Elsevier

The American Journal of Medicine

Volume 130, Issue 10, October 2017, Pages 1219.e1-1219.e17
The American Journal of Medicine

Review
Brief Mindfulness Practices for Healthcare Providers – A Systematic Literature Review

https://doi.org/10.1016/j.amjmed.2017.05.041Get rights and content

Abstract

Mindfulness practice, where an individual maintains openness, patience, and acceptance while focusing attention on a situation in a nonjudgmental way, can improve symptoms of anxiety, burnout, and depression. The practice is relevant for health care providers; however, the time commitment is a barrier to practice. For this reason, brief mindfulness interventions (eg, ≤ 4 hours) are being introduced. We systematically reviewed the literature from inception to January 2017 about the effects of brief mindfulness interventions on provider well-being and behavior. Studies that tested a brief mindfulness intervention with hospital providers and measured change in well-being (eg, stress) or behavior (eg, tasks of attention or reduction of clinical or diagnostic errors) were selected for narrative synthesis. Fourteen studies met inclusion criteria; 7 were randomized controlled trials. Nine of 14 studies reported positive changes in levels of stress, anxiety, mindfulness, resiliency, and burnout symptoms. No studies found an effect on provider behavior. Brief mindfulness interventions may be effective in improving provider well-being; however, larger studies are needed to assess an impact on clinical care.

Introduction

Mindfulness is defined as “a way of being in which an individual maintains openness, patience, and acceptance, while focusing attention on an unfolding situation in a nonjudgmental way.”1 Accumulating evidence suggests that mindfulness-based therapies can improve symptoms of anxiety, burnout, and depression.2 Mindfulness training has been associated with an attitude of curiosity, connection to self and patient, attentive listening, error recognition, and clinical insight.3 Individual mindful practice has thus been offered as a method to improve medical decision-making, be it appropriateness of antibiotic treatment,4 placement of urinary catheters,5 or employee outcomes such as work engagement6 and job performance.7 It is not surprising then, that collective mindfulness (ie, collective capacity to discern discriminatory detail about emerging issues),8 is a hallmark of high-reliability organizations and is associated with lower turnover rates,9 improved quality, and safety.10, 11

An important barrier to broad implementation of mindfulness in health care settings is the time required for training and practice. For example, the mindfulness-based stress-reduction program developed by Jon Kabat-Zinn includes 8 weekly 2.5-hour didactic and practice sessions, one full-day silent retreat, and a recommendation for 45 minutes of daily independent meditation practice.12 Consequently, while participation in mindfulness-based stress reduction programs benefits the well-being of providers, one review concluded that attrition due to time and schedule requirements limits impact.13 Abbreviated interventions using principles of mindfulness have been introduced to overcome this barrier.14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 However, whether these brief interventions improve well-being and provider practice is not known. Therefore, we performed a systematic review to examine the effectiveness of brief mindfulness programs on health care providers in the hospital setting.

Section snippets

Protocol and Registration

This review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline28 and registered with the International Prospective Register of Systematic Reviews (PROSPERO registration number 2016:CRD42016048388).

Data Sources and Searches

The business, theology, philosophy, psychology, social work, nursing, and medical literature were searched to identify brief (ie, lasting ≤4 hours) mindfulness-based practices, with a specific focus on bedside nurses and physicians in the

Results

The literature search yielded 4181 citations. After removal of duplicates, 3561 articles were reviewed by title and abstract. Of these, 221 full-length articles were reviewed and 14 met inclusion criteria (Figure). All included publications reported findings from studies that used volunteer/convenience samples. One of the 14 studies reported qualitative findings,20 while 7 were randomized controlled trials.16, 17, 19, 21, 22, 23, 24 Sample sizes ranged from 10 to 245 participants, with most

Discussion

In this systematic review of studies evaluating the effect of brief mindfulness interventions on provider well-being, brief mindfulness interventions were associated with improvement of stress in 5 studies14, 19, 22, 23, 24 and anxiety in 4 studies.19, 22, 23, 24 Improvements were reported across various types of interventions and modalities. Notably, mindfulness interventions were modified to fit the schedules of providers and included tools for home practice to promote uptake of the behavior.

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  • Cited by (0)

    Systematic review registration number: PROSPERO 2016: CRD42016048388.

    Funding: None.

    Conflicts of Interest: None.

    Authorship: HG is the guarantor. HG, SS, JM, and VC planned the review. All authors contributed to the development of the selection criteria, search strategy, risk of bias assessment strategy, and data extraction criteria. All authors read, provided feedback, and approved the final manuscript. The lead author (HG) affirms that the manuscript is an honest, accurate, and transparent account of the review being reported; that no important aspects of the review have been omitted; and that any discrepancies from the review as planned have been explained.

    Disclaimer: The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the United States Government.

    Copyright for authors: The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats, and media (whether known now or created in the future), to i) publish, reproduce, distribute, display and store the Contribution, ii) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the Contribution, iii) create any other derivative work(s) based on the Contribution, iv) to exploit all subsidiary rights in the Contribution, v) the inclusion of electronic links from the Contribution to third party material where-ever it may be located; and, vi) licence any third party to do any or all of the above.”

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