Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR)

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Abstract

Demands faced by health care professionals include heavy caseloads, limited control over the work environment, long hours, as well as organizational structures and systems in transition. Such conditions have been directly linked to increased stress and symptoms of burnout, which in turn, have adverse consequences for clinicians and the quality of care that is provided to patients. Consequently, there exists an impetus for the development of curriculum aimed at fostering wellness and the necessary self-care skills for clinicians. This review will examine the potential benefits of mindfulness-based stress reduction (MBSR) programs aimed at enhancing well-being and coping with stress in this population. Empirical evidence indicates that participation in MBSR yields benefits for clinicians in the domains of physical and mental health. Conceptual and methodological limitations of the existing studies and suggestions for future research are discussed.

Introduction

Burnout is endemic in health care professionals with over 40% of nurses reporting general occupational burnout, 28% of physicians endorsing two out of the three aspects of burnout, and up to 60% of psychologists admitting to having practiced at times when they viewed themselves as distressed to the point of clinical ineffectiveness.1, 2, 3 Numerous authors have noted that stress and burnout in health care professionals are associated with various physical health problems including: fatigue, insomnia, heart disease, depression, obesity, hypertension, infection, carcinogenesis, diabetes, and premature aging.4, 5

Burnout has been also associated with decreased patient satisfaction, “suboptimal self-reported patient care”, and longer patient-reported recovery times.3, 6, 7, 8 Moreover, stress has been shown to significantly reduce clinicians' attention and concentration, detract from decision-making skills, and diminish health care professionals' abilities to communicate effectively, to convey empathy, and to establish meaningful relationships with patients.9, 10, 11

In light of these findings, there has been a call for initiatives aimed at promoting the well-being of health care professionals. The practice of mindfulness meditation has been proposed as one means of engendering self-care with the additional benefit of enhancing communication with patients and clients for clinicians. Epstein's (1999)12 seminal article in the Journal of American Medical Association entitled, “Mindful practice” defined mindfulness as a logical extension of the concept of reflective practice, consistent with being present in everyday experience and open to all thoughts, actions, and sensations. He asserted that the goals of mindful practice are to be aware of one's own mental processes as well as what is occurring around oneself and thereby be able to act with compassion. In one review, Stewart (1995)13 underscored the connection between effective physician–patient communication and patient outcomes (i.e., emotional health, symptom resolution, functional status, and pain control). He purported that in order for optimal physician–patient communication to occur, physicians must be “mindful” of themselves, the patient, and the context.

This article will provide an overview of the current literature pertaining to clinicians' health and wellness. A review of empirical studies that have examined the impact of participation in mindfulness training will be presented. Finally, a critique of existing methods as well as implications for future research and practice will be provided.

Section snippets

Clinician stress and burnout

Initial investigations of burnout in health care professionals have largely focused upon so-called “occupational hazards” such as anxiety, depression, substance abuse, and heightened rates of suicide.14, 15, 16 Given these findings, attention has been extended to health care trainees, particularly at the outset of their training periods.17 Professional training in medicine, nursing, and psychology is posited to be particularly stressful in light of the challenges inherent to the application of

Health care professionals' well-being: balance and self-care

Relative to the ample body of research examining distress and burnout in health care professionals, scant attention has been directed towards preventive interventions and the promotion of wellness. Taub and colleagues (2006)21 called for the establishment of ethical guidelines pertaining to health and wellness in physicians, and highlighted the need for the medical profession to take the initiative in establishing physician health programs. Weiner et al (2001)22 found that physicians engaged in

Definition of mindfulness

Mindfulness practice has been proposed to reduce stress and burnout among health care professionals through a number of pathways linked to the tenets underlying the philosophy of practice. In the psychological literature, mindfulness has been defined in many ways, with various foci including cognition, awareness (metacognition), and emotion. Huss and Baer (2007)25 stated that one of the defining features of mindfulness is that “[p]articipants learn to observe these phenomena without evaluating

What is mindfulness-based stress reduction?

Mindfulness-based stress reduction (MSBR) is a psycho-educational program developed by Kabat-Zinn and colleagues at the University of Massachusetts Medical Center. Spanning 8 weeks, the program consists of weekly 2.5 h-long classes and one “day of silence” in between the 6th and 7th weeks. Participants are taught various types of meditation practices, which they apply in class and at home to routine aspects of daily life such as eating, driving, walking, washing the dishes, and interacting with

MBSR for trainees and clinicians in the health care professionals

In this section, studies that examined the effectiveness of MBSR on trainees and clinicians will be reviewed. A summary of these studies is presented in Table 1.

Critique and directions for future research

Despite the promising findings for both clinical and non-clinical populations, research on MBSR, and mindfulness more generally, has been limited by a number of conceptual and methodological issues. Many of the quantitative studies employed small sample sizes, and only one included an additional treatment comparison intervention in order to control for factors such as group support, home practice, or placebo effects. For example, the amount of time the participants spend in home practice is

Conclusions

As the demands placed upon health care providers continue to mount, the interest in the applications of mindfulness training for this population is timely. Research suggests that mindfulness training can serve as a viable tool for the promotion of self-care and well-being. Despite the promising results of the existing body of literature, there remain many questions surrounding the mechanisms through which mindfulness training contributes to positive health related outcomes. Research initiatives

Conflict of interest

None.

Role of the funding source

This research is supported by the Social Sciences and Humanities Research Council of Canada Doctoral Fellowship and by funds from the Jewish General Hospital of Montreal, Segal Center and the Weekend to End Breast Cancer.

Acknowledgements

The authors would like to thank those who made this work possible. Special thanks to Dr. Tom Hutchinson, as well as Ms. Eileen Lavery and Ms. Nancy Gair at McGill Programs in Whole Person Care for their support and Dr. Marilyn Fitzpatrick for her helpful comments and suggestions.

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