Projects

LAB PROJECTS

Prevention of Injuries Among Nurses and Nursing Aides Using Eastern Principles Acceptance and Commitment Therapy: Clinical Trial and Dissemination Research

Nurses and nursing aides (NNAs) working in healthcare settings are a multicultural, diverse, vulnerable, and often marginalized group of workers who experience high rates of work-related psychological (e.g., burnout, trauma) and physical injuries (O’Brien et al., 2022). They are also exposed to high levels of assault and aggression from patients, families of patients, and co-workers (O’Brien et al., 2019a, O’Brien et al., 2022). Addressing work-related injuries among NNAs is an important health, social, economic, and humanitarian concern.

We have established that mindfulness is a significant and unique predictor of injuries among NNAs (O’Brien et al., 2019a) and that a mindfulness-based cognitive behavioral intervention (Acceptance and Commitment Therapy, ACT) was feasible, well-received, and effective in (a) reducing Ohio NNA days lost due to work injuries and (b) improving psychological wellbeing (Horan et al., 2018; O’Brien et al., 2019b).

In a separate line of research, we demonstrated that High Frequency Heart Rate Variability (HF-HRV) is a significant predictor of therapy engagement and responsiveness to a work-stress intervention (O’Brien et al., 2021)and is a significant correlate of mindfulness (Lim et al., 2022; Watford et al., 2018).  

ACT and all Western mindfulness-based cognitive behavioral interventions are based on long-standing and well-articulated theories and techniques that were developed in Southeast Asia. Scholars are recognizing that Western mindfulness interventions took many Eastern concepts in a haphazard and culturally insensitive manner. Western mindfulness-based interventions such as ACT may thus be missing critically important elements that are connected to wellbeing. Van Gordon and Shonin (2020) cogently argued that the misappropriation of Eastern teachings has resulted in a proliferation of “McMindfulness” interventions that exerted “damaging consequences for scientific, social scientific and healthcare disciplines” (p. 1). Importantly, these missing elements are particularly relevant for coping and injury prevention among healthcare workers.

In the past three years, in consultation from mindfulness researchers in Thailand, we developed a mindfulness-based cognitive behavioral intervention for NNAs called the Eastern Perspectives-added Acceptance and Commitment Therapy (EPACT NNA). EPACT NNA incorporates the important Eastern theories and perspectives into an existing ACT protocol for NNAs (ACT for NNAs).

The specific aim 1 of this project is to conduct a strongly powered randomized clinical trial that will evaluate the effectiveness of EPACT (Eastern Perspective Acceptance and Commitment Therapy), relative to (a) a traditional mindfulness intervention (ACT for NNAs) used in prior research and (b) a no-treatment control group. The outcome variables for this RCT will fall into three domains: (a) physiological measures of stress, injuries, and wellbeing (physical symptoms, HF-HRV); (b) psychological measures of work stress, burnout, compassion, and psychological flexibility; and (c) behavioral outcomes (doctor visits for injuries, days of work missed due to injury). To evaluate intervention effectiveness, we will collect physiological, psychological, and behavioral measures during a comprehensive pre-treatment psychophysiological assessment, post-treatment psychophysiological assessment, and a 3-month follow-up assessment.

The specific aim 2 of the project is to conduct a prediction study evaluating the extent to which psychological and physiological measures collected at baseline independently and significantly predict likelihood of (a) responsiveness to the EPACT NNA intervention and (b) the likelihood of experiencing psychological and physiological injuries among NNAs. To our knowledge, this will be the first investigation of HF-HRV as a predictor of occupational injuries.  

The specific aim 3 is to conduct a dissemination project focused on evaluating the intervention at randomly selected healthcare sites in Ohio and Thailand to evaluate the feasibility and effectiveness of the intervention under conventional circumstances (i.e., volunteer participation without participant payment and across cultures).