Taking three sighs is a mindfulness technique nurses are using in their everyday practice to cope with the pressures of their high-stress work environments.

Far from being the latest zen trend to counter our fast-paced and plugged-in lifestyles, Australian researchers are investigating the benefits of mindfulness for nurses to prevent burnout and compassion fatigue.

Dr Mark Craigie, a privately practising clinical psychologist who specialises in mindfulness-based cognitive therapy, says nurses choosing to sigh when they notice they’re getting tense or entering into a stressful situation can help them remain focused on the task at hand.

“You take a normal in-breath and then a very long slow out-breath and then on the out-breath you sigh just gently, and focus on the feeling of the out-breath as you sigh,” he explains.

“That’s just enough to switch you away from being overreactive to a more balanced level of reactivity, so it helps you relax just a little bit.

“Just redirecting the attention to something very simple, the feeling of your breath as you sigh on the out-breath, that’s an extremely easy thing to do.

“As you get better at doing that you might only need one sigh to relax your body.”

Dr Craigie and Associate Professor Clare Rees, of the School of Psychology and Speech Pathology at Curtin University, are part of a team who are trialling the benefits of mindfulness-based interventions, specifically designed for nurses, as part of a study at Perth’s Sir Charles Gairdner Hospital.

Their research team is equipping about 90 nurses at the hospital with a range of skills to practice efficient and effective mindfulness-based interventions, including the three sighs technique, as part of the controlled trial.

After the completion of the trial, researchers hope to roll-out mindfulness-based techniques to other health services nation-wide and will also trial an online program of mindfulness training.

Assoc. Professor Rees, who leads the International Collaboration on Workforce Resilience which is focused on building nursing resilience, says mindfulness can be particularly beneficial to nurses who are often at risk of stress, anxiety, depression and burnout.

“A lot of people get too caught up in things, they can’t distance themselves from what’s going on, they get overly absorbed and reactive but you actually can step back and be more of an observer, and in touch with your own values and intentions,” she says.

The group-based intervention comes after an initial pilot study of about 20 nurses at the hospital returned significant outcomes, from reducing nurses’ levels of stress to improving their workplace satisfaction.

In the current trial, nurses participated in a full-day workshop where they learnt about mindfulness and then practiced the mindfulness techniques in weekly sessions, spanning three weeks, before implementing the techniques at work.

Dr Craigie says while the data is yet to be analysed, the initial results are encouraging.

“Most people have completed the whole program and the initial feedback is quite positive,” he says.

“The most important thing is how they translate some of the ideas and skills to workable day to day mindfulness practice that can be implemented either at home or at work.”

Dr Craigie says while nurses working in hospitals face multiple stressors in their everyday practice, from confronting clinical cases to critical patients and colleagues plus fluctuating staff levels, they have the power to choose how to respond to situations.

“It’s not getting too hooked into peripheral things that are in the environment that can stress you out whether it be, for example staffing on a ward, because that’s the type of stress that we don’t have any control over,” he says.

“Mindful responding would be - we may be short one or two staff members on the ward, I can’t think too much about that or worry about that because I can’t do anything about it, I just need to refocus on what I’m doing and how I’m doing it, and what’s the best thing I can do right here, right now.

“And try to relax the body as well because if I notice I’m tensing up, which is sort of natural when you’re stressed…when your body is more relaxed, you can focus better.

“If they can do that, they’ll be able to focus on the task at hand - it’s within their control and then they can probably feel more relaxed than if they are worried about things that are out of their control.

“It doesn’t mean they don’t have to deal with it at some stage, through their manager or line manager but in this present moment you can focus,” he adds.

“The more focused you are in the present moment, from day to day, the less likely you are going to be stressed, you can contain your stress in a more workable zone rather than allowing yourself to become chronically stressed.”

Dr Craigie says mindfulness is also noticing how your mind and body reacts to situations so that you can work on preventing negative reactions, through implementing techniques, exercise, socialising or a favourite pastime.

Three minute breathing space

Another mindfulness-based technique nurses are practising in the trial is the three-minute breathing space.

“It’s something they can do whenever they need - when they need a break, they are going to the toilet or they are going to get a cup of tea, they might do a three-minute breathing space while they’ve got that three minutes,” Dr Craigie says.

The technique is not designed to completely relax nurses but aims to help nurses stop and refocus, steadying them so that they can become more intentional in the next situation.

“If you’re on autopilot and you’re not constraining that focus, then it’s very easy for one situation to flow over into another situation, which then flows over into another situation,” Dr Craigie says.

“If you don’t do that then hours could go by and in those hours your body becomes tense from stress, your breathing’s become rapid, you’ve probably developed a headache, you’ve been worrying and by then you’ve used up a lot of your physical and emotional energy in your day,” Assoc. Professor Rees adds.

The first step is to acknowledge what you’re experiencing, Dr Craigie says.

“What types of thoughts am I experiencing, what types of feelings in the body, any other physical sensations, and just acknowledging what’s going on internally. You might just do that for a minute roughly.”

Secondly, focus on your breath.

“That’s what we call gathering or steadying the mind, so you need to steady the mind by focusing on one thing…once you feel a little bit more steady on the breath, you might actually count at least 10 breaths while you focus on the breath.”

The third and final step is called expanding.

“That involves just being aware of your body as a whole as you start to leave the practice, noticing how the body feels now, opening and softening and relaxing the body, and preparing to move into the new situation.

“It’s like a little sort of - stop, slow down and be aware and then prepare to move into the new situation.”

Nurses shouldn’t underestimate the importance of their mindset.

“It’s very easy to believe our thoughts too much, and that can then taint our way of approaching our work and our life more generally,” Dr Craigie says.

“Obviously the more you practice mindfulness, the more you’ll get out of it.

“Once you can see the benefit of it, then you might find you’ll keep doing it and it might become a daily habit, like brushing your teeth.”

For more information email Assoc. Professor Rees - c.rees@curtin.edu.au