| Objective: Due to their special working environment,nature of work and clients,Intensive Care Unit(ICU)nurses are recognized as one of the most stressful occupational groups in the healthcare professionals.This continuous stressful working state of ICU nurses leads to the frequent occurrence of stress-related burnout symptoms,anxiety,depression,decreased wellbeing and other mental health problems,which may cause the loss of nursing staff,reducing nursing quality and patient satisfaction,increasing medical error rate,and affect clinical nursing outcomes.Studies show that Mindfulness based Intervention(MBI)can improve individuals' Mindfulness level and emotional regulation ability,which is an effective strategy for preventing and managing stress,anxiety and job burnout,enhancing sense of control over work and life,and promoting well-being.How about the mental health condition and the prevalence of burnout syndrome of ICU nurses? What is the relationship between perceived stress,mindfulness,mental health and burnout? Can mindfulness-based intervention improve the mental health level of ICU nurses,relieve their symptoms of burnout,and improve their subjective well-being? If mindfulness intervention is effective,what are the efficacy factors? These subjects are rarely reported.Therefore,this study chose ICU nurses,a group with high stress,as the research object and the objectives are(1)to explore the characteristics of mental health condition and burnout syndromes and the relationships among mindfulness,mental health and burnout syndromes;(2)to evaluate the effect of mindfulness intervention on alleviating burnout symptoms and improving mental health;(3)further explore the possible function of mindfulness intervention.Methods:The cross-sectional study adopt Perceived Stress Scale,Five Facets of Mindfulness Questionnaire,Maslach Burnout Inventory,Self-rating Anxiety Scale,Center of Epidemiological Survey-Depression Scale and Subjective Well-being on 500 Chinese ICU nurses to investigate the characteristics of perceived stress,anxiety,depression,well-being and burnout,and to explore the influence of perceived stress on burnout and mental health factors and the effect of mindfulness on the relationships between perceived stress and the outcome variables.These format the foundations for constructing mindfulness intervention programs for ICU nurses.Based on the conclusions of cross-sectional study,a Mindfulness-based intervention program for ICU nurses was constructed based on the elements of Mindfulness-based Stress Reduction(MBSR),loving-kindness Meditation(LKM)and ICU nurses' working environment,physical and mental states.ICU nurses were recruited for mindfulness intervention to examine the short-term and long-term effects of mindfulness intervention on promoting ICU nurses' mental health and alleviating burnout symptoms.The last part explores the possible psychological mechanism of the effect of mindfulness intervention.According to previous studies,attentional control is considered to be the potential mechanism for positive effects of mindfulness intervention.Therefore,the role of attentional control in the alleviation of job burnout and the improvement of mental health was firstly detected by path analysis,and then the emotional Flanker task was further used to detect the change of ICU nurses' conflict adaptability from subjective self-report and objective behavioral results.Thus,the possible psychological mechanism of the therapeutic effect of mindfulness intervention was revealed,so as to further optimize the mindfulness based intervention program for ICU nurses.Excel,SPSS20.0 and AMOS20.0 were used for data processing.Main statistical methods include descriptive analysis,correlation analysis,t test,variance analysis,linear regression,simple slope test,path analysis,etc.Results:1.Through questionnaire survey,it was found that the prevalence of burnout syndrome of ICU nurses was higher.Perceived stress was significantly positively correlated with anxiety,depression,emotional exhaustion and depersonalization,and negatively correlated with subjective well-being and personal achievement.Mindfulness buffered the effects of perceived stress on anxiety,depression,subjective well-being,and job burnout.2.The repeated measures MANONA for total mindfulness and its facets(except for description),anxiety,depression,subjective well-being and emotional exhaustion revealed significant effects of time(pre-,post intervention,2 months after intervention and 6 months after intervention)×group(mindfulness-based intervention group and control group).We then further conducted simple effect analysis and the results indicated significant group effect(1)at post intervention and 2 months after intervention for total mindfulness and facet of observation,(2)at posttest for facet of non-reactivity,(3)at 2 months after intervention for anxiety,depression and subjective well-being,(4)at post intervention,2 months after intervention and6 months after intervention for facet of acting with awareness and emotional exhaustion.That is to say,after receiving mindfulness intervention,the level of mindfulness in the intervention group was significantly improved,and the improvement effect could be maintained until 2months after the intervention.Anxiety and depression symptoms were significantly relieved,and the well-being was promoted.Symptoms of emotional exhaustion were significantly reduced,and this effect was maintained until 6 months after the intervention.3.The path analysis of mindfulness,attentional control,anxiety,depression,subjective well-being and emotional exhaustion of ICU nurses in the intervention group pre-and postintervention was conducted to examine the mediating effect of attention control on the relationship among mindfulness,burnout and mental health.The results showed that attentional control played a mediating role in the improvement of the symptoms of depression,emotional exhaustion and subjective well-being with the mediating effect values of 0.497,0.536 and 0.332,respectively.Furthermore,emotional Flanker task was used to detect the changes of ICU nurses' conflict adaptability pre-and post-intervention.The results showed that,after intervention,the conflict adaptation level of response time and error rate of ICU nurses in the intervention group was significantly higher than that in the control group(p=0.004,0.017).It is suggested that attentional control may be one of the possible potential mechanisms for mindfulness intervention to promote mental health and alleviate job burnout.Conclusions:1.ICU nurses were under chronically high stress due to their special working environment,nature of work and clients,which may cause burnout syndromes,anxiety and depressive symptoms and lower well-being.Mindfulness moderated the effects of perceived stress on burnout,anxiety,depression and well-being.2.Mindfulness-based intervention program,which developed based on MBSR,LKM and ICU nursing characteristics can improve the level of mindfulness and subjective well-being,and decreased burnout syndrome,anxiety and depression symptoms.3.Attentional control may serve as a possible potential mechanism for the positive effects of mindfulness intervention.Mindfulness-based intervention improved emotional regulation ability and cognitive function,decreased burnout syndrome,depression symptoms and promote well-being by improving attentional control. |
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