is a brief pause before the start of class, just a 10-minute mindfulness session designed to help these future health care practitioners relieve stress so they can better care for themselves and their patients.

“It’s really important to do this because of the amount of stress practitioners encounter daily. It’s important students learn to buffer that stress,” says Viveiros, who has a facilitator certification from the Benson-Henry Institute for Mind Body Spirit.

Stress has become a critical issue for health care providers: long hours, patient needs, and time spent on electronic documentation can put pressure on even the most seasoned caregivers. In a profession where mistakes can have serious implications, stress can often lead to burnout—the physical, emotional, and mental exhaustion that can affect a caregiver’s health and outlook.

“More and more is being asked of health professionals,” says Emily Zeman, an assistant professor of occupational therapy and associate director of the department’s clinical education. “With all those demands, burnout is common.”

“An Occupational Phenomenon”

Studies estimate that more than 50 percent of physicians and about 40 percent of nurses who work in hospitals experience burnout during their career. Burnout rates for nurse practitioners and physician assistants have not been studied as extensively, but initial reports suggest they may be similarly high.

Dr. Zeman says increased demands to learn new technologies and documentation procedures, along with changing medical and insurance regulations, can lead to “caregiver fatigue,” in which practitioners may become emotionally exhausted and disengage from their patients.

Stress isn’t confined to the field of health care, of course. In fact, it’s so widespread that earlier this year the World Health Organization recognized burnout as an “occupational phenomenon” characterized by exhaustion, negative feelings about one’s job, and reduced professional efficacy.

Mindfulness-based stress reduction programs, once considered on the fringes, are showing up everywhere—in offices and classrooms, in business schools, hospitals, and political circles, says Bonnie Halvorson-Bourgeois, an assistant professor of speech-language pathology, who introduces mindfulness techniques in both her clinical and online classes. Although the research base is still evolving, mindfulness’s popularity, she says, has been bolstered by multiple studies that suggest mindfulness can not only reduce stress and anxiety, but may also improve working memory and concentration, promote empathy and self-compassion, and have positive effects on depression, chronic pain, and many other ailments.

A 2018 study of mindfulness interventions in the workplace found that mindfulness-based programs improved decision making, productivity, resilience, interpersonal communication, organizational relationships, perspective, and self-care.

A new course, Mindfulness for Health Care Providers, is taught by Halvorson-Bourgeois, Tina Luberto, a health psychologist and mindfulness researcher at Massachusetts General Hospital, and Janice Goodman, a professor of nursing and director of the IHP’s Mind, Body, Health, and Healing certificate program, which focuses on a holistic approach to patient care. Certificate students from various health care disciplines, and those from the IHP’s nursing, physical therapy, occupational therapy, and speech-language pathology programs, are enrolled. “Experiential practice is an essential component of learning in this course, not only for the personal benefits for the health care professional, but also because you can’t teach what you don’t know,” says Dr. Goodman. “It is important for health care practitioners who want to bring mindfulness to the patients they care for to experience and understand mindfulness from the inside.”

Improving Patient Care

Doctor of Physical Therapy students are introduced to self-care techniques at daylong cohort retreats at the start of each semester. Sara Knox, associate chair and an assistant professor of physical therapy, says meditation, positive self-talk, guided imagery, visualization, and controlled breathing are on the agenda, along with ways to use those techniques to cope with the stress of both graduate school and clinical situations. “If we can introduce our students to mindfulness and self-care techniques that they can take with them into their careers, perhaps we can impact their stress management during graduate school and reduce the burnout rate for health care professionals, which will improve patient care,” Dr. Knox says.

These strategies also increase physical stamina and compassion, adds Viveiros, which produces workers who are better focused and can make better decisions. “All of those things benefit the patients in terms of both clinical care and also in terms of the relationship we have with them,” she says.

Even just taking several deep breaths, says Zeman, can help mitigate stress. “One thing I teach my students is when you go in and out of patient rooms, take two deep breaths,” she says. “It’s just one mindful moment, but it allows them to be more present with their next patient.”

Lynn D’Angelo, who graduated in 2014 from the IHP’s Doctor of Nursing Practice program, is director of professional practice, innovation, and magnet at Miriam Hospital in Rhode Island. She has incorporated mindfulness in nursing workshops to encourage members of the nursing team to take care of themselves, while the hospital has supported the creation of mindfulness spaces with soothing colors where employees can regain their bearings. “When nurses are mindful and therefore intentionally present, patients report increased feelings of trust, caring, understanding, and safety,” says Dr. D’Angelo, “and because of that, patients have better outcomes.”

An Operational Experience

Mindy Butler was terrified she was going to pass out during her first clinical rotation working in an emergency room: “My hands were shaking and my heart was racing,” says the PA student, now in her second year of the program. “I was alternating between holding my breath and hyperventilating—excited and terrified at the same time.”

In the middle of her excitement and terror, Viveiros’ lessons on mindfulness kicked in. “I went through all the steps she taught us,” Butler recalls. “Every scary, terrifying step. My fear was that I was not good enough to do this. But instead of saying ‘I shouldn’t be here,’ I said to myself, ‘If the surgeon didn’t want me here, I wouldn’t be here.’” Once the operation was over, smiles from the ER team were all she needed to confirm she had made it through her first procedure with flying colors.

For Stephanie Gaglini, a second-year speech-language pathology student, mindfulness has helped her cope with the stress of dealing with a heavy client load during her clinical placements. “I’m very empathic, so it’s hard for me to separate myself from my clients. I just can’t leave everything at work,” she explains. “I need to be aware of that and know how to take care of myself while trying to help others.”

Health professionals who find those opportunities to center themselves can develop a level of personal satisfaction as well. “Those mindful moments can allow you to know that you’ve played a positive role in a patient’s life while coming away with knowing you’ve done a good job,” says Zeman.

And that may be the most rewarding moment of all.