Abstract
The COVID-19 pandemic placed healthcare workers, particularly those in high-risk units such as fever clinics, under immense occupational stress. While mindfulness is recognized as a protective factor against burnout, its specific mechanisms among frontline nurses during a public health crisis warrant further investigation. This study aimed to assess the levels of job burnout, perceived stress, workplace stressors, and mindfulness among fever clinic nurses, and to examine the effects of mindfulness on these occupational challenges. A cross-sectional study was conducted. A total of 375 fever clinic nurses completed an online survey between July 1 and September 30, 2022. Data were collected using the Chinese versions of the Maslach Burnout Inventory (MBI), the Chinese version of the Perceived Stress Scale (CPSS), the Mindfulness Attention Awareness Scale (MAAS), and a custom Stress Source Scale. Pearson correlation analysis and structural equation modeling were employed for data analysis. Workload and time pressure were identified as the primary workplace stressors (2.36 ± 0.67). Pearson correlation analysis indicated that mindfulness was significantly negatively correlated with emotional exhaustion (r = −0.344, P < 0.01) and reduced personal accomplishment (r = −0.298, P < 0.01) dimensions of burnout, perceived stress (r = −0.264, P < 0.01), and the overall workplace stressors (r = −0.299, P < 0.01). The structural equation model verified that mindfulness had a significantly negative impact on job burnout, perceived stress, and workplace stressors (β = −0.375, −0.327, and −0.313, respectively; all P < 0.001). The findings confirm the protective role of mindfulness in alleviating burnout and stress among fever clinic nurses. An integrated “individual-organization” support model, combining mindfulness-based training with systematic workplace improvements, is recommended to safeguard the mental health of frontline nurses during ongoing public health challenges.
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All data relevant to the study are included in the article or uploaded as supplementary information. The datasets generated and/or analyzed during the current study are not publicly available due to participant privacy concerns, but are available from the corresponding author on reasonable request.
References
Aguayo R, Vargas C, Fuente EIDL, Lozano LM (2011) A meta-analytic reliability generalization study of the Maslach Burnout Inventory. Int J Clin Health Psychol 11(2):343–361
Ahmad F, Jhajj AK, Stewart DE, Burghardt M, Bierman AS (2014) Single item measures of self-rated mental health: a scoping review. BMC Health Serv Res 14: 398
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 8(16):1987–1993
Alharbi BAA, McKenna N (2025) A systematic review of mindfulness-based interventions to reduce ICU nurse burnout: global evidence and thematic synthesis. BMC Nurs 24(1):927
Bartlett L, Martin A, Neil AL, Memish K, Otahal P, Kilpatrick M, Sanderson K (2019) A systematic review and meta-analysis of workplace mindfulness training randomized controlled trials. J Occup Health Psychol 24(1):108–126
Bilgiç Ş, Çelikkalp Ü, Mısırlı C (2021) Stress level and sleep quality of nurses during the COVID-19 pandemic. Work Work 70(4):1021–1029
Bodini L, Bonetto C, Cheli S, Del Piccolo L, Rimondini M, Rossi A, Carta A, Porru S, Amaddeo F, Lasalvia A (2022) Effectiveness of a Mindful Compassion Care Program in reducing burnout and psychological distress amongst frontline hospital nurses during the COVID-19 pandemic: a study protocol for a randomized controlled trial. Trials 23(1):734
Botha E, Gwin T, Purpora C (2015) The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI Database Syst Rev Implement Rep 13(10):21–29
Bremer B, Wu Q, Mora Alvarez MG, Holzel BK, Wilhelm M, Hell E, Tavacioglu EE, Torske A, Koch K (2022) Mindfulness meditation increases default mode, salience, and central executive network connectivity. Sci Rep 12(1):13219
Brown KW, Ryan RM (2003) The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 84(4):822–848
Calderone AD, Latella F, Impellizzeri P, De Pasquale F, Fama A, Quartarone e RS Calabro (2024) Neurobiological changes induced by mindfulness and meditation: a systematic review. Biomedicines 12(11)
Chen L, Yan S, Fan X, Ding Q (2020) Stress sources, panic and anxiety of nurses in fever clinics under the COVID-19: a cross-sectional survey. J Southeast Univ China (Med Sci Ed) 05(39):569–575
Chen R, Sun C, Chen J-J, Jen H-J, Kang XL, Kao C-C, Chou K-R (2021a) A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic. Int J Ment Health Nurs 30(1):102–116
Chu Y (2009) The effect of mindfulness-based intervention on cancer and uremia patients. Master’s degree, Capital Normal University, Peking, China (in Chinese)
Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396
Cui S, Jiang Y, Shi Q, Zhang L, Kong D, Qian M, Chu J (2021) Impact of COVID-19 on Anxiety, Stress, and Coping Styles in Nurses in Emergency Departments and Fever Clinics: A Cross-Sectional Survey. Risk Manag Health Policy 14:585–594
Eby LT, Allen TD, Conley KM, Williamson RL, Henderson TG, Mancini VS (2019) Mindfulness-based training interventions for employees: a qualitative review of the literature. Hum Resour Manag Rev 29(2):156–178
Fan H, Zhang Z (2023) Study on the Relationship between Mindfulness and Job Burnout among Medical Staff. J Chongqing Three Gorges Univ 39(05):91–101
Green AA, Kinchen EV (2021) The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. J Holist Nurs 39(4):356–368
He G, Chen Y, Wang D, Wang H (2023) Influencing factors of work stress of medical workers in clinical laboratory during COVID-19 pandemic: Working hours, compensatory leave, job satisfaction. Front Public Health 11:1078540
Hesselink G, Straten L, Gallee L, Brants A, Holkenborg J, Barten DG, Schoon Y (2021) Holding the frontline: a cross-sectional survey of emergency department staff well-being and psychological distress in the course of the COVID-19 outbreak. BMC Health Serv Res 21(1):525
Holzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW (2011) Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res 191(1):36–43
Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, Wan SW, Liu Z, Shen Q, Yang J, He HG, Zhu J (2020) Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine 24:100424
Jin T, Zhou Y, Zhang L (2023) Job stressors and burnout among clinical nurses: a moderated mediation model of need for recovery and career calling. BMC Nurs 22(1):388
Kabat-Zinn J (2006) Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice 10
Khatatbeh H, Al-Dwaikat T, Rababah J, Olah A, Pakai A (2024) Paediatric nurses’ burnout, quality of life and perceived patient adverse events during the COVID-19 pandemic: Testing an integrated model using structural equation modelling. J Clin Nurs 33(1):255–264
Labrague LJ (2021) Pandemic fatigue and clinical nurses’ mental health, sleep quality and job contentment during the covid-19 pandemic: The mediating role of resilience. J Nurs Manag 29(7):1992–2001
Lee SE, Seo JK, Squires A (2024) Voice, silence, perceived impact, psychological safety, and burnout among nurses: A structural equation modeling analysis. Int J Nurs Stud 151:104669
Li J, Gao R, Gao F, Yang J (2020) Investigation and analysis of the psychological status of the nurses to support the clinical work of fever clinic during the outbreak of novel coronavirus pneumonia. J Cardiovasc Pulm Dis 39(6):642–649
Li X, Liu Y (2000) Job Stressors and Burnout among Staff Nurses. Chin J Nurs 11(35):4–8
Li Y (2019) The relationship between mindfulness and psychological distress of psychiatric nurses: the mediating role of positive coping. Today Nurse 04(26):22–25
Liu X, Xu Y, Xu H, Jiang L, Wang T, Chen C, Lee A, Zhu P (2022) Anxiety and sleep quality among front-line nurses treating first wave COVID-19 in China: The mediating role of mindfulness. Arch Psychiatr Nurs 41:341–347
Liu Y, Han Y, Xiong L, Ma Q, Mei L, Chong MC, Che CC (2023) The mediating role of psychological capital in the relationship between job stress and professional identity in Chinese medical interns. Work 76(4):1597–1604
Luo B, Wang J (2022) Influential factors of acute stress disorder among nursing staff in fever clinic under the COVID-19. Chin J Clin Res 35(04):590–593
Luo LX, Peng X, Hou J, Xie Y, Dong H, Peng S, Ma G, Zhang J (2023) Effects of mindfulness decompression therapy on mental health and job burnout among nurses working in the frontline of the novel coronavirus pandemic: A retrospective study. J Occup Health 65(1):e12398
Marthiensen R, Sedgwick M, Crowder R (2019) Effects of a Brief Mindfulness Intervention on After-Degree Nursing Student Stress. J Nurs Educ 58(3):165–168
Maslach C, Jackson SE (1981) The measurement of experienced burnout. J Organ Behav 2(2):99–113
McConville J, McAleer R, Hahne A (2017) Mindfulness Training for Health Profession Students-The Effect of Mindfulness Training on Psychological Well-Being, Learning and Clinical Performance of Health Professional Students: A Systematic Review of Randomized and Non-randomized Controlled Trials. Explor (NY) 13(1):26–45
Mo K, Li M, Shao Y, Xu Y, Xu C, Xu S, Xu X (2020) Effect of mindfulness-based stress reduction on Perceived stress, negative emotions, and psychological well-being in Nurses. Nurs J Chin People’s Lib Army 6(37):47–50
Ong NY, Teo FJJ, Ee JZY, Yau CE, Thumboo J, Tan HK, Ng QX (2024) Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis. Gen Psychiatr 37(3):e101115
Pérez V, Menéndez-Crispin EJ, Sarabia-Cobo C, de Lorena P, Fernández-Rodríguez A, González-Vaca J (2022) Mindfulness-based intervention for the reduction of compassion fatigue and burnout in nurse caregivers of institutionalized older persons with dementia: a randomized controlled trial. Int J Environ Res Public Health 19(18)
Peter KA, Voirol C, Kunz S, Gurtner A, Renggli F, Juvet T, Golz C (2024) Factors associated with health professionals’ stress reactions, job satisfaction, intention to leave and health-related outcomes in acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organisations. BMC Health Serv Res 24(1):269
Ramachandran HJ, Bin Mahmud MS, 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. J Clin Nurs 32(11-12):2323–2338
Rodriguez-Vega B, Palao A, Munoz-Sanjose A, Torrijos M, Aguirre P, Fernandez A, Amador B, Rocamora C, Blanco L, Marti-Esquitino J, Ortiz-Villalobos A, Alonso-Sanudo M, Cebolla S, Curto J, Villanueva R, de-la-Iglesia MJ, Carracedo D, Casado C, Vidal E, Trigo D, Iglesias N, Cabanas D, Mellado L, Garcia D, Fernandez-Encinas C, Navarro R, Mediavilla R, Vidal-Villegas MP, Bravo-Ortiz MF, Bayon C (2020) Implementation of a Mindfulness-Based Crisis Intervention for Frontline Healthcare Workers During the COVID-19 Outbreak in a Public General Hospital in Madrid, Spain. Front Psychiatry 11:562578
Rushing CJ, Casciato DJ, Ead JK, Spinner SM (2020) Perceptions of Burnout, Personal Achievement, and Anxiety Among US Podiatric Medicine and Surgery Residents: A Cross-Sectional Pilot Study. J Foot Ankle Surg 59(5):953–956
Sarazine J, Heitschmidt M, Vondracek H, Sarris S, Marcinkowski N, Kleinpell R (2021) Mindfulness Workshops Effects on Nurses’ Burnout, Stress, and Mindfulness Skills. Holist Nurs Pr 35(1):10–18
Schaufeli W, Taris T (2005) The conceptualization and measurement of burnout: Common ground and worlds apart. Work Stress 19:256–262
Schwartz-Mette RA, Sapp M, Strout K (2025) Online and In-Person Mindfulness-Based Stress Reduction (MBSR) Improves Stress Resilience in Nursing Education. Worldviews Evid Based Nurs 22(3):e70031
Serrano-Ripoll MJ, Ricci-Cabello I, Jimenez R, Zamanillo-Campos R, Yanez-Juan AM, Bennasar-Veny M, Sitges C, Gervilla E, Leiva A, Garcia-Campayo J, Garcia-Buades ME, Garcia-Toro M, Pastor-Moreno G, Ruiz-Perez I, Alonso-Coello P, Llobera J, Fiol-deRoque MA (2021) Effect of a mobile-based intervention on mental health in frontline healthcare workers against COVID-19: Protocol for a randomized controlled trial. J Adv Nurs 77(6):2898–2907
Shahid, A, Wilkinson K, S Marcu S (2011) Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). In: Shahid A, Wilkinson K, Marcu S, Shapiro CM, eds. STOP, THAT and One Hundred Other Sleep Scales. New York, Springer
Snyder E, Cai B, DeMuro C, Morrison MF, Ball W (2018) A New Single-Item Sleep Quality Scale: Results of Psychometric Evaluation in Patients With Chronic Primary Insomnia and Depression. J Clin Sleep Med 14(11):1849–1857
Song X, Xiang M, Liu Y, Yu C (2020) Relationship Between Job Satisfaction and Burnout Based on a Structural Equation Model. J Occup Environ Med 62(12):e725–e731
Suleiman-Martos N, Gomez-Urquiza JL, Aguayo-Estremera R, Canadas-De La Fuente GA, De La Fuente-Solana EI, Albendin-Garcia L (2020) The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. J Adv Nurs 76(5):1124–1140
Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, Wang H, Wang C, Wang Z, You Y, Liu S, Wang H (2020) A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control 48(6):592–598
Sun Y, Liu F, Cao F (2019) Job burnout subtypes and emotional problems among medical staff in a tertiary hospital. J Shandong Univ China (Health Sci) 06(68):100–105
Sun Y, Lin M, Liu C, Lyu Y, Liu T, Zhao N (2023) Influence of mindfulness decompression training on job burnout and quality of life of emergency department nurses. Chin Nurs Res 37(16):3007–3011
Suyi Y, Meredith P, Khan A (2017) Effectiveness of mindfulness intervention in reducing stress and burnout for mental health professionals in Singapore. Explore13(5):319–326
Talebiazar N, Salamat E, Abbasi M, Azizi N, Goli R, Faraji N, Bagheri M, Amiri N, Kazemi S (2024) The impact of mindfulness-based stress reduction training on the occupational stress and burnout experienced by nurses in geriatric wards? A randomized controlled trial. Geriatr Nurs 58:373–381
Talebiazar N, Anzali BC, Abbasi M, Azizi N, Goli R, Faraji N, Bagheri M, Amiri N, Kazemi S (2025) Does mindfulness-based stress reduction training have an impact on the occupational burnout and stress experienced by nurses? A randomized controlled trial. Int Arch Occup Environ Health 98(1):1–11
Truscott PL (2025) Reducing stress among nurses: The impact of mindfulness-based stress reduction programs. Geriatr Nurs: 103730
van der Riet P, Levett-Jones T, Aquino-Russell C (2018) The effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review. Nurse Educ Today 65:201–211
Wang H, Yao N, Guo Y, Pan Y, Sun M, Yan S, Wang C, Zhao H, Li B (2021b) Prevalence and correlates of psychological distress in the front-line anti-epidemic medical staff during the COVID-19 outbreak in Wuhan. Ann Palliat Med 10(6):6180–6188
Wang Y, Qiang W-M, Wang C, Wu P-P, Li M-M, Kong Q-Q, Yu L-Y, Chen L (2021a) Nursing management at a Chinese fever clinic during the COVID-19 pandemic. Int Nurs Rev 68(2):172–180
Wang C, Xie A, Zhou W, Cheng F, Tian J, Xu Y(2022) A phenomenological study of nurses’ experiences in a pediatric fever clinic during the COVID-19 epidemic. Res Theory Nurs Pract
Weibelzahl S, Reiter J, Duden G (2021) Depression and anxiety in healthcare professionals during the COVID-19 pandemic. Epidemiol Infect 149:e46
Woo T, Ho R, Tang A, Tam W (2020) Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. J Psychiatr Res 123:9–20
Xie X, Zhou Y, Fang J, Ying G (2022) Social Support, Mindfulness, and Job Burnout of Social Workers in China. Front Psychol 13:775679
Yang T, Huang H (2003) An epidemiological study on stress among urban residents in social transition period. Chin J Epidemiol 09(24):11–15
Yin T, Han Q, Zheng Y, Wang B (2021) Study on the influencing factors of nurses’ sleep quality and mindfulness level during the COVID-19 epidemic. 21(01): p. J Nurs Adm 01(21):15–20
Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS (2021) Mindfulness-based interventions: an overall review. Br Med Bull 138(1):41–57
Zhang D, Jia Y, Chen Y, Meng G, Zhuang X, Chen L, Wang D, Zhang YP (2022) Effect of an online resourcefulness training in improving psychological well-being of front-line medical staff: a quasi-experimental study. BMC Psychol 10(1):217
Zheng R, Zhou Y, Fu Y, Xiang Q, Cheng F, Chen H, Xu H, Fu L, Wu X, Feng M, Ye L, Tian Y, Deng R, Liu S, Jiang Y, Yu C, Li J (2021) Prevalence and associated factors of depression and anxiety among nurses during the outbreak of COVID-19 in China: A cross-sectional study. Int J Nurs Stud 114:103809
Acknowledgements
We would like to thank all participants in this study and the staff from the Affiliated Nanhua Hospital, University of South China, and Xi'an Jiaotong University Health Science Center. This work was supported by the Fund of Hunan Social Science Achievement Appraisal Committee (grant no. XSP25YBC327, to Dandan Zhang) and the fund from Hengyang Science and Technology Bureau (grant no. 202010031581, to Dandan Zhang).
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Dandan Zhang and Shuangyan Yi contributed to the conception and design of the study. Yongjun Chen, Yitong Jia, Lichun Huang, and Qingqing Liao contributed to the study delivery, data collection, and interpretation of the data. Dandan Zhang, Shuangyan Yi, and Lichun Huang wrote the manuscript, and all authors read the final manuscript and approved its submission. Shuangyan Yi and Lichun Huang are the corresponding authors.
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This study complies with the Declaration of Helsinki. The ethics committee of Affiliated Nanhua Hospital, University of South China, conducted an ethical review and approved the study (project number 2022-ky-171) on May 25, 2022.
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Participants were thoroughly briefed on the study’s objectives and the process of providing informed consent. They were assured that their responses would be used exclusively for academic research and that their anonymity would be strictly maintained. Additionally, participants were informed of their right to withdraw from the survey at any time without any consequences. After reviewing the consent form, participants voluntarily consented by selecting the ‘consent’ option, which granted them access to the survey questionnaire. This data collection process occurred between July 1, 2022, and September 30, 2022. All collected data remains anonymous and confidential, with access limited solely to the study’s authors.
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Zhang, D., Chen, Y., Jia, Y. et al. Impact of mindfulness on job burnout, perceived stress, and workplace stressors among fever clinic nurses: a structural equation modeling approach. Humanit Soc Sci Commun (2026). https://doi.org/10.1057/s41599-026-07029-x
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DOI: https://doi.org/10.1057/s41599-026-07029-x
