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

Sarah Ellen Braun, Patricia Kinser, Caroline K Carrico, Alan Dow, Sarah Ellen Braun, Patricia Kinser, Caroline K Carrico, Alan Dow

Abstract

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

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

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

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

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

Keywords: burnout; health-care professional well-being; health-care students; interprofessional education; mindfulness.

Figures

Figure 1.
Figure 1.
Study Flow Diagram.

References

    1. Maslach C, Leiter MP, Schaufeli W. Measuring burnout In: Cartwright Susan, Cooper Cary L, eds. The Oxford handbook of organizational well being. Oxford, England: Oxford University Press; 2009.
    1. Sokka L, Leinikka M, Korpela J, et al. Job burnout is associated with dysfunctions in brain mechanisms of voluntary and involuntary attention. Biol Psychol. 2016; 117:56–66. doi:10.1016/j.biopsycho.2016.02.010
    1. Melamed S, Shirom A, Toker S, Berliner S, Shapira I. Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychol Bull. 2006; 132(3):327–353. doi:10.1037/0033-2909.132.3.327
    1. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016; 50(1):132–149. doi:10.1111/medu.12927
    1. Ahola K, Väänänen A, Koskinen A, Kouvonen A, Shirom A. Burnout as a predictor of all-cause mortality among industrial employees: a 10-year prospective register-linkage study. J Psychosom Res. 2010; 69(1):51–57.
    1. Bianchi R, Schonfeld IS, Laurent E. Burnout-depression overlap: A review. Clin Psychol Rev. 2015; 36:28–41.
    1. Consiglio C, Borgogni L, Alessandri G, Schaufeli WB. Does self-efficacy matter for burnout and sickness absenteeism? The mediating role of demands and resources at the individual and team levels. Work Stress. 2013; 27(1):22–42.
    1. Atallah F, McCalla S, Karakash S, Minkoff H. Please put on your own oxygen mask before assisting others: a call to arms to battle burnout. Am J Obstet Gynecol. 2016; 215(6):731.e1–731.e6.
    1. Dyrbye L, Shanafelt T, Sinsky C, et al. Burnout among health care professionals a call to explore and address this underrecognized threat to safe, high-quality care. Natl Acad Med. 2017; 1–11.
    1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014; 12(6):573–576.
    1. Burton A, Burgess C, Dean S, Koutsopoulou GZ, Hugh-Jones S. How effective are mindfulness-based interventions for reducing stress among healthcare professionals? A systematic review and meta-analysis. Stress Health. 2016; 33(1):3–13.
    1. Lamothe M, Rondeau É, Malboeuf-Hurtubise C, et al. Outcomes of MBSR or MBSR-based interventions in health care providers: a systematic review with a focus on empathy and emotional competencies. Complement Ther Med. 2016; 24:19–28.
    1. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Delacorte Press; 1990.
    1. Davidson RJ, Kaszniak AW. Conceptual and methodological issues in research on mindfulness and meditation. Am Psychol. 2015; 70(7):581–592.
    1. Chiesa A. The difficulty of defining mindfulness: current thought and critical issues. Mindfulness (N Y). 2013; 4(3):255–268.
    1. Runyan C, Savageau JA, Potts S, Weinreb L. Impact of a family medicine resident wellness curriculum: a feasibility study. Med Educ Online. 2016; 21(1):30648.
    1. Craigie M, Slatyer S, Hegney D, et al. A pilot evaluation of a mindful self-care and resiliency (MSCR) intervention for nurses. Mindfulness (N Y). 2016; 7(3):764–774.
    1. Greeson JM, Toohey MJ, Pearce MJ. An adapted, four-week mind–body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care. Explor J Sci Heal. 2015; 11(3):186–192.
    1. Bond AR, Mason HF, Lemaster CM, et al. Embodied health: the effects of a mind-body course for medical students. Med Educ Online. 2014; 18(1):1–8.
    1. Raab K, Sogge K, Parker N, Flament MF. Mindfulness-based stress reduction and self-compassion among mental healthcare professionals: a pilot study. Ment Health Relig Cult. 2015; 18(6):503–512.
    1. Kraemer KM, Luberto CM, O’Bryan EM, Mysinger E, Cotton S. Mind–body skills training to improve distress tolerance in medical students: a pilot study. Teach Learn Med. 2016; 28(2):219–228.
    1. Burgess DJ, Beach MC, Saha S. Mindfulness practice: a promising approach to reducing the effects of clinician implicit bias on patients. Patient Educ Couns. 2016; 100(2):372–376. doi:10.1016/j.pec.2016.09.005
    1. Drach-zahavy A, Saban M. Mindful triage: improving the quality of care of patients with mental illness in the emergency department. Int J Emerg Ment Heal Hum Resil. 2016; 18(2):742–744.
    1. Dierynck B, Leroy H, Savage GT, Choi E. The role of individual and collective mindfulness in promoting occupational safety in health care. Med Care Res Rev. 2017; 74(1):79–96.
    1. Sibinga EMS, Wu AW. Clinician mindfulness and patient safety. JAMA. 2010; 304(22):2532–2533.
    1. Vinson AE, Wang J. Is mindful practice our ethical responsibility as anesthesiologists? Int Anesthesiol Clin. 2015; 53(3):1–11.
    1. Braun SE, Kinser PA, Rybarczyk B. Can mindfulness in health care professionals improve patient care? An integrative review and proposed model [published online ahead of print June 26, 2018]. Transl Behav Med. doi:10.1093/tbm/iby059
    1. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982; 4(1):33–47.
    1. Kinser P, Braun S, Deeb G, Carrico C, Dow A. “Awareness is the first step”: an interprofessional course on mindfulness & mindful-movement for healthcare professionals and students. Complement Ther Clin Pract. 2016; 25:18–25. doi:10.1016/j.ctcp.2016.08.003
    1. Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008; 31(1):23–33. doi:10.1007/s10865-007-9130-7
    1. Gard T, Noggle JJ, Park CL, Vago DR, Wilson A. Potential self-regulatory mechanisms of yoga for psychological health. Front Hum Neurosci. 2014; 8(September):1–20.
    1. Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol. 1986; 42(3):488–492.
    1. West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009; 24(12):1318–1321.
    1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2017; 90(12):1600–1613.
    1. Shanafelt TD. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002; 136(5):358–367. doi:10.7326/0003-4819-136-5-200203050-00008
    1. Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. Soc Psychol Heal. 1988; 13:31–67.
    1. Roberti JW, Harrington LN, Storch EA. Further psychometric support for the 10-item version of the perceived stress scale. J Coll Couns. 2006; 9:135–147.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001; 16:605–613.
    1. Moriarty AS, Gilbody S, McMillan D, Manea L. Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. Gen Hosp Psychiatry. 2015; 37(6):567–576.
    1. Tilton BSR. Review of the state-trait anxiety inventory (STAI). J Pers. 2008; 48(2):2883–2894.
    1. Spielberger CD, Spielberger DC. State-trait anxiety inventory. In: The Corsini Encyclopedia of Psychology. Hoboken, NJ: John Wiley & Sons, Inc.; 2010.
    1. Fleeson W. Toward a structure- and process-integrated view of personality: traits as density distributions of states. J Pers Soc Psychol. 2001; 80(6):1011–1027.
    1. Fleeson W. Moving personality beyond the person-situation debate: the challenge and the opportunity of within-person variability. Curr Dir Psychol Sci. 2004; 13(2):83–87.
    1. Baer RA, Smith GT, Lykins E, et al. Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment. 2008; 15(3):329–342. doi:10.1177/1073191107313003
    1. Thomas HP, Pollio S. Listening to patients: a phenomenological approach to nursing research and practice. J Nurses Staff Dev. 2003; 19(5):260.
    1. Cohen MZ, Kahn DL, Steeves RH. Hermeneutic phenomenological research: a practical guide for nurse researchers. Methods Nurs Res. 2000;( 2):x, 114, p.
    1. Giorgi A. The phenomenological movement and research in the human sciences. Nurs Sci Q. 2005; 18(1):75–82.
    1. Epstein RM, Dannefer EF, Nofziger AC, et al. Comprehensive assessment of professional competence: the Rochester experiment. Teach Learn Med. 2004; 16(2):186–196.
    1. Roter D, Larson S. The Roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions. Patient Educ Couns. 2002; 46(4):243–251.
    1. Roter D. The enduring and evolving nature of the patient—physician relationship. Patient Educ Couns. 2000; 39:5–15.
    1. Dobkin PL, Bernardi NF, Bagnis CI. Enhancing clinicians’ well-being and patient-centered care through mindfulness. J Contin Educ Heal Prof. 2016; 36(1):11–16.
    1. Beach MC, Sankar A, Roter D, et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013; 11(5):421–428.
    1. Rodriguez Vega B, Melero-Llorente J, Bayon Perez C, et al. Impact of mindfulness training on attentional control and anger regulation processes for psychotherapists in training. Psychother Res. 2014; 24(2):202–213.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir