正念减压疗法对护士压力及职业倦怠干预效果的系统评价

Effects of mindfulness-based stress reduction on stress and job burnout in nurses:a systematic review

目的系统评价正念减压疗法(MBSR)对护士压力及职业倦怠的有效性。方法计算机检索PubMed、Cochrane Library、EMbase、Medline、Web of Science、中国生物医学文献服务系统(CBM)、CNKI、万方、维普数据库,查找关于正念减压疗法(MBSR)干预护士压力及职业倦怠的相关研究文献,检索从建库至2018年6月的所有RCT。由2名研究者按纳入与排除标准独立筛选文献、提取资料并进行质量评价后,采用RevMan 5.3软件进行meta分析。结果最终纳入文献10篇,定性分析纳入5篇,对另外5篇进行meta分析,包括260例研究对象。Meta分析结果显示,较对照组,MBSR对护士职业倦怠有明显改善作用。但亚组分析结果显示,正念减压疗法干预8周与干预4周,干预组与对照组在情绪衰竭、去人格化及个人成就感的变化比较结果存在差异。正念减压疗法干预8周MBSR组在情绪衰竭[MD=-4.72,95%CI(-7.91～-1.53),P<0.01]和去人格化方面[MD=-3.65,95%CI(-5.21～-2.08),P<0.01]较对照组变化更明显,差异均有统计学意义(均P<0.01),而干预4周的效果却不显著;个人成就感的变化差异却在干预4周时显示有统计学意义[MD=8.11,95%CI(5.82～10.41),P<0.01],干预8周后2组的差异不明显。此外,在减轻护士压力方面,正念减压疗法同样产生积极的影响(P<0.05)。结论现有证据表明,正念减压疗法(MBSR)是预防及管理护士压力及职业倦怠的有效策略,干预效果比较稳定。

[Objective]To systematically evaluate the effectiveness of mindfulness-based stress reduction(MBSR)on nurses’stress and job burnout.[Methods]A systematic literature search was carried out in PubMed,Cochrane Library,EMbase,Medline,Web of Science,CBM,CNKI,Wan Fang Database and VIP Database,to retrieve the RCTs of MBSR on nurses’stress and job burnout from the inception to June 2018.Two researchers independently screened literature,extracted data and evaluated the quality according to inclusion and exclusion criteria,and the data were analyzed by RevMan 5.3.[Results]Finally,ten articles were included,five articles were included in qualitative analysis,and other five articles were surveyed by the meta analysis,including260 subjects.The results of meta analysis showed that MBSR significantly improved nurses’job burnout as compared with control group.The results of subgroup analysis showed that there were differences in the changes of emotional exhaustion,personalization and personal accomplishment between intervention group and control group after eight weeks and four weeks of intervention.After eight weeks of intervention,the improvement of emotional exhaustion[MD=-4.72,95%CI(-7.91--1.53),P<0.01]and personification[MD=-3.65,95%CI(-5.21--2.08),P<0.01]in MBSR group were better than those in control group and the differences were statistically significant,while the effect of the intervention was not significant after four weeks of intervention.The difference in personal accomplishment[MD=8.11,95%CI(5.82-10.41),P<0.01]was statistically significant after four weeks of intervention while there was no significant difference at intervention for eight weeks.Moreover,MBSR had a positive impact on nurse’stress(P<0.05).[Conclusion]The existing evidence shows that MBSR is an effective strategy to prevent and manage nurses’stress and job burnout and have stable short-term effects.