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.