Orientation, Preceptorship Support Platform, Tips for Preceptors, Wellness

The Relaxation Response

The relaxation response is a physiological state of deep rest. It is the opposite of fight-or-flight. The relaxation response is associated with decreased heart rate, blood pressure, and muscle tension, and increased energy and self-control. Regular practice of the relaxation response reduces anxiety and repetitive worry patterns, increases resistance to stress, and reduces symptoms of many medical conditions.

Nurses, especially new nurses, can benefit from practicing the relaxation response to help manage their stress. Some days can be incredibly overwhelming, and you can use this technique, or share it with others.

By adopting a daily practice, people can:

Develop a sense of purpose and wisdom. By turning down the outside noise of pictures, words, and sounds, we become more attuned to the silence within, and our own intuition. We can listen more deeply.
Create a space between stimulus and response. By increasing concentration, awareness, and centeredness, we become more able to listen, to hear, to reflect, and to respond out of choice. This is especially important during stressful days at work.
Align behaviors with life purpose and meaning. By transcending our self-defeating attitudes, beliefs, and assumptions that act as filters for the way we perceive, we are more able to override our conditioned response and behave in new ways.
Health and Renewal. Quieting the bodymind through relaxation helps to reduce pain and anxiety, promote deep rest and sleep, reduce muscle tension, increase blood flow and reduce blood pressure, improve immune function, improve overall sense of well-being.

Methods to Elicit Relaxation Response

Focused Belly Breathing
Repetitive Exercise
Meditation
Mindful Walking
Repetitive Prayer or Mantra
Imagery
Body Scan

Basic Components of Relaxation Response

Mental focusing, such as your focusing on the breath; repeating a word, phrase, prayer, or sound; or using repetitive muscular activity.
Passive disregard toward distracting thoughts, sounds, or intrusions.

Try it!

Find a comfortable position.
Take several deep breaths.
Begin to relax muscles and quiet the mind by being still.
Find and maintain a mental focus for 10 – 20 minutes.
Let go of distracting thoughts and judging attitude.

Orientation, Preceptorship Support Platform, Studies, Tips for Preceptors

What does the evidence say about nursing orientations?

Recently we conducted a review of current published articles (2015-2017) to evaluate evidence and recommendations for Transition into Practice programs including orientation and residency models. The evidence is clear in a number of areas:

New graduate RN retention in the first year of employment is a challenge for hospitals, ranging from a low of 25% to a high of 64% or greater. Furthermore, the decision to leave nursing is frequently related to dissatisfaction with orientation and begins within the first few months of hire. The most frequently mentioned barriers to a smooth transition included: Lack of consistent preceptor communication, Short staffing, high patient acuity, having to make critical decisions without help, little personnel support, lack of skills and knowledge, high variability in the orientation process in different institutions, and emotional stress of “reality shock”.

Implementation of residency/ internship models with multiple units and preceptors has been well documented to reduce turnover and increase retention of new graduates, increase nursing and unit satisfaction, provide significant cost savings for the hospital, and increase actual recruitment and desire for employment. The key factors contributing to success of residency programs can be incorporated into less formal orientation structures.

Investment in preceptor development through training and feedback is critical to their effectiveness. Specific learning needs include development of affirmative coaching, dealing with difficult communication, creating civility in the workplace, specific teaching strategies and learning styles, the role of emotional intelligence in learning and how to effectively manage change.

Effective preceptor coaching can significantly improve development of clinical reasoning and critical thinking.

Preceptors need structured support and consistency of feedback based on shared data. They also need time to precept, role clarification, and some formal reward or recognition system for the critical importance of their work to safe practice and patient care.

A few studies have begun to address the crucial need to support development of wellbeing and resilience skills of newly hired nurses. Transition stress has been documented for many years, and a strong preceptor relationship can help with this stress. There are other strategies that can be easily taught to new nurses and it is important to recognize the impact of supporting wellbeing on learning, competency development, and integration into the culture. Orientees can learn to manage their wellbeing and emotional/ physical stress; preceptors can help with this by tracking and coaching.

Research to improve efficiency and outcomes of transition into practice is increasing. While there is a need for ongoing correlational research the body of current evidence demands integration into our transition structures. One of the most comprehensive sites we have to support evidence based transition is the Vermont Nurses in Partnership (VNIP). Their website provides numerous resources, literature and concrete suggestions to improve transition process and outcomes. For more information visit their website or take a look at their Clinical Transition Framework Evidence Base.

Orientation, Tips for Preceptors, Wellness

Centering tips for orientees, residents, and preceptors

What is Centering?

Learning to Center your awareness is one of the most important skills you can develop as a caregiver. Centering is foundational to connecting deeply with others and developing your full healing potential. Centering is a mindfulness practice of learning to manage your attention so that you are aware of your inner reference of peace, calm and stability. Learning to center is developed over time with practice.

Imagine that the points of the star represent different parts of yourself. You have thoughts, emotions, a physical body with sensory input/ sensation, imagination, intuition and impulses and desires. Most of us perceive ourselves according to how we think, how we feel, what our body looks like, what we want or desire. These dimensions of ourselves develop as we grow and mature. While these “parts” of our personality help to define who we are it is important to recognize that we are more than these parts. Within each of us we have a core—a center of, peace, love, joy and deep connection that can be accessed. Accessing this deep part of our being may be viewed as a spiritual experience.

Centering is a practice that allows you to become more deeply aware of this inner core, this still point within. There is a deep sense of connecting to the “spirit” within. As you practice centering techniques, you are able to access this core self more easily and you begin to direct your life from this centered awareness of peace and connection. You become less reactive. This process can be thought of as disidentifying from the parts of yourself and identifying with your core being.

Thus, centering involves a process of moving the attention inward to that still point within—the centered self. There is an active and passive aspect of the centered self. You become aware of an inner reference of peace, stability, open awareness and connection. You are a pure, objective, loving witness to what is happening within and without. There is also an active part of the inner self, the “will-er” that can act from this deep level of awareness to instigate action in the world. So, at the center of the self there is a unity of love and will….action and observation.

How can the practice of Centering benefit you and your patients?

When you are centered, your awareness is grounded in the body. You are connected directly to your inner energy of love and peace; you have ability to be fully present to others and you have the ability to act with intent and compassion. Centered awareness provides you the power to freely choose how you will act in any situation. It allows you to choose how you want to “show up” in any given situation.

Having a centering practice benefits you and your patients. Benefits of centering include:

Calm Mind—ability to think clearly and calmly; ability to learn; more open observation and awareness of surroundings; connection with scientific reasoning and logic
Quiet emotions—ability to stand by someone who is expressing pain or anxiety without. reacting to the pain/ anxiety. Ability to remain present to the person and provide comfort.
Relaxed, grounded body—ability to be aware of internal stress and anxiety and self-regulate the autonomic nervous system so that you can manage your energy.
Receptivity to intuition and imagination—ability to listen to and respond from deep levels of knowledge that we call our intuition; creative insights and use of imagination to act—the ability to act artfully and create new ways of responding.
Choice about how and if to act on impulses or desires—freedom to act; freedom to choose action rather than reacting mindlessly from past experience.

How do I learn to center?

One of the most common ways to learn the skill of Centering is practicing awareness of the breath.

Try this exercise:

Get in a comfortable position and take a moment to just look around the room. Really see the light…the colors…the environment…

Now take a deep breath and close your eyes and let all of the visual awareness go.

And now be aware of the sounds…..and take a deep breath and let the sounds fade.

Scan your body from head to toe…..very gently… and if you need to move, do that now.

And now lightly put your attention to your breath and become aware of your breathing. With each out breath let go of anything you no longer need…..just be aware of your breathing without trying to change it.

Be aware of any thoughts, feelings or images come to mind just notice them and let them be. There is nothing you have to do about these feelings now….Do not hold onto them just let them pass and return your attention to the breath.

say to yourself—I AM AT PEACE.

As you focus on your breathing, allow your awareness to move into your center of silence within….say to yourself, I AM AT PEACE and just breathe in the peace and silence of this center….still….calm…deepening….

And now notice how it feels to be you in this moment. Say to yourself.

I have a mind, but I am not my mind….

I have emotions, but I am not my emotions…

I have a body, but I am not my body….

I AM a Center of Peace and Power…….. A Center of Love and Compassionate Action……

Take all of the time you need to experience your centered state of awareness and when you are completed, slowly bring your attention back to the breath and then the environment you are in.

There are many forms of breath awareness, relaxation, and guided imagery exercises that can help you learn to center your awareness into this relaxed, open state of awareness. The Ohio State University Center for Integrative Health and Wellness has a number of excellent resources you can try.

Orientation, Preceptorship Support Platform

The importance of well-being in nursing practice

Why is well-being important?

Reality shock for nurses is a problem that shows no signs of going away. Self-care is so vital for new hire nurses, but it is also important that hospitals support reflective learning practices that support well-being. Because around 25% of new nurses leave nursing during their first year of practice, hospitals can build strong programs with less turnover by focusing on well-being during nursing orientation.

How to focus on well-being

Neuroscience evidence suggests mental training and learning skills in four key areas can make a difference in improving well-being and even rewire areas of the brain.

Sustaining positive emotion. Prolonging positive emotion has been shown to improve psychological well-being.
Rebounding from negative emotion. The second component of well-being is a person’s response to negative emotion. Science in this area suggests resilience, or how quickly a person recovers from adversity, can result in a person experiencing less negative emotion overall and may even have protective properties against mental health disorders.
Mindfulness and mind-wandering. Mindfulness-based practices of all types have now entered the mainstream. Data show that when people are really focused on what they’re doing, and their minds are not wandering, they actually feel better about themselves, perform better, and experience less negative emotion.
Caring for others. Prosocial behaviors such as empathy, compassion, and gratitude comprise another component of well-being. There’s substantial evidence to suggest that engaging in acts of generosity is a very effective strategy to increase well-being.

The first two points regarding staying positive and coping with negativity can be difficult for new nurses. This post from allnurses.com shows how quickly new hires can become overwhelmed and start questioning if they made the right career choice. Providing resources for both Preceptors and Preceptees to effectively give positive and negative feedback is one way to make this easier. Open lines of communication with their Preceptor will help new nurses feel supported, and if Preceptors are mindful about pointing out when their Preceptees are doing something well, staying positive about their experiences as a new nurse in a new hospital won’t seem so impossible.

Building self-care into nursing orientation

Encouraging new hire nurses to engage in reflective learning activities as a part of their orientation is a great way to help them manage their well-being and resiliency. The American Holistic Nurses Association provides a number of resources for nurses, including Holistic Self-Care information and exercises and Stress Management tips.