Brief mindful coloring for stress reduction in nurses working in a Hong Kong hospital during COVID-19 pandemic: A randomized controlled trial

Janet Shuk Yan Fong, Anna Na Na Hui, Ka Man Ho, Albert Kam Ming Chan, Anna Lee, Janet Shuk Yan Fong, Anna Na Na Hui, Ka Man Ho, Albert Kam Ming Chan, Anna Lee

Abstract

Background: Effective interventions to promote well-being at work are required to reduce the prevalence and consequences of stress and burnout especially during the COVID-19 pandemic. This study determined the effects of mindful coloring on perceived stress levels, mental well-being, burnout, and state and trait mindfulness levels for nurses during COVID-19.

Methods: This was a single-center, two-armed, parallel, superiority, blinded randomized controlled trial. Seventy-seven participants were randomly allocated (by computer-generated sequence) to either mindful coloring (n = 39) or waitlist control groups (n = 38). Twenty-seven nurses in the mindful coloring group and 32 in the control group were included in the full compliance per protocol analysis. 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. 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 primary outcome was the perceived stress level.

Results: Baseline prevalence of moderate to high perceived stress level was high (79.2%). There was a large mindful coloring effect on reducing mean perceived stress levels (Mean difference [MD] in change between groups -3.0, 95% CI: -5.0 to -1.00; Cohen's d = 0.80). Mindful coloring may lead to a small improvement in mental well-being level (P = .08), with an improvement found in the intervention group (MD 0.9, 95% CI 0.0-1.8, P = .04) through enhanced state mindfulness (P < .001). There were no effects on changing burnout subscales or trait mindfulness levels. No adverse reactions were reported.

Conclusion: Coloring mandalas may be an effective low-cost brief intervention to reduce perceived stress levels through enhancing state mindfulness and it may promote mental well-being. Hospitals may promote or provide mindful coloring as a self-care and stress-relief practice for nurses during their off hours or work breaks.

Trial registration: ClinicalTrials.gov NCT04942509.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1.
Figure 1.
Participants flow diagram for the randomized controlled trial.
Figure 2.
Figure 2.
Waterfall plot showing change (%) in perceived stress level within nurses by intervention groups using results from the per protocol analysis. Orange bars represent the mindful coloring group (n = 27) and blue bars represent the waitlist control group (n = 32).

References

    1. Wahlster S, Sharma M, Lewis AK, et al. . The coronavirus disease 2019 pandemic’s effect on Critical Care Resources and health-care providers. Chest. 2021;159:619–33.
    1. Maben J, Bridges J. Covid-19: Supporting nurses’ psychological and mental health. J Clin Nurs. 2020;29:2742–50.
    1. Mo Y, Deng L, Zhang L, et al. . Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag. 2020;28:1002–9.
    1. Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: a systematic review and meta-analysis. J Psychosom Res. 2021;141:110343.
    1. Malaquin S, Mahjoub Y, Musi A, et al. . Burnout syndrome in critical care team members: a monocentric cross sectional survey. Anaesth Crit Care Pain Med. 2017;36:223–8.
    1. Salvagioni DA, Melanda FN, Mesas AE, et al. . Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One. 2017;12:e0185781.
    1. Dall’Ora C, Ball J, Reinius M, et al. . Burnout in nursing: a theoretical review. Hum Resour Health. 2020;18:41.
    1. van der Riet P, Levett-Jones T, Aquino-Russell C. The effectiveness of mindfulness meditation for nurses and nursing students: an integrated literature review. Nurse Educ Today. 2018;65:201–11.
    1. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822–48.
    1. Kiken LG, Garland EL, Bluth K, et al. . From a state to a trait: trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Pers Individ Dif. 2015;81:41–6.
    1. Finkelstein-Fox L, Park CL, Riley KE. Mindfulness’ effects on stress, coping, and mood: A daily diary goodness-of-fit study. Emotion. 2019;19:1002–13.
    1. Ghawadra SF, Abdullah KL, Choo WY, et al. . Mindfulness-based stress reduction for psychological distress among nurses: a systematic review. J Clin Nurs. 2019;28:3747–58.
    1. Gilmartin H, Goyal A, Hamati MC, et al. . Brief mindfulness practices for healthcare providers – a systematic literature review. Am J Med. 2017;130:1219.e1–17.
    1. Schumer MC, Lindsay EK, Creswell JD. Brief mindfulness training for negative affectivity: a systematic review and meta-analysis. J Consult Clin Psychol. 2018;86:569–83.
    1. Curry NA, Kasser T. Can coloring mandalas reduce anxiety? Art Therapy. 2005;22:81–5.
    1. Flett JAM, Lie C, Riordan BC, et al. . Sharpen your pencils: preliminary evidence that adult coloring reduces depressive symptoms and anxiety. Creat Res J. 2017;29:409–16.
    1. Mantzios M, Giannou K. When did coloring books become mindful? Exploring the effectiveness of a novel method of mindfulness-guided instructions for coloring books to increase mindfulness and decrease anxiety. Front Psychol. 2018;9:56.
    1. Czerwinski N, Egan H, Cook A, et al. . Teachers and mindful colouring to tackle burnout and increase mindfulness, resiliency and well-being. Contemp School Psychol. 2020;25:535–45.
    1. Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. Spacapan S, Oskamp S, eds. In: The Social Psychology of Health: Claremont Symposium on Applied Social Psychology. Newbury Park, CA: Sage, 1988: 31–67.
    1. Stewart-Brown S, Tennant A, Tennant R, et al. . Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Health Qual Life Outcomes. 2009;7:15.
    1. Maslach C, Jackson SE. Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Mind Garden Inc. Available at: [access date October 20, 2020].
    1. Bohlmeijer E, ten Klooster PM, Fledderus M, et al. . Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment. 2011;18:308–20.
    1. Doulougeri K, Georganta K, Montgomery A. “Diagnosing” burnout among healthcare professionals: can we find consensus? Cogent Med. 2016;3:1.
    1. Faul F, Erdfelder E, Buchner A, et al. . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–60.
    1. Gillespie TW. Understanding waterfall plots. J Adv Pract Oncol. 2012;3:106–11.
    1. Pocock SJ, Ware JH. Translating statistical findings into plain English. Lancet. 2009;373:1926–8.
    1. Burton A, Burgess C, Dean S, et al. . How effective are mindfulness-based interventions for reducing stress among healthcare professionals? A systematic review and meta-analysis. Stress Health. 2016;33:3–13.
    1. Rodriguez-Vega B, Palao A, Muñoz-Sanjose A, et al. . Implementation of a mindfulness-based crisis intervention for frontline healthcare workers during the COVID-19 outbreak in a public general hospital in Madrid, Spain. Front Psychiatry. 2020;11:562578.
    1. Sarazine J, Heitschmidt M, Vondracek H, et al. . Mindfulness workshops effects on nurses’ burnout, stress, and mindfulness skills. Holist Nurs Pract. 2021;35:10–8.
    1. Gauthier T, Meyer RM, Grefe D, et al. . An on-the-job mindfulness-based intervention for pediatric ICU nurses: a pilot. J Pediatr Nurs. 2015;30:402–9.
    1. Garland EL, Hanley A, Farb NA, et al. . State mindfulness during meditation predicts enhanced cognitive reappraisal. Mindfulness (NY). 2015;6:234–42.
    1. Atanes AC, Andreoni S, Hirayama MS, et al. . Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals. BMC Complement Altern Med. 2015;15:303.
    1. De la Fuente-Solana EI, Pradas-Hernández L, González-Fernández CT, et al. . Burnout syndrome in paediatric nurses: a multi-centre study. Int J Environ Res Public Health. 2021;18:1324.

Source: PubMed

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