Conditional effects of mindfulness on sleep quality among clinical nurses: the moderating roles of extraversion and neuroticism

Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction in nurses with insomnia: a non-inferiority internet delivered randomized controlled trial

Background

Insomnia is a highly prevalent sleep disorder frequently comorbid with mental health conditions in nurses. Despite the effectiveness of evidence-based cognitive behavioral therapy for insomnia (CBT-I), there is a critical need for alternative approaches. This study investigated whether internet-delivered mindfulness-based stress reduction (IMBSR) for insomnia could be an alternative to internet-delivered CBT-I (ICBT-I).

Objective

The hypothesis was that the IMBSR would be noninferior to the ICBT-I in reducing the severity of insomnia among nurses with insomnia. Additionally, it was expected that ICBT-I would produce a greater reduction in the severity of insomnia and depression than IMBSR.

Method

Among 240 screened nurses, 134 with insomnia were randomly allocated (IMBSR, n = 67; ICBT-I, n = 67). The assessment protocol comprised clinical interviews and self-reported outcome measures, including the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), the 15-item Five Facet Mindfulness Questionnaire (FFMQ), and the Client Satisfaction Questionnaire (CSQ-I).

Results

The retention rate was 55% with 77.6% (n = 104) of participants completing the study. At post-intervention, the noninferiority analysis of the ISI score showed that the upper limit of the 95% confidence interval was 4.88 (P = 0.46), surpassing the pre-specified noninferiority margin of 4 points. Analysis of covariance revealed that the ICBT-I group had significantly lower ISI (Cohen's d = 1.37) and PHQ-9 (Cohen's d = 0.71) scores than did the IMBSR group. In contrast, the IMBSR group showed a statistically significant increase in the FFMQ-15 score (Cohen's d = 0.67). Within-group differences showed that both the IMBSR and ICBT-I were effective at reducing insomnia severity and depression severity and improving mindfulness.

Conclusion

Overall, nurses demonstrated high levels of satisfaction and adherence to both interventions. The IMBSR significantly reduced insomnia severity and depression, but the findings of this study do not provide strong evidence that the IMBSR is at least as effective as the ICBT-I in reducing insomnia symptoms among nurses with insomnia. The ICBT-I was found to be significantly superior to the IMBSR in reducing insomnia severity, making it a recommended treatment option for nurses with insomnia.

Low mindfulness is related to poor sleep quality from middle adolescents to emerging adults: a process model involving resilience and emotional dysfunction

OBJECTIVES

Transitions from middle adolescence into merging adulthood, a life stage between age 15-25, has a high prevalence of sleep problems. Mindfulness is a trait defined as being attentive to the present moment which positively relates to sleep quality. In this study, we aimed to investigate how resilience and emotional dysfunction may influence the relationship between trait mindfulness and sleep quality.

METHODS

The Five Facet Mindfulness Questionnaire, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index and Depression Anxiety Stress Scales were used to measure the key variables through an online survey of 497 participants between middle adolescence and emerging adults (317 females, mean age 18.27 ± 0.76 years). A process model was built to investigate the mediating roles of resilience and emotional dysfunction in the impact of trait mindfulness on sleep quality, together with the relationships between their specific components.

RESULTS

We found a positive association between mindfulness and sleep quality through resilience and through emotional dysfunction, and through the sequential pathway from resilience to emotional dysfunction. Of note, acting with awareness (mindfulness facet) showed significant indirect effects on sleep quality, mediated by resilience and emotional dysfunction.

CONCLUSIONS

Our findings may unveil the underlying mechanisms of how low mindfulness induces poor sleep quality. The findings indicate that conceiving mindfulness as a multifaceted construct facilitates comprehension of its components, relationships with other variables, and underscores its potential clinical significance given its critical implications for mental health.

Association Between Role Overload and Sleep Quality Among Chinese First-Line Nurses During the COVID-19 Outbreak: The Moderating Effect of Mindfulness

BACKGROUND

Nurses working during the coronavirus disease 2019 (COVID-19) pandemic have experienced a high incidence of insomnia because of exposure to life-threatening occupational risks. Good sleep is essential for nurses to maintain their ability to care for patients with infectious diseases.

PURPOSE

The aim of this study was to assess the influence of role overload on sleep quality and the moderating role of mindfulness.

METHODS

A cross-sectional survey design was used in this study, which was conducted between March 20 and April 5, 2020. The survey was completed by 357 nurses who had relocated from Fujian Province to the epicenter of the outbreak in China to treat patients with COVID-19. Role overload, sleep quality, and mindfulness in these nurses were evaluated using the Role Overload Scale, Pittsburgh Sleep Quality Index, and Five-Facet Mindfulness Questionnaire, respectively.

RESULTS

Hierarchical regression and other statistical methods were used to analyze the data. Role overload was shown to be positively related to poor sleep quality, and mindfulness was found to be effective in alleviating sleep disorders associated with role overload.

CONCLUSIONS

The high risk of sleep disturbance among frontline nurses may be alleviated by reducing their perceived role overload. The identification of mindfulness as a moderating mechanism in the relationship between role overload and sleep quality provides new insights to improve sleep quality in nurses.

Anxiety and sleep quality among front-line nurses treating first wave COVID-19 in China: The mediating role of mindfulness

AIM

To explore anxiety, sleep quality, and mindfulness of frontline nurses at the initial epicenter of the pandemic, to examine the mediating effects of mindfulness.

BACKGROUND

COVID-19 was first identified in Wuhan, China in January 2020. Nurses were at the forefront of care and treatment across hospitals in response to the pandemic.

METHODS

Single site cross-sectional survey conducted in Wuhan province (China) between March and April in 2020. Quantitative analysis of survey data from N118 nurses working in the frontline COVID response. Questionnaires included: The general information questionnaire, the Self-Anxiety Scale, the Short Inventory of Mindfulness, and the Pittsburgh Sleep Quality Index.

RESULTS

Front-line nurses' anxiety was positively associated with sleep quality and mindfulness was negatively associated with anxiety and sleep quality. Mindfulness had a mediating role on anxiety and sleep quality, with intermediary adjustment effects (ES = 0.136, 95 % CI 0.02 to 0.26), accounting for 21.9 % of the total effect ratio.

CONCLUSIONS

Anxiety causes a reduction in sleep quality and mindfulness can help with anxiety. Mindfulness strategies may help during periods of higher anxiety in the workplace; however, other factors must be considered. Further research is required on strategies for assisting nurses during periods of extreme anxiety.

When Mindfulness Becomes a Mental Health Risk: The Relevance of Emotion Regulation Difficulties and Need Frustration

Although a great deal of research has shown the positive effects of mindfulness on mental health, some studies have provided evidence that mindfulness can have negative consequences. However, not much is known about the conditions that can account for such negative effects. We examined the moderating roles of difficulties in emotion regulation and basic psychological need frustration in the relationship between mindfulness and psychological ill-being. Longitudinal data were collected at three points in time during a 6-month period from two adult samples in Turkey and Germany. Self-report measures were used to measure ill-being, mindfulness, emotion regulation difficulties, and need frustration. In the German sample, difficulties in emotion regulation and need frustration were related to ill-being, but there were no significant interactions. In the Turkish sample, need frustration predicted ill-being, and the interaction between mindfulness and difficulties in emotion regulation also predicted ill-being. Mindfulness was a protective factor among people with no major difficulties in emotion regulation, whereas it was a risk factor among those with emotion regulation difficulties. The findings suggest that the relationship between mindfulness and ill-being may be more complex than previously thought.

Effects of mindful breathing combined with sleep-inducing exercises in patients with insomnia

BACKGROUND

Insomnia is the most common sleep disorder. It disrupts the patient’s life and work, increases the risk of various health issues, and often requires long-term intervention. The financial burden and inconvenience of treatments discourage patients from complying with them, leading to chronic insomnia.

AIM

To investigate the long-term home-practice effects of mindful breathing combined with a sleep-inducing exercise as adjunctive insomnia therapy.

METHODS

A quasi-experimental design was used in the present work, in which the patients with insomnia were included and grouped based on hospital admission: 40 patients admitted between January and April 2020 were assigned to the control group, and 40 patients admitted between May and August 2020 were assigned to the treatment group. The control group received routine pharmacological and physical therapies, while the treatment group received instruction in mindful breathing and a sleep-inducing exercise in addition to the routine therapies. The Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Insomnia Severity Index (ISI) were utilized to assess sleep-quality improvement in the patient groups before the intervention and at 1 wk, 1 mo, and 3 mo postintervention.

RESULTS

The PSQI, GAD-7, and ISI scores before the intervention and at 1 wk postintervention were not significantly different between the groups. However, compared with the control group, the treatment group exhibited significant improvements in sleep quality, daytime functioning, negative emotions, sleep latency, sleep duration, sleep efficiency, anxiety level, and insomnia severity at 1 and 3 mo postintervention (P < 0.05). The results showed that mindful breathing combined with the sleep-inducing exercise significantly improved the long-term effectiveness of insomnia treatment. At 3 mo, the PSQI scores for the treatment vs the control group were as follows: Sleep quality 0.98 ± 0.48 vs 1.60 ± 0.63, sleep latency 1.98 ± 0.53 vs 2.80 ± 0.41, sleep duration 1.53 ± 0.60 vs 2.70 ± 0.56, sleep efficiency 2.35 ± 0.58 vs 1.63 ± 0.49, sleep disturbance 1.68 ± 0.53 vs 2.35 ± 0.53, hypnotic medication 0.53 ± 0.64 vs 0.93 ± 0.80, and daytime dysfunction 1.43 ± 0.50 vs 2.48 ± 0.51 (all P < 0.05). The GAD-7 scores were 2.75 ± 1.50 vs 7.15 ± 2.28, and the ISI scores were 8.68 ± 2.26 vs 3.38 ± 1.76 for the treatment vs the control group, respectively (all P < 0.05).

CONCLUSION

These simple, cost-effective, and easy-to-implement practices used in clinical or home settings could have profound significance for long-term insomnia treatment and merit wide adoption in clinical practice.

A balanced view of mindfulness at work

Mindfulness has grown from an obscure subject to an immensely popular topic that is associated with numerous performance, health, and well-being benefits in organizations. However, this growth in popularity has generated a number of criticisms of mindfulness and a rather piecemeal approach to organizational research and practice on the subject. To advance both investigation and application, the present paper applies The Balance Framework to serve as an integrative scaffolding for considering mindfulness in organizations, helping to address some of the criticisms leveled against it. The Balance Framework specifies five forms of balance: 1) balance as tempered view, 2) balance as mid-range, 3) balance as complementarity, 4) balance as contextual sensitivity, and 5) balance among different levels of consciousness. Each form is applied to mindfulness at work with a discussion of relevant conceptual issues in addition to implications for research and practice.

Plain Language Summary

In order to appreciate the value of mindfulness at work researchers and practitioners might want to consider both the benefits and potential drawbacks of mindfulness. This paper presents a discussion of both the advantages and possible disadvantages of mindfulness at work organized in terms of the five dimensions of an organizing structure called The Balance Framework.

Influence of rotating shifts and fixed night shifts on sleep quality of nurses of different ages: a systematic literature review and meta-analysis

The objective of this study was to understand the influence of rotating shifts and fixed night shifts on the sleep quality of nurses using a systematic literature review and meta-analysis and to determine whether the sleep quality of nurses working rotating shifts or fixed night shifts differs from that of nurses working fixed day shifts. We conducted a meta-analysis on literature that had used the Pittsburgh Sleep Quality Index (PSQI) to gauge sleep quality and had been published between 2000 and 2020 in the Cochrane Library, CINAHL, MEDLINE, and PubMed databases. This study was conducted in accordance with PRISMA, and the quality of the literature was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. CMA 3.0 was employed for data analysis, and meta-regression analysis was conducted to examine the differences between the PSQI scores of nurses working fixed day shifts and those working rotating shifts or fixed night shifts. Following assessment, a total of 29 papers (34 items of data) were analyzed. The papers included a total of 3,935 nurses who worked fixed day shifts, 3,777 nurses who worked rotating shifts, and 1,559 nurses who worked fixed night shifts. Our subgroup analysis indicated that the sleep quality of nurses working rotating shifts was poorer than the sleep quality of nurses working fixed day shifts; the standardized mean difference (SMD) was 0.38 (95% CI: 0.24-0.52, p< .001), and the meta-regression analysis found that the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts was significantly smaller than the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts (β = -0.368, p= .011). The sleep quality of nurses working fixed night shifts was also poorer than the sleep quality of nurses working fixed day shifts; the SMD was 0.58 (95% CI: 0.38-0.78, p< .001), and the meta-regression analysis revealed that the difference in sleep quality between nurses over 40 years old working fixed night shifts and those working fixed day shifts was not significantly different from the difference in sleep quality between nurses 40 years old or younger working fixed night shifts and those working fixed day shifts (β = -0.118, p= .608). This meta-analysis found that both nurses working rotating shifts and those working fixed night shifts had poorer sleep quality than those working fixed day shifts and that age influenced the difference in sleep quality only between nurses working rotating shifts and those working fixed day shifts; the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts was greater than the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts.

Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization-embryo transfer

The present study aimed to evaluate psychological distress and scrutinized whether family resilience plays a moderating role in the association between infertility-related stress and psychological distress among infertile females preparing for their first IVF-ET. A total of 492 infertile females completed self-reported measures including the Kessler 10 Psychological Distress Scale (K10), the fertility problem inventory (FPI), and the Family Resilience Assessment Scale (FRAS). The results showed 21 (65.2%) participants reported moderate or higher levels of psychological distress. While controlling for economic status, we found psychological distress to be positively linked to infertility-related stress (β=0.483, P<0.001), and negatively related to family resilience (β=-0.145, P=0.001). The simple slopes analysis showed that infertility-related stress had a weaker positive association with psychological distress for individuals at 1 SD (β = 0.443, P < 0.001) above the mean on family resilience compared to those at 1 SD (β = 0.537, P < 0.001) below the mean. Thus, it suggests that clinical practice should conduct family resilience-oriented interventions to facilitate family resilience among infertile females preparing for their first IVF-ET, with the goal to reduce psychological distress.

Mindfulness as a Protective Factor for Dissatisfaction in HCWs: The Moderating Role of Mindful Attention between Climate Stress and Job Satisfaction

With the aim of investigating the possible moderating effect of job control and dispositional mindfulness between different sources of organizational stress and job satisfaction, a correlational study was designed involving health care workers (HCWs). The following questionnaires were administered and completed by 237 HCWs: (1) Occupational Stress Indicator (OSI), to measure the sources of stress at work (managerial role, climate power, climate structure, internal relationships), and job satisfaction; (2) Mindfulness Attention Awareness Scale (MAAS) to assess the individual’s level of attention to what is taking place in the present; (3) Job Control Scale (JCS) to assess the perceived control at work. Hierarchical regression analyses were used to test the hypothesized relationships between variables; the results showed that, between the different sources of stress, the organizational climate dimension was negatively associated with job satisfaction; moreover, mindfulness attention moderated the relationship between climate stress and job satisfaction; unexpectedly, the interaction between job control and the organizational climate dimension was not significant in affecting job satisfaction. This study can provide useful information for Human Resources Management (HRM) practices regarding job and mental control interventions and empowerment, and possibly offer a new interpretation of the role of attention to what is happening in the present moment and autonomy between climate stressors and occupational satisfaction.