Effectiveness of Mindfulness-Based Therapy for Managing Stress and Anxiety in Medical Nurses During the COVID-19 Pandemic

Background

Stress and anxiety among nurses and healthcare workers have become a major concern for healthcare workers in the COVID-19 era due to intense work pressures and unusual work hours. Therefore, addressing this issue is critical to maintaining the quality of patient care. Nurses and other health professionals face greater challenges during the pandemic due to stress and anxiety (Mo et al., 2020). In a recent cross-sectional study by Mosolova et al. (2020), researchers reported that the presence of stress and anxiety significantly impaired the mental health of healthcare workers. In this study, the researchers recruited 1,090 health care workers, of whom about 49.1% had moderate anxiety according to the SAVE-9 score, while those surveyed 21.9% of caregivers had severe anxiety. This finding was also supported by the results of Elbay et al. Supported. (2020), the researchers reported conducting an online survey similar to the current study to assess doctors’ levels of stress and anxiety during the COVID-19 pandemic. In this study, the Depression Anxiety Stress Scale-21 (DAS-21) was used to measure stress levels. The researchers found that of the 442 participants in the study, 286 had symptoms of depression, 51.6 percent of the 224 participants had symptoms of anxiety, and 182 had symptoms of stress. reported having symptoms of The study also found that women, less work experience, younger, single, and frontline work experience were associated with higher rates of anxiety, depression, and stress. Abadi et al. (2020) Also, among the 125 nurses who participated in the study, the association between age and depression was p-value 0.002, the association between age and anxiety was p-value 0.018, and the fact that there was an association also confirmed. Relationship between employment status and stress (p=0.009), relationship between age and stress (p=0.011), relationship between employment status and stress (p=0.023). The overall results of the study revealed moderate rates of depression, anxiety and depression among nurses working in the COVID-19 ward of Torbat-e Heydarie hospital. The use of mindfulness-based therapy has been reported to be successful in treating depression and anxiety in college students. In this nonrandomized controlled study design, researchers reported that the use of mindfulness-based meditation therapy reduced depression and anxiety at 6 and 12 months follow-up (Carpena et al. al., 2019). A study by Strege et al. (2018), researchers also support the use of mindfulness-based exercise to manage stress and depression in the adult population. In this study, researchers evaluated the effectiveness of mindfulness-based cognitive therapy in improving anxiety symptoms and reported improvements in anxiety symptoms after implementing the intervention.

Literature Review

Considering the analysis of the existing literature revealed that there is lack of evidence regarding the effectiveness of the mindfulness-based intervention for managing stress and depression among the nurses.

Aim of the Study

Therefore, the main of the current study is to assess the efficacy of the mindfulness-based therapy for improving experiences of the nurses in terms of stress and anxiety reduction in the health care setting.

Research Question

Can implementation of the mindfulness-based therapy improve the experiences of nurses in terms of the stress and anxiety conditions?

Study Design

As part of the study design of the current qualitative study design, researchers will consider a theory-based approach because, for the purposes of the study, it can be shown that the views of Nurses are needed to understand their stress and anxiety states. Using a qualitative study design would be relevant to the current study, as this particular study design will allow researchers to explore nurses’ thoughts on stress and their thoughts. after performing mindfulness-based therapy to reduce stress and anxiety (Kamal, 2019). Using a theoretical approach based on the design of qualitative research will help researchers explore different individuals’ experiences of stress and anxiety after implementing mindfulness-based therapy to improve the quality of life. relieve stress and anxiety. Therefore, using a well-founded theoretical approach will also allow researchers to generate new theories from the data collected from the participants. The main reason for choosing a qualitative study design for this current study was related to the fact that the researchers were able to assess the effectiveness of mindfulness-based therapy through the experiences of nurses facing with the same problem (Turner & Astin, 2021).

Study Population

Nurses from the local healthcare facility complaining of depression and anxiety will be included in the study, and participants will also be selected based on several inclusion and exclusion criteria.

The inclusion criteria for the participants will be as follows-

• The nurses must have the moderate level of anxiety and depression according to the score of Depression Anxiety and Stress Scale-21 (DAS-21).
• The nurses must have the experiences of 6 months to 12 months
• The nurses must work in the emergency department

As a part of the exclusion criteria of the current study the researchers will consider the following criteria-

• The nurses having the experiences of less than 6 months or more than 12 months will be excluded from the current study.
• The nurses having the anxiety and depression of mild and high level will be excluded the current study.
• The nurses working in the other departments apart from the emergency department will be excluded from the study.

Sampling method

Study samples will be taken from four different local government health departments, and to select the study population, researchers will follow a targeted sampling method, which will ultimately help those participants selected only participants who met the current study criteria (Campbell et al., 2020).

Data collection

To collect data from the study participants, the researcher will use the interview method and the questionnaire will be developed by the researcher himself. The first part of the questionnaire will include demographic profile and work experience-related questions, and this section will include open-ended questions that help researchers explore the nurses’ perspectives. about their experience of stress and anxiety after performing a mindfulness-based exercise. Nurses’ experiences regarding the use of mindfulness-based therapy will be collected using open-ended questions (DeJonckheere & Vaughn, 2019). Furthermore, it should be mentioned that the use of open-ended questionnaires based on questions helps the participants to share their views on the topic. Each interview will last between 15 and 20 minutes. The researchers will hire a research assistant to conduct interviews to avoid possible biases in the study. Interview sessions will also be recorded using an electronic tape recorder.

Purpose Of The Study

Data Analysis

sampling method

Study samples will be taken from four different local government health departments, and to select the study population, researchers will follow a targeted sampling method, which will ultimately help those participants selected only participants who met the current study criteria (Campbell et al., 2020).

Data collection

To analyze the data collected from the participants, the researchers would replicate the data and the thematic analysis method would be followed by the researchers. For the topic analysis process, researchers will use NVivo software and the results or conclusions of the current study will be presented using different topics generated from the interview transcripts ( Castleberry & Nolen, 2018).
To maintain the rigor or reliability of existing research, researchers will try to avoid researcher bias by hiring different research assistants for the data collection process, This will help build the credibility of the study. In addition, the researchers will also try to improve the generalizability of the study results by selecting study participants from four different public hospitals. This multicentre nature of the study will help to improve the generalizability of the research results, since by their nature the results can be applied to different contexts, which will also improve the validity of the results intrinsic of the study (Maxwell, 2021).

The present study has the same limitations as other studies and within the framework of the first limitation of the study, it can be shown that the use of a targeted sampling strategy can be considered as one of the limitations of the study. The purported selection of sampling may introduce bias in the data collection in this current study. In addition, researchers will employ research assistants solely for the purpose of data collection, and analysis will be performed by the researchers themselves. Therefore, because of the well-founded theoretical research approach, it is possible to introduce bias in relation to data analysis, which can be considered as another limitation (Singh & Estefan, 2018).

As part of the ethical review of this study, the researchers will make sure to collect consent forms from the nurses before the interviews begin. Researchers will also ensure the security of the data collected by establishing a strong data security system so that anyone other than the researchers can access the data. In addition, the researchers will obtain permission from the hospital administration and the human ethics committee because of the participatory research process (Arifin, 2021). In the case of Indigenous nurses, researchers will also ensure a culturally sensitive approach when conducting interviews (McGrath, Palmgren & Liljedahl, 2019).

References

Abadi, T. S. H., Askari, M., Miri, K., & Nia, M. N. (2020). Depression, stress and anxiety of nurses in COVID-19 pandemic in Nohe-Dey Hospital in Torbat-e-Heydariyeh city, Iran. Journal of Military Medicine, 22(6), 526-533. https://eprints.thums.ac.ir/2762/

Arifin, S. R. M. (2018). Ethical considerations in qualitative study. International Journal of Care Scholars, 1(2), 30-33. https://journals.iium.edu.my/ijcs/index.php/ijcs/article/view/82

Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., … & Walker, K. (2020). Purposive sampling: complex or simple? Research case examples. Journal of Research in Nursing, 25(8), 652-661. https://journals.sagepub.com/doi/abs/10.1177/1744987120927206

Carpena, M. X., de Souza Tavares, P., & Menezes, C. B. (2019). The effect of a six-week focused meditation training on depression and anxiety symptoms in Brazilian university students with 6 and 12 months of follow-up. Journal of affective disorders, 246, 401-407. https://www.sciencedirect.com/science/article/pii/S0165032718310498

Castleberry, A., & Nolen, A. (2018). Thematic analysis of qualitative research data: Is it as easy as it sounds?. Currents in pharmacy teaching and learning, 10(6), 807-815. https://www.sciencedirect.com/science/article/pii/S1877129717300606

DeJonckheere, M., & Vaughn, L. M. (2019). Semistructured interviewing in primary care research: a balance of relationship and rigour. Family medicine and community health, 7(2). https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6910737/

Elbay, R. Y., Kurtulmu?, A., Arpac?o?lu, S., & Karadere, E. (2020). Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry research, 290, 113130. https://www.sciencedirect.com/science/article/pii/S0165178120312038

Kamal, S. S. L. B. A. (2019). Research paradigm and the philosophical foundations of a qualitative study. PEOPLE: International Journal of Social Sciences, 4(3), 1386-1394. https://doctor2015.jumedicine.com/wp-content/uploads/sites/9/2021/02/RESEARCH-PARADIGM-AND-THE-PHILOSOPHICAL-FOUNDATION-OF-A-QUALITATIVE-STUDY.pdf

Maxwell, J. A. (2021). Why qualitative methods are necessary for generalization. Qualitative Psychology, 8(1), 111. https://psycnet.apa.org/record/2020-36022-001

McGrath, C., Palmgren, P. J., & Liljedahl, M. (2019). Twelve tips for conducting qualitative research interviews. Medical teacher, 41(9), 1002-1006. https://www.tandfonline.com/doi/abs/10.1080/0142159X.2018.1497149

Mo, Y., Deng, L., Zhang, L., Lang, Q., Liao, C., Wang, N., … & Huang, H. (2020). Work stress among Chinese nurses to support Wuhan in fighting against COVID?19 epidemic. Journal of nursing management, 28(5), 1002-1009. https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.13014

Mosolova, E., Chung, S., Sosin, D., & Mosolov, S. (2020). Stress and anxiety among healthcare workers associated with COVID-19 pandemic in Russia. Psychiatria Danubina, 32(3-4), 549-556. https://hrcak.srce.hr/file/364857

Singh, S., & Estefan, A. (2018). Selecting a grounded theory approach for nursing research. Global qualitative nursing research, 5, 2333393618799571. https://journals.sagepub.com/doi/abs/10.1177/2333393618799571

Strege, M. V., Swain, D., Bochicchio, L., Valdespino, A., & Richey, J. A. (2018). A pilot study of the effects of mindfulness-based cognitive therapy on positive affect and social anxiety symptoms. Frontiers in Psychology, 866. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00866/full

Turner, C., & Astin, F. (2021). Grounded theory: what makes a grounded theory study?. European Journal of Cardiovascular Nursing, 20(3), 285-289. https://academic.oup.com/eurjcn/article-abstract/20/3/285/6190569