The Use of Mindfulness-Based Interventions to Mitigate Stress and Burnout in Nurses.

Research indicates that mindfulness-based interventions can positively change how individuals perceive stress and burnout. Part of the responsibility of mitigating stress and burnout among nurses should be placed upon the organization; thus, nursing professional development practitioners are in a unique position to engage nurses in mindfulness-based practices. Therefore, a quality improvement project aimed to decrease perceived stress and/or burnout among nurses on three pilot units was implemented utilizing evidence-based mindfulness interventions.

In-service nurse mentoring in 2020, the year of the nurse and the midwife: learning from Bihar, India.

In-service nurse mentoring is increasingly seen as a way to strengthen the quality of health care in rural areas, where healthworkers are scarce. Despite this, the evidence base for designing large-scale programs remains relatively thin. In this capacity-building article, we reflect on the limited evidence that exists and introduce features of the world's largest program, run by CARE-India since 2015. Detail on the mechanics of large-scale programs is often missing from empirical research studies, but is a crucial aspect of organizational learning and development. Moreover, by focusing on the complex ways in which capacity-building is being institutionalized through an embedded model of in-service mentorship, this article bridges research and practice. We point to a number of areas that require further research as well as considerations for program managers designing comparable workforce strengthening programs. With careful planning and cross-national policy learning, we propose that in-service nurse mentoring may offer a cost-effective and appropriate workforce development approach in a variety of settings.

How medical specialists experience the effects of a mindful leadership course on their leadership capabilities: a qualitative interview study in the Netherlands.

OBJECTIVES: Medical leaders are facing leadership challenges that ask for a leadership style that takes care of both themselves and their coworkers. Mindfulness may support this leadership style. We explored how a 'Mindful leadership for medical specialists' course affected medical specialists' leadership. DESIGN: We conducted a qualitative study based on in-depth interviews. The grounded theory method was used to analyse the data. SETTING: A university medical centre in the Netherlands. PARTICIPANTS: Seventeen medical specialists (six male) with an average age of 51 years (ranging from 40 to 66 years). INTERVENTIONS: The mindful leadership course consisted of 10-weekly 5-hour sessions that focused on cultivating mindfulness and compassion. In addition, sessions included didactic and interactional teaching about leadership theories. RESULTS: Four categories emerged from the data: (A) Self - Attitude: psychological attitude towards self, (B) Self - Behaviour: behaviour towards self, (C) Other - Attitude: psychological attitude towards others, and (D) Other - Behaviour: behaviour towards others. Themes were defined within these categories: awareness of self, open mind, insight and appreciation of self (A), emotional and cognitive self-regulation, letting go of unhelpful behaviour and developing helpful behaviour (B), differences in attitude to others such as awareness of (impact on) others, keeping an open mind about others, allowing difficult emotions associated with others, appreciating of others (C), and communicating more effectively, providing direction, empowering and caring for others (D). CONCLUSIONS: The results help us understand the core elements of mindful leadership, both with respect to one's psychological attitude and behaviour towards oneself and others. More research on mindful leadership and the effects on self and others is needed. Mindful leadership courses could be a valuable part of clinical training and might contribute to more sustainable healthcare organisations.

Self-Care Strategies for Professional Development: Transcendental Meditation Reduces Compassion Fatigue and Improves Resilience for Nurses.

The Transcendental Meditation technique was provided to 27 nurses across levels and areas of the organization. Quantitative tools measured the effect on nurses' compassion fatigue and resilience. Paired-sample t test analyses revealed significant improvements in the phenomena studied. Further, resilience showed a large significant, inverse relationship with burnout. This study contributes new knowledge for an innovative self-care strategy to improve resilience and reduce compassion fatigue and burnout among nurses.

Educational renewal of physician training in Australia and New Zealand: Multiple educational innovations in a complex environment.

AIM: The Royal Australasian College of Physicians is renewing its specialty training programs and shifting towards competency-based medical education. Our aim is to improve the quality and rigor of training and graduate outcomes, and promote high standards of physician practice to serve the health of patients, families, and communities in a changing healthcare environment. METHODS: We are progressing holistic change and multiple educational innovations in a complex environment. Numerous stakeholders, a disparate training landscape and a largely volunteer supervisor workforce pose challenges in supporting effective implementation. This paper describes our progress and experience with three key components of our education renewal program: curricular renewal, a new selection process and faculty development. It offers reflections on the practical challenges, lessons learned and factors critical for success. CONCLUSIONS: Our experience highlights opportunities for training organizations to maximize their influence over workplace training experiences and outcomes by taking a systems approach to the design, delivery and evaluation of the components of education renewal. We found that design, development and delivery of our multiple educational innovations have benefited from co-design approaches, progressive and concurrent development, continual exploration of new strategies, and implementation as soon as viable with a commitment to iterative improvements over time.

Conhecimentos e expertises de universidades tradicionais para o desenvolvimento de cursos a distância da Universidade Aberta do Sistema Único de Saúde (UNA-SUS) / Knowledge and expertise from traditional universities for the development of Open University of Brazilian National Health System (UNA-SUS) distance courses / Conocimientos y expertises de universidades tradicionales para el desarrollo de cursos a distancia de Universidad Abierta del Sistema Brasileño de Salud (UNA-SUS)

Este trabalho foi desenvolvido no contexto da Universidade Aberta do Sistema Único de Saúde, um modelo de rede interinstitucional firmado entre o setor de gestão de políticas de saúde e instituições de ensino, visando ao desenvolvimento de iniciativas de formação a distância da força de trabalho em saúde. Por meio da condução e análise de conteúdo de entrevistas semiestruturadas com informantes qualificados em quatro instituições selecionadas para o estudo, objetivou-se identificar como os conhecimentos das universidades são mobilizados a partir das demandas de formação para o Sistema Único de Saúde. Os resultados apontam que são desencadeados processos de constituição de equipes de desenvolvimento de cursos a distância, influenciados por programas preexistentes, que alavancam a mobilização e cooperação de unidades universitárias das instituições sede em resposta à demanda de formação da força de trabalho em saúde.

This study was developed in the context of the Open University of the Brazilian National Health System (UNA-SUS), an inter-institutional network model established between the health policy managerial department and educational institutions to develop distance education initiatives directed to the health workforce. Content analysis was performed on semi-structured interviews with qualified informants in four institutions, selected for the study. It aimed to identify how the educational demands of the Health System may mobilize knowledge coming from universities. The results show that team building processes are set up for distance learning courses development, influenced by pre-existing programs, that leverage the mobilization and cooperation of university units of host institutions in response to the demand for the health workforce education.

Este trabajo fue desarrollado en el contexto de la Universidad Abierta del Sistema Brasileño de Salud, un modelo de red inter-institucional firmado entre el sector de gestión de políticas de salud e instituciones de enseñanza, con el objetivo del desarrollo de iniciativas de formación a distancia de la fuerza de trabajo en salud. Por medio de la dirección y análisis de contenido de entrevistas semi-estructuradas con informantes calificados en cuatro instituciones seleccionadas para el estudio, se buscó identificar cómo los conocimientos de las unidades se movilizan a partir de las demandas de formación para el Sistema Único de Salud. Los resultados señalan que se desencadenan procesos de constitución de equipos de desarrollo de cursos a distancia, con influencia de programas pre-existentes que apalancan la movilización y cooperación de unidades universitarias de las instituciones sede en respuesta a la demanda de formación de la fuerza de trabajo en salud.

Professional development programs in health promotion: tools and processes to favor new practices.

Developing innovative interventions that are in sync with a health promotion paradigm often represents a challenge for professionals working in local public health organizations. Thus, it is critical to have both professional development programs that favor new practices and tools to examine these practices. In this case study, we analyze the health promotion approach used in a pilot intervention addressing children's vulnerability that was developed and carried out by participants enrolled in a public health professional development program. More specifically, we use a modified version of Guichard and Ridde's (Une grille d'analyse des actions pour lutter contre les inégalités sociales de santé. In Potvin, L., Moquet, M.-J. and Jones, C. M. (eds), Réduire les Inégalités Sociales en Santé. INPES, Saint-Denis Cedex, pp. 297-312, 2010) analytical grid to assess deductively the program participants' use of health promotion practices in the analysis and planning, implementation, evaluation, sustainability and empowerment phases of the pilot intervention. We also seek evidence of practices involving (empowerment, participation, equity, holism, an ecological approach, intersectorality and sustainability) in the intervention. The results are mixed: our findings reveal evidence of the application of several dimensions of health promotion (equity, holism, an ecological approach, intersectorality and sustainability), but also a lack of integration of two key dimensions; that is, empowerment and participation, during various phases of the pilot intervention. These results show that the professional development program is associated with the adoption of a pilot intervention integrating multiple but not all dimensions of health promotion. We make recommendations to facilitate a more complete integration. This research also shows that the Guichard and Ridde grid proves to be a thorough instrument to document the practices of participants.

Looking at Graduate Medical Education Through a Different Lens: A Health Care System's Perspective.

In the era of the accountable care organization, U.S. models of physician practice are shifting from the solo, independent practitioner to the physician who is part of a multispecialty group practice or is employed by a health care institution, and from paper-based small offices to practice settings that emphasize technology-enabled, team-based systems of care. In this light, Kaiser Permanente's (KP's) long experience as an integrated, population-based health care delivery system makes it an increasingly relevant model in which to consider how graduate medical education (GME) can best prepare physicians for 21st-century health care. KP's multiple perspectives-as a GME setting, a health care delivery system, a health research enterprise, a community benefit organization, and the nation's largest private, multispecialty group practice of physicians-provide a multifaceted opportunity to consider GME in the context of health care transformation. The authors suggest that all participants in medical education have a role to play in preparing physicians for this future. They recommend that partnerships between universities and health care delivery systems serve as a highly effective model for education; that to better serve the needs of society, medical education institutions must adopt a broad community benefit mindset; and that, when medical groups and other institutions that employ physicians take the baton from GME, they need to commit to ongoing development and lifelong learning to enable their new physicians to reach their full potential.

Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

Policy paradox and political neglect in community health services.

Community health services (CHSs) have never had a settled organisational existence but the turmoil has intensified since the publication of Transforming Community Services in 2009. CHSs are now beset by three dilemmas: ongoing organisational fragmentation; the extension of competition law and the spread of privatisation; inadequate workforce development and lack of clarity on the nature of CHS activity. This has left the services in a position of policy and political vulnerability. The solution may be for the service to be part of horizontal integration models such as the accountable care organisation, with a focus on locality and multi-professional teams wrapped around patient pathways.

Faculty development initiatives to advance research literacy and evidence-based practice at CAM academic institutions.

OBJECTIVES: To present the varied approaches of 9 complementary and alternative medicine (CAM) institutions (all grantees of the National Center for Complementary and Alternative Medicine) used to develop faculty expertise in research literacy and evidence-based practice (EBP) in order to integrate these concepts into CAM curricula. DESIGN: A survey to elicit information on the faculty development initiatives was administered via e-mail to the 9 program directors. All 9 completed the survey, and 8 grantees provided narrative summaries of faculty training outcomes. RESULTS: The grantees found the following strategies for implementing their programs most useful: assess needs, develop and adopt research literacy and EBP competencies, target early adopters and change leaders, employ best practices in teaching and education, provide meaningful incentives, capitalize on resources provided by grant partners, provide external training opportunities, and garner support from institutional leadership. Instructional approaches varied considerably across grantees. The most common were workshops, online resources, in-person short courses, and in-depth seminar series developed by the grantees. Many also sent faculty to intensive multiday extramural training programs. Program evaluation included measuring participation rates and satisfaction and the integration of research literacy and EBP learning objectives throughout the academic curricula. Most grantees measured longitudinal changes in beliefs, attitudes, opinions, and competencies with repeated faculty surveys. CONCLUSIONS: A common need across all 9 CAM grantee institutions was foundational training for faculty in research literacy and EBP. Therefore, each grantee institution developed and implemented a faculty development program. In developing the framework for their programs, grantees used strategies that were viewed critical for success, including making them multifaceted and unique to their specific institutional needs. These strategies, in conjunction with the grantees' instructional approaches, can be of practical use in other CAM and non-CAM academic environments considering the introduction of research literacy and EBP competencies into their curricula.

Development and evaluation of targeted psychological skills training for oncology nurses in managing stressful patient and family encounters.

PURPOSE/OBJECTIVES: To reduce workplace stress by developing a brief psychological skills training for nurses and to evaluate program feasibility, acceptability, and preliminary efficacy in decreasing burnout and stress. DESIGN: Intervention development and evaluation. SETTING: Outpatient chemotherapy unit at a comprehensive cancer center. SAMPLE: 26 infusion nurses and oncology social workers. METHODS: Focus groups were conducted with nurses. Results informed the development and evaluation of training for nurses. Participants completed the Maslach Burnout Inventory and Perceived Stress Scale post-training. MAIN RESEARCH VARIABLES: Burnout and stress. FINDINGS: Focus groups indicated strong commitment among nurses to psychosocial care and supported the idea that relationships with patients and families were sources of reward and stress. Stressors included factors that interfered with psychosocial care such as difficult family dynamics, patient behaviors and end-of-life care issues. Psychological skills training was developed to address these stressors. Evaluations suggested that the program was feasible and acceptable to nurses. At two months, participants showed reductions in emotional exhaustion (p = 0.02) and stress (p = 0.04). CONCLUSIONS: Psychological skills training for managing difficult encounters showed feasibility, acceptability, and potential benefit in reducing emotional exhaustion and stress. IMPLICATIONS FOR NURSING: Brief training that targets sources of clinical stress may be useful for nurses in outpatient chemotherapy units. KNOWLEDGE TRANSLATION: Specific stressors in relationships with patients and families present challenges to nurses' therapeutic use of self. Targeted psychological skills training may help nurses problem-solve difficult encounters while taking care of themselves. System-level strategies are needed to support and promote training participation.

Meeting spiritual needs in mental health care.

Belief in Recovery is a project introduced into Northumberland, Tyne and Wear Foundation Trust between 2010 and 2012 to develop nursing staff members' confidence and skills in meeting the spiritual, religious and cultural needs of patients in mental health recovery. This article describes how we assessed and understood their training needs and developed a training programme, and how this led to positive outcomes for staff.

Evaluation of a compassion fatigue resiliency program for oncology nurses.

PURPOSE/OBJECTIVES: To evaluate a resiliency program designed to educate oncology nurses about compassion fatigue. DESIGN: Descriptive pilot study. SETTING: A National Cancer Institute-designated comprehensive cancer center in the midwestern United States. SAMPLE: 13 oncology nurses employed in an outpatient infusion center. METHODS: Nurses attended a five-week program involving five 90-minute sessions on compassion fatigue resiliency. A pre- and post-test design, using repeated measures, was conducted over six months. MAIN RESEARCH VARIABLES: Scores on the Professional Quality of Life (ProQOL) IV, Maslach Burnout Inventory-Human Services Survey, Impact of Event Scale-Revised (IES-R), and the Nursing Job Satisfaction Scale. FINDINGS: Long-term benefits were realized from the program. Secondary traumatization scores on the ProQOL IV declined immediately after the program, remained down at three months, and then dropped again at six months, with a statistically significant mean difference compared with baseline. The average IES-R total scores improved significantly overall and for each of the three postintervention time points. Participants evaluated the program positively with respect to their ability to apply and benefit from resiliency techniques. CONCLUSIONS: This is the first reported study to show benefits gained from a compassion fatigue intervention program. Participants received useful strategies for managing stress at work and home. IMPLICATIONS FOR NURSING: Compassion fatigue is a prevalent condition among healthcare providers. Development of resiliency to compassion fatigue may improve decision making, clarity of communication, and patient and nurse satisfaction. KNOWLEDGE TRANSLATION: Self-regulation offers an approach to reduce stress during a perceived threat. Working by intention reduces reactivity in the workplace and makes communication more intentional and, therefore, effective.

Development of a hospital-based integrative healthcare program.

Public demand for complementary and alternative medicine (CAM) therapies, often referred to as integrative health (IH), continues to grow. Health systems are now pursing the integration of these therapies with conventional medical care. This article describes the development and evolution of 1 nursing-led model for the integration of CAM services in an inpatient setting and to provide lessons learned for nursing administrators or others interested in developing hospital-based IH programs.

Navigating a safe path together: a theory of midwives' responses to the use of complementary and alternative medicine.

OBJECTIVE: this paper presents the findings from a qualitative study that aimed to explain the processes midwives engaged in when considering the use of complementary and alternative medicine by pregnant women. DESIGN: grounded theory methodology was employed for the study. Data was generated from in-depth interviews and non-participant observation of midwives interacting with expectant mothers. Twenty-five midwives who worked in four hospitals and associated community clinics in Victoria, Australia, participated. FINDINGS: the theory 'Navigating a safe path together' offers a possible explanation of how midwives are responding. When working with women interested in the use of complementary and alternative medicine, midwives move through an iterative process of individualising pregnancy care, encountering diverse perspectives and minimising the risks associated with childbearing. KEY CONCLUSION: at the heart of the theory is the meaning midwives' construct around safe childbirth and their professional roles. Despite widespread support for the therapies, midwives' actions in clinical practice are mediated by a number of factors including the context of their professional work, their beliefs and knowledge, and the woman's expectation and health. IMPLICATIONS FOR PRACTICE: the research highlights the need for improved education and greater professional guidance to equip midwives to respond with greater understanding, and confidence to the increasing prevalence of CAM in the maternity setting.

Control beliefs are related to smoking prevention in prenatal care.

BACKGROUND: Smoking during pregnancy is one of the most important avoidable health risks for the unborn child. Gynaecologists and midwives play a fundamental role in the prevention of smoking during pregnancy. However, a large number of health care practitioners still do not address smoking in pregnant patients. OBJECTIVES: We examined whether gynaecologists and midwives engage in screening and counselling of pregnant women and conducting interventions to prevent smoking during pregnancy. Further, we examined the role of gynaecologists' and midwives' control beliefs. Control beliefs involve efficacy expectations--the practitioner's confidence in his capacity to conduct prevention efforts adequately--and outcome expectations--the practitioner's expectation that such prevention efforts are successful in general. METHODS: A total of 486 gynaecologists and 366 midwives completed a questionnaire on screening of smoking, counselling and other interventions they conduct to prevent smoking during pregnancy. Moreover, gynaecologists and midwives rated their control beliefs regarding their influence on pregnant patients' smoking habits. RESULTS: The majority of gynaecologists and midwives reported screening all pregnant patients regarding smoking, explaining the risks and recommending smoking cessation. By contrast, only a minority engages in more extensive prevention efforts. Strong control beliefs were predictive of a higher likelihood of screening and counselling, as well as of engaging in more extensive interventions. CONCLUSIONS: The findings point to the importance of strengthening gynaecologists' and midwives' control beliefs by professional education and training on smoking prevention.