Julene Campion MBSR in Healthcare

Running head: MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE
PROFESSIONALS
Mindfulness-Based Stress Reduction in Healthcare Professionals
And the Relationship to Burnout and Empathy
A Capstone Submitted to Saint Joseph’s University
By Julene Campion
In Partial Fulfillment
Of the Requirement for the Degree Master of Science in
Organization Development and Leadership
September, 15 2014

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MINDFULNESS-BASED STRESS REDUCTION IN HEALTHCARE PROFESSIONALS
Abstract
Objective: Healthcare professionals are under a tremendous amount of pressure given the
changes of healthcare reform. As a result, many healthcare professionals experience burnout and
decreased empathy. Mindfulness-Based Stress Reduction (MBSR) has been shown to reduce
stress and improve overall well-being in healthy populations. The purpose of this study is to
determine if an eight-week MBSR program designed for healthcare professionals can decrease a
burnout tendencies and increase empathy. Design: A quantitative and qualitative method were
utilized for this study. For the quantitative method, the Maslach Burnout Inventory (MBI) and
the Jefferson Scale of Empathy (Healthcare Professionals version) were administered pre and
post-treatment. For the qualitative method, an open-ended class evaluation created by the
program facilitators was administered post-treatment. Participants: Healthcare professionals
from a large healthcare network in Pennsylvania were recruited for the MBSR program through
postings on the organization’s intranet and internet sites. The eight-week MBSR course met for
2.5 hours for eight weeks plus a seven-hour retreat at the end of the program. Participants were
offered continuing education credits and received a $200.00 stipend. The course was offered
from 2010-2014. Hypothesis 1: Healthcare professionals who complete an eight-week MBSR
program experience lower burnout tendencies as measured by the Maslach Burnout Inventory
(MBI) in the subscales of emotional exhaustion, depersonalization and lack of personal
accomplishment. Hypothesis 2: Healthcare professionals who complete an eight-week MBSR
program experience an increase in empathy as measured by the Jefferson Scale of Empathy (HP
version) which measures key dimensions of empathy including perspective-taking,
compassionate care and standing in the patient’s shoes. Results: (Hypotheses 1) Participants
post-test mean scores indicate a lower frequency of emotional exhaustion (-2.3) and

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depersonalization (-1.8) along with an increased frequency of personal accomplishment (1.8).
The combination of each subscale results indicate that the MBSR program positively affected
burnout in the participants. (Hypotheses 2) Participants post-test mean scores on the Jefferson
Scale of Empathy indicate a stronger level of agreement on the non-flipped questions (1.5) and a
higher level of disagreement on the flipped questions (-1.9). The results indicate that the MBSR
program positively affected the levels of empathy in the participants.
Key Words: Mindfulness-Based Stress Reduction, MBSR, Mindfulness, Healthcare
Professional, Burnout, Empathy

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Acknowledgments
I would like to dedicate this paper to my son, Pierce Campion who inspires me,
challenges me to think more deeply, and makes me laugh out loud! I would like to thank my
amazing husband, John who encourages me to chase my dreams and gives me loving support in
so many ways. I could not have completed this program without his unwavering reassurance.
Finally, I want to thank my Lehigh Valley Health Network colleague, Susan Wiley, MD for her
passion, commitment, knowledge and for making this study possible.

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Table of Contents
Chapter I: Introduction
1.1 Problem Statement
1.2 Need for Research
1.3 Purpose of the Study
Chapter II: Literature Review
2.1 Overview
2.2 Mindfulness-Based Stress Reduction (MBSR)
2.3 MBSR in Healthcare Professionals and the Relationship to Burnout and Empathy
2.4 Summary
Chapter III: Methodology
3.1 Research Questions
3.2 Research Hypothesis
3.3 Research Design
3.4 Operational Definitions and Variables
3.5 Participants
3.6 Instruments and Materials
3.7 Procedure
Chapter IV: Results
4.1 Introduction
4.2 Descriptive Data
4.3 Analysis of Research Questions
4.4 Other Findings
Chapter V: Discussion
5.1 Summary
5.2 Interpretation of Findings
5.3 Additional Analysis
5.4 Limitations
5.5 Recommendations
5.6 Conclusion
References
Appendices

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Chapter I: Introduction
1.1 Problem Statement
Passage of the Affordable Care Act (ACA) dramatically increased accountability for
acute hospitals in the United States. The Centers for Medicare & Medicaid Services (CMS)
developed a national standardized survey called the Hospital Assessment of Healthcare Providers
and Systems survey (HCAHPS and pronounced “H-CAPS”) to measure and publicly report
patients’ perceptions of the care they received while in hospital (The Hospital & HealthSystem
Association of Pennsylvania , 2013). In addition to the patient’s perception of care, the
Affordable Care Act mandates a value-based purchasing program. A value-based purchasing
program is similar to a pay-for-performance program. Under ACA, Medicare and Medicaid
reimbursements will be based on the perception of care, quality and outcomes of patient care
(The Hospital & HealthSystem Association of Pennsylvania , 2013).
In the rapidly changing healthcare environment, healthcare professionals (physician,
nurse practitioner, physician assistant, registered nurse and psychologist) are under a tremendous
amount of pressure to provide safe, effective and quality care while reducing costs and creating a
positive perception of the care delivery experienced by their patients. Healthcare professionals
need stress-coping skills in order to avoid burnout and to communicate in a caring and
empathetic way to their patients. Healthcare professionals may experience an inner conflict
between their personal values to heal and care for their patients while meeting the increasingly
demanding regulatory and economic requirements of the workplace (DiGiacoma & Adamson,
2001).
The pay-for-performance or value-based purchasing program places millions of dollars at
risk for acute care hospitals in the United States. In Pennsylvania alone, approximately $90

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million in annual CMS reimbursements will be at risk by 2017 (The Hospital & HealthSystem
Association of Pennsylvania , 2013).
1.2 Need for Research
The concept of burn-out refers to “the process in which the professional’s attitudes and
behaviors change in negative ways in response to job strain” (Cherniss, 1980). Some symptoms
related to burn-out in healthcare professionals include emotional exhaustion, depersonalization
or disregard for others, and a low sense of accomplishment (Krasner, et al., 2009). Burn-out in
healthcare professionals has been linked to poorer quality of care, increased medical errors,
decreased patient satisfaction, increased malpractice claims and a decrease in the healthcare
professional’s ability to express empathy.
Stress in the clinical environment can lead to irritability and negative attitudes toward the
patient and colleagues, rationalization and blame or lack of empathy. Patient care,
communication, friendliness, creativity and support for other colleagues decline as stress
increases (DiGiacoma & Adamson, 2001). During burnout, both professional performance and
personal health and well-being are negatively affected (Cherniss, 1980). A lack of genuine
interest, pessimism, and emotional irritability are perceived negatively by the patient and impact
the progression of care (Cherniss, 1980). Burnout leads to irritability, negative attitudes and a
lack of empathy which also negatively impact the patient’s perception of care delivery,
progression of care and quality of outcomes.
Although there is a substantial amount of research related to burnout in healthcare
professionals and the impact on the patients’ perception of care and quality outcomes, there are
few studies examining the effects of a Mindfulness-Based Stress Reduction program for
healthcare professionals related to decreasing burnout and enhancing empathy. If MBSR can be

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shown to decrease burnout and enhance empathy in healthcare professionals, there is strong
evidence to support the residual effects of a positive perception of care delivery by the patient,
progression of care and quality outcomes.
1.3 Purpose of the Study
The main purpose of this study is to determine if there is a positive correlation between
completion of an eight-week Mindfulness-Based Stress Reduction course by healthcare
professionals and a decrease in burnout tendencies along with enhanced empathy. If a positive
correlation can be determined, this study will help healthcare organizations evaluate their current
health and wellness strategy to better identify programs such as MBSR which can decrease
burnout and positively impact the healthcare professional’s level of empathy. Ultimately, this
may positively impact the patient’s perception of care, progression of care and outcomes.
As the healthcare industry morphs from a pay-for-service model to a value-based-
purchasing model, consumers gain more control and greatly influence the bottom line of a
hospital’s financial health. The consumer’s voice will be heard through the HCAPPS survey and
their in-hospital experiences with healthcare professionals will significantly impact the
percentage of payment from CMS. It is essential that healthcare professionals practice self-care
to avoid emotional exhaustion, irritability, negative attitudes and a lack of empathy (Krasner, et
al., 2009).
The scope of this study will focus on a large health network in Pennsylvania, Lehigh
Valley Health Network (LVHN). In 2014, LVHN was recognized by U.S. News and World
Report’s Best Hospital list for the 19th consecutive year. The network received a grade of “A”
from The Leapfrog Group. (Leapfrog collects information from hospitals across the United
States and grades efforts to provide quality, safety and customer value.)

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The Center for Mindfulness at LVHN was co-founded by Susan Wiley, MD and Joanne
Cohen-Katz, PhD. In 2010, 2012, 2013 and 2014, the co-founders facilitated an eight-week
MBSR program for healthcare professionals (physicians, nurse practitioners, physician
assistants, registered nurses and psychologists). Two surveys were administered during the pre
and post periods of each eight-week program. The Maslach Burnout Inventory (MBI) was
utilized to measure burnout with the subscales of Emotional Exhaustion (EE), Depersonalization
(DP) and Personal Accomplishment (PA) (Appendix I). The Jefferson Scale of Empathy (HP
version) was utilized to measure empathy with a focus on perspective taking, delivering
compassionate care and the ability to stand in the patient’s shoes (Appendix II). The quantitative
portion of this study will examine the data from the pre and post surveys to determine if the
completion of the eight-week MBSR program resulted in a decrease in burnout and an increase
in empathy. Additionally, the qualitative portion of this study will include free-form responses
to three questions (Q8, Q9 and Q10) from the post-treatment class evaluation (Appendix III).
Limitations to the study include the small number of matched pre and post surveys
(n=22), the low number of completed class evaluations (n=20) and the low number of completed
demographic information (n=15) which limits the ability to determine correlations to gender,
role, specialty and age. A second limitation is the period of time passed when the post survey
was administered. The post survey was administered immediately following the final class. The
addition of a post survey following a nine or twelve month maintenance period may reveal
additional information about the effects MBSR has on burnout and empathy.
The overall goal of this study is to understand how the completion of a Mindfulness-
Based Stress Reduction course by healthcare professional’s impacts burnout and empathy which
are key drivers of a positive perception of care delivery by the patient, progression of care and

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quality outcomes. If a health network can influence more healthcare professionals to enroll in a
MBSR program, then it is possible that the patient’s perception of care would be improved along
with the progression of care and quality outcomes. Ultimately these improvements affect the
financial viability and future of the health network’s continued operation under the new
guidelines of healthcare reform.
Approval from Susan Wiley, MD, Vice Chair Department of Psychiatry at Lehigh Valley
Health Network was granted to analyze the survey data and class evaluations of participants who
participated in a MBSR program for healthcare professionals during the period of 2010 – 2014
(Appendix IV).

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Chapter II: Literature Review
2.1: Overview
An electronic search was conducted using Google Scholar and the Saint Joseph’s
University online database Discover which includes journals from key sources such as PubMed
(MEDLINE), ISI Web of Knowledge and PsycINFO. The database search included only peer-
reviewed studies published in English from 1980-2014. The main search terms were
Mindfulness-Based Stress Reduction, MBSR, Mindfulness, Healthcare Professional, Burnout and
Empathy in various combinations as needed. Other sources include websites for The Hospital &
HealthSystem Association of Pennsylvania and the Lehigh Valley Health Network and books by
Jon Kabat Zinn.
2.2: Mindfulness-Based Stress Reduction (MBSR)
In 1979, Kabat-Zinn and colleagues at the University Of Massachusetts Medical Center
in Worcester, MA introduced Mindfulness-Based Stress Reduction or MBSR (Kabat-Zinn,
1990). In addition to being the founding director of the Center for Mindfulness in Medicine,
Health Care, and Society at the University of Massachusetts Medical School, Kabat-Zinn was
also a student of Zen Master Seung Sahn for many years. His practice of yoga and studies with
Buddhist teachers led him to integrate their teachings with those of Western science. Kabat-
Zinn’s original intention was to evolve MBSR into a public health intervention, which led to
individual and societal transformation (Kabat-Zinn, 2011).
MBSR was originally developed for use in a clinical setting to introduce training in
mindfulness-meditation to patients experiencing stress (Kabat-Zinn J. , Mindfulness-based
interventions in context: Past, present and future, 2003). However, today MBSR is frequently
used as an intervention for a healthy population experiencing everyday stressors to help maintain

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a positive state of mind. MBSR provides participants with training in formal and informal
practices to approach stressful events mindfully in order to intentionally choose a response rather
than responding in automatic pilot mode (Bishop, 2002). A study conducted with a healthy
population concluded there is evidence to support MBSR reduces stress (Chiesa & Serretti,
2009). In this study, comparisons between groups suggested that there was “a significant
positive nonspecific effect compared to the absence of treatment (waiting list)” (Chiesa &
Serretti, 2009, p. 596). MBSR has also been shown to be an effective intervention on positive
states of mind and overall psychological well-being (Chang, et al., 2004).
Mindfulness-meditation techniques used in MBSR help people to cope with stress,
anxiety, pain and illness. Participants learn to observe the triangle (thoughts, body sensations,
emotions) in motion from various starting points without judgment, labels, resistance or striving
to change or stop it (Kabat-Zinn, 1990). MBSR is a highly structured program consisting of an
eight-week course. Participants meet weekly for two-and-one-half hours during the eight weeks
and conclude the program with an all-day (eight hours) retreat. The principle mindfulness-
meditation techniques taught in MBSR contain three broad elements (Crane, 2008):
1. The development of awareness through formal and informal practice
2. Adopting an intentional awareness and attitude of curiosity, acceptance, kindness and
openness to be with the present experience without judgment, labeling, or striving for
it to be different or better
3. A new acceptance and understanding of human suffering in others and in
ourselves which is further realized mindful-meditation is experienced more deeply.

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In addition to the group meetings during the eight-week session, the MBSR program
includes daily homework assignments including reading, journaling, meditation, body scan, yoga
and triangle of awareness exercises for 45 minutes (Carmody & Baer, 2008).
Researchers in the San Francisco Bay area recruited forty-three participants to measure
the effects of a MBSR program on perceived levels of stress, positive state of mind and
mindfulness self-efficacy in healthy adults (Chang, et al., 2004). Of the 43 participants recruited,
only twenty-eight of the participants completed all follow-up measures. The participants were
students enrolled in a private university continuing education program. Self-reported measures
collected demographic data and information related to previous experience with meditation. The
Perceived Stress Scale (PSS) was used to measure perceived levels of stress in the most recent 30
days. The PSS uses a five-point Likert scale from 0 (never) to 4 (very often). A short version of
the PSS was used for the study. A six-item scaled called the Positive States of Mind (PSOM)
was used to measure six domains of satisfying states of mind: focused attention, productivity,
reasonable caretaking, restful repose, sensual/non-sexual pleasure, and sharing (Chang, et al.,
2004). The PSOM uses a 3-point Likers scale ranging from 0 (unable to have it) to 3 (have it
easily). Levels of perceived stress were measured using the Mindfulness self-efficacy (MSE).
The MSE is comprised of 15 items that measure whether or not the participant can remain
impartial (non-judgmental) during various situations. Participants indicate their confidence level
on a percentage scale between 0 percent (no confidence) to 50 percent (moderate confidence) to
100 percent (complete confidence) (Chang, et al., 2004). Following the 8-week MBSR program,
there was a significant decrease in the perceived level of stress score and a significant
improvement in the positive state of mind and mindfulness self-efficacy score.

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2.3: MBSR in Healthcare Professionals and the Relationship to Burnout and Empathy
A randomized trial by Shapiro, Astin, Bishop, and Cordova (2005) studied the effects of
MBSR in healthcare professionals who are currently working in a clinical environment. The
purpose of the research was to determine if MBSR would decrease overall psychological
distress, stress, and job burnout. Additionally, the researchers were interested in measuring the
positive benefits of MBSR related to overall life satisfaction and increased self-compassion. The
study design involved randomly assigning the participants to two groups, experimental and
control group. A baseline and post-treatment measurement was used for a between-groups
comparison. Participants included healthcare professionals (nurses, social workers, physical
therapists and psychologists) from a Veterans Affairs organization in California. Participants
were recruited through flyers and e-mail messages. All participants were required to be a current
health care professional, age of 18 years or older and English speaking (MBSR program
materials are only available in English at this time). Participants were not accepted into the trial
if they had current substance abuse problems or suicide ideation. The Brief Symptom Inventory
(BSI), the Total Mood Disturbance scale, the Maslach Burnout Inventory (MBI) and the
Perceived Stress Scale were used to measure stress levels and mood pre and post the MBSR
program (Derogatis, 1993) (Maslach & Jackson, 1986). Additionally, satisfaction with life and
self-compassion were measured using the Satisfaction with Life Scale (SWLS) and the Self-
Compassion Scale (Diener, Emmons, Larsen, & Griffin, 1985; Neff, 2003). Although the
sample size was small (n=18), the study found that the changes in self-compassion significantly
influenced positive changes in perceived stress (Shapiro, Astin, Bishop, & Cordova, 2005).
Participants indicated that the MBSR program had a significant positive effect on their life and
suggested that MBSR may be beneficial for healthcare workers who participate in the program.
Unfortunately, the dropout rate of 44% for this study was significantly higher than the average

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rate of most MBSR programs (20%). All participants who dropped out indicated it was due to
lack of time or increased responsibilities so this may be a barrier to introducing the eight-week
MBSR program to health care professionals in the current format. Health care professionals
already have a demanding and stressful schedule so adding two and a half hours each week with
daily home practice may be difficult to accomplish.
The Shapiro et al., (2005) study suggests that creative ways to deliver the MBSR program
to healthcare workers should be further explored such as incorporating in work schedule or
finding other ways to reduce time commitment. The study further suggests that additional forms
of self-report measures, follow-up assessments should be considered in future studies.
A pre-post study conducted in a university medical center with healthcare workers using
the Maslach Burnout Inventory offered the MBSR course for continuing education credits and
paid participants $400. (Note: not all participants were healthcare professionals and not all
participants were affiliated with the university medical center.) The course was advertised
through email announcements and local print media. The study found that burnout scores
improved significantly following the eight-week MBSR course (Goodman & Schorling, 2012).
Another study involving primary physicians and the eight-week MBSR program was
designed to determine if the program improved the physician’s sense of well-being,
psychological distress, burnout and capacity for relating to patients (Krasner, et al., 2009). The
study was offered to 70 primary care physicians as a Continuing Medical Education (CME)
course in Rochester, NY. Physicians who participated did not pay a fee, received CMA credits
and $250 upon completion of five self-administered surveys. The eight-week MBSR program
was followed by a 10-month maintenance phase. The objective of the study was to determine if
an MBSR program combined with communication and self-awareness education and practice

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would reduce physician’s burnout and psychological distress while improving well-being and
patient relationships. In addition to the informal and formal practices taught in the MBSR
program, the physicians participated in narrative discussions about clinical experiences and used
appreciative interviews with each other to better understand the importance of listening.
Participants were coached to listen to the personal stories with intention and non-judgment while
practicing focused questions to deepen understanding. In larger group discussions, participants
shared experiences related to using the mindfulness-based practices, narrative writing and
appreciative inquiry exercises and discussed the overall sense of well-being (Krasner, et al.,
2009).
The five self-administered surveys were completed according to the following schedule:
1. Time of registration
2. Beginning of the first session
3. End of the eight-week MBSR program
4. End of the 10-month maintenance phase
5. Three months after the 10-month maintenance phase ended
Several assessments were used in this study including the 2-Factor Mindfulness Scale,
Maslach Burnout Inventory, Jefferson Scale of Healthcare Professional Empathy, Physician
Belief Scale Mini-markers of the Big Five Factor Structure and Profile of Mood States (POMS)
(Krasner, et al., 2009). Scores were analyzed for each instrument and the changes in burnout,
empathy and other outcomes were associated with mindfulness. Measurable improvements in
well-being were found along with enhanced interpersonal characteristics related to a patient care.
A study involving Medical and Premedical Students examined the effects of an eight-
week MBSR program to determine if scores on overall empathy levels (among other items)

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increased following the program (Shapiro, Schwartz, & Bonner, Effects of Mindfulness-Based
Stress Reduction on Medical and Premedical Students, 1998). The study used the Empathy
Construct Sales (ECRS) to measure overall empathy. The participants reported increased scores
on overall empathy following the MBSR program. The study also suggested that the MBSR
program may have helped the students develop better listening skills and the awareness of higher
compassion for themselves and their future patients.
A pilot study of 30 primary care clinicians involved an abbreviated version of a
mindfulness program which included a total of 18 hours versus a typical MBSR program of 29-
33 hours. The abbreviated program included a weekend immersion (Friday evening: three hours;
Saturday: seven hours and Sunday: four hours) and two 2-hour follow-up evening sessions. The
study used a single sample and consisted of pre-post design using the Maslach Burnout
Inventory, Depression Anxiety Stress Scales-21, Perceived Stress Scale, the 14-item Resilience
Scale and the Santa Clara Brief Compassion Scale (Fortney, MD, Luchterhand, MSSW,
Zakletskaia, MA, Zgierska, MD, PhD, & Rakel, MD, 2013). Participants were surveyed four
times: survey one was sent two weeks before the program began; survey two was sent the day
following the last course; survey three was sent eight weeks after the last session and survey four
was sent nine months following the course. The participants reported a significant improvement
in scores on all Maslach Burnout Inventory subscales (Emotional Exhaustion, Depersonalization
and Personal Accomplishment). The effects of the program were maintained over 9 months with
no formal intervention. The class size was 15 individuals and there was no cost to the
participants.
A study conducted with 84 employees from a university hospital involved three pre/post
test questionnaires and an eight-week Mindfulness Meditation (MM) program utilizing materials

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from Jon Kabat-Zinn’s MBSR program and cognitive therapy (Galantino, Baime, Maguire,
Szapary, & Farrar, 2005). The program was delivered in two-hour weekly increments over eight
weeks. The course was adapted to address burnout, compassion, communication and work/home
balance. The questionnaires used for the study were the Profile of Moods States-Short Form,
Maslach Burnout Inventory and Interpersonal Reactivity Index. Participants completing the
Maslach Burnout Inventory reported improvements in the Emotional Exhaustion scale. This
study also reported improved patient satisfaction scores for participants the quarter following the
intervention.
2.4: Summary
The literature review confirmed that MBSR is an effective and safe treatment for
reducing medical and psychological symptoms in chronically ill individuals and for increasing
well-being in healthy populations (Carmody & Baer, 2008). The literature review also revealed
a growing interest in MBSR to reduce stress and anxiety in healthcare workers. However, very
few studies were found which evaluate the relationship between MBSR in healthcare
professionals and the impact on burnout and empathy. There are several common limitations to
the studies related to pre and post MBSR:
1. Lack of a control group
2. Small sample size
3. Population may be predisposed to register for the MBSR program as in the case
of offering CME credits
4. Since the MBSR program materials are only available in English, the sample
population does not include a diverse group

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Chapter 3: Methodology
3.1 Research Questions
Two research questions were utilized for this study.
Question 1: Do healthcare professionals who complete an eight-week Mindfulness-
Based Stress Reduction (MBSR) program experience reduced burnout tendencies?
Based Stress Reduction (MBSR) program experience an increase in empathy?
3.2 Research Hypotheses
Two research hypothesis were utilized for this study.
Hypothesis 1: Healthcare professionals who complete an eight-week Mindfulness-Based
Stress Reduction (MBSR) program experience lower burnout tendencies (emotional exhaustion,
depersonalization and lack of personal accomplishment) as measured by the Maslach Burnout
Inventory (MBI).
Stress Reduction (MBSR) program experience an increase in empathy (perspective-taking,
compassionate care and standing in the patient’s shoes) as measured by the Jefferson Scale of
Empathy (HP version).
3.3 Research Design
The research approach used for this study are both quantitative and qualitative. A
quantitative method will be undertaken using Maslach Burnout Inventory and the Jefferson Scale
of Empathy (HP version). The qualitative method will be undertaken by reviewing written
answers to three open-ended questions from the class evaluation to gain additional personal
insight from participants. The data was gathered from files stored by the lead facilitator of the

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MBSR program at LVHN, Dr. Susan Wiley. The Maslach Burnout Inventory and Jefferson
Scale of Empathy were organized by each participant’s pre and post survey. To ensure each
subject’s confidentiality and protect the integrity of the information gathered, a unique identifier
was used for each participant. Class evaluations were not organized by subject as unique
identifiers were not recorded on the forms. The evaluation contained 13 questions. However,
after consultation with Dr. Susan Wiley, the qualitative study was limited to questions 8, 9 and
10 as these questions aligned most closely with the research hypothesis.
The Maslach Burnout Inventory and Jefferson Scale of Empathy were provided to the
participants at the beginning of the first class and again at the end of the last class. The class
evaluation was provided to participants at the end of the last class. All items were collected prior
to the participants leaving the classroom.
3.4 Operational Definitions and Variables
Mindfulness: Mindfulness is often associated with a speciﬁc method of meditation with
the qualities of paying attention, accepting, and self/other caring and compassion. It has also
been referred to as the awareness that arises through intentionally attending to one’s moment-to-
moment experience in a nonjudgmental and accepting way (Kabat-Zinn J. , Full Catastrophie
Living, 1990).
Mindfulness-Based Stress Reduction (MBSR): MBSR was originally developed by Jon
Kabat-Zinn at the University Of Massachusetts Medical Center for use in a clinical setting to
introduce training in mindfulness-meditation to patients experiencing stress (Kabat-Zinn & Jon,
2011). However, today MBSR is frequently used as an intervention for a healthy population
experiencing everyday stressors to help maintain a positive state of mind. MBSR provides
participants with training in formal (meditation) and informal practices (body awareness, mindful

21
eating, mindful walking and yoga) to approach stressful events mindfully in order to intentionally
choose a response rather than responding in automatic pilot mode (Bishop, 2002). MBSR has
also been used as an intervention on positive states of mind and overall psychological well-being
(Chang, et al., 2004). While MBSR has its roots in spiritual teachings, the program is not
affiliated with any religious belief system (Kabat-Zinn J. , Mindfulness-based interventions in
context: Past, present and future, 2003).
Healthcare Professionals: For the purposes of this study, defined as Physicians, Advance
Practice Clinicians, Registered Nurses and Psychologists.
Healthcare Professional Burnout: Healthcare professional burnout is defined as
emotional exhaustion, a feeling a lack of personal accomplishment and depersonalization by
Maslach Burnout Inventory.
Healthcare Professional Empathy: Healthcare professional empathy is defined as the
ability to assume the patient and/or family members’ perspective, stand in the patient’s shoes and
to provide compassionate care.
Independent Variable: Participation in an eight-week MBSR course at Lehigh Valley
Health Network designed for healthcare workers. The program name is Mindfulness Training
for Medical Professionals (MTMP).
Dependent Variables: There are two dependent variables - Burnout and Empathy.
3.5 Participants
Male and female healthcare professionals (Physicians, Advance Practice Clinicians,
Registered Nurses and Psychologists) from Lehigh Valley Health Network (LVHN) in
Pennsylvania were invited to participate in an eight-week Mindfulness-Based Stress Reduction

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program specifically for healthcare professionals entitled Mindfulness Training for Medical
Professionals (MTMP). The program’s objectives include (Network, 2013):
 Mitigate the stress of work and home life
 Reduce negative moods and distress; promote well-being
 Learn a broad set of skills useful in the work-day and in building relationships
through empathy and connection
 Manage existential stressors of suffering and mortality without being sectarian
The availability of the program was posted on the organization’s internet and intranet
sites. Healthcare professionals who participated in the program were eligible for CME credits
and a $200 reimbursement from the Office of Medical Affairs (Network, 2013). Participants
were also eligible to receive a 100% refund of the cost through the organization’s Wellness
benefit program if they participate in the health coverage plan. All participants were required to
read and understand English. The program was sponsored by LVHN’s Center for Mindfulness.
3.6 Instruments and Materials
To measure burnout, the participants completed the Maslach Burnout Inventory pre and
post treatment, which includes three subscales of Emotional Exhaustion (EE), Depersonalization
(DP) and lack of Personal Accomplishment (PA). Three scores are calculated for each
respondent and there is no overall score. The Maslach Burnout Inventory consists of 22
questions and uses a 6-point Likert ranging from 0 “never” to 6 “every day”. Participants who
score high on the EE and DP scales while scoring low on the PA score exhibit a high level of
burnout. The Maslach Burnout Inventory is a validated assessment described frequently in the
literature review to measure burnout in healthcare professionals (Worley, Vassar, Wheeler, &
Barnes, 2008).

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To measure empathy, the participants completed the Jefferson Scale of Healthcare
Professional Empathy pre and post treatment which measures the dimensions of perspective-
taking, compassionate care and standing in the patient’s shoes. The Jefferson Scale of
Healthcare Professional Empathy consists of 20 questions and used a 7-point Likert scale with 1
being “strongly disagree” and 7 being “strongly agree”. Ten of the questions are flipped or
presented in a negative context – reversing the Likert scale values. The Jefferson Scale of
Healthcare Professional Empathy is a validated assessment described frequently in the literature
review to measure empathy in healthcare professionals (Hojat, et al., 2001).
The class evaluation was created by Dr. Susan Wiley and Joanne Cohen-Katz, PhD. The
evaluation consisted of 13 open-ended questions.
3.7 Procedure
All MBSR classes for the study were conducted annually in 2010, 2012, 2103 and 2014
in a conference room on a LVHN hospital site. Dr. Susan Wiley was the lead facilitator for all
classes. Classes were held on a Tuesday evening from 6:00-7:30 PM once a week for six weeks
followed by a seven-hour Saturday retreat. A typical room set up included chairs in a circle.
Floor mats and pillows or blankets were used as well. Pre and post surveys were administered to
all participants using Maslach Burnout Inventory and Jefferson Scale of Empathy for Healthcare
Professionals. The pre-test was administered at the beginning of the first course. The post-test
and class evaluation were administered the evening of the last course prior to participants’
dismissal. Access to the pre-test, post-test and class evaluations were provided by Dr. Susan
Wiley.
The practices taught in the eight-week MBSR at program are listed below courtesy of the
Lehigh Valley Health Network website (Network, 2013):

24
 Body scan – You’ll learn to slowly focus on each part of your body and be in
tune with the physical sensations. You develop greater familiarity and confidence
with your body.
 Meditation – You’ll learn to incorporate meditation into your life in practical
ways. You can meditate while lying down, sitting, standing, eating and walking.
 Mindful movement – You’ll learn to stretch and move without forcing your body
into complicated or difficult positions. You accept your body as you find it.
 Group discussion – There’s so much power in sharing your experiences and
listening to the experiences of others in a nonjudgmental way. You learn your
experiences are not unique and help each other cope with life’s chaotic moments.
 Awareness calendar – You’ll record the details of significant events – a pleasant
or unpleasant moment, a stressful communication. The exercise helps you become
in touch with your thoughts, moods and feelings, and resolve any issues.
 Communication – You will learn how mindful awareness can improve
communication skills, cultivating both a greater presence in listening and clarity
of speech

25
Chapter 4: Results
4.1: Introduction
The purpose of this study was to determine if the completion of an eight-week MBSR
program decreases a healthcare professional’s burnout tendencies and increases empathy.
Participants’ response to the Maslach Burnout Inventory and the Jefferson Scale of Empathy
were entered into an Excel workbook. The data was analyzed by determining the difference in
the average responses to each question.
4.2: Descriptive Data
Demographics were collected using the Jefferson Scale of Empathy (HP version). Data
collected included age range (<21, 21-30, 31-40, 41-50, 51-60, 71-70 and >70); gender; primary
specialty, medical or surgical sub-specialty. Of the 22 participants, demographic data was only
provided by 15 individuals. (Note: Participants in the 2010 cohort did not receive the
demographic survey.)
Gender % of
Total
Female 59%
Male 41%
n=15
Age
Range
% of
Total
31-40 7%
41-50 40%
51-60 27%
61-70 27%
n=15

26
Primary Specialty
% of
Total
Anesthesiology 8%
Hospice 8%
Internal Medicine 25%
Palliative Medicine 8%
Pathology 8%
Psychiatry 17%
Psychology 25%
n=12
Medical or Surgical
Sub-Specialty
% of
Total
Cardiology 33%
Critical Care
Pulmonary
33%
Geriatrics 33%
n = 3
4.3: Analysis of Research Questions
Stress Reduction (MBSR) program experience lower burnout tendencies as measured by the
Maslach Burnout Inventory (MBI) in the subscales of emotional exhaustion, depersonalization
and lack of personal accomplishment. Comparisons between pre and post survey data using the
MBI supported the first hypothesis. Positive changes related to burnout were reported for all
subscales post treatment.
Figure 1 compares the mean pre and post-test MBI scores for the Emotional Exhaustion
(EE) subscale and Figure 2 displays the results in a chart. Overall, the EE subscale post test
indicated that participant’s felt emotionally exhausted less frequently following the program.
Participants reported a decrease frequency for all questions with the exception of Q20 (end of
rope) which saw no change from pre to post test and was reported during both as a frequency of
1.3 or “a few times a year or less”. The questions reflecting the biggest change in frequency
(-0.4) were Q2 (used up), Q8 (burned out) and Q13 (frustrated).

27
Maslach Burnout Inventory
Emotional Exhausted (EE)
Question Description Pre-Treatment
Post-
Treatment
Difference
Q1 Emotionally drained 3.6 3.3 -0.3
Q2 Used up 3.9 3.5 -0.4
Q3 Fatigued in the morning 2.8 2.5 -0.3
Q6 Working with people 2.2 1.9 -0.3
Q8 Burned out 2.4 2 -0.4
Q13 Frustrated 3.5 3.1 -0.4
Q14 Working too hard 3.2 3.1 -0.1
Q16 Stress 1.6 1.5 -0.1
Q20 End of my rope 1.3 1.3 0
Summary (EE) 24.5 22.2 -2.3
Figure 1

28
Figure 2
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Emotionally
drained
Used up Fatigued in
the morning
Working with
people
Burned out Frustrated Working too
hard
Stress End of my
rope
Q1 Q2 Q3 Q6 Q8 Q13 Q14 Q16 Q20
Emotional Exhausted (EE)
Pre-Treatment Post-Treatment

29
Figure 3 compares the mean pre and post-test MBI scores for the Personal
Accomplishment (PA) subscale and Figure 3 displays the results in a chart. Overall, the PA
subscale post-test indicated that participant’s experienced a feeling of personal accomplishment
more frequently following the MBSR program. Participants reported an improvement on all
questions with the exception of Q4 (I can understand) and Q21 (deal with emotional problems
at work) which saw an unexpected decline in frequency of 0.1 and 0.2 respectfully. The
questions reflecting the biggest improvement in frequency were Q12 (feel very energetic), Q17
(easily create a relaxed atmosphere for patients) and Q19 (accomplish worthwhile things in this
job) with differences of 0.5, 0.4 and 0.5 respectfully.
Personal Accomplishment (PA)
Question Description Pre-Treatment Post-Treatment Difference
Q4 I can understand 5.3 5.2 -0.1
Q7 I deal effectively 5.0 5.3 0.3
Q9 I’m positively influencing 5.3 5.4 0.1
Q12 I feel very energetic 4.1 4.5 0.4
Q17
Easily create a relaxed
atmosphere for patients
4.9 5.4 0.5
Q18 I feel exhilarated 4.5 4.8 0.3
Q19
Accomplished many
worthwhile things in this job
4.7 5.2 0.5
Q21
Deal with emotional problems
at work
5.0 4.8 -0.2
Summary (PA) 38.8 40.6 1.8
Figure 3

30
Figure 4
0
1
2
3
4
5
6
I can
understand
I deal
effectively
I’m positively
influencing
Energetic Relaxed
atmosphere
I feel
exhilarated
Accomplished Deal with
emotional
problems
Q4 Q7 Q9 Q12 Q17 Q18 Q19 Q21
Personal Accomplishment (PA)

31
Figure 5 compares the mean pre and post-test MBI scores for the Depersonalization (DP)
subscale and Figure 6 displays the results in a chart. Overall, the DP subscale post-test indicated
that participant’s experienced feelings of depersonalization less frequently following the MBSR
program. Participants reported a decreased frequency for all questions with the exception of two
questions. Question 5 (I feel I treat recipients as impersonal objects) saw a slight increase in
frequency from pre-test (0.7) to post test (0.8). Question 11 (this job is hardening me
emotionally) also reported a slight increase in frequency from 1.0 pre-test to 1.2 post-test. The
question reflecting the greatest decrease in frequency was Q10 (more callous toward people
since taking this job) decreasing from 1.1 to 0.1 in frequency. This question had the greatest
improvement in all subscales. Question 15 (I don’t really care what happens) decreased in
frequency by -0.5 and Q22 decreased by -0.6.
Depersonalization (DP)
Question Description Pre-Treatment Post-Treatment Difference
Q5
I feel I treat recipients as
impersonal objects
0.7 0.8 0.1
Q10
More callous toward people
since taking this job
1.1 0.1 -1.0
Q11
This job is hardening me
emotionally
1.0 1.2 0.2
Q15 I don’t really care what happens 0.5 0.04 -0.5
Q22 Recipients blame me 1.8 1.2 -0.6
Summary (DP) 5.1 3.3 -1.8
Figure 5

32
Figure 6
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
Impersonal objects More callous toward
people since taking this
job
Hardening me
emotionally
I don’t really care Recipients blame me
Q5 Q10 Q11 Q15 Q22
Depersonalization (DP)

33
Stress Reduction (MBSR) program experience an increase in empathy as measured by the
Jefferson Scale of Empathy for Healthcare Professionals (HP version) which measures key
dimensions including perspective-taking, compassionate care and standing in the patient’s shoes.
Comparisons between pre and post survey data using the Jefferson Scale of Empathy supported
the second hypothesis. Positive changes related to empathy were reported post treatment.
Figures 7 compares the mean pre and post-test scores for the Jefferson Scale of Empathy,
non-flipped questions and figure 8 compares the mean pre and post-test scores for the flipped
questions. The data in figure 7 suggests that participants reported an increase in level of
agreement (1 = Strongly Disagree and 7 = Strongly Agree) for all questions with the exception of
Q5 (I have a good sense of humor and contribution to outcomes) which decreased by -0.4 and
Q20 (I believe that empathy is an important therapeutic factor in treatment) which decreased by
-0.1. The questions reflecting the biggest change in frequency for the non-flipped questions were
Q2 (patients feel better when I understand their feelings) with a 0.4 increase in agreement; Q13
(try to understand by paying attention to non-verbal cues) with a 0.5 increase in agreement and
Q17 (try to think like my patient to render better care) with a 0.4 increase in agreement.

34
Jefferson Scale of Empathy
(Questions - Not Flipped)
Question Description
Pre-
Treatment
Post-
Treatment
Difference
2
Patients feel better when I
understand their feelings
6.3 6.7 0.4
4
Understanding body language
as important as verbal
communication
6.6 6.7 0.1
5
I have a good sense of humor
and contribution to outcomes
5.7 5.4 -0.4
9 Imagine in patient's shoes 5.8 6.1 0.3
10
My patients value my
understanding of feelings
which is therapeutic
6.5 6.5 0.1
13
Try to understand by paying
attention to non-verbal cues
6.0 6.5 0.5
15
Empathy is a skill to
successfully treat
6.0 6.1 0.1
16
It is important to our
relationship to understand
patient and family emotional
status
6.5 6.6 0.1
17
Try to think like my patient to
render better care
5.3 5.7 0.4
20
I believe that empathy is an
important therapeutic factor in
treatment
6.9 6.7 -0.1
Overall Average 61.6 63.1 1.5
Figure 7

35
The data in figure 8 (flipped questions) suggests that participants reported an increase in
level of agreement (7 = Strongly Disagree and 1 = Strongly Agree) for all questions with the
exception of Q12 (asking patients about their personal lives is not helpful in understanding
physical complaints) and Q19 (I don’t enjoy reading non-medical literature of the arts) which
both increased in agreement by 0.1. Two questions indicated no change in level of agreement
from pre-test to post test. The questions were Q11 (emotional ties to my patients don’t influence
outcomes) and Q14 (emotion has no place in treatment of medical illness). The questions
reflecting the most positive increase in the level of agreement for the flipped questions were Q2
(patients feel better when I understand their feelings) with a -0.4 decrease in agreement; Q13 (try
to understand by paying attention to non-verbal cues) with a -0.5 decrease in agreement and Q17
(try to think like my patient to render better care) with a -.4 decrease in agreement.

36
(Flipped Questions)
Question Description
Pre-
Treatment
Post-
Treatment
Difference
1
Understanding of how
patients and families feel
1.9 1.6 -0.3
3
Difficult to view from
patient's perspective
2.4 1.9 -0.5
6
People are different so hard to
see things from other
perspectives
1.9 1.8 -0.1
7
Try not to pay attention to
emptions in asking about
physical health
1.5 1.2 -0.3
8
Attention to patients
experience does not influence
outcomes
1.7 1.4 -0.3
11
Emotional ties to my patients
don’t influence outcomes
1.2 1.2 0.0
12
Asking patients about their
personal lives is not helpful in
understanding physical
complaints
1.2 1.3 0.1
14
Emotion has no place in
treatment of medical illness
1.2 1.2 0.0
18
I do not allow myself to be
influenced by strong bonds
between patient and family
member
3.2 2.5 -0.7
19
I don’t enjoy reading non-
medical literature of the arts
1.2 1.3 0.1
Overall Average 17.3 15.3 -1.9
Figure 8

37
Figures 9 and 10 represent the Jefferson Scale of Empathy data in chart form.
Figure 9
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
PatientsfeelbetterwhenIunderstandtheirfeelings
Understandingbodylanguageasimportantasverbalcommunication
Ihaveagoodsenseofhumorandcontributiontooutcomes
Imagineinpatient'sshoes
Mypatientsvaluemyunderstandingoffeelingswhichistherapeutic
Trytounderstandbypayingattentiontonon-verbalcues
Empathyisaskilltosuccessfullytreat
Itisimportanttoourrelationshiptounderstandpatientandfamily
emotionalstatus
Trytothinklikemypatienttorenderbettercare
Ibelievethatempathyisanimportanttherapeuticfactorintreatment
2 4 5 9 10 13 15 16 17 20
(Not Flipped)

38
Figure 10
1.0
1.5
2.0
2.5
3.0
3.5 Understandingofhowpatientsandfamiliesfeel
Difficulttoviewfrompatient'sperspective
Peoplearedifferentsohardtoseethingsfrom
otherperspectives
Trynottopayattentiontoemptionsinasking
aboutphysicalhealth
Attentiontopatientsexperiencedoesnot
influenceoutcomes
Emotionaltiestomypatientsdon’tinfluence
outcomes
Askingpatientsabouttheirpersonallivesisnot
helpfulinunderstandingphysicalcomplaints
Emotionhasnoplaceintreatmentofmedical
illness
Idonotallowmyselftobeinfluencedbystrong
bondsbetweenpatientandfamilymember
Idon’tenjoyreadingnon-medicalliteratureof
thearts
1 3 6 7 8 11 12 14 18 19
(Flipped)

39
4.4: Other Findings
The qualitative data from the class evaluations adds richness to the quantitative data.
Common themes discovered from the participant’s responses include:
 More accepting of personal limitations
 Self-forgiveness
 Self-compassion
 Non-judgment
 Less reactive/less stressed
 Appreciation for the present moment (people, nature, sights, smells, sounds, etc.)
 Desire to listen (active listening, paying attention to verbal and non-verbal’s)
Questions 8: Please describe an example of how you might treat yourself with more
gentleness and tenderheartedness, even in moments of challenge.
“Try not to dwell on shortcomings of situations and to be more accepting of my limitations.”
“Instead of guilt, reflecting on all the ways that I am a good mom, wife, friend, daughter and
CRNP.”
“This is a tough one…I think relax, opening to oneself and realizing that I am doing the best I
can at this time. For example, if I order a medicine for a patient in error, show myself
compassion as a human and learn from it.”
“Take a few seconds before responding.”
“Pause and mentally say the words: This is hard/trying, etc. You’re human – don’t need to be
so hard on yourself/expect so much. Or after the fact, stop re-guessing/reevaluating and offer
compassion.”
“Practice mindful meditation formally every day to center and balance self and build stress
resilience.”
“I hope to be able to tell myself that it is okay to feel stressed and anxious while at work
especially b/c I’m, so new to medicine and it’s okay to ask for help and to not always have the
answers b/c it challenging but also learn to accept to work through these feelings so that I can
continue to learn to be productive.”
“Tell yourself you are human, other people experience similar situations, all things will pass
learn to deal with present situation with mindfulness.”
“Not to judge self and others. Breathing mindfulness. Cradle the heart.”
“I remember to direct feeling of compassion toward myself and then get the immediate benefit
of seeing that compassion extended to people around me.”
“Remind myself that I am human and that what is meant to be will happened. Trust in the
future.”
“To be more forgiving.”

40
“I actually feel very gentle toward myself most of the time.”
“By recognizing and reassuring myself that I am human and do the best I can.”
“Time out (quiet time) lunch.”
“Stop beating myself up when I don’t get something exactly right - accepting the situation and
moving past it.”
“Let go of striving. Value where I am in this moment. Acknowledge the triangle of
awareness.”
“Acknowledge my feelings of stress/overwhelming but not allowing it to control my
response.”
“Reactivity – tolerate contradictions.”
“Taking a deep breath and handle gently.”
Q9: Please name one way in which you use mindfulness practice to be more intimate
with your own experience, to feel more alive.
“Mindfulness – listening and experiencing each moment.”
“Positive thinking/sense of well-being. I am able to stop ruminating and focus better.”
“Awareness of breath.”
“It rejuvenates me when tired, I awaken better rested in AM.”
“Appreciate of the colors, odors and textures of food.”
“Pausing focus/on appreciations of strengths/those around me.”
“Mindfulness focus during exercise.”
“I will maintain more presence while walking the woods trail.”
“Attention to attention – listening.”
“Mindful movement allows me to re-connect with my body. The more I do that, the more I
will put myself as my own priority.”
“I give myself the gift of being fully present for moments full of sensations I can savor (e.g.,
when I indulge in rich dark coffee from the coffee cart, I start with my eyes closed, inhaling
and savoring the aroma, wrapping my cold hands around the cup, savoring the sensation of
warmth and I listen to the player piano, savoring the beauty of the musical sound filling my
head – it’s moments of bliss in the middle of an often crazy day).”
“I personally suffer from hurrying around living in the future. This is stressful and unhealthy.
Living in the moment is the appropriate answer. BEING not DOING.”
“I find myself practicing both formally and informally and realizing the importance of being
present and treating myself more kindly/not judging in stressful situation and to realize all the
positives that I have.”
“By stopping and being mindful, taking in sights, sounds, smells, sensations, allows us to feel
joy and beauty of life right now – without focusing on past and present.”
“Attention to breath, sounds, colors – this moment.”
“Enjoy the moment – see what is around me.”
“Enjoy the small things that I may take for granted everyday i.e. my food, my health, my
family, my work, my environment.”
“By breathing in fresh air and felling the rush of smells, calmness floods me.”
“Be more present.”

41
Q10: Please name one way to use mindfulness to be more present to the lives of others.
“Be more attentive to others’ needs.”
“Listening without judging.”
“Focusing on the here and now. Forget the laundry for a while and sit, listen and laugh with
my kids.”
“Attempting to be present with my children e.g. giving a bath, reading a book, playing
checkers, feeding my son…the experiences are so much richer if I am not in the past or
planning for the future.”
“Tune in to someone’s needs.”
“Awareness of their nonverbal cues there’s more authentic exchange/connection.”
“Pause and allow other person to speak without jumping in or fixing.”
“One way to use mindfulness to be more present to others is to practice mindful listening –
meaning that you are focused on what the other person is saying opposed to what your
response is going to be or your perception/judgment of what they are talking about.”
“Appreciate other people’s perspectives - learn to really listen fight the urge to talk all the
time.”
“Positive listening without judgment, less anxious with self and others.”
“Listen fully as a child speaks.”
“Allow focus and clear thought creating more presence toward the moment and others.
Making each moment more real.”
“Listening to words, tone, meaning of words, body language.”
“Stay present more consistently,”
“Active listening and less reactivity.”
“Focus/listen be really present with people.”
“Shut up and really listen.”
“Helps attend to what is happening in the moment, hear what they say, see their
express/movement, feel their experiences.”
“Allowing me to better ignore distractions of my own thoughts when being with my
kids/husband.”
“Active listening with an open mind. Awareness of the present moment with acceptance says
it all.”

42
Chapter 5: Discussion
5.1: Summary
The main purpose of this study was to determine if there is a positive correlation between
completion of an eight-week Mindfulness-Based Stress Reduction (MBSR) course by healthcare
professionals and a decrease in burnout and an increase in empathy. A combination of
quantitative and qualitative and methods were used. For the quantitative method, pre and post
surveys were utilized using the Maslach Burnout Inventory and the Jefferson Scale of Empathy.
The data for each question of the pre and post surveys was entered into an Excel workbook and
analyzed using the difference between the average mean from the pre-test and post-test. For the
qualitative method, answers to three open-ended questions from a course evaluation were
reviewed. These answers provided additional insights from the participants related to burnout
tendencies and empathy.
5.2: Interpretation of Findings
Two research questions were utilized for this study.
Based Stress Reduction (MBSR) program experience reduced burnout tendencies?
Participants post-test mean scores indicate a lower frequency of emotional exhaustion
(-2.3) and depersonalization (-1.8) along with an increased frequency of personal
accomplishment (1.8). The combination of each subscale results indicate that the MBSR
program positively affected burnout in the participants (Worley, Vassar, Wheeler, & Barnes,
2008).
Based Stress Reduction (MBSR) program experience an increase in empathy?

43
Participants post-test mean scores on the Jefferson Scale of Empathy indicate a stronger
level of agreement on the non-flipped questions (1.5) and a higher level of disagreement on the
flipped questions (-1.9). The results indicate that the MBSR program positively affected the
levels of empathy in the participants (Hojat, et al., 2001).
5.3: Additional Analysis
The literature search revealed other potential opportunities of research:
1. MBSR in healthcare workers and patient’s perspective of care as measured by
HCAHPS and/or Press Ganey.
 Does MBSR improve the patient’s perceived experience and patient
satisfaction?
2. A modified version of the MBSR program has been shown to be effective in
healthcare workers.
 Is a modified version as effective and more feasible?
5.4: Limitations
1. Lack of a control group
2. Small sample size
3. Population may be predisposed to register for the MBSR program as in the case
of offering CME credits
4. Since the MBSR program materials are only available in English, the sample
population does not include a diverse group
5.5: Recommendations
1. Repeat study at LVHN with a control group and larger number of participants

44
2. Repeat study adding an additional survey during the maintenance phase to
determine how long the effects last following the course – 10 months post course
3. Evaluate patient satisfaction scores pre and post MBSR program to determine if
scores improve in the area of communication with physician and nurse
5.6: Conclusion
MBSR is well-established as an effective model for reducing stress in healthy
populations. This study supports that healthcare professionals who participate in an 8-week
MBSR program experience decreased burnout as measured by the Maslach Burnout Inventory
and increased levels of empathy as measured by the Jefferson Scale of Empathy. Burnout and
lack of empathy have been associate with decreased patient satisfaction, poor quality and
outcomes. Given the increasing levels of stress that healthcare professionals are facing under the
Affordable Care Act and the importance of providing safe, effective and high quality care while
reducing costs and creating a positive perception of the care delivery experience by their
patients, leadership at LVHN should further explore the potential benefits of the MBSR program
for healthcare professionals through additional research.

45
References
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based stress reduction program. Journal of Behavioral Medicine, 31(1), 23-33.
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effects of a mindfulness-based stress reduction program on stress, mindfulness, self-
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Cherniss, C. (1980). Professioanl burnout in human service organziations. New York: Praeger.
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Quality Information From the Consumer Perspective:
http://www.hcahpsonline.org/home.aspx

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Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and
improves well-being among healthcare providers. International Journal Psychiatry in
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Kabat-Zinn, J. (2011, May). Some reflections on the origins of MBSR, skillful means, and the
trouble with maps. Contemporary Buddhism, 12(1), 281-306.
Kabat-Zinn, J. (1990). Full Catastrophie Living:using the wisdom of your body and mind to face
stress, pain and illness. New York: Delta.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present and future.
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Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., &
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Maslach, C., & Jackson, S. (1986). Maslach burnout inventory: Manual. Palo Alto, CA:
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Network, L. V. (2013). Wellness Resources: Mindfulness-Based Stress Reduction. Retrieved
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Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress
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Appendix
I. Maslach Burnout Inventory
II. Jefferson Scale of Empathy (HP version)
III. Class Evaluation
IV. Sponsor’s Letter

Julene Campion MBSR in Healthcare

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