How Nursing Nidra Was Created
The content of the Nursing Nidra Program comprises the most pivotal discoveries that each of us has made during our own recoveries from burnout and/or PTSD. In coming together to form our company, Healing Millions, our intent is to help streamline the recovery process for others and help people at risk for these conditions to avoid them in the first place. Our mission is nothing less than to embody, transmit and ignite the light of healing in millions of people.
Despite our very different professional backgrounds (a nurse and a government IT contractor), we share a passion for this work. We do not want people to have to struggle as long as we did trying to find solutions. And we especially do not want people to experience the loss of their careers and health before finding that solution.
Therefore, we took the best that has worked for each of us and put it together to create the Nursing Nidra program, beginning with Nursing Nidra - Building Your Firm Foundation. We then turned to the literature to see what research was available on the methods we had chosen, and to learn the prevalence of PTSD and burnout in nursing. Not surprisingly, the prevalence in nurses is very high (and the research bears out our personal successes with the methods chosen).
We decided to focus on the nursing population partly because Karrie is a nurse, and has a passion for helping other nurses, but also because we believe that if we teach nurses how to heal themselves, then we help all of humankind. As Karrie likes to say, “Nurses bookend humanity. It is a nurse who is there when a baby is born, and most likely there when a last breath is taken.” Very few other professions have such a profound effect on the overall population as nurses do. We know from experience that nurses give their hearts to their work, and their service is impossible to put a price on. We wanted to give back to them in equally positive ways to those with which they’ve touched our lives.
Burnout and PTSD/Compassion Fatigue in Nurses
Research shows that both burnout and PTSD are common in nursing. As high as 86% of critical care nurses met the criteria for burnout in one 2009 study (Mealer et al., 2009). This is consistent with other studies, in which 22-29% of critical care nurses were found to reach full burnout, and as many as 86% have 3 of the classic symptoms of burnout (Moss, Good, Gozal, Kleinpell, & Sessler, 2016). Compounding this, Brooks (2017) found that 85% of nurses report fatigue, which contributes to burnout.
As for PTSD, a 24-29% incidence of symptoms of PTSD was found in critical care nurses, and 14% in general med/surg nurses (Mealer, Shelton, Berg, Rothbaum & Moss, 2007). Meanwhile, Domingueq-Gomez and Ruthledge (2009) found that only 15% of emergency department nurses did not meet the criteria for secondary traumatic stress (a.k.a. compassion fatigue). These rates are similar to the rates in U.S. military veterans; PTSD is reported to occur in 13.8% in Gulf War veterans, and the estimated lifetime prevalence in women veterans is 26.9% (Gradus, 2017).
While compassion fatigue/PTSD and burnout are different, the outcomes are similar in that the nurses are depleted, feeling like they have nothing more to give (Boyle, 2011). To address that overall depletion, Nursing Nidra blends some of the best of western science with that of the eastern practice known as yoga nidra, to rebuild energy from within. Yoga nidra is well known to induce deep physical, mental and emotional relaxation, and is highly effective at reducing stress in individuals who employ the practice (Kumar, 2007). For this and other reasons, we chose to use yoga nidra as the backbone of the Nursing Nidra – Building Your Firm Foundation program.
Fundamentals of Nursing Nidra
Yoga nidra is known to support psychological, physical and spiritual healing (Miller, 2015). It is a proven approach to mind-body-spirit integration that has been used for thousands of years, although the exact origin is unknown (Halpern, 2017). It is not exercise (as many equate with yoga), yet it promotes deep relaxation of the body, the release of trauma and upset from the body and mind, and the dissolution of subconscious patterns that drive adverse behaviors. It is therefore not surprising that yoga nidra has been shown to decrease perceived stress in military healthcare workers (Bingham, Inman, Walter, Zhang & Peacock, 2012), to help military veterans returning from war with PTSD to heal their traumas, and is now being used at multiple VA and army hospitals (Miller, 2015).
Yoga nidra means “sleep of the yogi,” which is a play on words (Saraswati & Hiti, 1984). We have named our program Nursing Nidra – “The Rest of the Nurse." Nursing Nidra not only gives rest, but also it helps you reconnect with the rest of you - the part that gets lost so easily among the demands of everyday life and one’s profession.
The Nursing Nidra program teaches specific techniques of yoga nidra that give nurses the tools to deal with stress and upset in the moment - as they occur - or to process later. Two useful tools introduced in the first course are body sensing and meditation, both of which have been shown to help decrease stress in nurses (Raingruber & Robbinson, 2007 & Raingruber & Kent, 2003).
Most nurses understand and accept that nursing is a stressful profession. Nurses deal daily with life-and-death situations, and care for people at their most vulnerable and private of times. Yet, we do not generally recognize the toll this takes (Aycock & Boyle, 2009). There are few support systems in place for nurses to deal with the trauma, stress, grief, and even loss that they experience in caring for patients (Boyle, 2011). Because of this lack of support systems, Nursing Nidra has built in sharing circles to help fill the gap. The communal support of colleagues is critical to nurses’ overall survival, and creates renewal in the sharing experiences (Lippincott, Williams, & Wilkins, 2002). These circles also serve as ways to share learning; storytelling creates support and develops personal resilience (East et al., 2010).
To ensure an overall holistic approach to Nursing Nidra, we have also incorporated aspects of nutrition and sleep. We have found that overcoming stress is one thing, but to continue to heal, the body needs adequate nutrition and sleep (Stevenson, 2016).
A major component of Nursing Nidra is the importance of self-care. Improving self-care is vital to creating overall wellness (Portnoy, 2011). However, we know from experience, as well as talking with many nurses, that although nurses care deeply for others, they oftentimes neglect their own self-care. Each Nursing Nidra session ends with a mindset focus and meditation to help “hardwire-in” the practice of caring for oneself without guilt. We built self-care into the weekly homework assignments in the form of time spent in practicing the Nursing Nidra skills, meditation, and journaling.
To help evaluate the overall effectiveness of Nursing Nidra, we have employed one of the three common tools currently used to measure compassion fatigue in nurses: The Professional Quality of Life Scale (Boyle, 2011). This tool will allow nurses to determine their pre- and post-program status with regard to their compassion satisfaction, burnout, and secondary traumatic stress scores (ProQOL.org, 2017).
Aycock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13(2), 183-191.
Bingham, M., Inman, A., Walter, J., Zhang, W., & Peacock, W. (2012). Improving stress and resilience for military healthcare providers: Results from apilot study. BMC Complementary and Alternative Medicine, 12(1), p. 69. doi:10.1186/1472–6882–12–S1–P69
Boyle, D. (2011). Countering compassion fatigue: A requisite nursing agenda. OJIN: The Online Journal of Issues in Nursing. 16(1), Manuscript 2. doi:10.3912/OJIN.Vol16No01Man02
Dominguez-Gomez, E. & Ruthledge D. (2009). Prevalence of secondary traumatic stress among emergency nurses. Journal of Emergence Nursing, 33(3), 199-205. doi:10.1016/j.jen.2008.05.003
East, L., Jackson, D., O’Brien, L., & Peters, K. (2010). Storytelling: an approach that can help to develop resilience. Nurse Researcher, 17(3), 17-25. doi.org/10.7748/nr2010.04.17.3.17.c7742
Gradus, J. (2017). Epidemiology of PTSD. PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/ptsd-overview/epidemiological-facts-ptsd.asp
Halpern, M. (2017). The practice of yoga Nidra. California College of Ayurveda. Retrieved from http://www.ayurvedacollege.com/articles/drhalpern/practice-yoga-nidra
Kumar, K. (2008). A study on the impact of stress and anxiety through yoga nidra. Indian Journal of Traditional Knowledge, 7(3), 401-404.
Lippincott, Williams, & Wilkins, (2002). Illustrated manual of Nursing practice 3rd Edition. Philadelphia, PA: Springhouse.
Mealer, M., Burnham, E., Goode, C., Rothbaum, B., & Moss, M. (2009). The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety, 26(12): 1118-1126. doi:10.1002/da.20631
Mealer, M., Shelton A., Berg, B., Rothbaum, B., & Moss, M. (2007). American Journal of Respiratory and Critical Care Medicine. 175, 693-697.
Miller, R. (2015). The iRest Program for Healing PTSD: A Proven-Effective Approach to Using Yoga Nidra Meditation & Deep Relaxation Techniques to Overcome Trauma. Oakland, CA: Raincoast Books.
Moss, M., Good, V., Gozal, D., Kleinpell, R., & Sessler, C. (2016). A critical care societies collaborative statement: Burnout syndrome is critical in health-care professionals call to action. American Journal of Respiratory and Critical Care Medicine. 194(1), 106-113.
Portnoy, D. (2011). Burnout and compassion fatigue: Watch for the signs. Journal of the Catholic Health Association of the United States-Health Progress, 2011(July-Aug), 47-50.