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UCLA Electronic Theses and Dissertations UCLA UCLA Electronic Theses and Dissertations Title The Journey to Heart Transplant: Evaluating A Brief Mindfulness Intervention on Hospitalized Heart Failure Patients’ Stress, Anxiety and Resilience Permalink https://escholarship.org/uc/item/5bh7q911 Author Vandenbogaart, Elizabeth Publication Date 2021 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California UNIVERSITY OF CALIFORNIA Los Angeles The Journey to Heart Transplant: Evaluating A Brief Mindfulness Intervention on Hospitalized Heart Failure Patients’ Stress, Anxiety and Resilience A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Nursing Practice by Elizabeth Vandenbogaart 2021 © Copyright by Elizabeth Vandenbogaart 2021 ABSTRACT OF THE DISSERTATION The Journey to Heart Transplant: Evaluating A Brief Mindfulness Intervention on Hospitalized Heart Failure Patients’ Stress, Anxiety and Resilience by Elizabeth Vandenbogaart Doctor of Nursing Practice University of California, Los Angeles, 2021 Professor Carol Pavlish, Chair Background: Patients hospitalized with life-threatening conditions are exposed to constant psychological stressors that can lead to anxiety and poor patient outcomes. Mindfulness stress reduction interventions have been shown to decrease stress and anxiety with sustained effect. Objectives: This project aims to evaluate the feasibility and effect of a brief mindfulness intervention (MBI) on stress, anxiety, and resilience in advanced heart failure patients, hospitalized awaiting transplant. Methods: A one group, pretest-posttest design over a 4-week period in a single center’s cardiac care units was used. The intervention included a one-on-one ii mindfulness educational session and a 12-minute audio guided iPad application for daily self- practice. Variables measured at baseline, and every 2 weeks post intervention included stress (The Perceived Stress Scale [PSS)]), anxiety (the Generalized Anxiety Disorder [GAD-7]) and resilience (the Brief Resilience Scale [BRS]), with patient demographics and self-reported mindfulness performance collected. Statistical analysis included descriptive statistics, repeated measures ANOVA with Friedman tests verification, Bonferroni post hoc tests and Wilcoxon matched pairs tests applied. Results: Statistically significant differences were found from baseline to 2 and 4 weeks after intervention in reduced stress (p=.001) and anxiety (p=.001) and increased resilience (p=.001). The greatest change was seen at 2 weeks post intervention and was maintained at 4 weeks. Additionally, feasibility and acceptability of the MBI were evident from the patient experience survey data and focused interview responses. Conclusion: A brief mindfulness intervention holds promise in improving stress, anxiety and resilience for advanced heart failure patients awaiting transplant. Nurses could help to alleviate symptoms of distress through education on use of a mindfulness app in the daily patient care plan. Further study in a larger sample is warranted. iii The dissertation of Elizabeth Vandenbogaart is approved. Anna Gawlinski Karen Grimley Mary Ann Lewis Carol Pavlish, Committee Chair University of California, Los Angeles 2021 iv This dissertation is dedicated to my loving husband Michael, sister Fran and family for their unwavering support, and encouragement to always reach further. This project is in honor of my parents William and Catherine who instilled a determined work ethic and desire for ongoing education and to my sister Josie who’s battle inspired the project meaning and concept. v TABLE OF CONTENTS CHAPTER ONE: INTRODUCTION AND BACKGROUND ...................................................... 1 Problem Statement ...................................................................................................................... 3 PICOT Clinical Question ............................................................................................................ 4 Purpose and Objectives ............................................................................................................... 4 CHAPTER TWO: THEORETICAL FRAMEWORK.................................................................... 4 CHAPTER THREE: REVIEW OF LITERATURE ....................................................................... 6 Evidence Search .......................................................................................................................... 6 Efficacy of MBIs ......................................................................................................................... 6 Effectiveness of Brief MBIs ........................................................................................................ 8 Synthesis of Literature Review ................................................................................................. 10 CHAPTER FOUR: METHODS ................................................................................................... 12 Ethics / IRB Statement .............................................................................................................. 12 Project Design ........................................................................................................................... 13 Population Sample and Setting ................................................................................................. 13 Intervention ............................................................................................................................... 14 Data Collection and Instruments ............................................................................................... 16 Data Analysis ............................................................................................................................ 17 CHAPTER FIVE: RESULTS ....................................................................................................... 18 Participant Characteristics ......................................................................................................... 18 Efficacy of the Brief Mindfulness Intervention ........................................................................ 24 Themes in Subjective Reports of the Mindfulness Experience ................................................. 26 Summary ................................................................................................................................... 29 CHAPTER SIX: DISCUSSION ................................................................................................... 29 Primary Outcome Measures ...................................................................................................... 30 Alignment with Theoretical Framework ................................................................................... 31 vi Outcome Changes Over Time ................................................................................................... 32 Impact of a Brief MBI ............................................................................................................... 33 Impact of a Technology Based MBI ......................................................................................... 34 Feasibility of MBI ..................................................................................................................... 35 Lessons Learned during Project Implementation ...................................................................... 37 Medical Acuity Impact .......................................................................................................... 37 Mindfulness as A Concept ..................................................................................................... 37 Nurse Engagement ................................................................................................................ 38 Technical Logistics ............................................................................................................... 39 Project Limitations .................................................................................................................... 40 COVID-19 Impact ..................................................................................................................... 41 Implications for Practice and Research ..................................................................................... 42 CONCLUSION ............................................................................................................................. 44 APPENDICES .............................................................................................................................. 46 Appendix A: Table of Evidence ................................................................................................ 47 Appendix B: Sample Participant Information Flyer.................................................................. 58 Appendix C: Demographic Survey ........................................................................................... 59 Appendix D: Perceived Stress Scale (PSS) ............................................................................... 60 Appendix E: General Anxiety Disorder (GAD 7) ..................................................................... 61 Appendix F: Connor Davidson Resilience Scale (CD-RISC 10) .............................................. 62 Appendix G: Mindfulness Experience Survey and Focused Interview Questions ..................
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