Mindfulness Based

Stress ReductionMelissa J. Dunston, RN

University of Maryland School of Nursing

Mindfulness Based

Stress Reduction:

Introduction

What is Meditation?

Engaging in contemplation or reflection -or-

to engage in mental exercise (such as

concentration on one's breathing or

repetition of a mantra) for the purpose of

reaching a heightened level of spiritual

awareness.

Mindfulness Based Stress Reduction: Introduction

The many disciplines of meditation fall under two

categories:

concentrative meditation or mindfulness

meditation (Hill, 2011, p. 250).

History & Theory of Practice

Developed by Jon Kabat-Zinn and his colleagues in 1979 at the Stress Reduction

Clinic at the University of Massachusetts Medical Center to treat chronic pain.

According to the MBSR Standards of Practice MBSR “is a well-defined and

systematic patient-centered educational approach which uses relatively intensive

training in mindfulness meditation as the core of a program to teach people how to

take better care of themselves and live healthier and more adaptive lives” (Kabat-

Zinn, n.d.).

MBSR“the most popular, widely adapted, and widely researched meditation technique

in the West” (IONS, 2013, para. 4).

Mindfulness, as defined by Kabat-Zinn, is “the awareness that emerges through

paying attention on purpose in the present moment” (Stahl & Goldstein, 2010).

Description of the

MBSR Program

8-week intensive program.

Traditional MBSR programs entail weekly, two-hour

long classes and daily hour-long meditation practice.

Some MBSR programs also include weekend-long

intensives, multi-day retreats, take home workbooks,

& take home guided meditation recordings for home

practice.

Community Availability

University Of Massachusetts Medical School

(UMMS),

In Maryland, classes are available through a number

of locations including The Insight Community of

Washington, MedStar Georgetown University

Hospital, and Anne Arundel Medical Center, to

name a few.

Provider EducationMany of the MBSR classes are taught by health care professionals:

physicians, nurses, social workers, and psychologists. In order to

teach a MBSR class, the instructor must first be certified as a MBSR

instructor through the Oasis Institute for Mindfulness-Based

Professional Education and Training at the UMMS Center for

Mindfulness in Medicine, Health Care, and Society (CFM) (UMMS

CFM, 2014).

Prospective instructors first participate in an 8-week long program

themselves, and participate in a number of mindfulness based

meditation retreats, teaching intensives, complete a practicum which

includes teaching at least eight complete eight-week MBSR courses,

and also hold either a progressional graduate degree or

commensurate experience as determined by UMMS CFM(UMMS

CFM, 2014).

Research

FindingsClinical Question:

For nurses and nursing

students, does the use

of MBSR reduce stress

and anxiety and

compared with standard

care?

Article One: The Effects of Mindfulness-based

Stress Reduction on Nurse Stress and BurnoutJoanne Cohen-Katz, PhD, Susan Wiley, MD, Terry Capuano, MSN, MBA,

Debra M Baker, MA, Lynn Deltrick, PhD, Shauna Shapiro, PhD

Journal of Holistic Nursing Practice, 2005

2 part qualitative and quantitative study

Does MBSR “decrease burnout, as measured by the

Maslach Burnout Inventory (BMI), and psychological

distress, as measured by the Brief Symptom

Inventory (BSI), while increasing mindful awareness

and attention, as measured by the Mindfulness

Attention Awareness Scale (MAAS)” (Cohen-Katz,

2005).

Rating: 1B

Article One: The Effects of

Mindfulness-based Stress Reduction

on Nurse Stress and BurnoutLehigh Valley Hospital and Health Network (LVHHN), a healthcare

organization in Pennsylvania. The sample size for this study was 27

healthcare workers, mostly white female registered nurses.

Experimental, RCT with wait-list control group.

Inclusion criteria: participants had to be employed by LVHHN, hold a

position involving patient care, english literacy, and age 18 or older.

Exclusion criteria: suicidality and substance abuse.

Intervention: 8 week MBSR program: weekly meetings, two day-long

retreats, and daily homework to meditate.

Article One: The Effects of

Mindfulness-based Stress Reduction

on Nurse Stress and BurnoutPretest-posttest design

A second cohort composed of seven members of the initial wait

list control group and 4 additional individuals participated in

intervention and were measured in the same fashion as the first

cohort.

Post treatment scores for both intervention groups showed

statistically significant reductions in their scores on emotional

exhaustion and burnout as compared to control.

These results indicate that the 8-week MBSR can be

effective in decreasing burnout in nurses.

Article Two: The effectiveness of a

stress coping program based on

mindfulness meditation on the stress,

anxiety, and depression experienced by

nursing students in KoreaYune Sik Kang, So Young Choi, Eunjung Ryu

Nurse Education Today, 2009

The purpose of the study was “to investigate the effects of

a stress-coping program based on mindfulness meditation

on the stress, anxiety, and depression experienced by

nursing students in Korea.” (Kang et al., 2009).

Rating: 1B

Article Two: The effectiveness of a stress coping

program based on mindfulness meditation on the

stress, anxiety, and depression experienced by

nursing students in Korea

Location: South Korea.

Sample size was initially 41 (32 at the conclusion of the study), mostly

female nursing students who were in their junior or senior year. The

mean age of study participants was 49.8.

Experimental RCT. Study results were evaluated using a pretest-

posttest design.

Intervention: an initial one and a half hour lecture on stress and coping

as well as 8, 1-2 hour long weekly mindful meditation classes.

The control group also participated in the initial lecture, no further

intervention.

Article Two: The effectiveness of a stress coping

program based on mindfulness meditation on the

stress, anxiety, and depression experienced by

nursing students in Korea

Stress, anxiety and depression were measured

using self reporting multi question tools.

The intervention group reported a profound

decrease in stress & anxiety as compared to the

control group.

Integration into

Clinical

Practice SettingNurses experience high levels

of stress due to the nature of

their work and workplaces but

yet they are socialized into

ways of working that minimizes

the likelihood of self-care

(Foureur et al, 2013).

Cautionary Concerns

MBSR is a safe & effective.

High stress levels, however, can be incredibly

negative and health-endangering.

Ways to Introduce to Unit Staff

& Dealing with Resistance

Share research! Mindfulness meditation has been

shown to be more than just a relaxing activity: it has

also been found to physically alter portions of the

brain that improve focus and attention.

Share info on classes: in the Baltimore area start out

around $500 or more for the whole 8-week course.

Are classes too expensive? Share MBSR

workbooks and CDs.

Source: http://scrubsmag.com/scrubs-

meditation-tool/

Quick Nurse Meditations from

ScrubsMag:

Count each exhalation of your breath.

If you notice your attention is directed

toward something else (and your

attention will do just that), gently turn

your mind away from those thoughts

and back toward counting your breath.

1 Minute Meditation Exercise:

Conclusion

Nurses are at risk for experiencing chronic stress,

and chronic stress “is associated with compromised

cognitive functioning, immune suppression, and

degenerative changes in brain structures

responsible for storing new information” (Pipe et al,

2009).

What lies behind us and what lies before us are small matters compared to what lies within

us.

-Ralph Waldo Emerson

ReferencesCohen-Katz, J., Wiley, S., Capuano, T., Baker, D., Deitrick, L., & Shapiro, S. (2005). The effects of mindfulness-based stress

reduction on nurse stress and burnout: a qualitative and quantitative study, part III. Holistic Nursing Practice, 19(2), 78-

86.

Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot

of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and

stress. Contemporary Nurse: A Journal For The Australian Nursing Profession, 45(1), 114-125. doi:10.5172/

conu.2013.45.1.114

Hill, R. (2011). Nursing from the inside-out: Living and nursing from the highest point of your consciousness :

Transform yourself and impact your nursing practice through the art of self-care. Sudbury, Mass.: Jones and Bartlett.

Institute of Noetic Sciences. (2013). Meditation types. Institute of Noetic Sciences website. Retrieved from http://

noetic.org/meditation-bibliography/meditation-types/

Kabat-Zinn, J. (n.d.). MBSR Standards of Practice. Retrieved November 19, 2014, from

http://www.umassmed.edu/cfm/stress-reduction/mbsr-standards-of-practice/

Kang, Y., Choi, S., & Ryu, E. (2009). The effectiveness of a stress coping program based on

mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in

Korea. Nurse Education Today, 29(5), 538-543. doi:10.1016/j.nedt.2008.12.003

Pipe, TB, JJ Bortz, A Dueck, D Pendergast, V Buchda, and J Summers. 2009. "Nurse leader

mindfulness meditation program for stress management: a randomized controlled trial." Journal

Of Nursing Administration 39, no. 3: 130-137. CINAHL with Full Text, EBSCOhost (accessed

November 19, 2014).

Stahl, B., & Goldstein, E. (2010). A Mindfulness-Based Stress Reduction Workbook. Oakland, CA:

New Harbinger Publications.

Teacher Certification Review. (n.d.). Retrieved November 19, 2014, from

http://www.umassmed.edu/cfm/training/detailed-training-information/teacher-certification-review/