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Merrigan JJ, Klatt M, Quatman-Yates C, Emerson A, Kronenberg J, Orr M, Caputo J, Daniel K, Summers R, Mulugeta Y, Steinberg B, Hagen JA. Incorporating biofeedback into the Mindfulness in Motion Intervention for health care professionals: Impact on sleep and stress. Explore (NY) 2024; 20:103022. [PMID: 38981179 DOI: 10.1016/j.explore.2024.103022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 06/16/2024] [Accepted: 06/22/2024] [Indexed: 07/11/2024]
Abstract
CONTEXT Health care providers (HCP) experience high stress and burnout rates. Mindfulness Based Interventions (MBI) with biofeedback may help improve resiliency but require further research. DESIGN AND STUDY PARTICIPANTS Aims were to evaluate changes in sleep patterns, nocturnal physiology, stress, mood disturbances, and perceived experience with biofeedback during the Mindfulness in Motion (MIM) intervention. Data from 66 HCP were included after removing those below 75 % compliance with wearable sensors and wellness surveys. Participants were enrolled in MIM, including eight weekly one-hour virtually delivered synchronous group meetings and ∼10 min of mindfulness home practice at least 3 times per week using a mobile application. Participants wore wearable sensors to monitor sleep and nocturnal physiology and completed short daily stress and mood disturbances. RESULTS According to mixed effect models, no sleep nor physiological metrics changed across MIM (p > 0.05). More time was spent in bed after MIM sessions (8.33±1.03 h) compared to night before (8.05±0.93 h; p = 0.040). Heart rate variability was lower nights after MIM (33.00±15.59 ms) compared to nights before (34.50±17.04 ms; p = 0.004) but was not clinically meaningful (effect= 0.033). Significant reductions were noted in perceived stress at weeks 3 through 8 compared to Baseline and lower Total Mood Disturbance at weeks 3, 5, 6, and 8 compared to Baseline (p < 0.001). CONCLUSIONS Participating in the MIM with mobile applications and wearable sensors reduced perceived stress and mood disturbances but did not induce physiological changes. Additional research is warranted to further evaluate objective physiological outcomes while controlling for confounding variables (e.g., alcohol, medications).
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Affiliation(s)
- Justin J Merrigan
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, OH, USA.
| | - Maryanna Klatt
- Center for Integrative Health, Department of Family and Community Medicine, College of Medicine, Columbus, OH, USA; Gabbe Health and Wellbeing, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
| | - Catherine Quatman-Yates
- School of Health and Rehabilitation Sciences, Division of Physical Therapy, The Ohio State University, Columbus, OH, USA.
| | - Angela Emerson
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, OH, USA
| | - Jamie Kronenberg
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, OH, USA
| | - Morgan Orr
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, OH, USA
| | - Jacqueline Caputo
- Center for Integrative Health, Department of Family and Community Medicine, College of Medicine, Columbus, OH, USA
| | - Kayla Daniel
- Center for Integrative Health, Department of Family and Community Medicine, College of Medicine, Columbus, OH, USA
| | - Riley Summers
- School of Health and Rehabilitation Sciences, Division of Physical Therapy, The Ohio State University, Columbus, OH, USA
| | - Yulia Mulugeta
- Center for Integrative Health, Department of Family and Community Medicine, College of Medicine, Columbus, OH, USA
| | - Beth Steinberg
- Center for Integrative Health, Department of Family and Community Medicine, College of Medicine, Columbus, OH, USA; Gabbe Health and Wellbeing, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Joshua A Hagen
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, OH, USA; Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA.
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Ong NY, Teo FJJ, Ee JZY, Yau CE, Thumboo J, Tan HK, Ng QX. Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis. Gen Psychiatr 2024; 37:e101115. [PMID: 38737894 PMCID: PMC11086195 DOI: 10.1136/gpsych-2023-101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/07/2024] [Indexed: 05/14/2024] Open
Abstract
Background Growing evidence attests to the efficacy of mindfulness-based interventions (MBIs), but their effectiveness for healthcare workers remains uncertain. Aims To evaluate the evidence for MBIs in improving healthcare workers' psychological well-being. Methods A systematic literature search was conducted on Medline, Embase, Cumulative Index for Nursing and Allied Health Literature, PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords 'healthcare worker', 'doctor', 'nurse', 'allied health', 'mindfulness', 'wellness', 'workshop' and 'program'. Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion. R V.4.0.3 was used for data analysis, with the standardised mean difference as the primary outcome, employing DerSimonian and Laird's random effects model. Grading of Recommendations, Assessment, Development and Evaluation framework was used to evaluate the quality of evidence. Cochrane's Risk of Bias 2 tool was used to assess the risk of bias in the included studies. Results A total of 27 studies with 2506 participants were included, mostly from the USA, involving various healthcare professions. MBIs such as stress reduction programmes, apps, meditation and training showed small to large effects on anxiety, burnout, stress, depression, psychological distress and job strain outcomes of the participants. Positive effects were also seen in self-compassion, empathy, mindfulness and well-being. However, long-term outcomes (1 month or longer postintervention) varied, and the effects were not consistently sustained. Conclusions MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers. The review also highlights limitations such as intervention heterogeneity, reduced power in specific subgroup analyses and variable study quality. PROSPERO registration number CRD42022353340.
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Affiliation(s)
- Natasha Yixuan Ong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Finn Jing Jie Teo
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jane Zi Ying Ee
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Julian Thumboo
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Health Services Research Unit, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Hiang Khoon Tan
- Singhealth Duke-NUS Global Health Institute, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Takhdat K, Rebahi H, Rooney DM, Ait Babram M, Benali A, Touzani S, Lamtali S, El Adib AR. The impact of brief mindfulness meditation on anxiety, cognitive load, and teamwork in emergency simulation training: A randomized controlled trial. NURSE EDUCATION TODAY 2024; 132:106005. [PMID: 37944276 DOI: 10.1016/j.nedt.2023.106005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Emergency simulation training may impose a heavy psychological burden on health professions students (HPS), evoking anxiety, and overwhelming their cognitive load. Mindfulness may have a positive impact on HPS' anxiety, cognitive load, and teamwork during simulation training. The effects of integration of a brief pre-briefing mindfulness meditation (MM) practice into emergency simulation training, on anxiety, cognitive load, and teamwork remain understudied. METHODS From November 2021 to June 2022, 70 undergraduate HPS participated in this pilot randomized controlled study. Participants were randomly assigned to the experimental group (EG, n = 24) that completed a brief in-person mindfulness meditation training program (MMTP) (2 h/week during 4 weeks) or a control group (CG, n = 46). Each group was comprised of teams (2 medical students and 1-2 nursing students). Measures of anxiety, mindfulness, cognitive load, and teamwork were collected at 4-time points: baseline, after the completion of the brief MMTP (for the EG only), at the first simulation assessment within one month later, and the second (6-month follow-up) simulation assessment. Student's t and Wilcoxon Mann-Whiney tests were used to compare the groups' measures and changes over time. A one-way repeated measures ANOVA was conducted to assess anxiety and mindfulness scores' changes over time among EG participants. RESULTS 52 participants completed all time-point assessments. EG participants recorded better state-anxiety, cognitive load, and teamwork scores than the CG participants in both simulation assessments. However, no statistically significant differences were recorded between the EG and the CG in trait-anxiety and mindfulness at the 6-month follow-up assessment. CONCLUSION Brief pre-briefing MM practice mitigates HPS' state-anxiety, and promotes cognitive load, and teamwork during emergency simulation training. Simulation instructors should consider MM practice in the emergency healthcare simulation instructional design.
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Affiliation(s)
- Kamal Takhdat
- Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco; Higher Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco.
| | - Houssam Rebahi
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, 40000 Marakesh, Morocco
| | - Deborah M Rooney
- University of Michigan Medical School, Ann Arbor, MI, United States
| | | | - Abdeslam Benali
- The Research Team on Mental Health, Faculty of Medicine of Marrakesh, Morocco
| | - Saad Touzani
- Touzani Center for Training and Consulting, Marrakesh, Morocco
| | - Saloua Lamtali
- High Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco
| | - Ahmed Rhassane El Adib
- Marrakesh Simulation and Innovation in Health Sciences Center, Faculty of Medicine and Pharmacy, Marakesh, Morocco
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Ahn BT, Maurice-Ventouris M, Bilgic E, Yang A, Lau CHH, Peters H, Li K, Chang-Ou D, Harley JM. A scoping review of emotions and related constructs in simulation-based education research articles. Adv Simul (Lond) 2023; 8:22. [PMID: 37717029 PMCID: PMC10505334 DOI: 10.1186/s41077-023-00258-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows. METHODS The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses. RESULTS A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence. CONCLUSIONS Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.
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Affiliation(s)
| | | | - Elif Bilgic
- Department of Surgery, McGill University, Montreal, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
- McMaster Education Research Innovation and Theory (MERIT) program, Hamilton, Canada
| | - Alison Yang
- Department of Surgery, McGill University, Montreal, Canada
| | | | - Hannah Peters
- Department of Surgery, McGill University, Montreal, Canada
| | - Kexin Li
- Department of Surgery, McGill University, Montreal, Canada
| | | | - Jason M Harley
- Department of Surgery, McGill University, Montreal, Canada.
- Research Institute of the McGill University Health Centre, Montreal, Canada.
- Institute for Health Sciences Education, McGill University, Montreal, Canada.
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada.
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5
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Minichiello V, Webber S. Resident Physician Perspectives on Mindfulness Education in Residency: A Multispecialty Qualitative Assessment of Clinical Care Impact. J Grad Med Educ 2023; 15:356-364. [PMID: 37363667 PMCID: PMC10286909 DOI: 10.4300/jgme-d-22-00492.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/18/2022] [Accepted: 03/27/2023] [Indexed: 06/28/2023] Open
Abstract
Background Mindfulness training positively influences residents personally and professionally. Routine integration into residency may be impacted by limited understanding of the ways in which mindfulness training enhances clinical care. Objective We explored residents' direct experience and personal application of mindfulness in their clinical work following 10 hours of mindfulness training. Methods Mindfulness training sessions were facilitated between 2017 and 2019 for 5 groups of residents: pediatrics, ophthalmology, postgraduate year (PGY)-1 anesthesiology, and 2 different years of PGY-1 family medicine residents. Training was integrated into resident protected didactic time and attendance was expected, although not mandated, with the exception of pediatrics, in which the department mandated the training. Qualitative evaluation was conducted using a voluntary, semi-structured, de-identified phone interview within 2 months post-training. Reviewers independently coded the transcripts and then dialogued to reach consensus around emergent themes. Results Thirty-six of 72 residents (50%) who participated in the training completed interviews. Themes were similar across specialties. All residents acknowledged the potential usefulness of mindfulness training during residency. Six residents (17%) reported they had not applied the mindfulness training to their daily work by the end of the course. There were 4 emergent themes related to clinical application of mindfulness training: integrating brief moments of mindfulness practice, self-awareness, relational presence with patients, and maintaining perspective during clinical encounters and residency training as a whole. Conclusions After completing a 10-hour mindfulness training program, residents reported enhanced perspective-taking and relationship-building with themselves and their patients in clinical settings across medical and procedural specialties.
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Affiliation(s)
- Vincent Minichiello
- All authors are with the University of Wisconsin-Madison School of Medicine and Public Health
- Vincent Minichiello, MD, is Family Physician, Assistant Professor, and Director, Academic Integrative Health Fellowship, Department of Family Medicine and Community Health
| | - Sarah Webber
- All authors are with the University of Wisconsin-Madison School of Medicine and Public Health
- Sarah Webber, MD, is a Pediatric Hospitalist, Associate Professor, and Division of Hospital Medicine and Pediatric Sedation Provider, Department of Pediatrics
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Tamminga SJ, Emal LM, Boschman JS, Levasseur A, Thota A, Ruotsalainen JH, Schelvis RM, Nieuwenhuijsen K, van der Molen HF. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev 2023; 5:CD002892. [PMID: 37169364 PMCID: PMC10175042 DOI: 10.1002/14651858.cd002892.pub6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. SELECTION CRITERIA We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. AUTHORS' CONCLUSIONS Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.
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Affiliation(s)
- Sietske J Tamminga
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lima M Emal
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Julitta S Boschman
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Alice Levasseur
- Faculté des sciences de l'éducation, Université Laval, Québec, Canada
| | | | - Jani H Ruotsalainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Roosmarijn Mc Schelvis
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Body@Work, Research Center on Work, Health and Technology, TNO/VUmc, Amsterdam, Netherlands
| | - Karen Nieuwenhuijsen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Torné-Ruiz A, Reguant M, Roca J. Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study. Nurse Educ Pract 2023; 66:103533. [PMID: 36516640 DOI: 10.1016/j.nepr.2022.103533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
AIM To determine the efficacy of an online mindfulness intervention in reducing anxiety and stress levels in nursing students during clinical simulations. BACKGROUND Clinical simulation as a learning strategy has many benefits but the high levels of stress and anxiety it produces in participants can compromise learning, motivation or performance. DESIGN A quasi-experimental study with a non-equivalent control group design is presented. Forty-two undergraduate nursing students from a natural group were divided into: an experimental group (n = 21) and a control group (n = 21). METHODS Before conducting a clinical simulation, the experimental group followed a 10-day intensive online mindfulness intervention. All students received the same information and training. Instruments used were: Self-administered Analogue Stress Scale, State-Trait Anxiety Inventory and Five Facet Mindfulness Questionnaire. In addition, physiological data (blood pressure and heart rate) were collected at baseline, pre-briefing and debriefing. RESULTS Physiological variables increased in the prebriefing phase but remained statistically significantly lower in the experimental group (diastolic blood pressure p = .032 and heart rate p = .048). Levels of stress (p = .029) and anxiety (p = .016) were also managed better. Both groups in the debriefing session showed a statistically significant decrease in the different physiological variables, stress and anxiety. No changes in mindfulness were observed. CONCLUSIONS The clinical simulation is indicated to generate stress and anxiety in nursing students. Therefore, measures must be adopted to control it. The intensive online mindfulness intervention proposed in this study reduced physiological parameters, stress and anxiety in the clinical simulation.
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Affiliation(s)
- Alba Torné-Ruiz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, 2 Montserrat Roig, St, 25198 Lleida, Spain.
| | - Mercedes Reguant
- Department of Research Methods and Diagnosis in Education, University of Barcelona, 171 Passeig de la Vall d´Hebron, St, 08035 Barcelona, Spain.
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, 2 Montserrat Roig, St., 25198 Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 80 Alcalde Rovira Roure, St., 25198 Lleida, Spain.
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Vage A, Spence AD, Hamilton PK, Gormley GJ. Spoonful of sugar: a case for stress-reduction interventions in medical simulation. Simul Healthc 2022. [DOI: 10.54531/unol4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years simulation has gained popularity as an educational tool to shield learners from real-world consequence. However, the inherent risks levied upon those involved have largely remained unaddressed; psychological stress being one of the most potent. Research over the last two decades has shown us that an increase in simulation-related stress goes hand-in-hand with diminishing performance. It is, however, becoming more apparent that there is a solution to this problem, namely in the form of stress-reduction interventions. As educators the time has come to stop abandoning our learners at the edge of their limits, but instead support them in an environment free of the anxieties, stresses and worries that are all too
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Affiliation(s)
- Aaron Vage
- Centre for Medical Education, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Andrew D Spence
- Centre for Medical Education, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Paul K Hamilton
- Centre for Medical Education, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Gerard J Gormley
- Centre for Medical Education, Queens University Belfast, Belfast, Northern Ireland, UK
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Sekhar P, Tee QX, Ashraf G, Trinh D, Shachar J, Jiang A, Hewitt J, Green S, Turner T. Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors. Cochrane Database Syst Rev 2021; 12:CD013740. [PMID: 34890044 PMCID: PMC8664003 DOI: 10.1002/14651858.cd013740.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mindfulness interventions are increasingly popular as an approach to improve mental well-being. To date, no Cochrane Review examines the effectiveness of mindfulness in medical students and junior doctors. Thus, questions remain regarding the efficacy of mindfulness interventions as a preventative mechanism in this population, which is at high risk for poor mental health. OBJECTIVES: To assess the effects of psychological interventions with a primary focus on mindfulness on the mental well-being and academic performance of medical students and junior doctors. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and five other databases (to October 2021) and conducted grey literature searches. SELECTION CRITERIA: We included randomised controlled trials of mindfulness that involved medical students of any year level and junior doctors in postgraduate years one, two or three. We included any psychological intervention with a primary focus on teaching the fundamentals of mindfulness as a preventative intervention. Our primary outcomes were anxiety and depression, and our secondary outcomes included stress, burnout, academic performance, suicidal ideation and quality of life. DATA COLLECTION AND ANALYSIS: We used standard methods as recommended by Cochrane, including Cochrane's risk of bias 2 tool (RoB2). MAIN RESULTS: We included 10 studies involving 731 participants in quantitative analysis. Compared with waiting-list control or no intervention, mindfulness interventions did not result in a substantial difference immediately post-intervention for anxiety (standardised mean difference (SMD) 0.09, 95% CI -0.33 to 0.52; P = 0.67, I2 = 57%; 4 studies, 255 participants; very low-certainty evidence). Converting the SMD back to the Depression, Anxiety and Stress Scale 21-item self-report questionnaire (DASS-21) showed an estimated effect size which is unlikely to be clinically important. Similarly, there was no substantial difference immediately post-intervention for depression (SMD 0.06, 95% CI -0.19 to 0.31; P = 0.62, I2 = 0%; 4 studies, 250 participants; low-certainty evidence). Converting the SMD back to DASS-21 showed an estimated effect size which is unlikely to be clinically important. No studies reported longer-term assessment of the impact of mindfulness interventions on these outcomes. For the secondary outcomes, the meta-analysis showed a small, substantial difference immediately post-intervention for stress, favouring the mindfulness intervention (SMD -0.36, 95% CI -0.60 to -0.13; P < 0.05, I2 = 33%; 8 studies, 474 participants; low-certainty evidence); however, this difference is unlikely to be clinically important. The meta-analysis found no substantial difference immediately post-intervention for burnout (SMD -0.42, 95% CI -0.84 to 0.00; P = 0.05, I² = 0%; 3 studies, 91 participants; very low-certainty evidence). The meta-analysis found a small, substantial difference immediately post-intervention for academic performance (SMD -0.60, 95% CI -1.05 to -0.14; P < 0.05, I² = 0%; 2 studies, 79 participants; very low-certainty evidence); however, this difference is unlikely to be clinically important. Lastly, there was no substantial difference immediately post-intervention for quality of life (mean difference (MD) 0.02, 95% CI -0.28 to 0.32; 1 study, 167 participants; low-certainty evidence). There were no data available for three pre-specified outcomes of this review: deliberate self-harm, suicidal ideation and suicidal behaviour. We assessed the certainty of evidence to range from low to very low across all outcomes. Across most outcomes, we most frequently judged the risk of bias as having 'some concerns'. There were no studies with a low risk of bias across all domains. AUTHORS' CONCLUSIONS: The effectiveness of mindfulness in our target population remains unconfirmed. There have been relatively few studies of mindfulness interventions for junior doctors and medical students. The available studies are small, and we have some concerns about their risk of bias. Thus, there is not much evidence on which to draw conclusions on effects of mindfulness interventions in this population. There was no evidence to determine the effects of mindfulness in the long term.
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Affiliation(s)
- Praba Sekhar
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Qiao Xin Tee
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Gizem Ashraf
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Darren Trinh
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan Shachar
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Jiang
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jack Hewitt
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Green
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Takhdat K, Lamtali S, El Adib AR. The effects of mindfulness on health profession students' simulation training outcomes: An integrative review. NURSE EDUCATION TODAY 2021; 106:105082. [PMID: 34391989 DOI: 10.1016/j.nedt.2021.105082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/27/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Health profession students (HPSs) continuously experience psychological issues which can exacerbate cognitive errors and harm emotional well-being. The Healthcare simulation environment is stressful and overwhelming in nature and may impair learning outcomes. Therefore, integrating psychological interventions into simulation-based learning (SBL) instructional design may alleviate students' psychological distress and improve their learning outcomes. OBJECTIVES to examine the effects of mindfulness on health professions students' SBL outcomes. DESIGN a literature review, based on Whittemore and Knafl's (2005) updated methodology was used in this study. DATA SOURCES We investigated PubMed, ERIC, ScienceDirect, and Google Scholar to find papers addressing the effects of mindfulness on health professions students' SBL outcomes. We targeted Results: This integrative review suggests that although mindfulness improves SBL outcomes, HPSs still struggle to transfer mindfulness benefits to real clinical practice. CONCLUSION research on mindfulness in healthcare SBL is in its infancy, thus, further research is needed to prove mindfulness effects on HPSs' SBL outcomes.
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Affiliation(s)
- Kamal Takhdat
- Cadi Ayyad University, Faculty of Sciences Semlalia, Marrakesh, Morocco; Higher Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco.
| | - Saloua Lamtali
- Cadi Ayyad University, Faculty of Sciences Semlalia, Marrakesh, Morocco; Higher Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco
| | - Ahmed Rhassane El Adib
- Marrakesh Simulation and Innovation in Health Sciences Center, Faculty of Medicine and Pharmacy of Marrakesh, Cadi Ayyad University, Marrakesh, Morocco
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