Incorporating a Mindfulness Program in a Graduate Family Nurse Practitioner Program

J Holist Nurs. 2021 Mar 17;898010121997303.

Abstract

Mindfulness-based stress reduction (MBSR) activities have been shown to have psychological benefits. Studies have identified increased perceived levels of stress in graduate students; however, this is not specific to graduate nursing students. There is very little data on the use of MBSR as a nonpharmacologic tool to decrease stress levels in graduate nurse practitioner students. Therefore, the purpose of this study was to determine if the implementation of MBSR improves the overall perceived stress of graduate nursing students. The pilot MBSR program covered topics such as different forms of mindfulness meditation practice, mindful awareness during yoga postures, and mindfulness during stressful situations. Perceived stress scores mean for the sample (n = 25) was elevated at 26 (+4) indicating moderate stress prior to the MBSR training and significantly decreased post 14-week MBSR training (+6) (p < .05).

This finding suggests that the MBSR activities have contributed to the overall reduction in stress in these students. The graduate family nurse practitioner students are now familiar with the benefits of MBSR and can share this practice with their patients. Having this skill as a part of their clinical tool kit and practice will allow them to apply this to patient care and subsequently provide holistic care.

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The Lived Experience of Learning Mindfulness as Perceived by People Living With Long-Term Conditions: A Community-Based, Longitudinal, Phenomenological Study

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Qual Health Res. 2021 Mar 19;1049732321997130.

Abstract

While a considerable research base demonstrates the positive effects of 8-week secular mindfulness courses, it remains unclear to what degree their participants continue to engage with mindfulness practices; and there is a dearth of published reports on longer-term mindfulness interventions. Studies have also tended to focus on clinical “effectiveness,” with less attention given to participants’ own construal and expectations of mindfulness. To address these gaps, the study reported here implemented a year-long mindfulness program for a group of 20 individuals with long-standing health conditions who gradually transitioned to self-guiding. Their experiences, expectations, and understanding of mindfulness were investigated through the lens of descriptive phenomenology.

The findings revealed that mindfulness practice did bring therapeutic improvement but that it was a multi-faceted process where an individual’s intentionality toward practice was key, with a clear division between those pursuing an “embodied integrated” mindfulness and those viewing it as a stress management tool.

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Mindful Breathing: Effects of a Five-Minute Practice on Perceived Stress and Mindfulness Among Patients With Cancer

Clin J Oncol Nurs. 2021 Apr 1;25(2):174-180.

Abstract

Background: Cancer can cause undesired side effects that can significantly alter patients’ perceived stress and mindfulness. The integration of nonpharmacologic, complementary health interventions, such as mindful breathing, is potentially useful in reducing stress and promoting the well-being of patients during treatment.

Objectives: This study examined the effects of a five-minute mindful breathing practice performed three times per day for three months on perceived stress and mindfulness among patients with cancer.

Methods: This longitudinal, randomized controlled study used a two-group, pre-/post-study design. Patients with distress scores of 4 or higher were randomized into two study arms. Participants in the intervention group were educated on mindfulness and guided on how to perform a five-minute mindful breathing practice. Perceived stress and mindfulness were assessed at baseline, one month postintervention, and three months postintervention.

Findings: Both groups had no significant difference in perceived stress and mindfulness scores at baseline. At three months, the intervention group reported a significant reduction in stress and an increase in mindfulness.

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Mindfulness-based programmes to reduce stress and enhance well-being at work: a realist review

BMJ Open. 2021 Mar 19;11(3):e043525.

Abstract

Objectives To understand how and why workplace mindfulness-based programmes (MBPs) work or do not work.

Design A realist review.

Eligibility criteria for selection We considered any studies (experimental quasi-experimental, observational, qualitative and mixed-methods studies) of workplace MBPs as long as they provided data to explain our programme theories. All MBP formats and delivery modes were included.

Analysis Consistent with realist review methodology, we systematically screened and analysed data to explain how and why workplace MBPs work or do not work. These explanations were consolidated into a programme theory augmented by theories from organisational literature, such as conservation of resources theory.

Results Findings from 75 primary studies suggest that workplace MBPs enable participants (including healthcare professionals) to deal more skillfully with stressful events and improve their well-being. The mechanisms involved can be grouped around awareness/self-regulation, acceptance/compassion, feeling permitted to take care of self, sense of growth and promise of goal attainment. In order for professionals to invest in an MBP and benefit from it, it is important that they feel safe to engage with self-care at work and share emotional difficulties among peers. It is also important that employees are able to link the programme and its activities to existing goals and practices. Concerns of being non-productive, of not getting work done or of being exposed in front of colleagues can result in strategic use of brief mindfulness exercises, non-adherence or drop-out.

Conclusions Simply offering an MBP to (healthcare) professionals in order to reduce stress and enhance well-being does not suffice. A supportive environment must exist in order for the programme’s benefits to be reaped.

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The Mindful Path to Nursing Accuracy: A Quasi-Experimental Study on Minimizing Medication Administration Errors

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Holist Nurs Pract. 2021 May-Jun 01;35(3):115-122.

Abstract

Achieving error-free health care is critically vital and includes freedom from the occurrence of medication errors, which, as yet, is an unrealized goal in the United States. The purpose of this study was to minimize or potentially eliminate medication errors by adding training in mindfulness thinking to the current system protocol. The goal of this quantitative, quasi-experimental study was to determine whether training nurses in mindfulness thinking founded on the Dossey Integral Theory changed the frequency and severity of medication administration errors. Data analysis included the following steps: recording of data using the NCC MERP (National Coordinating Council for Medication Error Reporting) instrument, statistical analysis using paired t test, and a logistical interpretation of descriptive statistics.

An error reduction of 73.3% between pre- and posttraining mean for the experimental group was observed. This study may add to the limited body of research related to mindfulness and the resultant reduction in medication errors.

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Mindfulness-based intervention to promote psychological wellbeing in people with epilepsy: A randomized controlled trial

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Epilepsy Behav. 2021 Mar 17;118:107916.

Abstract

Background: We investigated the efficacy of mindfulness-based intervention (MBI) in promoting psychological wellbeing in people with epilepsy (PWE) using an assessor-blinded randomized controlled design.

Methods: A total of 28 PWE were randomly assigned to either intervention (n = 14 cases) or control group (n = 14 controls). The intervention group received a six 2.5-hour weekly MBI, while the control group did not receive any intervention. They were assessed at three timepoints (T0: before intervention, T1: immediately after intervention, and T2: 6 weeks after intervention). Repeated measures of analyses of variance (RM-ANOVAs) were used for inter-group comparisons to determine intervention effect from baseline -to T1 and -to T2 for all outcome measures. The individual changes were calculated using the reliable change index (RCI). Key outcomes included depression (BDI-II), anxiety (BAI), epilepsy-related quality of life (QOLIE-31), satisfaction with life (SWLS), and level of mindfulness (MAAS).

Results: Participants who participated in the MBI showed significant reduction in BDI-II (p = 0.001), significant increases in MAAS (p = 0.027) and QOLIE-31 (p = 0.001) at T1 when compared with the control group. However, BAI and SWLS were not significant. The trend was similar at 6-week follow-up, all outcome measures of MBI remained significant (p < 0.05) except for BAI and SWLS. Beyond the 6-week intervention, RCI analysis showed a significant improvement in levels of mindfulness (45.45% vs. 21.43%, p = 0.009), depression (45.45% vs. 0.00%, p = 0.016), quality of life (45.45% vs. 14.29%, p = 0.017) with MBI, as compared to the no-intervention phase.

Conclusion: Mindfulness-based intervention is effective in reducing psychological distress and improving the quality of life in PWE.

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Mindfulness-based interventions for breast cancer patients in China across outcome domains: a systematic review and meta-analysis of the Chinese literature

Support Care Cancer. 2021 Mar 26.

Abstract

Objective: This study aims to evaluate the treatment effect of a mindfulness-based intervention for Chinese breast cancer patients across outcome domains, including symptom-related, psychosocial, and quality of life outcomes.

Methods: Following the Cochrane Systematic Review guideline, we searched across five electronic databases, reference lists of eligible studies, professional websites, and major academic journals in Chinese. Publication bias was assessed using funnel plot and Vevea and Woods sensitivity analysis, and risk of bias was evaluated using the revised Cochrane risk of bias tool for randomized trials and risk of bias in non-randomized studies of interventions. A meta-analysis of Hedges’ g was conducted using meta-regression with robust variance estimation.

Results: Final analysis included a total of 45 controlled trials containing 286 effect size estimates. Across outcome domains, studies reported an overall large and statistically significant treatment effect, d = 0.921, 95% CI (0.805, 1.040), p < 0.001. Subgroup analyses of specific domains of outcome reported overall significant treatment effects for (1) symptom-related outcomes, d = 0.885, 95% CI (0.657, 1.110), p < 0.001; (2) psychosocial wellness outcomes, d = 0.984, 95% CI (0.879, 1.090), p < 0.001; and (3) quality of life, d = 0.990, 95% CI (0.776, 1.200), p < 0.001. Moderator analysis did not identify any significant moderator.

Conclusion: Chinese literature reported an overall statistically significant and large treatment effect of a mindfulness-based intervention for breast cancer patients in China. Except for physical symptom outcomes, e.g., nausea/vomiting and pain, a mindfulness-based intervention was effective across outcome domains among Chinese breast cancer patients.

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A qualitative exploration of a mindful resiliency program for community healthcare providers

Nurs Health Sci. 2021 Apr 1.

Abstract

Despite the important contribution of nongovernmental organizations (NGOs) to the community healthcare sector, the building and maintenance of occupational resilience in community health workers has received little attention. However, it is recognized that employees in this sector are exposed to significant stressors from the high demand work environment which negatively impacts on their well-being. Therefore, this research examined the acceptability, feasibility, and sustainability of a mindful resiliency program by employing a qualitative analysis of participant subjective experience of the program in this cohort. This was the first study to be conducted with senior managers and frontline healthcare providers in the nongovernmental organizations community sector. A 1-month post-delivery qualitative review of the program identified four major themes: applicability, changes to participant’s skills, social support, and coping with COVID-19. A major finding was the ability of the participants to immediately recognize their stress levels and then manage them. Additionally, lessons from the program were shown to be usefully applied with colleagues and clients within the work environment, and with family members.

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Twelve tips for mindful teaching and learning in medical education

Med Teach. 2021 Apr 1;1-8.

Abstract

Mindfulness practice has been shown to have many positive benefits for patients, clinicians, and trainees. Mindfulness fosters compassion, connection, and enhanced clinical reasoning and can reduce burnout among clinicians. A primary focus of mindfulness is present-moment awareness and may be achieved through openness, curiosity, perspective-taking, and letting go of judgment. We propose that the core principles of mindfulness can be harnessed by educators to enhance their teaching skills specifically around creating a supportive and safe learning environment, using questions effectively, providing feedback, and serving as role models. Mindful teaching promotes mindful learning, which focuses on context, openness to new possibilities, reflection, and critical thinking, as opposed to rote repetition and memorization. This article describes core mindfulness principles and strategies that can be used to become a more mindful teacher.

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Mindfulness-and acceptance-based interventions for symptom reduction of people with multiple sclerosis: A systematic review and meta-analysis

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Arch Phys Med Rehabil. 2021 Apr 1;S0003-9993(21)00260-4.

Abstract

Objective: To examine the effects of mindfulness- and acceptance-based interventions (MABIs) on reducing symptoms of people with multiple sclerosis (MS).

Data sources: A comprehensive search was conducted within the PubMed, CINAHL, PsycINFO, and SCOPUS databases for articles published from inception to July 3, 2020.

Study selection: Randomized controlled trials (RCTs) were included if MABIs were provided to people with MS exclusively, with reported pre-and post-test results in symptoms of depression, anxiety, stress, fatigue, or pain among people with MS.

Data extraction: Characteristics of the included RCTs and data for meta-analysis were extracted. The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool.

Data analysis: A random effects model with the inverse variance method was used with effect size reported as standardized mean difference. Heterogeneity was assessed using the I² statistic.

Results: 23 RCTs met the eligibility criteria. Meta-analyses found: large effects of MABIs on reducing depressive symptoms, anxiety, stress, and pain; and a moderate effect of MABIs on reducing fatigue at the immediate posttest. Large effects of MABIs on reducing depressive symptoms, anxiety, and stress at follow-up were also found while a moderate effect on reducing fatigue was found at follow-up. There was no significant effect of MABIs on reducing pain at follow-up.

Conclusions: Relatively fewer studies were included in meta-analyses for: pain at the immediate posttest and follow-up; and stress and fatigue at follow-up. The overall risk of bias was unclear. Future high-quality studies with follow-up evaluations are needed to support effects of MABIs on reducing symptoms in people with MS and examine intervention features that increase and maintain effects.

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