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An On-the-Job Mindfulness-based Intervention

For Pediatric ICU Nurses: A Pilot

TINA GAUTHEIR PHD, RIKA M.L. MEYER PHD,


DAGMAR GREFE PHD, JEFFREY I. GOLD PHD

Presented by: Sarah Brennan MN, RN, CCRN


Objectives

Define Mindfulness-based interventions


Look at study outcomes
Answer the following questions:
Can mindfulness be an intervention to help nurses deal with
job related stressors?
How did it changes nursing stress? Burnout? Self-compassion?
And job satisfaction?
Identify limitations of pilot study
Nurses deal with a lot on a daily basis!

Little time in our schedules to commit to self-care or


intensive stress reduction programs.
We endure heavy work loads, not always prepared to
deal with emotional and spiritual needs of patients
and families
Job stress can negatively correlate to group cohesion,
job satisfaction in an ICU setting.

Can mindfulness be a intervention to help nurses


effectively manage stress?
What contributes to job stress?

This article identified the following items as stress


inducing:
Nursing shortage
Times constraints
Increased paperwork/charting
Long hours
Lack of calm spaces
Physician-controlled work environments
Mindfulness Interventions

What is Mindfulness?
There is no universal definition as there are different
interpretations of how to achieve mindfulness and differing
opinions on the purpose of mindfulness.
However, the general idea is that Mindfulness is a state in
which one becomes more aware of ones physical, mental and
emotional condition in the present moment, without becoming
judgmental (Mindfulness Based Interventions, 2017).
This concept is thought to help people better control their
thoughts, feeling rather than being controlled by them.
Nursing Demands

As nurses we are expected to deliver quality


caregiving including providing emotional support
while facing intense suffering, open communication
with patients and families and effective interrelations
with coworkers. (Gauthier, Meyer, Grefe, & Gold,
2015)
Nursing Demands

Providing this quality care can be a challenge when


faced with:
Death
Conflicts among staff
Heavy work loads
Role ambiguity in emotionally and spiritually charge
situations

All of this leads to the likelihood of stress events for


nurses.
Nursing Demands

Many studies have identified high levels of stress in


nurses as well as the need for health promoting
behaviors and strategies. However, few studies
translate this knowledge into the nursing practice.
To date there have been 5 mindfulness studies from
2001-2009.
Overall the results support the feasibility and effectives of a
brief mindfulness intervention for reducing burnout while
increasing relations and life satisfaction in nurses and nurses
aids (Gauthier, Meyer, Grefe, & Gold, 2015)
Pilot Study

Aims:
Assess feasibility of 5-min mindfulness mediation for PICU
nurses
Investigate changes in nursing stress, burnout, self-
compassion, mindfulness and job satisfaction over three time
periods
Examine whether there were trait and state mindfulness group
differences in stress and burnout over time.
Pilot Study

Participants:
45 out of 104 PICU RNs in an urban pediatric academic
hospital.
Mostly Caucasian female nurses under 40 years old with less than
5 years nursing experience. (See Table 1 in article for full breakdown)
38/45 (84%) completes all three time points
1stpoint: pre study
2nd point: post study survey
3rd point: 1 month follow up survey

**Reasons for attrition: time constraints, other


priorities, difficulties starting new habit.
Pilot Study

Design
On-the-Job Mindfulness-based Intervention was derived from
a shorted version of Kabat-Zinns traditional Mindfulness-
based Stress Reduction (MBSR) model.
This design was adaptive to the time constrains of nurses.

5-min daily mindfulness sessions were led by an ordained Zen


Buddhist priest twice a day; before each shift change at 06:55
and 18:55 in PICU huddle room
Guided mindfulness mediations over the course of 30-days
have for primary foci:
Breath, sounds, body and mind. Focus was changed every 3 days.
Pilot Study

Procedure
2 weeks prior announcement during staff mtgs, daily huddles,
posted flyers, emails and induvial recruitment.
Consent forms distributed

Web-based links for surveys

5min sessions prior to day/night shifts

Upon completion of study participants were given a CD of the


four mediations, along with a small booklet of basic
mindfulness instructions for future practice.
Pilot Study

Measures
Burnout:
Symptoms of burnout measure by the Maslach Burnout Inventory,
measuring:
Emotional exhaustion, depersonalization, personal
accomplishment (measure with a Likert scale)
Stress:
Levels of stress measure using Nursing Stress Scale, identifying
situations that may cause stress:
Death and dying, conflicts with physicians, inadequate
preparation, lack of support, conflicts with other nurses,
workload and uncertainty concerning treatment (measure on a
4-point scale.never , occasionally, frequently or very
frequently stressful)
Pilot Study

Mindfulness
Measured using the Mindful Attention Awareness Scale (see
attached document)
Measured on a Likert Scale

Self-Compassion
Measured using Self-Compassion Scale, measuring:
Self-kindness vs self judgment, common humanity vs
isolation, mindfulness vs over-identification (on a Likert scale)
Job Satisfaction
Measure by a single item on a Likert Scale
Considering all aspects of my job, I would say that Im very
satisfied with my job.
Analysis and Results

Analysis results of ANOVA and sample t-tests.


Correlations of Variables
Many significant correlations were found within the study.
Positive Correlations
Between mindfulness and self-compassion

Between job satisfaction and stress/burnout

Negative Correlations
Between stress and mindfulness

Stress and self-compassion

Job satisfaction and mindfulness/self compassion


Conclusion

What does this mean?


High levels of stress were reported at baseline and had a
significant decrease post intervention. This was the most
significant piece of data.
Job satisfaction increased from baseline to post - intervention.
Discussion

Aim #1: feasibility of interventions


58% (60 RNs) of nurses in PICU consented to participate indicating
more than half were interested in mindfulness mediations and
looking to learn a new tool for coping with occupational stress.
It seems that this mindfulness-based intervention design was viable
for this nursing population (Gauthier, Meyer, Grefe, & Gold, 2015)
Aim #2: Changes in stress, burnout, mindfulness and
self-compassion over time
Most important finding was stress decreased over time, suggesting
this brief 1month intervention is helpful in RNs in high-stress
environments.
Additional studies will need to be conducted using randomized
control groups to truly determine if this intervention can
significantly decrease negative outcomes such as stress and burnout
and improve positive RN outcomes.
Discussion

Aim #3: Address trait and state mindfulness


RNs who reported moderate trait mindfulness at baseline
reported higher frequencies of stress
Higher mindfulness scores at baseline equated to greater
awareness.
No significant change in stress related to the number of
minutes spent meditating (guided or self mediation).
Limitations and Future Direction

Lack of control group


Misunderstanding of the guiding principles of
mindfulness.
Enrolling larger sample sizes, comparison studies
with different facilitators or other hospitals/units.
Continued research exploring designs that center on
mediation for beginners.
References

Mindfulness Based Interventions. (2017, January 27).


Retrieved November 29, 2017, from
https://www.goodtherapy.org/learn-about-
therapy/types/mindfulness-based-interventions

Gauthier, T., Meyer, R. M., Grefe, D., & Gold, J. I.


(2015). An On-the-Job Mindfulness-based
Intervention For Pediatric ICU Nurses: A Pilot.
Journal of Pediatric Nursing, 30(2), 402-409.
doi:10.1016/j.pedn.2014.10.005