Mindfulness is the self-regulation of attention with an attitude of curiosity, openness, and acceptance. (Bishop, 2004)

What comes to mind when you hear the word mindfulness? How would you describe it to a colleague? Is this something you practice on a daily basis? Our experience shows that, in a room of 100 people, there are possibly 150-200 definitions for this term. How is that possible? Let's just say that it is a term that generates a lot of vague thoughts but is rarely practiced in the workplace.

For the purpose of our column series on mindfulness, we will use the following working definition of mindfulness developed by Dr. Scott Bishop, in the journal Clinical Psychology: Science and Practice:

Mindfulness is the self-regulation of attention with an attitude of curiosity, openness, and acceptance. (Bishop, 2004)

Why this definition? In our opinion, this definition succinctly captures the essence of what mindfulness is by describing how it is to be practiced. It underscores the importance of "self-regulation" and of attention, which often go unmentioned. Lest one misses the central point here, the focus is on the"self" and "self-regulation". This point cannot be overemphasized. Too often, people become overly sensitive of their work environment or overly critical of their coworkers. In either case, we are inclined to erroneously conclude that both reflect a state of "mindfulness." This could not be farther from the truth.

As we will learn, self-regulation allows one to maintain control of one's response regardless of the nature of the stimuli (positive or negative). Curiosity, openness, and acceptance are attitudes that enable a person to remain predisposed toward actions that are nonjudgmental and reasonable. The goal of mindfulness training, therefore, is to learn how to control our emotions and response mechanisms so that our responses to external stimuli are appropriate and measured.

While we are being brutally honest, let us ask you, are you a mindful person? According to Bersin by Deloitte, modern-day learners, which include our current workforce, are overworked, overwhelmed, distracted, and impatient (Bersin by Deloitte, 2014). How accurately does this reflect you? How well does it describe your colleagues? While we are being brutally honest, let us ask you, are you a mindful person? Sadly, left to our own accord and the current workplace culture and trends, without mindful reflection and redirection, our acceleration toward exhaustion, disengagement, depression, and ultimately "burnout" will only worsen.

So, how can the modern nursing professional development practitioner rewrite our workplace narrative as it ought to be? How can we help foster a healthier workplace where people display mindfulness through healthy self-regulation? How might we encourage curiosity, openness, and acceptance among our colleagues?

We believe that simulation has much to say about this topic and that simulation will prove essential in helping make this endeavor a reality. To date, however, it has been grossly underutilized for this type of training. The inherent strength of simulation-based training is found in its ability to provide a space for immersion, deliberate practice, and interprofessional education. Tailored for the workplace setting, we offer the following simulation-based strategy on mindfulness that is practical, intuitive, and efficient. Our goal is to maximize workforce impact and to minimize workflow disruption. We call this the "six strategy approach to mindfulness."

Here are the six strategies:

1. Pause (minimum of 6 seconds)

2. Breathe

3. Identify the emotion

4. Recognize the space between stimulus and response

5. Choose how to respond

6. Respond

Let's take a closer look at each of these six strategies and see how they can be applied to help the learner "reframe" their daily interactions in a mindful manner.

Pause: When someone is emotionally triggered by a comment, the instinctive response is typically emotionally charged. So, if someone yells at us, we tend to yell back. This is normal defensive behavior. How can we break this instinctive response? Pausing for 6 seconds gives us a moment to objectively assess what happened and to reset our mind before discharging an emotional response.

Breathe: Taking an intentional deep breath as part of this 6-second pause centers us and reminds us that we have a choice on the type of response we give. In essence, both pausing and breathing promote a response that is measured, appropriate, and mindful, rather than instinctive.

Identify the emotion: Many of us have never been taught to identify or to name our emotion or feeling. Taking a moment to identify or name our feeling, be it anger, frustration, or something else, actually forces us to momentarily break from our instinctive or reflexive response. This seemingly brief pause often allows us to diffuse or discharge enough of the surge of emotion, thereby allowing us to handle our response in a more measured and appropriate manner.

Recognize the space between stimulus and response: Recognizing this "space" and the significance of this space is a bit more difficult to explain. The idea is that this space is where mindfulness practice takes place. Similar to a builder who places great value on the types of experience that have helped perfect his or her trade, a person also grows more mindful each time he or she deliberately incorporates mindful practices in response to all forms of stimuli. Thus, it is frequently said, "Important growth occurs in that space between the stimuli and response." Learning to reflect on this "space" helps us to realize that, despite the fact that external circumstances evoke a myriad of emotions, feelings, and thoughts, ultimately, they do not control our response. Recognizing this theoretical "space" can empower us to be more cognizant of our power and ability to control our behavior and response, which in turn helps us to become more mindful.

Choose how to respond: Becoming aware that how we respond, whether be it instinctive or mindful, is ultimately a decision we arrive at through a process of decisions. It is a reflection of our will, rather than something that happens haphazardly.

Respond: The final stage is the actual response. Based on how it is derived, it will likely reflect impulsiveness or mindfulness.

These six strategies can help empower any individual to maintain self-regulation and self-awareness under all situations. It focuses the attention to things that are within one's control. In so doing, it elevates the importance of self-regulation of attention and the importance of maintaining one's power. At the same time, these six strategies discourage efforts to deflect blame, to place blame on others, or to criticize the environment, all of which are beyond one's control.

By educating our learners on how to use these six strategies outlined above, we empower them to think about how to create and to develop their own mindfulness toolkit. Just as the builder learns how to use the tools in their toolbox through practice, learners need to be encouraged to use these strategies regularly in their daily workplace. The simulation environment can be a safe place to introduce the six strategies for mindfulness. Over time, however, the use of these strategies should be encouraged, reinforced, and celebrated in the workplace.

So, how do we actually incorporate the six strategies of mindfulness into our simulation-based training? Our experience has shown that these strategies can be incorporated into simulations that we already do for other purposes, including emergency response scenarios. For those who facilitate new staff orientations, unit staff meetings, and/or interprofessional team building sessions, these offer ideal settings where mindfulness strategies can be introduced.

In our next column, we will explore practical ways to use these six mindfulness strategies in simulation scenarios. How have you used mindfulness strategies with your learners? If you have, please share with us your successes and challenges. If you have not yet tried incorporating mindfulness, what barriers are standing in the way of you doing so? How interested are you to start incorporating this concept into your simulation training? Please e-mail us at mailto:[email protected] and mailto:[email protected] to continue the conversation. In future columns on this topic series, we will be addressing questions and comments from readers.

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