The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
Use the "Literature Evaluation Table" to complete this assignment.
Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
518 Bezerra CMB, Martino MFF. Stress and burnout syndrome in hospital urses: a descriptive study. Online braz j nurs [internet] 2016 Oct [cited year month day]; 15 (suppl.):518-520. Available from: http://www.objnursing.uff.br/index.php/nursing/ article/view/5525
Stress and burnout syndrome in hospital nurses: a descriptive study Clarissa Maria Bandeira Bezerra1, Milva Maria Figueiredo De Martino1
1 Federal University of Rio Grande do Norte
ABSTRACT Aim: to check stress levels and the presence of the burnout syndrome in a population of nurses on day and night shifts in a hospital. Method: descriptive cross-sectional study with a quantitative approach, performed at the Hospital of Federal University of Rio Grande do Norte. Consists in applying questionnaires to nurses to obtain data through the form of socio-demographic data, then the instruments: the Bianchi scale to quantify the level of stress, and the Maslach Burnout Inventory (MBI) to identify the presence of the burnout syndrome. The organization of data will involve the use of the Microsoft Windows Excel 2010 spreadsheets and will be analyzed using the Statistical Package for the Social Sciences version 20.0. The data will be organized in tables and charts, and analyzed according to descriptive and inferential statistics.
Descriptors: Occupational Stress; Burnout; Nursing.
519 Bezerra CMB, Martino MFF. Stress and burnout syndrome in hospital urses: a descriptive study. Online braz j nurs [internet] 2016 Oct [cited year month day]; 15 (suppl.):518-520. Available from: http://www.objnursing.uff.br/index.php/nursing/ article/view/5525
THE THEMATIC CONTEXTUALIZATION AND RESEARCH PROBLEM
Changes in work practices in the health ser- vice occur daily. Nursing as a component of the area is subject to improvements as technological advancement, but also arise dissatisfactions – in- creased demand for services, competitiveness, and long working hours. These factors trigger stress and emotional changes that can directly affect the care provided to patients and the worker’s own health(1).
Stress is defined as a set of sensibilities, and feelings of hate and nuisance that the subject feels and that can affect his psychological health, affecting his judgment and even his understan- ding of events. The change has both a psycho- logical and a physical impact. Stress at work is defined as occupational or work-related stress, and appears in the worker’s body because of the difficulty in developing his activities, added to the requirements of the service, becoming detrimental to his health and quality of life(2).
When work-related stress exceeds the adaptive levels and becomes chronic, it is given the name of the burnout syndrome. The term comes from the English ‘burn’ and ‘out’, and me- ans someone who does not have more energy, is the collapse of the adaptive capacity of the individual, it has reached the limit of his efforts, no longer works, and is finally burned out. What characterizes this syndrome is the exhaustion of emotion, the loss of identity and the reduced relevance of work(3).
The nursing profession is stressful because of the requirements placed on staff, reduced num- ber of staff in the team, long working hours (often double), daily contact with sick individuals, and death. With all these factors, the team area has been developing mental disorders in the last few years. The nurse, being responsible for the group, is a major cause for concern in this respect(3).
Thus, this study seeks to check the stress level of nurses and if there are disorder of profes- sionals due to stress and the burnout syndrome among workers of different hospital shifts.
Given the above, it is appropriate that the importance of the study focuses on the health worker, who could be hit by mental disorders such as stress and the burnout syndrome, the- reby endangering the health of teammates and of patients receiving their care. At the end of this research it is intended that we can create confronting strategies that will make the daily workload less stressful, contributing to the advancement of scientific knowledge in this subject, and strengthen the profession.
Check the level of stress and the presence of burnout syndrome in nurses on day and night shifts in the hospital context.
• Sample sociodemographic data; • Analyze the stress levels of nurses on day and
night shifts; • Identify the presence of burnout syndrome
and relate it to the stress levels in nursing staff on day and night shifts.
This is a descriptive study cross-sectional type, with a quantitative approach. Data col- lection will occur through the use of structured instruments for obtaining sociodemographic data, checking levels of stress (Bianchi Scale)
520 Bezerra CMB, Martino MFF. Stress and burnout syndrome in hospital urses: a descriptive study. Online braz j nurs [internet] 2016 Oct [cited year month day]; 15 (suppl.):518-520. Available from: http://www.objnursing.uff.br/index.php/nursing/ article/view/5525
and the presence of the burnout syndrome (Maslach Burnout Inventory – Human Services Survey, which uses the criteria of high levels in the dimensions “emotional exhaustion” and “depersonalization”, and low level in terms of “personal fulfillment”). The location will be the University Hospital Onofre Lopes, with a poten- tial study population of 118 nurses. As inclusion criteria they must be employed as a nurse at the hospital. The were excluded who were on vacation or in any license or sick leave at the time of data collection. The collection occurred between January and April 2016. The organi- zation of the data will occur involve the use of Microsoft Excel spreadsheets Windows® 2010 version, and then analyzed using the Statistical Package for the Social Sciences version 20.0. The descriptive analysis will be used to evaluate the collected results and provide a sample profile according to the variables studied. Frequency tables will be developed for categorical varia- bles (gender and work shift, for example) with absolute frequency values (N) and percentages (%). For the comparison of categorical variables (double shifts and physical activity, for example) the Mann-Whitney test will be used in case of a lack of normal distribution, and the ANOVA test to observe the variability among the samples (sectors and stress, for example). The level of statistical significance adopted for the statistical tests to be considered significant is p <0.05. The project was approved by the Ethics Committee of the Federal University of Rio Grande do Norte, under number 1313575.
1. Aiken L, Sermeus W, Van den Heede K, Sloane D, Busse R, McKee M, et al. Patient safety, satisfac-
tion, and quality of hospital care:cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ [internet] 2012 [Cited 2016 March 1]; 344: 1717. Available from:http://www.bmj.com/content/344/bmj. e1717.short
2. Schimidt D. Modelo Demanda-Controle e estresse ocupacional entre profissionais de enfermagem: revisão integrativa. Rev. bras. en- ferm. [internet] 2013. [cited 2016 mar 1]; 66(5). Available from:http://www.scielo.br/pdf/reben/ v66n5/20.pdf
3. Grazziano E, Bianchi E. Impacto do stress ocu- pacional e Burnout para enfermeiros. Enferm. glob. [internet] 2010 [cited 2016 mar 2] 30(18). Available from: http://scielo.isciii.es/pdf/eg/n18/ pt_revision1.pdf
All authors participated in the phases of this publication
in one or more of the following steps, in According to
the recommendations of the International Committee
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versión submitted of this manuscript. All authors declare for
the appropriate purposes that the responsibilities related to
all aspects of the manuscript submitted to OBJN are yours.
They ensure that issues related to the accuracy or integrity
of any part of the article were properly investigated
and resolved. Therefore, they exempt the OBJN of any
participation whatsoever in any imbroglios concerning
the content under consideration. All authors declare that
they have no conflict of interest of financial or personal
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Received: 03/23/2016 Revised: 04/26/2016 Approved: 04/26/2016
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October 2015WOrkplace HealtH & Safety
Abstract: The promotion of self-care and the prevention of burnout among nurses is a public health priority. Evidence supports the efficacy of yoga to improve physical and mental health outcomes, but few studies have examined the influence of yoga on nurse-specific outcomes. The purpose of this pilot-level randomized controlled trial was to examine the efficacy of yoga to improve self-care and reduce burnout among nurses. Compared with controls (n = 20), yoga participants (n = 20) reported significantly higher self-care as well as less emotional exhaustion and depersonalization upon completion of an 8-week yoga intervention. Although the control group demonstrated no change throughout the course of the study, the yoga group showed a significant improvement in scores from pre- to post-intervention for self-care (p < .001), mindfulness (p = .028), emotional exhaustion (p = .008), and depersonalization (p = .007) outcomes. Implications for practice are discussed.
Keywords: health promotion, mental health, nurse, yoga, burnout
A growing awareness of the stress and burnout experienced by nurses in a variety of clinical settings is evident worldwide (Ribeiro et al., 2014; Sermeus et al., 2011). Researchers have examined the negative consequences of burnout, which range from job dissatisfaction and anxiety to patient dissatisfaction with care, lower nurse-rated quality of care, and high risk of negative patient outcomes (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011; Poghosyan, Clarke, Finlayson, & Aiken, 2010; Vahey, Aiken, Sloane, Clarke, & Vargas, 2004). Recent research has documented the correlation between nurse burnout and health care-associated infections, patient falls, medication errors, and other patient adverse events (Cimiotti, Aiken, Sloane, & Wu, 2012; Van Bogaert, Dilles, Wouters, & Van Rompaey, 2014). Based on the findings of landmark studies, it is clear that working conditions for nurses
(including nurse-patient ratio, shift hours, and role strain/ overload) must be improved to effectively prevent burnout (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Li, Early, Mahrer, Klaristenfeld, & Gold, 2014; McHugh et al., 2011; Spence Laschinger & Fida, 2014; Van Bogaert et al., 2014).
In addition to policies that support positive changes in nurses’ work environments, health systems must provide occupational health resources to individual nurses that foster self-care and resilience in the practice setting. Nurses skilled in exercising self-reflection, self-care, and self-discovery are well-equipped to manage complex clinical dilemmas with emotional resilience, leading to higher quality care for patients (Quinn, 2014). Focusing on self-care strategies to prevent burnout and enhance resilience is not new; conceptual models that emphasize self-care and health promotion models to prevent burnout can be found in the medical, nursing, and allied health literature (Christopher & Maris, 2010; Dunn, Iglewicz, & Moutier, 2008; Kearney, Weininger, Vachon, Harrison, & Mount, 2009; Kravits, McAllister-Black, Grant, & Kirk, 2010).
Mind-body practices are a clear strategy for nurses to manage stress and build emotional resilience, according to a recent critical review of the literature (Smith, 2014). Nurses in a variety of specialty areas have reported improved outcomes after implementing mind-body techniques over time. Medical- surgical nurses participating in a mindfulness training program reported less burnout and stress than their controls after a 10-week intervention; in addition, the experimental unit reported higher patient satisfaction than the control unit during the same time period (Horner, Piercy, Eure, & Woodard, 2014). In addition, nurses working on a pediatric intensive care unit and practicing a 5-minute mindfulness-based intervention on the job reported less stress and burnout over time (Gauthier, Meyer, Grefe, & Gold, 2014).
One specific mind-body intervention with demonstrated benefits for wellness, self-care, and health promotion is yoga (Chapman & Bredin, 2011; Kumar, 2013; Yang, 2007). A study of
596102WHSXXX10.1177/2165079915596102WORKPLACE HEALTH & SAFETYWORKPLACE HEALTH & SAFETY research-article2015
Yoga for Self-Care and Burnout Prevention Among Nurses Gina k. alexander, phD, MpH, MSN, rN1, kari rollins, DO2, Danielle Walker, phD, MSN, rN, cNe1, lily Wong, rN, MHSM3, and Jacquelyn pennings, phD4
DOI: 10.1177/2165079915596102. From 1Texas Christian University, 2The Wellness Center, 3John Peter Smith Health Network, and 4Elite Research, LLC. Address correspondence to: Gina K. Alexander, PhD, MPH, MSN, RN, Assistant Professor, Texas Christian University, Harris College of Nursing and Health Sciences, TCU Box 298620, Fort Worth, TX 76129, USA; email: [email protected] For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2015 The Author(s)
vol. 63 ■ no. 10 WOrkplace HealtH & Safety
Applying Research to Practice A sample of 20 nurses who practiced yoga as part of an 8-week intervention reported greater self-care and mindfulness at the end of the study compared with 20 controls. In addition, yoga participants reported less emotional exhaustion and depersonalization, two chief components of burnout. Although more research is necessary to confirm these findings, the potential value of yoga for the occupational health and wellness of nurses is clear.
mental health counselors confirmed the value of yoga and other mind-body practices to increase self-care during counselor training (Christopher, Christopher, Dunnagan, & Schure, 2006). Although yoga studies among nurses are rare, one study reported the potential for yoga to improve nurse and patient outcomes (Raingruber & Robinson, 2007). In this study, a sample of nurses practicing at an academic medical center described increased self-awareness, as well as enhanced problem-solving and ability to focus on patient needs after participation in a 3-month self-care yoga-based intervention (Raingruber & Robinson, 2007).
Further research is necessary to support the benefits of yoga, both for patients and nurses, who represent the nation’s largest health care profession (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2010). Strong theoretical support for the value of self-care in promoting emotional resilience and an enhanced capacity for stress management and clinical decision making merits the investigation of yoga and other mind-body practices as an avenue for health promotion among nurses and other health care professionals. The purpose of the present study is to examine the efficacy of yoga to improve self-care and reduce burnout among nurses practicing at an urban, tax-supported health care network.
Method To achieve the study purpose, the research team adopted an
experimental study design; a randomized controlled trial consisted of 8 weeks of supervised yoga instruction for the intervention group and usual care for the control group. The Institutional Review Board (IRB) at the affiliated university approved the study. Written informed consent was secured from participants prior to study enrollment.
Institutional Support An urban 560-bed teaching hospital was contacted to host
this yoga research study. This hospital employs about 1,750 nurses practicing in a wide variety of settings—inpatient, outpatient, case management, and nurse informatics among other areas. Nursing administration and the Human Resources (HR) departments were contacted to initiate this possible collaboration, recruiting nurses, securing space, and obtaining
approval from the hospital IRB for the research study. Support from nursing administration was important because the target population for the study was nurses. The chief nursing officer was very supportive of the study, and a nurse representative from nursing administration served as the main contact and liaison between the hospital and the university. The responsibility of this nurse representative was to communicate with the nurses, recruit participants, facilitate the IRB approval process, and arrange rooms for the yoga sessions.
As a key stakeholder in the development of the study protocol, the HR department recognized the importance of employee health and wellness. HR leadership welcomed the research study as a means of exploring the receptivity of staff nurses to yoga practice as a wellness initiative for the future. In particular, HR staff expressed interest in applying the findings of the study and participant recommendations to the organization’s wellness program for all hospital employees.
Another key stakeholder was the Environmental Services department. The liaison from Nursing Administration contacted the Environmental Services staff to allocate a space large enough to accommodate 20 participants for the yoga group. Environmental Services also committed to a weekly schedule for cleaning and preparation of the space.
Recruitment Recruitment focused on nurses within the partner hospital
system. Primary recruitment strategies included distribution of email advertisements to all health care provider staff, as well as flyer distribution to work and break areas. Advertising for the study was also conducted through the company intranet and employee portals. The partnership with administration was integral to recruitment. Hospital administration met with managers and supervisors of eligible units to provide information about the study and to encourage managers to share information with employees at regularly scheduled staff meetings.
Contact information for research personnel was provided on the recruitment flyers and all electronic communication. Interested individuals were encouraged to contact research personnel to complete a short online screening survey consisting of questions about job title and job duties, demonstrate willingness to complete eight weekly sessions of yoga, and provide contact information for monitoring. After ensuring the potential participant met the initial eligibility criteria of being a nurse within the partner hospital system, a member of the research team made contact via phone. Over the phone, the research personnel screened potential participants to assess additional inclusion criteria: no prior experience with yoga practice, willingness to complete eight weekly sessions and homework exercises, and willingness to be randomly assigned to the research or control group. In addition, the investigators screened for exclusion criteria: serious illness or major orthopedic diagnoses of the neck, back, pelvis, or lower extremities that could interfere with completion of the yoga intervention protocol.
Target recruitment and enrollment was 50 participants, with 25 in each group. This recruitment goal allowed for 10% attrition,
October 2015WOrkplace HealtH & Safety
with the expectation that 40 participants would complete the study. This assumption was based on a power analysis in g*Power 3.1.7 indicating that for a repeated measures analysis of variance (ANOVA) with interaction effects, a minimum sample of 40 was needed to find significance with a moderate effect size (Cohen’s f = .25), alpha = .05, power = .80, and an estimated correlation among repeated measures of .40 (Faul, Erdfelder, Lang, & Buchner, 2007). Recruitment strategies yielded more than 100 responses, including many hospital employees who were not nurses. Respondents cited a variety of advertising methods that informed them of the study, with email being the most commonly cited method. The initial screening tool yielded 71 nurses within the hospital system. Those possible participants were contacted by phone for further screening to confirm inclusion/exclusion criteria. The phone-based screening identified 49 eligible participants. The recruitment period was intentionally compact to be within a time frame when staff members already knew their schedules, but the scheduling of sessions and conflicting work schedules were a significant challenge for recruiting nurses to participate in this 8-week study.
Following the phone screening, all eligible individuals were asked to complete another online survey which included the consent form, a demographic questionnaire, and core study questionnaires. After individuals completed consent forms and baseline assessments, they were enrolled in the study and randomized to the intervention (yoga) or usual care control group. A total of 54 individuals completed screening; of those, 40 met eligibility criteria and completed the enrollment process, including consent and baseline questionnaires.
Intervention The yoga intervention was led by an experienced yoga
instructor, who is an osteopathic physician in the local community. For more than 27 years, the instructor has provided health promotion services and yoga instruction in the Kundalini tradition through a wellness-based community practice.
The emphasis of the yoga intervention was to provide participants with self-care tools to manage and reduce stress. One of these tools is enhanced self-awareness, helping individuals become more aware of the simple, unconscious, daily activities, and functions that have a cumulative impact on health and well-being. Throughout the day, most individuals’ awareness is focused on activities outside the body while little attention is given to internal sensations and thoughts. Consequently, most bodily functions, such as breathing, are done unconsciously. Conscious awareness of the way in which one sits, stands, breathes, and thinks is crucial to improving the response to mental and physical stress. By teaching individuals how to observe themselves, many bodily and mental functions improve without strenuous or time-consuming exercise or activities (Mehling et al., 2011; Vago & Silbersweig, 2012).
In early yoga sessions, participants learned to become conscious of their breathing. Breathing is both a conscious and unconscious process and therefore gives conscious access to the
autonomic nervous system. Inhalation stimulates the sympathetic nervous system, while exhalation stimulates the parasympathetic nervous system. When one inhales, heart rate increases and when one exhales, heart rate decreases. Practicing mindful breathing allows individuals to calm the body and mind immediately, thereby decreasing stress or energizing the nervous system if one feels fatigued or depressed (Burg & Michalak, 2011; Mason et al., 2013).
Throughout the intervention, the instructor taught participants the basics of postural alignment, deep breathing, and monitoring the mind with simple meditations. Each session concluded with deep relaxation. Each participant received handouts for each session to provide further information and a visual reminder of the exercises, the basis for cultivating a home practice. As the series progressed, additional exercises, breathing practices, and meditations were added to expose participants to the wide range of movements that can work not only the skeletal muscles but also other body systems such as the internal organs, nervous system, circulation, and emotions.
Data Collection Participants completed assessments twice during the study:
at baseline and at the end of the 8-week intervention period. For each assessment, participants completed study questionnaires online using the secure Qualtrics survey system. For the baseline assessment, participants completed a demographic questionnaire, the Health Promoting Lifestyle Profile II (HPLP II; Walker & Hill-Polerecky, 1996), the Freiburg Mindfulness Inventory (FMI), and the Maslach Burnout Inventory (MBI; Maslach, Jackson, & Leiter, 1986).
The HPLP II consists of 52 items that measure the frequency of multiple health-promoting behaviors, ranging from physical activity and nutrition to psychosocial health and sleep hygiene. The HPLP II has a test–retest reliability of 0.89 and well-established validity (Walker & Hill-Polerecky, 1996). The FMI is a 14-item scale that measures perceptions of mental openness, acceptance, and curiosity. The measure demonstrates construct validity and good internal consistency with a Cronbach alpha of .86 (Walach, Buchheld, Buttenmüller, Kleinknecht, & Schmidt, 2006).
The MBI consists of 22 items that measure professional burnout across three domains: (a) emotional exhaustion related to work demands, (b) depersonalization when interacting with patients, and (c) personal accomplishment related to attainment of professional goals (Maslach et al., 1986). A meta-analysis of 84 research studies yielded mean alpha estimates ranging from .70 to .80 for each of the three domains (Wheeler, Vassar, Worley, & Barnes, 2011). Considerable evidence supports use of the MBI as a valid measure to assess burnout among nurses (Pisanti, Lombardo, Lucidi, Violani, & Lazzari, 2013; Poghosyan, Aiken, & Sloane, 2009).
Data Analysis Investigators used the Statistical Package for the Social
Sciences (SPSS; Version 20) to calculate descriptive and
vol. 63 ■ no. 10 WOrkplace HealtH & Safety
Table 1. Descriptive Statistics
Male 1 2.5
Female 39 97.5
Currently married 26 65.0
Widowed 1 2.5
Divorced 9 22.5
Never married 4 10.0
Number of children
None 18 45.0
One 11 27.5
Two 6 15.0
Three or more 5 12.5
Some college credit, but less than 1 year 1 2.5
One or more years of college, no degree 3 7.5
Associate degree 12 30.0
Bachelor’s degree 20 50.0
Master’s degree 2 5.0
Professional degree 1 2.5
Doctorate degree 1 2.5
Day shift 34 85.0
Night shift 5 12.5
Variable shift 1 2.5
Full-time 36 90.0
Part-time 2 5.0
PRN (as needed) 2 5.0
Not Hispanic or Latino 37 92.5
Hispanic or Latino 3 7.5
Black or African American 4 10.0
Native Hawaiian or Other Pacific Islander 1 2.5
White 35 87.5
Age (M ± SD) 46.38 ± 10.23
Years in profession (M ± SD) 14.21 ± 11.02
Note. PRN = Pro re nata.
October 2015WOrkplace HealtH & Safety
inferential statistics (IBM, 2014). Initial analyses focused on an exploration of the relationships among demographic variables and baseline measures. Based on the preliminary analyses, a repeated measures multivariate analysis of variance (MANOVA) was conducted. In addition, univariate ANOVAs were used as post hoc tests to interpret significant interactions.
Results Categorical demographic variable frequencies and
percentages as well as means and standard deviations of the continuous demographics are shown in Table 1. Preliminary analyses were conducted to test for significant relationships among demographic variables and for demographic differences between participants in the control and experimental groups. For these analyses, married participants were compared with unmarried participants, and those with children were compared with those without children due to small group sizes within the original variable coding. A series of cross-tabulations with chi- square, Pearson’s correlation, and independent samples t test revealed no significant relationships among the demographic variables. In addition, no significant differences in demographics were found between the control and experimental groups, suggesting that the two groups were similar in demographic makeup and the research team did not need to control for demographic characteristics in the primary analyses. In addition, the demographic variables were tested in relation to the outcome variables at baseline, and no significant relationships were found.
Preliminary analyses did reveal a pattern of significant relationships among the outcomes of interest at baseline (Table 2), suggesting that MANOVA be used to account for the increase in Type 1 error associated with correlated outcomes. Thus, a repeated measures MANOVA (time: within-subjects effect; group: between-subjects effect) was conducted on the outcomes of interest (self-care, mindfulness, and the three burnout subscales, measuring emotional exhaustion, depersonalization, and personal achievement). The results revealed a significant multivariate main effect of time, F(5, 34) = 5.57, p < .001, η2 = .450, and a significant multivariate
interaction effect of time by group, F(5, 34) = 2.57, p = .045, η2 = .274, but no significant multivariate main effect of group, p = .270 (Table 3).
Further investigation of the univariate effects for time revealed that self-care and mindfulness showed a significant improvement from pre- to post- intervention, regardless of group (p < .05). Investigation of the univariate interaction effects revealed a significant time by group interaction for self-care (p = .006, partial η2 = .179), emotional exhaustion (p = .041, partial η2 = .106), and depersonalization (p = .035, partial η2 = .111) scales. In addition, the mindfulness measure showed a marginally significant interaction (p = .0
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