mindfulness practices for healthcare
TRANSCRIPT
Mindfulness Practices for Healthcare
Presented by: James Pann, PhDNova Southeastern University
Today’s Moderator & CITI Program
The Collaborative Institutional Training Initiative (CITI Program) is dedicated to promoting the public’s trust in the research enterprise by providing high quality, peer-reviewed, web-based educational courses in research, ethics, regulatory oversight, responsible conduct of research, research administration, and other topics pertinent to the interests of member organizations and individual learners.
About Today’s Presenter
James Pann, PhDNova Southeastern University
James Pann received M.S.Ed. in Mental Health Counseling and Ph.D. in Counseling Psychology from the University of Miami (UM).
He is an Associate Professor at the Abraham S. Fischler College of Education at NSU where he focuses on mindfulness interventions and program evaluation and teaching graduate students.
Conflicts of Interest Disclosure: James Pann
I have no relevant personal/professional/financial relationship(s) with respect to this educational activity.
Learning Objectives
• Be able explain what mindfulness is and is not.• Identify the benefits of mindfulness practice
for healthcare workers.• Understand how to use two formal
mindfulness practices.• Be able to incorporate reflective questions
in their healthcare practice.
Burnout and Stressors
Self-Care
Mindfulness
Prevalence of Burnout
• 84% of healthcare workers indicated feeling at least mildly burned out from their work (Berxi survey conducted in October 2020 [Brusie 2020]).• 2020 Medscape National Physician Burnout and Suicide Report (Kane 2020)
found a burnout rate of about 42% (Prior to COVID-19).
What is burnout?
“Burnout is a work-related stress syndrome resulting from chronic exposure to job stress” (De Hert 2020).
Consists of:• Emotional exhaustion• Depersonalization• Feeling of decreased personal accomplishment leading to
lower work effectiveness
Stressors
5 top stressors that healthcare workers identified by Berxi study
Fear of getting COVID-19
Long hours/shifts
General state of the world
Fear of spreading COVID-19
Family responsibilities/issues
(Brusie 2020)
Symptoms of Burnout
• Personal• Anxiety• Depression• Substance abuse• Relationship problems• Suicide
• Professional• Lower patient satisfaction• Impaired quality of care• Medical errors
Self-Care
Strategy identified by De Hert (2020) consists of “self-care practices, in which an individual actively cultivates personal interests and self-awareness in addition to professional and family responsibilities.”
How to manage stress?
How to be resilient?
How to thrive with stress?
Overview of Session
• Definition of mindfulness•Why is it important?•What are the benefits?•Mindfulness meditation• 3-minute breathing space• Reflective questions• Additional resources
What is Mindfulness?
“The awareness that emerges by way of paying attention on purpose, in the present moment, and non-judgmentally, to the unfolding of experience moment to moment” (Kabat-Zinn 2003).
What is Mindfulness?
Bishop et al. (2004) described mindfulness as having 2 main elements:
“Self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment.
Adopting a particular orientation toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance.”
What is Mindfulness?
“And the faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will. . . .
An education which should improve this faculty would be the education par excellence.
But it is easier to define this ideal than to give practical directions for bringing it about” (James 2001).
Mindfulness is a natural state
Mindfulness reminder
You are here
Strengthening Mindfulness
• Notice when our minds wander • Return attention to the
present moment•Mindfulness is like a muscle;
it is something we can strengthen
Mindfulness Is Not
Religion
Relaxation technique
Cure for worrying
Panacea
Escaping from the world
Mindfulness is not about finding bliss at the top of a mountain.
Mindfulness is:
• Non-judging awareness of present-moment experience
• Awareness of experiences: bodily sensations, emotions, moods, thoughts, and sounds
• Noticing the present-moment with openness and acceptance
• Can reduce one’s suffering
(AMRA 2021)
Number of Mindfulness Articles Published from 2004 to 2018
34 2147
69 82
119147
216
264
309
467
595613
656
746
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Mindfulness Meditation - Awareness of Breath
(Tang et al. 2015)
Self-Regulation
Attention RegulationEmotion Regulation
Self-Awareness
Mindfulness Meditation
Benefits of Meditation
• Increased gray matter concentration in the areas of the brain• Helped improve focus and attention • Ability to work under stress• Improved information-processing and
decision-making• Improved anxiety and depression• Enhanced psychological well-being
“Third Wave” of Cognitive
Behavior Therapy
Acceptance and Commitment Therapy (ACT)
Dialectical Behavior Therapy (DBT)
Mindfulness-Based Cognitive Therapy (MBCT)
Other modalities
Mindfulness-Based Interventions (MBI) with Healthcare Providers
• Stress reduction and improved mindfulness were common outcomes achieved, with practice duration having a moderating effect (Ruiz-Fernández et al. 2019).•MBIs conducted with nurses generally show a positive
impact on burnout by enhancing their ability to manage stressful situations (Suleiman-Martos et al. 2020).
Mindfulness-Based Interventions (MBI) with Healthcare Providers
• Physicians generally perceived that mindfulness programs positively impacted their well-being and performance and that the practice of mindfulness addressed unmet self-care and reflection needs (Scheepers et al. 2020). •Mindful communication program resulted in reduced
professional isolation, improved ability to be attentive and listen to patients, and increased self-awareness that was experienced as beneficial (Beckman et al. 2012).
Mindfulness-Based Interventions (MBI) with Healthcare Providers
• Healthcare professionals and mental health therapists can use mindfulness training to enhance self-care and clinical acumen (Shapiro et al. 2014). • Can enhance therapeutic presence and responsiveness as
well as both self-attunement and empathy with clients with counselors (Christopher et al. 2011).
Mindfulness is simple…but not easy
Formal and Informal Mindfulness Practices• Formal meditation practices
• body scan meditation• sitting meditation• walking meditation
• Informal mindfulness practices• awareness of pleasant and unpleasant
experiences; awareness of breathing• mindful pausing• awareness during routine activities
Three-Minute Breathing Space
Segal et al. (2018)
Stimulus
CHOICE
Response
OR
"Human freedom involves our capacity to pause between stimulus and response and, in that pause, to choose the one response toward which we wish to throw our weight” (May 1994).
Pause between stimulus and response
“Even the greatest orchestras, they tune before they play together. 'I have a Stradivarius, I don't need to tune it, I'm a great violinist.' Nonsense, you still need to tune to everybody else and to yourself.
So that, you can think of meditation that way. The tuning your own instrument before you take it out on the road, you can continually retune it, musicians can tune while they are playing even. Retune throughout the day. The real meditation practice... life itself."
(Jon Kabat-Zinn from Meditation is Like Tuning an Instrument [Women Together n.d.])
Meditation is Like Tuning an Instrument
Reflective Questions
• Some mindfulness-based programs encourage the use of reflective questions to promote mindfulness in participants.• Ronald Epstein and his colleagues
(2008) describe the habit of self-questioning as important to developing self-monitoring and mindfulness in physicians. • “Using reflective questions enhances
the ability to see familiar situations with new eyes and to self-monitor one’s actions during actual practice.”
Reflective Questions Improving Self-Awareness
• This metacognitive practice can improve one’s ability to become more self-aware of bias in thinking. • “In this way, we can consciously sense our
tendency to draw rapid conclusions to quell our anxiety and have a conscious choice to inhibit such automatic reactions from controlling our decision-making processes” (Epstein et al. 2008).
Reflective Questions
• “If there were data that I ignored, what might they be?• Is there another way in which I can formulate this
patient’s story and/or my response?•What would a trusted peer say about how I am
managing or feeling about this situation?” (Epstein et al. 2008).
Additional Reflective Questions
What aspects of this situation have caused me to feel uncomfortable?
What is the most difficult issue or emotion that I have encountered in this clinical situation?
What have I done that, if I could do it again, I would do differently?
What am I most grateful for in this patient?
Impact on Work
Awareness of personal emotional states Cognitive biases
Awareness of automatically categorizing things as good or bad
Approaching situations with an open curiosity
Awareness of insights and intuition
Attention to task at hand
Making Meditation a Habit
Set a time
1Link with another habit
2Start small
3Make it easy
4Use a habit tracker like a meditation app
5
References
• American Mindfulness Research Association (AMRA). 2021. “Library: Figure 1. Mindfulness journal publications by year, 1980-2020.” Accessed May 17, 2021.
• Beckman, Howard B., Melissa Wendland, Christopher Mooney, Michael S. Krasner, Timothy E. Quill, Anthony L. Suchman, and Ronald M. Epstein. 2012. “The Impact of a Program in Mindful Communication on Primary Care Physicians.” Academic Medicine 87(6):815-9.
• Bishop, Scott R., Mark Lau, Shauna Shapiro, Linda Carlson, Nicole D. Anderson, James Carmody, Zindel V. Segal, Susan Abbey, Michael Speca, Drew Velting, and Gerald Devins. 2004. “Mindfulness: A proposed operational definition.” Clinical Psychology: Science and Practice 11(3):230-41.
• Brusie, Chaunie. 2020. “Survey of Healthcare Workers Reveals High Levels of Burnout, Stress, & Thoughts of Leaving Their Jobs.” Berxi, December 7.
• Christopher, John Chambers, Jennifer A. Chrisman, Michelle J. Trotter-Mathison, Marc B. Schure, Penny Dahlen, and Suzanne B. Christopher. 2011. “Perceptions of the Long-Term Influence of Mindfulness Training on Counselors and Psychotherapists: A Qualitative Inquiry.” Journal of Humanistic Psychology 51(3):318-49.
• De Hert, Stefan. 2020. “Burnout in Healthcare Workers: Prevalence, Impact, and Preventative Strategies.” Local and Regional Anesthesia 13:171-83.
• Epstein, Ronald M., Daniel J. Siegel, and Jordan Silberman. 2008. “Self-monitoring in clinical practice: A challenge for medical educators.” Journal of Continuing Education in the Health Professions 28(1):5-13.
• James, William. 2001. Psychology: The Briefer Course. Mineola, NY: Dover Publications, Inc.
• Kabat-Zinn, Jon. 2003. “Mindfulness-based interventions in context: Past, present, and future.” Clinical Psychology-Science And Practice 10(2):144-56.
• Kane, Leslie. 2020. “Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide.” Medscape, January 15.
References
• May, Rollo. 1994. The Courage to Create (Revised edition). New York, NY: W. W. Norton & Company.
• Ruiz-Fernández, María Dolores, Rocío Ortíz-Amo, Ángela María Ortega-Galán, Olivia Ibáñez-Masero, María del Mar Rodríguez-Salvador, and Juan Diego Ramos-Pichardo. 2019. “Mindfulness therapies on health professionals.” International Journal of Mental Health Nursing 29(2):127-40.
• Segal, Zindel V., Mark Williams, and John Teasdale. 2018. Mindfulness-Based Cognitive Therapy for Depression, Second Edition. New York, NY: The Guilford Press.
• Scheepers, Renée A., Helga Emke, Ronald M. Epstein, and Kiki M. J. M. H. Lombarts. 2020. “The impact of mindfulness-based interventions on doctors’ well-being and performance: A systematic review.” Medical Education 54(2):138-49.
• Shapiro, Shauna, Sonica Thakur, and Sarah de Sousa. 2014. “Mindfulness for Health Care Professionals and Therapists in Training.” In Mindfulness-Based Treatment Approaches: Clinician's Guide to Evidence Base and Applications (Second Edition), edited by Ruth A. Baer, 319-45. Elsevier Academic Press.
• Suleiman-Martos, Nora, Jose L. Gomez-Urquiza, Raimundo Aguayo-Estremera, Guillermo A. Cañadas-De La Fuente, Emilia I. De La Fuente-Solana, and Luis Albendín-García. 2020. “The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis.” Journal of Advanced Nursing 76(5):1124-40.
• Tang, Yi-Yuan, Britta K. Hölzel, and Michael I. Posner. 2015. “The neuroscience of mindfulness meditation.” Nature Reviews in Neuroscience 16:213-25.
• Women Together. n.d. “Meditation is Like Tuning an Instrument with Jon Kabat-Zinn.” Accessed May 3, 2021.
Additional Resources
Books• Wherever You Go There You Are by Jon Kabat-Zinn• Insight Meditation by Joseph Goldstein
Apps• Insight Timer - free mediation app that includes a timer, courses, and
guided meditations• Waking Up - guided meditation app by Sam Harris, recommended by Tim
Ferriss and Peter Attia
Additional Resources
Video:Making Meditation a Habit by James Pann
Podcast Episodes and Recordings• Jack Kornfield podcast• Dan Harris videos and podcast (10% Happier)
Guided Audio Recordings of Meditations• Mindfulness Based Stress Reduction program guided meditations
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