Effects of a mindfulness-based program on the occupational balance and mental health of university students. Protocol for a randomized controlled trial.

OBJECTIVE: The aim is to examine whether the addition of Virtual Reality (VR) meditation training to a standard 8-week Mindfulness-Based Health Care Program (MBHC-VR) results in a significantly increased improvement in occupational, mental health, and psychological functioning versus MBHC-only in university students. MATERIALS AND METHODS: A randomized controlled clinical trial with three arms (MBHC, MBHC-VR, Control Group), four assessment time points (pre-intervention, inter-session, post-intervention, and 3-month follow-up), and mixed methodology will be proposed. University students (undergraduate, master, or doctoral) interested in participating and who meet the inclusion/exclusion criteria will be included over two years. Data will be collected from different ad hoc questionnaires, several standardized tests, and an Ecological Momentary Assessment. We will use R software to carry out descriptive analyses (univariate and bivariate), multilevel modeling, and structural equation models to respond to the proposed objective. The qualitative analysis will be carried out using the MAXQDA program and the technique of focus groups. DISCUSSION: It is expected that with the proposed intervention university students will learn to relate in a healthier way with their mental processes, so as to improve their occupational balance (OB) and their psychological well-being. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05929430.

When and how do hospital nurses cope with daily stressors? A multilevel study.

BACKGROUND: During their workday, nurses face a variety of stressors that are dealt with using different coping strategies. One criticism of the contextual models of work stress is that they fail to focus on individual responses like coping with stress. Neverthless, little is know about the momentary determinants of coping in nurses. OBJECTIVES: To identify the momentary predictors of problem-focused approaching coping and emotion-focused approaching coping, as well as those for seeking social support and refusal coping strategies, during the working day in nurses. DESIGN: This study uses descriptive, correlational, two-level design with repeated measures. SETTINGS: Wards of two University hospitals. PARTICIPANTS: A random cohort of 113 nurses was studied. METHODS: An ecological momentary assessment was made of demand, control, effort, reward, nursing task, coping, mood and fatigue, and of coping style by questionnaire. Multilevel two-level statistical analyses were performed in order to identify both within person and between person relationships. RESULTS: Different momentary types of coping were associated with different tasks. The problem-focused coping could be explained by the direct care and medication tasks, demand, planning coping style, mood, and negatively by acceptation coping style. Emotion-focused coping could be explained by documentation and medication tasks (negatively), mood, demand, distraction, and disengagement coping styles. Seeking social support coping could be explained by the task of communication, mood, fatigue (negatively), and seeking emotional support as a coping style. Refusal coping could be explained by mood, and the coping style of focusing and venting emotions. Refusal coping is not specific to any task. CONCLUSIONS: The choice of the coping strategy depends on the task, of their appraisal and on the different styles of coping.

How the Lagged and Accumulated Effects of Stress, Coping, and Tasks Affect Mood and Fatigue during Nurses' Shifts.

Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses' mood and fatigue evolves during their shifts, and the temporal factors that influence these phenomena. Performing a two-level design with repeated measures with moments nested into a person level, a random sample of 96 nurses was recruited. The ecological momentary assessment of demand, control, effort, reward, coping, and nursing tasks were measured in order to predict mood and fatigue, studying their current, lagged, and accumulated effects. The results show that: (1) Mood appeared to be explained by effort, by the negative lagged effect of reward, and by the accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward, and by the accumulated effort, again following quadratic trends. (2) Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. (3) Fatigue was also associated with direct care and the prior effect of documentation and communication tasks. We can conclude that mood and fatigue do not depend on a single factor, such as workload, but rather on the evolution and distribution of the nursing tasks, as well as on the stress during a shift and how it is handled. The evening and night shifts seem to provoke more fatigue than the other work shifts when approaching the last third of the shift. These data show the need to plan the tasks within a shift to avoid unfinished or delayed care during the shift, and to minimize accumulated negative effects.

Stress in nurses: The 100 top-cited papers published in nursing journals.

AIM: To identify and analyse the 100 most cited papers on stress in nurses published in nursing journals. BACKGROUND: The number of citations an article receives is an index of its impact on the scientific community. An analysis of the most cited articles on stress in nursing would allow us to identify the most important articles and to obtain information about this area of knowledge. DESIGN: A retrospective bibliometric analysis. DATA SOURCES: In 2016, 111 journals belonging to the "nursing" category were identified in the Science and Social Science Citation Index. A search was performed of the Science Core Collection Website for articles on stress published in these journals. REVIEW METHODS: The topic, type of article, publishing journal, countries and institutions of origin and year of publication were extracted from the articles. The impact factor, immediacy index, journal country and publisher and h index were collected from the Institute for Scientific Information. The citation density, citation tendency and Bradford's law were calculated. RESULTS: They identified articles were mostly empirical quantitative studies with a transversal design, published from 1975 - 2011 in 23 journals. They were signed by 233 authors, most of whom are English-speaking from the USA and UK. The core distribution of the publications comprises a single journal, the Journal of Advanced Nursing. CONCLUSION: The study of stress in nursing has shown increased visibility and recognition each decade. The most recent articles have the highest number of citations, are the highest in rank and have the higher citation densities.

Flow in Nurses: A Study of Its Relationship With Health and Burnout in a Hospital Work Context.

How does the experience of flow among nurses influences their health? This question is addressed on the basis of a model of flow, stress, burnout, and coping. The results indicate that promoting flow can be a way to enhance the health of ward nurses in a hospital work context.

How does emotional exhaustion influence work stress? Relationships between stressor appraisals, hedonic tone, and fatigue in nurses' daily tasks: A longitudinal cohort study.

BACKGROUND: Work-related stress is a prevalent condition in the nursing profession, and its influence may vary according to changeable individual and situational factors. It is, therefore, important to investigate the real-time momentary changes in these factors and their relationship to emotional exhaustion experienced by nurses. OBJECTIVES: We aim to analyse how their perceptions of demand, control, effort and reward change according to the task performed through real-time assessment and interact with the emotional exhaustion level of ward nurses. DESIGN: The research design was longitudinal. METHOD: A three-level hierarchical model with a repeated measures design was used to assess the momentary self-reports of 96 hospital ward nurses, completed using a smartphone programmed with random alarms. RESULTS: Findings show that demand, effort, and control appraisals depend on the task performed. The task appraised as most demanding, effortful, and controllable was direct care. Reward appraisal depends on the task performed and personal variables, i.e. emotional exhaustion. The situations perceived as more rewarding were rest and direct care. Momentary hedonic tone can be explained by the task performed, demand, reward, emotional exhaustion and by the interaction between emotional exhaustion and demand appraisal. Momentary fatigue can be explained by the task performed, demand, reward, and the emotional exhaustion. CONCLUSIONS: This study highlights the importance of using momentary measures to understand complex and changeable inter-relationships. While also clarifying the targets of intervention programmes aimed at preventing burnout within the nursing profession.

Predictors of distress in hospital physicians: protective and vulnerability factors / Predictores de distrés en médicos hospitalarios: factores protectores y de vulnerabilidad

This study investigates the relationship between protective and vulnerability factors affecting health (distress) in medical staff. Participants were 127 doctors from four public hospitals, who were administered the Occupational Stress in Health Professionals Inventory, the Ways of Coping Questionnaire, the Maslach Burnout Inventory, the Symptom Check-list-90 Revised Questionnaire, and the Flow Trait Scale-2. Following the methodology of Partial Least Squares modeling (PLS), an explanation is given for distress in hospital physicians, where the avoidance coping strategy produces distress directly (beta = .296) and indirectly (beta = .139) through its influence on the increase of burnout (beta = .314), which in turn is in-creased by occupational stress (beta = .209). Professional flow, measured by professional efficacy and flow, acts as a good protector against distress (beta = -.133), partly compensating the effects of the variables which have an increasing impact on an individual’s distress (GoF = .983). To sum up, when trying to predict a physician’s distress, four key elements should be considered: avoidance coping and its indirect effect through burnout on distress; the burnout construct itself and professional flow

Este estudio investiga la relación entre factores protectores y de vulnerabilidad que afectan la salud (distrés) del personal médico. Los participantes fueron 127 médicos de cuatro hospitales públicos, a quienes se les administró el Cuestionario de Estrés Ocupacional, el Cuestionario de Estilos de Afrontamiento, el Inventario de Burnout de Maslach, el Cuestionario de 90 Síntomas-Revisado y la Escala de Experiencia Óptima-2. Siguiendo la metodología de Mínimos Cuadrados Parciales (PLS) se propone una explicación del estrés en médicos hospitalarios, según la cual la estrategia de afrontamiento de evitación produce directamente distrés (Beta = .314), que a su vez se ve incrementado por el estrés ocupacional (Beta = .209). La experiencia óptima profesional, medida mediante la eficacia profesional y el estado de flow, actuaría como un buen protector contra el distrés (Beta = -.133), compensando en parte los efectos de las variables que incrementan el distrés (ajuste global, GoF = .983). En resumen, cuatro serían los elementos a considerar al intentar predecir el distrés médico: afrontamiento evitativo y su efecto indirecto a través del burnout en el distrés, el constructo de burnout en sí mismo y la experiencia óptima profesional