The COVID-19 pandemic enters its third year, and China is currently in the stage of normalized epidemic prevention. The psychological state of the public has been eased with the effective prevention and control of the epidemic, while there are still some sporadic outbreaks that would cause more serious psychological problems(Li et al., 2022). Faced with the re-emergence of the epidemic, stressful working environments, and extra epidemic prevention work, medical staff still suffer from physical fatigue and psychological burden(Q. Wu et al., 2022).
As the largest workforce within healthcare systems, nurses are essential in the fight against the COVID-19 epidemic(Fernandez et al., 2020). In the face of the challenges such as overwhelming workload, extreme stress, and severe lack of sleep quality, feelings of fatigue have been common among the nurse (Labrague, 2021; Y. Liu et al., 2022; Sagherian et al., 2022; Sikaras et al., 2021). Fatigue is described as the subjective sensation of being tired or lacking energy, including both physical and mental fatigue. Previous studies have shown that the prevalence of moderate-to-high fatigue levels ranged from 35.06–72.2% during the COVID-19 pandemic(Labrague, 2021; Zhan et al., 2020). Nurses’ fatigue could cause various physical symptoms and negative emotions, further affecting their health and work performance(Wang et al., 2022). Thus, it is critical to relieve nurses’ fatigue to improve healthcare quality.
Mindfulness was defined as “the awareness that arises from paying attention on purpose, in the present moment, non-judgmentally”(Kabat-Zinn & Hanh, 2009). Not only described as a construct that can be induced via practice but mindfulness has also been conceptualized as a state or as a trait, playing a significant role in fatigue(Bodhi, 2013; Heshmati & Caltabiano, 2020; Pagnini et al., 2019; Whitaker et al., 2019). A plethora of previous research has shown that mindfulness-based interventions (MBIs) could promote psychological health, and alleviate suffering from fatigue(Cao et al., 2022; Ngo, Revue des effets de la meditation de pleine conscience sur la sante mentale et physique et sur ses mecanismes d'action./2013). Mindfulness has been considered a protective factor against the unprecedented psychological impact caused by the COVID-19 pandemic(Dailey et al., 2022). A person's psychological state was shown to be less negatively impacted by COVID-19 when they had higher levels of dispositional mindfulness(Wen et al., 2022). Additionally, the previous study has revealed the association between mindfulness and nurses’ quality of professional life during the outbreak of COVID-19(Zakeri et al., 2022). However, there are few studies examining whether mindfulness (dispositional mindfulness) could be a protective factor against fatigue among nurses during the COVID-19 pandemic. Therefore, we hypothesized that nurses with higher levels of mindfulness (dispositional mindfulness) are less likely to suffer fatigue.
Furthermore, the previous study has found a connection between sleep and fatigue in nurses, indicating that poor sleep quality was a contributing factor to fatigue(Çelik et al., 2017; Kryssie Kunert & Services, 2007). During the post-epidemic of the anti-COVID-19 era, clinical nurses demonstrated worse sleep, which would cause various adverse outcomes, including higher mental workload, and more fatigue(Y. Liu et al., 2022; Sagherian et al., 2022). According to the current study, the overall prevalence of sleep disturbances was 44.0% during the pandemic(Marvaldi et al., 2021). There has also been a positive correlation reported between mindfulness and the sleep quality of nurses, and the nurses in the COVID-19 care units could benefit from the implementation of the mindfulness-based stress reduction program in enhancing their sleep(Fang et al., 2019; Nourian et al., 2021). In summary, we speculated that sleep quality may be a possible pathway for mindfulness to impact the fatigue of nurses during the COVID-19 pandemic.
The main objective of the current research was to investigate the association between mindfulness and fatigue among nurses during COVID-19, with sleep quality serving as a mediator. The results might help develop better intervention programs to relieve fatigue and improve the sleeping habits of nurses. Two hypotheses were proposed: (1) Mindfulness would have a significant direct effect on fatigue. (2) Sleep quality would play a mediating effect between mindfulness and fatigue.