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.