Background
The issue of the stress and anxiety among the nurses and the health care setting has become a great problem for the health care professionals during the era of covid-19 due to the huge work pressure and unusual shift timings. Therefore, it is essential to address the issue in order to maintain the quality of care delivered to the patients. The nurses and the other health care professionals face a lot of difficulties during the pandemic due to the presence of the stress and anxiety (Mo et al., 2020). In a recent cross-sectional study by Mosolova et al. (2020) the researchers reported that the mental health of the medical workers had been affected greatly due to the presence of the stress and anxiety and in this study the researchers reported to include 1,090 healthcare workers and it was reported that approximately 49.1 per cent of the respondents had moderate level of anxiety and on the other hand, 21.9 per cent of the nurses had the severe level of anxiety as per the score of SAVE-9. The study findings were also supported by the findings of Elbay et al. (2020) as in this current study the researchers reported to conduct an online survey to assess the stress and anxiety level of the physicians during the covid-19 pandemic situation. The study measured the level of stress by using the Depression Anxiety and Stress Scale-21 (DAS-21). Among the 442 participants of the current study, the researchers reported that 286 patients had the signs of depression, 51.6 per cent or the 224 participants had the symptoms of anxiety and 182 patients had the symptoms of the stress. The study also stated that being female, less working experiences, young, single and frontline working experience were associated with the greater scores of anxiety, depression and stress. Abadi et al. (2020) also supported the fact among the 125 nurses included in the study the researcher reported that there was association between the age and depression along with a p value of 0.002, association between age and anxiety along with a p value of 0.018, association between the employment and stress (p=0.009), association between age and stress (p=0.011) and the employment status and stress (p=0.023). The overall study result reported that the rate of depression, anxiety and depression was moderate in case of the nurses working in the COVID-19 wards in Torbat-e-Heydariyeh Hospital. The use of the mindfulness-based therapy is reported to be successful for managing the depression and anxiety among the university students. In this non-randomized controlled trial study design the researchers reported that the application of the mindfulness-based meditation therapy had reduced the depression and anxiety after 6 months and 12 months of follow up conditions (Carpena et al., 2019). The study of Strege et al. (2018) the researchers also supported the use of the mindfulness-based exercise for the management of stress and depression among the adult population. In this study, the researchers investigated the effectiveness of the mindfulness based cognitive therapy for improving the anxiety symptoms and the results reported the improvements of anxiety symptoms after the intervention implementation.
Literature Review
Considering the analysis of the existing literature revealed that there is lack of evidence regarding the effectiveness of the mindfulness-based intervention for managing stress and depression among the nurses.
Aim of the Study
Therefore, the main of the current study is to assess the efficacy of the mindfulness-based therapy for improving experiences of the nurses in terms of stress and anxiety reduction in the health care setting.
Research Question
Can implementation of the mindfulness-based therapy improve the experiences of nurses in terms of the stress and anxiety conditions?
Study Design
As a part of the study design of the current qualitative study design the researchers will consider a grounded theory approach as considering the aim of the study, it can be reported that it is essential to standpoints of the nurses for understanding their stress and anxiety conditions. The use of the qualitative study design will be appropriate for the current study as this particular study design will allow the researchers to explore the thoughts of the nurses regarding their stress condition and their thoughts after the implementation of the mindfulness-based therapy for reducing the stress and anxiety (Kamal, 2019). The use of the grounded theory approach in the qualitative study design will help the researchers to uncover the different experiences of the individuals regarding the experiences of stress and anxiety after the implementation of the mindfulness-based therapy for improving the stress and anxiety. Therefore, the use of the grounded theory approach will allow the researchers to generate new theories from the collected data from the participants as well. The main reason of selecting the qualitative study design for this current study is associated with the fact that the researchers can assess the efficacy of the mindfulness-based therapy through the experiences of the nurses facing the same issue (Turner & Astin, 2021).
Study Population
The nurses of the local health care setting having the complain of the depression and anxiety condition will be included in the study and the participants will be selected based on a few inclusion and exclusion criteria as well.
The inclusion criteria for the participants will be as follows-
- The nurses must have the moderate level of anxiety and depression according to the score of Depression Anxiety and Stress Scale-21 (DAS-21).
- The nurses must have the experiences of 6 months to 12 months
- The nurses must work in the emergency department
As a part of the exclusion criteria of the current study the researchers will consider the following criteria-
- The nurses having the experiences of less than 6 months or more than 12 months will be excluded from the current study.
- The nurses having the anxiety and depression of mild and high level will be excluded the current study.
- The nurses working in the other departments apart from the emergency department will be excluded from the study.
Sampling Method
The study samples will be collected from the four different local government health care and for selecting the study population the researchers will follow the purposive sampling method which eventually help the participants to select only those participants who will meet the criteria for the current study (Campbell et al., 2020).
Data Collection
For collecting the data from the study participants, the researcher will use an interview method and the questionnaire will be constructed by the researchers themselves. The initial section of the questionnaire will comprise of the demographic profile and the working experience related questions and in the section will comprise of the open-ended questions that will help the researchers to explore the viewpoints of the nurses regarding their experience of stress and anxiety after the implementation of the mindfulness-based exercise. The experiences of the nurses related to the use of the mindfulness-based therapy will be gathered by using the open-ended questions (DeJonckheere & Vaughn, 2019). Moreover, it is essential to mention the fact the use of the open-ended question-based questionnaire will help the participants to share their views about the topic. The interview sessions will last for 15-20 minutes each. The researchers will hire research assistant to conduct the interview sessions to avoid the possible bias present in the study. The interview sessions will be recorded by using electronic tape recorder as well.
Purpose of the Study
Data Analysis
For analysis of the collected data from the participants the researchers will transcribe the data and the thematic analysis approach will be followed by the researchers. For the thematic analysis process, the researchers will use the NVivo software and the results or the findings of the current study will be represented by using the different themes generated from the interview transcription (Castleberry & Nolen, 2018).
For maintaining the rigourness or the trustworthiness of the current study the researchers will try to avoid the researchers bias through hiring different research assistant for the data collection process which will help to enhance the credibility of the study. Moreover, the researchers will also try to enhance the generalization of the study results as they will select the study participants from the four different government hospitals. This multicentred nature of the study will help to enhance the generalization of the study results as the results can be applied to different setting due to its nature and this will also enhance the internal validity of the study (Maxwell, 2021).
The current study also has limitations like other studies and as a part of the first limitation of the study, it can be reported that the use of the purposive sampling strategy can be considered as one of the limitations of the study. The choice of the purposive sampling can introduce the data collection bias into this current study. Moreover, the researchers will recruit the research assistant for only the data collection purpose and the analysis will be conducted by the researchers themselves. Therefore, due to the grounded theory research approach, there is chances of introducing the data analysis associated bias into the study that can be considered as another limitation (Singh & Estefan, 2018).
As a part of the ethical consideration of the current study, the researchers will ensure the collection of the consent forms from the nurses before the starting of the interview sessions. The researchers will also ensure the security of the collected data through the installation of the strong security system of the data so that any other individual apart from the researchers can access the data. Moreover, the researchers will collect permission letter from the hospital authority and from the human ethics committee as the research process includes the human participation (Arifin, 2021). In case of nurses from the indigenous background, the researchers will ensure the cultural sensitivity approach during the conduction of interview as well (McGrath, Palmgren & Liljedahl, 2019).
References
Abadi, T. S. H., Askari, M., Miri, K., & Nia, M. N. (2020). Depression, stress and anxiety of nurses in COVID-19 pandemic in Nohe-Dey Hospital in Torbat-e-Heydariyeh city, Iran. Journal of Military Medicine, 22(6), 526-533. https://eprints.thums.ac.ir/2762/
Arifin, S. R. M. (2018). Ethical considerations in qualitative study. International Journal of Care Scholars, 1(2), 30-33. https://journals.iium.edu.my/ijcs/index.php/ijcs/article/view/82
Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., … & Walker, K. (2020). Purposive sampling: complex or simple? Research case examples. Journal of Research in Nursing, 25(8), 652-661. https://journals.sagepub.com/doi/abs/10.1177/1744987120927206
Carpena, M. X., de Souza Tavares, P., & Menezes, C. B. (2019). The effect of a six-week focused meditation training on depression and anxiety symptoms in Brazilian university students with 6 and 12 months of follow-up. Journal of affective disorders, 246, 401-407. https://www.sciencedirect.com/science/article/pii/S0165032718310498
Castleberry, A., & Nolen, A. (2018). Thematic analysis of qualitative research data: Is it as easy as it sounds?. Currents in pharmacy teaching and learning, 10(6), 807-815. https://www.sciencedirect.com/science/article/pii/S1877129717300606
DeJonckheere, M., & Vaughn, L. M. (2019). Semistructured interviewing in primary care research: a balance of relationship and rigour. Family medicine and community health, 7(2). https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6910737/
Elbay, R. Y., Kurtulmu?, A., Arpac?o?lu, S., & Karadere, E. (2020). Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry research, 290, 113130. https://www.sciencedirect.com/science/article/pii/S0165178120312038
Kamal, S. S. L. B. A. (2019). Research paradigm and the philosophical foundations of a qualitative study. PEOPLE: International Journal of Social Sciences, 4(3), 1386-1394. https://doctor2015.jumedicine.com/wp-content/uploads/sites/9/2021/02/RESEARCH-PARADIGM-AND-THE-PHILOSOPHICAL-FOUNDATION-OF-A-QUALITATIVE-STUDY.pdf
Maxwell, J. A. (2021). Why qualitative methods are necessary for generalization. Qualitative Psychology, 8(1), 111. https://psycnet.apa.org/record/2020-36022-001
McGrath, C., Palmgren, P. J., & Liljedahl, M. (2019). Twelve tips for conducting qualitative research interviews. Medical teacher, 41(9), 1002-1006. https://www.tandfonline.com/doi/abs/10.1080/0142159X.2018.1497149
Mo, Y., Deng, L., Zhang, L., Lang, Q., Liao, C., Wang, N., … & Huang, H. (2020). Work stress among Chinese nurses to support Wuhan in fighting against COVID?19 epidemic. Journal of nursing management, 28(5), 1002-1009. https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.13014
Mosolova, E., Chung, S., Sosin, D., & Mosolov, S. (2020). Stress and anxiety among healthcare workers associated with COVID-19 pandemic in Russia. Psychiatria Danubina, 32(3-4), 549-556. https://hrcak.srce.hr/file/364857
Singh, S., & Estefan, A. (2018). Selecting a grounded theory approach for nursing research. Global qualitative nursing research, 5, 2333393618799571. https://journals.sagepub.com/doi/abs/10.1177/2333393618799571
Strege, M. V., Swain, D., Bochicchio, L., Valdespino, A., & Richey, J. A. (2018). A pilot study of the effects of mindfulness-based cognitive therapy on positive affect and social anxiety symptoms. Frontiers in Psychology, 866. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00866/full
Turner, C., & Astin, F. (2021). Grounded theory: what makes a grounded theory study?. European Journal of Cardiovascular Nursing, 20(3), 285-289. https://academic.oup.com/eurjcn/article-abstract/20/3/285/6190569
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