The impact of mindfulness training on reflective thinking and attitudes towards patients in dementia care
Clague, Fiona Doris Elizabeth
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Background: The current pilot study investigated the impact of an eight-week mindfulness intervention on reflective practice and attitudes to dementia among NHS staff using a mixed methods approach. A growing body of research evidence suggests that mindfulness training is an effective stress management intervention for health professionals (Irving et al., 2009)and may impact beneficially on direct client outcomes (Singh et al.,2006). Other commentators hypothesise that mindfulness intervention could promote reflective modes of clinical thinking (e.g. Epstein 1999; 2003, Connelly 2005). This pilot study aimed to assess the effect of mindfulness training on measures of reflection and person centred attitudes to care among healthcare workers with a high degree of clinical contact with people with dementia.Method: Following the granting of ethics permission from the local NFIS trust, staff participants were recruited via posters, email, team presentations and mindfulness ‘taster’ workshops. Three consecutive eight week intervention groups were facilitated by the investigator at 3 hospital sites where 25 participants attended initial sessions. A total of 18 participants completed the intervention and outcome data was collected using a mixed methods approach. Focus group data was analysed according to a thematic analysis based on the constructivist version of grounded theory (Charmaz 1995). Main outcome measures were the Groningham Reflective Abilities Scale (GRAS) (Aukes et al., 2007) and Approaches to Dementia Questionnaire (ADQ) (Lintem, 2000), which were collected in week one, week eight and at one month’s follow-up after the intervention. Background measures of the Kentucky Inventory of Mindfulness Skills (KIMS) (Baer et al., 2004) and Maslach Burnout Inventory (MBI) were also collected to see whether these variables influenced performance.Results: The overriding theme that emerged from grounded theory analysis was that mindfulness practice stimulated an awareness of and some reflection on personal experience which varied between individuals in its relevance to personal and work related situations. Six super ordinate themes were identified: experiencingmindfulness practice, wellbeing benefits, developing awareness, thinking aboutdementia, thinking about the course and applying mindfulness at work. Sub-themes included reflections about the ‘moment by moment’ qualities of dementia care giving and grounding oneself during difficult situations.Non-parametric quantitative analyses revealed a significant within group effect of mindfulness training on total ADQ score and the sub domain of hope related attitudes to dementia. Post hoc testing indicated significant differences between the start of intervention and 1 month’s follow-up for both scores with an additional effect between one week and eight weeks for the KIMS. Contrary to prior findings burnout scores did not change post-intervention and neither did the ADQ person centred rating scale, as was originally predicted.DiscussionThese findings suggest that mindfulness training may be relevant to fostering staff well being and promoting adaptive attitudes towards the care of people with dementia. Some participants fed back that the intervention had not met their needs and it may be relevant to consider adaptations specific to this professional group. These findings are discussed in relation to current conceptualisations of mindfulness training and its potential role within reflective practice and dementia specific care contexts. Results indicate that mindfulness based approaches may be relevant to this clinical setting though the intervention could require further adaptation or careful targeting.