![]() ![]() A previous study on university students shows that daily coloring is associated with lower anxiety and depressive symptoms. Structured coloring with predesigned, repetitive patterns (typically mandalas) is linked to mindfulness as the complexity and repetitiveness of structured coloring may facilitate focused attention and awareness of immediate experiences, inducing a meditative state. Coloring is an activity that may be easily accomplished by most people while promoting a sense of self-accomplishment on the completion of an art piece. Most mindfulness practices studied involve focused breathing, but findings from a meta-analysis indicate that other mindfulness exercises, such as mindfulness applied to a task, might be more effective. Brief MBIs that were adapted to increase accessibility were introduced to overcome this barrier, and studies demonstrate effectiveness of these MBIs in improving psychological outcomes for healthcare providers. However, time commitment is a barrier for traditional MBIs, such as the MBSR, to be implemented broadly in the nursing setting due to nurses’ irregular and long working hours. The mindfulness-based stress reduction (MBSR) program is an established 8-week MBI that has demonstrated effectiveness in reducing stress, burnout, anxiety, and depression, as well as enhancing well-being and quality of life across various populations including nurses. Those with higher trait mindfulness have superior stress-coping ability as they appraise daily experiences as less stressful, exercise more self-acceptance and less self-blame, and more readily accept events that are beyond their control. MBIs integrate mindfulness training and practices into daily living to help participants develop a more mindful trait. Trait mindfulness is the general tendency to be mindful in daily living, and increasing state mindfulness over repeated practices may increase trait mindfulness. A mindfulness state can be attained by purposefully focusing all attention on the ongoing flow of external and internal events as they arise, without suppressing, evaluating or fixating on any of them. When occupying a mindfulness state, an individual has a heightened awareness of the present-moment experiences including their outer surroundings and inner thoughts, feelings, and sensations while accepting these experiences in a non-judgmental way. Mindfulness can refer to either a momentary state or a dispositional trait. Mindfulness-based interventions (MBIs) have been recommended as an effective strategy to manage occupational stress and burnout among nurses. Leisure activities and effective interventions to promote well-being at work are therefore required to help reduce the prevalence and consequences of stress and burnout. In the healthcare system, nurses’ stress and burnout predict lower job performance, poor patient safety and quality of patient care, as well as increased turnover intentions and medical errors. Stress and burnout predict physiological, behavioral and psychological problems including cardiovascular diseases, prolonged fatigue, headaches, early mortality, alcohol abuse, absenteeism, insomnia, and depressive symptoms. Among critical care physician and non-physician practitioners, the prevalence of burnout is also high (56% and 50% respectively). A systematic review of 40 studies, involving 27,034 nurses, estimates the summary prevalence of stress to be 43% (95% CI 37–49%). Frontline nursing during this pandemic is more stressful than ever. The coronavirus disease 2019 (COVID-19) pandemic continues to challenge the provision of sufficient critical care resources and healthcare providers worldwide. The primary outcome was the perceived stress level. Participants in both groups completed the Perceived Stress Scale (total score 0–40), short Warwick-Edinburgh Mental Well-being Scale (total score 7–35), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (3 subscales), Five Facets Mindfulness Questionnaire-Short Form (total score 24–120) and Mindful Attention Awareness Scale-State version (total score 0–30) instruments. The mindful coloring intervention included participants viewing a 3-minutes instructional video and coloring mandalas for at least 5 working days or 100 minutes in total during a 10-day period. Twenty-seven nurses in the mindful coloring group and 32 in the control group were included in the full compliance per protocol analysis. Seventy-seven participants were randomly allocated (by computer-generated sequence) to either mindful coloring (n = 39) or waitlist control groups (n = 38). This was a single-center, two-armed, parallel, superiority, blinded randomized controlled trial. ![]()
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