The Mediating Role of Psychological Distress on the Relationship of Mindfulness and Social Support on Psychological Well-Being among Private Hospital Nurses in Kerala, India.
DOI:
https://doi.org/10.14456/abacodijournal.2023.37Keywords:
mindfulness, social support, psychological distress, psychological well-being.Abstract
The present study aimed to investigate the effect of mindfulness and social support on the psychological wellbeing of private hospital nurses in Kerala, India, mediated by psychological distress. Data were collected through a survey of 1050 nurses working in private hospitals in Kerala, India. The mediation analysis was carried out using Andrew Hayes Process Macro. The results of the mediation analysis indicated that psychological distress partially mediated the relationship of mindfulness, and social support on psychological well-being. Statistical evidence indicated that the higher levels of mindfulness and social support experienced by these nurses in Kerala reported to have lower psychological distress and lower the psychological distress, better were their psychological well-being. The nurses in private hospitals of Kerala have various challenges including long working hours, physical strain, exposure to human suffering and high job demands that necessitate constant vigilance in a complex and potentially chaotic environment. In light of these findings, it is suggested that private hospital administrators allocate resources to promote mindfulness and social support as part of an incentive and staff development program for their nurses. The hospital administration can augment their employees' psychological well-being, in spite of the taxing job demands that they are driven through to achieve relatively high productivity. One who has a balanced psychological wellbeing will tend to administer their duties nearer to perfection and as such, all stakeholders of the hospital industry would be happy and satisfied.
References
Abraham, B. (2004). Women nurses and the notion of their empowerment. Centre for Development Studies.
Anbazhagan, S., Ramesh, N., Nisha, C., & Joseph, B. (2016). Shift work disorder and related health problems among nurses working in a tertiary care hospital, Bangalore, South India. Indian Journal of Occupational and Environmental Medicine, 20(1), 35. https://doi.org/10.4103/0019-5278.183842
Ardekani, Z. Z., Kakooei, H., Ayattollah, S., Choobineh, A., & Seraji, G. N. (2008). Prevalence of mental disorders among shift work hospital nurses in Shiraz, Iran. Pakistan Journal of Biological Sciences, 11(12), 1605-1609. https://doi.org/10.3923/pjbs.2008.1605.1609
Australian Bureau of Statistics. (2018, September 18). National Survey of Mental Health and Well-being: Summary of Results. http://www.abs.gov.au/ausstats/abs @.nsf/ Latestproducts/4326.0Main%20Features32007
Bazarko, D., Cate, R. A., Azocar, F., & Kreitzer, M. J. (2013). The impact of an innovative mindfulness-based stress reduction program on the health and well-being of nurses employed in a corporate setting. Journal of Workplace Behavioral Health, 28(2), 107-133. https://doi.org/10.1080/15555240.2013.779518
Brady, S., O'Connor, N., Burgermeister, D., & Hanson, P. (2012). The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspectives in Psychiatric Care, 48(3), 129-137. doi:10.1111/j.1744-6163.2011.00315.
Brooke, C., & Nancy, L. C. (2015). A New Look at Social Support: A Theoretical Perspective on Thriving Through Relationships. Personality and Social Psychology Review, 19(2), 113-147.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848. https://doi.org/10.1037/0022-3514.84.4.822
Chana, N., Kennedy, P., & Chessell, Z. J. (2015). Nursing staffs' emotional well-being and caring behaviours. Journal of Clinical Nursing, 24(19-20), 2835-2848. https://doi.org/10.1111/jocn.12891
Cheung, T., & Yip, P. (2015). Depression, anxiety and symptoms of stress among Hong Kong nurses: A cross-sectional study. International Journal of Environmental Research and Public Health, 12(9), 11072-11100. https://doi.org/10.3390/ijerph120911072
Choi, B. (2018). Influence of social support and resilience on the nurse job performance. Indian Journal of Public Health Research & Development, 9(3), 788. https://doi.org/10.5958/0976-5506.2018.00385.6
Collins, N. L., Jaremka, L. M., & Kane, H. S. (2014). Social support during a stressful task reduces cortisol reactivity, promotes emotional recovery, and builds caring relationships [Unpublished manuscript]. University of California Santa Barbara.
Craigie, M., Slatyer, S., Hegney, D., Osseiran-Moisson, R., Gentry, E., Davis, S., Dolan, T., & Rees, C. (2016). A pilot evaluation of a mindful self-care and resiliency (MSCR) intervention for nurses. Mindfulness, 7(3), 764-774. https://doi.org/10.1007/s12671-016-0516-x
Creedy, D. K., Sidebotham, M., Gamble, J., Pallant, J., & Fenwick, J. (2017). Prevalence of burnout, depression, anxiety and stress in Australian midwives: A cross-sectional survey. BMC Pregnancy and Childbirth, 17(1), 2-8. https://doi.org/10.1186/s12884-016-1212-5
de Boer, J., van Rikxoort, S., Bakker, A. B., & Smit, B. J. (2014). Critical incidents among intensive care unit nurses and their need for support: Explorative interviews. Nursing in Critical Care, 19(4), 166-174.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71-75. https://doi.org/10.1207/s15327752jpa4901_13
Feng, D., Su, S., Wang, L., & Liu, F. (2018). The protective role of self-esteem, perceived social support and job satisfaction against psychological distress among Chinese nurses. Journal of Nursing Management, 26(4), 366-372. https://doi.org/10.1111/jonm.12523
Fortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., & Rakel, D. (2013). Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: A pilot study. The Annals of Family Medicine, 11(5), 412-420. https://doi.org/10.1370/afm.1511
Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot of a mindfulnessbased program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse, 45(1), 114-125. https://doi.org/10.5172/conu.2013.45.1.114
Gao, Y., Pan, B., Sun, W., Wu, H., Wang, J., & Wang, L. (2012). Anxiety symptoms among Chinese nurses and the associated factors: A cross sectional study. BMC Psychiatry, 12(1), 1-9. https://doi.org/10.1186/1471-244x-12-141
Ghods, A. A., Sotodehasl, N., Emadi Khalaf, M., & Mirmohamadkhani, M. (2017). Situational anxiety among nurses. Middle East Journal of Rehabilitation and Health, 4(4), 1-5. https://doi.org/10.5812/mejrh.57560
GOI (Government of India). (1929). Triennial report on the working of the civil hospitals and dispensaries in the Madras Presidency for the years 1926, 1927 and 1928. Government Press.
Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and improves well-being among healthcare providers. The International Journal of Psychiatry in Medicine, 43(2), 119-128. https://doi.org/10.2190/pm.43.2.b
Guillaumie, L., Boiral, O., & Champagne, J. (2016). A mixed-methods systematic review of the effects of mindfulness on nurses. Journal of Advanced Nursing, 73(5), 1017-1034. https://doi.org/10.1111/jan.13176
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLOS ONE, 11(7), e0159015. https://doi.org/10.1371/journal.pone.0159015
Heard, P. L., Hartman, S., & Bushardt, S. C. (2013). Rekindling the flame, using mindfulness to end nursing burnout. Nursing Management, 44(11), 24-29. https://doi.org/10.1097/01.numa.0000436366.99397.10
Heerde, J. A., & Hemphill, S. A. (2018). Examination of associations between informal help-seeking behavior, social support, and adolescent psychosocial outcomes: A meta-analysis. Developmental Review, 47, 44-62. https://doi.org/10.1016/j.dr.2017.10.001
Ho, R. (2013). Handbook of Univariate and Multivariate Data Analysis with IBM SPSS (2nd ed.). Chapman and Hall/CRC. https://doi.org/10.1201/b15605-3
Hou, T., Zhang, T., Cai, W., Song, X., Chen, A., Deng, G., & Ni, C. (2020). Social support and mental health among health care workers during coronavirus disease 2019 outbreak: A moderated mediation model. PLOS ONE, 15(5), e0233831. https://doi.org/10.1371/journal.pone.0233831
Hu, S. H., Yu, Y., Chang, W., & Lin, Y. (2017). Social support and factors associated with self‐efficacy among acute‐care nurse practitioners. Journal of Clinical Nursing,
(3-4), 876-882. https://doi.org/10.1111/jocn.14129
Huang, S., Li, R., Huang, F., & Tang, F. (2015). The potential for mindfulness-based intervention in workplace mental health promotion: Results of a randomized controlled trial. PLOS ONE, 10(9), e0138089. https://doi.org/10.1371/journal.pone.0138089
Hülsheger, U. R., Alberts, H. J., Feinholdt, A., & Lang, J. W. (2013). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98(2), 310-325. https://doi.org/10.1037/a0031313
Hunter, L. (2016). Making time and space: The impact of mindfulness training on nursing and midwifery practice. A critical interpretative synthesis. Journal of Clinical Nursing, 25(7-8), 918-929. https://doi.org/10.1111/jocn.13164
Jaggi, O. P. (2001). Nursing profession in India. In O. P. Jaggi, & D. Chattopadhyaya (Eds), Medicine in India: Modern Period History of Science, Philosophy and Culture in Indian Civilization (pp. 203-212). PHISPC Centre for Studies in Civilization.
Jibeen, T. (2015). Perceived social support and mental health problems among Pakistani University students. Community Mental Health Journal, 52(8), 1004-1008.
https://doi.org/10.1007/s10597-015-9943-8
Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Hyperion.
Kay-Eccles, R. (2012). Meta-analysis of the relationship between coworker social support and burn outusing a two-level hierarchical linear model. Western Journal of Nursing Research, 34(8), 1062-1063. doi:10.1177/0193945912453684.
Ko, H. S. (2017). A philosophical study on ethics of caring in nursing focused on Mencius’ mind- nature theory. Philos Med, 24, 3-38.
Li, S., Li, L., Zhu, X., Wang, Y., Zhang, J., Zhao, L., Li, L., & Yang, Y. (2016). Comparison of characteristics of anxiety sensitivity across career stages and its relationship with nursing stress among female nurses in Hunan, China. BMJ Open, 6(5), e010829. https://doi.org/10.1136/bmjopen-2015-010829
Lim, Nayoung & Kim, Eun & Kim, Hyunjung & Yang, Eunjoo & Lee, Sang. (2010). Individual and work-related factors influencing burnout of mental health professionals: A meta-analysis. Journal of Employment Counseling, 47(2), 86-96. 10.1002/j.2161-1920. 2010.tb00093. x.
Liu, Y., & Aungsuroch, Y. (2019). Work stress, perceived social support, self‐efficacy and burnout among Chinese registered nurses. Journal of Nursing Management, 27(7), 1445-1453. https://doi.org/10.1111/jonm.12828
Lovibond, P., & Lovibond, S. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343. https://doi.org/10.1016/0005-7967(94)00075-u
McConville, J., McAleer, R., & Hahne, A. (2017). Mindfulness training for health profession students-The effect of mindfulness training on psychological well-being, learning and clinical performance of health professional students: A systematic review of randomized and non-randomized controlled trials. EXPLORE, 13(1), 26-45. https://doi.org/10.1016/j.explore.2016.10.002
Nair, S. (2010). Nurses’ strikes in Delhi. Economic and Political Weekly, 45(14), 3-25.
Nair, S., Timmons, S., & Evans, C. (2016). Nurses in the private health sector in Kerala: Any lessons learnt from their strikes in recent years?. Indian Journal of Gender Studies, 23(1), 8-25. https://doi.org/10.1177/0971521515612858
Nandi, A., Galea, S., Lopez, G., Nandi, V., Strongarone, S., & Ompad, D. C. (2008). Access to and use of health services among undocumented Mexican immigrants in a US urban area. American Journal of Public Health, 98(11), 2011-2020. https://doi.org/10.2105/ajph.2006.096222
Nooryan, K., Sasanpour, M., Sharif, F., & Ghafarian Shirazi, H. (2014). Anxiety in physicians and nurses working in intensive care units in Yasuj's hospitals/Iran. Procedia - Social and Behavioral Sciences, 122, 457-460. https://doi.org/10.1016/j.sbspro.2014.01.1372
Penprase, B., Johnson, A., Pittiglio, L., & Pittiglio, B. (2015). Does mindfulness-based stress reduction training improve nurse satisfaction?. Nursing Management, 46(12), 38-45. https://doi.org/10.1097/01.numa.0000470772.17731.e6
Percot, M., & Irudaya, R. (2007). Female Emigration from India: Case Study of Nurses. Economic and Political Weekly, 42(9-10), 318-355.
Phang, C. K., Chiang, K. S., Ng, L. O., & Oei, T. P. S. (2013). The Effectiveness of Brief Mindfulness-based Cognitive Behavioral Therapy Program for Stress Reduction among Medical Students in a Malaysia University. International Mindfulness Conference.
Pidgeon, A. M., Ford, L., & Klaassen, F. (2014). Evaluating the effectiveness of enhancing resilience in human service professionals using a retreat-based Mindfulness with Metta Training Program: a randomized control trial. Psychology, Health & Medicine, 19(3), 355-364.
Raghavachari, R. (1990). Conflicts and adjustments: Indian nurses in an urban milieu. Academic Foundation.
Reid-Ponte, P., & Koppel, P. (2015). Cultivating mindfulness to enhance nursing practice. AJN, American Journal of Nursing, 115(6), 48-55.
https://doi.org/10.1097/01.naj.0000466321.46439.17
Robert, R. K., & Grubb, P. L. (2014). The consequences of nursing stress and need for integrated solutions. Rehabilitation Nursing, 39(2), 62-69. https://doi.org/10.1002/rnj.97
Roohafza, H. R., Afshar, H., Keshteli, A. H., Mohammadi, N., Feizi, A., Taslimi, M., & Adibi, P. (2014). What's the role of perceived social support and coping styles in depression and anxiety? Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 19(10), 944-949.
Tabrizi, K. N., & Kavari, S. H. (2011). A study of depression prevalence in nurses and its effective factors in Shiraz Namazi hospital. European Psychiatry, 26(S2), 640-640. https://doi.org/10.1016/s0924-9338(11)72346-x
Trained Nurses Association of India v. Union of India. (n.d.). Writ Petition (Civil) No. 7291 of 2018 & CM Applications Nos. 27848 of 2018, 31375 of 2018. Association of Healthcare Providers (India).
Walker, M., & Mann, R. A. (2016). Exploration of mindfulness in relation to compassion, empathy and reflection within nursing education. Nurse Education Today, 40, 188-190. https://doi.org/10.1016/j.nedt.2016.03.005
Westphal, M., Bingisser, M., Feng, T., Wall, M., Blakley, E., Bingisser, R., & Kleim, B. (2015). Protective benefits of mindfulness in emergency room personnel. Journal of Affective Disorders, 175, 79-85. https://doi.org/10.1016/j.jad.2014.12.038
Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size requirements for structural equation models. Educational and Psychological Measurement, 73(6), 913-934. https://doi.org/10.1177/0013164413495237
Xiao, H., Zhang, Y., Kong, D., Li, S., & Yang, N. (2020). The effects of social support on sleepquality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Medical Science Monitor, International Medical Journal of Experimental and Clinical Research, 26, 1-8. https://doi.org/10.12659/msm.923549
Yu, H., Li, M., Li, Z., Xiang, W., Yuan, Y., Liu, Y., Li, Z., & Xiong, Z. (2020). Coping style, social support and psychological distress in the general Chinese population in the early stages of the COVID-19 epidemic. BMC Psychiatry, 20(1), 1-11. https://doi.org/10.1186/s12888-020-02826-3
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30-41. https://doi.org/10.1207/s15327752jpa5201_2
