MBSRN/NURSE WELLNESS

1. Mindfulness Based
Stress Reduction
Melissa J. Dunston, RN
University of Maryland School of Nursing

2. Mindfulness Based
Stress Reduction:
Introduction
What is Meditation?
Engaging in contemplation or reflection -or-
to engage in mental exercise (such as
concentration on one's breathing or
repetition of a mantra) for the purpose of
reaching a heightened level of spiritual
awareness.

3. Mindfulness Based Stress Reduction: Introduction
The many disciplines of meditation fall under two
categories:
concentrative meditation or mindfulness
meditation (Hill, 2011, p. 250).

4. History & Theory of Practice
Developed by Jon Kabat-Zinn and his colleagues in 1979 at the Stress Reduction
Clinic at the University of Massachusetts Medical Center to treat chronic pain.
According to the MBSR Standards of Practice MBSR “is a well-defined and
systematic patient-centered educational approach which uses relatively intensive
training in mindfulness meditation as the core of a program to teach people how to
take better care of themselves and live healthier and more adaptive lives” (Kabat-
Zinn, n.d.).
MBSR“the most popular, widely adapted, and widely researched meditation technique
in the West” (IONS, 2013, para. 4).
Mindfulness, as defined by Kabat-Zinn, is “the awareness that emerges through
paying attention on purpose in the present moment” (Stahl & Goldstein, 2010).

5. Description of the
MBSR Program
8-week intensive program.
Traditional MBSR programs entail weekly, two-hour
long classes and daily hour-long meditation practice.
Some MBSR programs also include weekend-long
intensives, multi-day retreats, take home workbooks,
& take home guided meditation recordings for home
practice.

7. Community Availability
University Of Massachusetts Medical School
(UMMS),
In Maryland, classes are available through a number
of locations including The Insight Community of
Washington, MedStar Georgetown University
Hospital, and Anne Arundel Medical Center, to
name a few.

8. Provider Education
Many of the MBSR classes are taught by health care professionals:
physicians, nurses, social workers, and psychologists. In order to
teach a MBSR class, the instructor must first be certified as a MBSR
instructor through the Oasis Institute for Mindfulness-Based
Professional Education and Training at the UMMS Center for
Mindfulness in Medicine, Health Care, and Society (CFM) (UMMS
CFM, 2014).
Prospective instructors first participate in an 8-week long program
themselves, and participate in a number of mindfulness based
meditation retreats, teaching intensives, complete a practicum which
includes teaching at least eight complete eight-week MBSR courses,
and also hold either a progressional graduate degree or
commensurate experience as determined by UMMS CFM(UMMS
CFM, 2014).

9. Research
Findings
Clinical Question:
For nurses and nursing
students, does the use
of MBSR reduce stress
and anxiety and
compared with standard
care?

10. Article One: The Effects of Mindfulness-based
Stress Reduction on Nurse Stress and Burnout
Joanne Cohen-Katz, PhD, Susan Wiley, MD, Terry Capuano, MSN, MBA,
Debra M Baker, MA, Lynn Deltrick, PhD, Shauna Shapiro, PhD
Journal of Holistic Nursing Practice, 2005
2 part qualitative and quantitative study
Does MBSR “decrease burnout, as measured by the
Maslach Burnout Inventory (BMI), and psychological
distress, as measured by the Brief Symptom
Inventory (BSI), while increasing mindful awareness
and attention, as measured by the Mindfulness
Attention Awareness Scale (MAAS)” (Cohen-Katz,
2005).
Rating: 1B

11. Article One: The Effects of
Mindfulness-based Stress Reduction
on Nurse Stress and Burnout
Lehigh Valley Hospital and Health Network (LVHHN), a healthcare
organization in Pennsylvania. The sample size for this study was 27
healthcare workers, mostly white female registered nurses.
Experimental, RCT with wait-list control group.
Inclusion criteria: participants had to be employed by LVHHN, hold a
position involving patient care, english literacy, and age 18 or older.
Exclusion criteria: suicidality and substance abuse.
Intervention: 8 week MBSR program: weekly meetings, two day-long
retreats, and daily homework to meditate.

12. Article One: The Effects of
Mindfulness-based Stress Reduction
on Nurse Stress and Burnout
Pretest-posttest design
A second cohort composed of seven members of the initial wait
list control group and 4 additional individuals participated in
intervention and were measured in the same fashion as the first
cohort.
Post treatment scores for both intervention groups showed
statistically significant reductions in their scores on emotional
exhaustion and burnout as compared to control.
These results indicate that the 8-week MBSR can be
effective in decreasing burnout in nurses.

13. Article Two: The effectiveness of a
stress coping program based on
mindfulness meditation on the stress,
anxiety, and depression experienced by
nursing students in Korea
Yune Sik Kang, So Young Choi, Eunjung Ryu
Nurse Education Today, 2009
The purpose of the study was “to investigate the effects of
a stress-coping program based on mindfulness meditation
on the stress, anxiety, and depression experienced by
nursing students in Korea.” (Kang et al., 2009).
Rating: 1B

14. Article Two: The effectiveness of a stress coping
program based on mindfulness meditation on the
stress, anxiety, and depression experienced by
nursing students in Korea
Location: South Korea.
Sample size was initially 41 (32 at the conclusion of the study), mostly
female nursing students who were in their junior or senior year. The
mean age of study participants was 49.8.
Experimental RCT. Study results were evaluated using a pretest-
posttest design.
Intervention: an initial one and a half hour lecture on stress and coping
as well as 8, 1-2 hour long weekly mindful meditation classes.
The control group also participated in the initial lecture, no further
intervention.

15. Article Two: The effectiveness of a stress coping
program based on mindfulness meditation on the
stress, anxiety, and depression experienced by
nursing students in Korea
Stress, anxiety and depression were measured
using self reporting multi question tools.
The intervention group reported a profound
decrease in stress & anxiety as compared to the
control group.

16. Integration into
Clinical
Practice Setting
Nurses experience high levels
of stress due to the nature of
their work and workplaces but
yet they are socialized into
ways of working that minimizes
the likelihood of self-care
(Foureur et al, 2013).

17. Cautionary Concerns
MBSR is a safe & effective.
High stress levels, however, can be incredibly
negative and health-endangering.

18. Ways to Introduce to Unit Staff
& Dealing with Resistance
Share research! Mindfulness meditation has been
shown to be more than just a relaxing activity: it has
also been found to physically alter portions of the
brain that improve focus and attention.
Share info on classes: in the Baltimore area start out
around $500 or more for the whole 8-week course.
Are classes too expensive? Share MBSR
workbooks and CDs.

19. Source: http://scrubsmag.com/scrubs-
meditation-tool/
Quick Nurse Meditations from
ScrubsMag:

20. Count each exhalation of your breath.
If you notice your attention is directed
toward something else (and your
attention will do just that), gently turn
your mind away from those thoughts
and back toward counting your breath.
1 Minute Meditation Exercise:

21. Conclusion
Nurses are at risk for experiencing chronic stress,
and chronic stress “is associated with compromised
cognitive functioning, immune suppression, and
degenerative changes in brain structures
responsible for storing new information” (Pipe et al,
2009).

22. What lies behind us and what lies before us are small matters compared to what lies within
us.
-Ralph Waldo Emerson

23. References
Cohen-Katz, J., Wiley, S., Capuano, T., Baker, D., Deitrick, L., & Shapiro, S. (2005). The effects of mindfulness-based stress
reduction on nurse stress and burnout: a qualitative and quantitative study, part III. Holistic Nursing Practice, 19(2), 78-
86.
Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot
of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and
stress. Contemporary Nurse: A Journal For The Australian Nursing Profession, 45(1), 114-125. doi:10.5172/
conu.2013.45.1.114
Hill, R. (2011). Nursing from the inside-out: Living and nursing from the highest point of your consciousness :
Transform yourself and impact your nursing practice through the art of self-care. Sudbury, Mass.: Jones and Bartlett.
Institute of Noetic Sciences. (2013). Meditation types. Institute of Noetic Sciences website. Retrieved from http://
noetic.org/meditation-bibliography/meditation-types/
Kabat-Zinn, J. (n.d.). MBSR Standards of Practice. Retrieved November 19, 2014, from
http://www.umassmed.edu/cfm/stress-reduction/mbsr-standards-of-practice/

24. Kang, Y., Choi, S., & Ryu, E. (2009). The effectiveness of a stress coping program based on
mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in
Korea. Nurse Education Today, 29(5), 538-543. doi:10.1016/j.nedt.2008.12.003
Pipe, TB, JJ Bortz, A Dueck, D Pendergast, V Buchda, and J Summers. 2009. "Nurse leader
mindfulness meditation program for stress management: a randomized controlled trial." Journal
Of Nursing Administration 39, no. 3: 130-137. CINAHL with Full Text, EBSCOhost (accessed
November 19, 2014).
Stahl, B., & Goldstein, E. (2010). A Mindfulness-Based Stress Reduction Workbook. Oakland, CA:
New Harbinger Publications.
Teacher Certification Review. (n.d.). Retrieved November 19, 2014, from
http://www.umassmed.edu/cfm/training/detailed-training-information/teacher-certification-review/