INTRODUCTION
The
coronavirus disease 2019 (COVID-19) pandemic has imposed excessive
workloads and psychological pressure on frontline healthcare personnel
(Martínez-Caballero, García-Sanz, Cárdaba-García, & Martínez-Piedra,
2021).
Except
for acute severe cases,
patients
with fever and suspected infection were also referred to emergency
departments,
further
increasing
the
overwhelming workload on nurses.
Emergency
nurses have experienced intense insecurity due to insufficient
information, fears of infection, isolation from their families, and
exposure
to traumatic events. These factors led to a series of negative physical
and emotional changes, such as insomnia, fear, anxiety, burnout, and
distress, which had a lasting impact on nurses’
mental health even after the pandemic (An et al., 2020; Lai et al.,
2020; Saragih, Tonapa, Saragih, Advani, & Batubara, 2021).
Post-traumatic stress disorder (PTSD) was found to be one of the most
prevalent mental health issues and long-term consequences
among
emergency nurses during the COVID-19 pandemic (Saragih et al., 2021;
Yunitri, Chu, Kang, Jen, & Pien,
2022).
Studies have reported a prevalence rate of 9.1% to 30.9% (Bahadirli &
EserSagaltici, 2021; Martínez-Caballero et al., 2021; Song et al.,
2020).
Emergency
nurses experiencing symptoms of PTSD suffer from psychological and
physiological distress, leading to reduced work efficiency, diminished
quality of life, increased incidence of nursing errors, and a higher
likelihood of intending to leave their positions. These consequences
could have a negative impact on the effectiveness of the healthcare
system (Garrett, Salmon, Angela, & Morehead, 2019; Luo, Zhang, & Yuan,
2020).
Given
the critical role of emergency nurses in the healthcare system and the
potential hazards of continuous, complicated trauma-related situations
for them,
it
is crucial to identify potential strategies to improve PTSD symptoms in
this population. Unfortunately, there is a lack of research focusing on
this issue, despite the abundance of studies on the mental health of
nurses during the pandemic (Ramachandran et al., 2022).
Mindfulness-Based
Stress Reduction (MBSR) is a psychological intervention developed by Jon
Kabat-Zinn in 1979.
It
is based on the fundamental concept of mindfulness. Mindfulness is
defined as ’the intentional awareness of the present moment with a
non-judgmental and accepting attitude’. It
aims
to
encourage
practitioners to harness their internal resources and energy to manage
stress, pain, and even illness in healthier and adaptive ways
(Kabat-Zinn, 2013). The formal MBSR program is a group-based
intervention that consists of a 2.5-hour session once a week for eight
weeks. It guides participants to practice mindful breathing, body scan,
meditation, and yoga, and includes a daylong retreat between the sixth
and seventh weeks. Participants are also encouraged to practice
mindfulness at home for approximately 45 minutes per day.
MBSR
has been widely applied to nurses in recent years. Empirical evidence
shows many benefits of MBSR, including reduced anxiety, depression,
professional fatigue, and work stress (Wexler & Schellinger, 2022;
Yang, Tang, & Zhou, 2018). It also leads to improved job satisfaction
and quality of life, even in abbreviated programs
(Anderson, 2020; Ghawadra, Abdullah, Choo, Danaee, & Phang, 2020). A
recently published study also demonstrated the effectiveness of an
online MBSR program in improving the sleep quality of nurses working in
COVID-19 care units (Nourian, Nikfarid, Khavari, Barati, &
Allahgholipour, 2021).
Meanwhile, considering the limitations of traditional PTSD intervention
therapies such as cognitive-behavioral therapy and eye movement
desensitization and reprocessing in terms of patient compliance and
prognosis, MBSR has garnered interest as an alternative or adjunct
therapy for PTSD symptoms (Goetter et al., 2015).
A
growing body of evidence has suggested that MBSR has been effective in
reducing PTSD symptoms in a variety of populations, from veterans to
cancer patients. This is achieved by improving the ability to
distinguish between past and present, encouraging people to accept
distressing thoughts, feelings, and experiences without avoidance and
hypervigilance, and identifying and stopping emotional and physical
dysregulation at an early
stage
(Cole et al., 2015; Müller-Engelmann, Wünsch, Volk, & Steil, 2017;
Polusny et al., 2015; Schellekens et al., 2017).
A
review of neurobiological evidence suggests that MBSR could alleviate
PTSD by targeting the neurobiological pathways characteristic of PTSD
(Boyd, Lanius, & McKinnon, 2018). Despite these promising
findings,
as far as we know, there has been a lack of empirical research
evaluating the effectiveness of MBSR in improving
PTSD
symptoms in emergency nurses.
In
the present study, our aim was to develop an in-person MBSR program for
emergency nurses and examine its impact on PTSD symptoms among this
group. Additionally,
considering
the prevalence of emotional exhaustion among emergency nurses during the
pandemic and the impact of emotional exhaustion and coping styles on
PTSD symptoms as reported in previous research (Chen, Sun, Chen, Jen, &
Kang, 2021; Colville et al., 2017; Ding et al., 2015; Yuan, Wang, Shao,
Xu, & Lu, 2022), we also aimed to investigate the program’s
effectiveness in reducing emotional exhaustion and enhancing coping
styles.