|Health care workers' experiences of mindfulness training: a qualitative review
|Morgan P, Simpson J, Smith A
The authors concluded that mindfulness training could result in positive outcomes for health care workers and their clients, across a range of health care disciplines. This conclusion reflects the evidence presented, but caution is recommended in interpreting the review's reliability, given the potential for selection bias in the inclusion of studies.
To evaluate how health care workers experience training in mindfulness.
Eight databases (including the Mindfulness Research Guide) were searched in March 2013. Exact search dates were not reported. Some search terms were presented. An information specialist was involved in the initial searches. The reference lists of related papers, and papers eligible for inclusion in the review, were searched manually.
Eligible for inclusion were peer-reviewed qualitative studies focusing on the experience of health care workers (or those in clinical training) of mindfulness training. Studies had to be designed on a content-based approach such as thematic analysis or grounded theory, and include participant quotes. Interventions had to include mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), or programmes that explicitly drew on these approaches, with the integration of core mindfulness practices, such as sitting meditation, the body scan, and mindful movement. There was no restriction on the length of the programme.
The included studies were conducted between 2001 and 2013. Their locations were not reported. Most of the interventions were delivered by experienced facilitators, and used core mindfulness practices alongside other didactic or practical content related to the purpose of the study. Programmes ranged from four to 15 weeks. The participants were trainees or qualified professionals, in social work, counselling, nursing or clinical psychology, as well as trainee occupational or family therapists, and qualified physicians. Where reported, most participants were female. Studies with mixed methods were included if the qualitative component met the inclusion criteria. Where two or more papers referred to the same participants, the one with the most comprehensive analysis was selected to avoid a disproportionate influence on the synthesis.
It appears that one reviewer selected studies for inclusion.
Assessment of study quality
Study quality was assessed using the Critical Appraisal Skills Programme checklist. The studies were scored using the approach of Dixon-Woods and colleagues (2007), which classified studies as key (providing conceptual richness and a high contribution to the review), satisfactory, or with fatally flawed methods.
The authors did not report how many reviewers carried out the quality assessment.
The data were extracted to create concepts, categories, and themes, to form narrative summaries of the experience of mindfulness training by health care workers.
It appears that one reviewer extracted the data and conducted the synthesis.
Methods of synthesis
A narrative thematic analysis was presented. Differences between the emerging themes and the original papers were explored by constant comparison. The impact of including satisfactory and fatally flawed papers was explored.
Results of the review
Fourteen studies (254 participants) were included. Ten were rated key; three were satisfactory; and one was fatally flawed. Poor reporting of the data analysis methods, and reflections on the impact of the researcher, were common issues. None of the satisfactory or fatally flawed studies contributed uniquely to the findings, so they were excluded from the final analysis. Follow-up ranged from immediately after intervention to six years after training.
Two main themes emerged: experiencing and overcoming challenges to mindfulness practice, and changing relationship to experience in personal and interpersonal domains.
In general, engagement in formal mindfulness practice, and overcoming emotional and physical barriers practice, resulted in some health care workers becoming more self-aware, leading to improved ability to relate to themselves and others in a more accepting and compassionate way. Particular benefits included reduced stress, increased physical and spiritual well-being, more confidence in decision making while recognising when to ask for help, and improved productivity.
The benefits of mindfulness training appeared to depend on the participant's initial intentions, whether challenges to practice could be overcome, and their extent of engagement with mindfulness to a deeper level. The range of personal and interpersonal benefits was not experienced by all participants, and some of the variations were explored. Appropriate implementation of interventions, and organisational ongoing support for mindfulness practice, were reported to be important.
Mindfulness training could result in positive outcomes for health care workers and their clients, across a range of health care disciplines.
The review question was clear, and the inclusion criteria were specified adequately, though broadly for the outcomes. Relevant databases were accessed, but the search dates were not presented. This makes it difficult to replicate or update the search. The involvement of an information specialist early in the process was helpful, given the complexity of searching for reviews of qualitative studies. There was no reference to searching for unpublished studies, meaning that relevant articles may have been missed. Language restrictions were not reported; these could help avoid translation bias in reviews of qualitative studies.
The review process appears to have been largely carried out by one reviewer. This potential limitation, particularly in the selection of studies, was acknowledged by the authors. The necessity for multiple reviewers in reviews of qualitative studies is debated, but could improve consistency of decisions and interpretations. A suitable quality assessment tool was applied, and summary interpretations were presented. The conduct and presentation of the synthesis seems to have been appropriate (potential improvements were suggested by the authors). There was some linkage between raw data and the interpretations (illustrated by participant quotations), and variations in the data were explored.
The authors' conclusions reflect the evidence presented. Caution is recommended in interpreting overall reliability, given the potential for selection bias in the inclusion of studies.
Implications of the review for practice and research
Practice: The authors stated that their review highlighted several relevant points in the context of recommendations, at the time, for more compassion in UK health care delivery.
Research: The authors stated that future research should consider the aims of mindfulness training, how these are communicated through the actions of the facilitator and course content, how best to capture participants' motivations, how these impact on experience and engagement, and how challenges to practice can be overcome. Long-term evaluation and cost-effectiveness studies were recommended, as was the exploration of mandatory training and it's impact on the user experience.
Morgan P, Simpson J, Smith A. Health care workers' experiences of mindfulness training: a qualitative review. Mindfulness 2014: epub
Subject indexing assigned by CRD
Health Personnel; Humans; Mindfulness
Date bibliographic record published
Date abstract record published
This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.