KNOWLEDGE AND PRACTICE OF MINDFULNESS BASED STRESS

REDUCTION ON NURSES BURNOUT AS ST. LUKE’S ANGLICAN HOSPITAL

WUSASA

Chapter One

1.0 Introduction

1.1 Background to the Study

Nursing is widely acknowledged as one of the most stressful and emotionally demanding

professions globally. Nurses frequently encounter high levels of stress due to long working

hours, heavy workloads, the emotional toll of patient care, and the pressure to meet both

patient and organizational needs (Vahey et al., 2004). The constant exposure to life-and-death

situations, as well as the emotional and physical demands of caring for patients, significantly

contribute to burnout, which is defined as a state of emotional exhaustion, depersonalization,

and reduced personal accomplishment (Maslach & Jackson, 1981).

Burnout among nurses has become a pressing issue in healthcare settings as it not only affects

the well-being of nurses but also influences the quality of patient care. Studies have

demonstrated that burnout leads to job dissatisfaction, increased absenteeism, high turnover

rates, and reduced quality of care (Aiken et al., 2002; Shanafelt et al., 2012). These negative

consequences are particularly problematic in hospital environments where nurses play a

central role in patient care and healthcare delivery.

Mindfulness-Based Stress Reduction (MBSR) is an evidence-based intervention designed to

alleviate stress and promote mental well-being. Developed by Jon Kabat-Zinn in the 1970s,

MBSR combines mindfulness meditation, yoga, and body awareness practices to help
individuals reduce stress, improve emotional regulation, and enhance overall mental health

(Kabat-Zinn, 1990). The program focuses on cultivating mindfulness, which is defined as a

non-judgmental awareness of the present moment, allowing individuals to respond more

effectively to stressors (Kabat-Zinn, 1990).

MBSR has been shown to be particularly effective in reducing burnout among healthcare

professionals, including nurses. Several studies have highlighted the benefits of MBSR in

reducing emotional exhaustion, improving job satisfaction, and enhancing coping strategies

(Becker et al., 2008; Shapiro et al., 2005). Nurses who practice mindfulness report lower

levels of stress and burnout, as well as increased job satisfaction and overall well-being

(Hussain & Bhushan, 2010).

In the context of Nigerian healthcare settings, however, there is limited research on the

adoption and effectiveness of MBSR, particularly among nurses. While stress and burnout are

prevalent among Nigerian healthcare workers, the knowledge and practice of mindfulness-

based interventions have not been extensively studied. St. Luke’s Anglican Hospital Wusasa,

located in Zaria, Nigeria, is one such hospital where the stress and burnout levels of nurses

remain a concern. Despite the growing evidence supporting the effectiveness of mindfulness

techniques, it is unclear whether the nurses at this hospital are aware of or practicing MBSR

as a tool for stress reduction.

Therefore, this study aims to assess the knowledge and practice of mindfulness-based stress

reduction (MBSR) among nurses at St. Luke's Anglican Hospital Wusasa, and its potential to

mitigate burnout in this specific healthcare context. Understanding the current levels of

knowledge and practice of MBSR, as well as its association with burnout, will help identify

potential areas for improvement and provide recommendations for future interventions to

enhance the mental well-being of nurses at the hospital.

This research is significant because it could contribute to filling the gap in the literature on

MBSR in Nigerian healthcare settings, as well as inform policy and practice related to nurse

well-being. By exploring the role of MBSR in reducing burnout, this study could provide

evidence that supports the integration of mindfulness-based interventions into nursing

practice, potentially improving both the quality of care provided by nurses and their overall

health.

1.2 Statement of the Problem

Burnout among nurses is a widespread and escalating issue in healthcare settings globally,

and it is a major concern at St. Luke's Anglican Hospital Wusasa in Zaria, Nigeria. Nurses,

being at the forefront of patient care, face high-stress environments due to long working

hours, emotional and physical demands, and the pressure of dealing with life-and-death

situations. This constant stress leads to emotional exhaustion, depersonalization, and a

reduced sense of personal accomplishment — the three core dimensions of burnout as

defined by Maslach and Jackson (1981). These symptoms not only affect nurses' well-being

but also negatively impact patient care, job satisfaction, and retention rates. As a result, the

quality of healthcare services suffers, which has broader implications for the overall

healthcare system.

Mindfulness-Based Stress Reduction (MBSR) has emerged as a well-established intervention

designed to alleviate stress, improve emotional regulation, and reduce burnout, particularly

among healthcare professionals, including nurses (Shapiro et al., 2005). The approach, which

integrates mindfulness meditation, yoga, and body awareness, has shown positive results in

reducing stress and burnout across various healthcare settings. However, despite its proven

benefits, there is a lack of research on the knowledge and practice of MBSR among nurses in

St. Luke’s Anglican Hospital Wusasa.

At St. Luke’s Anglican Hospital Wusasa, the prevalence of burnout among nurses is of great

concern, yet little is known about their awareness of mindfulness practices or whether such

interventions are integrated into their daily routines. It is unclear whether nurses at this

hospital have adequate knowledge of MBSR or if they practice mindfulness-based techniques

to manage work-related stress. Given the high levels of stress and burnout in the healthcare

setting, it is essential to understand the extent to which MBSR can be a tool for improving

nurses' mental health and reducing burnout.

Thus, this study seeks to investigate the knowledge and practice of MBSR among nurses at

St. Luke's Anglican Hospital Wusasa, specifically focusing on the extent to which nurses are

aware of and utilize mindfulness techniques to cope with stress. By assessing the relationship

between MBSR knowledge, practice, and burnout levels, the study aims to provide valuable

insights that could inform hospital management strategies and healthcare policies in Nigeria.

This research also seeks to contribute to the body of knowledge regarding mindfulness

interventions in African healthcare contexts, where such approaches have not been widely

explored.

The problem, therefore, lies in the lack of information on the knowledge and application of

MBSR as a tool for mitigating burnout among nurses at St. Luke's Anglican Hospital

Wusasa. Addressing this gap will help determine whether MBSR can serve as an effective

intervention to improve the mental health of nurses and enhance the quality of care provided

at the hospital.

1.3 Research Objectives

The objectives of this study are:

1. To assess the level of knowledge of MBSR among nurses at St. Luke’s Anglican Hospital

Wusasa.
2. To evaluate the practice of MBSR among nurses at the hospital.

3. To examine the relationship between MBSR knowledge and practice and the level of

burnout among nurses.

1.4 Research Questions

1. What is the level of knowledge of mindfulness-based stress reduction among nurses at St.

Luke’s Anglican Hospital Wusasa?

2. How often do nurses at St. Luke’s Anglican Hospital Wusasa practice mindfulness-based

stress reduction techniques?

3. What is the relationship between the knowledge and practice of MBSR and burnout levels

among nurses at St. Luke’s Anglican Hospital Wusasa?

1.5 Significance of the Study

This study holds significant value for various stakeholders, including student nurses, the

hospital administration, and policymakers. The findings could have direct implications for

nurse well-being, healthcare service quality, and the development of healthcare policies that

promote mental health and stress management among healthcare workers. Below are the

specific areas where this research will have an impact:

To Student Nurses

For student nurses, this study provides valuable insights into how mindfulness-based

interventions, like Mindfulness-Based Stress Reduction (MBSR), can be utilized as a

practical tool to manage stress and prevent burnout. As future healthcare professionals,

student nurses often experience stress during their clinical placements and academic training.

By understanding the benefits of MBSR, they can adopt these practices early in their careers,

helping them develop healthy coping mechanisms that will sustain their mental health
throughout their professional journey. Additionally, this research may encourage nursing

schools to incorporate mindfulness training into their curricula, equipping students with the

skills to better handle the demands of the nursing profession.

Furthermore, by emphasizing the importance of self-care and stress management, the study

could foster a culture of mindfulness within nursing education, where students prioritize their

well-being in order to provide quality care to patients. This is essential in a profession that is

often characterized by high levels of emotional and physical exhaustion.

To the Hospital

For the hospital, this study will offer a comprehensive understanding of the stress levels and

burnout rates among nurses. The findings will highlight the extent to which burnout affects

the nursing staff and whether MBSR programs could be implemented to alleviate this issue.

If MBSR is found to be beneficial, the hospital administration can consider incorporating

mindfulness-based interventions into their wellness programs, which could lead to a

reduction in burnout and an improvement in nurse retention rates.

By adopting MBSR as part of the hospital's staff development program, St. Luke's Anglican

Hospital can enhance the overall job satisfaction of nurses, improve their emotional

resilience, and, ultimately, provide better care to patients. Moreover, the hospital can position

itself as a leader in innovative employee wellness programs in the region, attracting qualified

staff and improving the hospital’s reputation within the healthcare community.

To Policymakers

This research offers valuable evidence on the role of mindfulness-based practices in reducing

burnout and enhancing the mental health of healthcare workers, particularly nurses.

Policymakers, especially those in the healthcare sector, can use the results of this study to

advocate for the integration of mindfulness and stress-reduction programs into national
healthcare policies. If the study demonstrates positive outcomes for nurses at St. Luke's

Anglican Hospital, it could serve as a model for other healthcare institutions across Nigeria

and Sub-Saharan Africa.

Furthermore, the findings could encourage policymakers to allocate resources toward nurse

well-being programs, integrate MBSR into training and continuing education, and implement

mental health support structures for healthcare workers. This could have a broader impact on

the quality of healthcare delivery, as healthier, more satisfied healthcare workers are better

equipped to provide high-quality care to patients.

The significance of this study extends to various levels within the healthcare system. It

provides student nurses with essential tools for managing stress, offers St. Luke’s Anglican

Hospital Wusasa actionable insights into improving nurse well-being, and informs

policymakers of the potential benefits of mindfulness interventions in enhancing the mental

health of healthcare professionals.

1.6 Scope of the Study

This study will focus on the nurses working at St. Luke’s Anglican Hospital Wusasa, located

in Zaria, Nigeria. It will examine the knowledge and practice of MBSR, as well as the impact

on burnout levels within this specific healthcare setting.

1.7 Operational Definition of terms

To ensure clarity and precision in the context of this study, the following key terms are

operationally defined:

Mindfulness-Based Stress Reduction (MBSR): Mindfulness-Based Stress Reduction

(MBSR) refers to a structured program that combines mindfulness meditation, and body

awareness to reduce stress and improve emotional regulation.

Burnout: Burnout is defined as a state of physical, emotional, and mental exhaustion caused

by prolonged exposure to stress, typically in a workplace setting.

Nurses: Nurses in this study refer to the professional healthcare workers employed at St.

Luke’s Anglican Hospital Wusasa, whose primary role is to provide care, support, and

treatment to patients.

Knowledge of MBSR: Knowledge of MBSR refers to the awareness and understanding of

mindfulness-based stress reduction techniques among nurses. This includes their ability to

identify key components of MBSR such as mindfulness meditation, breathing exercises, and

the principles of mindfulness.

Practice of MBSR: The practice of MBSR refers to the extent to which nurses engage in

mindfulness-based activities such as meditation, yoga, breathing exercises, or other

mindfulness techniques in their daily routines. In this study, practice will be measured by

asking nurses how often they engage in mindfulness exercises, including the specific

techniques they use and the frequency with which they practice them (e.g., daily, weekly,

rarely).

Stress: Stress in this study refers to the emotional and physiological response to work-related

demands or pressures experienced by nurses. Stress can be acute (short-term) or chronic

(long-term) and can result from high workloads, patient care responsibilities, long working

hours, or lack of support in the workplace.

Hospital: The hospital according to this study, refers to St. Luke’s Anglican Hospital

Wusasa. This hospital serves as the study site and is where the nurses being studied are

employed. It is an institution providing healthcare services to the local population, with

nurses playing a central role in patient care delivery.

 CHAPTER TWO
Literature review
2.0 Introduction

This chapter reviews existing literature on the prevalence of burnout among nurses, the

effectiveness of mindfulness-based stress reduction (MBSR), and its application in healthcare

settings. The review will focus on studies related to the knowledge, practice, and impact of

MBSR on nurses' burnout.

2.1 Conceptual review

2.1.1. Mindfulness-Based Stress Reduction (MBSR)

Mindfulness-Based Stress Reduction (MBSR) is a structured, evidence-based program

designed to reduce stress, enhance well-being, and promote emotional regulation. MBSR was

developed by Jon Kabat-Zinn in the late 1970s at the University of Massachusetts Medical

School. It combines mindfulness meditation, body awareness, and yoga to cultivate

mindfulness, which is defined as a non-judgmental awareness of the present moment (Kabat-

Zinn, 1990).

MBSR typically involves an eight-week program with weekly sessions and daily home

practice, focusing on mindfulness meditation, body scans, mindful movement, and breathing

exercises. The goal is to help participants become more aware of their thoughts, emotions,

and physical sensations without reacting to them. This can help individuals break patterns of

negative thinking and increase their ability to manage stress effectively (Kabat-Zinn, 2003).

In healthcare settings, MBSR has shown significant benefits in reducing stress, anxiety, and

burnout among healthcare workers, including nurses. Studies have demonstrated that MBSR

can improve nurses' emotional well-being by enhancing their ability to cope with work-
related stress and improving their resilience (Becker et al., 2008; Shapiro et al., 2005).

However, while there is substantial evidence supporting the effectiveness of MBSR in

reducing burnout, the knowledge and practice of these techniques among nurses in Nigerian

hospitals, such as St. Luke's Anglican Hospital Wusasa, have not been extensively studied.

2.1.2. Burnout

Burnout is a psychological condition that results from prolonged exposure to work-related

stress. It is characterized by three primary components: emotional exhaustion,

depersonalization, and reduced personal accomplishment (Maslach & Jackson, 1981).

Emotional Exhaustion refers to the feeling of being emotionally drained and fatigued by the

demands of work. Nurses experiencing emotional exhaustion may feel overwhelmed and

unable to cope with the demands of their job.

Depersonalization involves a sense of detachment or cynicism towards patients and

colleagues. Nurses may begin to view patients as objects rather than individuals, which can

affect the quality of care provided.

Reduced Personal Accomplishment is the feeling of ineffectiveness or failure at work. Nurses

may feel that their efforts are not making a meaningful impact, leading to a decreased sense

of professional fulfillment.

Burnout in nurses is a significant concern, as it can affect job satisfaction, lead to

absenteeism, and increase turnover rates, all of which can compromise patient care (Aiken et

al., 2002; Shanafelt et al., 2012). The high-stress environment in healthcare settings,

particularly in hospitals, significantly contributes to burnout. Nurses often face heavy

workloads, long shifts, emotional strain from patient care, and a lack of organizational

support, all of which can exacerbate stress and burnout. As such, the exploration of effective
interventions to address burnout, such as MBSR, is crucial for improving nurses' well-being

and the overall quality of healthcare services.

2.1.3. The Relationship Between Knowledge and Practice of MBSR and Burnout

The relationship between the knowledge and practice of MBSR and burnout is an essential

concept in this study. Understanding the extent to which nurses are familiar with mindfulness

techniques and how often they practice them is critical in assessing the potential of MBSR as

an intervention for burnout.

Knowledge of MBSR refers to the awareness of mindfulness techniques, including

meditation, breathing exercises, and yoga, and their potential benefits for stress reduction and

emotional well-being. While many healthcare workers may have heard of mindfulness, their

level of understanding and familiarity with specific practices may vary.

Practice of MBSR involves the actual engagement in mindfulness techniques, such as daily

meditation, breathing exercises, or yoga. Research has shown that practicing mindfulness

regularly can lead to improved emotional regulation, decreased stress, and lower burnout

levels (Becker et al., 2008). However, even if healthcare workers possess knowledge of

mindfulness, their ability to incorporate these practices into their daily routines can be

influenced by various factors, such as workload, time constraints, and organizational culture.

In many cases, individuals with a greater understanding of mindfulness practices are more

likely to engage in these techniques consistently. Conversely, if nurses lack knowledge of

MBSR or are not trained in how to practice mindfulness effectively, they may not reap the

full benefits of these interventions. This study aims to explore the level of knowledge and

practice of MBSR among nurses at St. Luke’s Anglican Hospital Wusasa and examine the

relationship between these factors and burnout levels.

2.1.4. Mindfulness in Healthcare and Nursing

In healthcare, mindfulness has been widely researched as a tool for stress reduction and

emotional resilience. Nurses, in particular, experience high levels of stress due to the nature

of their work, which often involves long shifts, high patient demands, and emotional strain

(Dyrbye et al., 2020). Mindfulness practices have been shown to improve nurses' mental

health, increase empathy, reduce emotional exhaustion, and enhance patient care (Hussain &

Bhushan, 2010).

Mindfulness training for healthcare professionals, especially nurses, has been linked to

improvements in self-awareness, better management of negative emotions, enhanced focus,

and increased job satisfaction (Shapiro et al., 2005). Studies have found that mindfulness not

only reduces burnout but also improves communication with patients, leading to better

outcomes (Becker et al., 2008). Given the demanding nature of nursing, it is essential that

healthcare systems integrate stress management programs like MBSR to support nurses’

well-being.

2.1.5. MBSR in Nigerian Healthcare Settings

While MBSR has been extensively studied in Western healthcare contexts, there is limited

research on its application in African or Nigerian healthcare settings. The unique socio-

cultural, economic, and healthcare system challenges in Nigeria may affect the

implementation and effectiveness of mindfulness-based interventions. Nigerian nurses face

significant stressors, such as inadequate resources, high patient-to-nurse ratios, and a lack of

institutional support, which could exacerbate burnout (Oladipo et al., 2020).

As the healthcare system in Nigeria continues to evolve, there is a growing need for

innovative approaches to addressing stress and burnout. MBSR could offer a culturally

adaptable, low-cost intervention that could help Nigerian nurses manage stress more

effectively. However, the knowledge and acceptance of mindfulness practices in Nigerian

healthcare settings remain underexplored, making this study critical in understanding whether

MBSR could be a viable solution for reducing burnout among Nigerian nurses.

2.2 Theoretical Framework

2.2.1 Mindfulness Theory

Mindfulness Theory, particularly as developed by Jon Kabat-Zinn (1990), underpins the

practice of Mindfulness-Based Stress Reduction (MBSR). According to Kabat-Zinn,

mindfulness involves paying attention to the present moment in a non-judgmental way. This

heightened awareness allows individuals to observe their thoughts, emotions, and bodily

sensations without becoming overwhelmed or reactive.

In the context of healthcare workers, mindfulness has been shown to improve emotional

regulation, reduce stress, and enhance resilience. The process of mindfulness helps

individuals gain perspective on stressful events by creating a space between the stimulus

(e.g., work stress) and their response (e.g., stress reaction). This ability to "pause" and

respond thoughtfully, rather than react impulsively, can significantly reduce emotional

exhaustion and depersonalization — two key components of burnout.

The theory suggests that mindfulness interventions like MBSR provide a systematic approach

to increasing awareness, focus, and emotional regulation. Nurses who regularly practice

mindfulness may experience greater well-being, reduced stress, and lower burnout levels.

Furthermore, mindfulness increases the ability to focus on the present, which may help nurses

better manage their emotional and cognitive resources when dealing with challenging

situations at work.

Key components of Mindfulness Theory relevant to this study include:

Non-judgmental awareness: Nurses become more aware of their stress and emotional

reactions without labeling them as “good” or “bad.” This approach reduces emotional

reactivity, which is a key contributor to burnout.

Acceptance: Mindfulness encourages individuals to accept their emotions and thoughts

without judgment, allowing nurses to cope with work-related challenges more effectively and

with less emotional strain.

Present-moment focus: Practicing mindfulness allows individuals to focus on the present

rather than ruminating over past mistakes or worrying about future challenges. This can

alleviate feelings of burnout and emotional exhaustion.

When nurses are exposed to high job demands (e.g., long shifts, high patient loads), they are

at risk of burnout. However, by engaging in mindfulness practices (e.g., meditation, body

awareness, breathing techniques), nurses can develop the emotional resources necessary to

manage these demands more effectively. Mindfulness can improve focus, reduce negative

emotional responses, and increase overall well-being, which ultimately lowers burnout levels

and enhances the quality of care provided.

2.2.2 Application of Mindfulness Theory to the Study

Mindfulness Theory, particularly as developed by Jon Kabat-Zinn (1990), plays a central role

in understanding how mindfulness-based interventions, such as Mindfulness-Based Stress

Reduction (MBSR), can be used to reduce burnout and improve the well-being of nurses.

This theory will be applied to this study by guiding the exploration of how mindfulness

practices can enhance emotional regulation, increase stress resilience, and reduce burnout

among nurses at St. Luke's Anglican Hospital Wusasa.

1. Mindfulness as Non-Judgmental Awareness

One of the core tenets of Mindfulness Theory is non-judgmental awareness — the ability to

observe one’s thoughts, feelings, and bodily sensations without categorizing them as “good”

or “bad.” This principle is particularly relevant to the issue of burnout among nurses. Nurses

who experience stress may become overwhelmed by their emotions and thoughts, leading to

emotional exhaustion and depersonalization. Mindfulness practice teaches individuals to

observe their emotions with acceptance, without becoming emotionally entangled in them.

In the context of this study, the application of non-judgmental awareness could help nurses at

St. Luke’s Anglican Hospital Wusasa acknowledge and accept their feelings of stress and

frustration without allowing these emotions to dictate their behavior or affect their

performance. By practicing mindfulness, nurses may be able to regulate their emotions,

reduce negative reactions to stressful situations, and create a buffer against burnout. Example;

A nurse might experience frustration when a patient is non-compliant with their treatment

plan. Instead of reacting emotionally, the nurse can use mindfulness techniques to observe

their frustration without judgment, allowing them to respond more calmly and thoughtfully.

2. Mindfulness and Present-Moment Focus

Another essential concept of Mindfulness Theory is the emphasis on focusing on the present

moment. This "present-moment awareness" is beneficial in reducing stress and preventing

burnout. Nurses working in fast-paced, high-stress environments like hospitals often

experience cognitive overload from constantly thinking about multiple tasks, patients, or

possible negative outcomes. This constant "worrying" or "ruminating" can lead to emotional

exhaustion and burnout.

By applying mindfulness practices, nurses can train themselves to focus on the present

moment, rather than worrying about past events (e.g., a difficult case or a mistake) or future
concerns (e.g., an overwhelming shift ahead). This focus on the present moment helps to

reduce anxiety and increases emotional resilience by creating a mental "space" to respond

thoughtfully rather than react impulsively.

In this study, the practice of mindfulness techniques such as meditation, body scans, and

mindful breathing will allow nurses at St. Luke’s Anglican Hospital to center their attention

on the present, reducing feelings of stress and emotional exhaustion. Over time, nurses who

practice mindfulness may feel less overwhelmed by their daily tasks and experience greater

job satisfaction. Example; A nurse may feel anxious about a particularly challenging patient

care situation. By focusing on the present moment through mindful breathing, the nurse can

reduce anxiety and improve concentration, enabling them to address the situation calmly and

effectively.

2.3 Empirical review

2.3.1. To Assess the Level of Knowledge of MBSR Among Nurses

Knowledge of Mindfulness-Based Stress Reduction (MBSR) is crucial in understanding

whether nurses can effectively engage in mindfulness practices to manage stress and prevent

burnout. Knowledge of MBSR typically involves understanding the fundamental principles

of mindfulness, such as non-judgmental awareness, meditation, breathing exercises, and

yoga, and recognizing the benefits these techniques offer in reducing stress and burnout.

Shapiro et al. (2005) conducted a study that explored the knowledge and attitudes toward

mindfulness and its application among healthcare professionals. The study found that while

many nurses expressed interest in mindfulness practices, a significant number lacked

comprehensive knowledge about the structured MBSR program. Nurses who had undergone

mindfulness training showed greater awareness of the techniques and reported lower levels of

stress and burnout compared to those who had little to no knowledge of mindfulness.
Kabat-Zinn (2003) emphasized that formal training in MBSR programs enhances the ability

of individuals to manage stress effectively. In a study conducted by Becker et al. (2008) on

the implementation of mindfulness programs in hospitals, the results indicated that nurses

who received training in MBSR demonstrated better knowledge and understanding of the

mindfulness concepts and practices. This knowledge led to improved emotional regulation

and stress management.

Bazzano et al. (2013) found that many healthcare workers, including nurses, had limited

knowledge of mindfulness practices despite some awareness of their potential benefits. The

study noted that structured education and training programs were essential for increasing

awareness and knowledge about MBSR.

From these studies, it is clear that knowledge of MBSR among nurses varies widely, with

formal education and training playing a significant role in increasing understanding and

awareness of mindfulness techniques.

2.3.2. The Practice of MBSR Among Nurses

Practice of MBSR refers to the frequency with which nurses engage in mindfulness activities,

such as meditation, yoga, or breathing exercises, to manage stress and enhance their

emotional well-being.

Becker et al. (2008) explored how MBSR was incorporated into the daily routines of

healthcare professionals. They found that while many nurses were aware of mindfulness

techniques, a significant number struggled to implement them regularly due to time

constraints, high workload, and lack of institutional support. Nurses who practiced MBSR

regularly, however, reported lower levels of emotional exhaustion and higher levels of job

satisfaction.
Dyrbye et al. (2017) highlighted that the practice of mindfulness, particularly through

structured programs like MBSR, led to significant improvements in the mental health and

well-being of healthcare workers. The study found that healthcare professionals who engaged

in daily mindfulness practices showed significant reductions in perceived stress and burnout.

However, it also noted that consistent practice was often difficult for nurses due to the high

demands of the job.

Hussain and Bhushan (2010) examined the barriers to practicing mindfulness in a healthcare

setting. They found that despite understanding the benefits of mindfulness, many nurses

found it difficult to integrate the practice into their work-life balance. Factors such as high

patient-to-nurse ratios, inadequate staffing, and long working hours were cited as primary

barriers to the consistent practice of mindfulness.

Fresno et al. (2020) conducted a study on nurses in a hospital setting, finding that regular

mindfulness practice was associated with reduced anxiety and burnout. However, the study

also pointed out that for nurses to consistently engage in MBSR practices, hospitals need to

provide time and resources for mindfulness training and practice.

The literature shows that while the practice of MBSR is beneficial for reducing stress and

burnout, there are significant barriers to its regular implementation among nurses.

Overcoming these barriers requires structural support from healthcare organizations and a

culture that promotes well-being.

2.3.3. The Relationship Between MBSR Knowledge and Practice and the Level of

Burnout Among Nurses

The relationship between the knowledge and practice of MBSR and burnout among nurses

has been extensively studied. Burnout, characterized by emotional exhaustion,

depersonalization, and a reduced sense of personal accomplishment, is a significant issue in

healthcare settings, including nursing.

Shapiro et al. (2005) explored the relationship between mindfulness knowledge, practice, and

burnout among healthcare professionals. They found that nurses with a higher level of

knowledge and practice of MBSR experienced significantly lower levels of burnout. Nurses

who engaged in mindfulness practices were better equipped to cope with work-related stress,

reducing emotional exhaustion and increasing job satisfaction.

Bissonnette et al. (2018) conducted a study on the effects of MBSR on burnout in a hospital

setting. The results indicated that nurses who participated in an MBSR program showed

reductions in all three dimensions of burnout: emotional exhaustion, depersonalization, and

personal accomplishment. The study emphasized that both knowledge and practice were

crucial factors in reducing burnout, as nurses who were trained in MBSR and actively

engaged in the practices demonstrated greater resilience and emotional regulation.

Gardner et al. (2017) examined the link between mindfulness practice and burnout among

healthcare workers, finding that individuals with higher levels of mindfulness (both in terms

of knowledge and practice) were more likely to report lower burnout levels. Their study

reinforced the idea that practicing mindfulness helps healthcare professionals to manage

work-related stress, regulate emotions, and cope better with the demands of patient care.

Cheng et al. (2021) investigated the role of MBSR in reducing burnout among nurses in a

large hospital setting. The study found that nurses who regularly practiced mindfulness

experienced lower levels of emotional exhaustion and depersonalization, and higher levels of

personal accomplishment. Furthermore, the relationship between mindfulness knowledge and

burnout reduction was stronger for those who practiced mindfulness consistently.
 CHAPTER THREE
Methodology

3.0 Introduction

This chapter outlines the research design, population, sample size, sampling techniques, data

collection methods, and data analysis procedures for this study.

3.1 Research Design

This study will use a descriptive cross-sectional design to assess the knowledge and practice

of mindfulness-based stress reduction (MBSR) among nurses at St. Luke’s Anglican Hospital

Wusasa. A descriptive design is suitable because it provides a snapshot of the current state of

knowledge and practice within the population.

3.2 Research Setting

The study was carried out in St. Luke’s Anglican Wusasa former known as Wusasa

Hospital is located in the northern part of Kaduna State within the main town of Wusasa.

The hospital is the oldest missionary hospital and school in Zaria, and one of the oldest in

Kaduna State. It was founded by the church missionary society (CMS) of England in 1929

and handed over to the Anglican diocese Northern Nigeria in 1962. It is a combination of

Hospital and school.

Brands of governors were appointed and the Bishop as chairman in 1938, the government

colonial recognized and approved the hospital for training of nurses. At about 1964, the
 hospital was also approved for training of medical practice. The major aim of the hospitals

runs on the concept of Christian faith, mutual love, confidence honesty and absolute

dedication to the ideas of services to humanity. The hospitals readers secondary health

care service. The hospital known for its in patients and out patient services, the hospital

structure comprises of the general out- patient department (GOPD), theatre, laboratories,

pharmacy antenatal clinic etc.

3.3 Target population

The target population for this study consists of both staff nurses and student on clinical

posting during the time of the research at St. Luke’s Anglican Hospital Wusasa.

3.4 Sample size

Determining an appropriate sample size is essential for ensuring that the results of the study

are statistically valid and that the conclusions drawn can be generalized to the target

population. For this study, which seeks to assess the knowledge and practice of Mindfulness-

Based Stress Reduction (MBSR) and its relationship with burnout among nurses at St. Luke’s

Anglican Hospital Wusasa, the sample size will be calculated based on the objectives and

research design.

1. Formula for Sample Size Calculation

The most common method to determine the sample size for a descriptive or correlational

study is based on Cochran's formula for sample size calculation for a population with an

unknown proportion. This formula is used when the population size is large, which is typical

for hospital-based studies involving healthcare professionals such as nurses.

The formula is as follows:

 2
Z x P(1−P)
N= 2
e ( N −1 ) +Z 2 x P(1−P)

Where:

N = required sample size

Z = Z-value (based on the desired confidence level) For a 95% confidence level, Z=1.96

p = estimated proportion of the population (if unknown, p = 0.5 is used as it provides the

maximum sample size)

e = margin of error (usually set to 0.05 or 5%)

2
1.96 x 0.5 (1−0.5)
N=
0.052

3.8416 x 0.25
N=
0.0025

0.9604
N=
0.0025

N=384.16

3.5 Sampling Technique

The sample technique for this study was sample random technique, where all the respondents

have equal chances foe being represented in the sample to prevent sample bias.

3.6 Instrument for data collection

Data will be collected using a self-structured questionnaire, which will be divided into four

sections:

Section A; Demographic Information: Age, gender, educational level, and work experience.

Section B; Knowledge of MBSR: This section will assess nurses' awareness of MBSR, its

techniques, and its benefits.

Section C; Practice of MBSR: This section will assess the frequency and types of MBSR

practices (e.g., meditation, yoga, mindfulness exercises).

Section D; will seek to evaluate the relationship knowledge and practice of MBSR and

burnout levels among nurses

3.7 Validity of Instrument

Validity refers to the extent to which an instrument (such as a questionnaire or interview)

measures what it is intended to measure. Ensuring the validity of the research instrument is

essential for the accuracy and credibility of the study's findings. In the context of this

study on the knowledge and practice of Mindfulness-Based Stress Reduction (MBSR) and

nurse burnout, the instrument must be able to accurately measure the knowledge and

practice of MBSR, as well as the level of burnout experienced by nurses. The

questionnaire was submitted to the research supervisor for correction, modification and

approval.

3.8 Reliability of Instrument

Reliability refers to the consistency and stability of an instrument over time. In other

words, a reliable instrument should produce the same results under consistent conditions.

Ensuring the reliability of your research instrument is crucial because it ensures that the

data collected is dependable, and the conclusions drawn from the study are accurate. The

instrument is administered to a small sample of participants (a pilot group) at two different

points in time. The correlation coefficient between the two sets of results (usually the

Pearson correlation) indicates how consistent the instrument is. A higher correlation

(above 0.8) suggests good test-retest reliability.

3.9 Method of Data Collection

 Prior to obtaining information from the respondents, the researcher looks for permission

from the management of St. Luke’s Anglican Hospital to distribute the questionnaire to

the respondents. The questionnaire was shared to the sample population. A total number of

384 questionnaire were give out to the respondents and it was correctly filled and

retrieved.

3.10 Method of Data Analysis

All data collected were analysed in an organized table of percentage and chart (pie chart

and bar chart)

3.11 Ethical Considerations

Ethical approval will be obtained from the ethics committee of St. Luke’s Anglican

Hospital Wusasa. Informed consent will be sought from all participants, ensuring that their

participation is voluntary and anonymous.

References

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[Link]

Bazzano, A. T., et al. (2013). Mindfulness-Based Stress Reduction in healthcare workers.

Journal of Clinical Psychology, 69(8), 901-913.

Becker, C. B., Zayas, L. H., & Mello, M. A. (2008). Mindfulness and stress reduction in
healthcare professionals: A review of the literature. Journal of Behavioral Health,
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Cheng, L., et al. (2021). The role of MBSR in reducing burnout among nurses: A hospital-
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Cochran, W.G. (1977). Sampling Techniques (3rd ed.). New York: John Wiley & Sons.

Dyrbye, L. N., et al. (2017). The impact of mindfulness-based interventions on healthcare

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JNS.0b013e3181e8f78b

Kabat-Zinn, J. (2003). Mindfulness-based stress reduction (MBSR). In Handbook of

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Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of
Occupational Behavior, 2(2), 99-113. [Link]

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Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2005). Teaching self-care to caregivers:
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[Link]

Section A: Socio-Demographic Characteristics

1. What is your gender?
a. Male [ ] b. Female

2. How old are you?

a. 20-30 years [ ] b. 31-40 years [ ] c. 41-50 years [ ] d. 51 years and above

3. What is your highest level of education?

a. Diploma in Nursing
b. Bachelor's Degree in Nursing
c. Master's Degree in Nursing
d. Other (please specify) ___________

4. How many years of experience do you have as a nurse?

a. 0-5 years
b. 6-10 years
c. 11-20 years
d. 21 years and above

5. What is your current position at the hospital?

a. Registered Nurse [ ]
b. Chief Nursing Officer [ ]
c. Certify Nurse Assistant [ ]
c. Other (please specify) ___________
Section B: Level of Knowledge of MBSR Among Nurses

6. How familiar are you with the concept of Mindfulness-Based Stress Reduction (MBSR)?
a. Very familiar [ ]
b. Somewhat familiar [ ]
c. Not familiar at all [ ]

7. Which of the following techniques are part of MBSR? (Select all that apply)
a. Meditation [ ]
b. Deep breathing exercises [ ]
c. Progressive muscle relaxation [ ]
d. Cognitive behavioral therapy [ ]
e. Yoga [ ]
8. How effective do you believe MBSR is in reducing stress among healthcare professionals?
a. Very effective [ ]
b. Somewhat effective [ ]
c. Not effective at all [ ]
d. Not sure [ ]

9. In your opinion, what is the primary goal of MBSR?

a. To improve physical fitness [ ]
b. To reduce stress and promote mental well-being [ ]
c. To manage chronic pain [ ]
d. To improve interpersonal relationships [ ]

10. Have you ever attended any formal training or course in Mindfulness-Based Stress
Reduction (MBSR)?
a. Yes [ ] b. No [ ]

Section C: Practice of MBSR Among Nurses

11. How often do you practice MBSR techniques such as meditation or deep breathing?
a. Daily [ ]
b. 2-3 times a week [ ]
c. Once a week [ ]
d. Rarely [ ]
e. Never [ ]

12. What is your preferred MBSR technique?

a. Meditation [ ]
b. Breathing exercises [ ]
c. Yoga [ ]
d. Progressive muscle relaxation
e. Other (please specify) ___________

13. In the past month, how much time have you spent practicing MBSR activities each week?
a. Less than 1 hour [ ] b. 1-2 hours [ ] c. 3-5 hours [ ] d. More than 5
hours [ ]
14. Have you integrated MBSR practices into your daily routine at work (e.g., during breaks
or before/after shifts)?
a. Yes, regularly [ ] b. Occasionally [ ] c. No [ ]

15. What challenges, if any, do you face in practicing MBSR at work? (Select all that apply)
a. Lack of time [ ]
b. Lack of space [ ]
c. Stressful work environment [ ]
d. Lack of knowledge or training [ ]
e. Other (please specify) ___________

Section D: Relationship Between MBSR Knowledge and Practice and the Level of
Burnout Among Nurses

16. How often do you feel emotionally exhausted at work?

a. Always [ ]
b. Frequently [ ]
c. Occasionally [ ]
d. Rarely [ ]
e. Never [ ]

17. To what extent do you feel detached from your colleagues or patients due to work stress?
a. Very detached [ ]
b. Somewhat detached [ ]
c. Not detached at all [ ]
d. Not sure [ ]

18. Do you believe that practicing MBSR techniques can reduce feelings of burnout at work?
a. Strongly agree [ ]
b. Agree [ ]
c. Disagree [ ]
d. Strongly disagree [ ]

19. Have you noticed a reduction in stress or burnout symptoms since practicing MBSR
techniques?
a. Yes, significantly
b. Yes, somewhat
c. No, not at all
d. Not sure

20. In your opinion, does the knowledge of MBSR techniques correlate with lower levels of
burnout among nurses at St. Luke’s Anglican Hospital Wusasa?
a. Strongly agree [ ]
b. Agree [ ]
c. Disagree [ ]
d. Strongly disagree [ ]