Introduction

Meditation practices can be found in various cultures, religions, and societies dating back to ancient times. Meditation practices, both formal and informal, can be classified based on concentrative attention or mindfulness. Many supportive studies investigate meditation’s beneficial effects on the body and mind. Within the nursing context, nurses can utilize mindful techniques before, during, and after their shift to combat burnout, stress, and anxiety. This course will teach nurses basic meditation skills, define and classify meditation types, explore the benefits of meditation, and provide tips and resources to promote mindfulness in work and daily life.

Why Nurses Need Meditation 

Nurses are frequently exposed to high-stress environments and scenarios involving moral or mental distress. During an eight or 12-hour shift, nurses are pulled in multiple directions that require focused attention and clinical judgment. Burnout rates among nurses have skyrocketed after the COVID-19 pandemic, and many are leaving the workforce altogether [2]. Without proper, evidence-based tools to calm the mind and body, nurses can quickly become anxious and stressed, reaching their limits physically, mentally, and emotionally. 

A Brief History of Meditation

The earliest transcription of meditation practices can be found in the ancient Hindu sacred texts, the “Vedas,” written over 3,000 years ago [1]. Early Eastern Buddhist traditions adopted meditation practices as a core part of finding true consciousness and transcending into enlightenment. As Eastern philosophy and beliefs migrated west, meditation was secularized and morphed into a self-help and stress-reduction tool.

Meditation Classifications 

Defining meditation is difficult, given the overlap and nuances between practices and techniques. Meditation can be crudely classified into two categories: mindfulness (open monitoring) and concentrative (focused attention) [4,5]. Concentrative or focused attention meditation requires the person to attend to a mental task such as repeating a mantra, walking, or breathing [5].

Types of concentrative meditation include loving kindness or transcendental meditation [5]. Open monitoring includes mindfulness and Zen meditation practices. In these techniques, the person allows the appearance and disappearance of thoughts and emotions without manipulating them. Mindfulness meditation is popularized in the West and is not anchored to a specific religion or culture.

Definitions and Meditation Types

The terms mindfulness and meditation are often interchanged in research.

Meditation is a tool or practice for embodying mindfulness, stillness, and peace [7]. Many people use meditation as a general tool to decrease stress and anxiety, while others incorporate it into a spiritual or religious practice.

Mindfulness is an umbrella term that encapsulates many practices, mental exercises, and experiences [4].

Mindfulness meditation is selectively controlling one’s attention and accepting any thought, emotion, or sensation that arises without judgment or control [3].

Transcendental meditation (TM) originated in India in the 1950s and was popularized by celebrities such as the Beatles in the 1960s and 1970s. TM is a meditation practice taught by a certified instructor. In it, you repeat a mantra sound with closed eyes for 15-20 minutes twice a day [3]. Instead of focusing inward, this meditation expands the mind outward toward the universe and the collective human experience of being.

Loving-kindness meditation (LKM) is derived from Buddhist ideology that focuses on sending love, compassion, and positive thoughts to oneself and others [13]. Even if you are not a practicing Buddhist, you could still benefit from LKM, especially if you lack empathy and compassion in your life or workplace. Loving-kindness meditation can aid positive self-talk, reduce distressing thoughts, and promote emotional regulation [11]. As compassion and empathy are pillars of nursing, LKM could be a beneficial practice to cultivate meaningful connections with patients and coworkers.

The Benefits of Meditation

Numerous clinical trials and research studies explore the effect meditation has on psychological and mental health. Mindfulness meditation can decrease the body’s stress response by reducing cortisol levels and lowering blood pressure [12]. There is also moderate evidence showing meditation reduces anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and chronic pain [3,6]. For healthcare professionals, mindfulness practice can help fight burnout, minimize chronic stress, and build resiliency to face the endless challenges in nursing.

Studies investigating the neurological effects of meditation are still preliminary and limited in number. A meta-analysis of meditation studies shows that meditation affects areas of the brain responsible for emotional regulation, memory, attention, and self-consciousness [9, 10]. Meditation can be used as an adjunct therapy to complement cognitive behavioral therapy or other mental health treatments for anxiety, depression, PTSD, and other psychiatric conditions [10].

Mindfulness in Clinical Practice

Nurses are on the frontlines, expected to perform complex clinical decision-making for diverse patient populations. A competent nurse can safely and efficiently perform critical thinking and clinical decision-making while promoting patient health and minimizing risks and harm. Incorporating mindfulness into nursing practice enhances the nurse’s awareness, allowing for self-reflection and curiosity about previous biases interfering with healthcare delivery [15]. Whereas mindlessness or operating on autopilot can lead to clinical and technical errors, practicing mindfulness can re-center one’s attention and act as a protective factor against mistakes [15]. Utilizing the foundational meditation tools and techniques will allow nurses to show up with authenticity and provide quality patient care.

How to Practice Mindfulness

Mindful meditation can be practiced in various ways, unique to the person’s intention and experience. Before beginning, one must find a quiet environment to sit peacefully and focus on the task without disruption. Most meditation practices encourage sitting with closed eyes and slowing down your breath. Visualization can be used during meditation, envisioning moving energy in and out of the body. Mindfulness meditation emphasizes remaining open and nonjudgmental [7]. During a guided meditation, if thoughts or feelings arise, acknowledge them without trying to change your current state.

During moments of hyperactive thinking, you can create an anchor to settle your mind and bring awareness into your body. Intentional breathing, such as inhaling for four, holding for two, and exhaling for six counts, can gently redirect your mind into purposeful focus [8]. Staying curious and practicing self-compassion during meditation can increase self-worth and self-acceptance.

Try out different meditation techniques until you find one that resonates with you. What time of day and how frequently you meditate are your personal preferences. Some people meditate daily, while others meditate right before or during a stressful event. Practicing once daily could help you develop new neuropathways and behaviors useful in daily life or nursing practice [8]. Several mobile apps provide 5-, 10-, or 15-minute guided meditations with numerous topics to fit your needs.

Establishing a Meditation Practice

Before A Work Shift 

It is common for nurses to experience anxiety before a work shift, especially if they anticipate entering a stressful environment or working with a challenging patient. Listening to a short, guided meditation in the car before walking to work can calm the nervous system and help you arrive in the present moment. Focusing your attention on breathing as you drive to work or while you get a report can help anchor you into your body and reduce overactive thinking [8]. You can practice saying words of affirmation, such as, “I am safe at work. My peers support me. I am a competent nurse.”

One example of a guided meditation designed for nurses is Releasing Fear [14]. In this guided meditation, the speaker asks listeners to think of the worst situation at work, such as a code blue, a medication error, or not receiving help when needed. Shining a light onto your fears can relinquish their power over you—practice allowing those fears to surface without trying to get rid of them, just noticing. Send your breath to the parts of your body that this fear activates. Then, practice exhaling and releasing all the fear that is present. Visualize filling those spaces with light, confidence, and gratitude. Repeat the mantra, “I release fear,” and return to it during the day if you need reminders.

During The Work Shift 

Meditation during a work shift can be challenging to manage because of time constraints or the inability to find a calm and quiet environment. Focusing on your breathing can be the most powerful tool you can carry anywhere. Right before entering a patient’s room, pause and take three deep breaths. While washing your hands outside a room, use this moment to feel the ground beneath your feet and quickly perform a body scan, noticing where you hold the most tension or energy [7]. There are often supply or medication rooms where you can collect your thoughts and take a few mindful moments before returning to work.

Some hospital inpatient units have huddles at least once a shift. Remain seated in that space, and take three more minutes to close your eyes and tune in. Notice how you are feeling and what thoughts appear. Stay curious about those sensations and thoughts and send yourself compassion and gratitude for showing up and doing your best [7]. After practicing this mindful pause for a few shifts, take note of the differences in how you feel and how you handle the stress you experience.

After The Work Shift 

Clocking out at the end of your shift is a physical and symbolic way to leave the work stresses behind. You can visualize putting your experiences into a box and leaving them in the locker room as you clock out. If thoughts arise about a patient or work experience, acknowledge them and kindly guide them on their way [9]. The goal is not to suppress your thoughts and emotions—it is to accept what transpires and view your thought processes through a bird ‘s-eye view.

The drive home is a time to decompress from work by listening to affirmations or uplifting music. You should not listen to meditation while driving as it can cause drowsiness and distraction.  If you need to debrief a scenario troubling you, you can practice reflective debriefing, which some studies have shown to reduce anxiety and stress [2]. The post-work shower is another great opportunity to visualize washing off the day’s negative interactions or stressful situations.

If work anxiety prevents you from falling asleep, practice telling yourself, “I am not at work right now. I am safe in my warm bed, trying to fall asleep.” Sometimes, the mind thinks that right before sleep is an appropriate time to remember the day’s tasks and events. The mind then thinks you are physically in those situations, releasing stress hormones and making you more wired and anxious [3]. Practicing intentional breathing with long inhales and exhales can activate your parasympathetic nervous system and tell the body it doesn’t need to trigger a stress response [3].

Dispelling Meditation Myths

“Meditation takes too long… I don’t have time for it.”

You do not need to meditate for 30 minutes or an hour every day to feel the benefits. Some guided meditations are as short as three minutes, where you can achieve the same relaxation and mindful awareness as a longer practice. Mindfulness is more than a meditative practice – it is walking through life with an understanding and curiosity that keeps you in the present moment [4].

“Meditation is only for spiritual or religious people.”

While meditation practices are found in numerous religious and cultural traditions, you do not need to follow a religious doctrine to practice meditation. Anyone can find it beneficial regardless of their religious, socioeconomic, or political background. Meditation is not reserved for the spiritual or elite – it is accessible to anyone from anywhere [7].

“I need to take a class or be trained in meditation to be good at it.”

It is helpful to follow a guided meditation where the teacher instructs you on how to breathe, what to visualize, and where to focus your attention. Meditation is an inclusive practice that anyone can do with or without training. People can practice meditation formally, under the guidance of a trained teacher, or integrate mindful concepts into their daily lives to prevent compassion fatigue and burnout [11].  No special equipment or membership is needed to establish a meditation practice.

“Once I’ve mastered mindfulness, I will be happy or achieve X, Y, or Z.”

While this might sound counterintuitive, mindfulness is not something you can successfully achieve. Humans are born with higher cognitive functions, such as self-awareness and attunement. Suppose we enter a meditation practice to solve problems with ourselves or the world. In that case, we miss the opportunity to join the present moment and live as a human “being” [7]. Mindfulness allows individuals to come home to themselves and experience the world with openness and acceptance [7]. It is the process, not the outcome or the end.

Additional Resources

Below are meditation resources and websites to explore. You can find free guided meditations or subscribe to a meditation app on your phone.

• Insight timer app: A free version allows you access to guided meditations and courses.
• Mindful.org: Free blog posts, guided meditations, digital guides, and courses about mindfulness.
• Headspace app: This mindfulness meditation app requires a subscription after a free trial.
• Calm app: While there is free content, the premium content, which includes more meditation options, requires a subscription.
• YouTube: You can search for meditation and mindfulness keywords and find free guided meditations.

Conclusion

The nursing field faces numerous challenges where workers feel stressed, defeated, and distressed. Implementing meditation practices into nursing and daily life can reduce stress and provide the tools to build resiliency. Many people hesitate to try meditation based on their preconceptions or limited understanding. There are many ways to integrate mindfulness leading up to a work shift and during patient or coworker interactions. While this course is meant to be a foundational introduction to meditation, it also serves as a challenge to take action and practice what you’ve learned. Remember to approach each experience with openness, curiosity, and non-judgment, and see how your perspective can shift to mindfulness in no time.