***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this project is to develop and evaluate a psycho-educational program that assists nurses to develop stress management plans . Discussion of nursing-specific risk factors , practice with relaxation techniques , and exploration via art are used as interventions . Quantitative and qualitative measures of stress and burnout are conducted pre- and postcourse using the  Maslach Burnout Inventory , Draw-a-Person-in-the-Rain Art Assessment , and wellness plans .  Descriptive statistics are used , and preliminary analysis indicates that the course is useful in impacting levels of emotional exhaustion . There are opportunities for evolving the program so that more enduring change in self-care is generated Highly stressed employees are subject to greater health risks , increased cost , and productivity losses than those with normal stress levels . To address this issue in an evidence -based manner , worksite stress management programs must be able to engage individuals as well as capture data on stress , health indices , work productivity , and health care costs . In this r and omized controlled pilot , our primary objective was to evaluate the viability and proof of concept for two mind-body workplace stress reduction programs ( one therapeutic yoga-based and the other mindfulness-based ) , in order to set the stage for larger cost-effectiveness trials . A second objective was to evaluate 2 delivery venues of the mindfulness-based intervention ( online vs. in-person ) . Intention-to-treat principles and 2 ( pre and post ) × 3 ( group ) repeated- measures analysis of covariance procedures examined group differences over time on perceived stress and secondary measures to clarify which variables to include in future studies : sleep quality , mood , pain levels , work productivity , mindfulness , blood pressure , breathing rate , and heart rate variability ( a measure of autonomic balance ) . Two hundred and thirty-nine employee volunteers were r and omized into a therapeutic yoga worksite stress reduction program , 1 of 2 mindfulness-based programs , or a control group that participated only in assessment . Compared with the control group , the mind-body interventions showed significantly greater improvements on perceived stress , sleep quality , and the heart rhythm coherence ratio of heart rate variability . The two delivery venues for the mindfulness program produced basically equivalent results . Both the mindfulness-based and therapeutic yoga programs may provide viable and effective interventions to target high stress levels , sleep quality , and autonomic balance in employees Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Part III of the study on mindfulness-based stress reduction ( MBSR ) describes qualitative data and discusses the implication s of the findings . Study analysis revealed that nurses found MBSR helpful . Greater relaxation and self-care and improvement in work and family relationships were among reported benefits . Challenges included restlessness , physical pain , and dealing with difficult emotions Mindfulness-based stress reduction ( MBSR ) has produced behavioral , psychological , and physiological benefits , but these programs typically require a substantial time commitment from the participants . This study assessed the effects of a shortened ( low-dose [ ld ] ) work-site MBSR intervention ( MBSR-ld ) on indicators of stress in healthy working adults to determine if results similar to those obtained in traditional MBSR could be demonstrated . Participants were r and omized into  MBSR-ld  and wait-list control groups . Self-reported perceived stress , sleep quality , and mindfulness were measured at the beginning and end of the 6-week intervention . Salivary cortisol was assessed weekly . Significant reductions in perceived stress ( p = .0025 ) and increases in mindfulness ( p = .0149 ) were obtained for only the MBSR-ld group ( n = 22 ) . Scores on the global measure of sleep improved for the MBSR-ld group ( p = .0018 ) as well as for the control group ( p = .0072 ; n = 20 ) . Implication s and future research are discussed This article is the second in a series reporting on research exploring the effects of Mindfulness-based Stress Reduction  on nurses and describes the quantitative data . The third article describes qualitative data . Treatment  group participants reduced scores on 2 of 3 subscales of the Maslach Burnout Inventory significantly more than wait-list controls ; within-group comparisons for both groups pretreatment and posttreatment revealed similar findings . Changes were maintained as long as 3-month posttreatment . Implication s of these findings are discussed OBJECTIVE To assess the effect of a meditation training program , Mindfulness-Based Stress Reduction ( MBSR ) , on depressive symptoms , psychological status , and disease activity in patients with rheumatoid arthritis ( RA ) through a r and omized , waitlist-controlled pilot study . METHODS Participants were r and omized to either an MBSR group , where they attended an 8-week course and 4-month maintenance program , or to a waitlist control group , where they attended all assessment visits and received MBSR free of charge after study end . Participants received usual care from their rheumatologists throughout the trial . Self-report question naires were used to evaluate depressive symptoms , psychological distress , well-being , and mindfulness . Evaluation of RA disease activity ( by Disease Activity Score in 28 joints ) included examination by a physician masked to treatment status . Adjusted means and mean changes in outcomes were estimated in mixed model repeated measures analyses . RESULTS Sixty-three participants were r and omized : 31 to MBSR and 32 to control . At 2 months , there were no statistically significant differences between groups in any outcomes . At 6 months , there was significant improvement in psychological distress and well-being ( P = 0.04 and P = 0.03 , respectively ) , and marginally significant improvement in depressive symptoms and mindfulness ( P = 0.08 and P = 0.09 , respectively ) . There was a 35 % reduction in psychological distress among those treated . The intervention had no impact on RA disease activity . CONCLUSION An 8-week MBSR class was not associated with change in depressive symptoms or other outcomes at 2-month followup . Significant improvements in psychological distress and well-being were observed following MBSR plus a 4-month program of continued reinforcement . Mindfulness meditation may complement medical disease management by improving psychological distress and strengthening well-being in patients with RA This study sought to develop a stress management program based on the arousal-attribution stress model and to evaluate the effectiveness of the program in reducing anxiety and depression experienced by nursing students . Forty-two sophomore and 34 senior nursing students in a private , sectarian , liberal arts college were r and omly assigned to experimental and control groups . All subjects were given pre- and posttests consisting of the State form of the State-Trait Anxiety Inventory and the Institute for Personality and Ability Testing Depression Scale . Posttest analysis indicated that the experimental group had significantly lower anxiety and depression than the control group ( p less than .05 ) . These results support the use of the arousal-attribution stress model as a theoretical framework for stress management training This study examined the effectiveness of a stress coping program based on mindfulness meditation on the stress , anxiety , and depression experienced by nursing students in Korea . A nonequivalent , control group , pre-posttest design was used . A convenience sample of 41 nursing students were r and omly assigned to experimental ( n=21 ) and control groups ( n=20 ) . Stress was measured with the PWI-SF ( 5-point ) developed by Chang . Anxiety was measured with Spieberger 's state anxiety inventory . Depression was measured with the Beck depression inventory . The experimental group attended 90-min sessions for eight weeks . No intervention was administered to the control group . Nine participants were excluded from the analysis because they did not complete the study due to personal circumstances , result ing in 16 participants in each group for the final analysis . Results for the two groups showed ( 1 ) a significant difference in stress scores ( F=6.145 , p=0.020 ) , ( 2 ) a significant difference in anxiety scores ( F=6.985 , p=0.013 ) , and ( 3 ) no significant difference in depression scores ( t=1.986 , p=0.056 ) . A stress coping program based on mindfulness meditation was an effective intervention for nursing students to decrease their stress and anxiety , and could be used to manage stress in student nurses . In the future , long-term studies should be pursued to st and ardize and detail the program , with particular emphasis on studies to confirm the effects of the program in patients with diseases , such as cancer Mindfulness describes a state of consciousness in which individuals attend to ongoing events and experiences in a receptive and non-judgmental way . The present research investigated the idea that mindfulness reduces  emotional exhaustion  and improves job satisfaction . The authors further suggest that these associations are mediated by the emotion regulation strategy of surface acting . Study 1 was a 5-day diary study with 219 employees and revealed that mindfulness negatively related to emotional exhaustion and positively related to job satisfaction at both the within- and the between-person levels . Both relationships were mediated by surface acting at both levels of analysis . Study 2 was an experimental field study , in which participants ( N = 64 ) were r and omly assigned to a self-training mindfulness intervention group or a control group .  Results revealed that participants in the mindfulness intervention group experienced significantly less emotional exhaustion and more job satisfaction than participants in the control group . The causal effect of mindfulness self-training on emotional exhaustion was mediated by surface acting . Implication s for using mindfulness and mindfulness training interventions in organizational research and practice are discussed in conclusion This study implemented an innovative new model of delivering a Mindfulness-Based Stress Reduction ( MBSR ) program that replaces six of the eight traditional in-person sessions with group telephonic sessions ( tMBSR ) and measured the program 's impact on the health and well-being of nurses employed within a large health care organization . As part of a nonr and omized pre – post intervention study , 36 nurses completed measures of health , stress , burnout , self-compassion , serenity , and empathy at three points in time . Between baseline ( Time 1 ) and the end of the 8-week tMBSR intervention ( Time 2 ) , participants showed improvement in general health , t(37 ) = 2.8 , p < .01 , decreased stress , t(37 ) = 6.8 , p < .001 , decreased work burnout , t(37 ) = 4.0 , p < .001 , and improvement in several other areas . Improvements were sustained 4 months later ( Time 3 ) , and individuals who continued their MBSR practice after the program demonstrated better outcomes than those that did not . Findings suggest that the tMBSR program can be a low cost , feasible , and scalable intervention that shows positive impact on health and well-being , and could allow MBSR to be delivered to employees who are otherwise unable to access traditional , on-site programs This qualitative study assesses the experience of an intervention that provided spiritually based self-management tools  to hospital-based nurses . Drawing on wisdom traditions of the major world religions , the eight point program can be practice d by adherents to any religious faith , or those outside of all traditions . Five of eight program points were perceived as directly useful in improving the nurses ’ workplace interactions and enhancing fulfillment of compassionate caregiving missions . The findings suggest that this program can be an effective intervention among nurses in dealing with the dem and s of the healthcare environment and may be a re source for continuing education curricula Background . Nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance . Method . A biofeedback‐assisted relaxation training program was created to reduce test anxiety . Anxiety was measured using Spielberger 's Test Anxiety Inventory and monitoring peripheral skin temperature , pulse , and respiration rates during the training . Participants were introduced to diaphragmatic breathing , progressive muscle relaxation , and autogenic training . Results . Statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session ; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session ; respiratory and pulse rates , and peripheral skin temperatures during the autogenic sessions . No statistically significant difference was noted between the first and second TAI . Subjective test anxiety scores of the students did not decrease by the end of training . Conclusion . Autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature AIM This paper reports a study to determine the effectiveness of autogenic training in reducing anxiety in nursing students . BACKGROUND Nursing is stressful , and nursing students also have the additional pressures and uncertainties shared with all academic students . Autogenic training is a relaxation technique consisting of six mental exercises and is aim ed at relieving tension , anger and stress . Meta- analysis has found large effect sizes for autogenic trainings intervention comparisons , medium effect sizes against control groups , and no effects when compared with other psychological therapies . A controlled trial with 50 nursing students found that the number of certified days off sick was reduced by autogenic training compared with no treatment , and a second trial with only 18 students reported greater improvement in Trait Anxiety , but not State Anxiety , compared with untreated controls . METHODS A r and omized controlled trial with three parallel arms was completed in 1998 with 93 nursing students aged 19 - 49 years . The setting was a university college in the United Kingdom . The treatment group received eight weekly sessions of autogenic training , the attention control group received eight weekly sessions of laughter therapy , and the time control group received no intervention . The outcome measures were the State-Trait Anxiety Inventory , the Maslach Burnout Inventory , blood pressure and pulse rate completed at baseline , 2 months ( end of treatment ) 
    Output:
    
Meta- analysis suggests that mindfulness-based interventions may be effective in significantly reducing state anxiety and depression at posttreatment and state anxiety and trait anxiety at follow-up .
Qualitative studies and uncontrolled studies shed light on benefits overlooked in RCTs , including improvements in the well-being of individuals ( e.g. inner state of calmness , awareness and enthusiasm ) and improved performance at work ( better communication with colleagues and patients , higher sensitivity to patients ' experiences , clearer analysis of complex situations and emotional regulation in stressful context s ) .
Mindfulness appeared to improve nurses ' mental health significantly .
It could be used in worksite health promotion programmes .
Only a few studies have explored the impact of mindfulness on nurses ' professional behaviours and their relationships with patients and colleagues .