CONCEPT ANALYSIS
Mindfulness in nursing: an evolutionary concept analysis
Lacie White
Accepted for publication 15 May 2013
Correspondence to L. White:
e-mail: lwhit025@uottawa.ca
WHITE L. (2014)
Lacie White BScN RN
PhD Student
School of Nursing, Faculty of Health
Sciences, University of Ottawa, Ontario,
Canada
Abstract
Mindfulness in nursing: an evolutionary concept analysis.
Journal of Advanced Nursing 70(2), 282–294. doi: 10.1111/jan.12182
Aim. To report an analysis of the concept of mindfulness.
Background. Mindfulness is an emerging concept in health care that has
significant implications for a variety of clinical populations. Nursing uses this
concept in limited ways, and subsequently requires conceptual clarity to further
identify its significance, use and applications in nursing.
Design. Mindfulness was explored using Rodgers evolutionary method of concept
analysis.
Data Sources. For this analysis, a sample of 59 English theoretical and researchbased articles from the Cumulative Index to Nursing and Allied Health Literature
database were obtained. The search was conducted between all-inclusive years of
the database, 1981–2012.
Review Methods. Data were analysed with particular focus on the attributes,
antecedents, consequences, references and related terms that arose in relation to
mindfulness in the nursing literature.
Results. The analysis found five intricately connected attributes: mindfulness is a
transformative process where one develops an increasing ability to ‘experience
being present’, with ‘acceptance’, ‘attention’ and ‘awareness’. Antecedents,
attributes and consequences appeared to inform and strengthen one another over
time. Mindfulness is a significant concept for the discipline of nursing with
practical applications for nurse well-being, the development and sustainability of
therapeutic nursing qualities and holistic health promotion.
Conclusion. It is imperative that nurse well-being and self-care become a more
prominent focus in nursing research and education. Further development of the
concept of mindfulness could support this focus, particularly through rigorous
qualitative methodologies.
Keywords: concept analysis, evolutionary method, holistic, mindfulness, nursing,
presence, self-care
282
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JAN: CONCEPT ANALYSIS
Why is this research or review needed?
•
Stress, burnout and high attrition rates in nursing are an
ongoing concern; the application of mindfulness in nursing
requires further exploration as one possible response to
•
addressing these concerns.
Mindfulness is an emerging concept in health care and
research communities demonstrating significant value for
•
holistic health promotion, yet remains relatively undeveloped
in nursing.
The concept of mindfulness has similar theoretical perspectives to those of holistic nursing practices and requires conceptual clarification for further development in the discipline.
What are the three key findings?
•
The concept of mindfulness encompasses intricately connected
attributes: it is a transformative process, where one develops
an increasing ability to experience being present with aware-
•
ness, acceptance and attention.
Mindfulness can support improving physical, emotional, psychosocial and spiritual well-being, and can help translate
•
holistic health promotion from theory to practice.
Integrating mindfulness into education and practice can
enhance therapeutic nursing qualities and support a shift from
a purely theoretical way of knowing to one that is more
embodied and holistic.
How should the findings be used to influence policy/
practice/research/education?
•
With access to training, nurses can gain personal experience
of being and practising mindfulness, subsequently giving them
tools to promote holistic health practices across various clini-
•
cal settings and health populations.
The mechanisms of mindfulness are poorly understood; qualitative research designs will contribute to the evolving science
of mindfulness and would help ground the concept in
nursing.
Introduction
Mindfulness is an emerging concept in health care that has
gained substantial interest in research communities in the
last two decades (Mindfulness Research Guide 2011).
Situated in 2,600-year-old Eastern Buddhist philosophy,
mindfulness was taught as a means to alleviate human
suffering (Matchim et al. 2011b) and cultivate compassion
(Ludwig & Kabat-Zinn 2008). The alleviation of suffering
is a universal concern, particularly relevant in the field of
health care where there is extensive contact with suffering,
© 2013 John Wiley & Sons Ltd
Mindfulness in nursing: a concept analysis
and additionally healthcare providers themselves struggle to
maintain their own health and well-being in the midst of
caring. Mindfulness is now being adopted in Western medicine and psychology as a secular perspective with mainstream application (Koerbel & Zucker 2007, Teixeira
2010). Empirical evidence is accumulating that mindfulness
programmes and practices can improve physical and psychological health, and promote overall well-being in many
different health settings (Roth & Creaser 1997, Proulx
2003, Matchim et al. 2008). In addition, systematic reviews
of healthcare providers reveal that practitioners who incorporate mindfulness into their personal and professional lives
demonstrate an improved sense of well-being and ability to
employ self-care strategies (Irving et al. 2009, Escuriex &
Labbé 2011).
Despite growing attention, the concept of mindfulness
remains ambiguous and abstract (Tusaie & Edds 2009).
Proulx (2003) suggests that mindfulness practices promote
‘a holistic self-regulatory approach to health, congruent
with nursing values and beliefs’ (p. 201). With similar theoretical perspectives to that of nursing (Cohen-Katz et al.
2004, Smith et al. 2005, Poulin et al. 2008), mindfulness
has the potential to inform nursing education, practice and
research levels. However, to integrate mindfulness more
directly into the discipline of nursing, a clearer understanding of the concept is required.
Background
The integration of mindfulness into Western healthcare
settings has been largely credited to Jon Kabat-Zinn who
developed the first standardized mindfulness-based programme in 1979 at the University of Massachusetts Medical School (Baer 2010). This mindfulness-based stress
reduction (MBSR) programme involves eight 25-hour
weekly group sessions, a daylong silent retreat, and a
commitment to practice mindfulness activities for 45 minutes, 6 days a week. MBSR continues to predominate
interventions and outcome research related to mindfulness
(Poulin et al. 2008). Evidence suggests that mindfulness is
supportive of a variety of clinical populations, including
but not limited to, the improvement of chronic and
cancer-related pain, sleep disorders, eating disorders,
psoriasis and a variety of psychological disorders (CohenKatz et al. 2004).
In addition, other variations of MBSR: mindfulnessbased cognitive therapy (MBCT; Segal et al. 2002), mindfulness-based relationship enhancement (MBRE; Carson
et al. 2004), mindfulness-based wellness education
(MBWE; Poulin et al. 2008), mindfulness-based eating
283
L. White
awareness treatment (MB-EAT; Kristeller & Hallett 1999)
and mindfulness-based medical practice (MBMP; Irving
et al. 2012) are emerging. Acceptance and commitment
therapy (ACT; Hayes et al. 1999) and dialectical behaviour therapy (DBT; Linehan 1993) also have mindfulness
processes embedded in them and are demonstrating empirical benefits (Lynch et al. 2007, Ruiz 2010). Although
appearing supportive to the growing movement of mindfulness in mainstream health promotion, the variety
between and in all of these programmes may be a contributing factor in the challenge to create a working definition
of mindfulness.
Abercrombie et al. (2007) suggest, ‘it is essential that
holistic nurses conduct and participate in research that is
relevant to their clinical practice’ (p. 33). Mindfulness as a
holistic intervention has many potential benefits for nurse
well-being and for the varied health populations they serve,
and subsequently requires nursing-directed research. This
cannot be undertaken without a clearly defined concept, as
concepts are the necessary foundation in building theory
(Rodgers 2000). However, a conceptual analysis of mindfulness is challenging as Sharpiro and Carlson (2009) highlight that ‘attempting to write about mindfulness in an
academic and conceptual way is in some ways antithetical
to the very nature of mindfulness’ (p. 3), which is grounded
in an experiential process. Despite this, conceptual development is important so that mindfulness can be fully integrated into health care.
Rodgers evolutionary method (Rodgers 2000) was used
for the purpose of this concept analysis on mindfulness.
The philosophical perspective embedded in this method
views concepts as context-dependent, dynamic and constantly evolving. The method is inductively focused and is
“a means of identifying a consensus or the ‘state of the art’
of the concept” (Rodgers 2000, p. 97). The purpose of this
method is not to arrive at a conclusion or definitive definition of the concept, but rather to describe the current use
of a concept for further development of nursing knowledge.
This iterative process is supported through six primary
activities (Table 1).
Data sources
To gain clarity on how the concept of mindfulness has
been integrated into the discipline of nursing, the leading
database for nurses, the Cumulative Index to Nursing and
Allied Health Literature (CINAHL) was used. This database includes virtually all-nursing and allied health journals (Polit & Beck 2008) and, therefore, offers a
perspective on how mindfulness is being integrated specifi284
Table 1 Primary activities in evolutionary method of concept
analysis (Rodgers 2000).
•
•
•
•
•
•
Identify concept of interest and surrogate terms.
Identify and select: setting and sample.
Collect data with focus on concept attributes, context of
concept use, interdisciplinary, sociocultural and temporal
variations.
Analyse data.
If available, identify exemplar of the concept.*
Identify implications of analysis and future development of the
concept.
*Mindfulness is a subjective experience that has application across
many contexts; therefore, identifying an exemplar would risk limiting understanding of its varied uses, and thus was omitted from
this analysis process.
cally into nursing. Mindfulness was not a major subject
heading in the database. No other search terms for this
concept were included in the final sample to provide a
clearer picture of its use separate from other concepts. The
dates searched were all-inclusive of the CINAHL database,
and fell between 1981 and 2012. Inclusion criteria
included English journal articles with theoretical or
research-based content. The key search terms and decisions
made to arrive at final sample are described in Figure 1.
The final sample for this analysis included 59 articles that
fell between 1994–2012.
All items in the sample were identified with a number
and read through once to support immersion in the
concept, and to gain a general tone of the individual and
collective works. Code sheets for the organization of data
were created individually for attributes, antecedents, consequences, references, related terms and nursing-specific
implications for research, education and practice. Methodological and reflexive journals were started at the beginning
of this study to ensure rigour and to retrace steps as
necessary throughout the analysis.
Formal analysis was delayed until the completion of data
collection as Rodgers (2000) cautions: ‘there are few occurrences more detrimental in concept analysis than the
researcher getting stuck on a particular idea and, consequently, being unable to allow the characteristics of the
concept to emerge from the data’ (p.94). Formal analysis
began with individually examining coding sheets to establish themes. In each category, common themes were organized and reorganized until trends were comprehensively
and clearly identified and subsequently labelled. This analysis also focused specifically on the use, emerging trends and
future development of mindfulness in the context of
nursing.
© 2013 John Wiley & Sons Ltd
used and results obtained from the
CINAHL database.
944
Keyword searched: mindful*
A scan of abstracts from the 944 results from this search revealed that
mindfulness was not consistently a central theme within the articles.
557
Keyword searched: mindfulness, in the abstract or title.
Within these 557 results the concept of mindfulness in relation to the
nursing discipline appeared infrequently.
Keywords searched: mindfulness in the article abstract or title,
and nurs* anywhere within the article OR in the publication name
76 results relevant to the discipline of nursing obtained.
Filtering out book reviews, editorials, brief commentaries and
conference abstracts resulted in 59 journal articles.
59
Figure 1 Description of search terms
Mindfulness in nursing: a concept analysis
76
JAN: CONCEPT ANALYSIS
Results
the others and so there will be notable overlap in the
discussion.
References
References describe the ways a concept has been applied
(Rodgers 2000). Table 2 presents a breakdown of the
research and theoretical based papers for this sample. The
use of mindfulness in this literature was divided into context of use for varied health populations and separately for
its use directly with healthcare practitioners. In addition,
although the use of mindfulness in the CINAHL database
appears to be growing exponentially, the application of
mindfulness in nursing remains limited (Figure 2).
Attributes
The defining attributes of mindfulness are subtle (Cacciatore & Flint 2012) and intricately connected to one
another. The most frequently cited definition in the literature remains one from Kabat-Zinn (1994) who stated that
mindfulness is ‘paying attention in a particular way: on
purpose in the present moment, and nonjudgmentally’
(p. 4; Proulx 2003, Poss 2005, Matchim et al. 2008,
Stanton & Dunkley 2011). Through the analysis, five
defining attributes emerged to clarify the concept. The
‘experience of being present’ is one attribute of mindfulness
that is cultivated and sustained through three additional
attributes: ‘awareness’, ‘acceptance’ and ‘attention’. In addition, mindfulness can be understood as a ‘transformative
process’. Although each of the attributes will be addressed
in turn, one cannot be appreciated contextually without
© 2013 John Wiley & Sons Ltd
Experience of being present
Mindfulness is difficult to understand outside the realm of
experience (Sitzman 2002). Poulin et al. (2008) posit that
learning mindfulness can lead to improved health and wellbeing ‘through greater experiential understanding of the
interplay between mind, body and emotions’ (p. 78). Challenging current societal and cultural norms, which place
emphasis on completing tasks, remaining busy and ‘doing’
something at all times, this experience is associated with ‘a
way of being,’ (Proulx 2003), ‘being in the moment’
(Cohen-Katz et al. 2004) or engaging in ‘being mode’ (Day
& Horton-Deutsch 2004a). As an experience of being,
mindfulness is highly subjective (York 2007); but, in
general, it is the ability to be present moment-to-moment
(Day & Horton-Deutsch 2004a, Smith et al. 2005) while
sustaining qualities of awareness, acceptance and attention
through each moment.
Awareness
The ability to become deeply aware of self (Praissman 2008)
in the midst of moment-to-moment experiences is another
attribute of mindfulness. Tusaie and Edds (2009) explain that
awareness ‘is the background of consciousness, which is constantly monitoring the environment’ (p. 359). Said another
way, awareness is ‘being with observations’ (Tusaie & Edds
2009), able to observe ‘the constant stream of thoughts, emo285
L. White
Table 2 References to mindfulness in CINAHL nursing literature.
Context of use for varied health populations
Mindfulness meditation-based stress reduction:
experience with a bilingual inner-city program (Roth & Creaser
1997)
Cancer (Ando et al. 2009, Kvillemo & Br€anstr€
om 2011,
Weitz et al. 2012)
Cancer survivors (Lengacher et al. 2011, Matchim et al.
2011b)
Diabetic peripheral neuropathy (Teixeira 2010)
Healthy adults (Matchim et al. 2008)
HIV-infected patients (Ampunsiriratana et al. 2005)
Mental health (Day & Horton-Deutsch 2004a,b, Davis et al.
2007, York 2007, Kitsumban et al. 2009)
Minority children with depression and anxiety (Liehr &
Diaz 2010)
Multiethnic women with abnormal pap smears (Abercrombie
et al. 2007)
Pregnancy and maternal well-being (Beddoe et al. 2009)
Substance use disorder (Carroll et al. 2008)
School aged children (Wall 2005)
Theoretical discussions/literature reviews/practice implications of
mindfulness
Cancer: literature reviews (Smith et al. 2005, Matchim &
Armer 2007)
Cancer survivors: literature review
(Matchim et al. 2011a)
Chronic hepatitis C (Koerbel & Zucker 2007)
Mental health (Bashford 2011, Klainin-Yobas et al. 2012)
Paediatric clinical practice (Ott et al. 2002)
Psychological support for people with stomas
(Trunnell 1996)
Substance abuse disorder (Bankston 2008, Miller 2010, Lange
2011)
Varied populations (Proulx 2003, Praissman 2008, Stanton &
Dunkley 2011)
Veteran’s (Cuellar 2008)
Context of use for healthcare practitioners
Mindfulness-based intervention research
Human service professionals (Poulin et al. 2008)
Interdisciplinary stress/coping (McCracken &
Yang 2008)
Nurse stress/burnout (Cohen-Katz et al. 2005a,b, Mackenzie
et al. 2006, Pipe et al. 2009)
Student nurse stress/burnout (Young et al. 2001, Beddoe &
Murphy 2004, Kang et al. 2009)
Theoretical discussions/literature reviews/practice implications of
mindfulness
Certified Nursing Assistant stress in long-term care (Zeller &
Lamb 2011)
Interdisciplinary mindfulness bereavement model (Cacciatore &
Flint 2012)
Interdisciplinary stress/coping (O’Neal 1997, Klatzker 2006,
While 2010)
Nurse healing and transformation (Ott 2004)
Nurse leadership (Pipe 2008)
286
Table 2 (Continued).
Nurse practitioners (Poss 2005)
Nurse stress/burnout (Ott et al. 2002, Cohen-Katz et al. 2004)
Mindfulness/nursing theory (Sitzman 2002)
Palliative care communication model (Wittenberg-Lyles et al.
2010)
Psychiatric/mental health nursing (Hirst 2003, Horton-Deutsch
& Horton 2003, Tusaie & Edds 2009)
tions and body sensations’ (Roth & Creaser 1997, p. 152).
Day and Horton-Deutsch (2004a) described this as one
becoming a ‘detached witness.’ With this awareness, it is suggested that individuals have a greater ability to reflect and
respond in healthy ways to their experience as it arises (Davis
et al. 2007).
Acceptance
Being able to accept what arises in ones awareness without
judging (Kvillemo & Br€
anstr€
om 2011), resisting (CohenKatz et al. 2004) or avoiding (Cacciatore & Flint 2012) is
particularly important and is another defining attribute of
mindfulness. Instead of reacting in these ways, one develops
the ability to witness his/her experience, accepting moments
as they arise, and can learn ‘to respond rather than react to
[their] habitual ways of thinking, moving, and doing’ (Day
& Horton-Deutsch 2004a, p. 165). In addition, acceptance
can foster a more compassionate approach to self and other
in the midst of experiences that arise in phenomena (Ott
2004, York 2007), particularly those that may be uncomfortable or challenging. When one can accept what is occurring moment-to-moment without evaluating it as ‘good’ or
‘bad’ (Matchim et al. 2011a), they may, as Pipe (2008)
suggests, be able to offer a more balanced presence through
‘nurturing a healthy regard for the emotions of self and
others’ (p. 121).
Attention
Awareness requires that one is also able to maintain his/her
attention on that which he/she is aware of. Attention,
another attribute of mindfulness, is the ability to stay in the
moment-to-moment experience (Wittenberg-Lyles et al.
2010, Matchim et al. 2011b). It is a shift in the mind from
habitually unconscious automatic functioning, worry and
rumination (Zeller & Lamb 2011) of past and future experiences to focus on what is occurring in the present (Day &
Horton-Deutsch 2004a). Matchim et al. (2011b) summarize
attention as being ‘receptive to the whole field of aware© 2013 John Wiley & Sons Ltd
JAN: CONCEPT ANALYSIS
Mindfulness in nursing: a concept analysis
120
100
Mindfulness in title or
abstract
# of results
per year
80
Mindfulness in title or
abstract with nurs* in journal
article or title of journal
60
40
20
‘mindfulness’ in CINAHL Database relative to application directly within nursing
discipline.
0
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
Figure 2 Rate of growth for term
Year
ness’ (p. 62) where one can maintain focus on what arises
without becoming distracted or lost in thought (York
2007).
Transformative process
The literature refers frequently to mindfulness as a process
(O’Neal 1997, Cohen-Katz et al. 2005a, Mackenzie et al.
2006, Cacciatore & Flint 2012). The transformative process
of mindfulness as a defining attribute is clearly articulated
from different scholars. Ott (2004) discussed mindfulness as
a ‘life-affirming process.’ This view is echoed in a statement
from Poulin et al. (2008) that ‘being aware of our embodied
experiences is a crucial step towards living in a more integrated way’ (p. 73). Kabat-Zinn et al. (1998) stated that
through mindfulness ‘we … gain immediate access to our
own powerful inner resources for insight, transformation,
and healing’ (as cited in Ott 2004, p. 24). Owing to
mindfulness as a process of continual development, the
ability to clarify the concept by antecedents, attributes, and
consequences becomes difficult as they all become intertwined (Tusaie & Edds 2009, Figure 3).
Antecedents
Antecedents refer to those things which precede the concept
(Rodgers 2000). Formal and informal practices support one
in cultivating the attributes that encompass mindfulness
(Table 3). These practices are varied and used to differing
degrees based on individual need and preference (Smith
et al. 2005). Practices that focus on the breath are considered foundational as ‘it is always present, always changing,
and is the link between the body and the mind’ (Roth &
Creaser 1997, p. 152). Formal practices inform and
s
es
At
ten
Consequences
en
Requirements for practice
Practices: formal
informal
Present
Moment
Experience
ar
Aw
Antecedents
tio
n
Attributes of mindfulness
Physical
Psychosocial
Spiritual
Acceptance
Figure 3 Attributes, antecedents and
Transformative process
consequences of mindfulness.
© 2013 John Wiley & Sons Ltd
287
L. White
Table 3 Antecedents.
Engaging in the practice of mindfulness
Requirements of practice
Types of practice
Capacity
Desire and commitment to
practice
Time to practise
Patience
Persistence
Non-striving – Non-goal
oriented
Formal practices*
Breath
Yoga
Sitting meditation
Walking meditation
Body scan
Mindful eating
Informal practices
Practice of being present in
moment-to-moment experience
while in daily activities
i.e. washing dishes, sitting with
patient
*Formal practices of mindfulness are not an exhaustive list; however, they are the most discussed within this analysis of the nursing
literature.
strengthen informal ones, as it is easier to practise in calm
moments than during more active and stressful times (Pipe
2008). Through the development of being present with
attention, awareness and acceptance in formal practices,
one is more able to cultivate and sustain qualities of mindfulness informally in their day-to-day activities (Day &
Horton-Deutsch 2004a).
Mindfulness practices, although seemingly simple, are
quite challenging (Young et al. 2001, Sitzman 2002) and
therefore notable characteristics are required for one to be
with the practices in an engaged and healthy way. Despite
being mentioned relatively infrequently, the capacity to be
present to and endure uncomfortable experiences as they
arise is acknowledged as a necessary antecedent to participate in mindfulness practices (Davis et al. 2007, Tusaie &
Edds 2009). This is particularly significant as there are conflicting discussions regarding ‘who’ can practice mindfulness. Some scholars offer the view that anyone can practise
mindfulness (Ott 2004, Cacciatore & Flint 2012), while
others raise caution against introducing mindfulness
interventions to those with certain psychological diagnosis
(i.e. those experiencing psychosis or who are actively
suicidal; Poss 2005, Smith et al. 2005).
It is consistently stated that commitment, dedicated time
to practise, patience, and persistence with which one is willing to return to the practices over and over again are
needed to successfully develop mindfulness (Roth & Creaser 1997, Young et al. 2001). It is also identified that these
practices need to be done without attachment to outcome
(Ott 2004, Weitz et al. 2012). Pipe (2008), in a theoretical
288
paper discussing leadership and mindfulness in nursing,
suggests that practice is by its nature not goal-oriented, but
‘rather with the objective of continually becoming more
conscious of how we approach ourselves and those we lead’
(p. 119).
Consequences
Consequences are identified themes that arise from the concept (Rodgers 2000). Consequences of mindfulness are
improved physical and mental health as well as changes in
personal behaviours (Proulx 2003). Participants in one
study identified sleeping better, having more vitality and a
reduction in pain levels (Kvillemo & Br€
anstr€
om 2011).
Lower levels of stress, anxiety, depression and burnout
are also noted outcomes in many mindfulness-based
intervention studies with specific health populations, and
for the healthcare practitioner themselves (Cohen-Katz et al.
2005b, York 2007, Ando et al. 2009, Kang et al. 2009,
Pipe et al. 2009). Also, for some participants in mindfulness
programmes, there may be a possible increase in distress
and anxiety that can occur as one cultivates the ability see
themselves, their thoughts and behaviour patterns more
clearly (Davis et al. 2007, Klainin-Yobas et al. 2012). However, there is also indication that as a result of practising
and cultivating mindfulness, one of the outcomes, consistent
with mindfulness as a process, is that antecedent qualities
are strengthened and one has increasing capacity for these
experiences (Tusaie & Edds 2009).
Behavioural and trait characteristics noted by participants
engaged in the process of mindfulness include feeling a
sense of calm (Day & Horton-Deutsch 2004b), peace
(Young et al. 2001, Cohen-Katz et al. 2005a, Matchim
et al. 2008), equanimity (Horton-Deutsch & Horton 2003)
increased levels of empathy and compassion for self and
other (Beddoe & Murphy 2004, Cohen-Katz et al. 2005a,
Davis et al. 2007, Kvillemo & Br€
anstr€
om 2011), new or
increased engagement with spirituality (Young et al. 2001,
Weitz et al. 2012) and improved health awareness and
self-care practices (Matchim et al. 2008). In addition, a
frequently discussed outcome in the literature is that mindfulness practices teach one to self-regulate his/her experience (Wall 2005, Wittenberg-Lyles et al. 2010, Matchim
et al. 2011a). Individuals are empowered to move from
unconscious and automatic internal and external reactions
to a more conscious relationship with them (Koerbel &
Zucker 2007, Pipe et al. 2009). Furthermore, as reactions
to situations change and transform, personal and professional relationships can also improve (Horton-Deutsch &
Horton 2003, Cohen-Katz et al. 2004).
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JAN: CONCEPT ANALYSIS
Related concepts
To clarify a concept further, Rodgers (2000) encourages the
identification of related concepts which ‘bear some relationship to the concept of interest but do not seem to share the
same attributes’ (p. 92). Presence, awareness and attention
are all attributes embedded in the concept of mindfulness
and can be considered also to be related concepts. In addition, Tusaie and Edds (2009) highlight and discuss some of
the other related concepts of mindfulness: metacognition,
reflection, reflective practice and meditation. Although all
of these appear to be directly synonymous with mindfulness, they do not wholly encompass the concept.
Discussion
One of the most significant contributions that the evolutionary method of concept analysis provides is a heuristic
tool for further inquiry, development and research (Rodgers
2000). Theories in the humanistic caring paradigm
espoused by Watson, Newman, Parse (Sitzman 2002, Ampunsiriratana et al. 2005, Pipe 2008, Pipe et al. 2009) and
Orem (Smith et al. 2005) can be appreciated as a theoretical match between nursing theory and practice, and mindfulness (Mackenzie et al. 2006). Despite this match, the
ability to fully operationalize and engage with the concept
of mindfulness in the discipline of nursing has remained
limited.
Mindfulness as a concept based on experience may
remain abstract and ungrounded in practical application if
its association remains solely in meta and grand theories
(which are themselves abstract in nature; Higgins & Moore
2009). Development of a middle range theory for mindfulness could offer greater ability to integrate its applications
and processes in practice, education and research. The
implications and potential directions for development of
mindfulness in nursing will be discussed in four themes:
education for self-care and nurse well-being, development
of therapeutic nursing qualities, support at practice levels
for varied health populations and research directions.
Education for self-care and nurse well-being
Significant attention in nursing literature and research has
been placed on the incidence and implications of stress, burnout (Poulin et al. 2008), compassion fatigue and vicarious
trauma (Sabo 2006), while there is limited focus on prevention and reduction of these concerns (Young et al. 2001,
Poulin et al. 2008). Cohen-Katz et al. (2004) identify that
although ‘caring and compassion for ‘the patient’ have been
© 2013 John Wiley & Sons Ltd
Mindfulness in nursing: a concept analysis
held up as the nursing ideal, self-care has not been socialized
into nurses’ ways of thinking or into their work environments’ (p. 306). Nursing curriculum does not adequately
prepare nurses for their work and offers little insight into
self-care practices beyond reinforcing that it is practitioners’
responsibility to engage in them (Christopher et al. 2006).
This concern needs to be addressed more directly as nurses
often understand the importance of self-care and healthy coping strategies, but are not confident in their own capacity to
implement and use these strategies (Glass & Rose 2008).
Mindfulness has been identified theoretically and in a
limited way through research (Young et al. 2001, Beddoe
& Murphy 2004, Cohen-Katz et al. 2005a, Poulin et al.
2008, Kang et al. 2009) as an approach to closing this gap
between stress and well-being in nursing practice. The
reduction of student and clinical nurse stress, anxiety, and
burnout can be cautiously appreciated in the context of this
analysis, given the dearth of research studies to support this
claim. Consistent with mindfulness as a transformative process, Cohen-Katz et al. (2005a) noted in their study that
nurses who engaged in mindfulness practices ‘began to
develop greater self-kindness and reported a dramatic shift
in their capacity to care for themselves’ (p. 85). In another
study, salient perspectives from student nurse participants
in a comprehensive mindfulness programme were offered;
one participant expressed feeling their experience helped
them to ‘understand health promotion from theory to practice’ (Young et al. 2001, para 12), and others felt that
mindfulness training should be incorporated into nursing
programmes.
Development of therapeutic nursing interactions
In addition to supporting nurse well-being, mindfulness has
the potential to enhance the development of less tangible
aspects of nursing (Sitzman 2002). Tusaie and Edds (2009)
posit that mindfulness can support transforming therapeutic
nursing interactions ‘from an intellectual activity to an
actual experience’ (p. 364). Based on current literature presence, empathy, patience, awareness (of self and other) and
compassion have been conceptualized as particularly important to nursing practice and nurse–patient relationships.
There are indications through this analysis that mindfulness
can serve as a practical approach to cultivating these qualities to develop a more embodied nursing practice. CohenKatz et al. (2005a) found that after a mindfulness-based
stress reduction programme, nurse participants described
being more fully present and empathetic in their relationship with others. Although these findings require further
investigation through ongoing research, mindfulness has the
289
L. White
potential to support the cultivation of holistic nursing
practices.
To be present with another in the midst of life challenges
and suffering is considered fundamental to nursing practice
(Ferrell & Coyle 2008). Despite this, multiple studies
describe nurses using distancing and avoidance strategies to
protect themselves from these experiences (Chang et al.
2006, Blomberg & Sahlberg-Blom 2007, Timmermann et al.
2009). In addition, scholars suggest that the phenomenon of
distancing is detrimental to the nurses’ well-being and the
therapeutic clinical process (Chang et al. 2006, Blomberg &
Sahlberg-Blom 2007, Iglesias et al. 2010). Through this
analysis, a possible response and prevention to these avoidance strategies appeared in the form of emerging care models
that hold mindfulness as a central component (WittenbergLyles et al. 2010, Cacciatore & Flint 2012). With the
emphasis on mindfulness in care practices, nurses are offered
a way of cultivating a greater capacity to be in these challenging moments with sustained presence. This may help not
only to therapeutically support the client but also to ‘help
insulate providers from the long-term effects of others’
suffering’ (Cacciatore & Flint 2012, p. 68).
Support at practice level for varied health populations
The positive implications of mindfulness-based programmes
for nurses and their practice are evident. Despite this, mindfulness as a concept has been explored to a greater degree
with other varied health populations, but remains minimally
integrated into the discipline of nursing. The theoretical
discussions and research results offer a promising perspective
on the benefits of mindfulness in mainstream health care to
promote well-being in various clinical and non-clinical
populations. However, there is overwhelming agreement by
many scholars in this analysis that for mindfulness to be
successfully integrated into a supportive clinical practice, the
‘teacher’ must also have a mindfulness practice of their own
(Poss 2005, Klatzker 2006, Davis et al. 2007, Lengacher
et al. 2011).
The subtleties and challenges of mindfulness can only be
offered in an authentic and realistic way if taught by those
who have experience of being in the practice (Roth & Creaser 1997, Stanton & Dunkley 2011). Poulin et al. (2008)
posit that for the successful integration of mindfulness into
health care, ‘health service professionals are a critical
population for mindfulness training because as they begin
to embody this learning, and experience benefits in their
own lives, they also bring this education to the people they
are working with’ (p. 78). Without nurses themselves
learning to practise and integrate mindfulness into their
290
own lives, they will be unable, skillfully, to offer it as a
holistic practice and perspective to those health populations
they serve. Placing attention on how to integrate mindfulness into nursing education and practice would strengthen
their ability to offer this knowledge to others.
Directions for research
As an emerging concept in nursing, mindfulness has great
potential to support practitioners, and subsequently the
health populations they serve. However, rigorous methodological research designs are needed to ground this concept
in nursing practice. There are significant gaps and directions
that nursing can explore to contribute to the science of
mindfulness.
To date, mindfulness research has been explored mainly
through quantitative research designs. A frequently cited
limitation of quantitative studies on mindfulness is that they
have insufficient statistical power (Young et al. 2001, Mackenzie et al. 2006). In addition, many scholars also critique
the self-selection method as a limitation in study designs as
it leads to biased results (Beddoe & Murphy 2004, Pipe
et al. 2009). However, as a key determining factor in one’s
ability to practise and integrate mindfulness is his/her willingness and capacity to participate, this should be taken into
consideration when designing education and research protocols.
Furthermore, appreciations of the contextual subtleties of
mindfulness have not been captured through the empirical,
quantitatively driven designs that dominate the current
research. There are now multiple tools to measure mindfulness and appreciate outcomes of mindfulness-based practices (Baer 2011). Despite these measurements, the
mechanisms of mindfulness are not well understood (Kvillemo & Br€
anstr€
om 2011). This may be partly because it is
difficult to expand the understanding of how mindfulness
truly affects participants outside the predetermined conceptualizations derived from these validated tools. Brown et al.
(2007) suggest that a greater appreciation of the mechanisms of mindfulness and the use of a theoretical model to
ground research could support the development of sound
knowledge about mindfulness.
Given the experiential and subjective nature of mindfulness, qualitative approaches to researching mindfulness
would be beneficial (Proulx 2003, York 2007). In this
analysis, there were only a handful of qualitative studies;
this is consistent with concerns that there is a lack of qualitatively focused research designs in the study of mindfulness
(Smith et al. 2005). In this respect, nursing could present a
unique contribution to the development of mindfulness in
© 2013 John Wiley & Sons Ltd
JAN: CONCEPT ANALYSIS
health care and health promotion as their research practices
include a strong grounding in qualitative research methodologies. In particular, knowledge gained from phenomenological and grounded theory research could offer important
insight into the concept.
In research designs, attention to variables, such as interventions offered, the amount one practices (dose) and
which practices they gravitate towards, is needed, as there
are significant variations on these aspects of mindfulness
research and subsequent outcomes. Beddoe and Murphy
(2004) found that there was a correlation between the
amount of mindfulness practice one engaged in and the
positive outcomes evident as a result of those practices.
Also, some believe that longer programmes are necessary to
appreciate the subtleties of the mindfulness process, while
other studies show that even small dose interventions offer
positive outcomes to participants (Mackenzie et al. 2006).
This is particularly relevant in the nursing profession where
demands on many nurses in their professional lives are staggering (Cohen-Katz et al. 2004). It is therefore important to
research what interventions, over what period of time, and
at what dose could offer positive outcomes to nurses who
are interested in practising mindfulness. In addition, longitudinal studies are being encouraged (Mackenzie et al.
2006) to gain insights into the practitioner’s experience of
integrating mindfulness into their lives overtime.
Limitations
Based on inclusion criteria, an anglophone bias is a limitation
to this sample selection. Although this analysis served to support the current use of mindfulness in nursing literature, it
does not completely capture how the concept has been integrated into the discipline without reviewing educational programmes and nursing texts. Exclusion of multiple conference
abstracts regarding mindfulness (e.g. Mindfulness of practice:
mind to care – 35th international mental health conference;
Petrie 2009) does reveal that mindfulness is becoming integrated into healthcare practices. In addition, the discussion
of mindfulness in nursing texts is also appearing (Spross
2009, Reed & Shearer 2011). The research and development
of mindfulness in other disciplines is also in its infancy, but
continues to gain momentum, and highlights the need for this
concept. A cross-disciplinary analysis could further situate
and expand this concept for the discipline of nursing.
Mindfulness in nursing: a concept analysis
concept and its significant benefits into their respective
practices. This may speak of a larger sociocultural problem
that fails to address self-care promotion and support for
nurse well-being in the face of their challenging work. To
move the concept of mindfulness forward in nursing, there
first needs to be a global shift in perspective that identifies the
health of nurses as a priority in education and research
initiatives. Mindfulness can offer practical tools for health
promotion and lends itself to holistic practices and perspectives on nursing care. Furthermore, as nurses experience
mindfulness themselves, they will have additional knowledge
available to promote it as a holistic health practice in their
various clinical settings.
Finally, mindfulness can support an ontological orientation to nursing knowledge development. Specifically, the
concept of mindfulness has significant potential to enhance
cultivating and sustaining qualities considered imperative to
therapeutic nursing practice. The current emphasis on taskoriented approaches to care and evidence-based practices
has limited the ability to foster other avenues of knowing
in nursing education and practice. Consequently, value
must be placed on other forms of knowing, such as personal and embodied knowledge. Integrating mindfulness
more intentionally into nursing education, practice and
research can assist nurses to develop a particular way of
being present for themselves and others, and can create a
shift from a purely theoretical way of knowing to one that
is more embodied and holistic.
Acknowledgements
I offer sincere gratitude to Professor Marilou Gagnon PhD
RN ACRN at the University of Ottawa who encouraged
the development of this manuscript and provided invaluable
guidance throughout the process.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the author.
Author contributions
Conclusion
The development of mindfulness in nursing lags behind other
disciplines that have been more engaged with integrating the
© 2013 John Wiley & Sons Ltd
All authors have agreed on the final version and meet at
least one of the following criteria [recommended by the
ICMJE (http://www.icmje.org/ethical_1author.html)]:
291
L. White
•
•
substantial contributions to conception and design,
acquisition of data, or analysis and interpretation of
data;
drafting the article or revising it critically for important
intellectual content.
References
Abercrombie P.D., Zamora A. & Korn A.P. (2007) Lessons
learned: providing a mindfulness-based stress reduction program
for low-income multiethnic women with abnormal pap smears.
Holistic Nursing Practice 21(1), 26–34.
Ampunsiriratana A., Triamchaisri S., Nontasorn T., Chuaprapaisilp
A. & Sangkard K. (2005) A palliated-suffering model for
HIV-infected patients: a combination of the foundations of
mindfulness meditation and Watson’s caring. Thai Journal of
Nursing Research 9(4), 268–280.
Ando M., Morita T., Akechi T., Ito S., Tanaka M., Ifuku Y. &
Nakayama T. (2009) The efficacy of mindfulness-based
meditation therapy on anxiety, depression, and spirituality in
Japanese patients with cancer. Journal of Palliative Medicine 12
(12), 1091–1094. doi:10.1089/jpm.2009.0143.
Baer R. (2010) Mindfulness- and acceptance- based interventions
and processes of change. In Assessing Mindfulness and
Acceptance Processes in Clients (Baer R.A., ed.), New Harbinger
Publications, Oakland, CA, pp. 1–15.
Baer R. (2011) Measuring Mindfulness. Contemporary Buddhism:
An Interdisciplinary Journal 12(1), 241–261.
Bankston S.M. (2008) Aligning mindfulness and therapeutic
community concepts to create a meaningful intervention for
substance abuse. Southern Online Journal of Nursing Research 8
(2), 1 p.
Bashford S. (2011) Using ‘mindfulness’ to help treat anxiety and
depression. Independent Nurse 38–39.
Beddoe A.E. & Murphy S.O. (2004) Does mindfulness decrease
stress and foster empathy among nursing students? Journal of
Nursing Education 43(7), 305–312.
Beddoe A.E., Yang C.P., Kennedy H.P., Weiss S.J. & Lee K.A.
(2009) The effects of mindfulness-based yoga during pregnancy on
maternal psychological and physical distress. JOGNN: Journal of
Obstetric, Gynecologic & Neonatal Nursing 38(3), 310–319.
Blomberg K. & Sahlberg-Blom E. (2007) Closeness and distance: a
way of handling difficult situations in daily care. Journal of
Clinical Nursing 16(2), 244–254.
Brown K.S., Ryan R. & Creswell J.D. (2007) Mindfulness:
theoretical foundations and evidence for its salutary effects.
Psychological Inquiry 18, 211–237.
Cacciatore J. & Flint M. (2012) ATTEND: toward a mindfulnessbased bereavement care model. Death Studies 36(1), 61–82.
Carroll D., Lange B., Liehr P., Raines S. & Marcus M.T. (2008)
Evaluating mindfulness-based stress reduction: analyzing stories
of stress to formulate focus group questions. Archives of
Psychiatric Nursing 22(2), 107–109.
Carson J., Carson K., Gil K. & Baucom D. (2004) Mindfulnessbased relationship enhancement. Behavior Therapy 35, 471–494.
Chang E.M., Daly J., Hancock K.M., Bidewell J.W., Johnson A.,
Lambert V.A. & Lambert C.E. (2006) The relationship among
292
workplace stressors, coping methods, demographic characteristics,
and health in Australian nurses. Journal of Professional Nursing:
Official Journal of the American Association of Colleges of
Nursing 22(1), 30–38.
Christopher J.C., Christopher S.E., Dunnagan T. & Schure M.
(2006) Teaching self-care through mindfulness practices: the
application of yoga, meditation, and qigong to counselor
training. Journal of Humanistic Psychology 46, 494–509.
Cohen-Katz J., Wiley S.D., Capuano T., Baker D.M. & Shapiro S.
(2004) The effects of mindfulness-based stress reduction on nurse
stress and burnout: a quantitative and qualitative study. Part of a
series. Holistic Nursing Practice 18(6), 302–308.
Cohen-Katz J., Wiley S., Capuano T., Baker D.M., Deitrick L. &
Shapiro S. (2005a) The effects of mindfulness-based stress
reduction on nurse stress and burnout: a qualitative and
quantitative study, part III. Holistic Nursing Practice 19(2), 78–86.
Cohen-Katz J., Wiley S.D., Capuano T., Baker D.M. & Shapiro S.
(2005b) The effects of mindfulness-based stress reduction on
nurse stress and burnout, part II: a quantitative and qualitative
study. Holistic Nursing Practice 19(1), 26–35.
Cuellar N.G. (2008) Business and leadership. mindfulness
meditation for veterans–implications for occupational health
providers. AAOHN Journal 56(8), 357–363.
Davis L.W., Strasburger A.M. & Brown L.F. (2007) Mindfulness:
an intervention for anxiety in schizophrenia. Journal of
Psychosocial Nursing & Mental Health Services 45(11), 22–29.
Day P.O. & Horton-Deutsch S. (2004a) Using mindfulness-based
therapeutic interventions in psychiatric nursing practice – part 1:
description and empirical support for mindfulness-based
interventions. Archives of Psychiatric Nursing 18(5), 164–169.
Day P.O. & Horton-Deutsch S. (2004b) Using mindfulness-based
therapeutic interventions in psychiatric nursing practice – part
II: mindfulness-based approaches for all phases of
psychotherapy – clinical case study. Archives of Psychiatric
Nursing 18(5), 170–177.
Escuriex B. & Labbe E. (2011) Health care providers’ mindfulness
and treatment outcomes: A critical review of the research
literature. Mindfulness 2, 242–253.
Ferrell B. & Coyle N. (2008) The Nature of Suffering and the
Goals of Nursing. Oxford University Press, New York.
Glass N. & Rose J. (2008) Enhancing emotional well-being
through self-care: the experiences of community health nurses in
Australia. Holistic Nursing Practice 22(6), 336–347.
Hayes S., Strosahl K. & Wilson K. (1999) Acceptance and
Commitment Therapy: An Experiential Approach to Behavior
Change. The Guildford Press, NY.
Higgins P. & Moore S. (2009) Levels of theoretical thinking in
nursing. In Perspectives on Nursing Theory (Reed P. & Shearer N.,
eds), Lippincott-Williams & Wilkins, Philadelphia, PA, pp. 49–56.
Hirst I.S. (2003) Perspectives of mindfulness. Journal of Psychiatric
& Mental Health Nursing 10(3), 359–366.
Horton-Deutsch S. & Horton J.M. (2003) Mindfulness:
overcoming intractable conflict. Archives of Psychiatric Nursing
17(4), 186–193.
Iglesias M., Vallejo R. & Fuentes P.S. (2010) The relationship
between experiential avoidance and burnout syndrome in critical
care nurses: a cross-sectional questionnaire survey. International
Journal of Nursing Studies 47(1), 30–37.
© 2013 John Wiley & Sons Ltd
JAN: CONCEPT ANALYSIS
Irving J.A., Dobkin P.L. & Park J. (2009) Cultivating mindfulness
in health care professionals: a review of empirical studies of
mindfulness-based stress reduction (MBSR). Complementary
Therapies in Clinical Practice 15(2), 61–66.
Irving J.A., Park-Saltzman J., Fitzpatrick M., Dobkin P.L., Chen A.
& Hutchinson T. (2012) Experiences of professionals health care
enrolled in mindfulness based medical practice: a grounded theory
model. Mindfulness, doi: 10.1007/s12671-012-0147-9.
Kabat-Zinn J. (1994) Wherever You Go There You Are:
Mindfulness Meditation in Everyday Life. Hyperion, New York.
Kabat-Zinn J., Wheeler E., Light T., Skillings A., Scharf M., Cropley
T., Hosmer D. & Bernhard M. (1998) Influence of a mindfulness
meditation-based stress reduction intervention on rates of skin
clearing in patients with moderate to severe psoriasis undergoing
phototherapy
(UBV)
and
photochemotherapy
(PUVA).
Psychosomatic Medicine 60, 625–632.
Kang Y.S., Choi S.Y. & Ryu E. (2009) The effectiveness of a stress
coping program based on mindfulness meditation on the stress,
anxiety, and depression experienced by nursing students in
Korea. Nurse Education Today 29(5), 538–543.
Kitsumban V., Thapinta D., Sirindharo P.B. & Anders R.L. (2009)
Effect of cognitive mindfulness practice program on depression
among elderly Thai women. Thai Journal of Nursing Research
13(2), 95–107.
Klainin-Yobas P., Cho M.A.A. & Creedy D. (2012) Efficacy of
mindfulness-based interventions on depressive symptoms among
people with mental disorders: a meta-analysis. International
Journal of Nursing Studies 49(1), 109–121.
Klatzker C. (2006) Mind/body/spirit. What works: helping caregivers
cope with death. American Nurse Today 1(2), 38–40.
Koerbel L.S. & Zucker D.M. (2007) The suitability of mindfulnessbased stress reduction for chronic hepatitis C. Journal of Holistic
Nursing 25(4), 265–277.
Kristeller J. & Hallett C. (1999) An exploratory study of a
meditation-based intervention for binge eating disorder. Journal
of Health Psychology 4, 357–363.
Kvillemo P. & Br€
anstr€
om R. (2011) Experiences of a mindfulnessbased stress-reduction intervention among patients with cancer.
Cancer Nursing 34(1), 24–31.
Lange B. (2011) Cocreating a communicative space to develop a
mindfulness meditation manual for women in recovery from
substance abuse disorders. Advances in Nursing Science 34(3),
E1–E13.
Lengacher C.A., Johnson-Mallard V., Barta M., Fitzgerald S.,
Moscoso M.S., Post-White J. & Kip K.E. (2011) Feasibility of a
mindfulness-based stress reduction program for early-stage
breast cancer survivors. Journal of Holistic Nursing 29(2),
107–117.
Liehr P. & Diaz N. (2010) A pilot study examining the effect of
mindfulness on depression and anxiety for minority children.
Archives of Psychiatric Nursing 24(1), 69–71.
Linehan M. (1993) Cognitive-Behavioral Treatment of Borderline
Personality Disorder. Guilford, New York.
Ludwig D. & Kabat-Zinn J. (2008) Mindfulness in medicine.
Journal of the American Medical Association 300, 1350–1352.
Lynch T.R., Trost W.T., Salsman N. & Linehan M.M. (2007)
Dialectical behavior therapy for borderline personality disorder.
Annual Review of Clinical Psychology 3, 181–205.
© 2013 John Wiley & Sons Ltd
Mindfulness in nursing: a concept analysis
Mackenzie C.S., Poulin P.A. & Seidman-Carlson R. (2006) A brief
mindfulness-based stress reduction intervention for nurses and
nurse aides. Applied Nursing Research 19(2), 105–109.
Matchim Y. & Armer J.M. (2007) Measuring the psychological impact
of mindfulness meditation on health among patients with cancer: a
literature review. Oncology Nursing Forum 34(5), 1059–1066.
Matchim Y., Armer J.M. & Stewart B.R. (2008) IOS new scholar
paper: a qualitative study of participants’ perceptions of the
effect of mindfulness meditation practice on self-care and overall
well-being. Self-Care, Dependent-Care & Nursing 16(2), 46–53.
Matchim Y., Armer J.M. & Stewart B.R. (2011a) Effects of
mindfulness-based stress reduction (MBSR) on health among
breast cancer survivors. Western Journal of Nursing Research 33
(8), 996–1016.
Matchim Y., Armer J.M. & Stewart B.R. (2011b) Mindfulness-based
stress reduction among breast cancer survivors: a literature review
and discussion. Oncology Nursing Forum 38(2), E61–E71.
McCracken L.M. & Yang S. (2008) A contextual cognitivebehavioral analysis of rehabilitation workers’ health and wellbeing: influences of acceptance, mindfulness, and values-based
action. Rehabilitation Psychology 53(4), 479–485.
Miller S. (2010) How mindfulness based stress reduction can reduce
anxiety after alcohol abstinence. Nursing Times 106(31), 22.
Mindfulness Research Guide (2011) Mindfulness Research Publications. Retrieved from http://www.mindfulexperience.org/
publications.php on 15 February 2012.
O’Neal J. (1997) Mindfulness: treasuring the moments. Creative
Nursing 3(3), 8–9.
Ott M.J. (2004) Mindfulness meditation: a path of transformation
& healing. Journal of Psychosocial Nursing & Mental Health
Services 42(7), 22.
Ott M.J., Longobucco-Hynes S. & Hynes V.A. (2002) Mindfulness
meditation in pediatric clinical practice. Pediatric Nursing 28(5), 487.
Petrie E. (2009) Mindfulness of practice … mind to care – 35th
international mental health nursing conference of the Australian
college of mental health nurses, 29 September – 2 October,
Sheraton on the park, Sydney, NSW, Australia. International
Journal of Mental Health Nursing 18, A19–A20.
Pipe T.B. (2008) Illuminating the inner leadership journey by
engaging intention and mindfulness as guided by caring theory.
Nursing Administration Quarterly 32(2), 117–125.
Pipe T.B., Bortz J.J., Dueck A., Pendergast D., Buchda V. &
Summers J. (2009) Nurse leader mindfulness meditation program
for stress management: a randomized controlled trial. Journal of
Nursing Administration 39(3), 130–137.
Polit D.F. & Beck C.T. (2008) Nursing Research: Generating and
Assessing Evidence for Nursing Practice, 8th edn. Lippincott
Williams & Wilkins, Philadelphia, PA.
Poss J.E. (2005) Mindfulness-based stress reduction: applications for
nurse practitioners. American Journal for Nurse Practitioners 9(7), 9.
Poulin P.A., Mackenzie C.S., Soloway G. & Karayolas E. (2008)
Mindfulness training as an evidenced-based approach to reducing
stress and promoting well-being among human services
professionals. International Journal of Health Promotion &
Education 46(2), 72–80.
Praissman S. (2008) Mindfulness-based stress reduction: a literature
review and clinician’s guide. Journal of the American Academy
of Nurse Practitioners 20(4), 212–216.
293
L. White
Proulx K. (2003) Integrating mindfulness-based stress reduction.
Holistic Nursing Practice 17(4), 201–208.
Reed P. & Shearer C. (2011) Nursing Knowledge and Theory
Innovation. Springer Publishing Company, LCC, New York.
Rodgers B.L. (2000) Concept analysis: an evolutionary view. In
Concept Development in Nursing: Foundations, Techniques and
Application, 2nd edn (Rodgers B.L. & Knafl K.A., eds),
Saunders, Philadelphia, PA, pp. 77–102.
Roth B. & Creaser T. (1997) Mindfulness meditation-based stress
reduction: experience with a bilingual inner-city program
[corrected] [published erratum appears in NURSE PRACT 1997
may; 22(5): 215]. Nurse Practitioner 22(3), 150.
Ruiz F.J. (2010) A review of Acceptance and Commitment Therapy
(ACT)
empirical
evidence:
correlational,
experimental,
psychopathology, component and outcome studies. International
Journal of Psychology and Psychological Therapy 10, 125–162.
Sabo B.M. (2006) Compassion fatigue and nursing work: can we
accurately capture the consequences of caring work?
International Journal of Nursing Practice 12, 136–142.
Segal Z., Williams J. & Teasdale J. (2002) Mindfulness-Based
Cognitive Therapy for Depression: A New Approach to
Preventing Relapse. Guilford, New York.
Sharpiro S.L. & Carlson L.E. (2009) The Art and Science of
Mindfulness: Integrating Mindfulness into Psychology and the
Helping Professions. American Psychological Association,
Washington, DC.
Sitzman K.L. (2002) Interbeing and mindfulness: a bridge to
understanding Jean Watson’s theory of human caring. Nursing
Education Perspectives 23(3), 118–123.
Smith J.E., Richardson J., Hoffman C. & Pilkington K. (2005)
Mindfulness-based stress reduction as supportive therapy
in cancer care: systematic review. Journal of Advanced Nursing
52(3), 315–327.
Spross J. (2009) Expert coaching and guidance. In Advanced Practice
Nursing: An Integrative Approach, 4th edn (Hamric A.B., Spross
J.A. & Hanson C.M., eds), Elsevier, Toronto, ON, pp. 159–190.
Stanton M. & Dunkley C. (2011) First steps in mindfulness skills.
Nursing Times 107(6), 22–24.
Teixeira E. (2010) The effect of mindfulness meditation on painful
diabetic peripheral neuropathy in adults older than 50 years.
Holistic Nursing Practice 24(5), 277–283.
Timmermann M., Naziri D. & Etienne A.M. (2009) Defence
mechanisms and coping strategies among caregivers in palliative
care units. Journal of Palliative Care 25(3), 181–190.
Trunnell E.P. (1996) Mindfulness and people with stomas. Journal
of Wound, Ostomy & Continence Nursing 23(1), 38–45.
Tusaie K. & Edds K. (2009) Understanding and integrating
mindfulness into psychiatric mental health nursing practice.
Archives of Psychiatric Nursing 23(5), 359–365.
Wall R.B. (2005) Tai chi and mindfulness-based stress reduction in
a Boston public middle school. Journal of Pediatric Healthcare
19(4), 230–237.
Weitz M.V., Fisher K. & Lachman V.D. (2012) The journey of
women with breast cancer who engage in mindfulness-based
stress reduction: a qualitative exploration. Holistic Nursing
Practice 26(1), 22–29.
While A. (2010) Mindfulness: me-time counts. British Journal of
Community Nursing 15(11), 570.
Wittenberg-Lyles E., Goldsmith J. & Ragan S.L. (2010) The
COMFORT initiative: palliative nursing and the centrality of
communication.. communication, orientation and opportunity,
mindfulness, family, oversight, reiterative and radically adaptive
messages, and team. Journal of Hospice & Palliative Nursing 12
(5), 282–294.
York M. (2007) A qualitative study into the experience of
individuals involved in a mindfulness group within an acute
inpatient mental health unit. Journal of Psychiatric & Mental
Health Nursing 14(6), 603–608.
Young L.E., Bruce A., Turner L. & Linden W. (2001) Evaluation
of a mindfulness-based stress reduction intervention. Canadian
Nurse 97(6), 23–26.
Zeller J.M. & Lamb K. (2011) Mindfulness meditation to improve
care quality and quality of life in long-term care settings.
Geriatric Nursing 32(2), 114–118.
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