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Healing the healers

February 18, 2021

ASU poetry project aims to help health care workers de-stress amid pandemic

Sometimes, when you’re stretched to the limit and you think you can’t go on, all it takes to bring you back to a state of equilibrium is a calming voice — and a little poetry.

Arizona State University English Professor Mark Lussier knows this well. For several years he has been researching the use of literature as medicine, and what his work, and the work of colleagues he has collaborated with along the way, has shown is that there is real evidence behind its efficacy.

Now, in the midst of a pandemic, Lussier and others are taking what they’ve learned about the healing power words can have for patients and turning it toward front-line health care workers. “Equipment for Living” is a series of videos in which ASU professors slowly and purposefully read aloud one of their favorite poems as the words scroll across a backdrop of soothing imagery — think ASMR, but elevated.

The project came into being after a conversation between Lussier and longtime collaborator Alison Essary, a faculty associate at ASU who serves as the Scrivner Family Director of HonorHealth’s research, quality improvement and patient safety program.

“She reached out to me and just sort of said, ‘Mark, I'm here at the hospital, and I'm in charge of people coming off of these long, challenging shifts. Is there anything we can do to reduce their stress?’” Lussier recalled. “And I told her, ‘I feel like we need to get the band back together and figure out something that we can do.’”

Based on previous research they had conducted, including that which resulted in a 2014 white paper titled “The Necessity of Narrative: Linking Literature and Health Care in Higher Education Curricula,” the pair knew bibliotherapyBibliotherapy is a creative arts therapies modality that involves storytelling or the reading of specific texts with the purpose of healing. It uses an individual's relationship to the content of books and poetry and other written words as therapy. could be an effective therapeutic tool. And based on research conducted by another of Lussier’s frequent collaborators, Sir Jonathan Bate, an ASU Foundation Professor of Environmental Humanities and founder of ReLit: The Bibliotherapy Foundation, they knew he’d be the perfect addition to round out their “band.”

The trio drew on current and past work and personal experiences to come up with the idea for “Equipment for Living.”

In her role at HonorHealth, Essary has been entrenched in the thick of the pandemic for the past year, watching firsthand as health care and other essential workers come off 18-hour shifts with lines marking their faces and noses red from both personal protective equipment and tears.

“It’s the clinicians, it’s the people in environmental services, it’s the people in food services. It’s literally everybody across the system who is bearing the burden,” she said. “I don’t think any of us thought that it would take us this long to wrap our heads and arms around the pandemic.”

Lussier remembers working long, overnight shifts as a supervisor at a hospital in Houston during his days as a pre-med student. The stress of it all is why he switched to studying the humanities.

“My job was to go into rooms and tell people that their loved ones had just died,” Lussier said. “The humanities are much better for that.”

His work since then has been inspired by the ideas of American literary theorist Kenneth Burke, who posited in his essay “Literature as Equipment for Living” that “art forms (could) be treated as equipment for living.” 

“His idea was that there is a use value to literature,” Lussier explained. “We tend to think it's more like a pleasure principle. We read novels because they take us away and we read poetry because it can inspire us. And all of that is true, but Kenneth Burke thought that one of the things that is underappreciated about literature is that it also has a type of medical component in that it can be used to ease stress in situations of suffering.”

Video: Yeats' "The Lake Isle of Innisfree" read by Sir Jonathan Bate. Courtesy of ASU's Department of English.

Bate thought so too, strongly enough that the bibliotherapy foundation he founded with his wife and research partner Paula Byrne was uniquely devoted to the idea that poetry is “a great tool in the kit of a mental health practitioner.”

Together, Bate and Byrne conducted an experiment with students from the University of Oxford, where Bate was a professor at the time. One group of students were given mindfulness and meditation exercises to deal with stress and anxiety. Another group were asked to read a poem in response to stress and anxiety. And a third group were given nothing. Throughout the duration of the experiment, the students filled out mental health questionnaires to assess their sense of well-being.  

“The results were very interesting,” Bate said. “It was quite clear that poetry and mindfulness were effective, but the placebo group did not record any improvements in their sense of mental health or well-being.”

Another experiment they conducted involved using a pulse oximeter to measure the heart rate of high-level offenders in response to having poetry read aloud to them.

“We saw these hardened criminals, many serving life sentences in a harsh prison environment, and as they listened to poetry, we could see their pulse slow down,” Bate said.

He was the first to record an installment for “Equipment for Living,” for which he chose to read the William Butler Yeats’ poem “Lake Isle of Innisfree.” In the recording, the words of the poem scroll slowly over an image of a boat softly rocking on the water as they describe absconding to a lakeside cabin for a bit of R&R.

“A poem can be a place where we go to de-stress,” Bate said. “Carefully, slowly and preferably aloud, reading a poem can do the same kind of work for us mentally as mindfulness and meditation. It takes you out of yourself, the same way looking at a beautiful landscape painting can transport you to another place. The imagery of poetry can work on the human imagination to displace negative thoughts caused by life stressors and transport us to a better, calmer, happier place.”

After watching the video, Essary shared it with her colleagues. She looks forward to sharing more as they are recorded, which Lussier and other ASU professors, including Alberto Rios and Sally Ball as well as Lussier’s wife and “permanent research partner” Marcia, are hard at work on.

“We really just wanted to help in any way we could, and also say thank you,” Lussier said of his hopes for how health care workers will respond. “Whether you like poetry or not, thanks for everything you do.”

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Finding peace in the ER

Burnout is common among nurses. An ASU dean says mindfulness can help.
June 7, 2018

ASU College of Nursing Dean Emerita Teri Pipe on how mindfulness can prevent health provider burnout and improve patient outcomes

We count on nurses for a lot of things — to be a calming presence, a helping hand, a source of knowledge. Filling those roles is demanding enough, and with the added pressure of a nursing shortage on the horizon, already tired, overworked RNsregistered nurses may not be getting a break any time soon.

As dean emerita of ASU’s College of Nursing and Health Innovation, Teri Pipe knows all about burnout in the health care field. As the director of ASU’s Center for Mindfulness, Compassion and Resilience, she also knows about a potent antidote.

For Pipe’s final project for her Robert Wood Johnson Executive Fellowship, she created a video featuring nurses telling stories of how they used the practice of mindfulness to help them through difficult situations. “In the Moment: Stories of Mindfulness in Nursing” was recently accepted to the National Academy of Medicine’s new art collection on clinician well-being and resilience.

ASU Now asked her to share more of her insights about the practice and how it is beneficial for both nurses and patients alike.

ASU nursing dean Teri Pipe headshot

Dean of ASU's College of Nursing and Health Innovation Teri Pipe

Question: What does mindfulness in the health care field look like? How is it practiced?

Answer: In health care, mindfulness at its best is often practiced as a focused presence between the health care provider and the patient. Mindfulness is focused awareness to what is happening for that particular patient in the moment; it is linked with patient safety and quality of care because providers are able to filter out unimportant distractions and care for the patient. It is an unhurried, empathetic way of being with someone, listening carefully not only to the words that are said, but also to the underlying meaning and emotional tone. 

Q: How is the practice of mindfulness beneficial to nurses and other health care providers?

A: Mindfulness can be an excellent way of preventing and addressing burnout, exhaustion and compassion fatigue. By focusing on the present moment, nurses and other health-care providers can keep the mind from being pulled to the past (rumination, depression) or the future (worry, anxiety) and stay focused on the reality of the present. In this way, people are more able to live by design rather than by default, making more considered choices rather than simply reacting automatically. Once an individual learns to practice mindfulness, it is often the case that they feel more “awake” and alert to all of life, personally as well as professionally.

Q: Can it also be beneficial to patients?

A: Patients often face uncertainty, fear and pain. Mindfulness can’t change the situation, however it can help change the response to the situation, which turns out to be quite powerful. When patients practice even a few minutes of focused breath awareness or a mental scan through the body, they often feel calmer and less likely to create a cognitive narrative of what is happening. By staying with what is real and true in the present moment, the anxiety of the future and the regret of the past are less powerful, and the patient can more effectively allocate attention and energy to what is actually true. They are able to shape their experience a bit more.

I once taught a mindfulness class to a group of patients with cancer. One of the gentlemen was receiving daily radiation treatments, so he decided that instead of just lying passively on the radiation table, he would use his treatment time as his meditation practice time. He said it totally changed his experience into one of active, well-being supportive attention rather than feeling like something was being done “to” him. His situation didn’t change, but his experience of it did. He showed up so differently that his health care team actually remarked on the difference!

Q: Why is the practice of mindfulness gaining traction in the health care field?

A: Jon Kabat-Zinn brought mindfulness to patients at UMass Medical Center as early as 1979, and his eight-week training program, Mindfulness Based Stress Reduction, is the gold standard in terms of the emerging research in the area of mindfulness and health. Mindfulness practice for nurses, physicians, veterinarians and other health-care professionals is being more widely recognized as a preventive strategy for anxiety, depression and suicidal thoughts. The rate of burnout, depression and suicide in these sectors is high and receiving more attention than in the past. The Institute for Healthcare Improvement recently published an entire module in their Open School about mindfulness in health care, including the link between mindfulness and patient safety and mindfulness and workforce burnout prevention.

Q:  How is ASU’s College of Nursing and Health Innovation incorporating mindfulness into its philosophy?

A: The college leadership has implemented mindfulness practices in some meetings and in individual classes. There is a CONHICollege of Nursing and Health Innovation major in integrative health that has a component of mindfulness, but mostly the integration of mindfulness depends a lot on the individual faculty member. We want to make mindfulness an opportunity, but not a mandated approach. Like many innovations, it is best met with an open mind and healthy skepticism, and it is a very personal practice. Across ASU we are finding that faculty are integrating mindfulness practices into courses in most disciplines, including health, engineering, design, dance, psychology, sustainability and athletics. It is relevant to virtually any field.

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