Mindfulness & self-compassion in nursing education: Promoting compassionate relational-centred nursing care.
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Summary
The fellowship focus was to continue to build knowledge and expertise required to support the integration of strategies to enhance compassion for self and others in nursing students and faculty. The need to support the emotional and physical well-being of nursing professionals and students is critical during this time of a global pandemic. As evidenced within the review of literature mindfulness and self-compassion are empirically supported approaches that enhance coping, resilience, emotional intelligence, enhanced relational skills, motivation and mastery of skills while decreasing anxiety, depression, fear of failure and fear of evaluation (Hagerman, et al., 2020).
The benefits of mindfulness and self-compassion extend beyond psychological and academic support, it has also been found to support nurses in providing relational-centred compassionate care. To minimize the effect of compassion fatigue nurses must first be able to care for themselves and recognize their own suffering in order to be able to see the suffering in others and respond to that suffering with compassion. It is for this reason important to identify evidence-informed approaches to teaching and learning that answer the question of what knowledge and skills are needed to be compassionate? (Hartirick Doane & Varcoe, 2015). To answer this question three learning objectives were developed.
Overall learning goal (objectives). The fellowship goal was to enhance my capacity for developing mindfulness and self-compassion from leadership perspective and gain expertise in curriculum development related to these concepts. The experience was framed within two theoretical lenses. The first lens was Hartrick Doane and Varcoe’s (2015) five ontological capability of relational inquiry and how these inform curricular innovations. The second was that of Germer and Neff’s (2019) mindful self-compassion (MSC) program and how mindfulness-based self-compassion training can be used to support academic success and compassion for self and others.
Learning objective 1. To continue to build on my knowledge of mindful self-compassion and relational practice. Hartrick Doane and Varcoe’s (2015) recognize that to be compassionate towards others we need to be first compassionate towards ourselves. This focus on how self-compassion is essential in preparing for compassionate practice, along with Germer & Neff’s (2019) MSC program, allows for the development of a nursing centred relational-inquiry approach to compassionate practice. A steering committee comprised of faculty and students from the PN and BScN programs was formed to examine how MSC could be integrated into undergraduate nursing curriculum to support relational-centred compassionate care. The working group committee was guided by Dr. Louela Manankil-Rankin, Dr. Jasna K. Schwind and Michele Chaban. The impact of mindfulness and self-compassion will be evaluated at a later date using the Knowledge to Action Framework as a way of supporting knowledge translation into practice.
Learning objective 2. The second learning objective for this fellowship was to apply the knowledge gained from the 2019 to 2020 fellowship to inform the creation of a faculty development MSC workshop series. A series of 8 mindful self-compassion faculty development workshops were developed and delivered over an 8-week period to full and part-time faculty using Zoom. Finlay et al., (2016) identified that online self-compassion training was effective in “increasing self-compassion and reducing psychological distress” (p. 12). Though the findings by Finlay et al., (2016) are preliminary, it shows promise for using technology, specifically online learning, to enhance mindfulness and self-compassion in faculty. The 8 MSC workshops developed as part of this fellowship included core meditations, informal practices, experiential exercises and discussions on how these strategies can be integrated into day-to-day life and the teaching/learning experience.
Learning objective 3. The third learning objective was to apply my knowledge of mindful self-compassion and expertise in technology enhanced learning to support MSC in faculty through the delivery of a web-based resources. The identified deliverables included the development of an evidence-based technology enhanced resources to inform teaching/learning of mindfulness-based self-compassion practices. This learning objective was met with the creation of three web-based resources. These resources included a: 1) Mindful self-compassion teaching/learning repository; 2) mindful self-compassion workshop intranet site (objectives, readings, homework) to support the series of 8 faculty focused MSC workshops; and 3) an internet site to showcase the work being conducted by the MSC working group and the program focus on compassionate care.
Outcomes
Patient/client population outcomes experienced. Gustin and Wagner (2012), using the metaphor of the butterfly effect, noted that “small compassionate moments within interactive processes also make a change in the aftertime and give rise to new understanding of compassionate care as an expression of mutuality that transcends the present moment.” (p. 180). Compassion towards others begins with an awareness that suffering is part of the human experience. It is the process of being with another in an open, accepting and non-judgmental manner with a focus on not only tolerating moments of suffering but being motivated to relieve the suffer (Strauss et al., 2016). To build capacity for compassion within students and faculty for self and other is the anticipated outcome of the MSC workshops. Anecdotal data from faculty suggest that the workshops were effective in design and delivery.
Mindfulness training promotes positive psychological effects in students (optimism, coping, resilience, social connectedness, a decrease in anxiety and depression) and physical benefits such as improved cardiovascular and immune function (Barnard & Curry, 2011; Finlay-Jones et al., 2016; Germer & Neff, 2013; Neff & Corstigan, 2014). Academic benefits of mindfulness and self-compassion such as a reduction in the fear of failure or evaluation (positive and negative), strengthened confidence in communication and ability to engage in discussions, emotional intelligence, enhanced intrinsic motivation and the mastery of goals supporting the ability to view moments of failure as learning experiences (Barnard & Curry, 2011; Finlay-Jones et al., 2016; Germer & Neff, 2013 Long & Neff, 2018). While this was not formally evaluated, future evaluation will be designed to measure outcomes on students of mindful self-compassion training.
Colleagues/staff, organization and stakeholder outcomes. Mindful self-compassion workshops were offered twice weekly over an 8-week period to full-time and part-time faculty in the Practical Nursing and Bachelor of Nursing programs. Each mindfulness-based self-compassion training session included discussions designed to support understanding of the practices. These discussions were provided to enhance participant ability to integrate these practices into their daily life and teaching/learning experiences. Each week core meditations, informal practices, exercises such as the compassionate letter writing exercise, poetry, pre-readings and home practice exercises were provided (Germer & Neff, 2019). An intranet site was created to provide in advance of each session learning outcomes, pre-readings, post-session activities (homework), definitions of key terms, and audio recordings to support learning. Building capacity within faculty for mindful self-compassion, similar to Gustin and Wagner (2012) Butterfly effect metaphor is a way to not only support faculty in these difficult times, but through small moments of compassion support students and the clients they care for in practice. Mindfulness and self-compassion is an approach to not only build resilience in times of stress to support well-being and compassion, it also is an effective method of developing skills, address difficult emotions while enhancing relationships between clients, students and faculty (Germer & Neff, 2019).
Overall experience
The fellowship experience provided me with the opportunity to continue to build on and support my understanding of mindfulness and self-compassion through the completion of the Live Online Mindful Self-Compassion course, a Compassion Cultivation Course, and the Contemporary Applications of Mindfulness, Mindfulness Meditation and Mindfulness-Based Interventions course. The courses strengthened my knowledge, skills, and confidence in mindfulness and self-compassion and informed the design and delivery of training workshops offered to Conestoga College nursing faculty. Intranet websites to support the mindful self-compassion workshops, showcase the mindful self-compassion project working group and provide teaching/learning resources were created.
The experience has been incredibly rewarding. I have had the opportunity to work with and learn from experts such as my mentors Dr. Louela Manankil-Rankin and Dr. Jasna K. Schwind. To make connections with Michele Chaban from the University of Toronto and explore her work in mindfulness-based education. Finally, to build on my knowledge and expertise mindful self-compassion. Through these experiences and working with my program Chair, Heather Cross, I have gained an increased confidence in leading and supporting others in transforming learning to a compassionate care and relational inquiry focus.
References
Barnard, L. K., & Curry, J. F. (2011). Self-compassion: Conceptualizations, correlates, & interventions. Review of General Psychology, 15(4), 289–303. https://doi.org/10.1037%2Fa0025754
Finlay‐Jones, A., Kane, R., & Rees, C. (2017). Self‐Compassion online: A pilot study of an Internet‐Based Self‐Compassion cultivation program for psychology trainees. Journal of Clinical Psychology, 73(7), 797-816. https://doi.org/10.1002/jclp.22375
Germer, C. K., & Neff, K. D. (2013). Self‐Compassion in clinical practice. Journal of Clinical Psychology, 69(8), 856-867. https://doi.org/10.1002/jclp.22021
Gustin, L. W. & Wagner, L (2012). The butterfly effect of caring – clinical nursing teachers understanding of self-compassion as a source to compassionate care. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/j.1471-6712.2012.01033.x
Germer, C.K., & Neff, K. D. (2019). Teaching the mindful self-compassion program: A guide for professionals. Guilford Press.
Hagerman, L.A., Manankil-Rankin, L. & Schwind, J.K. (2020). Self-compassion in undergraduate nursing: An integrative review. International Journal of Nursing Education Scholarship, 17 (1). https://doi.org/10.1515/ijnes-2020-0021
Hartrick Doane, G. & Varcoe, C. (2015). How to nurse? Relational inquiry with individuals and families in changing health and healthcare contexts. Lippincott, Williams & Wilkins.
Long, P., & Neff, K. D. (2018). Self-compassion is associated with reduced self-presentation concerns and increased student communication behavior. Learning and Individual Differences, 67, 223-231. https://doi.org/10.1016/j.lindif.2018.09.003
Neff, K. D. (2003). Self-Compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85-102. https://doi.org/10.1080/15298860309032
Neff, K. D., & Costigan, A. P. (2014). Self-compassion, wellbeing, and happiness. Psychologie in Österreich, 114-117.
Strauss, C., Taylor, B.L., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47, 15 – 27. https://doi.org/10.1016/j.cpr.2016.05.004