Reduce Burnout in Medical Residents with Mindfulness

Reduce Burnout in Medical Residents with Mindfulness

 

By John M. de Castro, Ph.D.

 

while they appreciate the great meaning in their work, clinicians’ ability to disconnect and recharge may be even more critical than it is for others when it comes to how they view work environments and feel as employees.” – David Gregg

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout contributes to the shortage of doctors and nurses.

 

Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout. So, it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnoutincreasing resilience, and improving sleep. Hence, mindfulness may be a means to reduce burnout and improve well-being in hospital residents.

 

In today’s Research News article “Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081870/), Parsons and colleagues review and summarize the published research regarding methods to reduce burnout in medical residents. From this research they formed conclusions  and recommendations.

 

They report that the published studies demonstrate that medical resident burnout is mitigated by interventions that emphasize mindfulness, stress management, and resilience training. The evidence is fairly strong from well conducted controlled trials. It should be noted that mindfulness training improves both stress management and resilience. So, mindfulness training may be the key to all of the effective training strategies. They also report that working conditions tend to produce fatigue and stress that contribute to burnout. Reduction in burnout can be accomplished by adjustments to the work environment including shift scheduling.

 

So, reduce burnout in medical residents with mindfulness.

 

Research exploring the effects of mindfulness training suggests it produces broad and significant improvements in attributes applicable to patient care and physician well-being.” – American Medical Association

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Parsons, M., Bailitz, J., Chung, A. S., Mannix, A., Battaglioli, N., Clinton, M., & Gottlieb, M. (2020). Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors. The western journal of emergency medicine, 21(2), 412–422. https://doi.org/10.5811/westjem.2019.11.42961

 

Abstract

Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.

Best Practice Recommendations for Individual Interventions

  • Mindfulness training should be incorporated into residency training to improve wellness and reduce burnout (Level 1b, Grade B).
  • Consider incorporating behavioral interventions, such as reframing, self-compassion, and empathy into residency training (Level 4, Grade C)
  • Encourage self-care with respect to physical, psychological, and emotional health. This should include an emphasis on sleep, healthy eating, regular exercise, development of social and professional support networks, PCP visits, resources for substance abuse, and counseling or mentoring programs (Level 4, Grade C)
  • Program faculty should meet privately with residents potentially suffering from burnout to identify the unique causes and appropriate interventions. Close follow-up meetings should assess improvement (Level 4, Grade C)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081870/

 

Improve Doctor’s Performance and Well-Being with Mindfulness

Improve Doctor’s Performance and Well-Being with Mindfulness

 

By John M. de Castro, Ph.D.

 

Anyone whose work involves immense human suffering needs to be aware of their inner life. The nature of the work that physicians do makes [them] more vulnerable to negative emotions or making errors,” – Ronald Epstein

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion.

 

Improving the psychological health of doctors has to be a priority. Contemplative practices have been shown to reduce the psychological and physiological responses to stress. Indeed, mindfulness has been shown to be helpful in treating and preventing burnoutincreasing resilience, improving emotional regulation, and improving sleep. Hence, mindfulness may be a means to improve the performance and psychological health of doctors. Indeed, there have been a number of research studies on the topic. So, it makes sense to step back and summarize what has been found.

 

In today’s Research News article “The impact of mindfulness-based interventions on doctors’ well-being and performance: A systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003865/), Scheepers and colleagues review and summarize the published research studies on the effects of mindfulness training on the performance and well-being of doctors. They report on 24 published studies.

 

They report that the published studies found that mindfulness-based trainings significantly improved the performance and well-being of doctors. This was true particularly for group based mindfulness trainings and for trainings such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) that contained multiple elements of mindfulness trainings. There are “five different elements: (i) integration of mindfulness theory; (ii) provision of didactic information on mindfulness; (iii) development of self‐awareness about thoughts, feelings and bodily sensations; (iv) promotion of attentive and behavioural self‐regulation and positive qualities (curiosity, joy, compassion), and (v) training of meditation practice.” These positive effects were reported across different educational and hospital settings and equally for residents and specialists.

 

The accumulating evidence makes a convincing case for the efficacy of mindfulness-based trainings to improve the performance and well-being of physicians. This should improve their impacts on their patients’ health and should reduce the likelihood of eventual burnout. Although, the review did not focus on mechanisms it is likely that mindfulness has these effects by improving the doctors’ ability to withstand stress and improve their ability to effectively deal with their emotions.

 

So, improve doctor’s performance and well-being with mindfulness.

 

Mindfulness is especially suited to physicians, because it can help counteract the worrying, perfectionism and self-judgment that are so common among doctors.” – WellMD

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Scheepers, R. A., Emke, H., Epstein, R. M., & Lombarts, K. (2020). The impact of mindfulness-based interventions on doctors’ well-being and performance: A systematic review. Medical education, 54(2), 138–149. https://doi.org/10.1111/medu.14020

 

Abstract

Objectives

The well‐being of doctors is at risk, as evidenced by high burnout rates amongst doctors around the world. Alarmingly, burned‐out doctors are more likely to exhibit low levels of professionalism and provide suboptimal patient care. Research suggests that burnout and the well‐being of doctors can be improved by mindfulness‐based interventions (MBIs). Furthermore, MBIs may improve doctors’ performance (eg in empathy). However, there are no published systematic reviews that clarify the effects of MBIs on doctor well‐being or performance to inform future research and professional development programmes. We therefore systematically reviewed and narratively synthesised findings on the impacts of MBIs on doctors’ well‐being and performance.

Methods

We searched PubMed and PsycINFO from inception to 9 May 2018 and independently reviewed studies investigating the effects of MBIs on doctor well‐being or performance. We systematically extracted data and assessed study quality according to the Medical Education Research Study Quality Instrument (MERSQI), and narratively reported study findings.

Results

We retrieved a total of 934 articles, of which 24 studies met our criteria; these included randomised, (un)controlled or qualitative studies of average quality. Effects varied across MBIs with different training contents or formats: MBIs including essential mindfulness training elements, or employing group‐based training, mostly showed positive effects on the well‐being or performance of doctors across different educational and hospital settings. Doctors perceived both benefits (enhanced self‐ and other‐understanding) and challenges (time limitations and feasibility) associated with MBIs. Findings were subject to the methodological limitations of studies (eg the use of self‐selected participants, lack of placebo interventions, use of self‐reported outcomes).

Conclusions

This review indicates that doctors can perceive positive impacts of MBIs on their well‐being and performance. However, the evidence was subject to methodological limitations and does not yet support the standardisation of MBIs in professional development programmes. Rather, health care organisations could consider including group‐based MBIs as voluntary modules for doctors with specific well‐being needs or ambitions regarding professional development.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003865/

Mindful Nurses are Better Nurses

Mindful Nurses are Better Nurses

 

By John M. de Castro, Ph.D.

 

“Mindfulness practice helps nurses to be more fully present with their patients and themselves. The ability to pay attention to what is happening “right now,” in this room with this patient, and not be distracted by other demands and concerns, creates space to use your wisdom and knowledge effectively and with care for the dignity of each patient. Being more present to your own experience and habitual responses increases your ability to manage stress and enhances decision-making, well-being, and self-efficacy.” – Sandra Bernstein

 

In high stress occupations, like nursing, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout contributes to the shortage of doctors and nurses.

 

It is beyond the ability of the individual to change the environment to reduce stress and prevent burnout. So, it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur and thereby make them better in their roles as healthcare providers. Mindfulness has been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnoutincreasing resilience, and improving sleep. Hence, mindfulness may be a means to reduce burnout and improve well-being, dedication, and compassion in nurses.

 

In today’s Research News article “The mediating role of cognitive and affective empathy in the relationship of mindfulness with engagement in nursing.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947930/), Pérez-Fuentes and colleagues recruited Spanish nurses and had them complete measures of mindfulness, empathy, including measures of cognitive and affective empathy, and work engagement including measures of vitality, dedication and absorption.

 

A correlational analysis revealed that the higher the level of mindfulness the higher the level of work engagement including vitality, dedication and absorption and cognitive empathy, and the lower the level of affective empathy. A mediation analysis of these data revealed that mindfulness had direct associations and also indirect associations via cognitive empathy with higher work engagement including vitality, dedication and absorption. That is that mindfulness was directly associated with work engagement and also indirectly associated as a result of mindfulness being associated with higher cognitive empathy that was, in turn, associated with higher work engagement.

 

These findings are correlational and as such causation cannot be established. Nevertheless, the findings suggest that mindful nurses have greater levels of energy (vigor), feel greater challenge and enthusiasm for their work (dedication), have greater attention to and concentration on their work (absorption), and have a better intellectual understanding of the feelings of others (cognitive empathy). In addition, mindful nurses, because they have higher levels of cognitive empathy, have additionally higher levels of work engagement.

 

These findings suggest that mindfulness is an important contributor to the work engagement, vigor, and absorption of nurses. This suggests that mindful nurses are better nurses. Future research should attempt to determine causation by training the nurses in mindfulness and observing whether work engagement increases and burnout decreases as a result of the training.

 

So, mindful nurses are better nurses.

 

Nursing is a high-stress profession that may be taking a toll on our nurses. Mindfulness-based programs can help nurses develop skills to manage clinical stress and improve their health; increase overall attention, empathy, and presence with patients and families; and experience work satisfaction, serenity, decreased incidental overtime, and reduced job burnout.” – Sue Penque

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Pérez-Fuentes, M., Gázquez Linares, J. J., Molero Jurado, M., Simón Márquez, M., & Martos Martínez, Á. (2020). The mediating role of cognitive and affective empathy in the relationship of mindfulness with engagement in nursing. BMC public health, 20(1), 16. https://doi.org/10.1186/s12889-019-8129-7

 

Abstract

Background

The work of health professionals is characterized by a high demand for psychological and emotional resources and high levels of stress. Therefore, the promotion of commitment and job well-being through strategies such as increased mindfulness, is important among nursing workers. Although mindfulness has shown positive effects in the health field, few studies have explored the mechanisms and processes underlying these results. We investigated the mediating role of empathy (cognitive/affective) in the effect of mindfulness on the dimensions of engagement in nursing professionals.

Methods

Sample was comprised of 1268 Spanish nurses between 22 and 62 years old, that completed the Utrecht Labor Engagement Scale and the adapted versions of Mindful Attention Awareness Scale and Basic Empathy Scale. The relationship between variables to be included in the regression analyses, bivariate correlations were carried out, and the descriptive statistics of these variables were also found. To estimate the mediation model was used, in this case for multiple mediation effects.

Results

Mindfulness is found to affect the Vigor and Dedication factors of engagement through cognitive empathy. While for the Absorption factor, the affective component of empathy also exerts a mediating role, although weaker than cognitive empathy. Cognitive empathy, as an individual factor, was shown to have a mediating effect between mindfulness and the factors of engagement in healthcare workers.

Conclusions

The level of mindfulness influences engagement of nursing professionals positively, and this result is mediated mainly by cognitive empathy. Both mindfulness and empathy are modifiable individual factors, so their intervention by designing and implementing specific programs, can increase the commitment and wellbeing of professionals generating benefits to workers and to their patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947930/