mHealth Gratitude Exercise Mindfulness App for Resiliency Among Neonatal Intensive Care Unit Staff: Three-Arm Pretest-Posttest Interventional Study

Abstract

Background: Health care is highly complex and can be both emotionally and physically challenging. This can lead health care workers to develop compassion fatigue and burnout (BO), which can negatively affect their well-being and patient care. Higher levels of resilience can potentially prevent compassion fatigue and BO. Strategies that enhance resilience include gratitude, exercise, and mindfulness.

Objective: The purpose of this study was to determine if a 3-week daily resiliency practice, prompted via a gratitude, exercise, and mindfulness smartphone app, impacted the professional quality of life, physical activity, and happiness level of health care workers in a newborn intensive care unit setting.

Methods: In total, 65 participants from a level III newborn intensive care unit at a regional hospital in the western United States completed this study. The Professional Quality of Life Scale, Physical Activity Vital Sign, and Subjective Happiness Score instruments were used to evaluate the effects of the mobile health (mHealth) intervention. Further, 2-tailed dependent paired t tests were used to evaluate participant pre- and postintervention instrument scores. Multiple imputation was used to predict scores of participants who practiced an intervention but did not complete the 3 instruments post intervention.

Results: Dependent t tests using the original data showed that participants, as a whole, significantly improved in BO (t₃₅=2.30, P=.03), secondary trauma stress (STS; t₃₅=2.11, P=.04), and happiness (t₃₅=-3.72, P<.001) scores. Compassion satisfaction (CS; t₃₅=-1.94, P=.06) and exercise (t₃₅=-1.71, P=.10) were trending toward, but did not reach, significance. Using the original data, only the gratitude intervention group experienced significant improvements (CS, BO, and happiness), likely due to the higher number of participants in this group. Analysis using imputed data showed that participants, as a whole, had significant improvements in all areas: CS (t₆₄=-4.08, P<.001), BO (t₆₄=3.39, P=.001), STS (t₆₄=4.08, P<.001), exercise (t₆₄=-3.19, P=.002), and happiness (t₆₄=-3.99, P<.001). Looking at the intervention groups separately using imputed data, the gratitude group had significant improvements in CS, BO, STS, and happiness; the exercise group had significant improvements in STS and exercise; and the mindfulness group had significant improvements in CS and happiness.

Conclusions: Phone app delivery of resilience-enhancing interventions is a potentially effective intervention model for health care workers. Potential barriers to mHealth strategies are the technical issues that can occur with this type of intervention. Additional longitudinal and experimental studies with larger sample sizes need to be completed to better evaluate this modality.

Keywords: ICU; NICU; QoL; app; applications; apps; burnout; compassion; compassion fatigue; compassion satisfaction; exercise; gratitude; happiness; health care worker; health care workers; intensive care; intensive care unit; mHealth; meditation; mindfulness; mobile health; mobile phone; neonatal intensive care unit; nurse; nurses; nursing; phone app; physical activity; provider; providers; quality of life; resilience; resiliency; satisfaction; secondary trauma; trauma.