Equitable Mindfulness: The practice of mindfulness for all.

The benefits of mindfulness are well-documented; however, these benefits may not be evenly distributed across communities. Equitable Mindfulness aims to make these benefits accessible to a wider and more inclusive audience. The aim of this study was to investigate the applicability of Equitable Mindfulness and systemic barriers that prevent mindfulness programs from being equitably accessed across communities. Twenty-one participants were recruited for qualitative in-depth interviews during a 2-day mindfulness conference. The constant comparison method was used to iteratively identify and categorize themes that emerged within and across interviews. Five dominant themes emerged from the data as follows: inherent equitability, accessibility, inclusiveness, awareness and knowledge-sharing, and acknowledgement of multiple perspectives. Having an applicable and meaningful term to use when describing mindfulness as an inclusive and equitable practice can facilitate the exploration of a new area of research. There is a need for future initiatives aimed at making mindfulness trainings and programs more equitable and accessible to all, regardless of socioeconomic status, race/ethnicity, or abilities/disabilities.

A randomized phase II trial evaluating two non-pharmacologic interventions in cancer survivors for the treatment of sleep-wake disturbances: NCCTG N07C4 (Alliance).

PURPOSE: Sleep disturbance is a prevalent problem for cancer survivors and effective behavioral treatments are not widely used for this population. This study evaluated home-based sleep interventions based on cognitive behavioral therapy for insomnia (CBT-I). METHODS: This phase II randomized controlled trial evaluated two manualized interventions over 7 weeks. The intervention group received sleep hygiene information, stimulus control, sleep restriction, and a bedtime imagery audio recording. The control group was similar, but without sleep restriction and used audio recordings of bedtime short stories instead of imagery. Eligibility included adult cancer survivors who had trouble falling asleep or falling back to sleep on 3 of 7 days. Patients with diagnoses of sleep or mental health disorders were excluded. The primary endpoint was change in time to fall asleep or falling back to sleep after awakening, from baseline to week 7. Two-sample T tests evaluated differences between arms for this endpoint. RESULTS: Ninety-three of 168 planned participants were enrolled from 20 institutions. The study closed early for poor accrual. Baseline time to sleep was 45 min and 52 min for the intervention and control group, respectively. At 7 weeks, both groups improved, the intervention group to 26 min and control group to 30 min, a non-significant difference between groups (p = 0.85). Secondary outcomes improved in both groups with no significant differences between arms. CONCLUSIONS: Improvement in sleep outcomes in both arms was consistent with other CBT-I interventions delivered through alternative approaches to provider-delivered therapy. More research on optimal scalable delivery of CBT-I is needed. CLINICAL RELEVANCE: This study supports the effectiveness of CBT-I based behavioral interventions for sleep but also the need for better delivery methods to improve uptake and effect size. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00993928.

The mindful nurse leader: Key take-away: Go slow before you go fast.

The first and second articles in this three-part series on mindfulness described the production of the video "In the Moment: Stories of Mindfulness in Nursing" as part of the authors' Robert Wood Johnson Foundation Executive Nurse Fellowship program. In this final installment, we discuss our leadership approaches and lessons learned, both as a team and individuals.

The mindful nurse leader: Advancing executive nurse leadership skills through participation in action learning.

In this second installment of a three-part series on mindfulness, we describe the process of producing video vignettes to illustrate how clinical nurses draw on the power of mindfulness to build their own resiliency while delivering compassionate care.

The mindful nurse leader: Improving processes and outcomes; restoring joy to nursing.

In this first installment of a three-part series on mindfulness, we describe a dynamic project aimed at elevating the importance of mindfulness, compassion, and presence as key competencies for professional nurses across the career span in all healthcare settings.

Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients.

INTRODUCTION: Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment. METHODS: Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group. RESULTS: While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one's emotional state. CONCLUSIONS: An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.

Spiritual well-being and quality of life of women with ovarian cancer and their spouses.

BACKGROUND: There is little research on the quality of life (QOL) and spiritual well-being (SWB) of women diagnosed with ovarian cancer and their spouses. OBJECTIVE: We compared the SWB and QOL of these women and their spouses over a 3-year period. METHODS: This is a descriptive, longitudinal study involving 70 women with ovarian cancer and 26 spouses. Questionnaires were completed postoperatively and by mail 3, 7, 12, 18, 24, and 36 months later. All participants completed the Functional Assessment of Chronic Illness Therapy (FACIT)-Spiritual Well-Being-Expanded Version, Symptom Distress Scale, and open-ended questions about changes in their lives. Diagnosed women completed the FACIT-Ovarian and spouses the Caregiver Burden Interview and Linear Analog Self-Assessment scales. RESULTS: Women reported a high level of SWB over time. Spouses' SWB was significantly worse than the women's at 1 and 3 years (P ≤ .05). Insomnia, fatigue, and outlook/worry were problematic across time, with no significant differences between women and spouses except that women experienced more insomnia through 3 months (P = .02). Emotional well-being was compromised over time for the women but not their spouses until year 3. Physical and social well-being were compromised in spouses across time, while women's social well-being remained high and physical well-being was problematic only for the first year. LIMITATIONS: Limitations include a small spouse sample and, due to the disease process, attrition over time. CONCLUSIONS: Ovarian cancer has significant, but different, effects on women and spouses. Some effects are static, while others are not, which underscores the need for continual monitoring.

Rediscovering the art of healing connection by creating the Tree of Life poster.

The goal of this project was to provide a way for hospital staff to form meaningful therapeutic relationships with patients in the fast-paced hospital environment. Watson's Theory of Human Caring was the framework guiding the project. The Lifestory intervention was a Tree of Life poster depicting sources of encouragement and enjoyment, special memories, life lessons, family, and roots. Preintervention and postintervention measures included quality of life (QOL) and spirituality scales with established psychometrics. A one-sample t test was used to analyze data. Mean age of participants (n = 15) was 73.8. Ten (67%) patients reported the intervention positively affected their QOL. Improvements were noted in overall QOL (p = 0.05), as well as emotional (p = 0.005), physical (p = 0.02,) and spiritual well-being, as measured by the Expanded Version of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (p = 0.02). This simple Lifestory intervention was feasible and associated with improvement in several QOL dimensions in hospitalized older adults.

Nurse leader mindfulness meditation program for stress management: a randomized controlled trial.

OBJECTIVE: The aim of this study was to rigorously evaluate a brief stress management intervention for nurse leaders. BACKGROUND: Despite the nursing shortage, evidence-based workplace approaches addressing nurse stress have not been well studied. METHODS: Nurse leaders (n = 33) were randomly assigned to brief mindfulness meditation course (MMC) or leadership course (control). Self-report measures of stress were administered at baseline and within 1 week of course completion. RESULTS: Among MMC participants, change scores (from baseline to postintervention) on several subscales of the Symptom Checklist 90-Revised showed significantly more improvement in self-reported stress symptoms relative to controls. Mindfulness meditation course participants had significantly more improvement in Positive Symptom Distress Index (P = 0.010; confidence interval [CI] = -0.483 to -0.073) and Global Severity Index (P = 0.019; CI = -0.475 to -0.046) and nearly significantly more improvement in Positive Symptom Total (P = 0.066; CI = -16.66 to 0.581) compared with controls. CONCLUSION: Results support preliminary effectiveness of a 4-week MMC in reducing self-reported stress symptoms among nursing leaders.

A prospective descriptive study exploring hope, spiritual well-being, and quality of life in hospitalized patients.

A study evaluating relationships among interventions and outcomes of hope, spiritual well-being, quality of life and length of stay in hospitalized patients at admission, discharge, and 6 weeks after discharge is described. The findings highlight the importance of presence, listening; and other caring behaviors in the patient experience.