Effect of Mindfulness Meditation on Perceived Stress, Somatic Symptoms and Inflammatory Biomarkers Among Nurses

Introduction

The nursing profession has historically been associated with significant chronic stress due to frequent exposure to various work-related stressors. These include psychological or physical violence in the workplace, coping with patient deaths, staff shortages, and a high patient load. The pandemic has added additional pressures and stressors, including dealing with emergency patients, fear of exposure to the virus, increased working hours, imbalance between work and personal life, disruption of family life, and inability to adapt to a rapidly changing work environment. These unprecedented situations require nurses to work long hours with more limited resources, which lead to sever level of chronic stress.

Some nurses demonstrate resilience in the face of stress. However, most experience prolonged stress that dysregulate physiological functions and reduce physical and psychological health. According to Yaribeygi, et al. (2017) psychological stress is associated with the activation of several body systems, including the hypothalamic pituitary-adrenal axis and the sympathetic nervous system. The activation of these two pathways results in elevated cortisol and catecholamines. Although the mechanism is still not fully understood, chronic stress results in prolonged, excessive production of cortisol, causing chronic release of pro-inflammatory factors such as InterLeukine-6 (IL-6) and TNFα. Such a chronic increase of proinflammatory markers in healthy individuals is generally known as low-grade inflammation, which is associated to several chronic illness such as cardiovascular disease, type 2 diabetes, metabolic syndrome and major depression. Studies have revealed that persistent workplace stress lead to increased inflammatory activity in healthcare professionals with unsatisfied working conditions.

The elevated cortisol and catecholamines also puts nurses at increased risk of developing somatic symptoms, known as physical complaints, that cannot be explained by medical condition, mental disorder, or substance abuse. These complaints are often associated with psychological stress and may involve sleep problems, digestive problems, heart disease, palpitations, headache, weight gain and memory and concentration and muscle tension. A recent systematic review investigating the prevalence of somatic symptoms during the COVID-19 pandemic showed that such symptoms, including shortness of breath, dyspnea, palpitations, and pain, were reported by 7.4% to 67% of patients, healthcare workers, and the general population. Also, a study revealed that the overall prevalence rates somatic symptoms among nurses during COVID-19 pandemic was 50%. Such symptoms affect negatively nurses' quality of life and job performance, resulting in increased errors in patient care.

The high prevalence of somatic symptoms and low-grade inflammation among healthcare professionals, including nurses, indicates unmet needs within this population. Addressing these needs requires implementing preventive strategies to enhance mental resilience, particularly for high-risk individuals such as nurses. Mindfulness is one of the most important methods used in psychotherapy, which is strongly associated with promotion physical and psychological well-being, it is an effective method for reducing stress and improving health. The practice of mindfulness originally began in Asian culture due to meditative practices in Buddhist philosophy and eastern spiritual traditions; where it emphasized the value of presence, non-exaggeration, and experience acceptance. In the 1970s and 1980s, mindfulness began to be used in Western countries, and it gradually developed into one of the most important techniques in contemporary psychotherapy. In recent years, the practice of mindfulness has been widely applied in both clinical and non-clinical settings