Virtual Mindfulness and Breathing Training for Stress, Burnout, Sleep, and Cognition in Rotating-Shift Nurses

This scale assesses how unpredictable, uncontrollable, and overloaded individuals perceive their lives to be. It contains two subscales: perceived helplessness and perceived self-efficacy. Each item is rated on a 5-point Likert scale from 0 (never) to 4 (very often). The scale has demonstrated high internal consistency (Cronbach's α = 0.85) and good test-retest reliability (r = 0.66, p < 0.001) over three months in Chinese-speaking nursing samples.

This measure uses the "Perception of Stress" subscale from the Taiwan version of the Safety Attitudes Questionnaire (SAQ), which includes four items that assess healthcare professionals' awareness of stress and its effects on performance. One item is reverse-coded. Items are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Subscale scores are transformed to a 0-100 scale using the formula: Transformed score = (mean score - 1) × 25. Higher scores indicate greater perceived stress. This transformation supports standardization and enables comparison across domains.

This scale was developed for clinical nurses and evaluates emotional exhaustion, reduced personal accomplishment, and depersonalization. It includes 12 items across three subscales, with four items per subscale. Each item is rated on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The total scale has demonstrated high internal consistency (Cronbach's α = 0.92) and acceptable subscale reliability (Cronbach's α = 0.64-0.86), indicating good psychometric properties for use among nursing professionals.

A composite sleep quality score derived from multiple actigraphy-based parameters including total sleep time, sleep efficiency, number of awakenings, and sleep onset latency. Each parameter will be normalized and weighted based on validated sleep scoring algorithms (e.g., Sadeh algorithm), and then aggregated into a composite index to represent overall sleep quality. Higher scores indicate better sleep.

This outcome measure uses the Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-TC) to evaluate participants' sleep quality. The PSQI-TC includes 19 items across seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each item is scored from 0 to 3, and total scores range from 0 to 21, with higher scores indicating poorer sleep quality. The scale has demonstrated strong internal consistency, with Cronbach's α ranging from 0.83 to 0.85, and is culturally adapted for use among shift-working nurses in Taiwan.

This test evaluates visual orientation performance and spatial scanning ability under time pressure. The outcome will include accuracy rate and average reaction time (in milliseconds).

This test assesses reactive stress tolerance and decision-making performance under time constraints. The outcome measures include number of errors and average reaction time (in milliseconds).

This test measures sustained attention and the ability to distinguish relevant signals from distractors. Key outcome variables include hit rate, false alarm rate, and attentional stability.

Heart rate variability (HRV) will be measured non-invasively using the Blood Volume Pulse (BVP) sensor of the Thought Technology system (ProComp Infiniti hardware and BioGraph Infiniti software). HRV data will be collected using photoplethysmography (PPG), and derived from inter-beat intervals (IBI). Analysis will include both time-domain indices (e.g., SDNN, RMSSD) and frequency-domain indices (e.g., LF, HF, LF/HF ratio). The assessment will be conducted in accordance with international standards for HRV evaluation and will reflect both sympathetic and parasympathetic autonomic activity. Participants will undergo HRV assessment at Weeks 0 (baseline), 4, 8, and 12 as part of their stress and recovery evaluation.

This outcome will include measurements of systolic and diastolic blood pressure using the Omron HEM-907XL, a validated automatic digital sphygmomanometer. Blood pressure will be recorded using the three-reading average method while participants are in a seated resting position. Data will be used for subsequent analysis of cardiovascular responses to intervention.