miun.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
van Vliet, Marja
Publications (7 of 7) Show all publications
van Vliet, M., Jong, M. C. & Jong, M. (2018). A Mind Body Skills Course Among Nursing and Medical Students: A Pathway for an Improved Perception of Self and the Surrounding World. Global Qualitative Nursing Research, 5
Open this publication in new window or tab >>A Mind Body Skills Course Among Nursing and Medical Students: A Pathway for an Improved Perception of Self and the Surrounding World
2018 (English)In: Global Qualitative Nursing Research, ISSN 2333-3936, Vol. 5Article in journal (Refereed) Published
Abstract [en]

Despite increased recognition of self-care and self-awareness as core competences for health care professionals, little attention is paid to these skills during their education. Evidence suggests that a Mind-Body (MB) skills course has the potential to enhance self-care and self-awareness among medical students. However, less is known about the meaning of this course for students and how it affects their personal and professional life. Therefore, we examined the lived experiences with an MB skills course among Dutch medical and Swedish nursing students. This course included various MB techniques, such as mindfulness meditation and guided imagery. Guided by a phenomenological hermeneutical method, three main themes were identified: "ability to be more present," "increased perception and awareness of self," and "connection on a deeper level with others." Overall, participation in the MB skills course served as a pathway to inner awareness and supported connecting with others as well as with the surrounding world.

Keywords
professional education, lived body, empathy, holistic care, resilience, self-care, stress, nurse–patient communication, doctor– patient communication, phenomenology
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-34910 (URN)10.1177/2333393618805340 (DOI)000447783900001 ()30349869 (PubMedID)2-s2.0-85065005043 (Scopus ID)
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2019-07-08Bibliographically approved
van Vliet, M. (2017). Integrative Medicine in the Dutch healthcare system: prerequisites and tools for implementation. (Doctoral dissertation). Sundsvall: Mid Sweden University
Open this publication in new window or tab >>Integrative Medicine in the Dutch healthcare system: prerequisites and tools for implementation
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Integrative Medicine (IM) is a care approach that focuses on the overall well-being and healing process of patients rather than solely on their disease. IM educates and empowers people to be active players in their own care, emphasizes the therapeutic relationship, and makes use of all appropriate evidence-based approaches. The health-oriented foundations of IM are in line with the recently posed concept that describes health as ”the ability to adapt and to self-manage”. Due to the shared underpinnings of both IM and the new concept of health, incorporation of this new concept of health may serve as a facilitator for the development and implementation of IM. From a practical viewpoint, working from an integrative care approach requires specific competences from healthcare providers, such as socio-communicative and self-reflective skills, and reflexivity towards a holistic perspective on health. Previous studies have shown that a Mind-Body Medicine (MBM) course can potentially foster these competences among future healthcare providers. This thesis intended to gain increased insight into the prerequisites and tools for implementation of IM. Therefore, in the first part it aimed to explore the attitudes and practice of IM among Dutch nurses and the support for the new dynamic concept of health as ”the ability to adapt and to self-manage” among main stakeholders within the Dutch healthcare community. Furthermore, in the second part it aimed to evaluate the possibilities of an MBM course among medical and nursing students as a tool to foster an integrative care approach.

Methods Both quantitative and qualitative research designs were used. Attitudes and practice of IM were assessed in a semi-structured survey study among 355 Dutch nurses (study I). Support for the new concept of health was explored in a mixed method study, where in the first step data from interviews and focus-groups among 140 stakeholders were investigated by use of manifest content analysis, and in the second step a cross-sectional survey was performed among 1938 stakeholders to verify the findings of the first step (study II). The MBM course was evaluated by a controlled, quasi-experimental intervention study (74 participants / 61 controls among medical students and 47 participants / 64 controls among nursing students) in which validated questionnaires were used (study III). Furthermore, in-depth interviews with 11 medical and 15 nursing students were employed and analysed by a Phenomenological Hermeneutical method to obtain an in-depth understanding of the meaning of the MBM course for the participants (study IV).

Findings Study I showed an overall positive attitude towards IM among nurses. Patient-centeredness and a focus on individuals’ own resources and responsibility to promote health met the most support among both nurses and other stakeholders. These elements were considered to be the main positive aspects of the new dynamic concept of health among stakeholders as well (study II). Use of evidence-based and safe complementary therapies and a healing environment received some support from the nurses, but lack of knowledge and lack of evidence seems to hinder further incorporation in the current healthcare practice (study I). Additionally, study II revealed that health was perceived to comprise six dimensions: bodily functions, mental functions & perception, spiritual / existential dimension, quality of life, social and societal participation and daily functioning. In line with patients, nurses had a more broad conception of health in comparison to other healthcare professionals. Study III showed long-term beneficial effects of the MBM course on two dimensions of empathy (personal distress and empathic concern) among medical students, and on perceived stress and empathy (personal distress) among nursing students. Study IV brought forth that the MBM course can be understood as a pathway to inner awareness and a support to connecting with others as well as the outside world. The following themes were identified: “ability to be more present”, “an increased perception and awareness of self”, and “connecting on a deeper level with others”.

Conclusion It can be concluded from the results in the first explorative part of this thesis that the observed positive attitudes and perceptions among healthcare professionals toward IM and the newly proposed health concept can serve as important facilitators for further implementation of IM within the Dutch healthcare system. Furthermore, the increased ability to deal with stress, improved empathic abilities and more openness toward different perspectives on health and new treatment options among medical and nursing students following a MBM course, as reported in the second part of this thesis, suggest that this course might be a suitable tool to foster an integrative care approach among future healthcare professionals.

Abstract [sv]

IM (Integrativ Vård mer adekvat term på svenska) är ett vårdkoncept/vårdansats som mer fokuserar på patienters välmående och läkeprocesser än enbart deras sjukdom. IM överlämnar makten och utbildar individen till att själv bli aktiva i sin vård, den framhäver vikten av en god vårdande relation och använder alla tillämpliga evidensbaserade metoder. Den hälsofrämjande grunden i IM är i linje med ett nyligen utvecklat hälsobegrepp, som beskriver hälsa som ”en persons förmåga till att anpassa sig och hantera utmaningar”. Utifrån den liknande grunden och förutsättningarna hos IM och det nya hälsobegreppet så kan en integration av dem vara en understödjande faktor för utveckling och implementering av IM. Utifrån en praktisk synvinkel så innebär en integrativ vårdansats att den som vårdar måste inneha specifika kompetenser och förmågor relaterade till bland annat socio-kommunikativ och självreflektiv förmåga, såväl som en reflektiv öppenhet till ett holistiskt perspektiv på hälsa. Tidigare forskning har visat att en Mind-Body Medicine (MBM) kurs potentiellt kan understödja utveckling av dessa kompetenser bland framtida vårdare. Denna avhandling avsåg i första hand att uppnå ökad insikt i förutsättningar och verktyg för implementering av Integrativ Vård. Mer specifikt syftade den till att beskriva attityder till, och utövande av IM bland Nederländska sjuksköterskor, samt undersöka stödet för det nya dynamiska hälsobegreppet (”en persons förmåga till att anpassa sig och hantera utmaningar”) bland intressenter inom Nederländsk Hälso- och Sjukvård. Vidare i andra hand, avsåg avhandlingen också att utvärdera förutsättningarna för att använda en MBM kurs som ett verktyg till att understödja och fostra ett mer integrativt förhållningssätt bland läkar- och sjuksköterskestudenter.

Metod Både kvantitativ såväl som kvalitativ forskningsdesign tillämpades. Attityder till, och utövande av IM undersöktes i en semistrukturerad enkätstudie bland 355 Nederländska sjuksköterskor (studie I). Stödet för det nya hälsobegreppet undersöktes i en studie som genomfördes med mixad design, där i det första steget data från individuella- och fokusgruppintervjuer bland 140 intressenter genomgick en manifest innehållsanalys, och i det andra steget genomfördes en tvärsnittsstudie bland 1938 intressenter för att validera fynden från det första steget (Studie II). MBM kursen utvärderades i en kontrollerad, kvasi-experimentell interventionsstudie (71 deltagare/61 kontroller bland läkarstudenter, och 47 deltagare/64 kontroller bland sjuksköterskestudenter) med validerade frågeformulär (Studie III). Vidare även i en Fenomenologisk-Hermeneutisk ansats via individuella intervjuer med 11 läkar- och 15 sjuksköterskestudenter för att uppnå en djupare förståelse över MBM kursens betydelse för deltagarna (Studie IV).

Fynd I studie I framkom att sjuksköterskorna övergripande hade en positiv attityd till IM. Patientcentrering och fokus på individens resurser, samt deras egna ansvar för att arbeta hälsofrämjande var områden som hade mest stöd bland både sjuksköterskor och andra intressenter. Dessa element ansågs också av intressenterna vara den mest positiva aspekten av det nya dynamiska hälsobegreppet (Studie II). Användandet av evidensbaserade komplementärmedicinska metoder och hälsofrämjande miljöer stöddes till viss del av sjuksköterskorna men brist på kunskap och brist på evidens förefaller vara hinder för integration i nuvarande vårdpraxis (Study I). I studie II framkom att begreppet hälsa uppfattades som att bestå i sex olika dimensioner; ”kroppslig funktion”, ”mental funktion och perception”, ”spirituell/existentiell dimension”, ”livskvalitet”, ”social-samhällelig inklusion” samt ”daglig funktion”. I samklang med patienter, så hade sjuksköterskor en bredare syn på hälsa än andra hälsoprofessioner. I studie III framkom långsiktiga positiva effekter av att delta i MBM kursen avseende i två dimensioner av empatisk förmåga (Personal distress och Empatic concern) bland läkarstudenterna, samt avseende upplevd stressnivå (perceived stress) och empati (personal distress) bland sjuksköterskestudenterna. I studie IV framkom att MBM kursen kan ses som ”en väg till inre medvetenhet och stöd till att knyta an till andra och den omgivande världen” vidare identifierades temana: ”en förmåga till en mer medveten närvaro”, ”en ökad uppfattningsförmåga och inre medvetenhet” samt ”att knyta an till andra människor på en djupare nivå”.

Slutsats Utifrån resultaten i avhandlingens explorativa (I, II) del är slutsatsen att de observerade positiva attityderna, och uppfattningarna bland vårdgivare avseende IM och det nyutvecklade hälsobegreppet kan ses som viktiga facilitatorer för ytterligare implementering av IM i det Nederländska hälso- och sjukvårdssystemet. Vidare, den ökade förmågan att hantera stress, utveckla empatisk förmåga och mer öppenhet för nya perspektiv på hälsa och behandlingsalternativ hos läkar- och sjuksköterskestudenter efter deltagande i en MBM kurs (implementeringsdelen i denna avhandling, III, IV), stöttar antagandet att kursen kan ses som ett användbart verktyg för att understödja en mer integrativ vårdansats bland framtida vårdpersonal.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2017. p. 149
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 261
Keywords
Integrative Medicine, Complementary Medicine, self-management, health, salutogenesis, perceived stress, empathy, self-reflection, nursing education, medical education
National Category
Other Health Sciences
Identifiers
urn:nbn:se:miun:diva-30607 (URN)978-91-88527-13-4 (ISBN)
Public defence
2017-05-19, E409, Holmgatan 10, Sundsvall, 10:00 (English)
Opponent
Supervisors
Funder
Ekhaga Foundation, 2011-17
Note

Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 i tryck, delarbete 4 inskickat.

At the time of the doctoral defence the following papers were unpublished: paper 3 in press, paper 4 submitted.

Available from: 2017-04-19 Created: 2017-04-18 Last updated: 2017-04-26Bibliographically approved
van Vliet, M., Jong, M. & Jong, M. C. (2017). Long-term benefits by a mind–body medicine skills course on perceived stress and empathy among medical and nursing students. Medical teacher, 39(7), 710-719
Open this publication in new window or tab >>Long-term benefits by a mind–body medicine skills course on perceived stress and empathy among medical and nursing students
2017 (English)In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 39, no 7, p. 710-719Article in journal (Refereed) Published
Abstract [en]

Background: A significant number of medical students suffer from burnout symptoms and reduced empathy. This controlled, quasi-experimental study aimed to investigate whether a mind–body medicine (MBM) skills course could reduce perceived stress and increase empathy and self-reflection in medical and nursing students.

Methods: The MBM course (consisting of experiential sessions of mind–body techniques and group reflections) was piloted among Dutch medical students and Swedish nursing students. Main outcome variables were perceived stress (PSS), empathy (IRI subscales perspective taking, fantasy, empathic concern, and personal distress), and self-reflection (GRAS). Participating and control students completed questionnaires at baseline, post-intervention, at 6 and 12 months follow-up.

Results: Seventy-four medical and 47 nursing students participated in the course. Participating medical students showed significantly increased empathic concern [1.42 (95% CI 0.05, 2.78), p = 0.042], increased fantasy [3.24 (95% CI 1.58, 4.90), p < 0.001], and decreased personal distress [−1.73 (95% CI −3.04, −0.35), p = 0.010] compared to controls until 12 months follow-up. Participating nursing students showed significantly decreased levels of perceived stress [−5.09 (95% CI −8.37, −1.82), p = 0.002] and decreased personal distress [−5.01 (95% CI −6.97, −3.06), p < 0.001] compared to controls until 12 months follow-up.

Conclusions: This study demonstrated long-term beneficial effects of the MBM course on perceived stress and empathy in medical and nursing students.

Keywords
medical education, nursing education, Mind-Body Medicine, complementary therapies, self-reflection, empathy, perceived stress
National Category
Other Health Sciences
Identifiers
urn:nbn:se:miun:diva-30606 (URN)10.1080/0142159X.2017.1309374 (DOI)000404352900007 ()28395570 (PubMedID)2-s2.0-85017451376 (Scopus ID)
Note

Published online: 10 Apr 2017

Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2018-03-01Bibliographically approved
Huber, M., van Vliet, M., Giezenberg, M., Winkens, B., Heerkens, Y., Dagnelie, P. C. & Knottnerus, J. A. (2016). Towards a 'patient-centred' operationalisation of the new dynamic concept of health: a mixed methods study. BMJ Open, 6(1), Article ID e010091.
Open this publication in new window or tab >>Towards a 'patient-centred' operationalisation of the new dynamic concept of health: a mixed methods study
Show others...
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e010091Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate among stakeholders the support for the new, dynamic concept of health, as published in 2011: 'Health as the ability to adapt and to self-manage', and to elaborate perceived indicators of health in order to make the concept measurable. Design: A mixed methods study: a qualitative first step with interviews and focus groups, followed by a quantitative survey. Participants: Representatives of seven healthcare stakeholder domains, for example, healthcare providers, patients with a chronic condition and policymakers. The qualitative study involved 140 stakeholders; the survey 1938 participants. Results: The new concept was appreciated, as it addresses people as more than their illness and focuses on strengths rather than weaknesses. Caution is needed as the concept requires substantial personal input of which not everyone is capable. The qualitative study identified 556 health indicators, categorised into six dimensions: bodily functions, mental functions and perception, spiritual/existential dimension, quality of life, social and societal participation, and daily functioning, with 32 underlying aspects. The quantitative study showed all stakeholder groups considering bodily functions to represent health, whereas for other dimensions there were significant differences between groups. Patients considered all six dimensions almost equally important, thus preferring a broad concept of health, whereas physicians assessed health more narrowly and biomedically. In the qualitative study, 78% of respondents considered their health indicators to represent the concept. Conclusions: To prevent confusion with health as 'absence of disease', we propose the use of the term 'positive health' for the broad perception of health with six dimensions, as preferred by patients. This broad perception deserves attention by healthcare providers as it may support shared decision-making in medical practice. For policymakers, the broad perception of 'positive health' is valuable as it bridges the gap between healthcare and the social domain, and by that it may demedicalise societal problems.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-27250 (URN)10.1136/bmjopen-2015-010091 (DOI)000369993900169 ()26758267 (PubMedID)2-s2.0-84960375835 (Scopus ID)
Available from: 2016-03-21 Created: 2016-03-17 Last updated: 2017-11-30Bibliographically approved
van Vliet, M., Jong, M., Busch, M., Meijer, J. E., von Rosenstiel, I. A. & Jong, M. C. (2015). Attitudes, Beliefs, and Practices of Integrative Medicine Among Nurses in the Netherlands. Journal of Holistic Nursing, 33(2), 110-121
Open this publication in new window or tab >>Attitudes, Beliefs, and Practices of Integrative Medicine Among Nurses in the Netherlands
Show others...
2015 (English)In: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 33, no 2, p. 110-121Article in journal (Refereed) Published
Abstract [en]

PURPOSE: This study assessed the attitude, beliefs, and practices of integrative medicine (IM) among nurses in the Netherlands.

DESIGN: Subscribers of a Dutch nursing journal were asked to fill in an anonymous, structured, online survey related to the topic under study.

RESULTS: A total of 355 people responded, of which 37% were familiar with the concept of IM in advance. On completion of the survey, the majority (83%) considered IM as a (very) important innovation in health care. Familiarity (odds ratio = 3.20; 95% confidence interval [1.48, 6.94]) and organization (nursing home compared to hospital (odds ratio = 5.98; 95% confidence interval [1.36, 26.23]) were characteristics associated with a positive attitude toward IM. Between 23% and 46% of respondents encountered obstacles regarding implementation of IM. The main obstacles were lack of support (69% to 78%), means (57% to 85%), and time (63% to 70%).

CONCLUSIONS: Dutch nurses seem to have relatively positive attitudes and beliefs regarding IM. The outcome of this survey may contribute an increased awareness of the key role that nurses can play in the development and implementation of IM.

Keywords
complementary and alternative, integrative medicine, medicine, nurse attitudes, survey
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-23496 (URN)10.1177/0898010114555339 (DOI)25351749 (PubMedID)2-s2.0-84930513192 (Scopus ID)
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2017-04-26Bibliographically approved
van Vliet, M., Jong, M. & Jong, M. (2014). A Barrier Opener for Personal Insights: Nursing and Medical Students Experiences of Participating in an Experiential Mind-Body Skills Program. Paper presented at The Integrative Medicine and Health 2014 conference. Journal of Alternative and Complementary Medicine, 20(5), A98-A99
Open this publication in new window or tab >>A Barrier Opener for Personal Insights: Nursing and Medical Students Experiences of Participating in an Experiential Mind-Body Skills Program
2014 (English)In: Journal of Alternative and Complementary Medicine, ISSN 1075-5535, E-ISSN 1557-7708, Vol. 20, no 5, p. A98-A99Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Purpose: This study aimed to obtain an in-depth understanding on how nursing-, and medical students participating in a Mind-Body Medicine Skills program experienced participation and what the program has meant to them on a personal and a professional level.

Methods: Based on a qualitative approach, first and second year students were interviewed 3 months after completion of the program. Interviews were analyzed with a qualitative content analysis. As a part of a larger study evaluating the effects on stress, empathy and self-reflection, this qualitative sub-study included 10 nursing students from Mid Sweden University, Sweden, and 10 medical students from University of Utrecht, The Netherlands. The Mind-Body Medicine Skills program was adapted from the program developed at Georgetown University School of Medicine, Washington DC, and included 11 experiential sessions were the students were introduced to different mind-body techniques (mindfulness meditation, guided imagery, bio-feedback etc).

Results: Data analysis is ongoing and more complete analysis will be presented at the conference. In preliminary analysis an overarching theme has been identified: The Mind-Body Medicine Skills program as a barrier opener of personal insights, and a starting point for a new journey in life. The participants describe how the course have made it possible for them obtain insights about themselves, both by self reflection in relation to experiences and through listening to the stories of the others. It is also described that they currently do not at all times explicitly use the direct techniques, but more separate personalized elements, which they have been able to incorporate in everyday situations: i.e. moments of mindfulness while walking, biking or eating, or taking a moment of breathing and relaxation before dealing with problematic situations with others.

Conclusion: Participation in the Mind-Body Medicine Skills program can on an individual basis have a deep and profound meaning, stimulating to personal growth.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-23504 (URN)10.1089/acm.2014.5260.abstract (DOI)
Conference
The Integrative Medicine and Health 2014 conference
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2017-04-26Bibliographically approved
van Vliet, M., Jong, M. & Jong, M. C. (2014). Effects of a Mind-Body Medicine Skills Program on Perceived Stress, Empathy and Self-Reflection Among Medicine and Nursing Students: A Quantitative Study. Paper presented at The Integrative Medicine and Health 2014 conference. Journal of Alternative and Complementary Medicine, 20(5), A99-A99
Open this publication in new window or tab >>Effects of a Mind-Body Medicine Skills Program on Perceived Stress, Empathy and Self-Reflection Among Medicine and Nursing Students: A Quantitative Study
2014 (English)In: Journal of Alternative and Complementary Medicine, ISSN 1075-5535, E-ISSN 1557-7708, Vol. 20, no 5, p. A99-A99Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Purpose: This study aimed to implement and quantitatively evaluate the Mind-Body Medicine (MBM) Skills program among Dutch medical and Swedish nursing students.

Methods: The MBM Skills program was piloted among second year medical students at Utrecht University and first year nursing students at Mid Sweden University in the period 2011–2013. During the course, the participating students learned and practiced Mind-Body techniques such as relaxation, meditation, guided imagery, biofeedback, physical exercise, art, music and movement. The effects of the MBM skills program on perceived stress, empathy, and self-reflection were evaluated by the following validated scales: Perceived Stress Scale, Interpersonal Reactivity Index, and Groningen Reflection Ability Scale. Participating students and controls answer(-ed) the different questionnaires at baseline, at the end of the course, and 6 and 12 months later.

Results: In total, 55 medical students and 49 nursing students have participated in the MBM skills program. Baseline analysis (age, gender, mind-body experience, perceived stress, four subscales of the IRI, and self-reflection) demonstrated that participating nursing students were significantly older (p<0.001), and had higher scores for empathetic concern (p<0.001) and self-reflection (p=0.001) than participating medical students. Further, baseline analysis showed no significant differences in baseline characteristics between intervention and control group for medical students, except from significantly higher levels of perceived stress among controls (p=0.008). Regarding nursing students, no differences were found between intervention and control group, except from significantly higher scores for empathetic concern among participants (p=0.023).

Conclusion: We have successfully implemented the MBM Skills program for medical and nursing students. Baseline analysis showed that participants of the course were not a selected group, except from perceived stress among medical students and empathetic concern among nursing students. Data on the effects of the MBM skills program on perceived stress, empathic concern and self-reflection are currently being evaluated and will be presented at the conference.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-23505 (URN)10.1089/acm.2014.5262.abstract (DOI)
Conference
The Integrative Medicine and Health 2014 conference
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2017-06-30Bibliographically approved
Organisations

Search in DiVA

Show all publications