Prevention of burnout among nurses Paper.

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.

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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: g.alexander@tcu.edu For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2015 The Author(s)

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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.