ReviewBrief Mindfulness Practices for Healthcare Providers – A Systematic Literature Review
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.
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