Can mindfulness in health care professionals improve patient care? An integrative review and proposed model

Mindfulness and Management of Low Desire and Vulvovaginal Pain

Mindfulness is defined as present-moment, nonjudgmental awareness. By reducing self-criticism, and depression, and increasing self-compassion, attention, and interoceptive awareness, mindfulness has been found across a variety of systematic reviews and meta-analyses to significantly improve sexual desire, sexual pain, and sex-related distress. It helps individuals connect with their bodies, fostering a deeper understanding of sensations and desires while reducing the focus on negative, judgmental, and catastrophic sex-related and pain-related thoughts. By teaching individuals to focus on bare sensations, mindfulness has also been found to significantly reduce vulvovaginal pain intensity with improvements retained a year later.

Mindfulness-based supportive therapy on reducing suffering in patients with advanced cancer: randomised controlled trial

OBJECTIVES

Suffering is common among patients with advanced cancer. The practice of mindfulness during patient care can potentially reduce suffering. We aimed to examine the efficacy of mindfulness-based supportive therapy (MBST) on reducing suffering in patients with advanced cancer.

METHODS

We conducted a parallel-group, single-blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Seventy-three patients with advanced cancer with an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned into either the MBST group (n=34) or the control group (n=39).

RESULTS

There was a statistically significant reduction in the overall suffering score in the MBST group compared with the control group (U=432.5, median1=-2.0, median2=-1.0, z=-2.645, p=0.008). There was also significant improvement in the total Hospital Anxiety and Depression Scale score (U=483.5, median1=-4.0, median2=-3.0, z=-1.994, p=0.046), and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (U=252.0, median1=+14.5, median2=+5.0, z=-4.549, p=0.000) in the MBST group compared with the control group.

CONCLUSIONS

The results provided evidence that the practice of MBST during patient care could promote positive psychosocial outcomes.

Improving physician wellness through the Applied Mindfulness Program for Medical Personnel: findings from a prospective qualitative study

BACKGROUND

Physicians play a critical role across health care delivery systems, yet their own well-being is often overlooked; mindfulness has been widely recommended as a promising modality to support physician wellness. We sought to explore how physicians experience and engage with a 5-week applied mindfulness program and how they perceive its impact on their personal well-being in the context of their daily lives.

METHOD

We delivered the Applied Mindfulness Program for Medical Personnel (AMP-MP) at a tertiary care hospital in downtown Toronto, Canada. This prospective qualitative study consists of a thematic analysis of post-program interviews with physicians, from across different specialties, who participated in the AMP-MP. The program includes 2-hour sessions, delivered once a week over 5 weeks, and is based on the teachings of Thích Nhất Hạnh.

RESULTS

We interviewed 28 physicians after they completed the AMP-MP. Our data show that a 5-week training was sufficient for physicians to develop a foundational level of mindfulness that integrated into their daily life. Two themes were identified: mindfulness encourages behavioural and cognitive changes that facilitate well-being, and mindfulness improves communication with patients and colleagues.

INTERPRETATION

Our results show applied mindfulness to be well received by physicians as an effective modality to increase their perceived sense of wellness and enhance communication with their patients and colleagues. Further research is necessary to better understand the individual and systemic implications of mindfulness training, and how this modality can complement other efforts being made to address and maintain physician wellness.

FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention

BACKGROUND

Burnout among emergency health care professionals is well-described, especially during the COVID-19 pandemic. Prevention interventions, such as mindfulness, focus on the management of stress.

OBJECTIVE

To evaluate the effects of the FIRECARE program (a mindfulness intervention, supplemented by heart coherence training and positive psychology workshops) on burnout, secondary stress, compassion fatigue, and mindfulness among advanced life support ambulance staff of the Paris Fire Brigade.

MATERIALS AND METHODS

We used a non-randomized, two-group quasi-experimental study design with a waitlist control and before-and-after measurements in each group. The intervention consisted of six, once-weekly, 2.5-h sessions that included individual daily meditation and cardiac coherence practice. The study compared intervention and waitlist control groups, and investigated baseline, post-program, and 3-month follow-up change on burnout (measuring using the ProQOL-5 scale) and mindfulness (measuring using the FMI scores). Baseline burnout (measured using the ProQOL-5) was evaluated and used in the analysis.

RESULTS

Seventy-four 74 participants volunteered to participate; 66 were included in the final analysis. Of these, 60% were classified as suffering from moderate burnout, the 'burnout cluster'. A comparison of intervention and waitlist control groups found a decrease in the burnout score in the burnout cluster (p = 0.0003; partial eta squared = 0.18). However, while secondary stress fell among the burnout cluster, it was only for participants in the intervention group; scores increased for those in the waitlist group (p = 0.003; partial eta squared = 0.12). The pre-post-intervention analysis of both groups also showed that burnout fell in the burnout cluster (p = 0.006; partial eta squared = 0.11). At 3-month follow-up, the burnout score was significantly reduced in the intervention group (p = 0.02; partial eta squared = 0.07), and both the acceptance (p = 0.007) and mindfulness scores (p = 0.05; partial eta squared = 0.05) were increased in the baseline burnout cluster.

CONCLUSION

FIRECARE may be a useful approach to preventing and reducing burnout among prehospital caregivers.

Resident Physician Perspectives on Mindfulness Education in Residency: A Multispecialty Qualitative Assessment of Clinical Care Impact

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.

The therapeutic concordance approach reduces adverse drug reactions in patients with resistant hypertension

Background

Adverse drug reactions (ADRs) remain among the leading causes of therapy-resistant hypertension (TRH) and uncontrolled blood pressure (BP). We have recently reported beneficial results in BP control in patients with TRH adopting an innovative approach, defined as therapeutic concordance, in which trained physicians and pharmacists reach a concordance with patients to make them more involved in the therapeutic decision-making process.

Methods

The main scope of this study was to investigate whether the therapeutic concordance approach could lead to a reduction in ADR occurrence in TRH patients. The study was performed in a large population of hypertensive subjects of the Campania Salute Network in Italy (ClinicalTrials.gov Identifier: NCT02211365).

Results

We enrolled 4,943 patients who were firstly followed-up for 77.64 ± 34.44 months, allowing us to identify 564 subjects with TRH. Then, 282 of these patients agreed to participate in an investigation to test the impact of the therapeutic concordance approach on ADRs. At the end of this investigation, which had a follow-up of 91.91 ± 54.7 months, 213 patients (75.5%) remained uncontrolled while 69 patients (24.5%, p < 0.0001) reached an optimal BP control. Strikingly, during the first follow-up, patients had complained of a total of 194 ADRs, with an occurrence rate of 68.1% and the therapeutic concordance approach significantly reduced ADRs to 72 (25.5%).

Conclusion

Our findings indicate that the therapeutic concordance approach significantly reduces ADRs in TRH patients.

A constructivist grounded theory exploration of Mindfulness for Healthcare Professional students

BACKGROUND AND PURPOSE

To better understand the effects of an intervention, Mindfulness for Healthcare Professional (MIHP), and how it may improve healthcare professional student (HCP) functioning, a constructivist grounded theory exploration was conducted.

MATERIALS AND METHODS

Ten participants with the lowest or highest changes on quantitative measures of burnout and perceived stress at the end of MIHP were interviewed at a long-term follow-up. A theoretical framework was developed from the resultant themes to describe the mechanisms by which MIHP had effects on work-relevant functioning.

RESULTS

Three overarching themes emerged as mechanisms of change both from their presence in those participants reporting an improvement in stress and their missingness from those participants who reported no change: developing a mindfulness practice, integrating practice into daily life, and enhanced awareness. These mechanisms led to optimized work-relevant functioning: 1) emotional competencies, including nonjudgement, emotion regulation, and burnout prevention; and 2) patient-centered care, including improved listening, patience, and efficiency at work.

CONCLUSION

The resultant framework is discussed in the context of previous literature on MIHP and mindfulness theory more broadly. Implications for future disseminations of MIHP encourage the use of group interventions with emphasis on developing at-home practice and informal mindfulness integrated into daily work.

Mindfulness and compassion training for health professionals: A qualitative study

Background

Compassion is a key component of quality care. Encouraging Health Care Professionals (HCPs) to develop a patient-centered care relationship through mindfulness and compassion training may be beneficial for both patients and HCPs.

Method

We assessed the impact of a compassion-centered mindfulness program [i.e., the Mindfulness Based (MB) CARE program] on healthcare practice conducting 10 phone interviews with HCPs who experienced the program.

Results

The training had an overall positive impact on the HCPs ability to feel compassion toward their patients and themselves, helped them develop kindness toward themselves and their patients, and enhanced their attention to their patient's needs and theirs. Participants were better able to accept the difficult work experiences or those their patients experienced, with more perceived equanimity and less reactivity.

Conclusion

Professional mindfulness and compassion training programs could be operational levers for institutions aiming at fostering more compassionate HCPs-patients relationships.

A study of the factors influencing HIV-preventive intentions among "hookup" application users

"Hooking up" refers to the act of experiencing sexual intimacy with strangers without committing to a romantic relationship. Social media provide more convenient conditions for hooking up; however, it also poses a greater risk for HIV infection. Therefore, it is necessary to study the factors influencing the HIV-preventive intentions of those who engage in online dating to devise effective strategies for preventing the spread of HIV. This study consisted of a questionnaire that was distributed to 520 users of the Hello Group application. The survey results revealed that structural equation modeling is a useful framework for understanding the risk of HIV transmission in casual hookup encounters. In addition, combining the health belief model with the theory of planned behavior can provide recommendations for enhancing HIV-preventive intentions among users of dating applications. The results showed that mindfulness, the Chinese cultural context, perceived benefits, and self-efficacy were the main predictors of users' HIV-preventive intentions when using online dating applications. Among the perceived HIV risks, only perceived barriers had a negative effect on users' HIV-preventive intentions. In addition, attitude, subjective norms, and behavior control served as mediating variables between independent variables and HIV-preventive intentions; however, the mediating effect of attitude on perceived benefits and intentions was not significant. According to our study, some users misunderstand the risks and make incorrect assessments of the cultural risks of hooking up. Therefore, it is necessary to pay attention to the research on the psychological tendencies of users and risk intervention when studying the concept of hooking up.

Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review

OBJECTIVE

Compassion is widely regarded as an important component of high-quality healthcare. However, its conceptualization, use, and associated outcomes in the care of people with multiple sclerosis (PwMS) have not been synthesized. The aim of this review is to scope the peer reviewed academic literature on the conceptualization, use, and outcomes associated with compassion in the care of PwMS.

METHODS

Studies were eligible for inclusion if reporting primary research data from quantitative, qualitative, or mixed-methods studies on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Relevant studies were identified through searching five electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, and PsycINFO) in January 2022. We followed the guidance outlined in the Joanna Briggs Institute (JBI) manual for evidence synthesis, and also referred to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist (PRISMA-ScR). Simple descriptive methods were used to chart quantitative findings, and a descriptive approach with basic content analysis was employed to describe qualitative findings.

RESULTS

Fifteen studies were included (participant n = 1722): eight quantitative, six mixed-methods, one exclusively qualitative. Synthesized qualitative data revealed that PwMS conceptualize compassion as involving self-kindness, agency, and acceptance. PwMS report using self-compassion in response to unpleasant sensations and experiences. Quantitative findings suggest that compassion may mediate benefit finding, reduced distress, and improved quality of life (QoL) in PwMS, that those with the condition may become more compassionate through time, and that self-compassion specifically can be increased through training in mindfulness. In this context, greater self-compassion in PwMS correlates with less depression and fatigue, better resilience and QoL. Among studies, self-compassion was the most common outcome measure for PwMS.

CONCLUSIONS

A nascent literature exists on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Further research is required to better understand what compassion means to PwMS and those caring for them. However, self-compassion can be cultivated among PwMS and may be helpful for managing unpleasant somatic symptoms and in benefit finding. Impact on other health outcomes is less clear. The use of compassion by health care providers in the care of PwMS is unstudied.

Conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation: a scoping review

The purpose of this review is to scope the literature on the conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation. Eligible studies included quantitative, qualitative, or mixed-methods research that presented primary data on the conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation. Relevant studies were identified through CINAHL, Cochrane Library, EMBASE, MEDLINE, and PEDRO. Twenty-four studies were included (participant n = 3715): 13 quantitative, six mixed-methods, and five qualitative. In qualitative analysis, empathy and compassion were conceptualized as both intrinsic and exhibitory. Where self-compassion was examined as an intervention for patients, improvements in anxiety, depression, and quality of life were reported. Survey data suggested that when rehabilitation health care providers were perceived to be more empathic, patients reported greater treatment satisfaction, acceptance, adherence, and goal attainment. Individuals receiving and health care providers who deliver rehabilitative care conceptualize empathy and compassion as valuable in physical medicine and rehabilitation settings, with cognitive and behavioural elements described. Health care provider empathy and compassion-based interventions may influence outcomes positively in this context. More research is needed to understand the mechanisms of action of empathy and compassion and effectiveness in physical medicine and rehabilitation settings.

Feasibility of a brief mindfulness-based program for burnout in pain healthcare professionals

Introduction

Stress inherent to health care, which is characterized by work overload and shortage of specialized staff, is associated with decreased quality of life and suboptimal patient care. Mindfulness-based programs have proved to be effective in reducing stress in healthcare providers. This study aims to assess the feasibility of an 8-week mindfulness program to reduce the burnout levels of the staff of a pain clinic in a tertiary public hospital.

Materials and methods

A longitudinal study with a within subject pre/post-intervention design, consisting of daily face-to-face 10-min sessions and the creation of a virtual group using a social media platform. Variables measured: burnout, mindfulness, empathy, self-compassion, and demographic characteristics.

Results

Program feasibility (i.e., reach, adherence, acceptability, and preliminary effectiveness) was evaluated in 10 participants (6 physicians, 2 nurse practitioners, 1 nursing assistant, and 1 administrative). The results revealed a high reach (i.e., participation rate of 90%), excellent adherence to the program (daily practice 95% of times), and very good acceptability of the group format and satisfaction with most treatment components. Regarding potential effectiveness, we report the results of the Wilcoxon signed-rank tests and its associated effect size (r). We observed improvements in mindfulness and all its subscales (−2.077 ≤ Z ≤ −2.703, 0.69 ≤ r ≤ 0.90, all p &lt; 0.05) except for non-reactivity and all subcomponents of self-compassion (−2.501 ≤ Z ≤ −2.611, 0.83 ≤ r ≤ 0.87, all p &lt; 0.05) but not on its global self-compassion score. Empathy and burnout did not change. In an exploratory manner, however, we found significant reductions in the burnout component of emotional exhaustion, but only in physicians (Z = −2.201, p = 0.028, r = 0.73).

Discussion

We believe that the 8-week mindfulness-based program described in the present investigation might be a feasible and potentially effective method that can be easily implemented to reduce burnout and promote mindfulness in specialized pain clinics.

Correlation of nurses' mindfulness with their perception of individualized care: A cross-sectional study

PURPOSE

The objective of this study is to investigate the correlation of nurses' mindfulness with their perception of individualized care.

DESIGN AND METHODS

It was designed as a descriptive correlational study. Two hundred seventy-one nurses were included in this study.

FINDINGS

The mean total score was 4.20 ± 0.04 on the "Mindful Attention Awareness Scale" and 3.97 ± 0.04 on the "Individualized Care Scale-Nurse." There was a significant positive correlation between the mean total score on the scales and the subscales (p < 0.01).

PRACTICAL IMPLICATIONS

Therefore, the education and practical training of nurses should include methods designed to improve their levels of mindfulness.

Effects of Mobile App-Based Mindfulness Practice on Healthcare Workers: a Randomized Active Controlled Trial

Objectives

Amidst the COVID-19 pandemic, healthcare workers (HCWs) may be at greater risk of suffering from psychological distress compared to the general population. This study aimed to investigate the effects of mindfulness practice as delivered using Headspace on psychological and cognitive outcomes among HCWs in Singapore.

Methods

A total of 80 HCWs were recruited and randomly assigned to engage in either 3 weeks (10 min/day) of mindfulness practice using Headspace or an active control condition (Lumosity; involving playing cognitive games). Participants were administered several self-report measures and two working memory (digit span) tasks at pre- and post-intervention, and one-month follow-up.

Results

There were no significant between-condition changes on any outcome variables from pre- to post-intervention. From pre-intervention to 1-month follow-up, there were significantly greater improvements among Headspace participants on fear of COVID-19 (p = .005), compassion satisfaction (p = .007), trait mindfulness (p = .002), self-compassion (p = .005), sleep quality (p = .002), and the forward digit span task (p < .001). Several outcomes were mediated by increases in trait mindfulness or self-compassion.

Conclusions

Use of Headspace may lead to downstream benefits in reducing distress and improving psychological health outcomes among HCWs. The findings have implications for improving psychological support resources for HCWs amidst a pandemic.

Trial Registration

ClinicalTrials.gov (Identifier: NCT04936893).

Maintenance of Effects and Correlates of Changes Following Mindfulness for Interdisciplinary Health Care Professional Students

OBJECTIVES

To evaluate long-term outcomes after an 8-week mindfulness intervention, Mindfulness for Interdisciplinary Health Care Professionals (MIHP), and investigate relationships between outcomes overtime.

DESIGN/METHODS

In this single-arm study, 35 participants received MIHP and completed measures of burnout, perceived stress, activity impairment, and dispositional mindfulness at baseline, post-MIHP, and a 3-month follow-up. Changes over time were evaluated using repeated-measures analysis of variance (ANOVA) and reliable change indices (RCIs). Then, correlations between dispositional mindfulness and distress/impairment outcomes were evaluated.

RESULTS

At follow-up, aspects of burnout and several mindfulness skills demonstrated maintained improvements. RCIs showed that a higher percentage of participants improved on all outcomes at each time period than declined-all outcomes showed little to no deterioration. However, most participants did not reliably change, and this was more pronounced at the follow-up. Changes in two mindfulness skills (acting with awareness and nonjudging of inner experience) were consistently negatively correlated with distress and impairment outcomes.

CONCLUSIONS

Acquired mindfulness skills during MIHP were maintained at the follow-up. RCI analyses demonstrated that MIHP may protect against worsening stress and burnout during training. Two mindfulness skills, acting with awareness and nonjudging of inner experience, showed potential mechanistic effects on work-relevant outcomes. Booster sessions to encourage maintained mindfulness practices and skills should be investigated in future trials. This study was registered on clinicaltrials.gov (#NCT03403335) on January 11, 2018.

Experiences of nurses practising mindfulness during self-leadership in delivering a rapid response system for general wards in a private hospital in Gauteng

Background

The increased complexity of the nursing care needs of patients and acuity in general wards present nursing care challenges for nurses. Self-led nurses are attentive, taking responsibility for activating the rapid response service when a patient is starting to deteriorate.

Objectives

The purpose of this article is to describe nurses’ experiences practising mindfulness during self-leadership in delivering a rapid response system (RRS) in a private hospital in Gauteng.

Method

A qualitative, exploratory, descriptive and contextual design was followed. Homogenous purposive sampling was used and a total of eight focus groups were conducted. Focus groups durations were between 45 min and 60 min. The data analysis was carried out through open coding on Atlas.ti using the noticing things, collecting things and thinking about things (NCT) approach. An independent coder met with the researcher during a consensus meeting and finalised the analysis.

Results

The findings indicated an underlying theme of nurses being mindful in their self-leadership through the development of self-motivation and self-direction in the RRS. Three categories with six subcategories emerged from the data analysis, namely self-motivation in an RRS by the team, self-direction through role-modelling to peers and training.

Conclusion

Nurses practised mindfulness during self-leadership, utilising behavioural and natural reward approaches and constructive thought patterns. These findings could assist management with developing training programmes for nurses.

Effects of Mindfulness Meditation on Doctors' Mindfulness, Patient Safety Culture, Patient Safety Competency and Adverse Event

Objective: This study investigated the effects of mindfulness meditation on doctors’ mindfulness, patient safety culture, patient safety competency, and adverse events. Methods: We recruited 91 doctors from a hospital in China and randomized them to mindfulness meditation group (n = 46) and a waiting control group (n = 45). The mindfulness meditation group underwent an 8-week mindfulness meditation intervention, while the control group underwent no intervention. We measured four main variables (mindfulness, patient safety culture, patient safety competency, and adverse event) before and after the mindfulness meditation intervention. Results: In the experimental group, mindfulness, patient safety culture and patient safety competency were significantly higher compared with those of the control group. In the control group, there were no significant differences in any of the three variables between the pre-test and post-test. Adverse events in the experimental group were significantly lower than in the control group. Conclusions: The intervention of mindfulness meditation significantly improved the level of mindfulness, patient safety culture and patient safety competency. During the mindfulness meditation intervention, the rate of adverse events in the meditation group was also significantly lower than in the control group. As a simple and effective intervention, mindfulness meditation plays a positive role in improving patient safety and has certain promotional value.

Mindfulness Matters: Use and Perceptions of Mindfulness Practices Among Athletic Trainers

CONTEXT

Mindfulness practices are effective for injury or illness recovery, decreasing stress and anxiety, and strengthening emotional resilience. They are also beneficial for health care professionals' wellbeing and improving patient outcomes and safety. However, mindfulness has not been studied in athletic trainers.

OBJECTIVE

To investigate athletic trainers' use of mindfulness practices and their perceptions of its importance for self-care and patient or client care.

DESIGN

Cross-sectional study.

SETTING

All athletic training practice settings.

PATIENTS AND OTHER PARTICIPANTS

A total of 547 athletic trainers who were currently practicing completed the survey.

MAIN OUTCOME MEASURE(S)

We developed an 18-item survey that measured use (1 = never to 6 = very frequently) and perceptions (1 = strongly disagree to 7 = strongly agree) of mindfulness practices. Mann-Whitney U or Kruskal-Wallis tests with post hoc pairwise comparisons were performed to assess differences in use (P < .05). A related-samples Wilcoxon signed rank test was calculated to assess differences in participants' perceptions between self-care and patient or client care.

RESULTS

Overall, 86% (n = 471) of respondents reported involvement in some form of mindfulness practice, with females (median [interquartile range] = 4 [2-5] versus males: 3 [2-4]; P < .002), those not in a committed relationship (4 [2-5] versus those in such a relationship: 3 [2-4]; P = .048), and those without children in the home (4 [2-5] versus those with children in the home: 3 [2-4]; P = .040) describing the highest frequency of use for self-care. Females (4 [2-4] versus males: 3 [2-4]; P < .001), those without children in the home (3 [2-4] versus those with children in the home: 3 [2-4]; P = .036), and those in emerging (4 [2-4]; P = .003) or collegiate (3 [2-4]; P = .006) settings most frequently incorporated mindfulness into patient or client care. Overall frequency of use for self-care was higher than for patient or client care (4 = occasionally [2-4] versus 3 = rarely [2-4]; P < .001). Mindfulness practices were perceived as more important for self-care than for patient or client care (6 [5-7] versus 5 [5-6]; P < .001).

CONCLUSIONS

Athletic trainers perceived mindfulness practices as more important for personal wellbeing and used them, albeit occasionally, more for self-care than for patient or client care. Differences in gender, relationship status, children, and setting were observed. Mindfulness-based interventions for athletic trainer wellbeing and patient-centered care and implementation barriers should be explored.

Meditation: Evidence Map of Systematic Reviews

Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions.

Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.

Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies.

Conclusions: Meditation has been applied in different areas. This Evidence Map intends to be an easy visual tool to access valuable evidence-based information on this complementary therapy for patients, health professionals, and managers.

A Telephone-Adapted Mindfulness-Based Stress Reduction Program: Preliminary Effects among Healthcare Employees

Healthcare employees often experience high stress and may benefit from accessible psychosocial interventions. In this pilot study, we explored preliminary feasibility, acceptability, and psychological effects of a telephone-based adaption of mindfulness-based stress reduction (MBSR) for healthcare employees. Eleven participants (M age = 49.9; 27.3% ethnic/racial minority) were enrolled in an eight-session group-based MBSR program adapted for telephone delivery. Feasibility was assessed using rates of program attrition and session completion; acceptability was explored qualitatively via participants' responses to an open-ended item about their program experience. Participants also completed pre-and post-program assessments on psychosocial outcomes (distress (overall distress, depression, anxiety, somatization), mindfulness, and self-compassion). We characterized mean change scores, 95% confidence intervals, and effect sizes to explore preliminary program effects. With regard to preliminary feasibility, one participant dropped out prior to the intervention; of the remaining 10 participants, 90% completed at least half (≥4) of the sessions; 70% completed at least three-quarters (≥6 sessions). Feedback reflected positive experiences and included suggestions for program delivery. Participants reported reductions in distress post-program (M difference range = -5.0 to -9.4), showing medium to large effect sizes (d range = 0.68 to 1.11). Mindfulness scores increased from pre- to post-intervention (M difference range = 1.0 to 10.4), with small-to-medium effects (d range = 0.18 to 0.55). Almost all aspects of self-compassion remained stable over time, with the exception of common humanity, which increased post-program (M difference = 2.9, CI 95% 0.5 to 5.4, d = 0.91). Preliminary findings from our small pilot trial suggest that telephone-based adaptations of MBSR may be a useful mode of delivery for healthcare employees; however, larger studies are needed to provide further evidence of feasibility, acceptability, and program effects.

Inter-brain co-activations during mindfulness meditation. Implications for devotional and clinical settings

Mindfulness meditation usually takes place as personal, introspective activity. It is not known if this practice activates the brain differently when done alone or with someone else. Sixteen couples of expert meditators performed mindfulness-oriented meditation (MOM) and instructed mind-wandering (IMW) tasks in two conditions: once sitting in the same room (SR) and once in two different rooms (DR). Spontaneous electroencephalographic (EEG) data was collected during 7-minute recording sessions in the four experimental settings (MOM/SR, MOM/DR, IMW/SR, IMW/DR). Power in band was computed in separate clusters of independent components of the EEG signals. In addition to significant task effects, found in frontolimbic (MOM > IMW in gamma) and frontoparietal locations (MOM < IMW in theta), significant condition effects were found in frontal (SR > DR in delta) and in temporo-occipital regions (SR > DR in theta and alpha). Moreover, a significant interaction between task and condition revealed higher gamma activity in limbic areas during MOM/SR vs. MOM/DR settings. This effect was not attributable to gender, age nor the meditation expertise of participants. We thus show that the brains of two people work differently when they are doing something together or alone; some of these differences are specific to mindfulness meditation. Implications for devotional and clinical settings are discussed.

A mobile mindfulness intervention for emergency department staff to improve stress and wellbeing: A qualitative study

BACKGROUND

Occupational stress and burnout in emergency departments (ED) are prominent issues requiring effective solutions. In other health settings use of a smartphone mindfulness app have been shown to be a cost-effective strategy for stress management.

AIM

To understand ED staff's experiences of practicing mindfulness using a smartphone app.

METHOD

A qualitative study was undertaken with 24 ED staff at two Australian EDs who had used a mindfulness app for 4 weeks. Semi-structured, one-to-one interviews were conducted between late 2019 and early 2020. Interviews were audio recorded and transcribed. Descriptive description was utilised in content analysis.

RESULTS

Four main themes were identified: individuality in use of the app, perceived benefits and impacts on life, perceived barriers and enablers to use. Participants reported that mindfulness practice had numerous benefits including better stress and anxiety management, as well as improved general wellbeing. The main barriers to mindfulness practice were poor time management for mindfulness and lack of motivation. Reported enablers included a strong desire for promoting wellbeing and the ability to embed practice into existing routine.

CONCLUSION

Practicing mindfulness with a smartphone app is a useful strategy to promote ED staff wellness and manage stress. Healthcare organisations should consider the implementation of a mindfulness app for staff.

Quality assessment with diverse studies (QuADS): an appraisal tool for methodological and reporting quality in systematic reviews of mixed- or multi-method studies

BACKGROUND

In the context of the volume of mixed- and multi-methods studies in health services research, the present study sought to develop an appraisal tool to determine the methodological and reporting quality of such studies when included in systematic reviews. Evaluative evidence regarding the design and use of our existing Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was synthesised to enhance and refine it for application across health services research.

METHODS

Secondary data were collected through a literature review of all articles identified using Google Scholar that had cited the QATSDD tool from its inception in 2012 to December 2019. First authors of all papers that had cited the QATSDD (n=197) were also invited to provide further evaluative data via a qualitative online survey. Evaluative findings from the survey and literature review were synthesised narratively and these data used to identify areas requiring refinement. The refined tool was subject to inter-rater reliability, face and content validity analyses.

RESULTS

Key limitations of the QATSDD tool identified related to a lack of clarity regarding scope of use of the tool and in the ease of application of criteria beyond experimental psychological research. The Quality Appraisal for Diverse Studies (QuADS) tool emerged as a revised tool to address the limitations of the QATSDD. The QuADS tool demonstrated substantial inter-rater reliability (k=0.66), face and content validity for application in systematic reviews with mixed, or multi-methods health services research.

CONCLUSION

Our findings highlight the perceived value of appraisal tools to determine the methodological and reporting quality of studies in reviews that include heterogeneous studies. The QuADS tool demonstrates strong reliability and ease of use for application to multi or mixed-methods health services research.

Mindful Ethical Practice and Resilience Academy: Equipping Nurses to Address Ethical Challenges

BACKGROUND

Ethical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care.

OBJECTIVES

To examine the impact of a longitudinal, experiential educational curriculum to enhance nurses' skills in mindfulness, resilience, confidence, and competence to confront ethical challenges in clinical practice.

METHODS

A prospective repeated-measures study was conducted before and after a curricular intervention at 2 hospitals in a large academic medical system. Intervention participants (192) and comparison participants (223) completed study instruments to assess the objectives.

RESULTS

Mindfulness, ethical confidence, ethical competence, work engagement, and resilience increased significantly after the intervention. Resilience and mindfulness were positively correlated with moral competence and work engagement. As resilience and mindfulness improved, turnover intentions and burnout (emotional exhaustion and depersonalization) decreased. After the intervention, nurses reported significantly improved symptoms of depression and anger. The intervention was effective for intensive care unit and non-intensive care unit nurses (exception: emotional exhaustion) and for nurses with different years of experience (exception: turnover intentions).

CONCLUSIONS

Use of experiential discovery learning practices and high-fidelity simulation seems feasible and effective for enhancing nurses' skills in addressing moral adversity in clinical practice by cultivating the components of moral resilience, which contributes to a healthy work environment, improved retention, and enhanced patient care.

The Effects of a Novel Mindfulness-based Intervention on Nurses' State Mindfulness and Patient Satisfaction in the Emergency Department

INTRODUCTION

The objective of this study was to examine the effect of a novel mindfulness-based time-out intervention on state of mindfulness among emergency nurses and, accordingly, on patient satisfaction.

METHODS

A pre-post intervention design among nurses in the emergency department was used with a between-subjects factor of patients who were nested within each nurse. The study was conducted between January 2017 and June 2018 among 48 nurses in the emergency department of a public tertiary academic hospital. For each nurse, a consecutive sample of 20 patients who attended the emergency department was recruited (n = 1920 patients; 960 in each phase). The mindfulness-based time-out intervention was based on theoretical mindfulness principles and carried out every 4 hours with direct communication to the patient at their bedside. Nurses' sociodemographic and professional characteristics and trait mindfulness were collected preintervention. Pre- and postintervention, data was collected on patients' sociodemographic and satisfaction, nurses' state mindfulness, and ED workload.

RESULTS

An increase in nurses' state mindfulness and patients' satisfaction was found after the mindfulness-based time-out intervention compared with before the intervention (4.35 [SD = 0.64] vs 4.03 [0.82], P < .001 and 4.03 [0.41] vs 3.16 [0.44], P < .001, respectively). A positive correlation was found between patients' satisfaction and nurses' state mindfulness (r = 0.29, P < .001). The findings also demonstrated that state mindfulness was higher among nurses, characterized by high trait mindfulness, after the mindfulness-based time-out intervention implementation.

DISCUSSION

By adapting mindfulness principles to the dynamic environment of the emergency department, we showed that the mindfulness-based time-out intervention was associated with a significant improvement in state mindfulness and patient satisfaction. The findings elucidate the interrelation among several conceptualizations of mindfulness that are increasingly reported in the literature, namely trait and state mindfulness, and interventions to promote mindfulness.

Mindful Mentors: Is a Longitudinal Mind-Body Skills Training Pilot Program Feasible for Pediatric Cardiology Staff?

Background

Stress and burnout among medical professionals are common and costly, placing professionals, organizations, and patients at risk.

Objectives

To determine feasibility and acceptability of a longitudinal mind-body skills training initiative to help staff decrease stress and burnout, improve well-being, and empower them to utilize basic mindfulness methods with coworkers, patients, and families.

Methods

Prospective cohort, mixed methods approach. Nurses, doctors, technicians, social workers, child life specialists were eligible to participate. The 12-month curriculum consisted of 16 hours of intensive education/practice over 2 days, with training in mindfulness skills, self-compassion, nonviolent communication, overcoming barriers to practice, and mindful listening/speaking, followed by monthly 1 hour booster/debriefing sessions.

Results

A total of 37 staff participated (RN = 18, MD = 5, Technician = 6, Social Worker = 3, Child life = 3, others = 2) in the initial training, and 24 (65%) completed the 3- and 12-month follow-up surveys. Compared with pretraining scores, there were significant improvements 3 to 12 months after the initial training in stress (P < .0001), distress (P ≤ .04), anxiety (P = .01), self-efficacy in providing non-drug therapies (P < .0001), mindfulness (P = .002), burnout (P < .0001), and confidence in providing compassionate care (P < .0001). In addition, 25 (67%) participants initiated projects incorporating what they learned into staff/patient wellness activities.

Conclusion

This longitudinal pilot program was feasible and was associated with improvements in measures of psychological well-being over the 12-month intervention. The innovative approach of training participants to teach basic techniques to coworkers and other staff can increase the impact of this program beyond any individual participant. Future research will investigate the aspects of implementation and potential effects on patient care and experience.

Mindfulness as a Protective Factor for Dissatisfaction in HCWs: The Moderating Role of Mindful Attention between Climate Stress and Job Satisfaction

With the aim of investigating the possible moderating effect of job control and dispositional mindfulness between different sources of organizational stress and job satisfaction, a correlational study was designed involving health care workers (HCWs). The following questionnaires were administered and completed by 237 HCWs: (1) Occupational Stress Indicator (OSI), to measure the sources of stress at work (managerial role, climate power, climate structure, internal relationships), and job satisfaction; (2) Mindfulness Attention Awareness Scale (MAAS) to assess the individual’s level of attention to what is taking place in the present; (3) Job Control Scale (JCS) to assess the perceived control at work. Hierarchical regression analyses were used to test the hypothesized relationships between variables; the results showed that, between the different sources of stress, the organizational climate dimension was negatively associated with job satisfaction; moreover, mindfulness attention moderated the relationship between climate stress and job satisfaction; unexpectedly, the interaction between job control and the organizational climate dimension was not significant in affecting job satisfaction. This study can provide useful information for Human Resources Management (HRM) practices regarding job and mental control interventions and empowerment, and possibly offer a new interpretation of the role of attention to what is happening in the present moment and autonomy between climate stressors and occupational satisfaction.

Mindfulness training for healthcare professional students: A waitlist controlled pilot study on psychological and work-relevant outcomes

OBJECTIVES

To fill gaps in the literature on the effects of mindfulness for healthcare professionals (HCPs), the current pragmatic trial investigated feasibility, acceptability, and effectiveness of Mindfulness for Interdisciplinary Healthcare Professional (MIHP) students on stress and work-relevant outcomes in the absence of offering school-based incentives.

DESIGN

A partially randomized waitlist-controlled design (intention-to-treat sample: 22 in the mindfulness group, 26 in the control group) was employed.

INTERVENTION

MIHP is an eight-week intervention that incorporates meditation training, yoga, and discussion on the application of mindfulness principles to stressors commonly faced by HCPs and students.

MAIN OUTCOME MEASURES

Domains of feasibility and acceptability; Maslach Burnout Inventory and other validated measures of psychological functioning; cognitive task performance on the Trail Making Test A & B; and the Work Productivity and Activity Impairment plus Classroom Impairment Questionnaire.

RESULTS

Results supported the feasibility and acceptability of MIHP but found randomization to be unacceptable. Small to large effects were found for MIHP, relative to the control group, on outcomes of burnout, perceived stress, mindfulness, and activity impairment. No effect of MIHP was found on cognitive performance or work productivity outcomes.

CONCLUSIONS

Preferential group allocation improved retention relative to randomization in the absence of school-based incentives. Results suggest that MIHP is feasible and acceptable and may have benefit for improving mindfulness and reducing burnout, stress, and activity impairment. Cognitive performance, work absenteeism, and work impairment did not change following MIHP. Results support future investigations into the effects of participant compensation on MIHP's dissemination and effectiveness.

Wellness: Combating Burnout and Its Consequences in Emergency Medicine

Medicine recognizes burnout as a threat to quality patient care and physician quality of life. This issue exists throughout medicine but is notably prevalent in emergency medicine (EM). Because the concept of "wellness" lacks a clear definition, attempts at ameliorating burnout that focus on achieving wellness make success difficult to achieve and measure. Recent work within the wellness literature suggests that the end goal should be to achieve a culture of wellness by addressing all aspects of the physician's environment. A review of the available literature on burnout and wellness interventions in all medical specialties reveals that interventions focusing on individual physicians have varying levels of success. Efforts to compare these interventions are hampered by a lack of consistent endpoints. Studies with consistent endpoints do not demonstrate clear benefits of achieving them because improving scores on various scales may not equate to improvement in quality of care or physician quality of life. Successful interventions have uncertain, long-term effects. Outside of EM, the most successful interventions focus on changes to systems rather than to individual physicians. Within EM, the number of well-structured interventions that have been studied is limited. Future work to achieve the desired culture of wellness within EM requires establishment of a consistent endpoint that serves as a surrogate for clinical significance, addressing contributors to burnout at all levels, and integrating successful interventions into the fabric of EM.

Mindful Opportunity to Reflect on Experience: Interdisciplinary Mind-Body Medicine Skills Training for Health-care Professionals

Interventions that support employee wellness and resilience hold potential to improve patient care, increase staff engagement, and decrease burnout. This repeat-measures study evaluated whether an abbreviated version of mind-body medicine skills training could decrease stress and improve mindfulness among an interdisciplinary cohort of health-care professionals. The study also assessed whether participants incorporated the mind-body medicine skills into their personal and professional lives. Aggregate results from this unpaired cohort showed decreased stress and increased mindfulness. Postcourse surveys demonstrated increased personal and professional use of mind-body medicine skills. There was high favorability among participants. These preliminary results suggest that a modest investment of time and resources to learn mind-body medicine skills may positively affect employee wellness among health-care professionals. In addition, skills learned could translate into improved patient care and increased staff engagement. Further study with larger cohorts and a paired design is needed.

An Analysis of Psychological Distress Profiles and their Correlates in Interdisciplinary Health-care Professional Students

Background

Health-care professional (HCP) students experience high levels of burnout, characterized by work- and school-related stress. Burnout is associated with a host of negative psychological and health outcomes. It may also contribute to cognitive dysfunction and decreased work productivity and may be related to trait mindfulness. This study cross-sectionally explored psychological distress and its correlates in a sample of interdisciplinary HCP students using cluster analysis.

Method

Fifty-seven interdisciplinary HCP students completed validated measures of burnout, depressive and anxiety symptoms, perceived stress, and rumination, which were entered into a cluster analysis. A neuropsychological test measured executive function; validated questionnaires assessed work productivity and trait mindfulness. Relationships between cluster membership and classroom productivity, executive function, and trait mindfulness were investigated.

Results

Burnout, depressive symptoms, and perceived stress were reported at high rates in this sample. The cluster analysis yielded 4 clusters, categorized as follows: Healthy, Ruminative Healthy, Moderate Distress, and High Distress. Cluster membership significantly differed based on trait mindfulness and classroom productivity. Trait mindfulness was related to classroom productivity. Although not significant, there were small to medium associations between executive function and both cluster membership and trait mindfulness.

Discussion

Cluster membership was highly related to trait mindfulness and classroom productivity, suggesting these are important correlates of psychological distress in HCP students. Taken together, these results underscore the need for interventions, especially ones that are mindfulness-based, to manage stress and work-relevant functioning in HCP students.

Supporting Families, Building Confidence, and Increasing Breastfeeding Success

Helping families feel more confident can lead to greater breastfeeding success. IBCLCs can play a role in this. They can help families learn to trust their own parenting abilities, trust themselves, and trust their babies to tell them what they need. This article outlines many practical tips for IBCLCs to try. Better communication leads to improved relationships with families and this in turn can help families learn to trust themselves.

Being Mindful: A Long-term Investigation of an Interdisciplinary Course in Mindfulness

Background

Burnout and work-related stress in health-care professionals (HCPs) is a growing concern to the optimal functioning of the health-care system. Mindfulness-based interventions may be well-suited to address burnout in HCPs.

Objective

The purpose of this study was (1) to quantitatively evaluate the effect of a mindfulness-based intervention for interdisciplinary HCPs over time and at a long-term follow-up and (2) to explore perceived benefits, facilitators, and barriers to the practice of mindfulness at the long-term follow-up.

Design

A mixed-method, repeated measures, within-subjects design was used to investigate Mindfulness for Interdisciplinary HCPs (MIHP) at baseline, post-MIHP, and a follow-up (6 months to 1.5 years after MIHP). MIHP is an 8-week, group-based course for interdisciplinary HCPs and students, with weekly meditation training, gentle yoga, and discussions on the application of mindfulness to common stressors faced by HCPs. Main outcome measures were the Maslach Burnout Inventory—Health Services Survey and the Five Facet Mindfulness Questionnaire. A semistructured interview was used to explore participants’ perceptions of sustained effects and practice in the context of HCP work at the long-term follow-up. The study protocol was registered with ClinicalTrials.gov (NCT02736292).

Results

Eighteen HCPs (88% female) participated in the study. Significant reductions were found after the intervention for 2 subscales of burnout: depersonalization, F(2, 17) = 5.98, P = .01, and emotional exhaustion, F(2, 17) = 2.64, P = .10. Three facets of dispositional mindfulness showed significant increases at long-term follow-up, act aware: F(2, 15) = 4.47, P = .03, nonjudge: F(2, 15) = 4.7, P = .03, and nonreactivity: F(2, 15) = 3.58, P = .05. Continued practice of skills long term was facilitated by the use of informal practice and perceived improvement in work and personal life.

Conclusion

In sum, MIHP improved subscales of burnout and mindfulness. These findings should be further explored with a larger, controlled study. Interventions should focus on developing mindfulness practice that can be integrated into the work of HCPs.