I am currently at the American Holistic Nurses Association conference in Snowbird, Utah. Snowbird is where I learned to ski 20 years ago when I first came here with my husband and his family. Snowbird is where my husband learned to ski and where my oldest daughter learned as well and it feels like home because of this, only more so as I am surrounded by the largest single gathering of heart-centered and caring nurses and educators. There is comfort in knowing that there are a number of us who know about healing, and there are a number of educators here who strive to create caring curricular experiences for others.
I was honored this week to present a workshop for educators and we gathered together to explore integral theory, self-care, and how to create change in our curricula; my goal is that every educator will begin to value caring, healing, and self-care in such a way for themselves that they can share it with our nursing students. As Jean Watson said in her 1999 work about postmodern nursing and beyond, we come into the profession as wounded healers. Because we know that approximately 80% of our students come to use from dysfunctional family backgrounds, and they therefore likely exhibit low stress resilience, we become ethically obligated (from an ethic of caring perspective) as educators to support these future nurses in their own self-care and healing processes.
There is now a strong body of evidence to indicate that chronic stress which many of our students likely have experienced creates changes in the brain which strengthen to fight or flight response of the amygdala and hippocampus (the “bottom” area of the brain); and this response, we as nurses know, can be helpful at times, but when it is continually activated, we compromise our stress resilience and activate inflammatory processes and genetic changes in how our chromosomes respond that leads to disease. How the brain reacts to stress and the structural changes that it makes are known as neuroplasticity. Additionally, the brain that is exposed to chronic stress has a tendency to create repeated responses from the amgydala that can lead to wear and tear on the body and the brain- we call this the allostatic load.
Allostatic load is increased by stress and anxiety and how we manifest it on our bodies is related to our personal lifestyle risk factors: we can decrease the allostatic load and the amygdala response by enacting healthy behaviors such as exercising, eating a diet that is high in antioxidants (fruits, vegetables) and low in inflammatory- producing agents (such as sugar and fat), getting enough sleep, meditating, and doing yoga. When we enact these healthy behaviors we decrease allostatic load. Indeed long term meditators show an increased response in their brain activity from the prefrontal cortex area of the brain (the top area) and a decreased amygdala development; in other words their brain functions from a “top down” response, where the brain develops to send signals from the prefrontal cortex instead of from the amygdala). Additionally genetic studies show that meditation changes the body’s cellular genetic response, so that the chromosomes that when stressed can lead to disease are not activated. Healthy behaviors that decrease amygdala response and increase prefrontal cortex response also increase our stress resilience and lead to a happy, healthy, life.
As I am myself still grasping these concepts, and I am far from an expert, I have provided here some in-depth references that clearly address this issue and can start nurse educators in learning about this neuroplasticity or psycho-neuro-immunological process:
Now that we have this great information at our fingertips, we can relate the idea of self-care, or of being on a spiritual-healing journey as Jean Watson implores us to do in her caring philosophy, as a way to heal ourselves and ensure that we can create a caring-healing sustainable practice. We become ethically obligated to provide students to take their own healing journey and we must support this across the curriculum of all of our nursing programs.
The problem though that many educators may encounter is that they have perhaps not been on a spiritual- healing journey themselves, or they struggle along with the lifestyle changes needed in order to decrease the amygdala response. One benefit of requiring students within an entire curriculum to practice self care is that the educator must also role model self-care. It becomes part of our job to insure students know that we are walking the talk of the importance of adequate sleep, exercise, a healthy diet, and personal lifestyle risk factors that increase stress resilience, decrease allostatic load and move us toward engaging with others from our prefrontal cortex. By strengthening the prefrontal cortex, that these students and nurses will be better able to create change in their workplace, manage stress in the workplace, role model healthy behaviors for colleagues and patients, and support patients on their healing journeys.
In the integral-caring-healing curriculum I have developed, we thread self-care across the curriculum. Students are exposed to meditative techniques and self-care is valued by points being assigned in every course for the students as they engage in self-care activities. I believe this curriculum is unique because we focus so highly on the continual process of self-care and healing that is based the science of neuroplasticity. I have found other schools that offer a one time class in self-care (such as Florida Atlantic University and Massachusetts General Hospital’s School of Nursing new mind-body-spirit certificate program), or offer students yoga classes on campus to attend as an option, but I would gather that nearly all nursing schools have not valued nor addressed supporting students on their healing journey throughout the lived and valued continual experience of the curricula.
At University of Maine at Augusta, we offer electives in yoga and reiki in addition to the emphasis on self-care, healing, and meditation that is threaded throughout the RN- BSN curriculum. I am currently teaching a yoga class with 20 nursing students. In this class, the students come together for gentle-classical yoga and meditation on a weekly basis, and they also practice at home and undertake reflective activities related to their self-care. They are awarded points for reflection and discussion online and they are required to relate the science of yoga and the stress response to a specific illness or disease process in an academic paper. They learn to share yoga and breathing techniques with their friends and family and they learn about the safety issues around yoga. They begin to understand that yoga is about following the breath and preparing for meditation that changes their allostatic load.
The real joy for me comes in being with the students as they learn about yoga and practice self-care. I am so honored to guide them through the yoga process and to sit with them in meditation. The feeling of connection we create is almost beyond description, as it is so experiential. But I will say that when we do yoga together we begin to create the transpersonal healing spaces that Jean Watson has written of and our time together expands as do our conscious intentions for love and healing of the self and others. We become a community of learners striving toward healing as we strengthen our pre-frontal cortex responses and move toward the “top> down” brain science ways of being.