Mindfulness: COVID stillness

Mindfulness and the Emergency Healthcare Professional

Chapter 14: COVID stillness

mindfulness may have positive beneficial effects on immunity…

On immunity

A systematic review¹ of the literature suggests that mindfulness has positive beneficial effects on immunity, looking at various indicators of immunity including antibody formation to vaccination, activity of lymphocytes and white cell numbers in the acute phase reaction to infection.

The degree of positive effect in most studies was moderate, and would be influenced by co-morbidities and the overall health status of the person being studied. What does this tell us in a time of COVID-19?

Vaccination, with the two doses and the booster, remains our most significant protection. Other evidence-based immune-modulators in the time of COVID-19 include adequate sleep, Vitamin D, Zinc, and Vitamin C.

Interestingly, in the systematic review there were no studies showing a negative or detrimental immune system effect from mindfulness meditation, when it was compared in randomised control studies. The form of mindfulness used in these studies was based on a standardised 6-8 week training course developed by Dr Jon Kabat-Zinn at Harvard

COVID implications

Doing whatever we can to support our immune system, in the face of the COVID-19 Omicron variant, makes good sense. This is intuitively logical, but studies and objective supporting data are lagging behind, as is to be expected with the short history of this pandemic.

We do require further studies to ascertain the direct benefits of mindfulness with COVID-19, either within the acute illness, or with the inflammatory processes seen in the post-acute phase, and in some patients in an even longer timeframe known as “long COVID”. We just don’t have enough longitudinal data specific to COVID-19 and mindfulness, at this time, so any advice must be generic, and extrapolated cautiously from specific immune benefits described¹.

In the trenches

There are examples of how “breaks” and “time outs” are used for staff in Emergency Departments. The ED in the Landspítali Hospital in Reykjavik, Iceland, has a room for staff to quietly retreat to for mindfulness breaks during their shifts.

At the shipyard in Ketchikan, Alaska, all staff are required to undertake 15 minutes of meditation followed by stretching exercise before starting work on the ships.

The WRaP-EM team have introduced staff trollies of snacks and healthy food to help combat sagging energy levels at the Gold Coast Hospital Emergency Department.

Applying these ideas needs to be customized to the location, people and culture of any specific ED, and there are useful “how to guides”, mentioned in the book below which is aimed at the teachers of mindfulness in clinical environments².

Setting the tone

For leaders, a crisis like COVID-19 provides opportunities to “show the way”, to be a role model, to support and nurture their team during the current times when exhaustion and stress are so prevalent.

Having our own mindfulness practice helps with managing any conflict in the workplace, as well as the challenging interdepartmental conversations that are more likely at present, due to stress at each level of hospitals during COVID-19.

The individual immune system benefits of mindfulness in relation to COVID-19 are likely but not yet proven.

Recharging the battery

Carrying stress forward from one day to the next is recognized as a factor in staff burn-out. Front-line clinicians need to cultivate activities that refresh and rebalance us, before we return to another shift.

Important in this process are physical exercise, diet, sleep, and the overall way that we think, and process emotions, particularly negative emotions. Mindfulness has its role in this domain.

Mindfulness exercise

(this one has been used with hospital staff working in a high-stress clinical area)

Duration: 5-10 minutes
Level of Difficulty: Easy
Special Equipment: Nil

Turn off pagers or phones if you safely can
Find a place to sit
Close your eyes during this exercise, but only if you feel comfortable doing so
Just study your breathing, regardless of its pattern
To start, we are all probably “spinning fast”
Just let that take care of itself
Study your breathing now, flowing in, and flowing out
It can be fast or slow, jerky or smooth, depending on the mental state you were in when you came into this room
What it is does not matter, as this is the starting point which we will soon leave
Just watch the breaths, as they go in, and go out
(do this for 2 minutes if you can)
Your breathing will slow, naturally as you observe it
Now, move on and study your muscles as they support you
Observe where any muscular pain or tension is
Just observe this, and slowly scan from your toes to your head
(do this for 2 minutes or so)
Now as you breathe, imagine letting all the stress go out from your muscles, in your breath, away, letting it really go
Repeat this for a few minutes
(do this for 2 minutes or so)
In your own time, just return slowly to the world of clinical care
Know that you can efficiently repeat this process of balancing any time you want, and that it will become faster and faster as you practice
Slowly stretch, and return to the room
Thankyou for your valuable time

And to close..

These are indeed unknown times, as COVID-19 fills our radar.

Find your own stillness, if you can, each day, amidst the noise and haste.

And don’t forget to practice

Thankyou for reading this, and take care of yourself

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Andrew Dean

A/Prof Andrew Dean, MBBS FACEM Grad Cert Clinical Simulation. Emergency Physician and DEMT at St John of God Hospital, Ballarat, Victoria, Australia. Head of Ballarat Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia.

Still searching for new and innovative teaching methods for emergency medicine education. Also a committed advocate for mindfulness meditation, and the nurturing of emotionally intelligent clinical teams in health care.