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The HAT model constitutes a psychologically versatile and comprehensive treatment methodology that is mindful, gentle, self-nurturing, easy to use, and blends comfortably with all forms and orientations in psychotherapy. HAT has been used beneficially to address a wide variety of life issues.
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Duke Study Info
Duke University Protocol ID: Pro00063807 Full Study Title: Heart Assisted Therapy- Self-Regulation (HAT-SR) for Caregivers of Persons with Dementia: A Mobile Application Continuing Education Activity.
DNP Student’s Name: Maria E. Pfrommer
Project Title: Heart Assisted Therapy-Self-Regulation (HAT-SR) for Caregivers of Persons with Dementia.
Clinical Site: The Evergreens Continuing Care Retirement Community (CCRC)
Statement of the Problem: Long-term care residents who have dementia are one of the most vulnerable and challenging populations for caregivers. Residents with dementia have impairments in memory, concentration, reasoning, and judgment creating difficulties for the provider in anticipating the needs of the individual. As the resident’s cognitive condition diminishes, the challenges of caring for these individuals’ increase (The National Institute on Aging, 2015). Examples of caregiver challenges include caring for patients with the behavioral issues such as agitation, aggression, delusions, hallucinations, and wandering. Healthcare professionals who work with persons with dementia are also at higher risk for caregiver burnout and report decreased empathy and negative attitudes towards the patients and families they serve (Gitlin, et al, 2010).
The ability to empathize with patients is a key component of dementia care because a caregiver’s emotional state can directly influence their patients. This increased emotional empathy translates into increased patients’ responsiveness to the expressions, words, and behaviors of their caregivers (Hughes, 2013). This phenomenon is commonly referred to as “emotional contagion” and can be defined as "a process in which a person or group influences the emotions or behavior of another person” (Schoenewolf, 1990, p. 50). Psychologists theorize emotional contagion is a primitive, automatic, and unconscious behavior (Hatfield, et al, 1994). Emotional contagion has been and the focus of research conducted on Alzheimer’s and dementia patients. Recent research revealed that individuals with Alzheimer’s show a higher-level emotional empathy that becomes stronger as the disease progresses. Thus caregiver anxiety or frustration may stimulate similar behaviors in patients with dementia and increase the likelihood of caregiver role strain (Sturm, et al, 2013).
The symptoms of caregiver role strain include anxiety, depression, heightened irritability, hopelessness, anger, exhaustion, hypertension, gastrointestinal complaints, insomnia, and headaches (Pfifferling & Gilley, 2000). Relieving stress and improving the resilience of caregivers should translate into improvements in clinical outcomes, quality of care, and an increased sense of well-being for both patients and caregivers (Bazarko, et al, 2013). Self-regulation techniques such as meditation, breathing exercises, and focused intention are gaining interest amongst healthcare professionals (Diepold, 2013). Specifically, self-nurturing techniques such as mindfulness and meditation practices have been shown to prevent and treat caregiver role strain or burnout. This self-nurturing strengthens compassion, resilience, awareness, focus, and caring behaviors (Bazarko, et al, 2013).
The aim of this Doctor of Nursing Practice (DNP) Capstone proposal is to improve patient outcomes related to emotional contagion by enhancing mindfulness and reducing the stress and anxiety of caregivers of patients with dementia. To accomplish this goal, the DNP student will implement and evaluate a stress reduction educational activity with a mindfulness enhancing technique known as Heart Assisted Therapy- SR (HAT-SR) (Diepold, 2006, 2013).
Outcomes related to the project include completing an End of Educational Activity Evaluation to assess how the likelihood of continuing to use HAT-SR and how the information from the educational activity may be used to improve their approach to caring for patients with dementia. In addition, the staff’s responses to the Cognitive and Affective Mindfulness Scale–Revised (CAMS-R) (Feldman, et al, 2007) and the HAT-SR activity recording sheets that were specifically designed for the HAT-SR educational activity will be used to track the number of times that an attendee completed the HAT-SR exercise.
Evidence- Literature Review and Synthesis
The relationship between decreasing stress, enhancing mindfulness, and self-compassion is especially important to healthcare providers who work with patients with dementia. A 2010 study investigated the link between nurse burnout and nurse-rated quality of patient care. Researchers collected survey data from 53,846 nurses in six countries, including the U.S (Poghoysan et al, 2010). Researchers found that U.S nurses had the second to highest reported levels of emotional exhaustion and depersonalization. Further, given these results, the researchers suggest that interventions that increase self-compassion and mindfulness have the potential to reduce stress and burnout in health care workers and improve patient outcomes. (Poghoysan et al, 2010).
Traditional Mindfulness Based Stress Reduction (MBSR) interventions require the attendee to complete one week of training and practice meditation for a minimum of 45 minutes per day. Fortney et al (2013) viewed this as a limitation citing previous studies that had high dropout rates due to this time commitment. In response, the researchers developed an abbreviated protocol and requested attendees complete 18 hours of training and also reduced the practice time of the MBSR to 10-20 minutes per day for eight weeks. The sample included primary care clinicians working in the departments of family medicine, internal medicine and pediatrics (N=30). Baseline scores were compared at 3 times during and after the study period and at 9 months post intervention. At 9 months post intervention, attendees had significantly better scores on all Maslach Burnout Inventory Burnout subscales (Maslach, et al, 1996 in Fortney et al., 2013) including emotional exhaustion (p =. 009), depersonalization (p =. 005), and personal accomplishment (p
HAT-SR Technique for Caregivers
Duke University Protocol ID:
Full Study Title: Heart Assisted Therapy- Self-Regulation (HAT-SR) for Caregivers of Persons with Dementia: A Mobile Application Continuing Education Activity.
￼What you need to do: All that you will need to do will be described below.
How long will it take to do? Each exercise will take less than 2 minutes.
How often will I need to practice? You are invited to do the exercise 3 to 5 times a day. Please record every time you do the exercise on the mobile application or the sheet provided.
Whom should I contact if I have questions? Contact Maria Pfrommer either through the mobile application (under contact) or by email: Maria.Pfrommer@duke.edu or phone: 609-458-1070
Here are the steps in the exercise:
A. The first set of 9 “Heart Breaths”:
1) Find a quiet place to sit.
2) Overlap your hands and place them directly over the center of your chest over your heart.
3) Free your mind and blankly focus your attention on something in front of you (e.g., an empty space on the wall).
4) Take 3 normal respirations (breaths) while keeping your hands over your heart.
5) Reverse your hands and again place them over your heart.
6) Again take 3 normal respirations while keeping your hands over your heart.
7) Reverse your hands once more and again place them over your heart.
8) Again take 3 normal respirations while keeping your hands over your heart.
B. The “Acceptance Statement”:
While keeping your overlapping hands over your heart, and continuing to blankly focus, please do and say the following out loud:
1) Take a complete normal respiration.
2) Upon completion of the respiration, say aloud,
“Deep in my heart I love and accept myself, (respiration), even though I am the way I am (respiration), and even though my patients are the way they are.”
3) Take another complete normal respiration.
4) Reverse your hands and again place them over your heart.
5) Take another complete normal respiration.
6) Upon completion of the respiration, say aloud again,
7) “Deep in my heart I love and accept myself, (respiration), even though I am the way I am (respiration), and even though my patients are the way they are.”
8) Reverse your hands once more and again place them over your heart.
9) Take a complete normal respiration.
10) “Deep in my heart I love and accept myself, (respiration), even though I am the way I am (respiration), and even though my patients are the way they are.”
11) Take a complete normal respiration.
C. The last set of 9 “Heart Breaths”:
1) Keep your overlapping hands over your heart.
2) Free your mind again and blankly focus your attention on something in front of you (e.g., an empty space on the wall).
3) Take 3 normal respirations (breaths) while keeping your hands over your heart.
4) Reverse your hands and again place them over your heart.
5) Again take 3 normal respirations while keeping your hands over your heart.
6) Reverse your hands once more and again place them over your heart.
7) Again take 3 normal respirations while keeping your hands over your heart.
Please record that you have completed this exercise on the sheet provided.
Diepold, J.H.Jr. (2014). Heart Assisted Therapy-SR: Self-regulation technique and skills. (Research Protocol) Moorestown, NJ: Author.
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