Julene Campion MBSR in Healthcare

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  • Running head: MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE

    PROFESSIONALS

    Mindfulness-Based Stress Reduction in Healthcare Professionals

    And the Relationship to Burnout and Empathy

    A Capstone Submitted to Saint Josephs University

    By Julene Campion

    In Partial Fulfillment

    Of the Requirement for the Degree Master of Science in

    Organization Development and Leadership

    September, 15 2014

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    MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS

    Abstract

    Objective: Healthcare professionals are under a tremendous amount of pressure given the

    changes of healthcare reform. As a result, many healthcare professionals experience burnout and

    decreased empathy. Mindfulness-Based Stress Reduction (MBSR) has been shown to reduce

    stress and improve overall well-being in healthy populations. The purpose of this study is to

    determine if an eight-week MBSR program designed for healthcare professionals can decrease a

    burnout tendencies and increase empathy. Design: A quantitative and qualitative method were

    utilized for this study. For the quantitative method, the Maslach Burnout Inventory (MBI) and

    the Jefferson Scale of Empathy (Healthcare Professionals version) were administered pre and

    post-treatment. For the qualitative method, an open-ended class evaluation created by the

    program facilitators was administered post-treatment. Participants: Healthcare professionals

    from a large healthcare network in Pennsylvania were recruited for the MBSR program through

    postings on the organizations intranet and internet sites. The eight-week MBSR course met for

    2.5 hours for eight weeks plus a seven-hour retreat at the end of the program. Participants were

    offered continuing education credits and received a $200.00 stipend. The course was offered

    from 2010-2014. Hypothesis 1: Healthcare professionals who complete an eight-week MBSR

    program experience lower burnout tendencies as measured by the Maslach Burnout Inventory

    (MBI) in the subscales of emotional exhaustion, depersonalization and lack of personal

    accomplishment. Hypothesis 2: Healthcare professionals who complete an eight-week MBSR

    program experience an increase in empathy as measured by the Jefferson Scale of Empathy (HP

    version) which measures key dimensions of empathy including perspective-taking,

    compassionate care and standing in the patients shoes. Results: (Hypotheses 1) Participants

    post-test mean scores indicate a lower frequency of emotional exhaustion (-2.3) and

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    MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS

    depersonalization (-1.8) along with an increased frequency of personal accomplishment (1.8).

    The combination of each subscale results indicate that the MBSR program positively affected

    burnout in the participants. (Hypotheses 2) Participants post-test mean scores on the Jefferson

    Scale of Empathy indicate a stronger level of agreement on the non-flipped questions (1.5) and a

    higher level of disagreement on the flipped questions (-1.9). The results indicate that the MBSR

    program positively affected the levels of empathy in the participants.

    Key Words: Mindfulness-Based Stress Reduction, MBSR, Mindfulness, Healthcare

    Professional, Burnout, Empathy

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    MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS

    Acknowledgments

    I would like to dedicate this paper to my son, Pierce Campion who inspires me,

    challenges me to think more deeply, and makes me laugh out loud! I would like to thank my

    amazing husband, John who encourages me to chase my dreams and gives me loving support in

    so many ways. I could not have completed this program without his unwavering reassurance.

    Finally, I want to thank my Lehigh Valley Health Network colleague, Susan Wiley, MD for her

    passion, commitment, knowledge and for making this study possible.

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    MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS

    Table of Contents

    Chapter I: Introduction

    1.1 Problem Statement

    1.2 Need for Research

    1.3 Purpose of the Study

    Chapter II: Literature Review

    2.1 Overview

    2.2 Mindfulness-Based Stress Reduction (MBSR)

    2.3 MBSR in Healthcare Professionals and the Relationship to Burnout and Empathy

    2.4 Summary

    Chapter III: Methodology

    3.1 Research Questions

    3.2 Research Hypothesis

    3.3 Research Design

    3.4 Operational Definitions and Variables

    3.5 Participants

    3.6 Instruments and Materials

    3.7 Procedure

    Chapter IV: Results

    4.1 Introduction

    4.2 Descriptive Data 4.3 Analysis of Research Questions 4.4 Other Findings

    Chapter V: Discussion

    5.1 Summary

    5.2 Interpretation of Findings

    5.3 Additional Analysis

    5.4 Limitations

    5.5 Recommendations

    5.6 Conclusion

    References

    Appendices

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    MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS

    Chapter I: Introduction

    1.1 Problem Statement

    Passage of the Affordable Care Act (ACA) dramatically increased accountability for

    acute hospitals in the United States. The Centers for Medicare & Medicaid Services (CMS)

    developed a national standardized survey called the Hospital Assessment of Healthcare Providers

    and Systems survey (HCAHPS and pronounced H-CAPS) to measure and publicly report

    patients perceptions of the care they received while in hospital (The Hospital & HealthSystem

    Association of Pennsylvania , 2013). In addition to the patients perception of care, the

    Affordable Care Act mandates a value-based purchasing program. A value-based purchasing

    program is similar to a pay-for-performance program. Under ACA, Medicare and Medicaid

    reimbursements will be based on the perception of care, quality and outcomes of patient care

    (The Hospital & HealthSystem Association of Pennsylvania , 2013).

    In the rapidly changing healthcare environment, healthcare professionals (physician,

    nurse practitioner, physician assistant, registered nurse and psychologist) are under a tremendous

    amount of pressure to provide safe, effective and quality care while reducing costs and creating a

    positive perception of the care delivery experienced by their patients. Healthcare professionals

    need stress-coping skills in order to avoid burnout and to communicate in a caring and

    empathetic way to their patients. Healthcare professionals may experience an inner conflict

    between their personal values to heal and care for their patients while meeting the increasingly

    demanding regulatory and economic requirements of the workplace (DiGiacoma & Adamson,

    2001).

    The pay-for-performance or value-based purchasing program places millions of dollars at

    risk for acute care hospitals in the United States. In Pennsylvania alone, approximately $90

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    MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS

    million in annual CMS reimbursements will be at risk by 2017 (The Hospital & HealthSystem

    Association of Pennsylvania , 2013).

    1.2 Need for Research

    The concept of burn-out refers to the process in which the professionals attitudes and

    behaviors change in negative ways in response to job strain (Cherniss, 1980). Some symptoms

    related to burn-out in healthcare professionals include emotional exhaustion, depersonalization

    or disregard for others, and a low sense of accomplishment (Krasner, et al., 2009). Burn-out in

    healthcare professionals has been linked to poorer quality of care, increased medical errors,

    decreased patient satisfaction, increased malpractice claims and a decrease in the healthcare

    professionals ability to express empathy.

    Stress in the clinical environment can lead to irritability and negative attitudes toward the

    patient and colleagues, rationalization and blame or lack of empathy. Patient care,

    communication, friendliness, creativity and support for other colleagues decline as stress

    increases (DiGiacoma & Adamson, 2001). During burnout, both professional performance and

    personal health and well-being are negatively affected (Cherniss, 1980). A lack of genuine

    interest, pessimism, and emotional irritability are perceived negatively by the patient and impact

    the progression of care (Cherniss, 1980). Burnout leads to irritability, negative attitudes and a

    lack of empathy which also negatively impact the patients perception of care delivery,

    progression of care and quality of outcomes.

    Although there is a substantial amount of research related to burnout in healthcare

    professionals and the impact on the patients perception of care and quality outcomes, there are

    few studies examining the effects of a Mindfulness-Based Stress Reduction program for

    healthcare professionals related to decreasing burnout and enhancing empathy. If MBSR can be

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    MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS

    shown to decrease burnout and enhance empathy in healthcare professionals, there is strong

    evidence to support the residual effects of a positive perception of care delivery by the patient,

    progression of care and quality outcomes.

    1.3 Purpose of the Study

    The main purpose of this study is to determine if there