Welcome to this Caring Science, Mindful Practice Intensive.

Transcription

1 Welcome to this Caring Science, Mindful Practice Intensive. 1

2 During our time together, I will introduce you to Jean Watson s Caring Science and mindfulness in the tradition of Thich Nhat Hanh. We will then explore practical ways to incorporate caring science and mindfulness practices into everyday life and work. 2

3 The content will help you envision personalized ways that you can incorporate daily mindful caring for yourself and the people around you. 3

4 There are many studies that validate the efficacy of a Caring Science approach in terms of staff satisfaction and performance, and there are also many studies that validate the positive effect of Caring Science approaches on student and patient learning and satisfaction. Here is just a sampling of these studies. 4

5 There are many more studies related to this topic. If you are interested in finding them, use search terms such as Caring Science, Watson s Caring Science, Watson s Theory of Human Caring, and Caritas Processes. 5

6 The basic tools needed to support engaged professional caring include Watson s Caritas practice, mindfulness, personal reflection, and a committed intent to care for self, colleagues, clients, the community, your organizational system, and beyond. Before we move forward, I want to be sure and clarify that mindfulness is not a religion. It is a practice that is applicable within any spiritual or religious tradition, or in the absence of spiritual tradition. It is a personal practice meant to support a healthy inner life. 6

7 Here are the specifics about what we will cover today. 7

8 Here a bit of information about Thich Nhat Hanh and mindfulness in case you are unfamiliar with this work: Thich Nhat Hanh is a Vietnamese Zen master who established a contemplative community in Plum Village (France). He has toured all over the world to teach people of varied cultures and faiths about mindfulness. Mindfulness practice is meant to help us be fully aware of the here and now. This sounds simple but it can be challenging to do because we are conditioned to park our bodies in the present and then engage our minds and hearts in thoughts of what has been and what will be. In doing this, we often miss what is right in front of us. Watson s Transpersonal Caring Moments dwell in the present moment, moment to moment, breath to breath, touch to touch, heartbeat to heartbeat. Mindfulness helps us to enact Transpersonal Caring Moments within Caritas practice, and in daily life. 8

9 I have worked closely with Dr. Watson for many years to develop knowledge about engaged professional caring, and conveying/sustaining caring in online classrooms and the contents of this presentation are based upon her Caring Science Theory. 9

10 So let s talk about Transpersonal Caring Moments first, since they are the crux of what we are trying to accomplish: Transpersonal Caring is made up of streams of transpersonal caring moments that radiate in all directions beyond the specific moment, through space, time, spirit, and the physical plane to create endless possibilities of caring influence. Dropping a pebble in a pond is a good illustration of this simple yet profound phenomenon. Spray and splash from the pebble enters the air and ripples in the water from the surface to deep below radiate in all directions. Energy moves in-among-around with widening impact of all in proximity (which is obvious), and then everything else with increasing subtlety as the energy moves outward into the universe (not so obvious). Energy does not dissipate so much as it simply moves and flows in-among-though-around This Pebble in pond model on the slide shows layers of interaction that we all engage in every day at work. The self is at the center because it is the foundation upon which all other interactions rest, therefore, conscious, mindful care of the self is critical to productive and life-affirming work in the other layers. Mindfulness practice, simply consciously breathing through life s experiences, paying attention to what is happening in and immediately around YOU will support caring practices in the circles of work and influence around you. Your calm and deliberate awareness will emanate from your mindful center and affect others, peers, leaders, communities, the environment, the virtual world, and beyond. Have you ever had an experience of profound calm and focus within a work situation that allowed you have rapid insights regarding what should be done in that exact moment? (Show love, mercy, support, compassion, OR sense danger, dishonesty, urgency, or need for immediate safety). This is mindfulness in action and it can be consciously cultivated through the simple acts of conscious breathing and coming back to the present moment over and over (even when monkey mind continually distracts.) Okay so mindfulness and awareness of transpersonal caring may be generally helpful, but what about practical application in relation to specific daily events, feelings, and situations? Here is one way to envision professional practice in a way that supports focus and clarity: Watson s Core and Trim 10

11 1. This Core and Trim Model illustrates the microcosm of professional practice 2. The constant core of practice is deliberative caring in all its forms and iterations (sections of the orange). This remains continuous over time and represents a stance, an inner resolve, from which trim activities originate. 3. The trim of nursing is composed of professional knowledge, technologies, skills, and activities that change over time. (Looks drastically different in 1800 than it does now, and it will look very different in the future). 4. Envision the core and trim as an orange, with the inside consumable part of the orange being the core and the peeling being the trim. Each needs the other to survive but each serving a distinct purpose. 5. Each Caritas that we will talk about today is a section of the inside of the orange (the core). 6. The core is the part that is meant to nourish the life force of the orange. It contains the seeds for future trees to grow. It ensures survival of the species (or in this case, the profession). 7. The trim, or the peel of the orange has great utility as it protects the inner nourishing part of the orange. It is what is seen first, and it is how the orange is initially judged in terms of fitness to consume. And so it is with professional life the external covering of work activities, technologies, skills, training, processes, etc. support and protect the true inner purpose of why the profession exists at all which is caring, sustaining, and providing nourishment for our selves, clients, each other, and the community. 11

12 The most important thing to remember about Caritas 1 is that it is not a style of behavior. It is an attitude, an intention, and an internally held stance. It is the will to care in whatever ways are meaningful and helpful within a given moment, and within a given situation. The temperament of the practitioner, temperament of the client, and other situation-specific factors will influence what the outward expression of caring will be (the orange peel!), while the inner resolve of the practitioner to care and to love remains constant (the nutrient center). 12

13 My many years of research have shown that caring at a distance is possible on the phone, in s, texts, and in online classrooms. I have an example from a 24/7 call center- this is a WCSI Caritas Coach project from the Caring Science, Mindful Practice book: As Caring Science was integrated throughout the medical center, often times the staff could not see how this model could be used in everyday practice in the call center. A call center program entitled I may not see you, I still care was begun because studies have shown first impressions are formed spontaneously within the first few moments of speaking based on tone and speech. The call center workers wanted each caller to know that they were important and cared for because they were committed to providing care on a transpersonal level they established a firm intent to care and then expressed that in ways that were meaningful within their specific work environment. The purpose of this I may not see you, I still care project was to show staff members that it is possible to provide transpersonal caring using the telephone. Since the only tangible contact was through the phone, they tried to consciously exude caring in conversations with our callers through kindness and loving speech. This project was reminder to everyone that the call center s staff main purpose was to connect with people in caring and meaningful ways. 13

14 This second Caritas Process is about be fully and authentically present in each moment. There is a wide range of structures, beliefs, and practices that support hope and faith. This Caritas asks us to carefully determine what instills faith and hope in ourselves and others with the understanding that each individual is unique and will require different things to feel attended to and honored. 14

15 Here is an example of Caritas Process 2 in action: A Hospital restructured its nursing units, which resulted in significant changes in environment, role and work groups for many employees, leading to increased job pressure, insecurity and stress (loss of faith and hope related to the job environment). Despite stressful changes, care providers were expected to provide compassionate care to clients while at the same time trying to cope with the uncertainty and anxiety that accompany organizational change. It was important to sustain helping-trusting relationships and to encourage trust/hope among nurses experiencing stress and anxiety during organizational restructuring. The ICU staff in this hospital reinforced the foundation of Caring Science for the ICU staff by publishing a Caritas Corner section of the monthly, in house Critical Care Newsletter. This newsletter provided opportunities for reflection and centering as a means of sustaining Caritas relationships. A practice of daily centering prayer/reflection between shifts was begun. Developing/strengthening relationships, and enhanced self-care was supported by forming a team to train for and run a 5Km charity race. This Team ICU Couch-to- 5K Program began with motivating and recruiting team members, training schedules and informational s were sent to all ICU staff, and fellow nurses 15

16 who were experienced runners were recruited to serve as coaches for new runners. Another activity was in response to an unforeseen restructuring event that involved a significant number of PCU nurses who were involuntarily transferred to the medical floor, and several ICU nurses who were asked to consider transferring either to medical/surgical or to another hospital within our system. Nurses began questioning their own worth, and anxiety and stress were high. Personal letters to acknowledge each nurse s unique value, each containing two pocket-sized stones with an inspirational word such as love, caring, healing, or faith engraved on it will be sent. The nurse who receives a letter will be asked to keep one stone and pass the other one on to a nurse who might need some encouragement. Nurses often do not take the time to acknowledge the excellent caring they witness in their work. By recognizing each other, staff members can build each other up from the inside, instilling faith and hope in one another. Caring and love beget caring and love (Watson, 2008, p. 87). 15

17 Spiritual practice can mean a number of things depending on the individual. The key, regardless of the type of spiritual/inner practice, is cultivation of mindful, patient, compassionate curiosity in relation to self and others. Engaging in simple curiosity rather than judging or drawing immediate conclusions opens possibilities and cultivates understanding & compassion that would not have been possible otherwise. 16

18 Here is an example of how cultivating curiosity might unfold: A co-worker tells you that she dislikes the unit manager. You say little and walk away. You happen to truly like and respect the unit manager and initially feel anger and defensiveness, but you let that go and decide to cultivate curiosity. Over the next few weeks, you quietly observe (with unfettered curiosity) interactions between the unit manager and co-worker who made the negative remarks. You find that the co-worker bites her lip nervously and fidgets whenever she talks to the unit manager. The co-worker also comments repeatedly that she is afraid that she will make a mistake and the unit manager will be harsh because she is so much more experienced than the co-worker. You make a conscious effort to mentor and support the co-worker. You draw her into non-threatening conversations with the unit manager so that she can become more familiar with the unit manager as a person. After a few weeks, the co-worker seems more at ease and mentions that she is beginning to like the unit manager after all. Cultivating curiosity provides calm, clear openings to positive possibilities in challenging situations. This approach is subtle, simple, and very effective. It does not require grand gestures or overt interventions just simple curiosity tempered with lovingkindness. Consistent, mindful, compassion-based spiritual practice supports the cultivation of curiosity, and is the foundation for caring, lovingkindness, compassion, and genuine connection. 17

19 Caritas Process 4 is all about shifting from a you and me mentality to a we and us mentality. It is about the process of becoming more aware of the fact that we all share the same human dilemma that we are all vulnerable, that life is unpredictable, and that nobody has all the answers. We are in this together and must make our way forward in the most caring and productive way possible. The best way to create caring relationships is to pay attention. The example for this Caritas Process comes from a research study I did many years ago. The results were unexpected and the lessons I learned have stayed with me my entire career. 18

20 Here is one example of how everyday practice of this Caritas might look; several years ago, I did a small research study about effective nursing interventions I had observed an occupational health nurse doing at a local hospital. This nurse assessed the workstations of hospital employees to see if improvements could be made to avoid medical conditions related to poorly designed workstations. She had an unusually high success rate related to compliance and decreased pain and injury and I wanted to see what she did when she interacted with clients. I wondered if caring behaviors had something to do with her success. I suspected I might see a warm, friendly, conversational approach because, at this time in my career, I equated caring with this type of behavior and believed that if it did not exist, then true caring could not occur. I was wrong. Results of this study showed that, in this case, clients expressed that they felt cared-for and inclined towards following prescribed interventions because the nurse paid focused and in-the-moment attention to them through mirroring, eyecontact, and verbal validation of the presenting concern(s). The average time required for these caring exchanges was 24 minutes. The results were notable in that this nurse did not ever touch the client directly, nor did she engage in any conversational banter during any of the observed interventions. She did not display personal warmth or a high level of friendliness. 19

21 The primary features of every observed exchange were mindfulness, immediacy, and a palpable sense of being wholly attentive and firmly present for each client in that moment (Sitzman, 2001). There was a strong sense of "I am here for you, right now, in this moment, and I will do my best as we work through this together." I learned something very valuable after completing that study and it has guided and informed my subsequent professional life; Caring, love, and trust, are best sustained through intention, presence, attentiveness, immediacy, and mindfulness. Friendliness, warmth, and maternal affection may be components of transpersonal caring moments, but they are not necessities. This point can be particularly helpful to remember when working with people who do not respond well to warmth, affection, or friendliness, or when you don t feel inclined to be overtly warm, affectionate, or friendly! 19

22 Feelings are universal and impermanent. It is important to focus on this shared humanity especially when working within difficult situations. In our jobs, we share some of life's most pivotal, transformative moments with others. These moments stir the need for expression of a wide range of feelings and emotions. We are not our feelings, and others, whether they are patients, families, coworkers, or administrators, are not their feelings either. Expression of feelings is most beneficial and therapeutic if viewed in this light. The next slide contains a simple mindfulness visualization that can be used any time with self or others. 20

23 Sometimes it can be challenging to keep this in perspective as it is easy to get attached to emotions as if they are something substantial, unchanging, and enduring. Over the years, I have personally used and taught this simple visualization as a reminder of the impermanent nature of feelings: Close your eyes and envision the blue sky. Your calm, unperturbed core essence is the blue sky. Breathe in the fresh, cool sparkling air in the clear blue sky that is the true "you." Now envision a few puffy white clouds drifting by in the sky of your mind. Reach out to grasp a cloud. Its cool mist floats between your fingers and your hand comes up empty. Clouds represent the many feelings that pass by your blue core essence. Clouds look solid and substantial, but if you reach out to hold onto a cloud, it is impossible to grasp it. It is the same with feelings. They continually go by in the calm blue sky of your mind, impermanent, always moving, changing, dissipating, and reforming. Acknowledge the flow of clouds. Feel the cool dampness as they roll by. Appreciate each cloud for what can be learned from its passing without trying to fruitlessly hang on to any one cloud. Whether it is negative or positive, none are permanent or graspable. This approach allows for freedom to experience emotions, to grow and learn from them, without the stress of trying to hang on to or keep something that 21

24 was never meant to be permanent. Using this visualization for self and in relation to others helps to keep the expression of positive and negative feelings within perspective. 21

25 All scientific inquiry is done in the pursuit of deepened understanding of various phenomena. Mindfulness is also meant to deepen understanding and support the full human experience. Mindfulness is the ultimate in unfettered observation, which is required in any good inquiry or problem-solving endeavor. 22

26 Mindful attention to communication patterns in digital settings is what drives my research. I have completed 9 studies in an effort to clarify what can be done to convey and sustain caring in digital settings. Through mindful attention to subtleties in tone, rhythm, frequency, and choice of words, I have been able to determine a great deal about the caring needs of students and faculty despite the fact that I am not in close physical proximity with my study participants. 23

27 Teaching is much more than conveying information to others. In order for significant learning to occur, a connection must be established that takes into account learner needs, styles, and frame of reference. 24

28 In working with students, I have found one of Thich Nhat Hanh s teachings to be particularly helpful. He describes the human mind as a vast and open field of consciousness where many different kinds of seeds are dispersed and cultivated based on what we are exposed to and what we pay attention to. For example there are seeds of compassion, joy, hope, sorrow, fear, pain, and difficulties. There is a vast array of wholesome and unwholesome seeds in our mindfield, sown every day by ourselves, our parents, schooling, ancestors, and society. Mindfulness helps us recognize the seeds in our consciousness so that we can then choose to water only the ones that are most beneficial. My role as a nurse and teacher is to help my students and patients water the seeds within themselves that will yield ease, wisdom, beauty, skill, healing, knowledge, and love. Now I am going to share a simple mindfulness activity that has enriched my professional practice over the years: Before each of my teaching activities, I envision a field of consciousness filled with vibrant sunflowers. I feel the sun as it bathes everything with warmth and light, and then I do my best to radiate that warmth and light to others while we engage in the teaching and learning process together. 25

29 Caritas Process 8 is about supporting dignity when coping with illness, loss, discouragement, grief, embarrassment, and vulnerability that can encompass physical, emotional, social, and spiritual dimensions. 26

30 I worked for many years in a home healthcare agency that focused on care of indigent and low socioeconomic status clients. I visited many people who had pets for desperately needed love and companionship, however struggled to purchase pet food during the period of time that they received homecare services due to the fact that they were unable to work or go out to collect discarded food to feed to their pets. When I visited these clients, I would make a point of bringing a small bag of pet food to last until my next visit and quietly leaving it behind when I left. I did not want clients to feel like they had to thank me or acknowledge this as I wanted to support dignity in the situation. I was usually able to obtain donations from local businesses for this purpose. Upon my return, I would discreetly look at the pet food bowl to see if there were remnants of the food I had previously brought to ensure that I was on the right track. In this small way, I would try to help clients with pets, who were struggling financially, to maintain a healing, dignified, loving environment. After many years of doing this, I ran into one of my old clients at a grocery store. I hardly recognized her. She was smiling, healthy, well-dressed, and had a cart full of groceries. She told me that during the time I took care of her, the only spiritual, physical, and emotional connection she had in the world was her cat. She wanted to heal only so that I could take care of my cat. She was very grateful for the cat food I brought each week. Before I came, the woman bought cat food first and used whatever money was left to feed herself. Sometimes it wasn't much and she would go hungry. She thanked me for helping her without making a big issue out of it. As we said good-bye, she offered to buy a bag of cat food for me to give to someone else in need and I accepted. There was dignity in both receiving and giving. 27

31 Caritas 9 is about seeing the sacred in the mundane. Each act, no matter how trivial it may seem to be, effects everything else, like dropping a pebble into a pond. One text or message can have a profound impact on the receiver, which in turn effects those who interact with the receiver and so on. One well-made hospital bed can make a profound difference on feelings of comfort and well-being for the patient. One kind word of encouragement can transform discouragement into hope and determination. Everything we do affects everything else in widening ripples of influence. Seeing the sacred nature of our actions helps to put the true impact of what we do into perspective. 28

32 Here is an example : I worked for several years on a women and newborn unit in a large urban hospital. We had care teams that consisted of one Registered Nurse, one Licensed Practical nurse, and one or two Nurse s Aids. We would work in these groups to care for women and their newborn babies. Each time I came to work, I would hope that a particular Nurse s Aid would be on my team because she was so wonderful to work with. She always made sure that every water pitcher was filled with fresh, cold water, commenting frequently that the human body is mostly made of water, so let s make sure it s good water! She worked to ensure that all of the beds were clean and beautifully made, commenting that nice beds make good nests for the ailing soul. She offered each patient attentiveness, patience, kindness, and respect, saying I treat people like I would want someone to treat my grandma. When she held and rocked the newborns, she would talk to each one, saying things like, I am so lucky to be one of your first friends! Let me whisper some wisdom in your ear. I know you don t know the words, but you ll get the idea: Your life is sacred. There is only one of you in the whole universe. Imagine that! Love this new life you have been given. Love others and yourself. Love is the most important thing. Remember that! She meant every word and tried to share these thoughts with every newborn she cared for. She treated every moment and human being as precious. 29

33 This one nurse s aide raised the level of care for the entire unit simply by making it clear to all that each caring act was sacred. It reminded the rest of us to do the same. Patients, families, and co-workers alike were grateful for her wisdom and caring presence. 29

34 Caritas Process 10 is about the miracle of life itself. Not just about the BIG and impressing miracles that people write books about and make movies about. It is mostly about the sum of all the small miracles that animate your life and the lives of those around you. This quote from Thich Nhat Hanh says it well: "Dear friends, you are nothing less than a miracle. There may be times when you feel that you are worthless. But you are nothing less than a miracle. The fact that you are here--alive and capable of breathing in and out--is ample proof that you are a miracle. One string bean contains the whole cosmos in it: sunshine, rain, the whole Earth, time space, and consciousness. You [and everyone who receives your care] contain[s] the whole cosmos" (Nhat Hanh, 2002a, pp ). 30

35 Here is Thich Nhat Hanh s paper meditation to help you glimpse the miracles in life: If you are a poet, you will see clearly that there is a cloud floating in this sheet of paper. Without a cloud there will be no water; without water, the trees cannot grow; and without trees, you cannot make paper. So the cloud is surely in the paper. The very existence of this paper is dependent on the existence of a cloud. Paper and cloud are intertwined. Consider the sunshine. Sunshine is very important because the forest cannot grow without sunshine, food plants need sunshine, and we humans cannot grow without sunshine either. Paper comes from trees. The logger who cuts the tree that forms the paper needs sunshine in order to live and work. Therefore, there is surely sunshine in this sheet of paper. And if you look more deeply, with mindfulness, with the heart of awareness, you see not only the cloud and the sunshine in it, but that everything is here; the food that fed everyone who worked to produce the sheet of paper, the logger and his ancestors, the paper mill workers and their families and ancestors, all of the people and materials that went into the production of the paper, and so on and so on until you end up realizing that the existence of everything depends upon the existence of everything else. 31

36 So in reality, everything is in this sheet of paper and that is a mystery and a miracle worth noting. 31

37 The last thing I will do is today is leave you with some simple Caritas Consciousness Touchstones that will support a firm and ongoing intent to care. 32

38 I present them to you now as a meditation: Begin the day with silent gratitude; set your intentions to be open to give and receive all that you are here to give and receive this day; intend to bring your full self, in the day-to-day moments of this day; cultivating a loving, caring consciousness toward yourself and all others who enter your path. 33

39 Take quiet moments to center, to empty out, to be still with yourself before entering any new situation; cultivate a loving-caring consciousness toward each person and each situation you encounter throughout the day; make an effort to see who the spirit-filled person is behind the client/colleague. Return to these loving-centered intentions again and again throughout the day, helping yourself to remember why you are here. In the middle of stressful moments, remember to breathe; ask for guidance when unsure, confused, and frightened; forgive and bless each situation. Let go of that which you cannot control. 34

40 At the end of the day, fold these intentions into your heart; commit yourself to cultivating a loving-caring practice for yourself. Use whatever has presented itself to you this day as lessons to teach you to grow more deeply into your own humanity and inner wisdom. At the end of the day, offer gratitude for all that has entered the sacred circle of your life and work this day. Bless, release, and dedicate the day to a higher, deeper order of the great sacred circle of life. 35

41 Create your own intentions and your own authentic practices to prepare your Caritas Consciousness; find your individual 36

42 spiritual path toward cultivating caring consciousness and meaningful experiences in your life and work and the world. 36

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