The Hershel “Woody” Williams Veterans Administration Medical Center, Huntington, W.Va., uses whole-health-oriented care to maximize the quality of life and functioning of the veteran patients it serves and the staff who serve them. Whole health is personalized, proactive, patient-driven care. It is a healthcare approach that empowers and equips people to take charge of their health and well-being and live life to the fullest extent. It goes beyond focusing only on a patient’s presenting symptoms to focusing on their values, aspirations and goals for well-being.
Incorporating the high-reliability organization concepts of continuous improvement, a commitment to resilience and ongoing learning, with the military ideals of adapting, improvising and overcoming, the medical center’s administrative and mental health leadership sought ways to help relieve the effects of COVID-19-related stress on its patients and staff. One way they are doing that is by offering the evidence-based practice of mindfulness meditation.
What Is Mindfulness Meditation?
Mindfulness meditation is a holistic approach that benefits mental and physical health and improves coping. It focuses on nonjudgmental awareness and efforts to get out of a painful past and a worrisome future and into the precious present. Mindfulness entails getting out of our heads and into our bodies, taking time to just be—not to always be in “must-do” mode. The practice involves learning to turn toward and face pain, stress and suffering by holding these hard things in one hand, which frees up the other hand to count our blessings and have gratitude for the gifts in our lives.
Research shows mindfulness practices can improve quality of life and the ability to deal with stress. Mindfulness meditation causes positive brain changes in the hippocampus that affect learning and memory, according to the article “Mindfulness practice leads to increases in regional brain gray matter density,” which appeared in the January 2011 issue of Psychiatry Research. The article’s lead author, Sara W. Lazar, PhD, with Massachusetts General Hospital and Harvard Medical School, writes that besides changes that could be measured neurologically, individuals who practiced mindful meditation reported subjective perceptions of improvement in terms of experiencing less anxious thoughts and feelings. The article is one of the first to cover the topic of mindfulness. Others have since been published, including “Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis,” in a 2017 issue of Clinical Psychology Review.
Patients First
Initial efforts started in 2012 with mindfulness groups for patients enrolled in the Psychosocial Rehabilitation and Recovery Center at this VA medical center. The PRRC is a mental health program for veterans with severe mental illnesses that offers a curriculum of psychoeducational and support groups to help veterans recover by learning coping skills and tools to live a full life consistent with their values and preferences. Mindfulness groups helped to expand the repertoire of coping skills for veterans in the program.
Team members presented mindfulness meditation as a secular practice and coping skill that can improve quality of life and the ability to handle stress. Centered on controlling and observing breathing, patients slow down, reduce or shut off fight-or-flight chemicals, release relaxing and renewing endorphins, and put things in perspective, according to Lazar’s research. This is not an escape; it is a timeout to regroup and then dig back into life and work. Patients were encouraged to assume a nonjudgmental, curious and self-compassionate attitude toward themselves.
Techniques such as progressive muscle relaxation (a step-by-step focus on various parts of the body and bodily sensations) and visualization (using the imagination and mindful focus to acknowledge hard things while making a conscious effort to pay attention to positive things) can improve one’s overall outlook, according to the 2021 study “Effectiveness of Progressive Muscle Relaxation, Deep Breathing and Guided Imagery in Promoting Psychological and Physiological States of Relaxation,” which appeared in Evidence Based Complementary Alternative Medicine.
These groups were consistently attended, and veterans reported high satisfaction. In addition, a peer specialist, who is both a patient and employee, offers mindfulness groups to patients receiving other mental healthcare services. During health training sessions for employees, the peer specialist also shares his story about how mindfulness has helped him.
Each quarter, using survey tools developed by the National Program Evaluation Center, veterans in the Psychosocial Rehabilitation and Recovery Center rate their satisfaction with the various services they received. In general, veterans record high satisfaction with PRRC services 98% of the time. In addition, at the end of the 12-week semester, veterans are asked to vote for classes they want to repeat. Mindfulness groups are consistently rated as one of the top five groups (out of 30 offerings). In addition, most veterans who participated in the mindfulness classes and who had a regular meditation practice (a minimum of five minutes per day) self-reported a higher quality of life and an improved ability to cope with stress.
It should be noted that many veterans were initially ambivalent or reluctant to engage in mindfulness meditation. There was a lack of awareness about the practice and how it works. Several possible reasons for this unfamiliarity include a lack of experience and awareness, particularly in Appalachia (The Huntington VA services veterans in a service area that includes 10 counties in West Virginia, two counties in southern Ohio and 12 counties in eastern Kentucky), about what this practice is (a secular practice), what it is not (a religious practice) and how it works. However, once veterans tried the mindfulness groups, most found the practice to be extremely helpful.
Staff Next
Encouraged by these results, the local recovery coordinator formed a small team in 2020, including a peer specialist and psychologist, to present mindfulness meditations to employees every Monday morning in a virtual setting. The 24 staff who attended these sessions reported either a mild or moderate improvement in their ability to cope with stress and an improved quality of life.
The team has since extended the invitation to employees at other VA medical centers in their regional network. Plans include putting links to these sessions on the national VA Employee Assistance Program and Whole Health Program calendars.
Lessons Learned
The team used patient and staff feedback to identify lessons learned:
- A thorough assessment of interest in and awareness of mindfulness meditation is an important first step. Plan promotional activities accordingly. Encourage patients and staff who are unfamiliar with mindfulness meditation, but are open to it, to try it out.
- Potential mindfulness meditation providers need the skills and experience to practice mindfulness meditation themselves, so they can teach it to others.
- It is important to communicate that mindfulness meditation does not take the place of needed or necessary medical or mental healthcare.
- Mindfulness meditation is a tool that requires frequent practice to be effective. A minimum of five minutes per day is the suggested frequency that leads to benefit from mindfulness meditation, with more benefit shown as more time is applied, according to research at The Chicago School of Professional Psychology conducted by Amy Lam, PhD; Sean Sterling, PhD; and Edward Margines, PhD (published in the Journal of Psychology & Clinical Psychiatry, March 26, 2015).
- Although employees often multitask when attending training, mindfulness meditation requires their full attention. Finding a good time for many employees to attend with their undivided attention can be challenging.
A Practical and Powerful Tool
Mindfulness meditation can be a practical and powerful tool for helping patients and employees cope with stress and improve their quality of life. The practice effectively promotes increased engagement and self-care.
Offering this kind of support to patients and staff, especially during stressful times, is consistent with the ideals of high reliability and whole health. Veterans and staff at Hershel “Woody” Williams Veterans Administration Medical Center now have another choice to assist in optimizing their health and well-being.
Mary-Ellen Piche, LFACHE, CPHQ, is a high-reliability organization leader coach, Cognosante, Albany, N.Y. (picheme@gmail.com). Charles Weinberg, BCD, LICSW, is a local recovery coordinator/ employee assistance program coordinator, Hershel “Woody” Williams VA Medical Center, Huntington, W.Va., a licensed, independent, clinical social worker and a board-certified diplomate in clinical social work with the American Board of Clinical Social Work (charles.weinberg@va.gov).
