The Architecture of Resilience

The holiday flurry is fading away -- exhale -- leaving us with an opportunity to pause and consider how to be more buoyant in 2014. Could taking a cue or two from our nursing curriculum reinforce your New Year's resolutions to better care for yourself, particularly in easing the stress of busy, everyday challenges?

It just might.

In healthcare, there's a burgeoning understanding that resilient practices -- things like meditation, yoga, reflective writing, deep breathing, even physical exercise -- make for happier, stronger, more centered clinicians. A growing body of evidence supports that fact -- and the way we teach at the University of Virginia reflects it. These very powerful nursing school lessons may just be what a stressed-out world needs -- particularly post-holiday season, when so many are recharging and committing to living more healthfully.

Our determination to weave resilience instruction into our nursing curriculum came several years ago with the creation of our Compassionate Care Initiative -- initially an informal way for nurses, doctors, social workers, chaplains and others to come together to cope with difficulties like death, loss and grief by talking and sharing experiences -- and culminated when the UVA Contemplative Sciences Center was established in 2012.

And these days, resilience has taken on a newer, deeper, more critical meaning. There's greater appreciation for teaching skills to bolster personal resilience and well-being, and that informs the quality, safety and effect of our care, the lessons we impart, the deals we broker -- and the relationships we have. UVA Medical Center's gotten in on the act, as has the Curry School of Education, the Engineering School, the McIntire School of Commerce, the College of Arts and Sciences, the School of Architecture, the Batten School of Leadership and Public Policy -- even the Darden School of Business, as more of us realize the critical role resilience plays in a broad variety of professional contexts.

We already know that stressed out nurses and physicians are more likely to give lackluster care. The same holds true for stressed out teachers, engineers, businesspeople and parents. But tend the caregiver and you'll tend the patient (and the student, the colleague, the business partner and your child), too. We posit that self-awareness, compassion and empathy and resilience are traits that indeed can be taught.

Practice mindfulness and compassion and you'll engage in resilient behaviors. Practice being patient, being kind, being in the moment; practice tuning in and connecting with others and you'll prime and strengthen cognitive circuitry that reinforce such ways of being. Just as exercise and weight training benefits your muscles, your brain's neuroplasticity -- its ability to be malleable - allows us to develop new healthy habits through practice.

Though activities like yoga, deep breathing and meditation are sometimes dismissed with a wave of the hand, in nursing care, we know this knowledge is as critical as book smarts. We also know that resilience practices help human beings across the spectrum cope in powerful, positive, measurable ways.

A plethora of research has already drawn the link. Brain imaging of long-term meditators reveals, in many studies, neural circuitry associated with more focus, less distraction, less emotional reactivity, and a better ability to shrug off distress. New meditators benefit as well. Mindfulness practices introduced over eight weeks to a high stress work environment enabled employees to stay on task longer, eased their distractibility and enabled them to experience less negative emotion, even improving their memories and recall abilities (Levy et al, 2012). Yet another study found that those who were taught to practice mindfulness and compassion meditation over eight weeks were five times as likely to exhibit compassionate behavior, like helping a stranger in need, than those who hadn't practiced meditation (Condon et al, 2013).

The significance and effects of contemplative, resilient practices are so profound that they're increasingly backed by dollars, too. Between 2000 and 2012, the number of peer-reviewed journal articles written on mindfulness, meditation and yoga rose by nearly 2,300 percent, from 21 to 477 (D.S. Black, 2013). Funding from the National Institutes of Health for mindfulness-, meditation- and yoga-related research has skyrocketed over the last dozen years, from just over $9 million in 2001 to more than $48 million in 2012.

Despite all this evidence, some still think the activities we're promoting have a New Age whiff, and that while 'nice' they're not as important as rote understanding, as scientific ability, pure reason and knowledge.

We respectfully beg to differ. With our increasingly complex care environments -- and against the backdrop of a world that often seems punctuated by stress, distractedness and incivility -- there is no substitute for resilience. We can all, each of us, be better versions of ourselves. And during this season of resolutions, we hope you'll slow down, look in, reach out and cultivate healthy habits of heart, mind, and body.

Happy New Year.

Dorrie K. Fontaine is dean of the School of Nursing at the University of Virginia, where Susan Bauer-Wu, the Kluge Professor in Contemplative End-of-Life Care, teaches and directs the Compassionate Care Initiative. David Germano, the director of U.Va.'s Tibet Center and SHANTI, is a professor of religious studies. Bauer-Wu, Fontaine and Germano are members of the University of Virginia's Contemplative Sciences Center directorate.