Virtual Mindfulness and Breathing Training for Stress, Burnout, Sleep, and Cognition in Rotating-Shift Nurses

Official title

Effectiveness of Virtual Mindfulness Combined With Brief Structured Breathing Training on Perceived Stress, Burnout, Sleep Quality, and Cognitive Function Among Rotating-Shift Nurses: A Randomized Controlled Trial

Overview

This randomized controlled trial aims to evaluate the effectiveness of a mobile- and virtual reality-based mindfulness and breathing intervention on stress, burnout, sleep quality, and cognitive function among Rotating-shift nurses. Participants will be randomly assigned to one of four groups: (1) health education control group, (2) mobile-based mindfulness only, (3) mobile-based mindfulness combined with brief structured breathing, and (4) virtual reality-assisted mindfulness combined with brief structured breathing. The intervention will last for 8 weeks, with participants practicing 5 times per week for 10 minutes per session. Primary outcomes include perceived stress, burnout levels, sleep quality, and cognitive function.

Detailed description

Rotating-shift nurses often experience high levels of chronic stress, occupational burnout, and disrupted sleep patterns, which can negatively affect their cognitive function and well-being. This study aims to investigate the effectiveness of technology-assisted mindfulness and breathing interventions in addressing these issues.

A total of four groups will be included in this randomized controlled trial:

1. Control Group (CG): Participants will receive a weekly electronic health education manual for 8 weeks. Topics include healthy eating habits, balanced nutrition, the physiological impact of shift work, sleep hygiene for shift workers, the effects of electronic devices on sleep, and identifying sources of stress. No mindfulness or breathing content is included. 2. Mobile-based Mindfulness Group (MMG): Participants will engage in guided mindfulness practice via a smartphone application, using a pre-recorded 360-degree nature video. 3. Mobile-based Mindfulness with Breathing Group (MMBG): Participants will follow a similar protocol as MMG, with the addition of brief structured breathing exercises embedded in the training. 4. Virtual Reality-based Mindfulness with Breathing Group (VMBG): Participants will wear a VR headset and immerse themselves in a virtual nature setting while engaging in combined mindfulness and structured breathing training. All intervention groups will complete 10-minute sessions, five times per week, for a total of eight weeks.

Primary outcome measures include: Perceived stress (Perceived Stress Scale, PSS-10-C), Occupational burnout (Nursing Burnout Scale), Sleep quality (Pittsburgh Sleep Quality Index, PSQI) and Cognitive function (including attention and memory tasks). Assessments will be conducted at baseline, immediately post-intervention, and at follow-up. This study will provide insights into the comparative effectiveness of mobile and immersive digital interventions for improving mental health and physiological functioning in Rotating-shift nurses.

Interventions

• Other Health Education Material
  Weekly electronic health education handbooks covering nutrition, sleep, shift work, stress awareness, and digital device use.
• Behavioral Mobile-Based Mindfulness
  Guided mindfulness practice via mobile app using pre-recorded 360° natural environment video.
• Behavioral Mobile-Based Mindfulness combined with Breathing
  Mindfulness training combined with brief structured breathing exercises via mobile app using 360° nature video.
• Behavioral VR-Based Mindfulness combined with Breathing
  Virtual reality-delivered mindfulness and structured breathing training using immersive 360° natural environment video.

Primary outcome measures

• Chinese version of the 10-item Perceived Stress Scale (PSS-10-C ) [Time frame: Data will be collected at baseline (pre-intervention), 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up)]
• Perceived Stress -Safety Culture Subscale. [Time frame: Data will be collected at baseline (pre-intervention), 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up)]
• Nursing Burnout Scale (NBS) [Time frame: Data will be collected at baseline (pre-intervention), 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up)]

Secondary outcome measures (6)

• Actigraphy-Based Sleep Quality Index [Time frame: Data will be collected at baseline (pre-intervention), 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up).]
• Sleep quality. Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-TC ) [Time frame: Data will be collected at baseline (pre-intervention), 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up)]
• Cognitive Function - Visual Pursuit Test (VTS-LVT) [Time frame: Data will be collected at baseline (pre-intervention), 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up).]
• Cognitive Function - Determination Test (VTS-DT) [Time frame: Data will be collected at baseline, 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up).]
• Cognitive Function - Signal Detection Test (VTS-SDT) [Time frame: Data will be collected at baseline, 4 weeks, 8 weeks (post-intervention), and 12 weeks (follow-up).]
• Heart Rate Variability (HRV) Measured via BVP using Thought Technology System [Time frame: Baseline (Week 0), Week 4, Week 8, Week 12]

Eligibility criteria

Inclusion criteria

• Age between 20 and 65 years.
• Able to understand spoken or written Mandarin or Taiwanese.
• Employed full-time for at least 3 months with a signed employment contract.
• Has worked rotating shifts (including day, evening, and/or night shifts) in the past 3 months.
• Willing to participate and sign informed consent.
• Registered nurse.
• A perceived stress score greater than or equal to 50 based on a standardized scale.

Exclusion criteria

• Pregnant or breastfeeding individuals.
• History of substance abuse (e.g., tobacco, illicit drugs).
• Alcohol consumption ≥350 ml/week with alcohol content ≥3.5%.
• Diagnosed or suspected autonomic nervous system disorders.
• History of severe or unstable cardiovascular disease, cerebrovascular disease, cancer, or end-stage organ failure within the past 6 months.
• Current diagnosis of psychiatric disorders (e.g., major depressive disorder, schizophrenia), or use of psychiatric or sleep medications (e.g., antidepressants, sedatives).
• Reported discomfort (e.g., dizziness, nausea) when using virtual reality devices.
• Engaged in other regular exercise programs, light therapy, or mind-body interventions during the study period.
• Participating in other clinical trials simultaneously.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07028788 · TSGH-PH_E_114018

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗