ICU Nurse ‘Prescribes’ Mindfulness to Help COVID-19 Survivors Cope

Early in the COVID-19 pandemic at IU Health Methodist Hospital in Indianapolis, critical care nurse John Shepard ran into a colleague dressed head-to-toe in personal protective equipment. He was about to enter the room of a COVID patient and looked nervous. Shepard asked him how he was doing.

“He said, ‘John, I’m a nurse and my wife’s a nurse. We have three small children, and we’re just waiting to find out which one of us is going to bring this home,'” Shepard remembers. “Tears welled up in his eyes.”

That moment has stayed with Shepard, who, as the hospital’s mindfulness program manager, has strived to help reduce the psychological effects of the crisis on the hospital’s workers and patients. As the pandemic has persisted over the last few months, he has introduced mindfulness techniques and meditation to providers and staff and led popular “Yoga in Scrubs” sessions around the hospital. At the same time, he has created programs to address the unique mental health issues of patients who have been dangerously ill with COVID-19 and continue to suffer even after their bodies have healed.

[Read: Her Young Patient Got the First COVID-19 Double-Lung Transplant in the U.S.]

Shepard’s path to his pandemic response actually started six years ago, when as a 10-year veteran of the intensive care unit, he began to feel symptoms of burnout. “I was bringing work home and thinking about it, and I had trouble sleeping,” he says. “I realized I needed to do something. I loved my work but this was getting in the way.”

He started meditating to reduce his stress levels. Eventually he brought the practice to the hospital campus with the idea of helping others reduce the effects of work stress. “I’d set up about 15 minutes before the start of a shift,” Shepard says. “And others started joining in.” Before he knew it, medical residents, therapists, nurses and doctors were also participating in his guided meditations.

Shepard was recognized for his initiatives in 2018 with a National Magnet Nurse of the Year Award by the American Nurses Credentialing Center. After that, the hospital sent him for mindfulness training and charged him with establishing a Center for Mindful Practice at the hospital. “I try to find creative ways to bring this to the bedside,” he says.

[Read: COVID-19: ‘Seared Into My Brain.’]

Now COVID-19 has put these efforts to the test. Shepard often rounds on his own, looking for opportunities to teach a stress-relieving or mindfulness technique or gather people to practice yoga poses.

“I lean on my clinical experience to know when it’s a good time and when it’s not,” Shepard says. “I get anywhere from four to as many as 26 people at these ‘pop-ups.’ I always try to end with some laughter yoga. While there’s nothing funny about any of this, laughing is good for the respiratory system. As I walk away, I hear laughter in the background. That’s enough to tell me that I am on the right track.”

Helping COVID-19 Survivors Cope

Crucially, Shepard has also developed resources for patients who have survived long-term battles with COVID-19. “After patients have been in the ICU for anywhere from as little as three days on a ventilator, delirium can start to set in,” he says. “Research shows that patients can suffer from symptoms of PTSD (post-traumatic stress disorder) for two years after that.” Given the amount of time that some COVID patients spend in the ICU, the emotional aftereffects, such as anxiety and depression, may be even more dire for them, he says.

Through the Critical Care Recovery Center that Shepard established, he and a multidisciplinary team of chaplains, pharmacists and other practitioners focus on helping COVID patients who suffer from “post ICU syndrome.” Patients start coming in about 30 to 60 days after they are discharged, allowing them time to go through rehabilitation. “We will see them for another 60 to 90 days,” Sheppard says. “We try to help them make sense of what has happened to them.”

One 30-year-old patient who recently came to the center had been in the ICU for 18 days. “It was amazing to see how well he was and how eager he was to get back to work,” Shepard says. “But he was also having trouble with the fear of COVID coming back and having to go through it again. He worried that he not could survive it again.” As a result, the patient was waking up in the middle of the night and having trouble falling back to sleep.

[Read: HERO Registry Doctor Studies the Toll of COVID-19 on Health Care Workers.]

Shepard “prescribed” several practices, including a breathing technique known as 4-7-8, which entails breathing in for a count of four, holding the breath for seven counts, and then exhaling for eight counts. “It disengages the sympathetic nervous system and re-engages the parasympathetic and allows the body to drift off,” he says. The COVID patient is now doing better.

Shepard is hopeful that his work will have a lasting impact. “The thing that concerns me the most is the silent toll that this is having on all of us, especially health care workers. And health care workers are notorious for not looking after themselves,” he says. “If we get hit with another wave of COVID, we need health care workers to take care of everybody else for the long haul. But we have to take care of ourselves first.”

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