Decreasing stress and burnout among nurses is an ongoing issue that has proven to be tremendously difficult to solve. Although many tactics and strategies have been employed by hospital organizations to combat this problem, nurses are continuing to report burnout at an alarming rate nationwide.1If burnout continues to rise at this current rate health care quality and patient safety could be critically compromised.
In 2015 researchers at Ohio State University Wexner Medical Center sought to determine if a workplace-mindfulness intervention could help decrease stress in the members of their surgical intensive care unit.2In today’s post we will take a look at this study, its results, and how these findings can help influence the future of addressing the problem of nurse burnout.
Nurses working in high-stress areas such as critical care, the ER, pediatrics, and oncology report some of the highest levels of burnout within the profession.3In this study the selected group of participants were all members of a high-stress, surgical intensive care unit. The unit members were randomized into two separate groups. One group attended mindfulness-based intervention sessions for 8 weeks, while the other group served as the control group and did not receive any intervention.
Each of the participants in the experimental group received the mindfulness-based intervention for 8 weeks. The interventions all took place in the workplace and consisted of mindfulness practice, gentle stretching, yoga, meditation, and music. Mindfulness practice promotes “intentionally bringing awareness to present-moment experience with an attitude of openness and curiosity.”4Neuroscientists have discovered that mindfulness training can improve a person’s ability to interpret situations more clearly and respond more thoughtfully to stressful events.4
Mindfulness practices often utilize a mind-body approach incorporating calming physical activities such as gentle-stretching and yoga in order to introduce increased awareness to the individual.4A previous study found that nurses who participated in a yoga program reported significantly higher levels of self-care, less emotional exhaustion, and decreased depersonalization towards their patients.5
Markers of Stress
In the study both subjective and physiological markers of stress were measured at the start and conclusion of the 8-week intervention period. The psychological effects of stress can present as an onset of depression or anxiety, difficulty sleeping, emotional instability, poor attitude towards work, as well as difficulty communicating with patients, maintaining good working relationships with co-workers, and judging the seriousness of situations.6For the study well-established self-report questionnaires of stress and burnout were administered.
The researchers measured the levels of participants’ salivary alpha-amylase to objectively measure the physical effect mindfulness intervention had on participants. Salivary alpha-amylase is one of the major enzymes in the oral cavity associated with sympathetic nervous system activation. Sympathetic activation is known as the “fight-or-flight” response that occurs in the presence of a perceivably stressful or dangerous situation.7
At baseline the participants’ average score for the level of stress at work was a 7.5 out of 10. This score did not change significantly over the course of the study, but the participants’ reactions to stress did. The group who received mindfulness-based intervention showed a 40% reduction in salivary alpha-amylase at the end of the 8 weeks, whereas the control group showed no significant changes. This demonstrates that although stressors in the work environment may be impossible to eliminate, mindfulness-based may be able to positively influence how employees respond to these stressors.2
Organizational changes aimed at improving working conditions should be given top priority in regard to combating workplace stress. However, some aspects contributing to nurses’ stress in the work environment will never change. The CDC advocates for a combination of organizational change and stress-management methods to provide health care personnel with better, healthier methods for coping with stress.8The Ohio State study shows that implementing mindfulness-interventions into the work environment of health care workers may serve as an effective method to reduce stress and burnout.
- De Keyrel A. Is nurse burnout on the rise? Startling statistics on nurse well-being. Mededwebs.com. https://www.mededwebs.com/blog/well-being-index/is-nurse-burnout-on-the-rise-startling-statistics-on-nurse-well-being. Published April 13, 2017. Accessed July 2, 2019.
- Ohio State study: ICU nurses benefit from workplace intervention to reduce stress. Wexnermedical.osu.edu. https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/ohio-state-study-icu-nurses-benefit-from-workplace-intervention-to-reduce-stress. Published May 11, 2015. Accessed July 2, 2019.
- Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and Resilience Among Nurses Practicing in High-Intensity Settings. American Journal of Critical Care. 2015;24(5):412-420. doi:10.4037/ajcc2015291
- Howland LC. The mindful nurse. Am Nurse Today. 2015; 10(9) https://americannursetoday.com/wp-content/uploads/2015/09/ant9-Mindfulness-820.pdf. Accessed July 2, 2019.
- Motley A. Saying yes to yoga. Am Nurse Today. 2017;12(5). https://www.americannursetoday.com/saying-yes-yoga/. Accessed July 2, 2019.
- American Holistic Nurses Association. Holistic stress management. Ahna.org. https://www.ahna.org/Home/Resources/Stress-Management. Accessed July 2, 2019.
- Petrakova L, Doering BK, Vits S, et al. Psychosocial Stress Increases Salivary Alpha-Amylase Activity Independently from Plasma Noradrenaline Levels. PLoS One. 2015;10(8):e0134561. Published 2015 Aug 6. doi:10.1371/journal.pone.0134561
- DHHS (NIOSH). Exposure to stress: Occupational hazards in hospitals. Cdc.gov. https://www.cdc.gov/niosh/docs/2008-136/pdfs/2008-136.pdf. Published July 2008. Accessed July 2, 2019.