Mindfulness Practice with Urban Youth: A Nursing Experience

The Mindfulness Journey

I spent 35 years as a nurse in an inner-city setting and was looking for a new challenge. It seemed as if I was in the winter of my career, and I longed for spring, for new growth and creative possibilities.

As a pediatric nurse practitioner (NP) with a master's degree in public health, I had spent the early part of my career in a community health center with other NPs, providing care to inner-city residents in Baltimore. Later, I transitioned to providing care to children in homeless shelters. In both settings, my colleagues and I often incorporated the disciplines of behavioral medicine into our nursing practice, having observed the interplay between mind and body and the effect it had on states of wellness as well as how stress affected the children we served. Mendelson et al. (2010) underscore the negative power of stress on youth:

It was at this point that I was first exposed to the concept of mindfulness through a program for parents offered at one of our support centers. Because I was reluctant to refer parents to a program with which I was unfamiliar, I decided to attend the ongoing sessions. During these group sessions, I experienced the personal benefits of the practice of mindfulness and observed positive responses by the parents. I was a member of the group as we explored the practice of mindfulness. Roles were relinquished; we were on this journey together. As we practiced paying attention to the present moment and developed skills in being attentive and nonjudgmental, I could envision how I might incorporate mindfulness into my work with the children in my care. I began a thorough study of mindfulness.

Exploring the Landscape

Jon Kabat-Zinn, Professor of Medicine Emeritus at the University of Massachusetts, is considered an expert in mindfulness. In 1979, he founded a clinic to relieve physical symptoms related to stress and anxiety; his Mindfulness-Based Stress Reduction program is widely recognized internationally. Kabat-Zinn recognizes mindfulness as having roots in ancient Buddhist practice, describing it as

In addition to clinical settings, mindfulness practices have found their way into business, politics, and education. For example, Chade-Meng Tan, an engineer with Google, developed a mindfulness program called Search Inside Yourself to enhance productivity in the workplace, reduce stress, and deepen self-awareness. The program has been offered to hundreds of Google employees (Tan, 2012). In another instance, Congressman Tim Ryan's recent book, A Mindful Nation (Ryan, 2012), reflects his search for ways to use mindfulness practices to address compelling issues facing our nation.

Mindfulness has also found its way into education. Dr. Amy Saltzman describes mindfulness as a foundation for learning and explores how mindfulness might enhance children's attention and learning and promote compassionate life skills (Saltzman, 2010). Thompson and Gauntlett-Gilbert (2008) discuss the historical development of mindfulness and the evidence of outcomes and ways to modify mindfulness practices for children and adolescents.

My own interest focused specifically on mindfulness and children. Susan Kaiser Greenland, known for her groundbreaking work introducing mindfulness in schools and community-based programs, describes mindfulness for children as “ … the new ABCs of learning: attention, balance, and compassion. By learning both attention skills and a compassionate worldview, children are introduced to tools that could help them live a balanced life” (Greenland, 2010, p. 18). Impressed by her work, I contacted Greenland to discuss the possibility of using mindfulness techniques with homeless children. With her encouragement, I became convinced that mindfulness could find a place in shelters.

Designing a Pilot Program

I suggested piloting a mindfulness program to the director of Marian House, a transitional shelter in Baltimore City. Marian House is a holistic healing community that provides housing and support services to women and children. The staff of Marian House agreed to the pilot program for the children.

Funding the program was the next challenge. I was aware that Mercy Medical Center in Baltimore had an endowment grant designed to fund services for homeless women and children. A proposal was submitted and Mercy Medical Center approved funding for this complementary care program for children. The next steps for the program included networking and consultation with experts in mindfulness and curriculum development. In addition, my research cautioned me to deepen my own mindful practices to teach mindfulness well (Greenland & Goodman, 2009; Hooker & Fodor, 2008). To that end, I attended several training sessions and workshops and continued my personal mindfulness practices.

The pilot program for the children of Marian House was developed using Greenland's mantra as a guide: “Keep it simple. Keep it fun. Keep a sense of humor” (Greenland, 2010, p. 46). Groups were formed with the developmental ages of the children in mind: ages 4–7 and 8–14. Sessions were held weekly for 45 minutes. Because mindfulness is a process as well as a practice, sessions were ongoing.

The curriculum, developed from the research and through conversation with experts in mindfulness, became the guide for the sessions, incorporating various mindfulness practices. Often, however, the children themselves shaped the curriculum by bringing their own experiences and needs to the group. This model sustained their interest and offered the opportunity to apply practices learned in the sessions to their everyday experiences (Thompson & Gauntlett-Gilbert, 2008).

A typical session began by gathering the children in what we called a mind-fulness circle. At the sound of a Tibetan bell, they quieted and became aware of their breathing. This time of stillness was followed by the invitation to share experiences that happened during the past week and to practice mindful listening to each other. Other activities during the session included yoga movements, storytelling, drama, and role-playing. Each session ended with a friendly wish meditation. During this meditative time, the younger children held a stuffed animal and gently rocked it to sleep while the leader suggested friendly wishes they might make for themselves, for someone in their family, and for the world. Older children were invited to place pebbles in a basket and, if comfortable, express their wishes for themselves, others, and the world.

Reflecting on the sessions, documenting the experiences, and consulting with other professionals were helpful. For example, at Marian House I partnered with a licensed child/adolescent therapist in coleading the groups. This strengthened the practices and provided support for both of us as facilitators.

The children at the shelter have experienced multiple transitions. They have doubled up living with relatives and friends and/or have lived on the street or in various shelters. Some have witnessed domestic violence, substance abuse by parents and relatives, and/or the loss of family members to violence. These experiences have created trauma in their lives and contributed to a myriad of feelings. Mindful awareness provides a venue for the children to develop skills and practices to process these feelings.

As the sessions unfolded, the children let us know, either verbally or with their body language, what was helpful and what did not resonate with them. As facilitators, we had to practice mindful listening as well, staying with the moment and paying attention to what the children required.

Assessing the Outcomes

The natural question for any newly developed program is “Did the outcomes match the expectations?” Unfortunately, research in mindfulness programs for children in homeless shelters is scarce because our population is transient and thus the membership of the groups changes. Research on the use of mindfulness with children in schools is under way and although the field is young, the results are encouraging. A study conducted by Saltzman (2010) in collaboration with the Psychology Department at Stanford showed that “ … after one hour of mind-fulness training for eight consecutive weeks the children demonstrated increased ability to orient their attention, as measured by the Attention Network Task, and decreased anxiety” (p. 3).

In our pilot program, we have documented self-reported changes in behavior. After emphasizing breathing, staying in touch with the moment, and not reacting, we elicited comments such as “I wanted to punch him, but I took a breath instead.” During the mindfulness circles, children reported ways in which they had used their weekly assigned practices. During the friendly wish meditation, they verbalized compassion, concern for others, moments of gratitude, and concern for world needs.

Conclusion

There is fertile ground for mindfulness to sprout in our organizations and in our communities. Today's health care environment is turbulent, presenting nurses with multiple stimuli, stress, and interruptions. Nurses in all roles must cope with numerous demands to make timely and accurate decisions. Stress negatively affects the caring relationship and the healing environment and is a major contributor to illness and burnout. Dr. Jean Watson's Caring Theory would suggest that systematic centering exercises and mindfulness practices could influence hospital cultures in a positive way (Watson, 2010). Nurses are challenged to incorporate mindfulness into their everyday lives and into the healing environment they know so well. Nurses can explore mindfulness and find ways to partner with others in finding their place in the mindfulness revolution.