Sunday, January 17, 2016

Mindfulness, Clinical Outcomes, and Patient Safety

Two months ago, when I wrote a post about using the walking we clinicians do in the course of the working day as opportunities for  meditation, I wondered if it was a harebrained idea or a piece of personal eccentricity. But when I came upon "Use Hand Cleaning to Promote Mindfulness in Clinic" published in BMJ earlier this month, I decided there's something to it.

The author is Heather Gilmartin, a nurse fellow in the Colorado VA system. She makes the excellent suggestion that hand washing, a recurrent act of patient care and self care, can be used as a moment of meditation. Here's the practical summary Ms. Gilmartin presents:
A moment of mindfulness
Focus your attention on your thoughts and emotions. Stay present and accept whatever arises, just as it is, without reacting.
Set an intention—be it listening with intent, choosing your words mindfully, or acting with compassion in your next encounter.
Smile to acknowledge this act of kindness to yourself and to your patient.
Alcohol based hand rub
Pause, take a breath, and notice the sound and feel of hand rub being delivered to your palm.
Be present in the moment and experience the sensation of rubbing the foam/gel into your wrists, hands, and fingers until the product evaporates and leaves you clean.
Soap and water
Pause, take a breath, notice that you are turning on the faucet, and regard the feeling of water flowing from your wrists to your fingers.
Be present in the moment and experience the sensation of rubbing soap into your wrists, hands, and fingers, and then washing it all down the drain.
The VA system disseminates innovations well. I anticipate the potential for an epidemic of meditative moments arising from Ms. Gilmartin's modest but well articulated proposal!

Via her article I read an empirical study of the simple idea of using recurrent components of our days as opportunities for "mini-meditative-moments." College students were instructed to wash dishes in their usual manner or to do the ordinarily mindless chore in a mindful manner. The group that meditated as they scrubbed showed increased positive emotion and decreased "nervousness." (The article is at:
"Washing Dishes to Wash the Dishes: Brief Instruction in an Informal Mindfulness Practice.")

Reading the two articles emboldens me to out myself for another practice I've built into my day. I'm vigilant about brushing my teeth twice a day. If tooth brushing takes one minute, in a year it adds up to 12 hours. If it takes two minutes, it's a full day. That's a lot of time to devote to an uninspiring chore. I've taken to applying what Ms. Gilmartin recommends for hand washing to those moments of tooth brushing. It's an N of 1 experiment, but I believe it makes a contribution to overall well being.

I believe that most participants in the US health "system" would agree that the "system" is a mess. There's a massive outpouring of proposals for fixing the broken "system." We need to seek mega-solutions. But micro-improvements, such as what Ms. Gilmartin proposes in her BMJ article, are steps all of us in health care can and should take as part of the larger movement of creating an ever-more ethical environment of care.


EastVailMom said...

Walking, hand washing, brushing your teeth. Every day, every action can make a smile easier to rise for burnt out healthcare providers. Thanks for "outing" your mindful practice.

Jim Sabin said...

Dear EastVailMom
Thank you for your kind comments on this post and its predecessor. Sadly, burnout is an all-too-common phenomenon for clinicians. Treating patients is a privilege, and, ideally, is profoundly satisfying. Referring to health care as a "calling" is more than just a word. Historically, the "call" was understood as coming from a divine source. Improving the overall health system is crucial for sustaining and promoting this approach to health care, but meditation can contribute be "clearing space" in the mind or soul for full contact with the opportunity to provide care.