NRI 13-353 – HSR&D Study
Career Development Projects
Efficacy of an Internet Mantram Program on RN-delivered Patient Centered Care
Carol Kostovich PhD RN MS
Edward Hines Jr. VA Hospital, Hines, IL
November 2014 -
The Institute of Medicine report on "The Future of Nursing" (2011) emphasized the need for nurses to preserve human connectedness and provide care that goes beyond physical health needs. Nurses are encouraged to 'be present' with their patients as a means to provide personalized care. 'Being present' means that the nurse is both physically and emotionally available to the patient. However, the work environment can challenge the nurses' ability to be present. Adverse working conditions have been associated with decreased nurse job satisfaction and increased emotional exhaustion, contributing to stress. Strategies to reduce workplace stress need to be available. One such strategy is the mantram repetition program (MRP), a mind-body-spiritual approach to stress management. The stress reduction strategies of MRP include mantram repetition, slowing down, and one-pointed attention.
Our long term goal is to facilitate patient-centered nursing care to Veterans. The objectives of this study were to (1) assess the feasibility of implementing an internet-based MRP (I-MRP) for RNs caring for hospitalized Veteran patients; (2) assess the impact of an I-MRP for nurses on RN outcomes; and (3) assess Veteran patients' perceptions of nursing presence and nursing care in Veterans receiving care from I-MRP trained nurses.
Thirteen nurses working on acute care medical-surgical in-patient units at one Illinois VA hospital and 22 patients cared for by these nurses participated in the study. For the nurses, a one group pre-/posttest design was used to assess change in nurses' perceptions of outcomes after participating in the 6-module I-MRP. A posttest-only design was used to assess hospitalized Veterans' perceptions of the presence of the nurse and overall satisfaction with nursing care. The following self-reported metrics were used to assess nurse outcomes: (1) Mindfulness measured by Mindfulness Attention Awareness Scale (MAAS); (2) Nursing presence measured by the Presence of Nursing Scale-RN (PONS-RN); (3) Professional Quality of Life measured by Professional Quality of Life Scale (ProQOL); and Spiritual well-being measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-sp). Metrics used to assess patient outcomes included (1) nursing presence as measured by the Presence of Nursing Scale (PONS); and (2) overall satisfaction with nursing care as measured by the Schmidt Perceptions of Nursing Care Scale.
Posttest findings indicated nurses reported a significant increase in mindfulness (p=<0.05), compassion satisfaction (p=0.05), overall scores on the FACIT-sp (p=<0.05), and the FACIT-sp Peace subscale (p=<0.05). While presence scores (PONS-RN) increased over time, no statistically significant difference was noted. There was a significant positive correlation between mindfulness and compassion satisfaction (rs=0.56; p=<0.01) and a significant negative correlation between mindfulness and burnout (rs= - 0.48; p=<0.05). Twenty-two hospitalized patients completed the Presence of nursing scale (PONS) and the Schmidt Perception of Nursing Care Survey (SPNCS). Scores indicated overall high levels of perceived nursing presence and satisfaction with nursing care. Patient-perceived nursing presence scores were significantly correlated with all four subscales of the SPNCS: (1) Seeing the Individual Patient subscale (rs=.604; p=<0.01); Explaining subscale (rs=.517; p<0.5); Responding subscale (rs=.629; p<0.01); and Watching Over subscale (rs=.624; p=0.01).
After completion of an I-MRP, nurses experienced increased levels of perceived mindfulness, spiritual well-being, and compassion satisfaction. Increased mindfulness was associated with increased compassion satisfaction and decreased burnout. Patients cared for by these nurses experienced high levels of nursing presence and were highly satisfied with their nursing care. The use of the I-MRP by nurses has the potential to facilitate nursing presence and the delivery of patient-centered nursing care.
None at this time.