JKEP (JURNAL KEPERAWATAN)
Vol 9.
No 2.
November 2024 ISSN: 2354-6042 (Prin.
ISSN: 2354-6050 .
Effectiveness of Mindfulness Intervention to Reduce Burnout in Intensive Care Nurses: A Systematic Review Luh Putu Sukmayanti*.
Nursalam.
Makhfudli Fakultas Keperawatan.
Universitas Airlangga.
Indonesia *email: yantisukmaa803@gmail.
Article history Posted.
Jun 12th, 2024 Reviewed.
Nov 11th, 2024 Received.
Nov 20th, 2024 Copyright A 2024 Authors This work is licensed under a Creative Commons Attribution-ShareAlike 4.
International License.
ABSTRACT
Nurses need proper self-management to deal with emotions caused by burnout.
One of the meditations that nurses can do is focus attention or mindfulness.
Mindfulness is a form of selfregulation strategy that involves focusing attention, responding to thoughts, sensations, and emotions with an attitude of acceptance, without judgment, and being aware of current situations and events.
This study aimed to examine of a mindfulness intervention that can reduce burnout in intensive care nurses.
Design study a systematic review, the sample used was intensive care nurses, variables are mindfulness intervention and burnout.
Mindfulnessbased interventions .
oga or meditation, music therapy, cognitive relaxation, breathing relaxation, stress managemen.
Were searched using four databases published through February 2024.
A total of 15 RCT and Quasi-Experimental were included in the final analysis.
Mindfulness-based interventions .
oga or meditation, music therapy, cognitive relaxation, breathing relaxation, stress managemen.
Effective mindfulness programs are generally carried out for 12-8 weeks with weekly meetings for 2 hours and intensive training between Overall, the modalities appeared to alleviate and reduce burnout .
<0,.
Mindfulness-based interventions appear to alleviate can reduce burnout in intensive care Future studies look at mindfulness-based interventions among nurses using more rigorous approaches and larger samples.
Keywords: Burnout.
Intensive Care Nurse.
Mindfulness-Based Interventions ABSTRAK Perawat memerlukan manajemen diri yang tepat untuk mengatasi emosi akibat burnout.
Salah satu meditasi yang dapat dilakukan perawat adalah memusatkan perhatian atau mindfulness.
Mindfulness merupakan suatu bentuk strategi pengaturan diri yang melibatkan pemusatan perhatian, respon terhadap pikiran, sensasi, dan emosi dengan sikap menerima, tanpa menghakimi, serta menyadari situasi dan kejadian saat ini.
Penelitian ini bertujuan untuk JKEP (Jurnal Keperawata.
Vol.
9 No.
2 November 2024 hlm 211- 231 menguji intervensi mindfulness yang dapat mengurangi burnout pada perawat perawatan Desain penelitiannya adalah sistematik review, sampel yang digunakan adalah perawat ICU, variabelnya adalah intervensi mindfulness dan burnout.
Intervensi berbasis kesadaran .
oga atau meditasi, terapi musik, relaksasi kognitif, relaksasi pernapasan, manajemen stre.
Dicari menggunakan empat database yang diterbitkan hingga Februari 2024.
Sebanyak 15 RCT dan Quasi-Experimental dimasukkan dalam analisis akhir.
Intervensi berbasis kesadaran .
oga atau meditasi, terapi musik, relaksasi kognitif, relaksasi pernapasan, manajemen stre.
Program mindfulness yang efektif umumnya dilakukan selama 12-8 minggu dengan pertemuan mingguan selama 2 jam dan pelatihan intensif antar pertemuan.
Secara keseluruhan, modalitas tersebut tampaknya meringankan dan mengurangi kelelahan .
<0,.
Intervensi berbasis kesadaran tampaknya dapat mengurangi kelelahan pada perawat perawatan Penelitian di masa depan melihat intervensi berbasis kesadaran di kalangan perawat dengan menggunakan pendekatan yang lebih ketat dan sampel yang lebih besar.
Kata Kunci: Burnout.
Intensive Care Nurse.
Mindfulness-Based Interventions INTRODUCTION the capacity to adapt to that situation Burnout is a major problem in the health (Landa.
, & Lopez-Zafra, 2.
worker employment sector (Sultana.
Sharma.
Hossain.
Bhattacharya.
In fact, according to WHO, the world may & Purohit, 2.
Burnout is a prolonged 6 million nurses by 2030.
As many as 35% of nurses report that they do not interpersonal stressors characterized by want to practice because of burnout (Hu et increased emotional exhaustion, a cynical , 2.
The study found that working in attitude toward patients, and a tendency to a tense environment.
ICU nurses suffer evaluate oneself negatively, especially from more job-related stressors and a when in contact with patients.
(Maslach.
higher incidence of occupational burnout Leiter.
, & Schaufeli, 2.
Burnout than nurses in general wards.
(Xie et al.
is a serious problem in the nursing profession that can affect their well-being and performance (Palvimo.
Vauhkonen and Hult, 2.
This is because nurses have the opportunity to have more contact with patients, are at greater risk of infection, and the physical and mental burden doubles.
(Guixia.
, & Hui, 2.
Burnout can occur over a longer or shorter period, depending on the situation experienced and A nurse needs proper self-management to deal with emotions caused by burnout.
Meditation needs to be done by nurses to increase moral emphasis, emotions, and interpersonal processes so that nurses again have a sense of empathy when serving One of the meditations that nurses can do is focus attention or mindfulness.
Mindfulness is a form of self-regulation strategy that involves focusing attention.
JKEP (Jurnal Keperawata.
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9 No.
2 November 2024 hlm 211- 231 responding to thoughts, sensations, and on burnout in nurses who work in intensive emotions with an attitude of acceptance, without judgment, and being aware of current situations and events.
(Azzam et al.
Previous researchers have carried out this mindfulness therapy, but the population is used by nurses in general.
researchers are interested in using a population of intensive care nurses , this is because intensive care nurses face very critical METHOD Initial scoping searches were conducted to identify similar and relevant systematic reviews that had already been conducted.
Articles and journals were appropriate for systematic review according to Preferred Reporting Items for Systematic Review and Meta Analyze (PRISMA).
threatening situations.
They have to face Selection Criteria high physical and emotional stress in caring The inclusion criteria in this study were for critical patients, which can lead to articles taken does not limit the year of publication until february 2024 using the exhaustion and intensive care nurses often Quasi-Experimental/RCT method.
This care for patients with critical conditions who require intensive attention and close mindfulness-based interventions are used to This can reduce burnout in intensive care nurses.
stress and increase the risk of burnout.
This The article search strategy was carried out systematic review aims to determine the using the PICOS framework.
This can be effectiveness of mindfulness interventions seen in Table 1.
Table 1.
PICOS framework
PICOS
Population Intervention Inclusion Criteria Intensive care nurse Mindfulness-based interventions .
oga or meditation, music therapy, cognitive relaxation.
No comparison Comparator Burnout in intensive care nurses Outcomes decreases so that it can improve nurse performance Quasi-Experimental Study Design and /RCT publication type Exclusion Criteria Laughter therapy, spiritual freedom technique (SEFT) training Non Experimental.
Letter to editor.
Commentaries.
Qualitative studies.
Abstract only.
Case series.
Case JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 reports.
Reviews.
Discussion papers.
Cross-sectional and cohort studies Publication Years Language Only published between 2019 until English language Literature Search and Screening adapted to Medical Subject Heading After carrying out the inclusion and (MeSH) articles are identified by keywords exclusion criteria, the next step is a (Aucompassion fatigueAy OR Aupsychological literature search.
A literature search was burnoutAy OR Ausecondary traumatic stressAy carried does only publised between 2019 until 2024 with four databases, namely Auburnout syndromeAy OR Auoccupational Scopus.
JSTOR.
WOS and Pubmed writing burnoutAy OR Aucompassion stress burnoutAy the results of the article follows the protocol OR AuturnoverAy ) AND (Auintensive care and rules with Preferred Reporting Items nurse*Ay OR Aunurse ICU*Ay OR Auintensive for Systematic Review (PRISMA).
Search careA.
for articles or journals using keywords and interventions*Ay boolean operator (AND.
OR.
NOT and interventions*Ay AND NOT) where this is used to expand or AumeditationAy OR Aumusic therapyAy OR specify the search, making it easier to Aucognitive determine the articles or quantities you relaxationAy OR Austress managementAy ).
Aucompassion AND dissatisfactionAy (Aumindfulness-based relaxationAy Aumindfulness AuyogaAy Aubreathing want to use.
Keywords in systematic review Search results based on keywords and selections made, obtained 15 articles from 1302 articles that were found.
Selection is carried out using PRISMA (Figure .
according to PRISMA guidelines, the first step is carried out by searching for articles according to the database, after that the articles are selected where duplicate articles will be deleted, after that the abstracts are selected and excluded for those that do not meet the criteria so that the full text is obtained which is by inclusion and exclusion criteria for further evaluation.
Identificat Identification of studies via databases and registers Records removed before screening:
1302 References entered for screening Scopus .
JSTOR .
PubMed .
, dan WOS .
Screening Record screened Dublicate .
= .
After Duplicate records removed .
= .
Records excluded does not inclusion Criteria Title and Abstrack .
Removal Screening by Abstract and full teks identification .
Excluded inappropriate substance .
= .
Include Reports assessed for eligibility full teks .
Studies included in review .
= .
Figure 1.
Literature screening flowchart Data Extraction calculated and added up, to meet the To determine the bias of a study, it is requirement of 70% meeting the critical carried out using Critical Appraisal Skills appraisal criteria with the cut-off point Programme value agreed upon by the study researchers (CASP).
Based assessment with JBI, the scores are then being included in the inclusion criteria.
RESULT
carefully read each title and abstract of the Study Selection 1282 journals to identify eligible journals.
A total of 1302 articles were identified from We focused on the main criterion, namely four databases simultaneously.
The search the population collected consisted of nurses identified a total of 1302 articles but the who experienced burnout.
These articles number of articles was reduced to 20 after focus on the effect of mindfulness therapy removing duplicate results.
Second, we on burnout in nurses in the ICU.
After that.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 8 articles will be included in the next review meditation, and music therapy and the stage, because they must be ensured that they meet all the necessary criteria.
education with the theme of burnout and Third, the remaining 20 articles were read and understood for further consideration for inclusion criteria.
In detail, the journal must not be a review/report/protocol article, must exclusively refer to nurse burnout, and must report at least one result that influences the The intervention ranged from 12 weeks to 2 months, with the length of the follow-up period varying from immediately postintervention to 3 months after intervention (Table .
reduction of nurse burnout in the ICU.
RoB in studies Research must also come from indexed and All studies considered were considered to reputable journals.
have low RoB.
However, some studies After the third step, 9 articles were The reason for exclusion is due to the research viewpoint.
Because it does not match the desired criteria.
Finally, the remaining 15 journals were deemed eligible for review and analysis.
All of them focused on the effect of providing mindfulness interventions on reducing nurse burnout in the ICU Study Characteristics The trials in this study were published between 2019 and 2023.
This research was conducted in hospitals with a sample of nurses working in the hospital's ICU room from china, spain, turkey, iran, german, america, italia, malaysia, and finlandia.
Participants' ages ranged from 22 years to 40 years.
Participants in the experimental publication bias due to the timing of modifications of the intended treatment (Table .
(Risk of bia.
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2 November 2024 hlm 211- 231 Table 4 Summary of included studies Author, year/country Study design Participant characteristics Intervention types Duration of Follows-up Outcomes .
Total Mean Age Experimental Control The provided was a mindfulnessbased program specifically for ICU nurses.
The includes various techniques such walking, eating, body scan, yoga.
Participants were allowed to take part in an 8week Over 8 weeks.
Baseline and The burnout two postrate decreases per intervention with p<0,001 Each 45-50 minutes 8 weeks (Xiang-Zi and Jia-yuan, 2.
China
RCT
-38 yea.
(Gracia Gozalo et al.
, 2.
Barcelona.
Spanyol
RCT
(O35 year, 36-50 year, and Ou51 yea.
Baseline and This decrease postwas observed value of -3.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 Author, year/country Study design Participant characteristics Total Mean Age Intervention types Experimental included short.
This supported by a WhatsApp group-based community that provides support Get program that is based on the MBSR.
MBCT.
ACT, compassion and Duration of Follows-up Outcomes .
Control points with a pvalue = 0.
The intervention in this study succeeded in reducing the level of .
in JKEP (Jurnal Keperawata.
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Author, year/country Study design
Participant characteristics Total
(Xie et
China
RCT
Mean Age 7 (SD 7.
Intervention types Experimental Get program that is based on the MBSR.
MBCT.
ACT, compassion and Duration of Follows-up Outcomes .
Before .
, .
, months after The results of the intervention between the treatment group (MBIB Grou.
and the control group (EB Grou.
in Thus, these results indicate that the provided to the MBIB group was effective in burnout levels and increasing Control Receive 8 weeks in the form of sessions in the first week and the fourth These training and burnout, its ICU nurses, as well as how to reduce job burnout and friendly with patients.
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Author, year/country Study design
Participant characteristics Total
Mean Age
(Lu et
China
RCT
(Mealer et al.
United States RCT .
/32.
Intervention types Experimental Duration of Follows-up Outcomes .
Control awareness and acceptance in ICU nurses compared to the EB control Get mindfulness No 4 weeks, with a Beseline and Mindfulnessintervention frequency of 2 postbased times a week can reduce symptoms of exhaustion and subjective wellbeing as well as symptoms of anxiety and depression in ICU nurses.
Received Assigned to a 8 weeks Baseline and Anxiety post(HADS) and (HADS) read the book and have an JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 Author, year/country Study design Participant characteristics Total Mean Age Intervention types Experimental (Othman.
Hassan Mohamed.
Spanyol A quasiexperimental 25-29 year Intervention (Ozgundondu and Gok Metin.
Turkey
RCT
, 27.
Progressive (PMR) combined with music therapy Duration of Follows-up Outcomes .
Control a No 2 month Education 20 minutes, twice a week for 12 weeks Baseline and Mindfulnesspostbased are effective in burnout levels in nurses Baseline and The postcombination of (PMR) with music therapy is effective in managing stress and fatigue, as well as supporting the use of coping focused on problems and JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 Author, year/country Study design Participant characteristics Total (Urso et al.
United States (Renholm.
Finlandia (Schonfeld , 2.
German
Mean Age
RCT
A quasiexperimental < 45
RCT
Not specifically Intervention types Experimental Duration of Follows-up Outcomes .
Control MindfulnessBased Intervention (MBI) which includes yoga classes and MindfulnessBased Intervention (MBI) training 8 weeks 1 years Digitally 4 weeks The long-term impact of and how certain factors may influence the results Baseline and Baseline and among ICU Burnout and stress levels can decrease with MBI Mindfulness therapy can have a positive effect in reducing stress and burnout as well as awareness and well-being in department and care unit Effectiveness and efficacy of JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 Author, year/country Study design Participant characteristics Total Mean Age Intervention types Experimental Duration of Follows-up Outcomes .
Control including apps and web-based (Hilcove.
Marceau.
Thekdi.
Larkey.
Melanie Brewer, et al.
United States of America
RCT
O 42
Yoga 6 weeks Baseline and (Faramarzi.
Dehghani and Hojat, 2.
Iran
RCT
Yoga and 8 weeks Complete the Maslach Burnout Inventory after the interventions in health and work among nurses Significant in reduced stress and burnout, as well in sleep quality, calmness, and compared to the control group.
Yoga and aerobic exercise have a positive effect in JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 Author, year/country Study design Participant characteristics Total Mean Age Intervention types Experimental Duration of Follows-up Outcomes .
and one month after Baseline and burnout levels among nurses Control (Abbasalizadeh et al.
, 2.
Iran
RCT
The training uses mHealth applications that and virtual 5 month (Bodini et al.
Italia
RCT
Not specifically Mindful Compassionate Care Program
(MCCP)
6 weeks Baseline and Training using mHealth based on microlearning methods can reduce stress and anxiety levels in nurses working in the ICU The Mindful Compassion Care Program (MCCP) is effective in reducing the level of burnout stress in nurses working during JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 Author, year/country Study design Participant characteristics Total (Ghawadra , 2.
Malaysia
RCT
Mean Age Not specifically Intervention types Experimental MindfulnessBased Training (MBI) Duration of Follows-up Outcomes .
Control 8 weeks Baseline and the COVID19 pandemic There was a effect over time on stress, depression and mindful level .
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 The mindfulness-based intervention tailored and performance of ICU nurses in caring Mindfulness-based specifically for ICU nurses had a positive impact in reducing levels of death anxiety effective approach to improving mental and burnout in nurses.
This reduction in well-being and reducing burnout in ICU death anxiety and burnout can have a nurses, which in turn can improve the positive impact on the mental well-being quality of care provided to patients.
DISCUSSION
(PMR).
Mindfulness is a mind-body therapy that interventions .
oga or meditation, music therapy, cognitive relaxation, breathing non-judgmental mindfulness-based practices that can relieve psychological distress by separating emotional reactions Mindfulness is a concept that involves and habitual behavior from unpleasant being fully aware of current experiences symptoms, thoughts, and emotions.
(Pratt et without judging or reacting to them.
The , 2.
In the nursing context, there is ability to focus on the present moment with can be an acceptance and without judgment of thoughts, feelings, or sensations that arise.
Traditional Mindfulness programs often rely on in-person group meditation, breathing, and body awareness delivery through several hours per week of exercises to help individuals develop self- instruction and home practice.
However, with such a large number of healthcare concentration, and improve overall well- workers, a more accessible alternative Mindfulness is beneficial in reducing approach to providing mindfulness therapy burnout, stress, anxiety, and depression, as could be beneficial.
well as improving mental and emotional The results of the review, interventions that well-being (Urso et al.
, 2.
can be carried out to reduce burnout in This study found that mindfulness-based nurses are mindfulness techniques such as interventions were effective in reducing mindful sitting, breathing, walking, eating, burnout in nurses in the ICU.
Providing body scan, yoga, summarization, music, aerobic and progressive muscle relaxation management, music, relaxation, yoga, and JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 meditation effectively reduces burnout in was that the results showed that nurses who ICU nurses.
In this research, it was found that the countries where this mindfulness experienced a decrease in anxiety and therapy has been provided are China.
Spain, burnout in the post-test compared to nurses Turkey.
Iran.
Finlandia with a large number who did not receive the intervention.
of studies .
, involving 777 ICU Previous research has also shown the nurses ranging in age from 22 years to 40 positive effect of mindfulness on burnout in This study found that the effects of The mindfulness intervention to reduce burnout applied in this research consisted of providing yoga, meditation, and music.
Inconsistent effectiveness in reducing burnout are related to differences in the type and The intervention in this study focused on breathing, walking, eating, and other daily activities to help nurses manage emotional awareness peacefully.
This is expected to improve emotional regulation abilities and (Xiang-Zi and Jia-yuan, administration of mindfulness interventions Previous studies show that mindfulness Mindfulness-based yoga can interventions can reduce emotional distress have a positive impact on the stress levels and burnout in ICU nurses.
MBIs help and well-being of nurses and healthcare individuals become more aware of their thoughts, feelings, and body sensations without judgment, thereby helping to improved sleep quality, reduced stress, and manage emotions, reduce stress, and build Through (Hilcove.
Marceau.
Thekdi.
Larkey.
Melanie A Brewer, et al.
Additionally.
MBIs can increase self- This suggests a holistic approach to awareness, and self-compassion and reduce evaluating the impact of yoga interventions burnout, which in turn improves mental on participants' well-being.
health by reducing levels of anxiety, stress.
One of the studies that tested the effectiveness of a specifically modified mindfulness-based program for ICU nurses and depression.
(Othman.
Hassan and Mohamed, 2.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 211- 231 The reduced effectiveness of mindfulness interventions is caused by differences in the intensity and duration of the intervention.
difficulty of situations, acceptance of Effective thoughts and emotions, and quality of life.
generally carried out for 12-8 weeks with This training helps participants become weekly meetings for 2 hours and intensive training between meetings.
This duration behavior, as well as improve concentration, has been proven and obtained from 7 energy, attitudes, and better behavior studies that have been conducted, this towards patients and co-workers (Renholm, duration is effective in reducing stress and In addition, mindfulness therapy has burnout as well as increasing self- an additional effect on patient satisfaction awareness and self-compassion.
And the recommended sample size usually reaches protocols and guidelines (Saban.
Dagan and a minimum of 30 participants to get Drach-zahavy, 2.
significant results.
(Othman.
Hassan and Mohamed, 2.
their situations and interventions that focus on CONCLUSION This latest review of 15 RCT provides The positive effects of a combined program evidence that mindfulness therapy can of MBSR and MBCT can last for at least reduce burnout in ICU nurses.
Mindfulness three months after the intervention is can be applied to all groups of nurses or carried out (Pyrez et al.
, 2.
Providing people who experience burnout, apart from mindfulness therapy can assist nurses in being very easy to do, mindfulness training developing awareness skills that can help also does not cost a lot of money.
Support nurses respond flexibly to stress in a for mental health among nurses must be demanding work environment, as well as help nurses manage symptoms of emotional exhaustion and burnout that they may professional development.
Future research This intervention is designed to evaluates mindfulness-based interventions provide nurses with tools and strategies so among working nurses with a more they can better face work challenges and rigorous methodology and larger sample improve their mental well-being.
Mindfulness training has a positive impact on nurses in emergency departments and intermediate care units.
Active participants JKEP (Jurnal Keperawata.
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REFERENCES