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Mindfulness and CNM Burnout
Does practicing mindfulness help prevent burnout in working CNM’s, compared to no intervention?
Burnout is a reaction to prolonged or chronic occupational stress and can be characterized by three main aspects: exhaustion, cynicism, and feelings of reduced accomplishment. Simply put, if you are exhausted, hate your job, or feel like you aren’t as capable at work, you are showing signs of burnout. A strong link has also long been established between a lack of compassion and user dissatisfaction with care (Kelly & Tyson, 2016). With patient satisfaction being of high importance in healthcare we really need to find ways to support each other and look after ourselves for the benefit of all the midwives, the profession of midwifery and the women we care for. Mindfulness is a process of bringing one’s attention to the internal and external experiences occurring in the present moment. Mindfulness can bring about a sense of clarity, calmness and understanding in oneself. Mindfulness based interventions have been gaining interest, its use in mental health has shown promise in preventing relapse in many mental health issues (Kelly & Tyson, 2016).
Summary of Evidence
- Search Process
When searching for evidence for the practice question the terms midwife burnout, burnout, and mindfulness were used, full text and 2010-2018 were the inclusion criteria and CINAHL was the search engine. The search showed 64 and 95 results respectively, these were then reviewed and narrowed down to three articles. Out of the three pieces of evidence used in this summary, one was a literature review, one was a cross-sectional study, and one was a course evaluation.
- Methods used in studies
The course evaluation done by Warriner, Hunter and Dymond (2016) used the course material, Finding peace in a frantic world by Mark Williams and Danny Penman. This program was for beginners, in which participants attended a weekly class over 8 weeks, lasting 60-90 minutes in length. Participants were taught formal and informal mindfulness and encouraged to follow the outline in the book, committing to 30 minutes a day of practice from their homes. Immediately following the 8-week course, participants were asked to evaluate the course based on six questions, using a five-point Linkert scale, where 0= never or very rarely true, 1= rarely true, 2= sometimes true, 3=often true, and 4 = very often or always true. Participants were also to complete a follow-up questionnaire 4-6 months post class.
The literature review conducted by Beaumont and Martin (2016) to determine what research had already been done to address in relation to self-compassion, compassion for others, empathic distress fatigue, compassion fatigue, and burnout in health professionals. The literature review used the keywords compassion, stress, compassion fatigue, burnout, midwifery education and self-compassion in the Medline (R), PsychINFO, PsycARTICLES full text and CINAHL search engines. Inclusion criteria used to capture relevant studies were papers published from 1995-2016 and written in English.
The cross-sectional study done by Taylor and Miller (2016) Participants start the research by clinking on a survey monkey link to access the survey. Mindfulness was measured with the Five Facet Mindfulness Questionnaire. This questionnaire has 39 items and five categories, Observe, Describe, Act-Aware, Non-judge, and Non-react. Dispositional optimism was measured with the Life Orientation Test-Revised Scale. Six items were rated on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Self-efficacy was measured with the General Self-Efficacy Scale. Ten items were rated on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The supportive climate in the workplace was measured through the Work Climate Questionnaire. 15 items were rated on a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The degree of autonomy in the participant’s job was measured using the Job Autonomy Scale. Four items were rated on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Skill discretion was measured by using the Skill Discretion Scale. Four items were rated on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Social support in the workplace was measured with the Job Social Support Scale. Four items were rated on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Workplace demands were measured using two subscales: the Tilburg Work Pressure scale, Work Load and Emotional Work Demands. The Work load subscale had seven items and the Emotional Work Demands had 6 items. They both were rated on a Likert scale ranging from 1 (strongly disagree) to 9 (strongly agree). Burnout was measured with the Maslach Burnout Inventory General (MBI-G). This measures three separate components of burnout: emotional exhaustion, cynicism (both have 5 items), and professional efficacy (6 items). All items were rated on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Each component of burnout is separate theory, and not summed for the analysis.
Gender differences in the facets of mindfulness and the components of burnout were explored with t-tests. Three hierarchical multiple regressions as explored the predictors of the separate components of burnout.
- Results of studies
Each of the studies had individualized results.
The Course evaluation by Warriner, Hunter, and Dymond (2016) demonstrated that investing in staff wellbeing through mindfulness has a benefit not only on the individual but within the culture of Midwives and the organization as well. 97 % of participants reported the course to be helpful/useful and would recommend it to others. There was a sustained positive impact on stress, anxiety, resilience, self-compassion and mindfulness, the range was 68%- 91%.
The literature review by Beaumont and Martin (2016) a CMT teaching program was designed with the intent to see if it can help student midwives develop self-compassion, build resilience and reduce self-criticism. Data was collected before and after CMT and will measure its effectiveness by using qualitative and quantitative methods. Qualitative methods included focus groups and data was collected using the Self-Compassion scale, Professional Quality of Life Scale, Short Warwick-Edinburgh Mental Well-being scale and the Compassion for others Scale. Initial introduction included the core theoretical elements of Gilbert’s model, progressing through 5 other sessions that include: Psycho-education and developing the compassionate self, Formulation: understanding yourself, cultivating and building compassionate capacities, building compassionate capacity using behavioral practices and using the compassionate mind to engage with difficulties. Evidence has shown that health-care educators level of self-compassion improved and decreased self-critical judgement post CMT training. CMT has also proven effective in treating symptoms of trauma in clinical populations. Therefore, CMT is worth incorporation into midwifery education to measure its effectiveness.
The cross-sectional study by Taylor and Millear (2016) All five factors of mindfulness were positively associated with each other, except for Observe and Non-judge. All five factors were significantly and negatively related with the three components of burnout, except for Observe and emotional exhaustion. All blocks added drastically to emotional exhaustion. It was strongly projected by extreme workload, greater emotional demands and where the person was low in the mindfulness dimension of not judging and not being overly reactive.
- State of science – adequacy of evidence
Out of the three pieces of evidence presented in this summary all would be considered Level V studies, one of high quality, one good quality and one being lower quality. The biggest weakness of this evidence is smaller sample sizes and the potential for biases and the age of the sample group was not taken into consideration.
Translation and Recommendations
The course evaluation by Warriner, Hunter, and Dymond (2016) showed great promise for mindfulness in not only the individual but within the culture of Midwives. The need for further qualitative research is important to explore the benefits of mindfulness classes.
Within the literature review by Beaumont and Martin (2016) it is recommended that compassionate mind training be incorporated into Midwifery education to help develop healthy coping strategies that midwives can use to balance the stress of their jobs. Incorporating CMT into a midwifery program may also bring about changes in the student’s level of self-compassion and self-critical judgement.
The cross-sectional study done by Talyor and Millear (2016) showed that mindfulness can be a resource for individuals to help prevent burnout. The results from this study could be furthered in the research between mindfulness and meditation when learning new skills.
All the of the studies here have the same foundation that the skills from mindfulness can help with work-related stress and burnout. Mindfulness can help individuals better deal with stress and develop the skills needed to remain calm, self-aware and positive, rather than succumbing to negative emotions.
- Kelly, M., & Tyson, M. (2016). Can mindfulness be an effective tool in reducing stress and burnout, while enhancing self-compassion and empathy in nursing? Mental Health Nursing, 36(6), 12-17. DOI: 10.1080/08854726.2014.913876
- Warriner, S., Hunter, L., & Dymond, M. (2016). Mindfulness in maternity: Evaluation of a course for midwives. British Journal of Midwifery, 24(3), 188–195. doi:10.12968/bjom.2016.24.3.188
- Beaumont, E., & Martin, C. J. H. (2016). Heightening levels of compassion towards self and others through use of compassionate mind training. British Journal of Midwifery, 24(11), 777–786. https://doi.org/10.12968/bjom.2016.24.11.777
- Taylor, & Millear. (2016). The contribution of mindfulness to predicting burnout in the workplace. Personality and Individual Differences, 89, 123-128. https://doi.org/10.1016/j.paid.2015.10.005
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