the effect of a combined nature-based and virtual mindfulness intervention on perceived stress in healthcare workers

Conditions: Stress, Psychological; Sleep Disturbance; Burnout, Caregiver; Posttraumatic Stress Disorder; Anxiety; Depression

Summary: rationale: healthcare workers that care for patients with covid-19 are at increased risk for stress-related symptoms. when these symptoms are chronic, they can result in burnout and other mental health conditions that can exacerbate the current national health crisis. social distancing can limit the accessibility of mental health services. feasible and effective interventions are needed to reduce stress-related symptoms and promote resilience in this population, while adhering to federal and local guidelines to mitigate the transmission of sars-cov-2. objectives: to investigate the feasibility and efficacy of a combined nature-based and virtual mindfulness intervention on stress-related symptoms and psychological resilience in healthcare workers that care for patients with covid-19. both components are reported to reduce levels of perceived stress and increase psychological resilience; however, the potential additive effect of their combined delivery is unknown. methods: ninety healthcare workers will be randomized into one of three groups: nature+mindfulness (n=30), nature only (n=30), and control (n=30). all participants will undergo assessments at baseline (week 0), post nature intervention (\~week 1), and post mindfulness intervention (\~week 3). the two intervention groups will have one final assessment at 2-month follow-up (\~week 11). perceived stress is the primary endpoint and will be assessed with the perceived stress scale. secondary endpoints include sleep quality, burnout, posttraumatic stress, anxiety, depression, mindfulness, self-efficacy, and psycho-social-spiritual healing. anticipated results: we anticipate that participants in the nature+mindfulness group will have greater reductions in stress-related symptoms and greater increases in psychological resilience compared with the nature only and control groups.

potential participants will be recruited through first descents, a non-profit 501(c)(3) organization located in the united states. the nature-based intervention is three days long and includes activities such as hiking, mountain-biking, and kayaking. the virtual mindfulness intervention is 10 to 25 minutes daily for 10 days and is offered online. mindfulness exercises include mindful breathing, body scan, and loving-kindness meditation.

Eligibility criteria:
inclusion: in order to be eligible to participate in this study, an individual must meet all of the following criteria: 1. is 18 years old or older 2. is a healthcare worker that cares for patients with covid-19 3. has access to technology to access study resources online 4. is fluent in english 5. is able to provide their own consent exclusion: an individual who meets any of the following criteria will be excluded from participation in this study: 1. is experiencing an acute psychiatric condition 2. has a hearing impairment that is not modified with aids or devices

Keywords: resilience mindfulness meditation nature interventions covid-19 pandemic healthcare workers