1College of Nursing, University of Mosul, City of Mosul, 41002 Mosul, Iraq
2College of Nursing, Ninevah University, City of Mosul, 41002, Iraq
*Corresponding Author’s Email: Prof.dr.radhwan@uomosul.edu.iq
Keywords: Burnout Mitigation; Cross-sectional Study; Emotional Regulation; Healthcare; Mindfulness; Nursing Leadership; Job Satisfaction
Set against the unique backdrop of Iraq's healthcare landscape, nurses in this context play a crucial role in delivering care and navigating challenges that blend the historical narrative with contemporary healthcare complexities. Exploring nursing dynamics in Iraq uncovers dedication, adaptability, and an unwavering commitment to citizens' well-being (Attia & Ibrahim, 2023; Hamarash et al., 2023; Sulaiman et al., 2023). This study, therefore, holds relevance in this context.
It aims to shed light on the relationship between mindfulness and nursing leadership outcomes, potentially offering insights for enhancing leadership practices in this setting.
Within the dynamic tapestry of healthcare, nursing leaders are the linchpin, orchestrating the symphony of care that resonates with optimal patient outcomes (Mallow, 2023; Ramachandran et al., 2023; Si et al., 2023). The multifaceted nature of their roles demandsa profound understanding of the challenges they face and the factors influencing their success or potential burnout (Chen et al., 2023; Egami & Highfield, 2023; Wang, Kou, & Han, 2023). Mindfulness, an ancient practice rooted in contemplative traditions, has emerged as a encouragement of potential within healthcare leadership (Villacarlos & Daño, 2020; Bennett & Boose, 2023). As nursing leaders grapple with evolving demands, a pressing need arises to investigate how mindfulness intertwines with leadership behaviours, job satisfaction, and burnout (de Oliveira Santana et al., 2024; Shurab et al., 2024).
This study aims to explore the connections between mindfulness and nursing leadership outcomes. It suggests that comprehending the level of mindfulness among nursing leaders is crucial for understanding their leadership behaviours, job satisfaction, and the prevalent issue of burnout. This research intends to evaluate the level of mindfulness among nursing leaders methodically, analyse its correlation with leadership behaviours, and investigate its potential impact on job satisfaction and the reduction of burnout.
The research employed a cross-sectional study design, simultaneously facilitating data collection from the nursing leaders. This design was optimal for examining the relationship between mindfulness and various outcomes in a dynamic healthcare setting.
The research was conducted in the Mosul Teaching Hospitals, providing a pertinent backdrop within the healthcare landscape for exploring mindfulness among nursing leaders. This setting was chosen for its diverse nursing leadership roles and significance in the regional healthcare system.
The study's sample consisted of 250 nursing leaders from various roles within the Mosul Teaching Hospitals; this diverse sample aimed to capture a comprehensive understanding of mindfulness across different leadership positions.
The study utilised three validated instruments to measure different aspectsof mindfulness, emotion regulation, and the quality of nursing work life:
Five-Facet Mindfulness Questionnaire (FFMQ): In 2006, Baer et al. developed the FFMQ, a self-report tool aimed at assessing mindfulness through five specific aspects: observing, describing, acting with awareness, non-judging of inner experience, and non- reactivity to inner experience. Participants used a Likert scale from 1 to 5 to rate each statement. Trained researchers conducted the FFMQ, ensuring confidentiality to encourage honest and precise self-reporting (Nguyen, Nguyen, & Bui, 2022).
The study received the Ethical Permission from the Ninevah Institutional Review Board (IRB), Iraq with the reference number CCMRE-NUR-23-7 on 11thAugust, 2023.
Data collected from the study were subjected to statistical analysis using IBM SPSS Statistics version 26. Descriptive statistics were employed to summarise the characteristics of the sample. In contrast, inferential statistics such as correlation analysis, regression analysis, and other relevant tests were utilised to explore the relationships between mindfulness, emotion regulation, and the quality of nursing work life among nursing leaders.
Table 1 presents the distribution of personal characteristics among the studied participants, who consisted of 250 head nurses. Most participants (59.2%) fell within the age range of 30-35 years. A significant portion (29.6%) belonged to the 36–40 age group, while 11.2% were below 40. The mean age was 35.6, with a standard deviation of 2.78. Male head nurses were predominant, constituting 74.8% of the participants, whereas females comprised 25.2%. Head nurses demonstrated varied years of experience, with 51.2% having 1–10 years, 34.4% having 11–20 years, and 14.4% having more than 20 years of experience. Most participants (75.6%) were affiliated with critical care departments, while 24.4% worked in general care departments.
Table 1: Distribution of Personal Characteristics According to the Studied Participants - Head Nurses (N=250)
Characteristics | N | Percentage (%) |
Age | ||
30-35 years | 148 | 59.2 |
36-40 years | 74 | 29.6 |
<40 years | 28 | 11.2 |
Mean + SD | 35.6 + 2.78 | |
Gender | ||
Male | 187 | 74.8 |
Female | 63 | 25.2 |
Years of Experience | ||
1-10 years | 128 | 51.2 |
11-20 years | 86 | 34.4 |
<21 years | 36 | 14.4 |
Department | ||
Critical | 189 | 75.6 |
General | 61 | 24.4 |
Table 2 illustrates the percentage distribution of head nurses regarding mindfulness and its dimensions. A significant proportion of head nurses reported "low" levels in observing (52.80%), describing (44.80%), acting with awareness (48.00%), nonjudging (52.80%), and nonreactivity (44.80%). Moderate levels were observed in describing (46.40%), acting with awareness (40.8%), nonjudging (34.40%), and nonreactivity (46.40%). "High" levels were reported by a smaller percentage in observing (12.80%), describing (8.80%), acting with awareness (11.20%), nonjudging (12.80%), and nonreactivity (8.80%).
Table 2: Percentage Distribution of Head Nurses about Mindfulness and its Dimensions (N=250)
Mindfulness Dimensions | Observe | Describe | Act with Awareness | Nonjudge | Nonreactive | Total Mindfulness |
Low | 52.80% | 44.80% | 48.00% | 52.80% | 44.80% | 48.00% |
Moderate | 34.40% | 46.40% | 40.80% | 34.40% | 46.40% | 40.80% |
High | 12.80% | 8.80% | 11.20% | 12.80% | 8.80% |
Table 3 displays the distribution of head nurses regarding emotional regulation and its dimensions. Emotional regulation was predominantly reported at "Moderate" levels, with 59.20% using reappraisal and 44.20% using suppression. "Low" levels were reported by 32.40% for reappraisal and 39.60% for suppression, while "High" levels were reported by 8.40% for reappraisal and 16.20% for suppression.
Table 3: Distribution of Head Nurses Regarding Emotional Regulation and its Dimensions (N=250)
Emotional Regulation | Reappraisal | Suppression | Total Emotional Regulation |
Low | 32.40% | 39.60% | 40.80% |
Moderate | 59.20% | 44.20% | 46.40% |
High | 8.40% | 16.20% | 12.80% |
The data in Table 4 suggests that a majority of head nurses perceive the quality of their work life across all dimensions (work context, work world, work-life, and work design) as low. The highest dissatisfaction is noted in the work context, with the lowest in work design. This indicates a need for targeted interventions to improve the work environment, organizational culture, and work-life balance to enhance the overall quality of work life for head nurses.
Table 4: Distribution of Head Nurses Regarding the Quality of Work Life and its Dimensions (N=250)
Quality of Work Life | Work Context | Work World | Work-Life | Work Design |
Low | 65.25% | 59.50% | 58.40% | 52.60% |
Moderate | 29.20% | 27.40% | 22.70% | 19.20% |
High | 5.55% | 13.01% | 18.09% | 28.02% |
Table 5 presents the correlation matrix, revealing relationships between mindfulness, emotional regulation, and quality of work life. Significant positive correlations were found between mindfulness and emotional regulation (r = 0.594, p < 0.01), mindfulness and quality of work life (r = 0.524, p < 0.01), and emotional regulation and quality of work life (r = 0.477, p < 0.01).
Table 5: Correlation Matrix of Mindfulness, Emotional Regulation, and Quality of Work-Life
Variable | Mindfulness | Emotional Regulation | Quality of Work-Life |
Mindfulness | 1 | 0.594 | 0.524* |
Emotional Regulation | 0.594 | 1 | 0.477* |
Quality of Work-Life | 0.524* | 0.477* | 1 |
The results of this study provide insight into the varying levels of mindfulness among head nurses, revealing detailed patterns in how they engage with mindfulness practices. It is worth noting that half of the head nurses showed lower levels of mindfulness, pointing to areas where interventions and support may be needed. Meanwhile, a smaller but notable proportion demonstrated high levels of mindfulness, indicating a subgroup of head nurses who have fully embraced mindfulness practices.
These findings involve recognising the dual nature of the observed mindfulness patterns among head nurses—identifying areas for improvement and acknowledging exemplary practices. This perspective sets the stage for future research inquiries, targeted interventions, and potential shifts in organisational strategies to foster mindfulness and well-being within nursing leadership.
Among head nurses with lower mindfulness ratings, the dimensions of "observe," "no judge," "non-react," "act with awareness," and "describe" presented varying degrees of engagement. The prevalence of lower ratings in these dimensions’ highlights specific areas where targeted interventions may prove beneficial. For instance, efforts could be directed towards enhancing observational skills, reducing judgmental attitudes, fostering non-reactivity, promoting awareness of actions, and encouraging the verbal articulation of internal experiences. By addressing these dimensions, organisations can contribute to developing a more mindful leadership culture among head nurses.
Conversely, the subgroup of head nurses with high mindfulness ratings illuminates exemplary practices that can serve as a source of inspiration for the broader nursing leadership community. Noteworthy is their elevated engagement in dimensions such as "observe," "no judge," "act with awareness," "non-react," and "describe." Understanding the factors contributing to their heightened mindfulness can inform leadership development initiatives and inspire best practices within healthcare organizations. These leaders may serve as mentors or facilitators in mindfulness training programs, fostering a culture of shared learning and growth.
The current investigation revealed a noteworthy association between age and the mindfulness dimension labelled "description." This discovery aligns with findings from a study conducted in the USA (Okafor et al., 2023). However, another study in the USA reported no significant correlation between age and mindfulness (Shemesh et al., 2023). These disparities could be attributed to variations in personality traits, social dynamics, and educational norms across different societies (Mawardi, 2023; Munif, Poeranto, & Utami, 2019). In the present study, the average mindfulness score was higher among women than men, aligning with similar findings in a study conducted in Iran. Conversely, in contrast to this outcome, a study in the USA indicated that mindfulness levels were higher in men than women (Creswell et al., 2007). These disparities may be attributed to variations in individual characteristics, cultural and social contexts (Vonderlin et al., 2020), religious conflicts, and inclinations within diverse societies (Walker, 2020). It is noteworthy that such variables can potentially influence individuals' mental well-being, subsequently impacting their levels of mindfulness. Consequently, future research endeavours in this domain should be meticulously designed to delve deeper into these factors and their intricate interplay (Lee & Par, 2024; Liu, Lee, & Wu, 2024).
The implications of these findings extend beyond individual mindfulness ratings, touching upon broader aspects of leadership development and well-being within nursing contexts. Identifying specific dimensions where head nurses may benefit from targeted support can inform the design of tailored training programs. Integrating mindfulness practices into leadership development initiatives may enhance emotional regulation, decision-making, and overall job satisfaction. Moreover, addressing mindfulness at the organisational level can create a workplace culture that priorities well-being and resilience among nursing leaders.
It is essential to note the limitations of this study, including its cross-sectional design and reliance on self-report measures. Future research should consider using longitudinal approaches and including objective measures of mindfulness to gain a more complete understanding. Additionally, examining contextual factors that influence mindfulness, such as organisational support and individual stressors, would help provide a more detailed interpretation of the findings.
The study provides important insights into the varying levels of mindfulness among head nurses. By identifying patterns in mindfulness dimensions and pinpointing areas that require focused interventions, healthcare organizations can improve leadership development programs and create a work environment that emphasizes mindfulness and well-being. Ultimately, promoting mindfulness among nursing leaders can positively impact both individual leaders and the overall organizational culture, leading to improved patient care quality.
This study lays the groundwork for further research in several key areas. Future studies could explore the longitudinal effects of mindfulness training on leadership effectiveness and patient outcomes. Expanding the research to include different regions and healthcare settings could provide a more comprehensive understanding of mindfulness among nursing leaders. Investigating the impact of specific mindfulness interventions, such as mindfulness-based stress reduction (MBSR) or mindfulness-based cognitive therapy (MBCT), on nurse leaders' performance and well-being could offer valuable insights. Moreover, integrating mindfulness training into nursing education curricula and evaluating its long-term benefits on nursing practice and leadership could help build a more mindful and resilient healthcare workforce.
The authors declare that they have no competing interests.
The authors express gratitude to the Deanship of the Nursing College for their support and cooperation throughout the research process. Their assistance in facilitating data collection and providing necessary resources is deeply appreciated. Appreciation is also extended to the nursing leaders who willingly participated in the study, as their cooperation was essential for its completion. The authors are also thankful to the Ethical Committee for approving thestudy, whose careful evaluation and guidance ensured that the research was conducted in compliance with ethical principles and safeguarded the rights and well-being of the participants.
Attia, Y. K., & Ibrahim, R. H. (2023). Difficulties experienced in clinical learning settings for nurses in Iraq: Perspectives of nursing administrators and nursing instructors. Informatics in Medicine Unlocked, 38, 101229.https://doi.org/10.1016/j.imu.2023.101229
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27-45. https://doi.org/10.1177/1073191105283504
Bennett, N., & Boose, J. (2023). Improving burnout and stress among advanced practice nurses using mindfulness-based stress reduction techniques. Doctoral Projects, 218 https://aquila.usm.edu/dnp_capstone/218/
Chen, J. Q., Zhang, X. Q., Shen, J. H., Guo, Y. F., Lei, G. F., Tong, L., ... & Li, D. H. (2023). The Relationship Between Mindfulness, Fatigue, and Perceived Symptoms Among Frontline Nurses Who Performed Nucleic Acid Sample Collection During the COVID-19 in China: A Cross- Sectional Study. Psychology Research and Behavior Management, 1165- 1180.https://doi.org/10.2147/PRBM.S401764
Creswell, J. D., Way, B. M., Eisenberger, N. I., & Lieberman, M. D. (2007). Neural correlates of dispositional mindfulness during affect labeling. Psychosomatic Medicine, 69(6), 560-565. https://doi.org/10.1097/PSY.0b013e3180f6171f
de Oliveira Santana, K., Figueira Pereira, C., Silva Ramos, M., da Silva, R. R., de Vargas, D., de Fátima Fernandes, M. N., & da Silva Gherard-Donato, E. C. (2024). The effectiveness of mindfulness for the management of anxiety in the nursing staff: Systematic review and meta- analysis. Archives of Psychiatric Nursing, 50, 129-146https://doi.org/10.1016/j.apnu.2024.03.016
Egami, S., & Highfield, M. E. F. (2023). The effect of a mindfulness phone application on NICU nurses' professional quality of life. Advances in Neonatal Care, 23(3), E70-E78. https://doi.org/10.1097/ANC.0000000000001064
Hamarash, M. Q., Yaas, M. H., Almushhadany, O. I., & Ibrahim, R. H. (2023). Preceptoring of Graduate Nursing Students in Iraq. Advances in Medical Education and Practice, 1025- 1034.https://doi.org/10.2147/AMEP.S418824
Lee, M., & Park, H. (2024). Socio-cognitive mindfulness in nursing: A scoping review. PLoS One, 19(4), e0300459. https://doi.org/10.1371/journal.pone.0300459
Liu, Y. L., Lee, C. H., & Wu, L. M. (2024). A mindfulness-based intervention improves perceived stress and mindfulness in university nursing students: a quasi-experimental study. Scientific Reports, 14(1), 13220. https://doi.org/10.1038/s41598-024-64183-5
Mallow, M. R. (2023). Development and Evaluation of a Nurse Leader-Directed Mindfulness Application for School Nurses. Wilmington University (Delaware). United States.
Mawardi, F. (2023, May). The Effect of Islamic Spiritual Mindfulness on Students’ Mental Health at Pot Covid-19 Pandemic: A Case Study in Indonesia. In Proceedings of the International Conference on Health and Well-Being (ICHWB 2022) (Vol. 61, p. 211). Springer Nature. New York City. https://doi.org/10.2991/978-94-6463-184-5_20
Munif, B., Poeranto, S., & Utami, Y. W. (2019). Effects of Islamic Spiritual Mindfulness on Stress among Nursing Students. Nurse Media Journal of Nursing, 9(1), 69-77. https://doi.org/10.14710/nmjn.v9i1.22253
Nguyen, H. T., Nguyen, H. V., & Bui, T. T. (2022). The psychometric properties of the Vietnamese Version of the Five Facet Mindfulness Questionnaire. BMC Psychology, 10(1), 300. https://doi.org/10.1186/s40359-022-01003-3
Okafor, G. N., Ford, B. Q., Antonoplis, S., Reina, A. M., Lutfeali, S., & Shallcross, A. J. (2023). Measuring mindfulness in Black Americans: A psychometric validation of the five facet mindfulness questionnaire. Mindfulness, 14(3), 565-581. https://doi.org/10.1007/s12671-023-
Ramachandran, H. J., Bin Mahmud, M. S., Rajendran, P., Jiang, Y., Cheng, L., & Wang, W. (2023). Effectiveness of mindfulness‐based interventions on psychological well‐being, burnout and post‐traumatic stress disorder among nurses: A systematic review and meta‐analysis. Journal of Clinical Nursing, 32(11-12), 2323-2338. https://doi.org/10.1111/jocn.16265
Shemesh, L., Mendelsohn, A., Panitz, D. Y., & Berkovich-Ohana, A. (2023). Enhanced declarative memory in long-term mindfulness practitioners. Psychological Research, 87(1), 294- 307.https://doi.org/10.1007/s00426-022-01642-6
Shurab, W. M. E., Ibrahim, S. A. E., Abdelaalem, M. M., Gabal, S. A. A., & Abdelhady, T. R. M. (2024). Effect of authentic leadership and mindfulness educational program on nursing managers' competencies: a quasi-experimental study. BMC Nursing, 23(1), 342. https://doi.org/10.1186/s12912-024-01976-z
Si, X., Xue, H., Song, X., Liu, X., & Zhang, F. (2023). The relationship between ethical leadership and nurse well‐being: The mediating role of workplace mindfulness. Journal of Advanced Nursing, 79(10), 4008-4021.https://doi.org/10.1111/jan.15719
Sulaiman, M. H., Jasim, M. S., Abd Ahmed, A., Ahmed, A. A., Ibrahim, R. H., & Al-Mashhadany,O. I. (2023). A winning formula for nursing education: Effective study strategies and techniques.Teaching and Learning in Nursing, 18(4), e142-e145. https://doi.org/10.1016/j.teln.2023.05.001
Villacarlos, F. A., & Daño, J. C. (2020). Impetus of Clinical Nurse Managers: Countless Stories of Nurses. Malaysian Journal of Medical Research (MJMR), 4(1), 9-19. https://doi.org/10.31674/mjmr.2020.v04i01.002
Vonderlin, R., Biermann, M., Bohus, M., & Lyssenko, L. (2020). Mindfulness-based programs in the workplace: a meta-analysis of randomized controlled trials. Mindfulness, 11, 1579-1598. https://doi.org/10.1007/s12671-020-01328-3
Walker, A. R. (2020). “God is my doctor”: mindfulness meditation/prayer as a spiritual well-being coping strategy for Jamaican school principals to manage their work-related stress and anxiety. Journal of Educational Administration, 58(4), 467-480. https://doi.org/10.1108/JEA-06-2019- 0097
Wang, Y., Kou, J., & Han, B. (2023). Effect of online modified mindfulness‐based stress reduction training on the resilience of nursing interns in China. Nursing Open, 10(8), 5493-5499. https://doi.org/10.1002/nop2.1788