Roxane Raffin Chan

A pilot study: mindfulness meditation intervention in COPD

Living well with chronic obstructive pulmonary disease (COPD) requires people to manage disease-related symptoms in order to participate in activities of daily living. Mindfulness practice is an intervention that has been shown to reduce symptoms of chronic disease and improve accurate symptom assessment, both of which could result in improved disease management and increased wellness for people with COPD. A randomized controlled trial was conducted to investigate an 8-week mindful meditation intervention program tailored for the COPD population and explore the use of breathing timing parameters as a possible physiological measure of meditation uptake. Results demonstrated that those randomized to the mindful meditation intervention group (N=19) had a significant increase in respiratory rate over time as compared to those randomized to the wait-list group (N=22) (P=0.045). It was also found that the mindful meditation intervention group demonstrated a significant decrease in level of mindfulness over time as compared to the wait-list group (P=0.023). When examining participants from the mindful meditation intervention who had completed six or more classes, it was found that respiratory rate did not significantly increase in comparison to the wait-list group. Furthermore, those who completed six or more classes (N=12) demonstrated significant improvement in emotional function in comparison to the wait-list group (P=0.032) even though their level of mindfulness did not improve. This study identifies that there may be a complex relationship between breathing parameters, emotion, and mindfulness in the COPD population. The results describe good feasibility and acceptability for meditation interventions in the COPD population.

Meditation Interventions for Chronic Disease Populations: A Systematic Review

The rapidly growing body of research regarding the use of meditation interventions in chronic disease presents an opportunity to compare outcomes based on intervention content. For this review, meditation interventions were described as those interventions delivered to persons with chronic disease where sitting meditation was the main or only content of the intervention with or without the addition of mindful movement. This systematic review identified 45 individual research studies that examined meditations effect on levels of anxiety, depression, and chronic disease symptoms in persons with chronic disease. Individual studies were assessed based on interventional content, the consistency with which interventions were applied, and the research quality. This study identified seven categories of meditation interventions based on the meditation skills and mindful movement practices that were included in the intervention. Overall, half of the interventions had clearly defined and specific meditation interventions (25/45) and half of the studies were conducted using randomized control trials (24/45).

The Experience of Learning Meditation and Mind/Body Practices in the COPD Population

CONTEXT Persons with Chronic Obstructive Pulmonary Disease (COPD) exhibit high levels of comorbid anxiety that severely worsens their sensation of dyspnea and is associated with high levels of avoidance of essential activities resulting in an increase morbidity and mortality. Increasing meditation and mind/body practices have been shown to decrease anxiety, and improve intrapersonal and interpersonal relationships in general populations, however, results of studies in the COPD population have been mixed. OBJECTIVE Understanding how persons with COPD experience learning meditation and mind/body skills would aid future meditation-focused mind/body intervention design. DESIGN/SETTING/PATIENTS A mixed-method study of a community based meditation-focused mind/body intervention for persons with COPD. MEASURES Reflective journaling, phone exit interviews and survey measures: chronic disease respiratory questionnaire, and Anxiety Sensitivity 3 questionnaire. INTERVENTION Eight weekly one hour meditation-focused mind/body classes that taught concentration and insight meditation skills along with mind/body exercises that facilitated increased body and emotional awareness. RESULTS Out of 41 participants, 32 (73%) contributed detailed experience about learning and practicing meditation and mind/body practices that distilled into four themes, barriers to practice, learning style, emotional processing, and benefits of practice. Of those 32 participants 21 (73%) identified improvement in physical or emotional symptoms. Overall, 13 (40%) participants provided details regarding how they adapted specific meditation skills into daily life to improve emotional function and lessen dyspnea. Anxiety sensitivity to social situations was associated with a lack of participation. Lessons learned for larger scale application to future meditation and mind/body intervention design for chronic illness populations such as COPD are identified.

MindfulWatch: A Smartwatch-Based System For Real-Time Respiration Monitoring During Meditation

With a wealth of scientifically proven health benefits, meditation was enjoyed by about 18 million people in the U.S. alone, as of 2012. Yet, there remains a stunning lack of convenient tools for promoting long-term and effective meditation practice. In this paper, we present MindfulWatch, a practical smartwatch-based sensing system that monitors respiration in real-time during meditation -- offering essential biosignals that can potentially be used to empower various future applications such as tracking changes in breathing pattern, offering real-time guidance, and providing an accurate bio-marker for meditation research. To this end, MindfulWatch is designed to be convenient for everyday use with no training required. Operating solely on a smartwatch, MindfulWatch can immediately reach the growing population of smartwatch users, making it ideal for longitudinal data collection for meditation studies. Specifically, it utilizes motion sensors to sense the subtle “micro” wrist rotation (0.01 rad/s) induced by respiration. To accurately capture breathing, we developed a novel self-adaptive model that tracks changes in both breathing pattern and meditation posture over time. MindfulWatch was evaluated based on data from 36 real-world meditation sessions (8.7 hours, 11 subjects). The results suggest that MindfulWatch offers reliable real-time respiratory timing measurement (70% errors under 0.5 seconds).

Ethical nursing care when the terminally ill patient seeks death

Although suicide consideration in the general population is generally treated as a symptom of mental disorder, assisted suicide as a reasonable choice for the terminally ill is a subject of ongoing debate. While legal and policy responses to this question are in flux and vary by state, nurses contin

Ethical Case Study of the Researcher–Participant Relationship in End-of-Life Research

Nurse-researchers studying interventions for patients at the end-of-life may become close with participants due to the nature of interactions within the research protocol. In such studies, participants may request further interactions that would constitute clinical care beyond the scope of the protocol. Nurse-researchers may feel a conflict of values between their obligation to the research goals and their inclinations and obligations as nurses to care for their patients. Nurse-researchers in this situation aspire to honor the bonds developed through close contact and ensure participants receive standard of care while maintaining standards of research ethics. Analysis of a case and review of applicable concepts in research ethics, including ethical relationships, therapeutic misconception, equipoise, and population vulnerability, are used to develop recommendations regarding the decision parameters for similar cases.

Building Sangha in the American Healthcare Setting for Persons with Chronic Disease

Background: For persons with chronic disease, participation in meditation interventions can reduce anxiety, depression, and chronic disease symptoms in a dose dependent fashion. Unfortunately, information about how to support long‐term participation in such an intervention is lacking. Therefore, a recent discovery of persons with chronic lung disease who have maintained a self‐led meditation group for more than four years created an opportunity to analyze experiences, meanings and relationship dynamics of this community‐based meditation group. Methods: A focused ethnography was conducted using the following techniques: participant observation of four group meditation sessions, semi‐structured interviews of six group participants, the interviewers reflective practice and collection of demographic information. Analysis of transcribed audio‐recordings followed an iterative approach. Results: Findings highlighted the inclusive nature of the group sessions that supported meditation practice through the processing of ancient wisdom traditions similar to a traditional Sangha. Reflecting the current culture of non‐affiliation, the group often moved beyond religious teachings to use the environment, literature and pop culture representations to teach wisdom traditions. Data analysis revealed that the holistic group characteristics of wisdom circling, non‐Stopping, organic way‐finding and sacred space were supported by identifiable yet inseparable individual and group actions. This holistic pattern is best described through the metaphor of flocking birds. Conclusions: This self‐led group supports long term meditation practice and provides a sense of eudemonic well‐being for a diverse group of individuals in an accessible community setting.

Development and testing of two lifestyle interventions for persons with chronic mild-to-moderate traumatic brain injury: Acceptability and feasibility

This clinical methods discursive highlights the development, piloting, and evaluation of two group interventions designed for persons who experienced chronic traumatic brain injury (TBI). Intervention science for this population is limited and lacking in rigor. Our innovative approach to customize existing interventions and develop parallel delivery methods guided by Allostatic Load theory is presented and preliminary results described. Overall, parallel group interventions delivered by trained leaders with mental health expertise were acceptable and feasible for persons who reported being depressed, stressed, and symptomatic. They reported being satisfied with the overall programs and mostly satisfied with the individual classes. Attendance was over the anticipated 70% expected rate and changes in daily living habits were reported by participants. These two group interventions show promise in helping persons to self manage their chronic stress and symptomatology.