Kelsey Black, MD, in the first year of a fellowship training program in pulmonology critical care there, was tasked with the roles of determining which patients needed to go on ventilators and then helping her team intubate them. “We take care of the sickest of the sick with COVID-19,” Dr. Black says. “We saw people die and had people on ventilators for long periods of time.” Patients’ families were distraught. They wanted to know why they couldn’t be at the bedside of their loved ones, Black says. Healthcare teams were still learning about the new virus and how to stay safe. Figuring out how to balance doing your job while protecting yourself and your fellow healthcare workers was stressful, she says. “We were helping families navigate a new disease as we were learning about it ourselves.” RELATED: Coronavirus Alert In November, Black heard about and took the Mindfulness in Motion course, a mindfulness-based intervention developed by other OSU researchers and offered virtually at the medical center. “I had been interested in mindfulness from a research standpoint. Now, I’ve found it so helpful personally,” she says. The OSU course teaches individuals how to notice their feelings, thoughts and responses in the moment — and how to use tools like mindfulness meditation, breathing exercises, and yoga to boost awareness and reduce stress. Some of the techniques Black learned include: scanning her body for tension and noticing her breathing. She also learned simple techniques for feeling grounded and relaxed, including yoga poses (like Tree, Chair, and Eagle poses) that can be done at work. She learned self-massage techniques. “Mindfulness works because it’s a gateway to restoration,” says Maryanna Klatt, PhD, a professor of clinical family medicine at Ohio State who developed the program. “Once you’re aware of what’s really going on for you in a difficult situation or really any situation, you have the power to deal with it. You can do something about it or let it go. It works because its grounded in each person’s real, in-the-moment experience.” Even catching a few seconds for a mindfulness break helped in the most stressful moments of being a first responder during the COVID-19 health crisis over the past year, Black says. “When I’m busy there isn’t always time for a 10-minute meditation,” Black says. “But just taking five breaths is something I do. I put my feet on the floor, let my muscles relax, stack the vertebrae in my spine so I’m sitting up straight and do some diaphragmatic breathing through pursed lips. It can really help, especially if I’m feeling overwhelmed.” And now, new research from Dr. Klatt’s group that evaluated the effectiveness of the Mindfulness in Motion program found that it can indeed ease burn-out, stress and emotional exhaustion for a wide range of people working in healthcare. The study was published in January 2021 in the journal Global Advances in Health and Medicine and found significant mental-health benefits for 267 hospital workers — doctors and nurses as well as therapists, pharmacists, dietitians, and administrative assistants — who took the free eight-week mindfulness class and practiced on their own with videos. RELATED: 7 Ways Meditation Can Help You Stick To Healthy Habits During the Coronavirus Pandemic
Data Show Mindfulness Programs Can Curb Stress and Burnout
Researchers began collecting data for the recent study years before the COVID-19 pandemic began, tracking outcomes of healthcare works who participated in Klatt’s Mindfulness in Motion program between 2017 and 2019. The paper also tracked use of stress-reducing, five- to six-minute mindfulness videos also developed by Klatt made available online through OSU at the start of the pandemic. The publicly-available videos were viewed 10,896 times in the first 90 days they were available. “We’re at over 20,000 views now,” Klatt says. Study volunteers who took the mindfulness classes also filled out questionnaires before and after the eight-week program that measure burnout, stress, resilience, and engagement at work. After completing the program, 27 percent fewer participants met criteria for burnout, which is significant because job burnout is a widespread risk for healthcare workers in high-stress environments. Levels of perceived stress dropped. Scores for resilience and work engagement increased substantially, with the participants reporting more vigor, absorption, and dedication to their work. The study also tracked views of 30-minute video “mindfulness booster sessions,” which were made available to all healthcare practitioners at the medical center during the pandemic. The booster videos got 1,720 views in the first 90 days, while the five- to six-minute mindfulness videos Klatt developed in the early days of the pandemic got 8,471 views in 60 days. “These were available to anyone, not just hospital employees, so we don’t know who was watching,” Klatt says. “But clearly people were interested.” RELATED: How Resilient Are You? Get Your Resilience Score
Why Mindfulness Helps: ‘I Notice the Good Moments That Sustain Me’
Interventions that can help with first responder stress and exhaustion are important during a health emergency. Healthcare practitioners are experiencing unprecedented levels of stress, anxiety and exhaustion during the COVID-19 pandemic. In a national survey of emergency medical technicians, nurses, doctors, therapists and other healthcare workers by Mental Health America, 76 percent reported burnout, 75 percent said they were overwhelmed, and more than half reported sleep problems. One in 4 U.K. hospital workers, including doctors and nurses, had signs of post-traumatic stress disorder in a study published December 29, 2020, in BJPsych Open. “When you’re dealing with extreme illness all the time, it’s hard to see the positives,” Black says of her experience treating patients with COVID-19. “The course helped me stay open to what’s going on around me. I notice the beautiful interactions between staff members and families, the ways coworkers come together as a team, and the good moments that sustain me.” Klatt says her group is currently working on two-minute videos that nurses and other healthcare practitioners can use during very short breaks such as between patients. These new videos are the result of a request for such tools from a critical-care nursing supervisor, Klatt says. “The short videos are like using a rescue inhaler during an asthma attack to help you get through high stress and anxiety. They will include a simple stretch or relaxation move to reduce tension, a breathing exercise, and a [reminder] to check in with yourself.” John Shepard, RN, a critical care nurse and mindfulness program manager for the Indiana University Health System, says he sees even brief mindfulness moments reduce stress at the 16-hospital system where he works in Indiana. Shepard was not involved with Klatt’s work. But he’s found similar results from a five-week course he teaches called Aware or through the “pop-up” mindfulness sessions he leads for hospital staffers. “We’ll do a few yoga stretches, a mindfulness exercise with breathing, and we often end with laughter yoga,” he says. “When a group of people simulate deep belly laughs — just making the sounds and using their breath — pretty soon people find themselves smiling and laughing for real.” Due to the pandemic, nurses and other healthcare workers are strained and stressed, Shepard says. “We care for everyone who comes through the door, whether they wore a mask and practiced social-distancing or not, whether they’re in favor of the new COVID-19 vaccines or not. We have to rise above our personal feelings. It can take a toll.”
What Makes a Mindfulness Intervention Successful at Scale: Connection and Investment
In Klatt’s classes and Shepard’s pop-up sessions, group support plays a quietly important roll. Klatt, who leads the virtual Mindfulness in Motion classes, says sessions begin with participants asking one another questions and sharing responses. “It’s good to know you’re not in this alone. To see that other people have different responses to situations is so valuable. And we hear new ideas about resilience and mindfulness every week from participants.” Having time with colleagues to acknowledge emotions and vulnerability is also important, Shepard says. “It’s a place where you don’t have to be tough,” he says. Klatt and Shepard also note that their programs are successful because the institutions where they work supports them. The investment of money and staff to develop programs is important; so is giving staff permission to work on mindfulness while they’re at work, right on the frontlines of medicine. “People take Mindfulness in Motion during the workday,” Klatt says. “They have the support to leave their job for an hour a week, turn off their cell phones, and focus on this. That makes a big difference for them in the moment — with long-term benefits for their own health and for the care of patients” RELATED: Your 10-Point Self-Care Plan for Boosting Resilience During the COVID-19 Pandemic
