Effect of a Mindfulness Meditation Program on Nurses

Subject: Nursing
Pages: 18
Words: 4855
Reading time:
21 min
Study level: Master

Introduction

Stress has become an integral element of modern life, and it is impossible to avoid it. Stress has permeated all areas of human activity, affecting people in a variety of ways. It is present in the workplace environment, in general, in everyday interaction, and even at home. Stress entails an array of negative consequences, as it affects people’s mental health and overall well-being. Moreover, while there is a certain amount of tension present in the majority of human activities, some events aggravate the situation, introducing new sources of colossal stress. The year 2020 has seen a pandemic of unprecedented magnitude, as COVID-19 virtually paralyzed the planet. The situation, in general, has become an important issue for millions of people across the globe. There are, for example, fears regarding one’s health, as well as their friends and relatives. Also, COVID-19 can cause lethal complications in the cases of patients who form risk groups in the context of the disease. This increases the workload experienced by the health care system and all its elements.

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Nurses play a role of paramount importance in the clinical environment, as they ensure proper communication and service delivery among other participants of the health care system. Due to the nature of their work, nurses experience increased levels of stress daily. This tension gradually accumulates within them, causing dire consequences in the long term. The issue is particularly topical for the nurses regularly working with high-morbidity patients. Such an environment is inseparable from the concept of death and suffering, which inevitably affects even the most experienced professionals. As a result, negative emotions become embedded in the lives of nurses. Many of them prefer to avoid intervention, as they are unsure of its effectiveness and prefer not to spend time if the results are not guaranteed. However, one must resort to specific measures to mitigate the detrimental impact of working with high-mortality patients. A mindfulness meditation program is often considered an effective instrument of stress management, and nurses may benefit from it. The purpose of this review is to examine the effectiveness of a mindfulness meditation program in nurses working with high-morbidity patients during the pandemic, as compared to no intervention.

Problem Statement

Nurses undergo profound professional training, which prepares them for stressful situations. Indeed, everyone who works in the health care system can expect such inevitable elements of the field as pain, suffering, and death. However, while the issue can be predicted, its impact remains significant. Also, the impact of the problem becomes even more profound in the unusual circumstances of a pandemic, which alters familiar processes in a variety of spheres. As discussed above, the present Covid-19 situation entails negative complications in both the physical and mental aspects of human existence. In the case of nurses, their workload has increased dramatically since the beginning of the pandemic. At the same time, previous issues have not disappeared, meaning that they have been combined with the new reality, thus posing a major problem for the system. Nurses who work directly with high-mortality patients experience additional stress caused by the Covid-19 pandemic, which leads to an alarming situation in health care. An effective intervention is required to propose a viable solution to the discussed issue and eradicate the problem.

Significance of the Practice Problem

Nurses working with high-morbidity patients experiences additional stress, which causes various issues and demands a prompt response. The problem is not limited to a particular practicum site or even to one nation, such as the United States. The issue, which is described within the framework of the present review, exists on a global scale, as no corner of the world remained untouched by the Covid-19 pandemic. Apart from the pandemic, the problem of work-induced stress experienced by health care system workers has always been topical. The nature of the nurses’ work is challenging in terms of both physical and mental conditions. Health care workers may spend longer shifts than usual, often working for more than twenty-four hours in critical situations. In addition to this, nurses in high-morbidity units interact with stressful cases directly, and the tension comes from all directions, including the patients, along with their friends and families. Nurses from across the globe work in similar, challenging conditions, as it is dictated by the holistic nature of their work.

On the other hand, despite the commonality of instances of stress in the nurses’ work, it was impossible to be prepared for the challenges entailed by the Covid-19 pandemic in the year 2020. Once the problem emerged on a global scale, hospital units began to work at their maximum capabilities to process the increasing number of patients. Many of these patients arrived in poor condition, demonstrating higher risks of a lethal outcome. Pain and suffering, which had been relatively common in the nursing profession, reached an unprecedented level. Que et al. (2020) confirm that medical workers experienced tremendous pressure amid the COVID-19 pandemic, which leads to higher risks of mental issues among them. The range of issues, which emerge due to the increased stress is large and includes such alarming conditions as anxiety, depression, and insomnia reported by 60% of nurses (Que et al., 2020). While these problems may seem common, they are difficult to eradicate without timely intervention. If measures are not taken, these conditions remain for a long time, thus lowering the quality of a person’s life.

The significance of the discussed problem can also be explained from a professional point of view. Despite modern advancements in the fields of technology and artificial intelligence, humans remain at the core of all processes in the sphere of health care. It is the professional expertise of doctors and nurses that determines the treatment outcome, and it is better for the patients if health care professionals are in optimal condition. Barbe et al. (2017) write that, in the clinical context, proper cognitive functioning is the key to error prevention and effective service delivery. Their study showed that “perceived stress and subjective concerns about cognitive function were associated with greater impairment of work function” (Barbe et al., 2017, p. 914). Accordingly, it is possible to say that nurses who experience immense stress are more likely to make errors in the line of work. Thousands of nurses continue to make great contributions to the global fight against the Covid-19 pandemic. Therefore, the discussed problem is directly related to the quality of health service delivery and public health, in general, on a global scale.

Theoretical Framework

As the issue described above poses considerable challenges, eradicating should be a matter of high priority for the health care systems worldwide. Increasing stress levels often remain without a proper response, as people decide to continue living with it. Nevertheless, evidence suggests that proper intervention is indispensable, as it would help the workers ensure the quality of care they provide for their patients. The methods of stress management and relief vary in the modern environment, as the issue has become an area of intense interest for researchers. Each method demonstrates different results, as it may be better applied in a particular situation. In other words, there is not a universal stress relief paradigm, which can be applied across all settings with constant efficiency. Nevertheless, mindfulness meditation appears to be a viable solution to the problem. First of all, it does not require much time or particular effort, making it an easier choice for nurses with busy lives. Secondly, this method is not associated with any potential risk, making it a harmless option for nurses aiming at reducing their occupational stress.

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The effectiveness of mindfulness meditation techniques has been tested across different settings. Heckenberg et al. (2018) emphasize the perceived relation between such methods of stress management and job satisfaction, health, general well-being, and reduced workplace anxiety. However, it is also stated that the evidence of mindfulness-based techniques has been insufficient (Heckenberg et al., 2018). The contemporary environment is stressful, which translates into people’s mental and physical health. Accordingly, stress relief techniques have been receiving increased attention, and mindfulness meditation techniques were among the most prominent ones in several settings. For example, Bamber and Morpeth (2019) studied the matter in the case of college students and concluded that mindfulness-based programs, among other important factors, can reduce the students’ anxiety. According to Heckenberg et al. (2018), research into such techniques reveals promising findings amid the global pursuit of effective stress reduction approaches. It appears possible to apply these results in the area of nursing, which served as the focus of the present research. Despite evident particularities of the field, health care workers retain basic human psychological processes, which is why it is justified to expect similarly positive results in the case of nurses.

Methodology

Review Protocol

Modern research databases contain substantial amounts of literature related to either mindfulness meditation programs or work-induced stress in practicing nurses. Accordingly, the first stage of the integrated review comprised a selection of sources, which would be useful in the context of the present review. The DNP student devoted sufficient time to this task, searching for relevant research in this area. In the academic setting, there are several respectable databases, which can be examined for useful sources. First of all, the DNP student opted for academic research databases, including Research Gate, ScienceDirect, and Springer, as they contain thousands of scholarly articles on a wide range of topics. This way, the DNP student was able to ensure the accuracy of the findings and the general credibility of the integrated review.

Once the databases were determined, it was necessary to select relevant materials among the great variety of sources. The present research examines the problem of nurses’ occupational stress and the effect of mindfulness meditation programs on the situation. Naturally, the amount of studies, which encompass the entire research area, is small, which is why the source selection process focused on the particular aspects of the problem and its solution. The topic of the research was divided into two major notions, which are “workplace-related stress in nurses working with high-morbidity patients” and “mindfulness meditation effect on workplace-related stress.” These two phrases comprised the maximum meaning, reflecting the nature of the present study. Accordingly, the number of pertinent sources grew, allowing the DNP student to cover the matter from various perspectives.

To order to improve the accuracy of the results further, each of the major notions was divided into key phrases. First, “workplace-related stress in nurses working with high-morbidity patients” contains two central terms of this research. Nurses who work with high mortality risk patients form the demographics of the study, as their line of work serves as the primary source of occupational stress in this context. Nevertheless, it is possible to use this notion as a combination of two sub-concepts, each of which can be searched independently: “nurses” and “high-morbidity patients.” At the same time, there is a second major aspect discussed within the framework of the present review. Mindfulness meditation forms the second crucial area of research, which makes it possible for it to serve as another key phrase. Naturally, there are several ways to describe this concept, and it can take the form of a “mindfulness-based program” or a “mindfulness meditation technique.” It is vital to consider possible phrasings during research, as it allows the DNP student to encompass a greater scholarly context.

Inclusion/Exclusion Criteria

Once the databases and the approach to material search were established, the DNP student proceeded to select the preliminary list of sources. To ensure the quality of the researched material, it was necessary to introduce particular criteria, according to which the sources were selected and utilized. The list of these criteria applied in the selection process comprises two major categories. First, the primary criteria were used to prepare the initial list of sources, many of which would not end up in the finalized research. At this stage, the materials were selected in accordance with limited basic criteria. Secondly, the selected materials were expected to come from recent research published within the last five years. At this stage, some articles written in 2014 and 2015 were also considered for further examination if they were found relevant.

Naturally, all of the primary criteria are superseded by the relevance of the material. As the search was conducted with the use of the terms defined in the previous section, each article was expected to directly relate to one of the core concepts. The list of these concepts included “nurses working with high-morbidity patients,” “nurses’ work-related stress,” and “mindfulness meditation technique.” If the source was, indeed, relevant, credible, and up-to-date, it was then added to the primary list. This fact did not imply that each of the papers, which met the primary inclusion criteria, would be reflected in the finalized research. On the contrary, it means that the materials on the primary list were put under further scrutiny to determine their pertinence to further study.

At this stage, the DNP student used particular secondary criteria, which allowed papers to be included in the finalized review. Among all articles written in English, preference was given to those, which were based in the United States. However, many of the initially selected articles come from other regions of the world and provide valuable international insight. In this case, the interest and relevance of the study outweighed the geographical factor. Next, while all of the sources were relevant to the topic, the degree of their relevance varied, meaning that it was possible to arrange them according to this parameter. To keep the length of the present review within an optimal range, a decision was made to select the top fifteen sources for an in-depth integrated review using the John Hopkins instrument. This way, the study retained the required diversity of standpoints while remaining within an adequate size.

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Data Analysis

Quantitative Research

Following the thorough selection of articles, it was possible to proceed to the next stage, which consisted of data extraction. The selection process implied preferences for neither qualitative nor quantitative studies, as it was important to include various information in different forms. The process of data extraction for each article began with listing the correlations between their objectives and results. The quantitative findings were compared directly based on their numerical values to determine the average figures. It was possible for studies that examined similar parameters. This way, the DNP student managed to see the general tendencies of occupational stress levels reported by nurses working in high-morbidity patient units. As the examined literature provided an international view of the topic, the calculations demonstrated average figures on a worldwide scale.

Qualitative Research

At the same time, the study relied on several pieces of qualitative research. This kind of study aims at describing the tendencies in verbal and introduce new theoretical perspectives. In fact, the qualitative research model prevailed in the selected works, as a comprehensive description of the concept was the objective of most of them. Many studies relied on surveys as their primary sources of information. Kelm et al. (2018) conducted several accurate tests and compared results against an interview to confirm their findings. Simultaneously, questionnaires were utilized by Gholizadeh et al. (2017), as well as Adzakpah et al. (2016) and Saedpanah et al. (2016). Test scales were also used to evaluate the findings by Penque (2019) and Sanko (2016). Systematic reviews and meta-analyses by Heckenberg et al. (2018) and Bamber and Morpeth (2019) helped the DNP student discern the primary tendencies within the researched field.Overall, the nature of the discussed issue suggested that the study should rely more on the qualitative model, allowing the DNP student to provide an in-depth explanation of the practice problem.

Results and Discussion

Characterization of the Body of Literature

As mentioned in the previous sections, the present research suggested a thorough review of the literature. Before being included in the present review, all sources went through a two-stage selection process. Particular criteria presented above were applied to each article to ensure its credibility and relevance. Therefore, it is possible to consider reliable all materials cited and examined within the framework of the present review. Overall, the selection process resulted in fifteen articles being included in the study. Each of them met both primary and secondary criteria, is then analyzed in the format of an integrated review. The quality of each article was adequate and met the requirements of the research. At the same time, the selection process led to the exclusion of seventeen sources. While they were relevant, to a degree, the articles, which ultimately were utilized, presented greater interest to the DNP student. For example, some of the excluded materials considered various methods of reducing work-related stress in nursing, but little or no attention was devoted to the mindfulness program. Therefore, the prior selection process ensures the quality of sources described in this review.

All fifteen articles come from respected, peer-reviewed journals with a great reputation in the academic environment. Most of the periodicals are dedicated to the issues, which exist in the sphere of health care. For example, Teaching and Learning in Medicine is a journal, which examines the problem of training health care professionals, including nurses. The articles it publishes, such as the one by Kelm et al. (2018), investigate various aspects of health service delivery in the educational context. Clinical Case Reports and Reviews is another example of a health care-centered periodical with solid research, including the article by Adzakpah (2016). Therefore, researchers of such journals understand the importance of their mission, as the work they publish will directly influence aspiring professionals. Such materials are credible and recent, whereas the data is accurate due to multiple peer reviews it undergoes before being published.

At the same time, there is a large number of journals that are devoted to nursing, along with its challenges and particularities. As discussed at the beginning of this review, nurses play a role of paramount importance in the system of health service delivery. They ensure quality communication within the process, which unites all elements of this framework, including patients and clinical staff. Doctors rely on nurses for professional assistance and expertise, whereas patients see them as those who provide them with comfort and human interaction. Accordingly, the issues related to nursing usually concern quality communication and patient-centered practices in the modern health care environment. Nurse Education Today focuses on the problems through the prism of future nurses’ training, and Sanko et al. (2016) utilized this opportunity to discuss the impact of mindfulness meditation. Nursing Management investigates the issues from the clinical managers’ perspective, listing mindfulness as one of the ways of ensuring nurses’ well-being and health (Penque, 2019). Nursing issues remain topical in the 21st century, and a large number of nurse-specific journal confirms the pivotal role of this occupation in the modern clinical environment.

Naturally, some studies demonstrate particular limitations despite their immense interest and potential. For example, while works are dealing with the effect of mindfulness meditation and similar practices on professional groups, their results cannot be deemed completely accurate and universal. In many cases, there is no control group present in the review, meaning that the outcome cannot be compared. This situation is observed in the research conducted by Kelm et al. (2018), Penque (2019), and Black et al. (2016). In addition, some of the samples are relatively small, thus decreasing the accuracy of the findings. This idea is true for studies conducted by Heredia et al. (2017) and Sanko et al. (2016). However, the contribution of the presented studies remains considerable, outweighing the limitations.

Findings Synthesis

The main objective of the discussed integrated review was to analyze the information related to the main topic, which is the effect of mindfulness mediation on occupation stress of nurses working with high-morbidity patients. As stated in the previous section, the DNP student attempted to select the source, which would cover the maximum of the notions included in the topic. The analysis instrument provided by the John Hopkins Institute was used to examine the findings of each paper and present them in a convenient form, as seen in the Appendix. This format allowed to determine the relevance of findings provided by each study and evaluate its relation to the practice question. Simultaneously, there was a particular sequence of findings, which allowed the DNP student to analyze the theoretical framework of each pertinent aspect.

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Occupational Stress in Nursing

First of all, it was indispensable to investigate the very foundation of this research area, which is the phenomenon of occupational stress in the context of nursing. There was a selection of several sources, which provide evidence supporting the idea of increased tension, which health care workers face daily. The findings discussed by Rabei et al. (2020) demonstrate that nurses begin to encounter particular psychological issues from the early stages of their practice, including nursing school. The list of effects is typical and comprises sleep disorders, depression, and anxiety. A similar perspective is provided by Barbe et al. (2017), although they extend their research to further stages of a nurse’s career. It is said that direct patient care involves elevated stress, disturbing the nurses’ cognitive functions, and impairing their ability to work effectively. Adzakpah et al. (2016) state that the profession of nursing is associated with a heavy workload and conflicting requirements. Therefore, this sphere is highly demanding in terms of physical and mental activity, while also being exhausting.

It appears possible to conclude that nursing is, indeed, a field, in which occupational stress consistently reaches high levels. In fact, the tension tends to prevail from the early periods of a nurse’s career and it is accumulated over the years if nothing is done to manage it. Furthermore, this idea represents the general situation infield, which is present at any given moment. However, there are periods, during which the level of pressure rises even higher. Que et al. (2020) add another context to the issue by discussing its relation to the COVID-19 situation. The pandemic has been highly stressful for people across the globe, and its impact on the health care system is unprecedented. Nurses and other professionals have been working in extremely hard conditions, as the negative impact of their occupation has increased dramatically. The effect of the Covid-19 situation becomes evident, thus introducing a new perspective to the present review.

The Effectiveness of Mindfulness Techniques

Previously listed findings confirm the idea, according to the work of a nurse is associated with additional stress experienced regularly. Therefore, the necessity of an effective stress-coping instrument becomes apparent within the integrated review. Mindfulness meditation techniques form the theoretical core of this review, which is why it was necessary to examine the materials related to this concept. It can be applied across different settings, and before discussing its effectiveness for nurses, it was useful to introduce evidence from other spheres of human activity. Bamber and Morpeth (2019) analyzed the use of mindfulness meditation in the case of college students, who may experience similar unfortunate conditions. It was revealed that such techniques helped students overcome anxiety and improve their academic results, making these findings promising for the present review. Janssen et al. (2018) developed this idea and researched mindfulness practices in professional settings. It was concluded that it increased awareness, stabilized emotional well-being, improved professional performance, and reduced stress. Therefore, it is possible to expect a similar effect in the case of nursing challenges.

Mindfulness Meditation Program in Nursing

Mindfulness meditation techniques can be applied in different situations, but it is their effectiveness in clinical settings that serve as the driving core of this study. Rusch et al. (2019) focused on different awareness meditation programs and investigated their effect on respondents. As it was discovered, such meditation techniques led to substantial improvements in the participants’ quality of sleep, and insomnia was reported to be one of the leading implications of workplace-induced stress. This effect is stated to remain in the long term, confirming the lasting positive effect of mindfulness meditation. At the same time, its effectiveness was tested over eight weeks, thus providing an adequate timespan of reference for the DNP student. A pilot study was conducted by Heredia et al. (2017) along the same lines. The findings suggest that psychological well-being programs also have a short-term positive effect. They reduce anxiety and increase productivity, making them a viable choice for those who experience the unfortunate complications of occupational stress.

Research Synthesis

Overall, the selected research provides valuable findings, which may serve as evidence in support of mindfulness program effectiveness in the clinical setting. The central question of the present review concerns, first of all, nurses who work in direct contact with high-mortality patients during pandemics. Intensive care units are an excellent example of such departments, in which instances of suffering and death are more frequent as compared to other parts of the hospital. According to Gholizadeh et al. (2017), intensive care units are particularly stressful for healthcare professionals due to the aforementioned challenges. Consequently, the importance of stress relief techniques in such units is significantly higher. To prevent stress from reaching critical levels, it is needed to implement the relief methods in a timely manner. This way, nurses will be able to accomplish their noble objectives without inflicting damage to their health.

Having considered the evidence from all sources, it is possible to synthesize a common conclusion. Occupational stress is a topical issue, which, however, gains additional importance in the health care environment. Nurses are particularly vulnerable to this problem, and they report an array of its negative effects, including anxiety, depression, and insomnia. Negative emotions are accumulated, which is why the negative impact proves to be continuous. At the same time, there are particular periods during which nurses experience additional pressure. The current pandemic has become such an event of an unprecedented magnitude, and, as a result, nurses and other health care workers operate under immense pressure. Mental health and well-being are an area of intense interest for modern researchers, as they seek effective ways of reducing the detrimental impact of work-induced stress. Mindfulness meditation techniques are proposed to attain this goal and allow people to relax even during the most stressful periods. Nurses demonstrate a strong positive response to such interventions, which is why it is important to promote similar techniques.

Conclusions and Further Recommendations

Implications for Nursing Practice

The nursing practice can benefit greatly from the analysis and implementation of these findings. It is possible to utilize them at the stage of nursing education, as aspiring professionals become acquainted with the multifaceted nature of their occupation. It is important to know both the advantages and the risk of each job, and work-induced stress, which nurses experience in their line of duty, is an aspect that cannot be disregarded. This is a phenomenon with which both aspiring and practicing nurses will have to deal regularly, which is why it is needed to implement effective practices as early as possible. Therefore, mindful meditation routines can be proposed to nursing students as a part of their first internships.

Conclusions and Contributions to the Professions of Nursing

In conclusion, nurses constitute the most vulnerable professional group within the clinical setting, as they deal with numerous stressful situations throughout their careers. In the case of high-morbidity patients, nurses face trauma, pain, and death regularly, which inevitably affects their mental condition. In addition, some critical periods make the situation worse by introducing new challenges, with which nurses have to cope effectively. The present COVID-19 pandemic has become one of such global problems, which entails excessive stress on a worldwide scale. Accordingly, nurses have been experiencing increased pressure, and the demand for effective stress relief techniques is higher than ever. Mindfulness meditation is one of such programs, which can be effectively utilized in many settings. The integrated review conducted within the framework of the present research suggests that this method is very promising in terms of alleviating stress. In addition, it helps people overcome such issues as sleep disorders, depression, and anxiety. The effectiveness of mindfulness programs in the case of nursing seems obvious, which is why it can be proposed to health care specialists as a means of continuous stress reduction applied regularly.

Recommendations

There remain considerable research opportunities in this area, despite various evidence of mindfulness meditation effectiveness. First of all, the DNP student should test the presented theoretical framework in practice using a quantitative method. It is proposed to conduct a twelve-week practical study on-site. The proposed study will implement an evidence-based approach to compare two scenarios within two months. The effect of a mindfulness meditation program will be examined in contrast with a lack of intervention. Registered nurses facing increased stress levels due to the nature of their work with high-morbidity patients will be the respondents in the study. Their experience with both options will serve as the main source of evidence on which the overall conclusion will be based. The data will be collected through an Expanded Nursing Stress Scale survey. This format will allow for a correct evaluation of both study groups, showing which one reports lower stress levels. Overall, the study has the potential to provide a valuable reference point for future work on nursing stress management.

References

Adzakpah, G., Laar, A. S., & Fiadjoe, H. S. (2016). Occupational stress among nurses in a hospital setting in Ghana. Clinical Case Reports and Reviews, 2(2), 333–338. Web.

Bamber, M. D., & Morpeth, E. (2019). Effects of mindfulness meditation on college student anxiety: A meta-analysis. Mindfulness, 10, 203-214.

Barbe, T., Kimble, L. P., & Rubenstein, C. (2017). Subjective cognitive complaints, psychosocial factors and nursing work function in nurses providing direct patient care. Journal of Advanced Nursing, 74(4), 914–925.

Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: A systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373(1), 13–24.

Gholizadeh, M., Khademohosseini, S. M., Mokhtari Nouri, J., & Ahmaditahoor, M. (2017). The effect of mindfulness intervention on job stress in nurses of intensive care units. Journal of Critical Care Nursing, 10(3). Web.

Heckenberg, R. A., Eddy, P., Kent, S., & Wright, B. J. (2018). Do workplace-based mindfulness meditation programs improve physiological indices of stress? A systematic review and meta-analysis. Journal of Psychosomatic Research, 114, 62-71.

Heredia, L., Gasol, L., Ventura, D., Vicens, P., & Torrente, M. (2017). Mindfulness-based stress reduction training program increases psychological well-being, and emotional regulation, but not attentional performance. A pilot study. Mindfulness & Compassion, 2(2), 130-137.

Janssen, M., Heerkens, Y., Kuijer, W., van der Heijden, B., & Engels, J. (2018). Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review. PLoS ONE, 13(1).

Kelm, D. J., Ridgeway, J. L., Gas, B. L., Mohan, M., Cook, D. A., Nelson, D. R., & Benzo, R. P. (2018). Mindfulness meditation and interprofessional cardiopulmonary resuscitation: A mixed-methods pilot study. Teaching and Learning in Medicine, 30(4), 433–443.

Penque, S. (2019). Mindfulness to promote nurses’ well-being. Nursing Management, 50(5), 38–44.

Phillips, C., Kenny, A., & Esterman, A. (2017). Supporting graduate nurse transition to practice through a quality assurance feedback loop. Nurse Education in Practice, 27, 121-127.

Que, J., Shi, L., Deng, J., Liu, J., Zhang, L., Wu, S., Gong, Y., Huang, W., Yuan, K., Yan, W., Sun, Y., Ran, M., Bao, Y., & Lu, L. (2020). Psychological impact of the COVID-19 pandemic on healthcare workers: A cross-sectional study in China. General Psychiatry, 33(3).

Rabei, S., Mourad, G., & El Din Hamed, A. (2020). Work stress and sleep disturbances among internship nursing students. Middle East Current Psychiatry, 27.

Rusch, H. L., Rosario, M., Levison, L. M., Olivera, A., Livingston, W. S., Wu, T., & Gill, J. M. (2019). The effect of mindfulness meditation on sleep quality: A systematic review and meta-analysis of randomized controlled trials. Annals of the New York Academy of Sciences, 1445(1), 5–16.

Saedpanah, D., Salehi, S., & Moghaddam, L. F. (2016). The effect of emotion regulation training on occupational stress of critical care nurses. Journal of Clinical & Diagnostic Research, 10(12).

Sanko, J., Mckay, M., & Rogers, S. (2016). Exploring the impact of mindfulness meditation training in pre-licensure and post graduate nurses. Nurse Education Today, 45, 142–147.

Appendices, Tables, and Figures

Appendix A

Johns Hopkins Nursing Evidence-Based Practice

Appendix G Individual Evidence Summary Tool

© The Johns Hopkins Hospital/Johns Hopkins University. May not be used or reprinted without permission.

Practice Question: “Among nurses who care for high morbidity/mortality patients during periods of pandemics would a mindfulness meditation program, compared to no intervention, reduce the level of work stress in two months?”

Article Number Author and Date Evidence Type Sample, Sample Size, Setting Findings That Help Answer the EBP Question Observable Measures Limitations Evidence Level, Quality
1 Adzakpah, G. (2016). mixed methods 73 respondents. Saint Dominic Hospital, Akwatia, Ghana. The central stress factors are workload and conflicting requirements. A 42-questions questionnaire consisting. The results of this study cannot be generalized to workers of the entire workforce of the hospital or healthcare sector. IIA
2 Janssen, M. (2018). systematic review of a combination of RCTs and quasi-experimental 24 article MBSR is probably leading to increased awareness, stabilized emotional well-being, and improved professional performance and reduced stress. The articles in three electronic databases were searched for by keyword and selected by inclusion and exclusion criteria. The authors point to the limitations of the selected studies, expressed in voluntary participation, which increases the likelihood of shifting the results. IIA
3 Kelm, D. J. (2018). mixed methods 24 respondents. Mayo Clinic Institutional Review Board. The use of neurophysiological skin and brain tests for stress assessment. Interview, questionnaire, and neurophysiological study. Lack of a control group, simulation of real actions, standardization of conditions. IIIA
4 Penque, S. (2019). quasi-experimental, longitudinal, pretest and posttest, correlational study 61 nurses. N/A. The meditation program is highly effective if the implementation conditions are met. Six test scales for determining anxiety, stress and fear. No randomized controlled sample and had no comparison group IIIA
5 Gholizadeh, M. (2017). quasi-experimental design. 60 nurses. Imam Hussein hospital. Especially important are programs for intensive care units. A scale-revised questionnaire N/A IIIA
6 Sanko, J. (2016). quasi-experimental pre/post. 45 respondents. N/A. Nurses are positive about the training course and agree to introduce meditation programs into clinical practice. Test scales for determining anxiety, stress and fear. Small sample size, territoriality of nurses. IIIA
7 Saedpanah, D. (2016). quasi-experimental pre/post. 60 nurses. Sanandaj, Iran. For the most stressful situations, such as the death of a patient, programs are virtually insignificant. ENSS questionnaire, statistical methods. Subjective characteristics of nurses IIA
8 Black, D. S. (2016). a comprehensive review of randomized controlled trials 20 RCTs. N/A. MBSR seems to increase the immune profile of nurses by reducing anti-inflammatory processes, increasing enzyme activity, and activating cellular-mediated body protection parameters. Search by thematic articles over 50 years, taking into account four inclusion criteria. The restrictions are caused by the use of control groups not by all authors, the lack of consideration of external factors, and not a narrow focus and features of sample preparation. IB
9 Heredia, L. (2017). pilot study/RCT 18 women and 7 men. N/A. In the short term, reduced awareness training programs help nurses improve psychological well-being, but more extended programs are needed to increase productivity and reduce anxiety. Before and after the training, participants were asked to fill in tests and questionnaires regarding neuropsychological conditions. The number of participants was not sufficient to scale up the results. IA
10 Rusch, H. L. (2019) systematic review and meta-analysis of RCT 79 articles and 18 tests. N/A. Awareness meditation programs significantly improve the quality of nurses’ sleep, which also has long-term effects. Testing of participants after eight weeks of training and comparison of results with the control group. Noticed heterogeneity of the sample affected the statistical analysis and the lack of completeness of the information provided in the studies about the experiment’s procedure. IB
11 Heckenberg, R. A. (2018) Systematic review and meta-analysis 9 papers. N/A Mindfulness meditation improves physiological indices of stress Daytime cortisol secretion, HRV coherence. The meta-analysis used a limited scope of papers. Extending the range of sources may lead to different results. IB
12 Bamber, M. D., & Morpeth, E. (2019). Meta-analysis 25 primary studies, 1492 participants Mindfulness meditation positively affects student anxiety. The overall summary effect was.56 (p < .001). Further research must concentrate on specific subgroups of students to test specific interventions. IB
13 Rabei, S. (2020) Descriptive study 95 nursing internship students Nursing students begin to experience the stress from their internships. Long shifts and overtime lead to insomnia. Results are calculated using Pittsburgh Sleep Quality Index (PSQI) and Expanded Nursing Stress Scale (ENSS) The scope of the study is not exhaustive. IB
14 Barbe, T. (2017) Descriptive correlational design with stratified random sampling. 96 nurses from the United States Perceived stress and personal concerns impaired the work-related abilities of nurses Self-reported via a web-based survey The results are primarily based on self-reported parameters. Objective examination would improve the accuracy. IIA
15 Que, J. (2020) Cross-sectional, web-based survey 2285 healthcare workers from China Anxiety, depression, sleep disorder, and other psychological problems were prevalent in the cases of those who worked at the front line of the pandemic. Generalized Anxiety Disorder Scale, Patient Health Questionnaire and Insomnia Severity Index were used for assessment The study is based on a cross-sectional web survey and may not represent the situation in total. The findings rely on self-reported questionnaires, which impairs the objectivity of the study. IIA