Improving the Cognitive Health of Nurses (and Clients)

How can we improve the cognitive health of our clients, and ourselves as nurses?

The systematic review and meta-analysis by De Vibe et al. (2017) suggests that mindfulness-based stress reduction (MBSR) influences participants’ mental health, quality of life, somatic health and social functioning.

This review proposes that 21% of MBSR program participants can expect to have an improved mental health outcome than if they were to have ‘usual treatment’ or were ‘wait-listed’ (De Vibe et al, 2017).

What is Mindfulness-Based Stress Reduction (MBSR)?

Liu, Sun and Zhong (2017) describe mindfulness practices in MBSR as often including ‘meditations, body scanning and yoga.’

Liu et al. (2017) have written a protocol for an MBSR intervention for carers of people with dementia. It is suggested that this intervention may alleviate the carer’s worries and ruminations often felt by healthcare professionals.

This is achieved by promoting acceptance, stress-management and being mindful of the present moment.

Stress in Nursing

With stress in nursing being a contemporary issue (Sarafis et al. 2016), it is evident that nurses should consider ways to minimise stress and optimise their wellbeing.

Sarafis et al. (2016) highlight that stress related to nursing is connected to a poor quality of life, and may in turn affect client health outcomes.

Stress in nursing does not appear to be a new issue.

NSW Health and NSW Nurses’ Association supported a guide (Brunero et al, 2006) for nurses to manage their stress over a decade ago ( see: http://www.health.nsw.gov.au/nursing/Publications/stress-mngt.pdf)

Nurses’ stress is linked to:

• Issues related to death
• Interactions with families and clients
• Staff conflict (e.g. with supervisors)
• ‘Uncertainty about the therapeutic effect’
• Conflict with supervisors affected mental health
• ‘Discrimination stress factor’ affected quality of life and physical health

(Sarafis et al. 2016)

Other Strategies for Improving Mental Health

Mayo-Wilson and Montgomery (2013) explain that ‘anxiety disorders are the most common mental health problems.’

Despite this, there appears to be insufficient access to interventions (Mayo-Wilson & Montgomery, 2013).

Whilst it is proposed that professional help in the form of face-to-face CBT (cognitive behavioural therapy) with a competent psychologist is more effective than self-help, self-help interventions could still help people with anxiety disorders that do not want to or cannot access professional help (Mayo-Wilson & Montgomery, 2013).

Mayo-Wilson and Montgomery (2013) highlight that anxiety disorders are unlikely to be entirely resolved without intervention. Hence, it could be concluded that clients and/or nurses experiencing anxiety disorders should consider seeking professional help from a psychologist skilled in CBT to work towards reducing negative experiences related to anxiety.

Exercise and Cognition

It is believed that exercise may be beneficial for the cognition of children and older adults (however, a study  by Erickson et al (2015) also highlighted a need for more RCTs (randomised controlled trials) to investigate this phenomenon further.)

‘Higher fit and more physically active older adults show greater hippocampal, prefrontal cortex, and basal ganglia volume, greater functional brain connectivity, greater white matter integrity, more efficient brain activity, and superior executive and memory function.’

(Erickson et al. 2015)

Kennedy et al. (2017), similarly to Erickson et al., state that regular physical activity can improve cognition. Furthermore, they convey that exercise may slow cognitive ageing processes and lessen the risk of dementia (including Alzheimer’s disease).

Kennedy et al. (2017) also acknowledge that there is a need for future research to investigate the reasons for these phenomena.

It is also important to note that hydration influences cognition (Casals Vazquez et al, 2015). The review by Casals Vazquez et al. (2015) showed that overall dehydration impaired cognition of athletes.

Although this finding was focused on athletes, it can serve as a reminder to nurses and clients to remain hydrated to optimise their cognitive performance.

For nurses, in particular, this information may be important for promotion of client safety. Nursing as already described can be a stressful occupation. It is important for nurses to engage in self-care to provide better client care.

Weight and Cognition

Interestingly, in a meta-analysis by Veronese et al (2016), improved cognition resulted from weight loss. Specifically, this improved cognitive effect related to better attention and memory (Veronese et al, 2016). Therefore, people that are overweight or obese could consider having further medical evaluations done by health professionals to check if intentional weight loss is a suitable goal for them. This could potentially result in improved cognition, as per the study by Veronese et al (2016).

Activity

Before finishing this article, you may want to engage in the following cognitive game:

(A) Create a phrase utilising the letters of your name, e.g.:

• Management of
• Adult
• Dehydration involves
• Electrolyte monitoring,
• Likely
• Intravenous fluids,
• Neurological assessments and
• Examination

References

• Casals Vazquez, C., Vazquez Sanchez, M. A., Casals Sanchez, J. L. & Suarez-Cadenas, E. (2015). Dehydration, cognitive and skill performance in sport. Systematic review. Retrieved 18/4/18 from http://www.redalyc.org/pdf/3092/309243334026.pdf
• De Vibe et al. (2017). Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta-analysis. Campbell systematic reviews. 2017, 13 (11). 10.4073/csr.2017.11 Retrieved 18/4/18 from https://brage.bibsys.no/xmlui/handle/11250/2486975
• Erickson, K. I., Hillman, C. H. & Kramer, A. F. (2015). Physical activity, brain, and cognition. Retrieved 18/4/18 from https://www.sciencedirect.com/science/article/pii/S2352154615000157
• Kennedy, G., Hardman, R. J., Macpherson, H., Scholey, A. B., & Pipingas, A. (2017). How Does Exercise Reduce the Rate of Age-Associated Cognitive Decline? A Review of Potential Mechanisms. Journal of Alzheimer’s Disease, vol. 55, no. 1, pp. 1-18, 2017. Retrieved 18/4/18 from https://content.iospress.com/articles/journal-of-alzheimers-disease/jad160665
• Liu Z, Sun YY, Zhong BL. Mindfulness-based stress reduction for family carers of people with dementia (Protocol). Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD012791. DOI: 10.1002/14651858.CD012791.
• Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD005330. DOI: 10.1002/14651858.CD005330.pub4.
• Sarafis et al. (2017). The impact of occupational stress on nurses’ caring behaviors and their health related quality of life. Retrieved 18/4/18 from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-016-0178-y
• Veronese et al. (2016). Weight loss is associated with improvements in cognitive function among overweight and obese people: A systematic review and meta-analysis. Retrieved 18/4/18 from https://www.sciencedirect.com/science/article/pii/S0149763416303542