Mindfulness Is Beneficial to Patients and Providers


In the era of COVID-19, building resiliency and reducing burnout are key goals for many oncology nurses. Mindfulness and yoga can help.

Yoga and mindfulness can be as beneficial to oncology nurses as it is to the patients that they are treating, explained Loren Winters, MSN, ANP-BC, OCN, an oncology nurse practitioner at Massachusetts General Hospital (MGH) Cancer Center and yoga instructor.

In a recent interview with Oncology Nursing News, Winters explained how patients and providers alike can cultivate resiliency through mindfulness.

Oncology Nursing News: How can mindfulness help oncology nurses and other clinicians – especially as they feel burnt out due to the ongoing COVID-19 pandemic?

Winters: We've been fortunate here at MGH, as that's been really, in the forefront from, I'd say, the very onset of the pandemic, we have a wellness program for clinicians that has offered a multitude of a menu of different tools that folks can access, if they wish. The hard part is [when] you give too many tools, it's overwhelming; when you're feeling burnt out, you also tend to feel overwhelmed. And taking one more thing on may seem like, you know, really just too much.

Even just the simple act of taking a breath, at different points in the day can be a really surprisingly powerful strategy. And I almost wish that was sort of built in a little bit more to our culture, because most of my colleagues don't even take time for a meal in a workday, much less taking a breath. So you know, maybe it could be to start to work meetings, you know, okay, everybody, before we start this meeting, let's just put our feet on the ground, let's just take a slow deep breath and check in and then we can proceed with the meeting, I would love to see that start to be part of the culture. And I think in some workplaces outside [of] health care, that is, I hear it from my friends who work in other areas, but it's strange that we don't see that in healthcare, you think you would. So I think it just, it needs more work to get into the culture in a way that healthcare providers give themselves permission to stop what they're doing, and do a little self-care, so that they can go back to the patients, and truly give their all because the reality is, if you're burnt out, you're exhausted, you're not going to be able to give your all, and then you get home and you've got nothing for yourself nothing for your family. And that, I know is going on in my institution, as well as I'm sure all across the country in the world right now.

It's going to take some more time and, and work to get it out there. But I'm hopeful that that's happening. And again, the fact that this is even exists like a wellness for clinicians, like a whole department that just as focused on that is a big step.

People have the misconception that you are either resilient or you’re not – it’s something that you are born with. But that’s not true. Can you talk about that misconception, and how mindfulness can build resiliency?

There are personality traits which are associated with maybe innately having resilience, you know, those easygoing people that use humor Well, they tend to enjoy recreation, they tend to be pretty organized, they're not sort of all over the place. You know, also, there's obviously Some conditioning going on, depending on how they grew up developmentally as well as you know, did they have their needs met, growing up that sort of thing, you know, the basic needs, were they in a supportive, loving, you know, family, all of those things can contribute as well as those sort of personality traits. And then socio-economic factors and such can contribute.

But it's definitely true that you can develop, resilience by the use of, of tools and practice and self-care. And that's where again, it comes in that you can never underestimate the power of eating good nutritious food, like feeding yourself the right stuff, the right fuel at the right times in the right manner, right, not on the go, not shoving it down, not guzzling down the coffee, but you just actually take 5 to 10 minutes for the meal, you let it digest, you just pause. And then, obvious like sleeping, and trying not to work until the wee hours of the night and then asking yourself to get up four hours, five hours later and do it all again. It's just, it's just ultimately going to wear away at anybody even maybe those folks who have those personality traits, it just wears away at your bandwidth, right? And then lastly, exercise recreation, right? Those tools of attending to one's body, like this machine, really is important for building resilience.

So I think, you know, those three things on top of and or, or in addition to, if it's not sort of easy for you seeking out practices saying, ‘Hey, I've heard about this thing called resilience, I want it, how do I get it?’ And maybe you just find yoga, you know, allows you to find that balance between movement and breath, and it just comes together. Maybe it's meditation, maybe it's forest bathing. I mean, maybe it's whatever a prayer. I mean, it doesn't have to be any one thing is right or wrong, but you find it I have a good friend who did yoga did meditation, she did all kinds of things studied at all for years, but she still had terrible anxiety. Well, ultimately, she found that doing pranayama, which is a breath practice breath control, is what really helped her with her anxiety, which, you know, for her is what ultimately is going to make her more resilient and more resilient person, right, she's not going to be so reactive, she's not going to freak out with every little thing. And so, you know, it's not necessarily true, right? That any one thing is going to be for everybody. And you may have to be a bit of a seeker if it doesn't come easy for you. But if you're open to it, it's there. And it's just going to be a little trial and error.

You are also a yoga instructor. How do you combine both of those worlds – yoga and oncology nursing?

I came to yoga, by probably graduate school, college graduate school time, or as just sort of wanting to do something to get flexible and strong – it was sort of just more physical oriented. But I had a few teachers who really would speak to the philosophy behind yoga tradition. And it really sparked my interest that I felt while I'm doing this all the time, and I don't really know why. Why do I feel the way I do? Why are we doing it in the way we're doing it, I don't understand. And I'm just sort of one of those people that can't settle for that, like, I need to kind of understand it.

I felt like it was a good time to just do it a teacher training, I figured just with the intention of learning about it. And, and really, unfortunately, once you do something like that, it's never the end of the story. It just sort of opens up this whole other world and community of awesome people that I met, that taught me more and more and more and just lead you down a certain path. So I found that whole community side, which was really enriching as a nice balance to my sort of medical community and colleagues, to have this sort of maybe separate interest. But ultimately, that didn't sit well with me either, as I wanted to bring it together.

Early on in my career as a nurse practitioner, propose a research project with our cancer center yoga therapist, she was awesome and was totally willing to do it with me. And we did a little pilot project where before, you know, kind of YouTube was freely available. And all this online videoing, we made a video filmed, like with a camera. for breast cancer, we tailored it to breast cancer patients, I worked with them on physical therapists and another nurse practitioner was in the surgical realm. You know, our yoga therapist, and we, we tried to build out a practice that we thought would be safe and effective for some of the discomforts associated with breast cancer. So we apply I applied for a research grant, we got the grant, we did that we ended up being able to successfully, you know, do this project. And again, this is before it was so easy to do stuff like that. It's just a few years before, and, and then we were able to publish that research in peer reviewed nursing journal.

So it was able to come together in a really cool way. And not just that, but provide an intervention for our patients, and also a taste of what yoga can do. So maybe they didn't do that practice forever. But maybe they did it a couple times. were like, yeah, I can do this. I'm going to go and maybe check out a class and try this out, because maybe it could help me so that was the idea behind that was just to sort of demystify the yoga practice and, and bring it to them rather than them having to come in because at that time, all of our integrative therapies, patients had to come to the hospital to receive, there was no virtual, there was no, you know, telehealth, it was either they drive all the way into Boston and get it or they don't get it. So my thought was, that's not right, we should be able to give it to them, which I know you're laughing because you're thinking, Oh, it's so easy. Now, it was not easy then. And so anyway, we're a little ahead of our time.

But it was the start of really, I think, seeing how useful it is to be able to meet patients where they are, I mean, physically where they are. And, and now, you know, we're continuing to do projects like that the integrative therapies group has done quite a lot here. And, and I'm continuing to do as much as I can to sort of bring these two realms together in my professional world, but then also maintaining my own yoga practice on, you know, my own time, which I think has helped me alleviate the symptoms and effects of burnout, which are real and even if you do yoga every day, you're still going to feel it in the middle of a pandemic. It's just really hard to get around. But it's definitely helped me stick with sort of myself practices and feel energized when I come in and do the best that I can. And I can't imagine having gone through this pandemic without having that yoga practice. It's just, like crazy to me. Because I know I probably would have burned myself out a long time ago.

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