Original researchPositive Effects of a Stress Reduction Program Based on Mindfulness Meditation in Brazilian Nursing Professionals: Qualitative and Quantitative Evaluation
Introduction
The negative consequences of stress and burnout among nursing professionals are well characterized in the literature. Factors potentially triggering stress and burnout include excessive emotional burden due to the constant contact with patient and family suffering, extensive workload, feelings of powerlessness regarding job control, and a deficient hospital organization where productivity has been valued more than humanizing service.1 In Brazil, investigations have focused on, among other factors, the lack of structure and working conditions, scarce material resources, high patient demand, and insufficient remuneration.2, 3, 4, 5, 6, 7
Studies conducted with nursing staff suggest that mindfulness can be an effective and inexpensive way to reduce symptoms of stress and burnout, improve quality of life, increase self-compassion, and strengthen professional improvement and personal fulfillment, leading to a higher level of life satisfaction and a better quality of service to patients (Figure 1).8, 9, 10, 11, 12, 13
Empirical evidence and literature reviews on mindfulness-based stress interventions with health professionals have suggested that this practice might yield significant improvement in full attention; general health; mental well-being; life satisfaction; perceived stress symptoms; burnout; self-compassion; and better handling clinical assistance of mindfulness practitioners, in relation to controls.14, 15, 16, 17, 18, 19
Mindfulness, a concept adapted of Buddhist tradition, could be defined as a process of bringing a certain quality of awareness and attentiveness to the experience of the present moment with an attitude of curiosity, openness, and acceptance for each experience. It is a special way of being attentive to events and mental contents (perceptions, sensations, cognitions, and affects) moment-by-moment, so that the perception of reality occurs without emotional or intellectual distortions. This awareness focused on the experiences of the present moment allows for the usual automatic reactivity of one׳s actions to be replaced by a more careful response that allows a greater understanding of one׳s own self and the surrounding world. Specifically, this practice helps avoid the “autopilot” mental mode, which systematically leads the individual to useless rumination, i.e., continuous repetitive negative thoughts about themselves in the past and the future.20
Recently investigated by researchers, the loving kindness meditation aims to develop an affective state of unconditional kindness to all people, using silent mental phrases to develop feelings of love and kindness toward oneself and other beings and to help the practitioner free him/herself from negative emotions.21 A literature review showed the effectiveness of mindfulness-based interventions and loving kindness to increase self-compassion and compassion for others, positive feelings and feelings of connectedness toward strangers, and other positive benefits for the participants.22 Fredrickson et al.23 conducted a randomized, longitudinal field experiment (n = 139), with adults working using loving kindness meditation, and revealed that this meditation practice produced increase overtime in daily experiences of positive emotions related to increase satisfaction with life and reduced depressive symptoms.
The aim of this study was to evaluate the effects of a Stress Reduction Program (SRP) involving the practices of mindfulness and loving kindness meditation on stress and burnout of nursing professionals (nurses, nursing technicians, and nursing assistants), working in a Brazilian hospital, using a design that included quantitative and qualitative analyses.
Section snippets
Participants
The 13 study volunteers were professional nursing (nurses, technicians, and nursing assistants) staff at a Teaching Hospital (São Paulo, Brazil), who were recruited through emails, posters, and the Universidade Federal de São Paulo (UNIFESP) Press Office. This study was approved by the UNIFESP Research Ethics Committee under Protocol no. 1789/10 and all participants signed an informed consent form. The nursing staff managers and the hospital׳s humanization group supported the study, allowing
Sociodemographic Characteristics
Table 1 presents participants׳ sociodemographic characteristics.
Quantitative Results
The 13 professionals who participated in the program completed all questionnaires before the intervention, at post-intervention (after six weeks) and at follow-up (six weeks after the end of the program).
Table 2 compares the results before the program (pre-intervention phase) and the phase immediately after the program (post-intervention). There was a significant reduction in depression, perceived stress, burnout, and anxiety
Discussion
Our initial aim was to investigate whether the Stress Reduction Program (SRP), based on the practice of mindfulness, could help hospital nursing staff face the negative effects of stress and burnout. Since the reaction to stress is mostly subjective, we also aimed to apply a qualitative analysis that would record professionals׳ perceptions of the SRP. We also used indicators of depression, anxiety, quality of life, life satisfaction, and self-compassion to better understand the processes
Conclusion
Our results suggest that a Stress Reduction Program involving mindfulness and loving kindness meditation may be a feasible and potentially effective approach to help problems associated with stress, burnout, depression, and quality of life in a Brazilian hospital setting.
As suggested by authors of other international studies, such as program may help improve reactivity to inner experiences, increase awareness of internal and external experiences, increase awareness of actions and attitudes at
Acknowledgments
We acknowledge the nursing professionals who participated in the research, the Humanization Group of Hospital São Paulo and Dr. Fernando de Camargo Aranha.
This article was reviewed by a professional science editor and by a native English speaking copy editor to improve readability.
References (67)
- et al.
A brief mindfulness-based stress reduction intervention for nurses and nurse aides
Appl Nurs Res
(2006) - et al.
Loving-kindness and compassion meditation: potential for psychological interventions
Clin Psychol Rev
(2011) - et al.
Psychosocial experiences among primary care patients with and without musculoskeletal pain
Eur J Pain
(2004) - et al.
The relationship between job-related burnout and depressive disorders—results from the Finnish Health 200 Study
J Affect Disord
(2005) - et al.
Nurses׳ reports on hospital care in five counties
Health Aff
(2001) - et al.
Cognitive and emotional effects of occupational stress in nursing professionals
Acta Paul Enferm
(2008) - et al.
Absenteísmo por transtornos mentais na enfermagem no período de 1995 a 2004
Arq Ciênc Saúde
(2005) - et al.
Prevalência da síndrome deburnout em trabalhadores de enfermagem de um hospital de grande porte da Região Sul do Brasil
Cad Saúde Pública
(2009) Saúde Mental dos Profissionais de Saúde
Rev Bras Med Trabalho
(2003)- et al.
O estresse do enfermeiro: análise das publicações sobre o tema
Rev Ciênc Méd Campinas
(2006)
Reflexões sobre estresse e burnout e a relação com a enfermagem
Rev Latino-Am Enferm
The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: a quantitative and qualitative study
Holist Nurs Pract
Mindfulness-based stress reduction for health care professionals: results from a randomized trial
Int J Stress Manag
Mindful meditation: healing burnout in critical care nursing
Holist Nurs Pract
Passage meditation reduces perceived stress in health professionals. A randomized, controlled trial
J Consult Clin Psychol
Nurse leader mindfulness meditation program for stress management: a randomized controlled trial
J Nurs Adm
Association of psychological and physiological measures of stress in health-care professionals during an 8-week mindfulness meditation program: mindfulness in practice
Stress Health
Mindfulness (Atención Plena): La meditación en psicología clínica
Gac Psicol
Mindfulness-based cognitive attitude training for primary care staff: a pilot study
Complement Health Pract Rev
A mindfulness course decreases burnout and improves well-being among healthcare providers
Int J Psychiatry Med
The impact of an innovative mindfulness-based stress reduction program on the health and well-being of nurses employed in a corporate setting
J Workplace Behav Health
Mindfulness-based stress reduction: an intervention to enhance the effectiveness of nurse׳s coping with work-related stress
Int J Nurs Knowledge
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness
The role of mindfulness and loving-kindness meditation in cultivating self-compassion and other-focused concern in health care professionals
Mindfulness
Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources
J Pers Soc Psychol
An inventory for measuring depression
Arch Gen Psychiatry
Validation of a portuguese version of the beck depression inventory and the state-trait anxiety inventory in Brazilian subjects
Braz J Med Biol Res
Manual da versão em português das Escalas Beck
Psychiatric morbidity among the elderly in a primary care setting: report from a survey in São Paulo, Brazil
Int J Geriatr Psychiatry
A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of São Paulo
Br J Psychiatry
Sintomas psiquiátricos entre pacientes com demência atendidos em um serviço ambulatorial
Arq Neuro-Psiquiatr
Living Well With Pain and Illness: The Mindful Way to Free Yourself From Suffering
Negative life events, perceived stress, negative affect, and susceptibility to the common cold
J Pers Soc Psychol
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