Document Type


Publication Date


Publication Title

Mindfulness Bundle Impact on Nurse Burnout Study


texas; covenant; covid-19



Nurse burnout is a widespread problem globally. Nurse burnout is not only exacerbating nurses’ physical and mental health, but also affects patient satisfaction as well as hospital performance. Due to negative outcomes of nurse burnout, high turnover rates, and excessive costs of hiring nurses, there is a growing body of literature about factors leading to burnout and interventions to control and reduce nurse burnout. Nurses working in Intensive Care Units (ICU) designated for SARS-CoV-2 infected patients during the height of the 2020 pandemic reported experiencing higher than usual levels of emotional exhaustion (EE), depersonalization (DP), physiological signs of stress and exhaustion, and lower levels of personal accomplishment (PA). Researchers observed changes in frontline nurse work patterns, mental and emotional health, and verbalization of frustrations and helplessness. Current literature does not have a definitive solution to combat individual burnout. The purpose of this study is to test the effectiveness of a mindfulness bundle toolkit on nurse EE, DP, PA, Nurse Work Index (NWI) and Stress Arousal Checklist (SACL) scores in nurses working in critical care units designated for the care of SARS-CoV-2 patients.


A quantitative quasi-experimental repeated measures design was utilized in this IRB approved study. Study participants consisted of (N = 52) a convenient sample of front-line registered nurses caring for SARS-CoV-2 patients. Study participants were provided a mindfulness bundle toolkit with aims to decrease burnout over a twelve-week period by developing skills to manage clinical stress and improve their overall health. Interventions included approximately 1 – 1.5 hours per week of intervention including mindfulness, spirituality training, music therapy, resilience, yoga, and therapeutic rooms. Data was collected at three time periods from study participants: pre-intervention, six-weeks post intervention, and twelve-weeks post intervention using the Maslach Burnout Inventory (MBI), NWI, and SACL. Data was entered into SPSS version 27. Descriptive analysis was conducted on all study variables. Normality was examined for interval-level dependent variables. A one-way repeated measures analysis of variance (ANOVA) was conducted to determine the effects of the mindfulness bundle on EE, PA, DP, NWI, Stress and Arousal scores.


The results of the analysis indicated a statistically significant effect from the mindfulness bundle on front-line nurses in three areas pertaining to burnout: Emotional Exhaustion, Wilks’ Lambda = .657, F(1, 41) = 19.02, p < .005, η2 = .31; Depersonalization, Wilks’ Lambda = .704, F(1, 41) = 7.93, p < .007, η2 = .16; and Stress, Wilks’ Lambda = .81, F(1, 41) = 8.81, p < .005, η2 = .17.


Significant effects were not found from the mindfulness bundle on the measures of Personal Accomplishment, NWI and Arousal scores. Study findings in this population suggest the use of a 12-week mindfulness bundle is an effective intervention to mitigate emotional exhaustion, depersonalization and stress linked to burnout in critical care nurses caring for SARS-CoV-2 patients. Replication of the intervention with a larger, randomized sample of nurses is recommended.


Gisele N Bazan, BSN, RN, CCRN-K, Jamie K Roney DNP, RN, NPD-BC, CCRN-K, Kelsey Sawyer BSN, RN, CCRN, NPD-BC, Tiffany Patterson BSN, RNC-NIC, Michelle Bradberry BSN, RN, CCRN, Deborah Wambui Kamau MSN, RN, FNP-BC, Cynthia Grissman BSN, RN, NE-BC, Sahar Mihandoust PhD, MArch,C Randall Stennett DNP, RN, NPD-BC, CHSE, JoAnn D Long PhD, RN, NEA-BC


Infectious Diseases




Mindfulness Bundle Impact on Nurse Burnout Study


Adimando, A. (2018). Preventing and alleviating compassion fatigue through self-care: an educational workshop for nurses. Journal of Holistic Nursing, 36(4), 304-317.

Alharbi, A. A., Dahinten, V. S., & MacPhee, M. (2020). The relationships between nurses' work environments and emotional exhaustion, job satisfaction, and intent to leave among nurses in Saudi Arabia. Journal of Advanced Nursing, 76(11), 3026–3038.

Alkhawaldeh, J. M. A., Soh, K. L., Mukhtar, F. B. M., Peng, O. C., & Anshasi, H. A. (2020). Stress management interventions for intensive and critical care nurses: A systematic review. Nursing in Critical Care, 25(2), 84–92.

Asgari, S., Shafipour, V., Taraghi, Z., & Yazdani-Charati, J. (2019). Relationship between moral distress and ethical climate with job satisfaction in nurses. Nursing Ethics, 26(2), 346–356.

Bell, M., & Sheridan, A. (2020). How organisational commitment influences nurses' intention to stay in nursing throughout their career. International Journal of Nursing Studies Advances, 2, 100007.

Bellanti, F., Lo Buglio, A., Capuano, E., Dobrakowski, M., Kasperczyk, A., Kasperczyk, S., Ventriglio, A., & Vendemiale, G. (2021). Factors Related to Nurses’ Burnout during the First Wave of Coronavirus Disease-19 in a University Hospital in Italy. International Journal of Environmental Research and Public Health, 18(10).

Delany, M.C. (2018). Caring for the caregivers: evaluation of the effect of an eight-week pilot mindful self-compassion (msc) training program on nurses’ compassion fatigue and resilience. PLOS One, 13(11).

Duhoux, A., Menear, M., Charron, M., Lavoie-Tremblay, M., & Alderson, M. (2017). Interventions to promote or improve the mental health of primary care nurses: a systematic review. Journal of Nursing Management, 25(8), 597–607.

Duarte, J., & Pinto-Gouveia, J. (2016). Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: A non-randomized study. International Journal of Nursing Studies, 64, 98–107.

Fadzil, N. A., Heong, W. O., Kueh, Y. C., & Phang, C. K. (2021). The Effect of a Mindfulness-Based Intervention on Nurses in Kelantan, Malaysia. The Malaysian Journal of Medical Sciences : MJMS, 28(6), 121–128.

Gensimore, M. M., Maduro, R. S., Morgan, M. K., McGee, G. W., & Zimbro, K. S. (2020). The Effect of Nurse Practice Environment on Retention and Quality of Care via Burnout, Work Characteristics, and Resilience: A Moderated Mediation Model. The Journal of Nursing Administration, 50(10), 546–553.

Ghawadra, S. F., Lim Abdullah, K., Choo, W. Y., Danaee, M., & Phang, C. K. (2020). The effect of mindfulness-based training on stress, anxiety, depression and job satisfaction among ward nurses: A randomized control trial. Journal of Nursing Management, 28(5), 1088–1097.

Ghawadra, S. F., Abdullah, K. L., Choo, W. Y., & Phang, C. K. (2019). Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. Journal of Clinical Nursing, 28(21-22), 3747–3758.

Green, A. A., & Kinchen, E. V. (2021). The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association, 39(4), 356–368.

Jakimowicz, S., Perry, L., & Lewis, J. (2018). Compassion satisfaction and fatigue: A cross-sectional survey of Australian intensive care nurses. Australian Critical Care, 31(6), 396–405.

Jarden, R.J., Sandham, M., Siegert, R. J., & Koziol-McLain, J. (2020). Intensive care nurses’ well-being: a systematic review. Australian Critical Care, 33(1), 106-111.

Jung, S.-E., Ha, D.-J., Park, J.-H., Lee, B., Kim, M.-S., Sim, K.-L., Choi, Y.-H., & Kwon, C.-Y. (2021). The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review. International Journal of Environmental Research and Public Health, 18(16).

Kang, M.-J., & Myung, S.-K. (2021). Effects of Mindfulness-Based Interventions on Mental Health in Nurses: A Meta-Analysis of Randomized Controlled Trials. Issues in Mental Health Nursing, 1–9.

Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2019). The Effects of a Modified Mindfulness-Based Stress Reduction Program for Nurses: A Randomized Controlled Trial. Workplace Health & Safety, 67(3), 111–122.

McDermid, F., Judy Mannix, & Peters, K. (2020). Factors contributing to high turnover rates of emergency nurses: A review of the literature. Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses, 33(4), 390–396

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91–98.

Rivaz, M., Tavakolinia, M., & Momennasab, M. (2021). Nursing professional practice environment and its relationship with nursing outcomes in intensive care units: a test of the structural equation model. Scandinavian Journal of Caring Sciences, 35(2), 609–615.

Sarazine, J., Heitschmidt, M., Vondracek, H., Sarris, S., Marcinkowski, N., & Kleinpell, R. (2021). Mindfulness Workshops Effects on Nurses’ Burnout, Stress, and Mindfulness Skills. Holistic Nursing Practice, 35(1), 10–18.

Sauerland, J., Marotta, K., Peinemann, M. A., Berndt, A., & Robichaux, C. (2014). Assessing and addressing moral distress and ethical climate, part 1. Dimensions of Critical Care Nursing : DCCN, 33(4), 234–245.

Sorenson, C., Bolick, B., Wright, K., & Hamilton, R. (2016). Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature. Journal of Nursing Scholarship, 48(5), 456–465.

Steinberg, B. A. (2017). Feasibility of a Mindfulness-Based Intervention for Surgical Intensive Care Unit Personnel. American Journal of Critical Care, 26(1), 10–18.

Van Osch, M., Scarborough, K., Crowe, S., Wolff, A. C., & Reimer, K. S. (2018). Understanding the factors which promote registered nurses’ intent to stay in emergency and critical care areas. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 27(5–6), 1209–1215.

Westermann, C., Kozak, A., Harling, M., & Nienhaus, A. (2014). Burnout intervention studies for inpatient elderly care nursing staff: systematic literature review. International Journal of Nursing Studies, 51(1), 63–71.

Xie, C., Zeng, Y., Lv, Y., Li, X., Xiao, J., & Hu, X. (2020). Educational intervention versus mindfulness-based intervention for ICU nurses with occupational burnout: A parallel, controlled trial. Complementary Therapies in Medicine, 52, 102485.

Yi-Yan Chen, & Xiang-Shu Cui. (2020). Intervention effect of mindfulness-based stress reduction for psychological health among nurses: A meta-analysis. TMR Integrative Nursing, 4(5), 163–171.