In the MomentMindfulness Meditation

Stephanie Kimbrel, BSN, RNNU 504 Integrative HealingSpring 2012

What is Mindfulness Meditation?• 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)

Background

• Eastern philosophy• Buddhism• Thich Nhat Hanh• Mind-body medicine• Western Medicine• Behavioral Science• Disease state

• Kabat-Zinn: Mindfulness-Based Stress Reduction (MBSR)

Pathophysiology• 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

Mindfulness Meditation• 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

Review of Literature• 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 of Literature• 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

Review of Literature• 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

Review of LiteratureFocus: Health care professionals

• “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)

Review of LiteratureFocus: Health care professionals• 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• Email 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

Review of LiteratureFocus: Health care professionals

• 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

Review of LiteratureFocus: Health care professionals• “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

Review of LiteratureFocus: Health care professionals

• Sample:• 38 health care professionals aged 18-65 • MBSR 18• Wait list 20

• Measurements:• Brief Symptom Inventory 10 item self report• Maslach Burnout Inventory• Satisfaction with life and self-compassion

Review of LiteratureFocus: Health care professionals

• 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

Incorporation intoAdvanced Nursing Practice• 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