Interventions to promote resilience and passion for work in health settings: A mixed-methods systematic review

Background

Resilience and passion for work are associated with better psychosocial wellbeing and professional quality of life for healthcare workers.

Objective

To evaluate the characteristics and efficacy of interventions to promote resilience and passion for work in health settings.

Methods

A comprehensive search was conducted across six databases (MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and PsycINFO) for articles published between January 2003 and February 2023. Studies utilizing both quantitative and qualitative methodologies were included. Methodological quality assessment was performed using the Mixed Methods Appraisal Tool. Data from the included studies were analyzed using a convergent mixed methods design.

Results

A total of 33 studies met the inclusion criteria. All reported on interventions designed to enhance resilience for healthcare workers. None reported on interventions to enhance passion for work. Interventions included mindfulness-based programs, psychoeducation workshops, stress management techniques, and professional coaching. Interventions varied widely in terms of delivery modality, format, content, intensity, duration, and outcomes. Of the studies reporting quantitative data, most (21/29) reported statistically significant improvements in resilience. Of the studies reporting qualitative data, all reported a positive impact of the intervention on resilience and psychological well-being.

Conclusions

Overall, interventions designed to enhance resilience in health care settings appear to be effective across a variety of healthcare settings. The diversity of effective intervention approaches, delivery formats, intensity and duration suggest that brief, light-touch or self-directed online interventions may be equally as effective as more intensive, lengthy, in-person or group-based interventions. This provides health care organisations with the opportunity to select and flexibly implement interventions that align with organisational, and staff needs and preferences. Future research needs to explore effective approaches to building passion for work.

Effects of interventions to promote resilience in nurses: A systematic review

BACKGROUND

Various trials are investigating the effect of digital and face-to-face interventions on nurse resilience; however, it remains unclear whether these interventions have immediate, short-term or long-term effects.

OBJECTIVE

The objective of the systematic review is to identify the types of interventions and assess the immediate (<3 months), short-term (3-6 months), and long-term (>6 months) effects of these interventions on nurse resilience.

DESIGN

This systematic review was registered in the International Prospective Register of Systematic Reviews (Registered Number: CRD 42023434924), and results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol.

METHODS

Data were collated from the databases of CINAHL, Cochrane Library, Embase (OVID), Medline, and Scopus between March and May 2023. The research protocol was determined following the framework of population, exposure, outcomes, and type of study. The articles with full text published between 2000 and 2023 were included. Studies were included if they (1) involved the nurses who provided patient care directly, (2) utilised digital or face-to-face interventions, (3) reported resilience outcomes, and (4) were randomised controlled trials or clinical trials. The JBI critical appraisal tool was utilised to assess the risk of bias for the studies collected.

RESULTS

A total of 18 studies met the criteria and were analysed. Pooled results demonstrated that digital interventions had a statistically significant positive effect on nurse resilience at 4-5-month follow-ups (standardised mean difference [SMD] = 0.71; 95 % CI = 0.13, 1.29; P = 0.02) compared to no interventions. Additionally, pooled data showed no effect on nurse resilience at all the follow-ups, compared to no interventions. No significant results were observed in comparisons of digital or face-to-face interventions between the intervention and control groups.

CONCLUSIONS

The review assessed digital and face-to-face resilience interventions in nurses across 18 trials. Digital methods showed a short-term impact within 4-5 months, whilst face-to-face interventions had no effect during follow-ups. Realistic expectations, ongoing support, and tailored interventions are crucial for nurse resilience enhancement.

TWEETABLE ABSTRACT

It was identified digital interventions had a short-term impact on nurse resilience, whilst face-to-face interventions had no effect during follow-ups @fionayyu.

Comparing the effectiveness of mind-body practices (MBPs) and various psychological methods on occupational stress among healthcare workers: a network meta-analysis of randomized controlled trials

OBJECTIVES

The purpose of this study is to compare the efficacy of mind-body practices (MBPs) and multiple psychological methods, and identify the optimal method for relieving work-related stress among healthcare workers (HCWs) by network meta-analysis (NMA).

METHODS

We applied six electronic databases, namely PubMed, Web of Science, Embase, PsycINFO, Cochrane, and Chinese National Knowledge Infrastructure to identify relevant RCTs from inception to September 16, 2023, and implemented a search strategy based on the PICOS principles. Data selection, extraction, and analysis of bias were carried out independently and in duplicate by separate researchers. State 16.0 was used to conduct NMA for comparing the effectiveness of various therapies.

RESULTS

We identified 23 studies including MBPs and three different psychological therapies, namely mindfulness-related therapy (MRT), psychoeducational therapy (PT), and comprehensive therapy (CT), which were divided into eleven specific techniques, namely yoga, meditation techniques (MT), Qigong, muscle relaxation(MR), biofeedback therapy (BT), mindfulness-based interventions (MBIs), modified mindfulness-based stress reduction (MBSR-M), mindfulness-based interventions combined with others (MBIs-C), mindfulness-based awareness(MBA), PT and CT. Our NMA results of MBPs and three psychological therapies showed MBPs (SMD = -0.90, CrI:-1.26, -0.05, SUCRA = 99%) were effective for occupational stress in HCWs, followed by MRT(SMD = -0.48, CrI:-0.87, -0.08, SUCRA = 66.5%). NMA results of eleven specific techniques showed yoga (SMD = 1.36, CrI:0.91, 1.81, SUCRA = 97.5%) was the most effective technique in relieving the stress of HCWs, followed by MR (SMD = 1.36, CrI:0.91, 1.81, SUCRA = 87.3%).

CONCLUSIONS

Our study suggested MBPs may be the most effective intervention to improve the occupational stress of HCWs. Furthermore, yoga is likely to be the most optimal of MBPs. Hospital managers should attach importance to yoga in addressing occupational stress among medical workers.

Guided self-help mindfulness-based intervention for increasing psychological resilience and reducing job burnout in psychiatric nurses: A randomized controlled trial

AIMS

The present study aimed to explore the effects of a guided self-help mindfulness intervention on psychological resilience and job burnout among psychiatric nurses.

BACKGROUND

Psychiatric nurses work in challenging and potentially high stress settings. Mindfulness interventions can improve psychological resilience and reduce job burnout of nurses. However, face-to-face delivery of mindfulness interventions may be inconvenient for individuals. Guided self-help interventions may be more accessible.

METHODS

This randomized controlled trial was conducted from January to August 2022. One hundred and eighteen psychiatric nurses were randomized into the intervention and control groups. The individuals in the intervention group received an 8-week guided self-help mindfulness intervention, while the individuals in the control group received a psycho-educational brochure. The Five Facet Mindfulness Questionnaire, the Connor-Davidson Resilience Scale and the Maslach Burnout Inventory-Human Services Survey were used to evaluate the levels of mindfulness, psychological resilience and job burnout, respectively.

RESULTS

After an 8-week intervention, compared with the control group, the levels of mindfulness and psychological resilience were higher, while the level of job burnout was lower in the intervention group.

CONCLUSIONS

The guided self-help mindfulness intervention can improve psychological resilience and reduce job burnout among psychiatric nurses.

The efficacy of mindfulness-based programs in reducing anxiety among nurses in hospital settings: A systematic review

BACKGROUND

The increasing pressure of their professional duties has led to a notable concern regarding the mounting anxiety levels among nurses. The ongoing discussion revolves around the efficacy of mindfulness as a means to alleviate anxiety in nurses.

AIM

This systematic review evaluated the effectiveness of mindfulness in reducing anxiety among nurses.

METHODS

The evaluation followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An extensive and comprehensive search was conducted across eight databases to identify studies that utilized randomized controlled trials (RCTs) and were published in English between 2011 and 2022. Independently, two reviewers assessed the validity of the randomized controlled trials using the Consolidated Standards of Reporting Trials criteria. Additionally, two authors independently employed the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-2) method to evaluate the potential bias in the RCTs.

RESULTS

Eight randomized controlled trial studies that were deemed eligible were included in the current analysis. Based on the literature review, it was determined that mindfulness-based training can assist nurses in reducing their anxiety levels. Furthermore, the effectiveness of mindfulness-based programs in enhancing nurses' mindfulness and self-compassion has been firmly established.

LINKING EVIDENCE TO ACTION

Based on existing literature, mindfulness-based interventions have proven to be effective in reducing anxiety levels among nurses. However, in order to enhance the overall quality of research, it is necessary to implement more rigorous controlled designs that include randomization. Additionally, larger sample sizes with a diverse range of participants are needed to establish and validate the effectiveness of mindfulness-based programs in alleviating anxiety among nurses. Implementing mindfulness-based training in healthcare organizations can offer numerous benefits. One such advantage is that it can help nurses in reducing anxiety and enhancing their ability to handle the pressures associated with their profession.

STUDY REGISTRATION

PROSPERO Protocol registration ID: CRD42023475157.

Mindful self-compassion program based on Watson's theory of human caring in nursing students: A randomized controlled study

AIMS AND BACKGROUND

This study investigated the impact of the Mindful Self-Compassion Program, based on Watson's Theory of Human Caring Model, on the physical and mental health of nursing students. The essence of nursing is care and compassion. While there are studies on compassion in nursing care, nurses' self-compassion is an underrecognized concept in the literature.

METHODS

The study employed a randomized controlled design and involved 80 seconds-grade nursing students from a university in Turkey between December 2021 and June 2022. The intervention group received an online program consisting of six weekly sessions, while the control group did not receive any intervention. The data were collected using the Promotive and Protective Health Behaviors Scale, Watson Caritas Self-Rating Score, Brief Resilience Scale, and Self-Compassion Scale before, at the end of, and 5 months after the program.

RESULTS

In both the post-test and follow-up test, the intervention group exhibited an increase in health-promoting and protective behaviors, self-care perception, psychological resilience, and self-compassion compared to the control group.

CONCLUSION

Therefore, it is recommended to use the program to improve the physical and mental health of individuals in nursing practice areas. Additionally, it would be beneficial to include the program in the nursing education curriculum. Our findings provide evidence supporting the use of the program for nursing students and nurses.

Influencing factors associated with mental workload among nurses: A latent profile analysis

Objective

This study aimed to examine the latent profile of nurses' mental workload (MWL) and explore the influencing factors via a person-centred approach.

Methods

From March to July 2023, a quantitative cross-sectional study was carried out to investigate 526 Chinese clinical nurses from five tertiary hospitals in Sichuan Province, China, by using demographic information, the Perceived Social Support Scale, Simplified Coping Skill Questionnaire, and NASA-Task Load Index. Latent profile analyses were performed using Mplus 7.3 software. Pearson's chi-squared and logistic regression analysis was done using SPSS 24.0 software.

Results

Three profiles of mental workload were identified based on the nurses' responses to the mental workload assessment, designated as "low MWL-high self-rated (n = 70, 13.3%)", "moderate MWL (n = 273, 51.9%)", and "high MWL-low self-rated (n = 183, 34.8%)". Based on the analysis of the three subtypes, nurses with working years < 5 years (χ 2  = 12.135, P < 0.05), no children (χ 2  = 16.182, P < 0.01), monthly income < 6000 (χ 2  = 55.231, P < 0.001), poor health status (χ 2  = 39.658, P < 0.001), no psychological training in the past year (χ2 = 56.329, P < 0.001) and suffering from workplace violence (χ 2  = 19.803, P < 0.001) were significantly associated with MWL. Moreover, the multivariate logistic regression analysis showed that negative coping styles (OR = 1.146, 95% CI: 1.060-1.238, P = 0.001) were accompanied by higher MWL while negatively associated with perceived social support (OR = 0.927, 95% CI: 0.900-0.955, P < 0.001).

Conclusion

Our results showed that the MWL of nurses could be classified into three subtypes. Monthly income, health status, psychological training, workplace violence, negative coping style, and perceived social support were the factors influencing MWL. Managers can employ personalised intervention strategies according to the individual characteristics of different subgroups to reduce nurses' MWL.

The impact of mindfulness-based stress reduction training on the occupational stress and burnout experienced by nurses in geriatric wards? A randomized controlled trial

In this clinical trial, 60 nurses from three geriatric centers were enlisted and randomly split into two groups: control (n = 30) and intervention (n = 30). Statistical analysis using SPSS version 21 employed Kolmogorov-Smirnov, Chi square, and t-test to assess results. The intervention group received eight training sessions. After the MBSR Training in the intervention groups, results showed there was a statistically significant difference between the two groups concerning the scores of the subscales of death and dying (t = 6.161, P < 0.001), conflicts with physicians (t = 7.962, P < 0.001), inadequate preparation (t = t = 6.524, P < 0.001), lack of support resources (t = 5.532, P < 0.001), conflicts with nurses (t = -6.632, P < 0.001), workload (t = 6.587, P < 0.001), uncertainty of treatment (t = 5.587, P < 0.001) as well as the scores of the subscales of burnout.

Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis

Background

Growing evidence attests to the efficacy of mindfulness-based interventions (MBIs), but their effectiveness for healthcare workers remains uncertain.

Aims

To evaluate the evidence for MBIs in improving healthcare workers' psychological well-being.

Methods

A systematic literature search was conducted on Medline, Embase, Cumulative Index for Nursing and Allied Health Literature, PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords 'healthcare worker', 'doctor', 'nurse', 'allied health', 'mindfulness', 'wellness', 'workshop' and 'program'. Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion. R V.4.0.3 was used for data analysis, with the standardised mean difference as the primary outcome, employing DerSimonian and Laird's random effects model. Grading of Recommendations, Assessment, Development and Evaluation framework was used to evaluate the quality of evidence. Cochrane's Risk of Bias 2 tool was used to assess the risk of bias in the included studies.

Results

A total of 27 studies with 2506 participants were included, mostly from the USA, involving various healthcare professions. MBIs such as stress reduction programmes, apps, meditation and training showed small to large effects on anxiety, burnout, stress, depression, psychological distress and job strain outcomes of the participants. Positive effects were also seen in self-compassion, empathy, mindfulness and well-being. However, long-term outcomes (1 month or longer postintervention) varied, and the effects were not consistently sustained.

Conclusions

MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers. The review also highlights limitations such as intervention heterogeneity, reduced power in specific subgroup analyses and variable study quality.

PROSPERO registration number

CRD42022353340.

Randomized crossover clinical trial of a Mindfulness-based intervention for nurse leaders: A pilot study

OBJECTIVE

to analyze the effects of a Mindfulness-based intervention on nurse leaders' emotional intelligence and resilience.

METHOD

a pilot study of a randomized crossover clinical trial. The sample (n=32) was randomized into Group A (n=18) and Group B (n=14) and evaluated at the pre-test, post-test and follow-up moments. The outcomes were assessed using the Emotional Intelligence Measure, the Connor-Davidson Resilience Questionnaire and the Five Facet Mindfulness Questionnaire, and analyzed using Generalized Linear Mixed Models.

RESULTS

a total of 32 nurses with a mean age of 42.6 years old were evaluated. The analyses showed significant interactions between the effects of the group x moment factors on the Self-motivation (p=0.005), Sociability (p<0.001), Self-control (p=0.013), and Total (p=0.002) emotional intelligence skill scores; as well as on the Observe (p=0.042), Describe (p=0.008), Non-judgment (p<0.001), Act with awareness (p=0.004) and Total (p<0.001) mindfulness facets. Post-test: there was a statistically significant increase in the Sociability (p=0.009) and Self-control (p=0.015) emotional intelligence skills; as well as in the Non-judgment (p=0.022) and Total (p=0.002) mindfulness facets. Follow-up: a significant increase was observed in the Non-judgment (p=0.024) and Total (p=0.026) mindfulness facets. The "resilience" variable did not present statistical significance in the "group x moment" factor, both in the post-test and during follow-up.

CONCLUSION

the Mindfulness-based intervention used proved to be effective in increasing nurse leaders' emotional intelligence and dispositional mindfulness skills. Brazilian Registry of Clinical Trials (RBR-3c62gy), registered on March 4 th , 2020, updated on September 16 th , 2022.

BACKGROUND

(1) Unpublished study of a Mindfulness-based intervention with nurse leaders.

BACKGROUND

(2) Positive effect on the participants' emotional intelligence and mindfulness.

BACKGROUND

(3) Advances in knowledge about emotional intelligence and leadership resilience.

BACKGROUND

(4) It encourages the implementation of sensitive and innovative health strategies.

A Mindfulness-Based Intervention for Acute Care Nursing Staff: A Pilot Study

Purpose:The purpose of this study was to determine if a mindfulness-based smartphone application, used for 5 minutes a day for 30 days, could address burnout among acute care nursing staff. Methods: A pretest-posttest design with a midpoint evaluation was utilized. The sample included 31 nursing staff from cardiovascular acute care units. The Copenhagen Burnout Inventory, Cognitive and Affective Mindfulness Scale-Revised, Perceived Stress Scale, and Brief Resilience Scale were used to measure the impact of the intervention on participants. Findings: In a repeated measures analysis, there were no statistically significant changes in scores on the Brief Resilience Scale across the three timeframes (F = 0.64, df = 1.42, p = .49). There were significant reductions over time for perceived stress (F = 10.56, df = 1.74, p = .002) and personal burnout (F = 11.8, df = 1.10, p = .007), and increased scores on mindfulness (F = 4.76, df = 1.57, p = .039). Conclusions: The utilization of a mindfulness-based smartphone application may promote the health and well-being of cardiovascular nurses in acute care units. Mindfulness-based smartphone apps should be considered as a method of self-care, along with other holistic approaches to improve well-being.

Effects of mindfulness-based interventions on reducing psychological distress among nurses: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

Nurses increasingly use mindfulness as an effective mental health intervention to reduce psychological distress. The effectiveness of mindfulness-based interventions remains inconclusive, which may lead to implementation of interventions in an inefficient or ineffective manner. This study aimed to examine the effects of mindfulness-based interventions on reducing stress, anxiety, and depression among nurses.

DESIGN

Systematic review and meta-analysis.

METHODS

Randomized controlled trials (RCTs) were searched using six databases published through May 20, 2023, which evaluated the effects of mindfulness-based interventions on reducing psychological distress among nurses. To assess the quality of methodology included in the RCTs, version 2 of the Cochrane risk-of-bias instrument for RCTs with five domains was used. Standardized mean difference (SMD) with 95% confidence interval (CI) were calculated using the random-effects model in the meta-analyses. Publication bias was assessed using Egger's regression test. Further, the robustness effect size of the pooled analysis was assessed using leave-one-out sensitivity analysis.

FINDINGS

A total of 16 RCTs were included in the final analysis. Overall, the modalities appeared to alleviate stress (pooled SMD: -0.50 [95% CI: -0.82 to -0.18]; p < 0.001) and depression (pooled SMD: -0.42 [95% CI: -0.78 to -0.06]; p = 0.02) among nurses.

CONCLUSION

Mindfulness-based interventions appear to alleviate stress and depression in nurses. Future research evaluating mindfulness-based interventions among working nurses with more rigorous methodological and larger sample size.

CLINICAL RELEVANCE

Support for nurses' mental health must be included while implementing personal and professional development plans.

Addressing Health Care Workers' Mental Health: A Systematic Review of Evidence-Based Interventions and Current Resources

Background. Mental health is declining in health care workers. Objectives. To provide a comprehensive assessment of intervention literature focused on the support and treatment of mental health within the health care workforce. Search Methods. We searched online databases (e.g., Medline, PsycINFO). Selection Criteria. We selected manuscripts published before March 2022 that evaluated the target population (e.g., nurses), mental health outcomes (e.g., burnout, depression), and intervention category (e.g., mindfulness). Data Collection and Analysis. Of 5158 publications screened, 118 interventions were included. We extracted relevant statistics and information. Main Results. Twenty (17%) earned study quality ratings indicating design, analysis, and implementation strengths. Randomized controlled trials were used by 52 studies (44%). Thirty-eight percent were conducted in the United States (n = 45). Ninety (76%) reported significant changes, and 46 (39%) reported measurable effect sizes. Multiple interventions significantly reduced stress (n = 29; 24%), anxiety (n = 20; 17%), emotional exhaustion or compassion fatigue (n = 16; 14%), burnout (n = 15; 13%), and depression (n = 15; 13%). Authors' Conclusions. Targeted, well-designed mental health interventions can improve outcomes among health care workers. Public Health Implications. Targeted health care‒focused interventions to address workers' mental health could improve outcomes within this important and vulnerable workforce. (Am J Public Health. 2024;114(S2):S213-S226. https://doi.org/10.2105/AJPH.2023.307556).

The Effects of Mindfulness Meditation on Nursing Students' Stress and Anxiety Levels

AIM

The aim of this study was to evaluate the effects of a virtual mindfulness meditation intervention on stress and anxiety levels of 145 nursing students.

BACKGROUND

Because of the twin demands of classroom and clinical workloads, nursing students experience greater amounts of stress and anxiety than the average college student. Mindfulness meditation is a promising method to alleviate stress and anxiety.

METHOD

A pretest-posttest randomized controlled design was used. Participants received either weekly mindfulness meditation recordings or recordings on nursing information. Participants completed the Perceived Stress Scale and the Generalized Anxiety Disorder-7 Scale.

RESULTS

A two-way mixed analysis of variance and follow-up simple main effects tests revealed that participants in the experimental group, who received meditation recordings, experienced significantly lower levels of stress and anxiety on posttest surveys than the control group.

CONCLUSION

Mindfulness meditation can reduce stress and anxiety levels in nursing students. This can improve students' overall mental and physical well-being.

Psychological Intervention to Promote Resilience in Nurses: A Systematic Review and Meta-Analysis

Nurses primarily focus on caring for others, but they also require care and support to enhance their own resilience. Thus, this study aims to determine the effects of psychological interventions on nurses' resilience support and to define the influence of moderating variables that can affect these effects. The literature search was conducted in 10 electronic databases, and 5 randomized controlled trials and 10 non-randomized controlled trials were finally selected for analysis (a total of 852 participants). Statistical analyses of the effect sizes and homogeneity of the intervention programs were conducted using RevMan 5.3 from the Cochrane Library and the R program. Publication bias in the retrieved studies was tested using contour-enhanced funnel plots. The meta-analysis found that psychological interventions were effective in improving nurses' resilience immediately after the intervention (SMD = 0.59, 95% CI 0.31 to 0.86, Z = 4.18, p < 0.001) and in the short term within three months (SMD = 1.52, 95% CI 0.74 to 2.31, Z = 3.80, p < 0.001). Interventions using emotion regulation, relaxation, and self-compassion were particularly effective, and the intervention period was effective in both a short period of 1 day and a long period of more than 12 weeks. In addition, the optimal one-session time was 121-150 min, and offline interventions were more effective than online interventions. Furthermore, the effect size was affected by the intervention time for one session (QB = 12.02, df = 3, p = 0.007) and the on/offline intervention method (QB = 5.85, df = 1, p = 0.015). These findings may inform the development of targeted interventions and resilience support systems for nurses. However, in the future, more rigorous studies, such as randomized controlled trials, should be conducted to ensure strict control over the variables and to establish a stronger evidence base for the effectiveness of these interventions.

Piloting a Mindfulness App for Use by Nursing Staff at Work

This article discusses the findings of a 5-week pilot using a mindfulness app among medical-surgical nursing staff in an acute care setting during a 12-hour shift. Informational sessions on compassion fatigue, mindfulness, and the process were implemented with leadership providing daily support. The postimplementation survey demonstrated increased calmness and reduced stress. Barriers identified involve perceived time constraints. Awareness is needed on compassion fatigue, interventions to combat, and modifications to promote the culture of self-care.

Perceived Stress Mediating the Association Between Mindfulness and Resilience Among Registered Nurses

Purpose

Resilience continues to be an important concept in the nursing profession due to its significant role in personal healthcare, patients' healthcare, and leadership. The present study examined the mediating role of perceived stress in the association between mindfulness and resilience among registered nurses in order to understand their importance among those in the Taiwanese nursing profession.

Materials and Methods

Between October and November 2021, a total of 816 registered nurses participated in a cross-sectional survey including psychometric measures assessing perceived stress (Chinese Perceived Stress Scale-10), mindfulness (Chinese Mindful Attention Awareness Scale), and resilience (Chinese Questionnaire of Resilience).

Results

Results indicated that perceived stress mediated the association between mindfulness and resilience (standardized coefficient = 0.251, p<0.001), although there was no significant association between mindfulness and resilience (standardized coefficient = 0.042, p=0.16). This suggests that perceived stress may function as both distress and eustress because mindfulness was not directly associated with resilience but indirectly via perceived stress.

Conclusion

Nurses and their administrators should focus on different ways of coping with stress so that they become more resilient in facing other stressors. Future studies may be conducted to examine the mediating role of perceived stress in the association between other coping strategies and resilience among registered nurses.

Effects of a mindfulness-based interventions on stress, burnout in nurses: a systematic review and meta-analysis

Background

Stress in the healthcare environment causes negative effects in nurses such as burnout, anxiety, and depression. The COVID-19 pandemic has resulted in increased pressure on medical staff globally, highlighting the potential benefits of mindfulness-based interventions in reducing nurses' stress levels. Despite numerous studies exploring the effect of mindfulness-based training on nurses, the results remain inconclusive.

Objective

To systematically evaluate the impact of mindfulness training on nurse's performance and increase the certainty of existing evidence.

Methods

This study searched various databases, including EBSCO, Embase, Web of Science, PubMed, ProQuest, Scopus, Cochrane Online Library, Wanfang, SinoMed, CNKI, and VIP, for randomized controlled trials on the impact of mindfulness-based interventions for nurses up until 02 December 2022. Two investigators independently screened and extracted data from the articles, while also assessing the risk of bias. The data was analyzed using RevMan 5.4 software.

Results

This review identified 15 studies out of the 2,171 records retrieved, consisting of a total of 1,165 participants who were randomized. Post-intervention analysis provided very-low certainty evidence of moderate effectiveness of mindfulness-based training in reducing stress [standardized mean difference (SMD) = -0.81; 95% confidence interval (CI) = -1.11 to -0.52], with no significant effect on anxiety (SMD = -0.30; 95% CI = -0.72 to 0.13) or depression (SMD = -0.24; 95% CI = -0.55 to 0.07). However, the training was effective in reducing burnout, as demonstrated by the lower scores for emotional exhaustion (SMD = -4.27; 95% CI = -5.94 to -2.59) and depersonalization (SMD = -2.89; 95% CI = -4.24 to -1.54) and higher scores for personal accomplishment (SMD = 2.81; 95% CI = 0.12 to 5.50). There was a sustained improvement in stress levels in the short-term (≤3 months), with delayed benefits for burnout. However, only two studies were available for later follow-ups, and there was no significant evidence of long-term effects.

Conclusion

Mindfulness-based training may be a viable intervention for improving the psychological wellbeing of nurses, including reducing stress, burnout.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023387081.

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.

Individual-level interventions for reducing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions.  OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms.  SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms.  DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);  2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);  3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above.  The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended).  MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised.  The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants.  Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention  Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention.  A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type  Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

AUTHORS' CONCLUSIONS

Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

Mindfulness-Based and Mindfulness-Informed Interventions at the Workplace: A Systematic Review and Meta-Regression Analysis of RCTs

Objectives

Positive effects of mindfulness-based interventions (MBIs) on occupational health have been demonstrated by several systematic review studies during the last two decades. So far, existing reviews excluded mindfulness-informed interventions (MIIs) that build on informal approaches or mixed techniques aiming at improving mindfulness indirectly. To address this research gap, the present comprehensive meta-analysis synthesizes the results of RCTs of MBIs and MIIs conducted in various workplace settings.

Method

A systematic literature search was conducted in five electronic databases complemented by manual search. Random-effects models were used to synthesize standardized mean differences (SMDs) for 25 outcomes and seven overarching categories of outcomes, and to detect various temporal effects. Meta-regressions were run to elucidate average SMDs between mindfulness intervention types and intervention and population characteristics, with the goal of detecting sources of heterogeneity and help guide the selection of the most appropriate mindfulness intervention type.

Results

Based on 91 eligible studies (from 92 publications), including 4927 participants and 4448 controls, the synthesis shows that MBIs and MIIs significantly improve mindfulness (SMD = 0.43; 95%-CI [0.33;0.52]), well-being (SMD = 0.63; 95%-CI [0.34;0.93]), mental health (SMD = 0.67; 95%-CI [0.48;0.86]), stress (SMD = 0.72; 95%-CI [0.54;0.90]), resilience (SMD = 1.06; 95%-CI [-0.22;2.34]), physical health (SMD = 0.45; 95%-CI [0.32;0.59]), and work-related factors (SMD = 0.62; 95%-CI [0.14;1.10]). Sensitivity analyses demonstrate a tendency towards smaller effect sizes due to extreme outliers. Effect sizes are stable in short-term follow-up assessments (1-12 weeks) for most outcomes, but not for long-term follow-up assessments (13-52 weeks). Meta-regressions suggest that observable intervention characteristics (e.g., online delivery) and population characteristics (e.g., age of participants), as well as study quality, do not explain the prevalence of heterogeneity in effect sizes.

Conclusions

Generally effective, mindfulness interventions are a useful tool to enhance aspects of employee health. However, because of heterogeneity and risk of bias, studies aiming at high-quality data collection and thorough reporting are necessary to draw firm conclusions.

Preregistration

A protocol of this systematic review was registered with PROSPERO (Registration-No. CRD42020159927).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-023-02130-7.

A rapid review of evaluated interventions to inform the development of a resource to support the resilience of care home nurses

BACKGOUND

Nurses working in care homes face significant challenges that are unique to that context. The importance of effective resilience building interventions as a strategy to enable recovery and growth in these times of uncertainty have been advocated. The aim of this rapid review was to inform the development of a resource to support the resilience of care home nurses. We explored existing empirical evidence as to the efficacy of resilience building interventions. undertaken with nurses.

METHODS

We undertook a rapid review using quantitative studies published in peer reviewed journals that reported resilience scores using a valid and reliable scale before and after an intervention aimed at supporting nurse resilience. The databases; Cumulative Index to Nursing and Allied Health Literature, Medline and PsychInfo. and the Cochrane Library were searched. The searches were restricted to studies published between January 2011 and October 2021 in the English language. Only studies that reported using a validated tool to measure resilience before and after the interventions were included.

RESULTS

Fifteen studies were included in this rapid review with over half of the studies taking place in the USA. No studies reported on an intervention to support resilience with care home nurses. The interventions focused primarily on hospital-based nurses in general and specialist contexts. The interventions varied in duration content and mode of delivery, with interventions incorporating mindfulness techniques, cognitive reframing and holistic approaches to building and sustaining resilience. Thirteen of the fifteen studies selected demonstrated an increase in resilience scores as measured by validated and reliable scales. Those studies incorporating 'on the job,' easily accessible practices that promote self-awareness and increase sense of control reported significant differences in pre and post intervention resilience scores.

CONCLUSION

Nurses continue to face significant challenges, their capacity to face these challenges can be nurtured through interventions focused on strengthening individual resources. The content, duration, and mode of delivery of interventions to support resilience should be tailored through co-design processes to ensure they are both meaningful and responsive to differing contexts and populations.

The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life

BACKGROUND

Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS).

PURPOSE

To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL.

METHODS

Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit, for 3 weeks.

RESULTS

Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low (P = .003), while their low BO scores (P = .12) and moderate CS scores (P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased (P =.01). The hypothesis was partly supported.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.

Nurse managers' burnout and organizational support: The serial mediating role of leadership and resilience

AIMS

To investigate the relationship between organizational support and nurse managers' burnout and the serial multiple mediating effects of leadership and resilience.

BACKGROUND

Nurse managers are at a high risk of burnout, especially during the COVID-19 pandemic. However, no research has been done to examine the associations between nurse managers' organizational support, leadership, resilience and burnout.

METHODS

This cross-sectional study recruited 458 nurse managers from 13 tertiary public hospitals in Jiangsu, China. They completed the Survey of Perceived Organizational Support, the Clinical Leadership Survey, the Resilience Scale and the Maslach Burnout Inventor-Human Service Survey. The serial mediating effect of individual leadership and resilience was estimated using the structural equation modelling method via Mplus 7.0.

RESULTS

There were direct and indirect effects of organizational support on burnout, controlling for work variables. Leadership and resilience serially mediate the association between organizational support and burnout (β = -.051, 95% confidence interval: -0.093 to -0.020).

CONCLUSIONS

Among nurse managers, organizational support may be sequentially associated with improved leadership first and then resilience, which in turn is related to decreased burnout.

IMPLICATIONS FOR NURSING MANAGEMENT

We recommend that hospital administrators incorporate leadership, resilience and burnout assessment in the routine psychological screening of nurse managers and creatively apply the organizational interventions to decrease nurse managers' burnout.

Interventions to foster resilience in nursing staff: A systematic review and meta-analyses of pre-pandemic evidence

BACKGROUND

Given the chronic work-related stressors experienced by nursing staff in today's healthcare systems, international evidence suggests an elevated risk of developing stress-related mental symptoms. Therefore, identifying effective methods to foster resilience (i.e., maintenance or fast recovery of mental health despite stressor exposure) seems crucial. To date, little is known about the efficacy of these interventions in nurses.

OBJECTIVE

This systematic review aimed at summarizing the evidence on the pre-pandemic efficacy of psychological interventions to foster resilience, to improve mental symptoms and well-being as well as to promote resilience factors in nurses. Based on training programs with evidence for positive effects on resilience and mental health in meta-analyses, we aimed at identifying important and helpful intervention techniques.

DESIGN

Systematic review and meta-analyses based on a Cochrane review on pre-pandemic resilience interventions in healthcare professionals.

DATA SOURCES

MEDLINE, Embase, CENTRAL and 11 other databases were searched until June 2020 to identify eligible randomized controlled trials. Trial registers, reference lists and contact with authors were additional sources.

REVIEW METHODS

Two reviewers independently assessed study eligibility and extracted data. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias of included studies. We conducted random-effects pairwise meta-analyses for five primary outcomes, including resilience. The intervention contents and techniques were narratively synthesized.

RESULTS

Of 39,794 records retrieved, 24 studies were included in the review (N = 1879 randomized participants), 17 in meta-analyses (n = 1020 participants). At post-intervention, we found very-low certainty evidence of moderate effects in favor of resilience training for resilience (standardized mean difference [SMD] 0.39; 95% CI [confidence interval] 0.12-0.66) and well-being (SMD 0.44; 95% CI 0.15-0.72), while there was no evidence of effects on symptoms of anxiety, depression and stress. The improvement of well-being was sustained in the short-term (≤3 months), with additional delayed benefits for anxiety and stress. There was no evidence of effects at later follow-ups, with the caveat of only three available studies. Among nine programs with evidence of positive moderate effect sizes, intervention contents included mindfulness and relaxation, psychoeducation, emotion regulation, cognitive strategies, problem-solving and the strengthening of internal and external resources.

CONCLUSIONS

Given the chronic stressor exposure in nursing staff, our findings may guide both the design and implementation of nurse-directed resilience interventions. To improve the certainty of evidence, more rigorous high-quality research using improved study designs (e.g., larger sample sizes, longer follow-up periods) is urgently needed.

REGISTRATION

PROSPERO 2017 CRD42017082827.

Mindfulness Practice and Job Performance in Social Workers: Mediation Effect of Work Engagement

Despite a rapid increase in the work force over the last decade, the social work labor force is still suffering through high amounts of stress and burnout that could negatively affect work engagement and job performance in China. A potential solution worth exploring, however, is the practice of mindfulness, a concept based on expanding one's awareness to target focus without judgement. Using 537 social workers from street-level social work service stations in Guangzhou, China, this paper examines the relation between mindfulness practice and job performance, and whether work engagement mediated the relation through the application of the job demand and resources theory. The findings indicate that that mindfulness practice directly increases work engagement (Beta = 0.33) and has an indirect effect on job performance (Beta = 0.21) through its effect on work engagement that fully mediated the relation between mindfulness practice and job performance. In contrast to formal mindful practices (Beta = 0.13), informal mindful practices (Beta = 0.22) encompass a broader impact on employee performance. The findings suggest that mindfulness practice can effectively be used in workspaces to enhance engagement and performance of social workers in China.

Workplace Stress in Portuguese Oncology Nurses Delivering Palliative Care: A Pilot Study

Oncology nurses often face complex end-of-life issues, underlining their need for specific training in palliative care. In this context, nurses experience several emotional and psychological dilemmas, which are often difficult to manage and result in high levels of workplace stress. This study aimed to determine the levels and work-related factors of workplace stress among oncology nurses. A descriptive baseline study was performed as part of a large four-phase study based on quantitative data collected from Portuguese oncology nurses. Of the 32 participating nurses, most were women, and the mean age was 42.69 ± 10.04 years. Overall, nurses revealed moderate levels of stress. Younger nurses with less professional experience had difficulties dealing with issues related to death and dying. This pilot study supported the development of a program of six Stress Management Training Workshops (SMTW) to reduce stress and increase adaptative strategies. Assessing workplace stress among oncology nurses should be the focus of intervention by managers and institutional leaders.

Interventions to reduce the risk of mental health problems in health and social care workplaces: A scoping review

Work in the health and social care sector is stressful, and work-related stress increases the risk of depression, anxiety, burnout, and sleep disorders. Although interventions to reduce stress and burnout at workplaces have been developed and studied, most studies have lacked the effectiveness to improve the situation. Thus, more knowledge on interventions and analysis of their mechanisms is needed to reduce the risk of more adverse mental health problems (MHP). We conducted a scoping review to identify the relevant literature on individual and organizational interventions to improve mental health in health and social care workplaces. Data were gathered on target groups, intervention types and their effectiveness, and the outcomes of the interventions. We summarized this data thematically. The final review consisted of 76 studies. Mental health interventions primarily focused on health care workers rather than social care professionals. The interventions were mostly directed at individual workers, ignoring organizational-level interventions. They used a great variety of outcomes and questionnaires, and the questionnaires that measured the outcomes were used ambiguously. In most cases, the reported effectiveness of the studied interventions was incoherent, and many of the interventions had both statistically significant and non-significant effects. Evidence that interventions reduce the risk of work-related MHP is scarce. High-quality randomized controlled trials of interventions to promote mental health with more coherently formed outcomes are needed, especially on the organizational level. More interventions to improve social care professionals' mental health are also needed.

Health Promotion for Outpatient Careworkers in Germany

Due to ongoing demographic changes, the need for care is increasing in Germany. The number of outpatient care services is also rising, and with it, the number of employees in outpatient care, who are also continuously becoming older. Workplace health promotion (WHP) becomes relevant in this context, as it can reduce negative strain reactions and promote employees’ health. The aim of this study was (1) to reveal implemented WHP interventions in German outpatient care services; (2) to examine the potential challenges regarding a successful implementation of WHP measures; and (3) to illuminate further requests and needs experienced by outpatient careworkers. In qualitative field research, 30 semi-structured individual interviews were conducted with German caregivers, using the problem-centered interview method. The collected data were deductively and inductively evaluated and interpreted, using qualitative content analysis according to Mayring. Outpatient caregivers reported various WHP measures known from their workplaces, such as the provision of fruit baskets, programmes to increase physical activity, or a subsidy for a personal gym. They further reported WHP, such as back training, known from other care services. However, the respondents spoke of the challenges regarding the implementation or the use of WHP interventions in general. The most frequently named barriers were a lack of time after work and interventions that were only offered in their leisure time. In the same course, the participants still needed offers to increase physical activity, joint activities, or relaxation techniques. However, respondents highlighted that they preferred the interventions to take place during working hours. This way, they would also be more likely to take advantage of the interventions. The results of this study provide an insight into various WHP measures that already exist, or that are desirable for implementation with regard to caregivers’ needs. Subjectively perceived challenges for a successful implementation of WHP measures represent the importance of adjustments in the work organization of caregivers. It becomes clear that WHP is not yet established in the ambulant care sector, although it appears to be imperative for keeping caregivers healthy. Considering the different needs of employees, the results can provide a basis for the development of needs-based health promotion measures for caregivers.

Complementary and integrative medicine intervention in front-line COVID-19 clinicians

OBJECTIVE

To assess the impact of a multidisciplinary complementary and integrative medicine (CIM) intervention on physical and emotional concerns among front-line COVID-19 healthcare providers (HCPs).

METHODS

A multimodality CIM treatment intervention was provided by integrative practitioners to HCPs in three isolated COVID-19 departments. HCPs' two main concerns were scored (from 0 to 6) before and following the CIM intervention using the Measure Yourself Concerns and Wellbeing questionnaire. Postintervention narratives identified reflective narratives specifying emotional and/or spiritual keywords.

RESULTS

Of 181 HCPs undergoing at least one CIM treatment, 119 (65.7%) completed post-treatment questionnaires. While HCPs listing baseline emotional-related concerns benefited from the CIM intervention, those who did not express emotional or spiritual concerns improved even more significantly following the first session, for both leading concerns (p=0.038) and emotional-related concerns (p=0.023). Nevertheless, it was shown that following subsequent treatments HCPs who expressed emotional and spiritual concerns improved more significantly than those who did not for emotional-related concerns (p=0.017).

CONCLUSIONS

A CIM intervention for front-line HCPs working in isolated COVID-19 departments can significantly impact emotional-related concerns, more so after the first treatment and among HCPs not using emotional-spiritual keywords in post-treatment narratives. Referral of HCPs to CIM programmes for improved well-being should avoid referral bias to those not expressing emotional/spiritual concerns.

Relationship between nurses' perceptions of mental support and their positive and negative effects: A cross-sectional study

PURPOSE

To examine the relationship between nurses' perceptions of mental support and their positive and negative effects.

DESIGN AND METHODS

The cross-sectional study was carried out with 333 nurses working in various clinics. The data were collected in Turkey between 12 and 19 December 2020. The data were collected using personal information form, spiritual support perception scale and positive-negative impact program.

FINDINGS

A positive relationship was found between the perceptions of mental support of nurses and their positive effects, and a negative relationship between their perceptions of spiritual support and their negative effects.

EFFECTS FOR APPLICATION

As nurses' perceptions of mental support increase, their positive sensitivity increases and their negative sensitivity decreases.

Chronic stress, behavioral tendencies, and determinants of health behaviors in nurses: a mixed-methods approach

BACKGROUND

Nurses experience high, and often chronic, levels of occupational stress. As high-quality care requires a healthy workforce, individualized stress-alleviating interventions for nurses are needed. This study explored barriers and resources associated with health behaviors in nurses with different stress levels and work-related behavioral tendencies and identified health behavior determinants based on the Health Action Process Approach (HAPA) model.

METHODS

Applying a mixed methods transformative triangulation design, n = 43 nurses filled out chronic stress (SSCS) and work-related behavior and experience patterns (German acronym AVEM) questionnaires, and participated in semi-structured interviews. With content analysis, categories of health behavior-related barriers and resources emerged. Behavior determinants (self-efficacy, outcome expectancies), health behavior, and barriers and resources were quantified via frequency and magnitude coding and interrelated with SSCS and AVEM scores to link level of health behavior with potential influencing factors. Nonparametric tests explored differences in quantified variables for SSCS and AVEM scores and 4-step-hierarchical regression analysis identified predictors for health behavior.

RESULTS

Eighty-four percent of the nurses were chronically stressed while 49% exhibited unhealthy behavioral tendencies at the workplace. 16 personal and organizational themes (six resources, ten barriers) influenced health behaviors. Stress was associated with resource frequency (p = .027) and current health behaviors (p = .07). Self-efficacy significantly explained variance in health behaviors (p = .003).

CONCLUSION

Health promotion related barriers and resources should be considered in designing nurse health promotion campaigns. Practitioners need to individualize and tailor interventions toward stress and behavioral experiences for sustainable effects on adherence and health.

Virtual reality during work breaks to reduce fatigue of intensive unit caregivers: A crossover, pilot, randomised trial

PURPOSE

Intensive care unit (ICU) caregivers are exposed to high levels of stress. Work-related stress can impact quality of life and may lead to burnout. Virtual reality (VR) simulates a person's presence in a pleasant and enjoyable artificial environment. Thus, VR may be used to improve breaktime efficacy during the work shift of ICU caregivers.

OBJECTIVE

The study objectives were to evaluate the feasibility and efficacy of VR to decrease stress, anxiety, and fatigue, as well as to increase work disconnection during the breaktime.

METHODS

We conducted a prospective, monocentric, open-label, crossover, randomised study comparing a half an hour breaktime including an 8-min-long VR session and a usual breaktime among ICU caregivers, on two consecutive work shifts. Participants were evaluated before and after the breaktime as well as at the end of the work shift for stress, anxiety, fatigue, and work disconnection using visual analog scales.

RESULTS

For the 88 participants, VR was easy to use. VR induced a significantly higher reduction in the fatigue score after the breaktime. Individual changes in the fatigue score were +0.17 (1.87) vs. -0.33 (1.87). A significantly higher feeling of disconnection from the work environment at the end of the breaktime was also observed with VR: 5.98 (3.04) vs. 4.20 (2.64). No significant difference was observed for other parameters, in particular at the end of the shift.

CONCLUSION

VR sessions could improve the efficacy of breaktimes among ICU caregivers and contribute to a better quality of work life; repeated or longer sessions may be required to induce sustained effects.

Mindfulness-Based Stress Reduction for Nurses: An Integrative Review

Introduction: The impact of occupational stress on the mental health and well-being of nurses is a growing concern, magnified by the COVID-19 pandemic. Such compromised health is considered an occupational and patient safety risk. Our aim is to critically examine, analyze, and synthesize the evidence regarding MBSR on the perceived stress levels of nurses including overall mental health and well-being. Methods: An integrative review was conducted. Databases included were PubMed, Embase, PsychINFO, CINAHL, and the Cochrane Library. Inclusion criteria were English only, MBSR, and practicing nurses. Results: We identified 833 articles during database searching. After removal of duplicates and two rounds of screening, 15 articles were included in the final analysis. Several themes were derived with 60% of the studies showing a significant effect of MBSR on decreasing stress. Other significant themes were the decrease in burnout and increase in mindfulness. Conclusions: MBSR may be an effective holistic method of improving mental health for nurses during the COVID-19 pandemic. In both the abbreviated and full, 8-week versions of MBSR, the findings indicate the intervention can reduce depression, anxiety, and stress. Future recommendations include larger sample sizes and measurements other than self-reports to promote generalizability.

Effectiveness of mindfulness‐based interventions on psychological well‐being, burnout and post‐traumatic stress disorder among nurses: A systematic review and meta‐analysis

AIMS AND OBJECTIVES

The aim of this study was to investigate the effectiveness of mindfulness-based interventions on psychological well-being, burnout and post-traumatic stress disorder symptoms among working registered nurses.

BACKGROUND

Nurses account for nearly half of the global healthcare workforce and are considered significant contributors in multi-disciplinary healthcare teams. Yet, nurses face high levels of psychological distress, leading to burnout and post-traumatic stress disorder. Mindfulness-based training is a strategy that has been introduced to foster a state of awareness of present physical, emotional and cognitive experiences to regulate behaviour.

DESIGN

This systematic review of randomised controlled trials was designed according to PRISMA guidelines. Eligible studies were screened and extracted. Methodological quality was evaluated by two researchers, independently. RevMan 5.4 was used to conduct the meta-analysis.

RESULTS

Fourteen studies including a total of 1077 nurses were included, of which only eleven were included in the meta-analysis as the remaining had missing or incomplete data. Meta-analysis revealed that MBI was more effective than passive comparators in reducing psychological distress, stress, depression and burnout-personal accomplishment. When compared to active comparators, MBI was also found to be more effective in reducing psychological distress and was as effective in reducing stress, anxiety, depression and burnout. Evidence on the effects of MBIs on PTSD was scarce.

CONCLUSION

Mindfulness-based interventions can effectively reduce psychological distress, stress, depression and some dimensions of burnout. However, evidence remains scarce in the literature. There is a need for more methodologically sound research on mindfulness-based training among nurses.

RELEVANCE FOR CLINICAL PRACTICE

An important aspect that relates to the success of mindfulness-based interventions is the continued and dedicated individual practice of the skills taught during mindfulness training amidst demanding clinical work environments. Therefore, relevant support for nurses must be accounted for in the planning, design and implementation of future mindfulness-based interventions.

Investigating the effect of inquiry-based stress reduction on mortality awareness and interpersonal problems among intensive care unit nurses

INTRODUCTION

Caring for dying patients is one of the job stressors. Nurses in intensive care units are among the medical staff who have a close interaction with dying patients. Studies have shown that psychological interventions are very helpful in improving thinking about death and its problems. Therefore, this study was conducted to investigate the effect of Inquiry-Based Stress Reduction on mortality awareness and interpersonal problems among intensive care unit nurses in southeastern Iran.

MATERIALS AND METHODS

This was a Quasi-experimental study with a pretest-posttest design in southeast of Iran in 2021. Nurses were selected using the convenience sampling method and divided into intervention (n = 32) and control (n = 35) groups using the block randomization method. The intervention group received a two-hour Inquiry-Based Stress Reduction counseling session every week for 6 weeks. Data were gathered using Multidimensional Mortality Awareness Measure and Inventory of Interpersonal Problems before, immediately after, and 6 weeks after the intervention. IBM SPSS Statistics software version 25 was used for data analysis.

RESULTS

In the intervention group, the mean scores of Mortality Awareness before, immediately after, and 6 weeks after the intervention were 130.41 ± 5.91, 164.47 ± 8.66, and 163.91 ± 9.29, respectively. Therefore, in the intervention group, the increase of Mortality Awareness mean score was statistically significant (P < 0.001). In the control group, the mean scores of Mortality Awareness before, immediately after, and 6 weeks after intervention were 129.63 ± 5.59, 135.26 ± 11.14, and 132.66 ± 5.62, respectively. Difference between the two groups was significant (P < 0.001). The results also showed that in the intervention group the mean scores of Interpersonal Problems immediately after and 6 weeks after the intervention were lower than before the intervention (P < 0.001). In the control group, Interpersonal Problems increased over time (P < 0.001). Accordingly, the difference between the two groups in terms of Interpersonal Problems during the study was statistically significant (P < 0.001).

CONCLUSION

The study results suggest that the Inquiry-Based Stress Reduction is an appropriate intervention method to improve mortality awareness and reduce interpersonal problems in intensive care unit nurses.

Effects of Mindfulness-Based Interventions on Mental Health in Nurses: A Meta-Analysis of Randomized Controlled Trials

Mindfulness as a positive mental health intervention approach has been increasingly applied to nurses. This meta-analysis evaluated the psychological effects of mindfulness-based interventions (MBIs) on mental health in nurses. We searched PubMed, EMBASE, Cochrane, and CINAHL up to February 2020. Randomized controlled trials (RCTs) evaluating the effects of MBIs for nurses were included. Data extraction and the risk of bias assessment were conducted by two authors independently. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Of 370 studies retrieve from databases, nine RCTs, which involved 572 participants with 283 in an intervention group and 289 in a control group, were included in the final analysis. Compared to the control groups (no treatment, treatment as usual, or active control), MBIs reduced psychological distress such as anxiety, depression, or stress (SMD = -0.47; 95% CI, -0.67 to -0.32; I² = 34.7; n = 17) in nurses. Also, MBIs slightly improved psychological wellbeing such as resilience, wellbeing, or quality of life (SMD = 0.28; 95% CI, 0.11 to 0.46; I² = 0.00; n = 8). However, no statistically significant effects were found in Job related outcomes (SMD = 0.23; 95% CI, -0.01 to 0.47; I² = 20.5; n = 6). This meta-analysis found that MBIs had beneficial effects on mental health such as psychological distress and wellbeing in nurses.

The Effect of Mindfulness Breathing Meditation on Psychological Well-being: A Quasi-Experimental Study Among Nurses Working for COVID-19 Patients

The study aims to test the effect of mindfulness breathing meditation on psychological well-being among nurses working for COVID-19 patients. A total of 50 nurses (25 each in the intervention and control groups) were included in the study. We found significant differences between the preintervention and postintervention mean scores of both groups, based on the Warwick-Edinburgh Mental Well-being Scale Indonesian version.

Effects of mindfulness-based stress reduction on psychological distress in health workers: A three-arm parallel randomized controlled trial

Mindfulness-based Stress Reduction (MBSR) has shown good efficacy for improving wellbeing in employees experiencing occupational stress. However, comparisons with other interventions, longer-term follow-up, and data from varying sociocultural contexts are lacking. This three-arm, parallel randomised controlled trial (RCT) examined the effects of MBSR on psychological distress in non-physician health workers in direct contact with patients. 105 participants were randomly allocated to either: (1) MBSR (N = 35), (2) Stress Management Course (SMC; N = 34) or (3) wait-list (N = 36). Participants and those assessing outcomes were blinded to group assignment. Participants completed questionnaires pre- and post-intervention and four months after the intervention. Psychological distress was measured using the General Health Questionnaire (GHQ-12) and Outcome Questionnaire (OQ-45). Secondary outcomes included perceived stress, job satisfaction, mindfulness skills and changes in salivary cortisol. 77 participants completed measures post-intervention and 52 at 4-month follow-up. MBSR showed a post-intervention effect in reducing GHQ-12 (ß = -0.80 [SE = 1.58] p < 0.01) and OQ-45 (ß = -0.72, [SE = 5.87] p < 0.05) psychological distress, compared to SMC and in reducing GHQ-12 (ß = -1.30 [SE = 1.38] p < 0.001) and OQ-45 (ß = -0.71, [SE = 5.58] p < 0.01) psychological distress compared to wait-list condition. In our secondary outcome, only MBSR was associated with a decrease in the cortisol awaking response by 23% (p < 0.05). At follow-up, only effects of MBSR on the psychological distress 'social role' subscale (ß = -0.76 [SE = 1.31] p < 0.05) remained significant, compared to SMC. In conclusion, MBSR appears useful in reducing short-term psychological distress in healthcare workers, but these effects were not maintained at follow-up. Trial registration: ISRCTN12039804.

Protocol for the Implementation and Evaluation of a Mindfulness-Based Intervention for Caregivers of Children with Mental Disorders in a Clinical Setting

Being a parent is complicated in typical circumstances, with a great psychological impact as well as feelings and experiences of great intensity. This impact is greater in families in vulnerable situations, such as those with children with mental health problems, receiving treatment in a clinical setting. Due to these challenges, parenting in these circumstances is often accompanied by experiences of stress. An approach that has shown evidence of effectiveness in mitigating the negative impact of stress is mindfulness-based interventions, including the Mindfulness-Based Stress Reduction intervention program. The Mindfulness-Based Stress Reduction intervention program is designed as a psychoeducational, instructional, multimodal, and structured program whose main objective is to provide strategies for the management, coping, and awareness of stress in order to reduce it. In this paper, a protocol for the implementation and evaluation of the original Mindfulness-Based Stress Reduction intervention program with the added positive parenting component is presented, in order to systematize the incorporation of a parenting component in the Mindfulness-Based Stress Reduction intervention program, analyze its effectiveness for parents whose children have mental health problems (in terms of stress, mindfulness, emotional intelligence, general health, and parental role), explore the mechanisms of change operating in this intervention as perceived by the participants, and examine the application of acquired strategies to daily life.

The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review

The mental health of nurses including burnout is an important issue. The purpose of this systematic review was to evaluate whether mind-body modalities improve burnout and other mental health aspects of nurses. A comprehensive search was conducted using six electronic databases. Randomized controlled trials using mind-body modalities on the mental health of nurses, up to January 2021, were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Seventeen studies were included in the review. Data on mindfulness-based interventions (MBIs) and yoga were available for burnout, and there was no evidence that multimodal resilience programs including MBIs statistically significantly improved burnout levels compared to no intervention or active control groups. However, one study reported that yoga could significantly improve emotional exhaustion and depersonalization, which are subscales of burnout, compared to usual care. In addition, the effects of MBIs, relaxation, yoga, and music on various mental health outcomes and stress-related symptoms have been reported. In conclusion, there was some evidence that yoga was helpful for improvement in burnout of nurses. However, due to the heterogeneity of interventions and outcomes of the studies included, further high-quality clinical trials are needed on this topic in the future.

Individual-Level Interventions for Decreasing Job-Related Stress and Enhancing Coping Strategies Among Nurses: A Systematic Review

Background: Nurses are facing unprecedented amounts of pressure because of the ongoing global health challenges. Improving nurses' resilience to job-related stress and enhancing their strategies to cope effectively with stressors are key issues facing many health care institutions during the COVID-19 pandemic. This literature review aimed to: a) provide a thorough overview of individual-level interventions for stress management among nurses, b) identify measurement tools utilized to evaluate nurses' stress level, and c) provide the best evidence-based recommendations for future research and practice adapted to the current restrictions. Design: Systematic review. Data Sources: Studies published between January 2000 and October 2020 were retrieved from the following sources: EBSCOhost, Dortmund University Library, PubMed, Medline, Google Scholar, Applied Nursing Research, and reference lists from relevant articles. Review methods: Individual-level interventions with a control group or a placebo intervention were included in the final sample. Primary outcome was defined as a change in individual stress level or stress symptoms which were measured by objective or subjective instruments with evidence of validity. Articles published in English or German were included in the present review. Results: In total, 27 relevant studies were included into the current review. There are some indications that technology-delivered interventions with relaxation and stress management interventions comprising cognitive-behavioral components might be effective in decreasing stress among nurses and improving their well-being. Furthermore, although there were some attempts to collect objectively measured parameters for assessing the primary outcome of stress, the majority of the interventions utilized self-reported stress scales. Conclusion: A wide range of interventions are available for nurses. However, it is of utmost importance to develop and implement stress management programs that are conveniently accessible in the workplace and above all, meet the current restrictions for minimizing human contacts. To this end, innovative interventions delivered through digital technology, such as virtual reality, seem to be a promising solution for combating the detrimental impact of stress on nurses. Special attention should be also paid to applying standardized objective measurement tools to allow the assessment of sensitive physiological indices and the generalizability of scientific knowledge.

Individual Resilience Interventions: A Systematic Review in Adult Population Samples over the Last Decade

Resilience interventions have been gaining importance among researchers due to their potential to provide well-being and reduce the prevalence of mental disorders that are becoming an increasing concern, especially in Western countries, because of the costs associated. The purpose of this systematic review is to identify the intervention studies carried out in the last decade in adult population samples, evaluate their methodological quality and highlight the trends of these types of interventions. This review was performed using systematic literature searches in the following electronic databases: B-on, PubMed, PsycNet and Science Direct. The application of eligibility criteria resulted in the inclusion of 38 articles, of which 33 were randomized controlled trials and the other five were nonrandomized controlled studies. Although most studies showed statistical significance for their results, these were constrained by the great heterogeneity of the studies, the lack of power of the samples and their fair methodological quality. Therefore, it is important to consolidate the theoretical basis and standardize certain methodologies so that the effects of the interventions can be compared through a meta-analysis.

The Effects of Mindfulness Meditation on Stress and Burnout in Nurses

Background: Occupational burnout related to stress in the workplace is experienced by nurses who are regularly confronted with trauma, suffering, and high workloads. Burnout can negatively impact patient care and have detrimental effects on nurses' physical and mental health. Mindfulness-based stress reduction programs have been researched as a potential holistic intervention for reducing stress and burnout in nurses through cultivating present awareness, emotional regulation, and positive thinking. Purpose: This critical review of the literature explores current knowledge on the effectiveness of mindfulness meditation on stress and burnout in nurses, examines gaps in the current literature, and provides recommendations for future research on this topic. Methods: Search terms included mindfulness, meditation, mindfulness-based stress reduction , occupational stress, stress, burnout, and nurs*. Peer-reviewed research directly related to the impact of mindfulness-based stress reduction on nurses experiencing stress and/or burnout was reviewed. Findings: Findings reveal evidence that mindfulness meditation is effective in decreasing stress and burnout in nurses. Mindfulness-based interventions have been shown to significantly decrease stress, improve all aspects of burnout, and increase self-compassion and compassion satisfaction in practicing nurses. Conclusions: Mindfulness meditation has the potential to decrease stress and burnout in nurses by decreasing self-judgment and overidentification with experience, and by increasing resiliency, compassion, and emotional regulation.

Nurses' experiences of the effects of mindfulness training: A narrative review and qualitative meta-synthesis

OBJECTIVE

To explore nurses' experiences of the effects of undertaking mindfulness training.

DESIGN

Qualitative meta-synthesis.

DATA SOURCES

Qualitative literature from seven scientific databases: Pubmed, Cochran Library, Science Direct, EBSCO, Web of Science, Scopus and PsycINFO were searched.

REVIEW METHODS

The PRISMA flow diagram was used to report the phases of the literature search. The Critical Appraisal Skills Program (CASP) qualitative research checklist, and the Mixed-Methods Appraisal Tool (MMAT) for mixed method studies were used as appraisal framework. Data synthesis was conducted using Thematic synthesis. The review steps were guided by Adams, Chamberlain, & Giles, 2019 and Whittemore & Knafl, 2005.

RESULTS

4 qualitative studies and 3 mixed-methods studies were included in the review. Four interpretive themes were generated to show how nurses experience of the effects of mindfulness training: 1. Stress conceptualisation and management; 2. Nurses' valued aspects of mindfulness training strategies; 3. Self-care awareness and strategies; 4. Challenges of mindfulness training.

CONCLUSION

Conducting mindfulness-based interventions among nursing professionals helps to reduce work-related stress and has positive effects on work and life.

Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: a systematic review and meta-analysis

BACKGROUND

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTE) and developing posttraumatic stress injuries (PTSI, e.g., depression, anxiety) by the nature of their work. PTSI are also linked to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. Evidence is lacking regarding the effectiveness of "prevention" programs designed to mitigate PTSI proactively. The purpose of this review is to measure the effectiveness of proactive PTSI mitigation programs among occupational groups exposed to PPTE on measures of PTSI symptoms, absenteeism, and psychological wellness.

METHODS

Five electronic databases were searched per PRISMA guidelines for English or French peer-reviewed studies from 2008 to 2019 evaluating PTSI and psychological wellness in adults exposed to occupational PPTE. The risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

We identified 42 studies evaluating 3182 public safety and frontline healthcare professionals, PPTE-exposed educational staff, and miners. Significant overlap was found across program themes that included mindfulness, psychoeducation, resilience promotion, and stress management strategies. Post-program effect sizes were small (SMD < 0.5) to moderate (SMD < 0.8) for reductions in PTSI symptoms and for promoting measures of well-being as indicated by a meta-analysis on 36 studies. There was no evidence for significant reductions in substance use, absenteeism, or biomarkers of distress except for heart rate. Subgroup analyses indicated that multimodal programs effectively improved general psychological health, while resilience programs improved measures of depression, burnout, coping, and resilience. Effect sizes for resilience, depression, and general psychological health improvements were greatest immediately or 1-month post-training, while improvements in PTSD symptoms and coping were larger at longer follow-up. Studies were of moderate quality and risk of bias.

CONCLUSIONS

The current results showcase modest evidence for time-limited reductions in PTSI following participation in holistic programs that promote resilience, stress, and emotion regulation among at-risk workers. Implications for organizational implementation of proactive PTSI mitigation programs and areas of future research are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42019133534).

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.

Job Stress, Psychological Capital, Perceived Social Support, and Occupational Burnout Among Hospital Nurses

PURPOSE

To determine the structural relationships among nurses' occupational burnout, job stress, psychological capital, and perceived support from society.

DESIGN

A cross-sectional design was performed to collect data from 766 registered nurses in three general tertiary Class A hospitals from March to August 2018.

METHODS

Structural equation modeling was performed to examine the proposed model.

FINDINGS

The research data supported the proposed model. Psychological capital, job stress, and perceived social support significantly influenced occupational burnout. Job stress indirectly influenced burnout through perceived social support and psychological capital. The influencing factors accounted for 49% of the variance in explaining burnout.

CONCLUSIONS

The findings identified structural relationships among the four studied variables. This study provides new information regarding the preventive role of perceived social support and psychological capital, which perform the mediating role between job stress and occupational burnout.

CLINICAL RELEVANCE

Nursing administrators should provide a healthy work environment, effective psychological capital training, and assistance to reduce nurses' occupational burnout.