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Mindfulness techniques
for clinical nurses
BY JESSICA A. MANCARELLA, MSN, RN, CCRN-K
Nurses experience stress and burnout
at excessive levels, negatively impact-
ing quality healthcare and patient
safety.1,2 The COVID-19 pandemic
complicated matters, increasing staff-
ing crises and patient acuity. This has
only heightened nurses’ stress, and
for many, making time for self-care
was already challenging. As a nurse
in high-stress EDs and ICUs for over
14 years, I have been guilty of forego-
ing meals and bathroom breaks while
advising others to make healthy
choices and prioritize self-care.
Nurses have a responsibility to apply
their skills and knowledge to care for
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NSG0123_Sharing_Dharam.indd 28
themselves, just as they care for their
patients. Self-care cannot be viewed
as just another “task” on a list.
Mindfulness is one strategy that can
be used to manage stress levels, re-
frame potentially overwhelming situa-
tions, and improve well-being.3 When
the pandemic began, I was the educa-
tor for the Emergency and Inpatient
Psychiatric Departments at a facility
in Connecticut. In March 2020, I was
asked to develop and execute a staff-
ing and training plan for nurses who
had never before used full personal
protective equipment in order to open
a COVID-19 testing site within a few
days. One week after opening the site,
the team had it operating smoothly,
and I was reassigned as a direct care
ICU nurse at a different hospital
within the system 35 miles outside
New York City. I had not been a direct
care nurse for 18 months, and I felt
anxious and powerless to save lives,
support families, or even support the
departments I served.
Stress has been cited as a top
healthcare burden for many years.4
When external demands exceed in-
ternal coping resources, one can be
overwhelmed, which can negatively
impact one’s health.1,5 Historically, I
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 had been able to manage my stress
with yoga, but at that time, self-care
seemed frivolous; there were too
many people, including staff, pa-
tients, and loved ones, who needed
me. Even when I felt I did not have
time for yoga, I realized that engag-
ing in mindfulness improved my
spirit and energy.
Mindfulness is one aspect of yoga,
and in my experience, I found that it
can be misunderstood. Mindfulness
is not placing a positive spin on hor-
rible situations or a state of detaching
from the world; it is the practice of
being willfully present in all experi-
ences, even if they are not ideal.
Mindfulness is a state of being aware
of the present moment, no matter
how busy the shift is or how many
distractions there are.6 Unlike yoga,
mindfulness can be done anytime,
anywhere.
I found that focusing on my
breath and movement in the mo-
ment helped prevent my mind from
racing. I intentionally made space to
focus on the moment at hand, leav-
ing less space to despair over the
many things still to be done.
Using several mindfulness strate-
gies allowed me to be fully present
with the person for whom I was
caring. I asked myself what I felt,
heard, saw, and even smelled. I
felt grief from the loss around me
in so many forms, but focusing on
the control I did have over my ac-
tions and my mind made me feel
more centered. As I expanded my
focus, I realized the environment
was not just full of the obvious suf-
fering and unknown, it was full of
humanity and hope too. We have all
heard that story, but sometimes it
is the story we tell ourselves in the
moment that matters most.
Throughout the next days, I con-
tinued to focus on what I was doing
in the moment, such as establishing
venous access instead of anticipat-
ing upcoming tasks. I focused on
my patient’s eyes and the feel of
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NSG0123_Sharing_Dharam.indd 29
their skin through my gloves to
connect with the person in front of
me and the humanity around me,
realizing my hands could be the last
touch this person remembered.
Using this technique, I felt more
efficient, present, and much less
overwhelmed with what needed
to be accomplished. Helping oth-
ers find a sliver of peace also gave
me the peace I was seeking, and
this still holds true despite families
being back at the bedside. Mindful-
ness has been shown to decrease
stress levels and burnout by allow-
ing oneself kindness, acceptance,
and the ability to objectively evalu-
ate professional accomplishments,
increasing overall well-being and
patient safety.7,8
To foster resiliency in fellow
nurses, I set up sessions to share how
these strategies could be easily inte-
grated into various situations. Since
different strategies work for different
people, I presented brief evidence-
based mindfulness techniques to
ED nurses, supplementing prac-
tice sessions with a handout and a
2-minute guided meditation exercise.
These techniques included focus-
ing on how something feels, such as
performing hand hygiene, noticing
sensations around you, labeling how
you feel momentarily, even if it is
negative; and breathing exercises. All
of these techniques take less than a
minute.
Another approach is concentrat-
ing on something to be grateful for.
Sometimes the only thing I could
identify to be grateful for was going
home when my shift ended. While
I looked forward to going home,
mindfulness made me aware that I
was creating my own guilt for leav-
ing such sick patients and fatigued
colleagues behind. I was able to label
my emotion in the moment, and
recognize my anguish over human
suffering because of compassion
and empathy, two key attributes of
nurses.1 That led to the objective
acknowledgment that making myself
sick would not help the sick patients
or fatigued colleagues. While that
did not alleviate my guilt, it did help
me cope.
These mindfulness techniques
can help nurses manage stress levels,
reframe overwhelming situations,
and improve well-being. While these
techniques can be done quickly, it
takes time to train your brain to al-
low yourself the space to pause. This
is especially true during a busy shift
when nurses feel pressured to ac-
complish many things. I hope that
by sharing my mindfulness story, I
inspire other nurses to make space
in their day to be self-compassionate,
even if it is just for a moment. ■
REFERENCES
1. Sulosaari V, Unal E, Cinar FI. The effectiveness
of mindfulness-based interventions on the
psychological well-being of nurses: a systematic
review. Appl Nurs Res. 2022;64:151565. doi:10.1016/j.
apnr.2022.151565.
2. Montgomery AP, Patrician PA, Azuero A. Nurse
burnout syndrome and work environment impact
patient safety grade. J Nurs Care Qual. 2022;37(1):87-
93. doi:10.1097/NCQ.0000000000000574.
3. Noble H, Reid J, Walsh IK, Ellison SE, McVeigh
C. Evaluating mindfulness training for medical and
PhD nursing students. Br J Nurs. 2019;28(12):798-
802. doi:10.12968/bjon.2019.28.12.798.
4. Magtibay DL, Chesak SS, Coughlin K, Sood A.
Decreasing stress and burnout in nurses: efficacy
of blended learning with stress management and
resilience training program. J Nurs Adm. 2017;47(7-
8):391-395.
5. McClance KL, Heuther SE. Stress and disease.
In: Pathophysiology: The Biological Basis for Disease in
Adults and Children. 8th ed. St. Louis, MO: Elsevier;
2019:323-345.
6. Dictionary.com. (version 9.9.3) [Mobile app].
Mindfulness. 2021.
7. Institute for Healthcare Improvement. Mindfulness
and patient safety [podcast]. 2018. www.ihi.org/
resources/Pages/AudioandVideo/WIHI-Mindfulness-
and-Patient-Safety.aspx.
8. Ruiz-Fernández MD, Ramos-Pichardo JD, Ibáñez-
Masero O, Carmona-Rega MI, Sánchez-Ruiz MJ,
Ortega-Galán ÁM. Professional quality of life, self-
compassion, resilience, and empathy in healthcare
professionals during COVID-19 crisis in Spain. Res Nurs
Health. 2021;44(4):620-632. doi:10.1002/nur.22158.
Jessica Mancarella is the manager of the Trauma
Program at Lawrence + Memorial Hospital in New
London, Conn.
The author has disclosed no potential conflicts of
interest, financial or otherwise.
DOI-10.1097/01.NURSE.0000902968.61284.1e
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