OBJECTIVE: To explore the potential factors that mediate the relationship between mindfulness and symptoms of posttraumatic stress (PTS) in women who experienced stillbirth.
DESIGN: A cross-sectional analysis of baseline data before women's participation in an online mindfulness intervention (i.e., online yoga).
SETTING: This was a national study, and women participated in their own homes.
PARTICIPANTS: Women who experienced stillbirth (N = 74) within the past 2 years and resided in the United States.
METHODS: Women were recruited nationally, primarily through social media. Participants (N = 74) completed baseline assessments (self-report mental and physical health surveys) via a Web-based survey tool. We conducted an exploratory factor analysis of the COPE Inventory subscales to reduce the number of variables before entry into a mediation model. We then tested the mediation effects of sleep quality, self-esteem, resilience, and maladaptive coping on the relationship between mindfulness and PTS symptoms.
RESULTS: Through the exploratory factor analysis we identified a two-factor solution. The first factor included nine subscales that represented adaptive coping strategies, and the second factor included five subscales that represented maladaptive coping strategies. Results from multiple mediation analysis suggested that mindfulness had a significant inverse relationship to PTS symptoms mediated by sleep quality.
CONCLUSION: Mindfulness practices may have potential benefits for grieving women after stillbirth. Evidence-based approaches to improve sleep quality also may be important to reduce PTS symptoms in women after stillbirth.
Ce mémoire se subdivise en cinq parties :
- Qu’est-ce que la «mindfulness» ?
- Quels sont les domaines d’application de la «mindfulness»?
- Quelles sont les limites de la «mindfulness»? Quels sont les contre-indications ou les effets secondaires de la méditation ?
- Quelle est la place de la «mindfulness» ou méditation en pleine conscience
dans le domaine des soins palliatifs ?
- La «mindfulness» ou méditation en pleine conscience est-elle une aide
proposée aux équipes de soins palliatifs en USP (Unité de Soins Palliatifs) en France en 2018 ?
This study was conducted to evaluate the effects of the Holy Name Meditation on cancer patients’ spiritual well-being, anxiety, depression, and pain. Twenty-eight patients were enrolled in the control group, and 18 patients were selected for the experimental group. Only the patients in the experimental group completed 5 weeks of the Holy Name Meditation Program. All participants were surveyed to assess spiritual well-being (Spiritual Well-Being Scale), anxiety and depression (Symptom Checklist 90-R), and pain (numeric pain rating scale). There were no significant differences between the two groups' general characteristics, but the baseline survey revealed that anxiety and depression levels were higher in the experimental group. Analyzing the results after controlling the baseline scores of anxiety and depression showed that spiritual well-being was increased (F = 4.80, P = .034), whereas anxiety (F = 4.98, P = .031) and depression (F = 7.28, P = .010) were decreased after the intervention. No difference in pain was found between the two groups. The Holy Name Meditation Program was thus effective in enhancing cancer patients' spiritual well-being and decreasing their anxiety and depression. Therefore, it is recommended that Holy Name Meditation be provided in clinical settings to reduce the psychosocial and spiritual suffering of cancer patients.
PROBLEM: Mindfulness training includes mindfulness meditation, which has been shown to improve both attention and self-awareness. Medical providers in the intensive care unit often deal with difficult situations with strong emotions, life-and-death decisions, and both interpersonal and interprofessional conflicts. The effect of mindfulness meditation training on healthcare providers during acute care tasks such as cardiopulmonary resuscitation remains unknown. Mindfulness meditation has the potential to improve provider well-being and reduce stress in individuals involved in resuscitation teams, which could then translate into better team communication and delivery of care under stress. A better understanding of this process could lead to more effective training approaches, improved team performance, and better patient outcomes.
INTERVENTION: All participants were instructed to use a mindfulness meditation device (Muse™ headband) at home for 7 min twice a day or 14 min daily over the 4-week training period. This device uses brainwave sensors to monitor active versus relaxing brain activity and provides real-time feedback.
CONTEXT: We conducted a single-group pretest-posttest convergent mixed-methods study. We enrolled 24 healthcare providers, comprising 4 interprofessional code teams, including physicians, nurses, respiratory therapists, and pharmacists. Each team participated in a simulation session immediately before and after the mindfulness training period. Each session consisted of two simulated cardiopulmonary arrest scenarios. Both quantitative and qualitative outcomes were assessed.
OUTCOME: The median proportion of participants who used the device as prescribed was 85%. Emotional balance, as measured by the critical positivity ratio, improved significantly from pretraining to posttraining (p = .02). Qualitative findings showed that mindfulness meditation changed how participants responded to work-related stress, including stress in real-code situations. Participants described the value of time for self-guided practice with feedback from the device, which then helped them develop individual approaches to meditation not reliant on the technology. Time measures during the simulated scenarios improved, specifically, time to epinephrine in Scenario 1 (p = .03) and time to defibrillation in Scenario 2 (p = .02), improved. In addition, team performance, such as teamwork (p = .04), task management (p = .01), and overall performance (p = .04), improved significantly after mindfulness meditation training. Physiologic stress (skin conductance) improved but did not reach statistical significance (p = .11).
LESSONS LEARNED: Mindfulness meditation practice may improve individual well-being and team function in high-stress clinical environments. Our results may represent a foundation to design larger confirmatory studies.
PURPOSE: Healthcare providers who are involved in the care of patients at the end of life are at risk of developing compassion fatigue, a condition characterized by emotional exhaustion and reduced professional engagement. Research has shown that development of a meditation practice can modify stress perceptions and promote quality of life. This study aimed to evaluate perceived benefits, challenges, and recommendations following participation in a workplace mobile application- and email-based meditation research program.
PARTICIPANTS & SETTING: 11 healthcare providers who participated in the feasibility pilot were recruited from Sparrow Health System in Lansing, Michigan.
METHODOLOGIC APPROACH: Three focus groups and one in-depth interview were conducted. Data were analyzed using qualitative methodology.
FINDINGS: Major themes included program advantages and limitations, challenges that affected adherence, and support for caregivers.
IMPLICATIONS FOR NURSING: Findings support further evaluation of a technology-mediated meditation program for professional caregivers to reduce perceived stress associated with the work environment.
Patients and families increasingly use mobile apps as a relaxation and distraction intervention for children with complex, chronic medical conditions in the waiting room setting or during inpatient hospitalizations; and yet, there is limited data on app quality assessment or review of these apps for level of engagement, functionality, aesthetics, or applicability for palliative pediatric patients. The pediatric palliative care study team searched smartphone application platforms for apps relevant to calming, relaxation, and mindfulness for pediatric and adolescent patients. Apps were reviewed using a systematic data extraction tool. Validated Mobile Application Rating Scale (MARS) scores were determined by two blinded reviewers. Apps were then characterized by infant, child, adolescent, and adult caregiver group categories. Reviewer discussion resulted in consensus. Sixteen of the 22 apps identified were included in the final analysis. The apps operated on either iOS or Android platforms. All were available in English with four available in Spanish. Apps featured a relaxation approach (12/16), soothing images (8/16), and breathing techniques (8/16). Mood and sleep patterns were the main symptoms targeted by apps. Provision of mobile apps resource summary has the potential to foster pediatric palliative care providers' knowledge of app functionality and applicability as part of ongoing patient care.
BACKGROUND: Nineteen million adults worldwide are in need of palliative care. Of those who have access to it, 80% fail to receive an efficient management of symptoms.
OBJECTIVES: To assess the effectiveness and safety of mindfulness meditation for palliative care patients.
METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, PEDro, CINAHL, PsycINFO, Opengrey, ClinicalTrials.gov and WHO-ICTRP. No restriction of language, status or date of publication was applied. We considered randomised clinical trials (RCTs) comparing any mindfulness meditation scheme vs any comparator for palliative care. Cochrane Risk of Bias (Rob) Table was used for assessing methodological quality of RCTs. Screening, data extraction and methodological assessments were performed by two reviewers. Mean differences (MD) (confidence intervals of 95% (CI 95%)) were considered for estimating effect size. Quality of evidence was appraised by GRADE.
RESULTS: Four RCTs, 234 participants, were included. All studies presented high risk of bias in at least one RoB table criteria. We assessed 4 comparisons, but only 2 studies showed statistically significant difference for at least one outcome. 1. Mindfulness meditation (eight weeks, one session/week, daily individual practice) vs control: statistically significant difference in favour of control for quality of life - physical aspects. 2. Mindfulness meditation (single 5-minute session) vs control: benefit in favour of mindfulness for stress outcome in both time-points. None of the included studies analysed safety and harms outcomes.
CONCLUSIONS: Although two studies have showed statistically significant difference, only one showed effectiveness of mindfulness meditation in improving perceived stress. This study focused on one single session of mindfulness of 5 minutes for adult cancer patients in palliative care, but it was considered as possessing high risk of bias. Other schemes of mindfulness meditation did not show benefit in any outcome evaluated (low and very low quality evidence).
Psychosomatic disorder is a condition in which psychological stresses adversely affect physiological (somatic) functioning to the point of distress. It is a condition of dysfunction or structural damage in physical organs through inappropriate activation of the involuntary nervous system and the biochemical response. In this framework, this review will consider anxiety disorders, from the perspective of the psychobiological mechanisms of vulnerability to extreme stress in severe chronic illnesses. Psychosomatic medicine is a field of behavioral medicine and a part of the practice of consultation-liaison psychiatry. Psychosomatic medicine in palliative care, integrates interdisciplinary evaluation and management involving diverse clinical specialties including psychiatry, psychology, neurology, internal medicine, allergy, dermatology, psychoneuroimmunology, psychosocial oncology and spiritual care. Clinical conditions where psychological processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence. Thus, the psychosomatic symptom develops as a physiological connected of an emotional state. In a state of rage or fear, for example, the stressed person's blood pressure is likely to be elevated and his pulse and respiratory rate to be increased. When the fear passes, the heightened physiologic processes usually subside. If the person has a persistent fear (chronic anxiety), however, which he is unable to express overtly, the emotional state remains unchanged, though unexpressed in the overt behavior, and the physiological symptoms associated with the anxiety state persist. This paper wants highlight how clinical hypnosis and meditative states can be important psychosocial and spiritual care, for the symptom management on neuro-psychobiological response to stress.
Research suggests that meditation can relieve stress, cultivate self-regulation skills, improve ability to focus, and modify risk for compassion fatigue (CF) and burnout in healthcare providers. However, studied interventions are time-consuming and combining disparate approaches, resulting in unclear mechanisms of effect. This pilot study examined a novel 6-week technology-assisted meditation program, coherently grounded in the system of yoga therapy that required minimal time. Five 10- to 12-minute meditations were offered via smartphone apps supported by biweekly e-mails. Hospice and palliative professionals at a Midwestern US healthcare network participated in the program (n = 36). Each meditation integrated attention, synchronized breath, gentle movements and a meditation focus. Weekly e-mails introduced a new meditation and reminded participants how and why to practice. The participants used the meditations a mean of 17.18(SD, 8.69) times. Paired t tests found significant presurvey to postsurvey improvements for CF/burnout (P < .05) and interoceptive awareness (P < .001). Participation significantly heightened perceived ability and propensity to direct attention to bodily sensations, increased awareness of physical sensations’ connections to emotions, and increased active body listening. The technology-assisted yoga therapy meditation program successfully motivated providers to meditate. The program required minimal time yet seemed to reduce CF/burnout and improve emotional awareness and self-regulation by heightening attention to present-moment bodily sensations.
Ce dossier thématique contient les articles suivants : le burn-out : une question de société ? ; pour éviter le burn-out, soyons vigilants ; institution et soignants en maisons de repos : partenaires pour prévenir l'épuisement professionnel ; la méditation de pleine conscience, un espace de coulisse à la souffrance du soignant ; prenons du recul pour voir l'horizon qui se cache derrière l'arbre ; témoignage d'une soignante ayant vécu un burn-out.
La méditation de pleine conscience connaît un engouement croissant comme objet d'étude et de pratique clinique. L'auteure examine comment cette pratique fonctionne et si elle a une application valide chez les patients en soins palliatifs.
Les auteurs proposent un éclairage réaliste sur la prise en charge de la fin de vie en France. Critiques avec une "médecine techniciste" qui parfois s'acharne à prolonger artificiellement la vie, refusant la banalisation de l'assistance au suicide, ils défendent la vie tracée par la médecine palliative, qui combine l'apaisement des souffrances physiques et l'accompagnement social et spirituel du mourant et de ses proches. Ce livre s'adresse aussi bien aux malades eux-mêmes qu'à leurs proches ainsi qu'aux soignants.
[Adapté résumé éditeur]
L'auteure propose un retour d'expérience de méditation de pleine conscience avec des personnes en soins palliatifs. Cette approche consiste à se rendre présent à soi-même et au monde ici et maintenant, instant après instant, sans attendre quoi que ce soit de spécial. Elle pourrait favoriser la qualité de vie en aidant ces personnes à mobiliser leurs ressources personnelles et à activer leurs capacités de résilience.
Ce numéro intitulé "Pourquoi recourir aux thérapies non conventionnelles ?" regroupe les articles suivants : place des thérapies complémentaires dans les soins oncologiques de support ; les thérapies complémentaires dans les parcours de soins ou l’introduction à une médecine intégrative à la française ; les paradoxes du recours aux médecines complémentaires ; la méditation inspirée de la pleine conscience en soins palliatifs : une approche en faveur du bien-être et de la qualité de vie ; la sophrologie : une étape dans la qualité de vie ; de l’homéopathie vers une médecine intégrative au service des malades en fin de vie ; l’accompagnement bénévole serait-il une thérapie qui tairait son nom ? ; chemin faisant… Des patientes atteintes d’un cancer gynécologique métastatique.