Laura Quigg, DNP, ANP, GNP, ACHPN

Abstract:

Background: Critical care nurses faced unprecedented challenges during the pandemic, exacerbating stress, burnout, and moral distress. Despite the significant implications of moral distress, few effective interventions exist. Shifting the focus from mitigating moral distress to strengthening moral resilience may help to address this gap and provides an opportunity to shape future research. Mindfulness practices have been shown to reduce distress and burnout, improve well-being and resilience, and may provide a useful tool in mitigating the negative effects of moral distress. Objectives: To determine the efficacy and feasibility of a brief mindfulness-based self-care program on critical care nurses’ resilience and well-being during the COVID-19 pandemic. Methods: A single-group pretest-posttest design was utilized. From an adult critical care unit in an academic hospital, a convenience sample of nurses working during the pandemic were enrolled. The four-week intervention was offered through a free online application. Participants were asked to complete five assigned guided practices per week at a location and time convenient to them. Pre-and-postintervention surveys were available through Qualtrics and utilized the 10-item Connor-Davidson Resilience Scale, Rushton Moral Resilience Scale, and Nurse Well-Being Index to evaluate outcome measures. Practice frequency was automatically tracked by the application. Demographic data and feasibility measures were included. Statistical analysis included descriptive statistics, Wilcoxon signed rank tests, nonparametric permutation tests, and nonparametric bootstrap analyses; a regression analysis evaluated relationships between variables. Results: Thirty nurses completed pretest data, and twenty-three participated in practices and the postintervention survey. Significant changes in resilience, moral resilience and well-being scores were noted. There was no significant correlation between practice frequency and changes in outcome measures. A positive correlation was found between resilience and moral resilience. Resilience measures were negatively correlated with at-risk well-being scores. Participant responses lent support to the acceptability and feasibility of the intervention. Conclusion: Participation in a brief, online MBSC intervention appeared beneficial in fostering resilience, moral resilience, and well-being in a sample of critical care nurses during the COVID-19 pandemic. Future studies are warranted. Interventions that offer room for personal and collective growth may be an important next step, particularly as we look forward. 

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