Nurses and nursing aides (NNAs) in healthcare settings are a diverse, vulnerable group
who experience high rates of psychological and physical injuries. Addressing work-related
injuries among NNAs is crucial for health, social, economic, and humanitarian reasons.
Research has shown that mindfulness predicts injuries among Ohio NNAs. A
mindfulness-based intervention (Acceptance and Commitment Therapy, ACT) was effective in
reducing injury-related absences and improving psychological wellbeing. However, Western
mindfulness interventions may miss critical Eastern elements. It has been argued that
Western "McMindfulness" interventions lack essential Eastern teachings, potentially
reducing effectiveness, especially for healthcare workers.
Acceptance of suffering, self-compassion/loving-kindness, acceptance of impermanence,
letting go of stress, nonself-attachment, and a common humanity are Eastern elements
missing in Western mindfulness interventions. In collaboration with Thai mindfulness
scholars, the researchers developed the Eastern Perspectives-added Acceptance and
Commitment Therapy (EPACT NNA) for NNAs, integrating Eastern theories into an existing
ACT protocol for NNAs. We hypothesize that EPACT NNA will more effectively reduce
psychological and physical injuries, improve psychophysiological well-being, and shorten
recovery times compared to conventional Western interventions or no treatment.
Specific Aim 1: Conduct a randomized clinical trial to evaluate EPACT NNA's effectiveness
against traditional ACT for NNAs and a no-treatment control group. Outcome variables
include: Psychological distress, injuries, well-being, work stress, burnout, compassion,
psychological flexibility, and behavioral outcomes.
Specific Aim 2: Predict the responsiveness to EPACT NNA and the likelihood of
psychological and physical injuries using on baseline measures of psychological and
physiological functioning.
Specific Aim 3: Evaluate the feasibility and effectiveness of EPACT NNA in healthcare
settings in Ohio and Thailand.
These aims align with NIH and Ohio BWC goals for preventing musculoskeletal and related
injuries, integrating health and wellness into occupational safety, and improving mental
health among workers. Additionally, this project acknowledges the Eastern origins of
mindfulness practices.
The EPACT intervention will be group-based with 5-10 participants per group. The EPACT
protocol is comprised of two 2.5-hour sessions spaced one week apart. The ACT for NNA
intervention has been previously tested for NNAs. It contains only the six core processes
identified above and omits the added EPACT components of acceptance of suffering, common
humanity, impermanence, self- and other-compassion, and non-self- attachment. It will be
delivered in a similar group-based format of 5-10 participants in two 2.5-hour sessions.
Control group participants will complete measures at the same time points as the EPACT
and ACT groups. The researchers opted to use a no-treatment control group to allow for
measurement of the durability of treatment gains across a 3-month follow-up period
without an expectation for treatment.
All NNAs agreeing to participate will be asked to complete the informed consent and the
pretreatment measures. The first EPACT and ACT for NNAs sessions will follow the
pretreatment assessment. The control group will have not further in-person contact with
researchers but will receive text and email messages. The following week, the ACT NNA and
EPACT NNA participants will attend the second session. Exposure to violence, injury,
musculoskeletal symptoms, burnout, mindfulness, and compassion measures will be completed
at pretreatment, post-treatment, and three-months follow-up. Participants will complete
these measures online. Heart rate variability will be assessed at pretreatment.