Stephanie Kimbrel, BSN, RN NU 504 Integrative Healing Spring 2012

Mindfulness meditation is moment to moment awareness. It is being fully awake. It involves being here for the moments of our lives, without striving or judging. Bringing our fullness of attention into anything is mindfulness. Experience your life Present to love, or experience peace, or joy, or contentment Acceptance/releasement towards things Relaxed state of awareness the observes both your inner world of thoughts, feelings and sensations, and the outer world of constantly changing phenomena without trying to control anything. (Meditation, 2012)

Eastern philosophy Buddhism Thich Nhat Hanh Mind-body medicine Western Medicine Behavioral Science Disease state Kabat-Zinn: Mindfulness-Based Stress Reduction (MBSR)

Sympathetic Nervous system Mobilizes body for action Fight or flight response Increases in breathing, heart rate, blood vessels narrow Parasympathetic nervous Relaxation Slows heart and breathing rate, blood vessels to dilate Increased Regional gray matter Left hippocampus: learning and memory process; and emotional regulation Posterior cingulate cortex Integration of self-referential stimuli in the emotional and autobiographical context of one’s own person Temporo-parietal junction Conscious experience of self, unity of self and body Cerebellum Regulation of emotion and cognition

Formal Practice Sitting meditation Walking meditation Yoga, chi gong, tai chi Informal Practice Meditate as we do what we do MBSR Meditation training course 8 week long training finishing with full day of mindful meditation

An extensive Review of Literature was performed during the Spring of 2012 to obtain research studies on Mindfulness meditation. Databases and resources: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, MEDLINE, Ovid SP, National Guideline Clearinghouse, Cochrane Collaboration’s systematic reviews websites of ClinicalTrial.org, the Agency for Healthcare Research and Quality, NCCAM KEYWORDS Mindfulness, mindfulness meditation, meditation, mindfulness-Based stress reduction, health outcomes, health, pain, clinical outcomes LIMITS Full Text, peer reviewed, English, <10 years

Review concluded that mindfulness meditation has shown benefits in: Mood and behavior Preventative medicine and health benefits Quality of life Chronic disease states Cancer, HIV, heart disease, rheumatoid arthritis, chronic pain, fibromyalgia Sleep disorders Stress reduction Sexual therapy

Challenge for evidence-based medicine complex, and multifaceted practice, difficult to standardize compared to pharmacological interventions Clinical trials Significant threats to quality Appropriate randomization: appropriate selection of controls Wait list Double blind procedures Funding

“The Effects of Mindfulness-based Stress Reduction on Nurse Stress and Burnout” Part I, Part II, and Part III Quantitative and Qualitative Study Authors: Joanne Cohen-Katz, PhD; Susan D. Wiely, MD; Terry Cauano, MSN, MBA; Debra M. Baker, MA; and Shauna Shapiro, PhD Published in Holistic Nursing Practice 2004 Purpose: Implementation of Mindfulness-based Stress Reduction in a hospital system as a way to lower burnout and improve well-being among nurses. Setting: Lehigh Valley Hospital and Health Network (LVHHN)

Sample 27 signed up, 14 to treatment grp (12 completed), 13 waitlisted Age range 32-60, avg. 46 yrs 100% female, 96% Caucasian Procedure: Attend a 1-hour information session about an 8-week stress management program advertisements, formal announcements at department meetings, informational articles published in an in-house magazine, and an information table at 2 of the hospital sites. Study Design: Pretest-posttest wait-list control group design with randomization Instruments: Maslach Burnout Inventory: 22-item self report using likert scale Emotional exhaustion subscale Brief symptom inventory: 53-item self-report symptom likert scale Mindfulness Attention Awareness Scale: 15-item self report likert scale Evaluation questionnaire

Conclusion: Effective strategy for reducing burnout Significant reduction in: Emotional exhaustion and depersonalization, and a trend toward significance in their improvement in sense of personal accomplishment Limits: Small sample size Not double blinded population

“Mindfulness-Based Stress Reduction for Health care Professionals: Results from a Randomized Trial” Authors: Shauna L. Shapiro, John A Astin, Scott R. Bishop, and Matthew Cordova Purpose: Replicate and extend initial research demonstrating the value of MBSR for medical students and pre-health students Address the need, by offering an intervention to health care professional to help cope with their considerable stress. Method: Pilot study using randomized controlled study design Study design Experimental vs. wait-list control group Baseline and post treatment

Sample: 38 health care professionals aged MBSR 18 Wait list 20 Measurements: Brief Symptom Inventory 10 item self report Maslach Burnout Inventory Satisfaction with life and self-compassion

Conclusion: Significant changes: Perceived stress Self compassion scales Greater satisfaction with life Decreased job burnout Decreased distress Limits Small sample size Drop out rate Not double blinded

Feasibility: Free Can do at anytime Ethical, Legal, or Cultural concerns or limitations: Must be open to it Further research needed Initial challenges: Beginning meditators realize how much they are thinking Initial discomfort: yoga… teachers