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Kreitzer MJ. Inspiring, Recruiting, and Retaining the Health-Care Workforce: What Will it Take? Creat Nurs 2023; 29:18-22. [PMID: 37551002 DOI: 10.1177/107845352202900107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The U.S. health-care system, the costliest in the world, is facing an exodus of nurses and other healthcare workers. The growth of corporate medicine has contributed to clinician stress and burnout, and has created conditions that have eroded autonomy. Reform is needed that creates cultures in which healthcare providers have agency to make decisions that impact their practice and all aspects of patient care. Massive change is needed to inspire, recruit, and retain the health-care workforce.
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Affiliation(s)
- Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing at the University of Minnesota in Minneapolis, Minnesota
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Abstract
The incidence of mental illness continues to increase since the start of the COVID-19 pandemic (Mental Health America, 2022). Demand for mental health services has grown, and providers report being "unable to meet the demand" or having an increase in wait times for access to care (American Psychological Association, 2022, para. 1). Due to this increase in demand, more patients are seeking mental health care from their primary care providers. Over the past decade, integrative models of care have been expanding into mental health care (Lake, 2017). Integrative Nursing is a strategy for improving the quality of care provided to patients seeking care for mental health diagnoses, as well as those with a goal of increasing mental health and wellbeing. This article proposes that Integrative Nursing can serve as a framework for providing whole-person mental health care.
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Affiliation(s)
- Megan E Voss
- Earl E. Bakken Center for Spirituality & Healing and School of Nursing at the University of Minnesota in Minneapolis, Minnesota, US
| | - Laura Sandquist
- Penny George Institute for Health and Healing at Allina Health in Minneapolis, Minnesota, US
| | - Kate Otremba
- Penny George Institute for Health and Healing at Allina Health in Minneapolis, Minnesota, US
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing and School of Nursing at the University of Minnesota in Minneapolis, Minnesota, US
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Kreitzer MJ, Koithan M, Sullivan SD, Nunez M, Voss M. Integrative Nursing and the ANA Scope and Standards of Practice: Expanding the Reach of Nursing for Families and Society. Creat Nurs 2022; 28:228-233. [PMID: 36411044 DOI: 10.1891/cn-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The American Nurses Association's (ANA) recently published 4th edition of the Scope and Standards of Practice provides authoritative guidance on actions and behaviors that all registered nurses are expected to perform competently, regardless of role, population, specialty, or setting. The newly defined scope emphasizes the art and science of caring, compassionate presence, and the expectation that nurses be advocates for all, recognizing the connections of all humanity. It also makes frequent reference to whole-person care and highlights the importance of mindfulness by inviting nurses to reflect on how they can incorporate mindfulness and other integrative therapies into their self-care and professional practice. A new standard explicitly states that advanced practice registered nurses should have the competency to prescribe evidence-based traditional and integrative treatments, therapies, and procedures that are compatible with the consumer's cultural preferences, norms, and abilities. Integrative Nursing is aligned with the ANA Scope and Standards of Practice and provides a useful framework for practice that expands the reach of nursing across clinical and community settings and patient populations. In this article, exemplars highlight how Integrative Nursing is being implemented in clinical settings and nursing education programs.
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Telke S, Leininger B, Hanson L, Kreitzer MJ. A Randomized Trial of 21 Days of Loving Kindness Meditation for Stress Reduction and Emotional Well-being Within an Online Health Community for Patients, Family, and Friends Experiencing a Cancer Health Journey. J Integr Complement Med 2022; 28:158-167. [PMID: 35167360 DOI: 10.1089/jicm.2020.0512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objectives: CaringBridge (CB) is an online health community for people undergoing challenging health journeys. Loving Kindness Meditation (LKM) is a systemized mind-body approach developed to increase loving acceptance and has previously been reported to increase resilience in the face of adversity. Materials and Methods: Results of a randomized controlled trial of immediate compared with deferred 21-day LKM intervention in an online community are reported. The deferred group received LKM intervention after a waiting period of 3 weeks. Inclusion criteria were >18 years old, ability to understand English, willingness to participate in a mind-body practice, and use of CB for a cancer journey. Change in perceived stress, self-compassion, social connectedness and assurance, and compassionate love scales from baseline to 21 days was assessed. Results: Of the 979 participants included in the study, 649 (66%) provided 3-week follow-up data and 330 (49%) self-reported engaging in the LKM practice 5 or more days/week. Participants in the immediate LKM group reported medium effect size improvement in stress (0.4), self-compassion (0.5), and social connectedness (0.4) compared with the deferred LKM group. Changes in perceived stress and self-compassion were larger in magnitude and increased with more frequent engagement in LKM. Conclusions: The immediate LKM group showed improvements in stress, self-compassion, and social connectedness compared with the deferred control group. Differential study retention rates by treatment arm and self-reported engagement in LKM subject the results to selection bias. Future research of similar interventions within online health communities might pay greater attention to promoting intervention adherence and engaging a more diverse economic and racial/ethnic population. ClinicalTrials.gov (NCT05002842).
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Affiliation(s)
- Susan Telke
- Earl E. Bakken Center for Spirituality and Healing, The University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, The University of Minnesota, Minneapolis, MN, USA
| | - Brent Leininger
- Earl E. Bakken Center for Spirituality and Healing, The University of Minnesota, Minneapolis, MN, USA
| | - Linda Hanson
- Earl E. Bakken Center for Spirituality and Healing, The University of Minnesota, Minneapolis, MN, USA
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality and Healing, The University of Minnesota, Minneapolis, MN, USA
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Austin RR, Lu SC, Geiger-Simpson E, Ringdahl D, Pruinelli L, Lindquist R, Koithan M, Monsen KA, Kreitzer MJ, Delaney CW. Evaluating Systemized Nomenclature of Medicine Clinical Terms Coverage of Complementary and Integrative Health Therapy Approaches Used Within Integrative Nursing, Health, and Medicine. Comput Inform Nurs 2021; 39:1000-1006. [PMID: 34074871 DOI: 10.1097/cin.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of complementary and integrative health therapy strategies for a wide variety of health conditions is increasing and is rapidly becoming mainstream. However, little is known about how or if complementary and integrative health therapies are represented in the EHR. Standardized terminologies provide an organizing structure for health information that enable EHR representation and support shareable and comparable data; which may contribute to increased understanding of which therapies are being used for whom and for what purposes. Use of standardized terminologies is recommended for interoperable clinical data to support sharable, comparable data to enable the use of complementary and integrative health therapies and to enable research on outcomes. In this study, complementary and integrative health therapy terms were extracted from multiple sources and organized using the National Center for Complementary and Integrative Health and former National Center for Complementary and Alternative Medicine classification structures. A total of 1209 complementary and integrative health therapy terms were extracted. After removing duplicates, the final term list was generated via expert consensus. The final list included 578 terms, and these terms were mapped to Systemized Nomenclature of Medicine Clinical Terms. Of the 578, approximately half (48.1%) were found within Systemized Nomenclature of Medicine Clinical Terms. Levels of specificity of terms differed between National Center for Complementary and Integrative Health and National Center for Complementary and Alternative Medicine classification structures and Systemized Nomenclature of Medicine Clinical Terms. Future studies should focus on the terms not mapped to Systemized Nomenclature of Medicine Clinical Terms (51.9%), to formally submit terms for inclusion in Systemized Nomenclature of Medicine Clinical Terms, toward leveraging the data generated by use of these terms to determine associations among treatments and outcomes.
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Affiliation(s)
- Robin R Austin
- Author Affiliations: School of Nursing (Dr Austin, Mr Lu, and Drs Geiger-Simpson, Ringdahl, Pruinelli, Lindquist, Monsen, and Delaney) and Earl E. Bakken Center for Spiritualty and Healing (Drs Austin, Ringdahl, Lindquist, and Monsen), University of Minnesota, Minneapolis; and College of Nursing, University of Arizona, Tucson (Dr Koithan)
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Abstract
The Covid-19 pandemic is having a significant impact on the well-being of nurses and has exacerbated long-standing issues of stress and burnout. Expecting or hoping that nurses will recover quickly or bounce back from the stress and deep trauma of the pandemic is not realistic. Each nurse has a story, and while these stories may have similar themes, they are all different. It is important to reflect on our stories, identify the myriad of emotions we are experiencing, and find ways to work through our feelings. Ignoring, denying, or suppressing feelings does not serve us well in the long run. Stifling negative emotions does not make them go away. A Call to Action is needed to address the impact of the pandemic, clinician burnout, and systemic racism on health-care organizations and educational institutions. Strategies are identified that will support personal and organizational well-being.
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Jiang H, Stieger J, Kreitzer MJ, Engel S, He B. Frontolimbic alpha activity tracks intentional rest BCI control improvement through mindfulness meditation. Sci Rep 2021; 11:6818. [PMID: 33767254 PMCID: PMC7994299 DOI: 10.1038/s41598-021-86215-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/08/2021] [Indexed: 12/03/2022] Open
Abstract
Brain-computer interfaces (BCIs) are capable of translating human intentions into signals controlling an external device to assist patients with severe neuromuscular disorders. Prior work has demonstrated that participants with mindfulness meditation experience evince improved BCI performance, but the underlying neural mechanisms remain unclear. Here, we conducted a large-scale longitudinal intervention study by training participants in mindfulness-based stress reduction (MBSR; a standardized mind-body awareness training intervention), and investigated whether and how short-term MBSR affected sensorimotor rhythm (SMR)-based BCI performance. We hypothesize that MBSR training improves BCI performance by reducing mind wandering and enhancing self-awareness during the intentional rest BCI control, which would mainly be reflected by modulations of default-mode network and limbic network activity. We found that MBSR training significantly improved BCI performance compared to controls and these behavioral enhancements were accompanied by increased frontolimbic alpha activity (9-15 Hz) and decreased alpha connectivity among limbic network, frontoparietal network, and default-mode network. Furthermore, the modulations of frontolimbic alpha activity were positively correlated with the duration of meditation experience and the extent of BCI performance improvement. Overall, these data suggest that mindfulness allows participant to reach a state where they can modulate frontolimbic alpha power and improve BCI performance for SMR-based BCI control.
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Affiliation(s)
- Haiteng Jiang
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - James Stieger
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - Bin He
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
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Rosa WE, Dossey BM, Koithan M, Kreitzer MJ, Manjrekar P, Meleis AI, Mukamana D, Ray MA, Watson J. Nursing Theory in the Quest for the Sustainable Development Goals. Nurs Sci Q 2020; 33:178-182. [PMID: 32180518 DOI: 10.1177/0894318420903495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 17 United Nations Sustainable Development Goals (SDG) are intended to promote a safe, healthy, and equitable world by the year 2030. Nurses are at the forefront of realizing the 2030 agenda through concerned citizenship and professional leadership. Nursing theory informs knowledge development and theory-guided practice essential for nurses working in all domains and in all nations. Although all extant nursing theories are relevant, a select few are discussed in detail to make explicit the links between theory and SDG realization. Middle-range theories are also valuable in helping to contextualize nursing practice through the lens of the SDGs. The SDGs address five themes - People, Planet, Peace, Prosperity, and Partnership - and theory remains vital to ensure nurses working in all settings are equipped to meet the needs of humanity and the world, now and in the future.
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Affiliation(s)
- William E Rosa
- RWJF Future of Nursing Scholar, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Barbara M Dossey
- Co-Director, International Nurse Coach Association, North Miami, FL, USA.,International Co-Director, Nightingale Initiative for Global Health, Santa Fe, NM, USA
| | - Mary Koithan
- Anne Furrow Professor and Associate Dean, University of Arizona College of Nursing, Tucson, AZ, USA
| | - Mary Jo Kreitzer
- Director, Earl E. Bakken Center for Spirituality & Healing, Professor, School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | | | - Afaf I Meleis
- Dean Emerita and Professor of Nursing and Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Donatilla Mukamana
- Dean, University of Rwanda School of Nursing & Midwifery, Kigali, Rwanda, East Africa
| | - Marilyn A Ray
- Colonel (Ret.), Unites States Air Force, Nurse Corps, Partnership Liaison, Caring-Based Academic Partnership in Excellence: Veteran RNs in Primary Care (CAPE-V) Grant, Emeritus Professor, Florida Atlantic University Christine E. Lynn College of Nursing, Boca Raton, FL, USA
| | - Jean Watson
- Founder & Director, Watson Caring Science Institute, Boulder, CO, USA
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Stieger JR, Engel S, Jiang H, Cline CC, Kreitzer MJ, He B. Mindfulness Improves Brain-Computer Interface Performance by Increasing Control Over Neural Activity in the Alpha Band. Cereb Cortex 2020; 31:426-438. [PMID: 32965471 DOI: 10.1093/cercor/bhaa234] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Brain-computer interfaces (BCIs) are promising tools for assisting patients with paralysis, but suffer from long training times and variable user proficiency. Mind-body awareness training (MBAT) can improve BCI learning, but how it does so remains unknown. Here, we show that MBAT allows participants to learn to volitionally increase alpha band neural activity during BCI tasks that incorporate intentional rest. We trained individuals in mindfulness-based stress reduction (MBSR; a standardized MBAT intervention) and compared performance and brain activity before and after training between randomly assigned trained and untrained control groups. The MBAT group showed reliably faster learning of BCI than the control group throughout training. Alpha-band activity in electroencephalogram signals, recorded in the volitional resting state during task performance, showed a parallel increase over sessions, and predicted final BCI performance. The level of alpha-band activity during the intentional resting state correlated reliably with individuals' mindfulness practice as well as performance on a breath counting task. Collectively, these results show that MBAT modifies a specific neural signal used by BCI. MBAT, by increasing patients' control over their brain activity during rest, may increase the effectiveness of BCI in the large population who could benefit from alternatives to direct motor control.
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Affiliation(s)
- James R Stieger
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA.,Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55414, USA
| | - Stephen Engel
- Department of Psychology, University of Minnesota, Minneapolis, MN 55414, USA
| | - Haiteng Jiang
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Christopher C Cline
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55414, USA
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN 55414, USA
| | - Bin He
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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Shafto K, Shah A, Smith J, Wang Q, Devries S, Kreitzer MJ, Baxley F. Impact of an Online Nutrition Course to Address a Gap in Medical Education: A Feasibility Study. PRiMER 2020; 4:5. [PMID: 32537605 PMCID: PMC7279113 DOI: 10.22454/primer.2020.368659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Nutrition is a foundation of health, yet there is a deficiency of nutrition training in graduate medical education. The purpose of this feasibility study was to assess the impact of a brief online clinical nutrition course on medical residents' knowledge and attitudes related to the role of nutrition in clinical practice. METHODS Medical residents from two institutions took a 3-hour, online, self-paced and interactive clinical nutrition course that reviewed macronutrients, evidence-based dietary patterns, a rapid nutrition assessment, and motivational interviewing. We administered surveys of nutrition knowledge and attitudes at three time points: (1) just prior to taking the online course, (2) immediately following, and (3) 3 months after course completion. RESULTS Seventy-six residents enrolled in the study and 47 (62%) completed the online course and postcourse surveys. For residents who completed the study, the summated nutrition knowledge scores assessed both immediately after taking the course and 3 months later showed significant improvement (P<.001). Three months after completing the course, residents were more likely to believe it was their role to personally provide detailed nutrition information to patients (P=.045) and to endorse the view that a healthy diet is important for self-care (P<.001). The estimated time residents spent counseling patients on nutrition did not change after the intervention. CONCLUSION This feasibility study demonstrated the potential of a 3-hour, online, self-paced nutrition course administered to medical residents to result in a significant and sustained increase in nutrition knowledge and positive attitudes about the role of nutrition in clinical practice.
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Affiliation(s)
- Kate Shafto
- University of Minnesota Medical School, Hennepin Healthcare, Department of Internal Medicine, Minneapolis, MN
| | - Anuj Shah
- Department of Family and Community Medicine, McGaw Northwestern Family Medicine, Chicago, IL
| | - Jacob Smith
- Erie Family Health Center, Chicago IL | Department of Family and Community Medicine, McGaw Northwestern Family Medicine Residency at Humboldt Park, Chicago, IL
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, IL | Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing | School of Nursing, University of Minnesota
| | - Frances Baxley
- Erie Family Health Center, Waukegan IL | Department of Family and Community Medicine, McGaw Northwestern Family Medicine Residency at Lake Forest, IL
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Brooks AJ, Maizes V, Billimek J, Blair J, Chen MK, Goldblatt E, Kilgore D, Klatt M, Kligler B, Koithan MS, Kreitzer MJ, Lee JK, Lopez AM, Taren D, Lebensohn P. Professional development in integrative health through an interprofessional online course in clinical settings. Explore (NY) 2020; 17:505-512. [PMID: 32229083 DOI: 10.1016/j.explore.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by health professionals. INTERVENTION Foundations in Integrative Health (FIH), a 32-h online competency-based interprofessional course to address this knowledge gap. METHODS The course was pilot-tested by an interprofessional sample of providers in various clinical settings as professional and staff development. OUTCOME MEASURES Prior to and following the course, participants completed an IH knowledge test, an IH self-efficacy self-assessment, and validated measures of burnout, wellness behaviors, and attitudes toward IH, interprofessional teams, and patient involvement. Evaluation surveys were administered following each unit and the course. RESULTS Thirty-one percent of the participants (n = 214/690) completed the course. Pre/post course improvements were found in IH knowledge, IH self-efficacy, attitudes towards IH and interprofessional teams, and several wellness behaviors. The course was positively evaluated with 81% of the participants indicating interest in applying IH principles in their practice and 92% reported that the course enhanced their clinical experience. CONCLUSION This study demonstrates the outcomes of a multi-site, online IH curriculum offered to a diverse group of health professionals in various clinical settings. This course may allow clinical settings to offer an interprofessional, IH curriculum even with limited on-site faculty expertise.
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Affiliation(s)
- Audrey J Brooks
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States.
| | - Victoria Maizes
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States; Department of Family and Community Medicine, University of Arizona, 655N Alvernon Way, Ste 228 Tucson, AZ 85711, United States; Mel and Enid Zuckerman College of Public Health, University of Arizona, PO Box 245163, Tucson, AZ 85724-5163, United States.
| | - John Billimek
- Department of Family Medicine and Health Policy Research Institute, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA 92617, United States.
| | - Jennifer Blair
- Penny George Institute for Health and Healing, Allina Health, Mail Route 15115, 2833 Chicago Avenue, Minneapolis, MN 55407-3799, United States.
| | - Mei-Kuang Chen
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States.
| | - Elizabeth Goldblatt
- Academic Collaborative of Integrative Health, 700 S Flower St., Ste 1000, Los Angeles, CA 90017, United States; American College of Traditional Chinese Medicine, 455 Arkansas St, San Francisco, CA 94107, United States.
| | - David Kilgore
- UC Irvine Department of Family Medicine, 200 S. Manchester Ave, Suite 835, Orange, CA 92868, United States.
| | - Maryanna Klatt
- Department of Family Medicine, The Ohio State University College of Medicine, 2231N High St., Ste 261 Columbus, OH 43201, United States.
| | - Benjamin Kligler
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, United States.
| | - Mary S Koithan
- College of Nursing, University of Arizona, PO Box 210203, Tucson, AZ 85721-0203, United States.
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing, School of Nursing, University of Minnesota, C510 Mayo Memorial Building, MMC 505, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Jeannie K Lee
- Pharmacy Practice & Science, College of Pharmacy, University of Arizona, PO Box 210202, Tucson, AZ 85721-0202, United States.
| | - Ana Maria Lopez
- School of Medicine, University of Utah, HSEB 5515, 26 South 2000 East, Salt Lake City, UT 84112, United States.
| | - Douglas Taren
- Mel and Enid Zuckerman College of Public Health, University of Arizona, PO Box 245163, Tucson, AZ 85724-5163, United States.
| | - Patricia Lebensohn
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States; Department of Family and Community Medicine, University of Arizona, 655N Alvernon Way, Ste 228 Tucson, AZ 85711, United States.
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Nijjar PS, Connett JE, Lindquist R, Brown R, Burt M, Pergolski A, Wolfe A, Balaji P, Chandiramani N, Yu X, Kreitzer MJ, Everson-Rose SA. Randomized Trial of Mindfulness-Based Stress Reduction in Cardiac Patients Eligible for Cardiac Rehabilitation. Sci Rep 2019; 9:18415. [PMID: 31804580 PMCID: PMC6895078 DOI: 10.1038/s41598-019-54932-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/21/2019] [Indexed: 01/05/2023] Open
Abstract
Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR's potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.
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Affiliation(s)
- Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - John E Connett
- Biostatistics, Epidemiology and Research Design (BERD), University of Minnesota, Minneapolis, Minnesota, USA
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ruth Lindquist
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roland Brown
- Biostatistics, Epidemiology and Research Design (BERD), University of Minnesota, Minneapolis, Minnesota, USA
| | - Marsha Burt
- Cardiac Rehabilitation, Fairview Health Services, Minneapolis, Minnesota, USA
| | - Aaron Pergolski
- Cardiac Rehabilitation, Fairview Health Services, Minneapolis, Minnesota, USA
| | - Alexandra Wolfe
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Priya Balaji
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Nitya Chandiramani
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Xiaohui Yu
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mary Jo Kreitzer
- Earl E Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan A Everson-Rose
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Musial F, Mist S, Warber S, Kreitzer MJ, Ritenbaugh C, Kessler C. Why and How Should We Integrate Biomarkers into Complex Trials? A Discussion on Paradigms and Clinical Research Strategies. Complement Med Res 2019; 26:343-352. [PMID: 30974436 DOI: 10.1159/000498981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 02/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Research in complementary and alternative medicine (CAM) encounters a variety of challenges, such as potentially synergistic, multimodal, and complex interventions which are often dependent on the relationship between practitioner and patient, on specific settings, and on patients' individual preferences, expectations, beliefs, and motivations. Moreover, patients seeking CAM care often suffer from chronic disease conditions, and multiple symptoms and/or pathologies. On the other hand, CAM interventions are often challenged as being solely dependent on subjective and nonspecific factors without biologically based mechanisms of action. If we agree that biomarkers as outcomes are important for the understanding of CAM interventions, a hypothesis- and strategy-driven process for the selection of the most appropriate biomarkers is needed. METHODS This paper presents the results of an expert panel on how to integrate biomarkers in whole system research of an interdisciplinary workshop on research methodology in CAM held in November 2012. RESULTS The following main CAM research challenges were identified: (a) finding appropriate biomarkers, which are able to picture the complex pathophysiological pathways and likewise complex interventions under study; (b) integrating these biomarkers into clinical trials in CAM; and (c) identifying the biomarkers specific to the particular CAM intervention being applied. CONCLUSION The paper provides a disease/condition/symptom- and intervention-driven strategy regarding how to identify the outcomes of interest and possible related biomarkers. The research approach presented here allows the selected biomarkers to be grounded in conventional physiology/pathophysiology as well as complementary and alternative concepts, including traditional systems of medicine. The goal is to provide researchers in the field with a framework on how to integrate biomarkers into complex trials.
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Affiliation(s)
- Frauke Musial
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,
| | - Scott Mist
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Sara Warber
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cheryl Ritenbaugh
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
| | - Christian Kessler
- Department of Internal and Complementary Medicine, Immanuel Hospital and Institute of Social Medicine, Epidemiology and Health Economics, Charité - University Medical Center, Berlin, Germany
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Kreitzer MJ, Telke S, Hanson L, Leininger B, Evans R. Outcomes of a Gratitude Practice in an Online Community of Caring. J Altern Complement Med 2019; 25:385-391. [PMID: 30785803 DOI: 10.1089/acm.2018.0460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing, The University of Minnesota, Minneapolis, MN
| | - Susan Telke
- Division of Epidemiology and Community Health, The University of Minnesota, Minneapolis, MN
| | - Linda Hanson
- Earl E. Bakken Center for Spirituality & Healing, The University of Minnesota, Minneapolis, MN
| | - Brent Leininger
- Earl E. Bakken Center for Spirituality & Healing, The University of Minnesota, Minneapolis, MN
| | - Roni Evans
- Earl E. Bakken Center for Spirituality & Healing, The University of Minnesota, Minneapolis, MN
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Kreitzer MJ, Carter K, Coffey DS, Goldblatt E, Grus CL, Keskinocak P, Klatt M, Mashima T, Talib Z, Valachovic RW. Utilizing a Systems and Design Thinking Approach for Improving Well-Being within Health Professions’ Education and Health Care. NAM Perspect 2019. [DOI: 10.31478/201901b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mary Jo Kreitzer
- Center for Spirituality and Healing at the University of Minnesota
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Gao G, Pieczkiewicz D, Kerr M, Lindquist R, Chi CL, Maganti S, Austin R, Kreitzer MJ, Todd K, Monsen KA. Exploring Older Adults' Strengths, Problems, and Wellbeing Using De-identified Electronic Health Record Data. AMIA Annu Symp Proc 2018; 2018:1263-1272. [PMID: 30815168 PMCID: PMC6371293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As new data sources including individuals' strengths emerge in electronic health records, such data provide whole-person oriented information to generate integrated knowledge for person-centered practice. The purpose of this study is to describe older adults' strengths and problems within a wellbeing context documented by the Omaha System. The Wellbeing Model is employed as a conceptual framework for wellbeing and is operationalized by the Omaha System Problem Classification Scheme. This study has a retrospective, descriptive design using de-identified EHR data of wellbeing assessments including problems, strengths, and signs/symptoms for a convenience sample of 440 assisted-living residents in a Midwest metropolitan area. Descriptive statistics and data visualization were used to summarize and display strength and signs/symptom attributes within wellbeing contexts. The study reveals cutting-edge knowledge regarding older adults' strengths and wellbeing, and creates a platform for further research use of a strength-based ontology in clinical practice and electronic system of documentation.
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Affiliation(s)
- Grace Gao
- School of Nursing, University of Minnesota, Minneapolis, MN 55455
| | - David Pieczkiewicz
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455
| | - Madeleine Kerr
- School of Nursing, University of Minnesota, Minneapolis, MN 55455
| | - Ryth Lindquist
- School of Nursing, University of Minnesota, Minneapolis, MN 55455
| | - Chih-Lin Chi
- School of Nursing, University of Minnesota, Minneapolis, MN 55455
| | - Sasank Maganti
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN 55455
| | - Robin Austin
- School of Nursing, University of Minnesota, Minneapolis, MN 55455
| | - Mary Jo Kreitzer
- Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN 55455
| | | | - Karen A Monsen
- School of Nursing, University of Minnesota, Minneapolis, MN 55455
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455
- Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN 55455
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Abstract
Stress associated with diabetes makes managing diabetes harder. We investigated whether mindfulness-based stress reduction (MBSR) could reduce diabetes distress and improve management. We recruited 38 participants to complete an MBSR program. Surveys and lab values were completed at baseline and post-intervention. Participants showed significant improvement in diabetes-related distress (Cohen's d -.71, p < .002), psychosocial self-efficacy (Cohen's d .80, p < .001), and glucose control (Cohen's d -.79, p < .001). Significant improvements in depression, anxiety, stress, coping, self-compassion, and social support were also found. These results suggest that MBSR may offer an effective method for helping people better self-manage their diabetes and improve mental health.
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Affiliation(s)
- Robin R. Whitebird
- School of Social Work, University of St Thomas, 2115 Summit Ave SCB #106, St Paul, MN 55105, 651-962-5867
| | - Mary Jo Kreitzer
- Center for Spiritualty & Healing, University of Minnesota, C510 Mayo Memorial Bldg., MMC 505, 420 Delaware Street SE, Minneapolis, MN 55455, 612-625-3977,
| | | | - Chris J. Enstad
- HealthPartners Institute, PO Box 1524, MS 21111R, Minneapolis, MN 55440-1524, 952-967-5007,
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Abstract
The principles of integrative nursing and caring science align with the unitary paradigm in a way that can inform and shape nursing knowledge, patient care delivery across populations and settings, and new healthcare policy. The proposed policies may transform the healthcare system in a way that supports nursing praxis and honors the discipline's unitary paradigm. This call to action provides a distinct and hopeful vision of a healthcare system that is accessible, equitable, safe, patient-centered, and affordable. In these challenging times, it is the unitary paradigm and nursing wisdom that offer a clear path forward.
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Affiliation(s)
- Mary S Koithan
- 1 Colleges of Nursing and Medicine, University of Arizona
| | - Mary Jo Kreitzer
- 2 Center for Spirituality & Healing and School of Nursing, University of Minnesota
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Hanson LR, Barclay M, Kashyap B, Somerville B, Kreitzer MJ, Stuck L, Barclay TR. [P4–315]: MINDFULNESS FOR EARLY ALZHEIMER's DISEASE: A PILOT STUDY. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Leah R. Hanson
- HealthPartners Center for Memory & AgingSt. PaulMNUSA
- HealthPartners InstituteBloomingtonMNUSA
| | | | - Bhavani Kashyap
- HealthPartners Center for Memory & AgingSt. PaulMNUSA
- HealthPartners InstituteBloomingtonMNUSA
| | | | | | | | - Terry R. Barclay
- HealthPartners Center for Memory & AgingSt. PaulMNUSA
- HealthPartners InstituteMinneapolisMNUSA
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Abstract
Stress and burnout of healthcare providers has become a major healthcare issue that has implications for not only workforce projections, but the cost and quality of care and the lives of healthcare providers and their families. Burnout, characterized by loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment is associated with early retirement, alcohol use, and suicidal ideation. Healthcare professional "wellbeing" or "care of the caregiver" is a topic that has not been significantly addressed in the education of healthcare professionals. The culture that has dominated much of education has been one where students have been expected to forego personal needs, endure stressful environments, and emerge from highly competitive and often dysfunctional environments to work in care settings where health and wellbeing is also largely ignored. Three curricular innovations are highlighted that target pre-professional students, students enrolled in health professions education and practicing health care professionals. Strategies are highlighted that both help individuals cultivate resiliency and wellbeing in their personal and professional lives and that address system issues that contribute to unhealthy learning and work environments.
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Affiliation(s)
- Mary Jo Kreitzer
- a Center for Spirituality & Healing, University of Minnesota , Minneapolis , MN , USA
| | - Maryanna Klatt
- b Department of Family Medicine , The Ohio State University , Columbus , OH , USA
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Chlan L, Halcon L, Kreitzer MJ, Leonard B. Influence of an Experiential Education Session on Nursing Students’ Confidence Levels in Performing Selected Complementary Therapy Skills. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1533210105284044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Efforts are under way in many nursing education programs across the United States to incorporate content into curricula on complementary/alternative therapies (CAT). Many of these efforts focus on didactic presentation of content. There is an absence of nursing programs that provide students with opportunities to actually experience and practice CAT skills; little is known about how these hands-on learning experiences affect confidence in applying selected CAT skills in beginning nursing practice. This article highlights efforts at the University of Minnesota School of Nursing to integrate practice and experience in selected CAT skills (music, hand massage, imagery, breathing/ mindfulness, reflexology) into an existing senior undergraduate clinical skills laboratory course. Students (n= 86) who participated in the class reported significant increases in their confidence levels after the experiential sessions for all of the CAT skills practiced. Directions for future curriculum integration efforts are discussed as well as opportunities for expansion of CAT skills experiences.
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Affiliation(s)
- Linda Chlan
- University of Minnesota School of Nursing, 5-160 Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN 55455;
| | - Linda Halcon
- School of Nursing; Graduate School in Nursing; University of Minnesota
| | - Mary Jo Kreitzer
- Center for Spirituality and Healing at the University of Minnesota; School of Nursing; R25 CAM Education Project (NCCAM, NIH R25-AT00556)
| | - Barbara Leonard
- Graduate School in Nursing; Center for Child and Family Health Promotion Research; University of Minnesota
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Halcón L, Leonard B, Snyder M, Garwick A, Kreitzer MJ. Incorporating Alternative and Complementary Health Practices Within University-Based Nursing Education. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153321010100600203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The University of Minnesota School of Nursing aims to fully incorporate comple mentary and alternative health philosophy and healing practices into its baccalau reate, master's and doctoral programs. A planning process (1998-99) included School of Nursing faculty, administrators, and representatives of the university's Center for Spirituality and Healing. A comprehensive course of action was devel oped that included strengthening didactic and experiential learning, offering indi vidualized plans of clinical study in a variety of modalities, improving access to an interdisciplinary graduate minor in Complementary Therapies and Healing Practic es, and encouraging faculty research initiatives and continuing education in CAM.
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Affiliation(s)
| | | | | | - Ann Garwick
- Academic Health Center, University of Minnesota
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Blaes A, Fenner D, Bachanova V, Torkelson C, Geller M, Haddad T, Shanley R, Kreitzer MJ. Mindfulness-based cancer recovery in survivors recovering from chemotherapy and radiation. J Community Support Oncol 2016. [DOI: 10.12788/jcso.0244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kreitzer MJ, Gross CR, Ye X, Russas V, Treesak C. Longitudinal Impact of Mindfulness Meditation on Illness Burden in Solid-Organ Transplant Recipients. Prog Transplant 2016; 15:166-72. [PMID: 16013466 DOI: 10.1177/152692480501500210] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In 2001, more than 24000 solid-organ transplant surgeries were performed in the United States. Although survival rates have steadily risen over the past 2 decades, transplant recipients commonly experience a myriad of symptoms after transplantation that compromise quality of life. Anxiety, depression, and insomnia frequently occur despite excellent function of the transplanted organ. Use of complementary and alternative medicine has risen sharply over the past 10 years, particularly among people with chronic illnesses. Methods Twenty solid-organ transplant recipients were enrolled in a clinical trial of mindfulness-based stress reduction. During the 8-week course, subjects learned various forms of meditation and gentle hatha yoga. Participants were given audiotapes for home practice and maintained practice diaries. Longitudinal analysis focused on the impact of mindfulness-based stress reduction on symptom management, illness intrusion, and transplant-related stressors. Results Significant improvements in the quality and duration of sleep continued for 6 months after completion of the mindfulness-based stress reduction course. Improvements after the completion of the course were also noted in self-report measures of anxiety and depression. Conclusions Mindfulness-based stress reduction is an effective treatment in improving the quality and duration of sleep. Because sleep is highly correlated with positive mental health and overall well-being, these findings suggest that mindfulness-based stress reduction has the potential of being an effective, accessible and low-cost intervention that could significantly change transplant recipients' overall health and well-being.
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Abstract
Background: Many people suffering from low back pain (LBP) have found conventional medical treatments to be ineffective for managing their LBP and are increasingly turning to complementary and alternative medicine (CAM) to find pain relief. A comprehensive picture of CAM use in the LBP population, including all of the most commonly used modalities, is needed. Study Objective: To examine prevalence and perceived benefit of CAM use within the US LBP population by limiting vs nonlimiting LBP and to evaluate the odds of past year CAM use within the LBP population Methods: Data are from the 2012 National Health Interview Survey, Alternative Health Supplement. We examined a nationally representative sample of US adults with LBP (N=9665 unweighted). Multiple logistic regression was used to estimate the odds of past year CAM use. Results: In all, 41.2% of the LBP population used CAM in the past year, with higher use reported among those with limiting LBP. The most popular therapies used in the LBP population included herbal supplements, chiropractic manipulation, and massage. The majority of the LBP population used CAM specifically to treat back pain, and 58.1% of those who used CAM for their back pain perceived a great deal of benefit. Conclusion: The results are indicative of CAM becoming an increasingly important component of care for people with LBP. Additional understanding of patterns of CAM use among the LBP population will help health professionals make more informed care decisions and guide investigators in development of future back pain–related CAM research.
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Affiliation(s)
- Neha Ghildayal
- Division of Health Policy & Management, University of Minnesota, Minneapolis (Ms Ghildayal), United States
| | - Pamela Jo Johnson
- Division of Health Policy & Management, University of Minnesota, Minneapolis; Integrative Health and Wellbeing Research Program, Center for Spirituality and Healing, University of Minnesota; Division of Epidemiology & Community Health, University of Minnesota (Dr Johnson), United States
| | - Roni L Evans
- Integrative Health and Wellbeing Research Program, Center for Spirituality and Healing, University of Minnesota (Dr Evans), United States
| | - Mary Jo Kreitzer
- Integrative Health and Wellbeing Research Program, Center for Spirituality and Healing, University of Minnesota; School of Nursing, University of Minnesota (Dr Kreitzer), United States
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Affiliation(s)
| | - William L Miller
- Lehigh Valley Health Network, Allentown, Pennsylvania (Dr Miller), United States
| | - Robert Saper
- Boston University School of Medicine, Massachusetts (Dr Saper), United States
| | - Mary Jo Kreitzer
- University of Minnesota, Minneapolis (Dr Kreitzer), United States
| | - Wayne Jonas
- Samueli Institute, Alexandria, Virginia (Dr Jonas)), United States
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Kreitzer MJ, Saper R. Advancing a Global Vision. Glob Adv Health Med 2015; 4:3. [PMID: 26665012 PMCID: PMC4653592 DOI: 10.7453/gahmj.2015.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kligler B, Brooks AJ, Maizes V, Goldblatt E, Klatt M, Koithan MS, Kreitzer MJ, Lee JK, Lopez AM, McClafferty H, Rhode R, Sandvold I, Saper R, Taren D, Wells E, Lebensohn P. Interprofessional Competencies in Integrative Primary Healthcare. Glob Adv Health Med 2015; 4:33-9. [PMID: 26421232 PMCID: PMC4563887 DOI: 10.7453/gahmj.2015.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 "meta-competencies" through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year.
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Affiliation(s)
- Benjamin Kligler
- Mount Sinai Beth Israel Department of Integrative Medicine, New York, United States (Dr Kligler)
| | - Audrey J Brooks
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr Brooks)
| | - Victoria Maizes
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr Maizes)
| | - Elizabeth Goldblatt
- Academic Consortium for Complementary & Alternative Health Care, Seattle, Washington, United States (Dr Goldblatt)
| | - Maryanna Klatt
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, United States (Dr Klatt)
| | - Mary S Koithan
- Department of Family and Community Medicine, University of Arizona, United States (Dr Koithan)
| | - Mary Jo Kreitzer
- Center for Spirituality & Healing, School of Nursing, University of Minnesota, Minneapolis (Dr Kreitzer)
| | - Jeannie K Lee
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, United States (Dr Lee)
| | - Ana Marie Lopez
- University of Utah Health Sciences Center, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, United States (Dr Lopez)
| | - Hilary McClafferty
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr McClafferty)
| | - Robert Rhode
- Department of Psychiatry, University of Arizona, Tucson, United States (Dr Rhode)
| | - Irene Sandvold
- Medical Training and Geriatrics Branch, Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland, United States (Dr Sandvold)
| | - Robert Saper
- School of Medicine, Boston University, Massachusetts, Academic Consortium for Integrative Medicine and Health, McLean, Virginia, United States (Dr Saper)
| | - Douglas Taren
- Mel and Enid Zuckerman College of Public Health, University of Arizona, United States (Dr Taren)
| | - Eden Wells
- School of Public Health, University of Michigan, Ann Arbor, United States (Dr Wells)
| | - Patricia Lebensohn
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr Lebensohn)
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Kreitzer MJ. Integrative Nursing around the Globe. Glob Adv Health Med 2015; 4:3-4. [PMID: 25984409 PMCID: PMC4424937 DOI: 10.7453/gahmj.2015.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
While the essence of nursing has long been whole person (body, mind, and spirit) and whole system-focused, in reality the contemporary practice of nursing in many settings around the globe has become increasingly fragmented and de-stabilized. Nursing shortages in many parts of the world are significant, and hierarchies and bureaucracies often remove nurses from the point of care, be that the bedside, home, or clinic, replacing them with less skilled workers and filling their time with documentation and other administrative tasks. Integrative nursing is a framework for providing whole person/whole system care that is relationship-based and person-centered and focuses on improving the health and wellbeing of caregivers as well as those they serve. It is aligned with what is being called the "triple aim" in the United States-an effort focused on improving the patient experience (quality and satisfaction), improving the health of populations, and reducing the cost of care. The principles of integrative nursing offer clear and specific guidance that can shape and impact patient care in all clinical settings.
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Affiliation(s)
- Mary Jo Kreitzer
- Director, Center for Spirituality & Healing; Professor, School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Kreitzer MJ. Grace and Grit in the Trenches of Healthcare. Glob Adv Health Med 2015; 4:3. [PMID: 29732241 PMCID: PMC5926544 DOI: 10.7453/gahmj.2015.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Affiliation(s)
- Mary Jo Kreitzer
- Center for Spirituality & Healing, University of Minnesota, Minneapolis (Dr Kreitzer), United States
| | - Karen A Monsen
- School of Nursing, University of Minnesota (Dr Monsen), United States
| | - Sharda Nandram
- Nyenrode Business University, Breukelen, Netherlands, and Praan Solutions, Amsterdam, Netherlands (Ms Nandram)
| | - Jos de Blok
- Buurtzorg Nederland, Almelo, Netherlands (Mr de Blok)
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Affiliation(s)
| | - Rob Saper
- Global Advances in Health and Medicine
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Winkler A, Sierpina VS, Kreitzer MJ. On harnessing the power of medical students to reach their peers. Explore (NY) 2014; 10:411-2. [PMID: 25456309 DOI: 10.1016/j.explore.2014.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gross C, Hubbling A, Reilly-Spong M, Kreitzer MJ. Mindfulness Training for People with Chronic Insomnia: Focus Group Results. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5147.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anderson LH, Whitebird RR, Schultz J, McEvoy CE, Kreitzer MJ, Gross CR. Healthcare utilization and costs in persons with insomnia in a managed care population. Am J Manag Care 2014; 20:e157-e165. [PMID: 25326930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To better understand the direct costs of insomnia. Our study aimed to compare healthcare costs and utilization of patients diagnosed with insomnia who received care in a managed care organization with a set of matched controls. DESIGN Our observational, retrospective cohort study compared 7647 adults with an insomnia diagnosis with an equally sized matched cohort of health plan members without an insomnia diagnosis between 2003 and 2006. We also compared a subset of patients diagnosed with and treated for insomnia with those diagnosed with insomnia but not treated. SETTING A large Midwestern health plan with more than 600,000 members. RESULTS Multivariate analysis was used to estimate the association between insomnia diagnosis and costs, controlling for covariates, in the baseline and follow-up periods. Although we cannot conclude a causal relationship between insomnia and healthcare costs, our analysis found that insomnia diagnosis was associated with 26% higher costs in the baseline and 46% in the 12 months after diagnosis. When comorbidities were recognized, the insomnia cohort had 80% higher costs, on average, than the matched control cohort. CONCLUSIONS These outcomes suggest the need to look beyond the direct cost of insomnia to how its interaction with comorbid conditions drives healthcare cost and utilization.
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Kreitzer MJ, Delagran L, Taylor B, Maiers M, Vihstadt C, Evans R. Evidence Informed Practice and Culture Change: The CAM Practitioner Research Education Partnership Project. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5268.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mary Jo Kreitzer
- (1) University of Minnesota, Minneapolis, MN, USA
- (2) Northwestern Health Sciences University, Minneapolis, MN, USA
| | - Louise Delagran
- (1) University of Minnesota, Minneapolis, MN, USA
- (2) Northwestern Health Sciences University, Minneapolis, MN, USA
| | - Barry Taylor
- (1) University of Minnesota, Minneapolis, MN, USA
- (2) Northwestern Health Sciences University, Minneapolis, MN, USA
| | - Michele Maiers
- (1) University of Minnesota, Minneapolis, MN, USA
- (2) Northwestern Health Sciences University, Minneapolis, MN, USA
| | - Corrie Vihstadt
- (1) University of Minnesota, Minneapolis, MN, USA
- (2) Northwestern Health Sciences University, Minneapolis, MN, USA
| | - Roni Evans
- (1) University of Minnesota, Minneapolis, MN, USA
- (2) Northwestern Health Sciences University, Minneapolis, MN, USA
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Geary C, McKee J, Triana C, Buck E, Walton S, Valdez D, Sierpina V, Kreitzer MJ. Bridging the Compassion and Empathy Gap in Medical School: The Physician Healer Track at UTMB-Health. Explore (NY) 2014; 10:203-5. [DOI: 10.1016/j.explore.2014.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hubbling A, Reilly-Spong M, Kreitzer MJ, Gross CR. How mindfulness changed my sleep: focus groups with chronic insomnia patients. BMC Complement Altern Med 2014; 14:50. [PMID: 24512477 PMCID: PMC3927626 DOI: 10.1186/1472-6882-14-50] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 02/06/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic insomnia is a major public health problem affecting approximately 10% of adults. Use of meditation and yoga to develop mindful awareness ('mindfulness training') may be an effective approach to treat chronic insomnia, with sleep outcomes comparable to nightly use of prescription sedatives, but more durable and with minimal or no side effects. The purpose of this study was to understand mindfulness training as experienced by patients with chronic insomnia, and suggest procedures that may be useful in optimizing sleep benefits. METHODS Adults (N = 18) who completed an 8-week mindfulness-based stress reduction (MBSR) program as part of a randomized, controlled clinical trial to evaluate MBSR as a treatment for chronic insomnia were invited to participate in post-trial focus groups. Two groups were held. Participants (n = 9) described how their sleep routine, thoughts and emotions were affected by MBSR and about utility (or not) of various mindfulness techniques. Groups were audio-recorded, transcribed and analyzed using content analysis. RESULTS Four themes were identified: the impact of mindfulness on sleep and motivation to adopt a healthy sleep lifestyle; benefits of mindfulness on aspects of life beyond sleep; challenges and successes in adopting mindfulness-based practices; and the importance of group sharing and support. Participants said they were not sleeping more, but sleeping better, waking more refreshed, feeling less distressed about insomnia, and better able to cope when it occurred. Some participants experienced the course as a call to action, and for them, practicing meditation and following sleep hygiene guidelines became priorities. Motivation to sustain behavioral changes was reinforced by feeling physically better and more emotionally stable, and seeing others in the MBSR class improve. The body scan was identified as an effective tool to enable falling asleep faster. Participants described needing to continue practicing mindfulness to maintain benefits. CONCLUSIONS First-person accounts are consistent with published trial results of positive impacts of MBSR on sleep measured by sleep diary, actigraphy, and self-report sleep scales. Findings indicate that mindfulness training in a group format, combined with sleep hygiene education, is important for effective application of MBSR as a treatment for chronic insomnia.
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Affiliation(s)
- Amber Hubbling
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Mary Jo Kreitzer
- Center for Spirituality & Healing and School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Cynthia R Gross
- College of Pharmacy & School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
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Lawson KL, Jonk Y, O'Connor H, Riise KS, Eisenberg DM, Kreitzer MJ. The impact of Telephonic Health Coaching on Health Outcomes in a High-risk Population. Glob Adv Health Med 2014; 2:40-7. [PMID: 24416671 PMCID: PMC3833538 DOI: 10.7453/gahmj.2013.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Health coaching is a client-centric process to increase motivation and self-efficacy that supports sustainable lifestyle behavior changes and active management of health conditions. This study describes an intervention offered as a benefit to health plan members and examines health and behavioral outcomes of participants. Methods: High-risk health plan enrollees were invited to participate in a telephonic health coaching intervention addressing the whole person and focusing on motivating health behavior changes. Outcomes of self-reported lifestyle behaviors, perceived health, stress levels, quality of life, readiness to make changes, and patient activation levels were reported at baseline and upon program completion. Retrospectively, these data were extracted from administrative and health coaching records of participants during the first 2 full years of the program. Results: Less than 7% of the 114 615 potential candidates self-selected to actively participate in health coaching, those with the highest chronic disease load being the most likely to participate. Of 6940 active participants, 1082 fully completed health inventories, with 570 completing Patient Activation Measure (PAM). The conditions most often represented in the active participants were depression, congestive heart failure, diabetes, hyperlipidemia, hypertension, osteoporosis, asthma, and low back pain. In 6 months or less, 89% of participants met at least one goal. Significant improvements occurred in stress levels, healthy eating, exercise levels, and physical and emotional health, as well as in readiness to make change and PAM scores. Discussion: The types of client-selected goals most often met were physical activity, eating habits, stress management, emotional health, sleep, and pain management, resulting in improved overall quality of life regardless of condition. Positive shifts in activation levels and readiness to change suggest that health coaching is an intervention deserving of future prospective research studies to assess the utilization, efficacy, and potential cost-effectiveness of health coaching programs for a range of populations.
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Affiliation(s)
- Karen L Lawson
- University of Minnesota Center for Spirituality and Healing, United States
| | - Yvonne Jonk
- University of Minnesota School of Public Health, United States
| | - Heidi O'Connor
- University of Minnesota School of Public Health, United States
| | | | - David M Eisenberg
- Harvard School of Public Health, Boston, Massachusetts, and Samueli Institute, Alexandria, Virginia, United States
| | - Mary Jo Kreitzer
- University of Minnesota Center for Spirituality and Healing, United States
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Kelsey P, Manahan B, Sierpina V, Kreitzer MJ. Leadership and education program for students in integrative medicine: building a new generation of physician healers. Explore (NY) 2013; 9:389-91. [PMID: 24199781 DOI: 10.1016/j.explore.2013.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haramati A, Adler SR, Wiles M, Sierpina VS, Kreitzer MJ. Innovation and collaboration: the First International Congress for Educators in Complementary and Integrative Medicine. Explore (NY) 2013; 9:118-20. [PMID: 23452717 DOI: 10.1016/j.explore.2012.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kreitzer MJ. Nursing at the forefront of integrative health care. Beginnings 2013; 33:8-10. [PMID: 24245338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Maltz A, Bjerke W, Belanger M, Franzen K, Brodsky M, Sierpina VS, Kreitzer MJ. Evaluation and Treatment of Breast Pain: An Integrative Medicine Learning Activity. Explore (NY) 2013; 9:255-9. [DOI: 10.1016/j.explore.2013.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bazarko D, Cate RA, Azocar F, Kreitzer MJ. The Impact of an Innovative Mindfulness-Based Stress Reduction Program on the Health and Well-Being of Nurses Employed in a Corporate Setting. J Workplace Behav Health 2013; 28:107-133. [PMID: 23667348 PMCID: PMC3646311 DOI: 10.1080/15555240.2013.779518] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study implemented an innovative new model of delivering a Mindfulness-Based Stress Reduction (MBSR) program that replaces six of the eight traditional in-person sessions with group telephonic sessions (tMBSR) and measured the program's impact on the health and well-being of nurses employed within a large health care organization. As part of a nonrandomized pre–post intervention study, 36 nurses completed measures of health, stress, burnout, self-compassion, serenity, and empathy at three points in time. Between baseline (Time 1) and the end of the 8-week tMBSR intervention (Time 2), participants showed improvement in general health, t(37) = 2.8, p < .01, decreased stress, t(37) = 6.8, p < .001, decreased work burnout, t(37) = 4.0, p < .001, and improvement in several other areas. Improvements were sustained 4 months later (Time 3), and individuals who continued their MBSR practice after the program demonstrated better outcomes than those that did not. Findings suggest that the tMBSR program can be a low cost, feasible, and scalable intervention that shows positive impact on health and well-being, and could allow MBSR to be delivered to employees who are otherwise unable to access traditional, on-site programs.
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Affiliation(s)
- Dawn Bazarko
- Center for Nursing Advancement, UnitedHealth Group, Minnetonka, Minnesota, USA
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