The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol : JBI Evidence Synthesis

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The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol

Botha, Elmarie; Gwin, Teri; Purpora, Christina

Author Information
JBI Database of Systematic Reviews and Implementation Reports 13(10):p 21-29, October 2015. | DOI: 10.11124/jbisrir-2015-2380
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Inclusion criteria

Types of participants

This review will consider studies that include Registered Nurses, regardless of their credentials or specialty fields, who are currently employed in adult patient care settings. Studies involving nurses employed in non-adult health service settings will be excluded.

Types of intervention(s)/phenomena of interest

This review will consider studies that evaluate any mindfulness based programs that originate from the original Mindfulness-Based Stress Reduction Program developed by John Kabat Zinn.

The intervention will be compared to standard care, which in most instances is no intervention. Studies examining the effectiveness of mindful meditation alone without a concurrent structured mindfulness based program will be excluded.

Types of outcomes

This review will consider studies pertaining to mindfulness based programs that include the following outcome measure: perceived stress. Studies will be selected that measure stress experienced by nurses as measured by a variety of perceived stress scales, including but not limited to, the Perceived Stress Scale (PSS-14, PSS-10 and PSS-4) and the Depression and Anxiety Stress Scale (DASS-21).

Types of studies

This review will consider any experimental study design including randomized controlled trials, non-randomized controlled trials, quasi-experimental, and before and after studies for inclusion.

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of PUBMED and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. Studies published since 1979 will be considered for inclusion in this review as the first mindfulness based stress reduction program was created in 1979 by John Kabat Zinn.

The databases to be searched include:





The search for unpublished studies will include:

Google Scholar

ProQuest Dissertation and Theses.

Initial keywords to be used will be:

Mindfulness; Nurses; Nursing; Stress; Stress reduction; Mindfulness based programs.

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological quality prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data extraction

Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. An attempt will be made to contact the authors of the primary studies for any missing information or to clarify unclear data.

Data synthesis

Quantitative data will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square. Where statistical pooling is not possible the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

Conflicts of interest

The authors have no conflict of interest to declare.


We would like to acknowledge the following for their contribution and assistance during the development of this protocol: Dr Michelle Hampton, Director of Doctorate of Nursing Practice, Samuel Merritt University School of Nursing. Dr Pamela Minarik, Professor, Samuel Merritt University School of Nursing.


1. Aiken L, Clarke S, Sloane D. Nurses’ reports on hospital care in five counties. Health Aff. 2001; 20(3):43-53.
2. Decker F. Occupational and non-occupational factors in job satisfaction and psychological distress among nurses. Res Nurs Health. 1997; 20:453-464.
3. Twigg D, McCullough K. Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. Int J of Nurs Stud. 2014; 51(11):1421-1538.
    4. Pipe TB, Bortz JJ, Dueck A, Pendergast D, Buchda V, Summers J. Nurse Leader Mindfulness Meditation Program for Stress Management: A Randomized Controlled Trial. JONA. 2009; 39(3):130-137.
      5. Shapiro SI, Astin JA, Bishop SR, Cordova M. Mindfulness-Based Stress Reduction for Health Care Professionals: Results From a Randomized Trial. Int J Stress Manag. 2005; 12(2):164-176.
      6. Spickard A, Gabbe S, Christensen J. Mid-career burnout in generalist and specialist physicians. JAMA. 2002; 288:1447-1450.
      7. Shimizu T, Mizoue T, Kubota S, Mishima N, Nagata S. Relationship between burnout and communication skill training among Japanese hospital nurses: a pilot study. J Occup Health. 2003; 45:185-190.
      8. Zangaro G, Soeken K. A meta-analysis of studies of nurses’ job satisfaction. Res Nurs Health. 2007; 30:445-458.
      9. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job satisfaction. JAMA. 2002; 288(16):1987-1993
      10. Wang J. Work stress as a risk factor for major depressive episode(s).Psychol Med. 2005; 35: 865-871.
      11. Ohler MC, Kerr MS, Forbes DA. Depression in nurses. CJNR. 2010; 42 (3):66-82.
        12. Gong Y, Han T, Yin X, Yang G, Zhuang R, Chen Y, Lu Z. Prevalence of depressive symptoms and work-related risk factors among nurses in public hospitals in southern China: A cross-sectional study. Scientific Reports. 2014;4:7109.
          13. Lin HS, Probst JC, Hsu YC. Depression among female psychiatric nurses in southern Taiwan: main and moderating effects of job stress, coping behavior and social support. J Clin Nurs. 2010; 19:2342-2354.
          14. Topa G, Moriano JA. Stress and nurses horizontal mobbing: moderating effects of group identity and group support. Nurs Outlook. 2013; 61:E25-E31.
          15. Griffin M. Teaching Cognitive Rehearsal as a Shield for Lateral Violence: An Intervention for Newly Licensed Nurses. The Journal of Continuing Education in Nursing. 2004; 35(6):257-263.
          16. Farrell GA. Aggression in clinical settings: Nurses’ views. J Adv Nurs. 1997; 25:501-508.
          17. Farrell G. From tall poppies to squashed weeds: why don't nurses pull together more? J Adv Nurs. 2001; 35 (1):26-33.
          18. McKenna BG, Smith NA, Poole SJ, Coverdale JH. Horizontal violence: experiences of Registered Nurses in their first year of practice. J Adv Nurs. 2003; 42(1):90-96.
          19. Nazarko L. Bullying and harassment. Nurs Manag. 2001;8(14):14-15.
          20. Roberts SJ. Oppressed group behavior: Implications for nursing. Adv Nurs Sci. 1983; 5(4):21-30.
          21. Roberts SJ. Breaking the cycle of oppression: Lessons for nurse practitioners? JAANP. 1996; 8:209-214.
            22. Thomka L. Graduate nurses’ experiences of interactions with professional nursing staff during transition to the professional role. J Contin Educ Nurs. 2001; 32:15-19.
            23. Griffin M, Clark CM. Revisiting Cognitive Rehearsal as an Intervention Against Incivility and Lateral Violence in Nursing: 10 Years Later. J Contin Educ Nurs. 2014; 45(12):535-542.
            24. Bowling N, Beehr T. Workplace harassment from the victim's perspective: A theoretical model and meta-analysis. J Appl Psychol. 2006; 91:998-1012.
            25. Bakker A, Killmer CH, Siegrist J, Schaufeli WB. Effort reward imbalance and burnout among nurses. J Adv Nurs. 2000; 31(4):884-891.
            26. Vegchel N, van Jonge J, de Bosma H, Schaufeli WB. Reviewing the Effort-Reward Imbalance Model: Drawing up the balance of 45 empirical studies. Soc Sci Med. 2005; 60(5):1117-1131.
            27. Reineck C, Furino A. Nursing career fulfillment: statistics and statements from registered nurses. Nurs Econ. 2005;23(1):25-30.
            28. Hauge LJ, Skogstad A, Einarsen, S. Individual and situational predictors of workplace bullying: Why do perpetrators engage in the bullying of others? Work & Stress. 2009; 23(4): 349-358
              29. Aikens KA, Astin J, Pelletier KR, Levanovich K, Baase CM, Yeo Yung P, Bodnar CM. Mindfulness Goes to Work. J Occup Environ Med. 2014; 56(7):721-731.
              30. Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clin Psychol Sci Pract. 2003; 10:144-156.
                31. Baer RA. Mindfulness training as a clinical intervention: A Conceptual and empirical review. Clin Psychol Sci Pract. 2003; 10(2):125-143.
                  32. Shapiro S, Schwartz G, Bonner G. Mindfulness in medical education: Fostering the health of physicians and medical practice. Integr Med. 1998; 1(3):93-94.
                  33. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. J Altern Complement Med. 2009; 15(5):593-600.
                  34. Kabat-Zinn J. Full Catastrophe Living. New York, NY: Bantam Dell; 1990.eak

                    Appendix I: Appraisal instruments

                    MAStARI appraisal instrument

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                    Appendix II: Data extraction instruments

                    MAStARI data extraction instrument

                    no caption available

                    burnout; depression; lateral violence; mindfulness; Mindfulness Based Stress Reduction (MBSR); nurses; stress

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