DISCUSSION
To
our knowledge, this is the first study to conduct a MBSR program to
reduce PTSD symptoms among emergency nurses.
The
current findings indicate that participants who underwent the MBSR
program showed improvements in symptoms of PTSD compared to those in the
comparison group, and these improvements remained stable one month after
treatment. The program was also successful in enhancing mindfulness and
reducing emotional exhaustion among emergency nurses. However, no
significant
changes have been observed in the coping styles of either group. The
evidence
contributes
to the existing literature by showing the feasibility and potential
effectiveness of MBSR for emergency nurses experiencing
PTSD
symptoms.
Attention
monitoring and acceptance are the two fundamental components in
mindfulness training (Bishop et al., 2010). According to the Monitoring
and Acceptance Theory,
attention
monitoring can help practitioners enhance their awareness of their
present experience, while acceptance encourages practitioners to
approach experiences with a non-judgment, open, and equanimous manner.
The combined effects of attention monitoring and acceptance
synergistically contribute to the positive health outcomes associated
with mindfulness training, as highlighted by Lindsay and Creswell
(2017).
The
results of this study are consistent with the theoretical framework.
Individuals who participated in the MBSR program showed lasting
improvements in PTSD symptoms after the treatment and at the 1-month
follow-up, while no similar improvements were observed in the control
group. The current finding is consistent with previous studies that
demonstrated moderate to strong effects of MBSR therapy on PTSD symptoms
in other populations (Harding, Simpson, & Kearney, 2018; Polusny et
al., 2015; Stephenson, Simpson, Martinez, & Kearney, 2017).
Findings from the present study suggest that a reduction in PTSD
symptoms may be associated with changes in mindfulness during the
treatment. Consistent with previous studies (Anderson, 2020; Ducar,
Penberthy, Schorling, Leavell, & Calland, 2020; Wang et al., 2017),
participants in the intervention group reported a significant
improvement in mindfulness skills after treatment. This suggests that
the current program facilitated self-acceptance and self-care among
emergency nurses.
No
significant differences in mindfulness were found between the two groups
in the post-intervention or follow-up. This lack of difference may be
attributed to
the
noisy work environment, heavy workload, high occupational risk, and
constantly changing situations in the emergency department. Nurses are
compelled to maintain a state of hypervigilance and hyperirritability in
order to cope with various stressful events.
This
finding highlights the need for supportive organizational measures to
accompany the intervention, creating a low-pressure environment for
nurses to manage their physical and mental health in practice.
This
intervention helped emergency nurses develop positive psychological
functioning and counteract the avoidance and suppression of thoughts
that frequently characterize PTSD symptoms (Lang, 2017).
The
implication is significant, as it demonstrates the practicality and
effectiveness of the MBSR program for managing PTSD symptoms, even for
nurses who are constantly exposed to traumatic stress.
In
addition to reductions in PTSD symptoms,
a
significant finding in this study is the sustained improvement in
emotional exhaustion among nurses in the intervention group observed at
the 1-month follow-up, compared to the comparison group. This finding is
consistent with prior research (Duarte & Pinto-Gouveia, 2016; Gauthier,
Meyer, Grefe, & Gold,
2014).
Emotional exhaustion is the central component of burnout, which is one
of the most common chronic psychological symptoms experienced by
clinical nurses (Maslach & Leiter, 1997). Yuan et al. (2022) previously
found that
emotional
exhaustion is a factor that promotes the development of
PTSD
symptoms among emergency nurses, and it also serves as a mediator
between mindfulness and PTSD symptoms.
The
present study demonstrated that emotional exhaustion decreased as
mindfulness improved, and these changes were in consistent with changes
in symptoms of PTSD.
The
empirically confirmed findings indicate that MBSR practice can help
increase the mental resources of emergency nurses, improve emotion
regulation skills, and thus alleviate emotional exhaustion and related
PTSD symptoms (Duarte & Pinto-Gouveia, 2016).
Few
previous studies have assessed the effectiveness of MBSR in coping
styles.
In
the present study,
there
was no significant improvement in either of the
coping
styles among all the subjects observed. This result challenges the
findings of Fuente et al. (2018), who reported a significant decrease in
the use of negative coping strategies and a significant increase in the
use of positive coping strategies among university students after a
mindfulness-based intervention. One
possible reason is differences in population. Stable preferences or
personality differences, which are relatively fixed, determine
individual differences in coping styles (Carver, Scheier, & Weintraub,
1989). Although mindfulness practice could help emergency nurses reduce
automatic reactions to stressful events by temporarily inhibiting coping
responses (Hamilton, Kitzman, & Guyotte, 2006), it is challenging to
change habitual and maladaptive coping styles in a short period.
Therefore, a longer MBSR intervention or a combination of MBSR with
coping training for emergencies may be necessary to enhance coping
mechanisms for managing stress and work-related
challenging.
There
are several strengths in this study. First, this study addresses a
significant gap in the field as there were only a few studies that
evaluated the effectiveness of the MBSR program on PTSD symptoms,
emotional exhaustion, and coping styles in emergency nurses. Secondly,
we
conducted an in-person MBSR program for emergency nurses. Given the
scheduling challenges faced by emergency nurses, we have implemented
several measures to offer more flexibility in scheduling. These measures
include holding each session twice a week and providing a self-guided
1-day retreat. These strategies have resulted in a lower attrition rate
compared to previous studies.
This
study has limitations.
First,
the findings relied entirely on the use of self-report questionnaires
and are subject to the limitations associated with this type of
methodology, such as response bias. Combined assessment methods, such as
interviews and behavioral measurements, could be an intriguing avenue
for future studies. Secondly, the short follow-up period also limited
our current findings. It is unknown whether the effects persist beyond
one month. Future trials with longer-term follow-up are necessary to
assess the long-term effectiveness of the treatment.