Mindfulness training for healthcare professional students: A waitlist controlled pilot study on psychological and work-relevant outcomes

ObjectivesTo fill gaps in the literature on the effects of mindfulness for healthcare professionals (HCPs), the current pragmatic trial investigated feasibility, acceptability, and effectiveness of Mindfulness for Interdisciplinary Healthcare Professional (MIHP) students on stress and work-relevant outcomes in the absence of offering school-based incentives.DesignA partially randomized waitlist-controlled design (intention-to-treat sample: 22 in the mindfulness group, 26 in the control group) was employed.InterventionMIHP is an eight-week intervention that incorporates meditation training, yoga, and discussion on the application of mindfulness principles to stressors commonly faced by HCPs and students.Main outcome measuresDomains of feasibility and acceptability; Maslach Burnout Inventory and other validated measures of psychological functioning; cognitive task performance on the Trail Making Test A & B; and the Work Productivity and Activity Impairment plus Classroom Impairment Questionnaire.ResultsResults supported the feasibility and acceptability of MIHP but found randomization to be unacceptable. Small to large effects were found for MIHP, relative to the control group, on outcomes of burnout, perceived stress, mindfulness, and activity impairment. No effect of MIHP was found on cognitive performance or work productivity outcomes.ConclusionsPreferential group allocation improved retention relative to randomization in the absence of school-based incentives. Results suggest that MIHP is feasible and acceptable and may have benefit for improving mindfulness and reducing burnout, stress, and activity impairment. Cognitive performance, work absenteeism, and work impairment did not change following MIHP. Results support future investigations into the effects of participant compensation on MIHP’s dissemination and effectiveness.     

Effects of performance feedback on patient pain outcomes

The purpose of this study was to examine the effects of an individual feedback intervention provided to nurses on selected patient outcomes related to postoperative pain management Individual performance feedback served as the intervention. Thirty orthopedic staff nurses received feedback information on their past performance of recommended pain management practices. Data were collected preintervention and postintervention on selected patient pain outcomes from the medical records of 240 patients who had undergone total knee arthroplasty. The patient outcome measures were mean 4-hour pain intensity ratings, mean highest pain intensity ratings, mean number of times pain ratings exceeded patients' acceptable level of pain, mean administered morphine equivalents, and mean pain ratings on reassessment following analgesia administration. An improvement was noted in all pain outcomes following the feedback intervention. Results indicate that providing nurses with feedback on their past performance of pain management practices may contribute to decreased postoperative pain.     

Effects of continuous intrapartum professional support on childbirth outcomes

The purpose of this stratified randomized trial was to determine the physical and psychological effects of continuous, one-to-one professional support on childbirth outcomes. Data were gathered during prenatal and postpartum interviews with, and from the medical records of, 103 low-risk women. All subjects had attended one of two types of prenatal education programs, were accompanied by husbands or partners during labor, and had vaginal deliveries. Subjects in the experimental group were less likely to have medication for pain relief and less likely to have episiotomies. Three variables were found to predict perceived control during childbirth--expectations of control, the presence of a continuous professional caregiver, and pain medication usage. The results demonstrate the importance of the traditional nursing support role during childbirth.     

The social relations of prayer in healthcare: Adding to nursing's equity-oriented professional practice and disciplinary knowledge

Although spiritual practices such as prayer are engaged by many to support well-being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest—whether embraced, tolerated, or resisted—in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the “spirit” of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person-centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity-oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care.     

Human trafficking and the healthcare professional

Despite the legislation passed in the 19th century outlawing human slavery, it is more widespread today than at the conclusion of the civil war. Modern human slavery, termed human trafficking, comes in several forms. The most common type of human trafficking is sex trafficking, the sale of women and children into prostitution. Labor trafficking is the sale of men, women, and children into hard labor for which they receive little or no compensation. Other forms of trafficking include child soldiering, war brides, and organ removal. Healthcare professionals play a critical role in both finding victims of human trafficking while they are still in captivity, as well as caring for their mental and physical needs upon release. Those working in the healthcare profession need to be educated regarding how a trafficking victim may present, as well as their unique healthcare needs.     

Discordant public and professional perceptions on transparency in healthcare

Sir, Transparency is becoming a major issue in healthcare.^1,2 Recentwork shows substantial differences between views of physiciansand those of the public on medical errors:³ while the publicviews open reporting as a very effective way of reducing errors,physicians prefer confidentiality. We conducted a survey to     

Promoting professional nursing practice: linking a professional practice model to performance expectations

Professional practice models (PPMs) provide the conceptual framework for establishing professional nursing practice. Integrating a PPM requires complex organizational change. One strategy for integrating a PPM is to directly link the PPM with performance expectations to ensure that underlying beliefs are integrated into everyday practice. This article describes the development, implementation, and successful outcomes of a clinical advancement system that was aligned with a PPM.     

Home healthcare and client outcomes

This study examined the outcome measures of readmission to the hospital and change in functional status/quality of life. Patients were admitted to the hospital most commonly by the 15th visit indicating complications arise soon after home care initiation. Implications for more specific data related to acuity, family support, and outcomes are suggested to develop and evaluate strategies for cost-effective care. The potential for preventing hospitalizations may be diminished due to the cost containment strategies currently used by agencies in response to PPS.     

The effect of implementing adult trauma clinical practice guidelines on outcomes of trauma patients and healthcare providers

ObjectivesThis study aimed to 1) Assess the effects of implementing the initial assessment and management practices of the Adult Trauma Clinical Practice Guidelines (ATCPGs) on the outcomes of multiple trauma patients and healthcare providers in the emergency department (ED) and hospital; 2) Evaluate the effects of implementing the ATCPGs on missed injuries in ED and hospital Length of Stay (LOS); 3) Examine the effect of implementing initial assessment and management on healthcare providers’ compliance with ATCPGs.MethodsA quasi-experimental design with three months before and three month after implementing ATCPGs was used. A total of 464 patient's files were reviewed in the study. However, 66 patients met the inclusion criteria, with 33 patients in each phase. The second sample was composed of 30 nurses and 13 physicians working at the ED.ResultsUsing multiple strategies of implementation of ATCPGs decreased the LOS for multiple trauma patients in the ED. Although the missed injuries did not differ significantly in the study's phases; it was lower in the post-intervention than in the pre-intervention phase. The mean of nurses’ and physicians’ compliance with post intervention was higher than preintervention (p < .001).ConclusionThe results will help the decision-makers to facilitate interdisciplinary ATCPGs training sessions, and establish policies and procedures to introduce ATCPGs in the ED to improve multiple trauma patients' outcomes.     

Nursing: concepts of professional practice

As we approach the twenty-first century, nursing is preparing itself to meet the expected health care needs of the population. In this paper, which was recently presented to the Royal College of Nursing National Conference at Hartlepool, Maureen Lahiff sets out her vision of the future.