Received: 4 April 2020 Revised: 3 September 2020
DOI: 10.1111/nicc.12552
QUALITY IMPROVEMENT INITIATIVES-
SERVICE IMPROVEMENT
An evaluation of a mindfulness-based stress reduction
intervention for critical care nursing staff: A quality
improvement project
Neil Anderson
Matron in Critical Care and Critical Care
Outreach, Bart's Health NHS Trust,
London, UK
Correspondence
Neil Anderson, Adult Critical Care Unit,
Ward 6A. St Bartholomew's Hospital,
West Smithfield, London EC1A 7BE, UK.
Email: neil.anderson7@nhs.net
Nurs Crit Care. 2020;1–8.
Accepted: 4 September 2020
Abstract
Background: Critical care is a stressful workplace for nursing staff. Mindfulness-
based stress reduction programmes are an emerging concept to manage stress in
nursing, but little is known about the impact of such interventions, especially in criti-
cal care settings.
Aims and objectives: A quality improvement initiative was introduced to explore the
effects of a mindfulness-based stress reduction intervention on a cohort of critical
care nurses in terms of quality of life, perceived stress, mindfulness awareness, and
sickness and absence rates.
Methods: A pre-/post-interventional design recruited nurses (n = 25) working within
a critical care unit to undertake the intervention. Participants were asked to complete
psychometric questionnaires at three time points, pre-course (0 months), immediately
post-course (8 weeks), and at a follow-up point at month 4. Sickness and absence
rates were analysed to detect differences pre- and post-course. Retention rates were
ascertained by numbers of participants completing the psychometric tests.
Findings: Overall, positive correlations were found when comparing pre-course vs
8-week mean scores of satisfaction with life (P < .001), reduced perceived stress
(P < .001), and mindfulness awareness (P = .002). Bootstrap analysis of the data con-
firmed that positive outcome measures were more significant at the 4-month mark in
reduced perceived stress and mindfulness awareness (P < .001) compared with the
satisfaction with life scale (P = .41). There was no significant change in sickness rates
pre- and post-intervention (P = .69). The retention rate was 70% at month 4.
Conclusions and recommendations: Mindfulness training is a feasible and accepted
intervention that critical care nurses may benefit from in terms of quality of life,
perceived stress, and mindfulness awareness. This has positive outcomes for staff
and patients.
KEYWORDS
caring, critical care, nursing, intensive care nurse, mindfulness, well-being
wileyonlinelibrary.com/journal/nicc © 2020 British Association of Critical Care Nurses 1
2 ANDERSON
1 | I N T RO DU CT I O N A N D B A CK GR O U N D
National Health Service (NHS) workers have declared that they expe-
rience significant stress in the workplace, with 56% describing work
as stressful.1 The NHS Staff Survey results2 show that 38% of NHS
staff reported work-related stress. Stress leads to ill health, potentially
contributing to the professional group of nursing staff having the sec-
ond highest sickness rates in the NHS of 5.78%.3
The adult critical care unit (ACCU) is acknowledged to be a stress-
ful workplace for nurses, with exposure to patient deaths, cardiopul-
monary resuscitation, and conflict named stress contributors.4
Mindfulness Based Stress Reduction (MBSR) training enables nurses
to adapt their behaviour by responding rather than reacting to stress-
ful situations, enhancing self-care, and subsequently improving clinical
outcomes in critical care patients.5
Stress, anxiety, and depression are key factors that impact sick-
ness rates in nursing. Data from the Office for National Statistics
determined that stress and depression accounted for 7.3% of NHS
6
sickness absences in 2016 and that nurses were the second highest
professional group contributing to sickness absence. There is no clear
consensus in the literature that MBSR training may reduce sickness
and absence in nursing staff.
1.1 | Rationale
Mindfulness training in nursing is an emerging concept, and nurses
7
have limited access to such programmes. The effects of mindfulness
8
training in health care workers are currently unknown. Therefore, an
8-week MBSR course for nurses was introduced to a large Central
London ACCU in October 2018.
1.2 | Setting
This study was conducted in a Central London NHS Trust. The ACCU
consists of 54 beds, over four units, and specializes in cardiothoracic
surgery, cardiology, advanced cardiac support including extracorporeal
membrane oxygenation (ECMO), and oncology. The service runs
24 hours a day, 7 days a week, and nursing staff are required to work
12.5-hour night or day shifts. At the time of writing, the vacancy rate
within the ACCU was significant at 17%, employee turnover was 4%,
and the sickness rate varies week by week at between 2% and 8%.
The ACCU has the capacity to employ up to 260 full time-equivalent
registered nursing staff, with most rotating between the four units in
teams. One of these units specializes in cardiology, including out-of-
hospital cardiac arrests, ECMO, and oncology. Because of the com-
plexities and high acuity of patients seen within this service, an
expected higher than UK national average mortality rate in ACCU of
38% is noted. Nurses have expressed the emotional toll of exposure
to death on a regular basis during debriefs and team meetings and
have described working on the ACCU as stressful.
What is known about this topic
• The adult critical care unit is acknowledged to be a stress-
ful workplace for nurses, with exposure to patient deaths,
cardiopulmonary resuscitation, and conflict named stress
contributors.
• Mindfulness practice is an alternative approach for nurs-
ing leaders to address nursing stress and burnout.
• Mindfulness-based stress reduction training may reduce
stress, enhance mindfulness awareness, and improve
health and well-being in a wide population of nursing
staff, including critical care nurses.
What this paper adds
• This study demonstrated that satisfaction with life, per-
ceived stress, and mindful attention awareness scores
were all significantly improved in a cohort of critical care
nurses immediately following an 8-week mindfulness-
based stress reduction programme.
• Scores for perceived stress and mindful attention aware-
ness also significantly improved at month 4, demonstrat-
ing longevity of positive effects.
• An 8-week mindfulness-based stress reduction pro-
gramme had no impact or influence on sickness and
absence rates in critical care nursing staff.
1.3 | Aim
The purpose of this study is to evaluate an MBSR course as a quality
improvement project in ACCU. Effectiveness of the course was
analysed using quantitative data to draw conclusions. Quantitative psy-
chometric test data were gathered and analysed in terms of general
health and well-being, perceived stress, and mindful awareness of the
participants at three time points: pre-course, immediately post-course,
and at a follow-up point at month 4. Sickness rates were analysed over
a 6-month period pre- and post-course during identical months.
This study tested the following hypothesis:
There will be a significant improvement in quality of life, perceived
stress, and mindfulness awareness scores and a reduction in sickness
and absence rates for nurses undertaking an 8-week MBSR course.
2 | METHODS
2.1 | Intervention
Following recommended Good Practice Guidelines from the UK
Mindfulness Network,9 a trained Zenways Zen meditation teacher
ANDERSON
conducted an 8-week MBSR programme. The mindfulness teacher
was self-employed and had 3 years of mindfulness teaching experi-
ence and had experience providing mindfulness training in NHS and
private organizations. The mindfulness teacher facilitated the course
using the MBSR programme, originally developed in 1979 by Kabat-
Zinn,10 to run an adapted course for ACCU nurses.
The MBSR programme aimed to provide nurses with an in-depth
and practical introduction to mindfulness. The course commenced
with a 2-hour group face-to-face training session, followed by
6 weeks of online mindfulness training. For the online training, a
YouTube video link was sent to each participant's email address
weekly. This video was not public and was only available to the
enrolled group and could be accessed 24/7 at a time that was conve-
nient. Homework instructions were provided after each online session
with mindfulness exercises and techniques to practice. To close the
course, a final face-to-face session was delivered with further medita-
tion practice, advice on continuity of MBSR activities, and evaluations.
Participants were asked to sign a register for the face-to-face sessions
and record when they accessed the online sessions.
2.2 | Study of the intervention
Quantitative data on satisfaction with life scale (SWLS), perceived
stress scale (PSS), and mindful attention awareness scale (MAAS) were
collected at three time points: pre-intervention (0-months), immedi-
ately post-intervention (8-weeks) and 4 months post-intervention
using a questionnaire. The mindfulness teacher used these tools to
evaluate the effectiveness of all MBSR courses that are facilitated. An
agreement was made to disclose the results of the questionnaires to
aid the quality improvement project. The questionnaires were com-
pleted anonymously. No additional psychometric tests were com-
pleted for the purpose of this project. Retention rates were
ascertained by the number of participants completing the psychomet-
ric tests at month 4.
2.3 | Measures
The SWLS is a short 5-item questionnaire used to assess global cogni-
tive function in terms of overall satisfaction with life initially devel-
oped by Diener et al.11 Pavot et al,12 report that the SWLS had a
satisfactory level of test-retest reliability and high internal consistency
after reviewing multiple studies in a systematic review.
One of the most popular tools for measuring psychological stress
is the PSS.13 Across diverse populations, the 10- and 14-item PSS
13-16 15
generate satisfactory levels of reliability. Khalili et al describes
that the face validity and scale content of the PSS were pronounced
with a Kaser-Meyer-Olkin coefficient of 0.82 and Bartlett's test yield-
ing 0.327, demonstrating statistical significance (P < .0001). Therefore,
the PSS is useful to screen and assess levels of perceived stress. This
study used the 10-item PSS, and Lee13 concluded that the 10-item
3
PSS is superior to the 14-item version, reporting a coefficient value of
>0.70 in all cases with the 10-item PSS.
The MAAS is one of the most popular measures of mindful-
ness ability, demonstrating efficacy of mindfulness-based interven-
tion outcomes.17 MacKillop and Anderson18 ascertained that
mindfulness ability as measured on the MAAS is not related to
gender, supporting its validity. The candidates in this study were
asked to reverse score the scale in half of the questions to prevent
intentional attention or awareness of mindfulness. Ruiz et al19
analysed the results of MAAS in undergraduates and found excel-
lent internal consistency (α = .92) and demonstrated theoretically
coherent correlations with the MAAS and negative thoughts, emo-
tional symptoms, and life satisfaction, thus supporting reliability.
Therefore, the MAAS seems to be a reliable and valid measure of
mindfulness.
Sickness rates within all staff are monitored in the ACCU and
are recorded on an electronic rota system. The system records the
number of episodes, days, and hours of sickness unavailability that
each nurse takes. Sickness and absence rates were monitored for
6 months pre-course and the 6-month period immediately post-
course to determine any interventional influences. Rates of sickness
absence among NHS workers vary at different times of the year,
with higher sickness reported during the winter months.6 Therefore,
to avoid any seasonal influence on the analysed sickness scores, the
6 months monitored pre-course were matched with the exact
months post-course (January to June) rather than the immediate
pre-course period. Only problematic intermittent short-term sick-
ness and chronic sickness were used in this study. Any pregnancy-
related sickness was excluded.
2.4 | Analysis
The distribution of SWLS, PSS, and MAAS was assessed using a histo-
gram with a normal curve imposed. Data were summarized using the
mean and SD. SPSS MIXED was used to fit mixed models with ran-
dom effects (intercepts) and to account for correlation between mea-
surements collected on the same individual. Paired comparisons
between time points were conducted using the Bonferroni procedure.
The histograms for SWLS, PSS, and MAAS were not always symmetric
with regard to the mean. To address this issue, an equivalent model
was fitted using the Stata longitudinal panel regression procedure
xtreg with 1000 bootstrap samples (ie, the model was fitted 1000
times to multiple samples of the data drawn with replacement). The
findings from both approaches were similar and did not impact the
main findings. The data were analysed using SPSS20 version 25.0 and
Stata version 15.
The Wilcoxon signed-rank test was used to test whether there
were significant differences pre- and post-intervention in average
hours of sick leave among the participating group. The probability
threshold of P = .05 (type I error) was used to reject the null hypothe-
sis for all statistical tests.
4 ANDERSON

2.5 | Recruitment of participants
A convenience sample was obtained by inviting all nursing staff work-
ing within the ACCU to apply for the MBSR programme via a group
email. No exclusion criteria were set to promote equitable opportuni-
ties to access the programme. Nurses were informed of the learning
objectives, commitment requirements, programme content, and the
duration of the course. The opportunity to take part and enrol was
voluntary. Interested participants were required to complete an appli-
cation form and were offered a place on a first come, first served
basis. All participants were required to pay a £20 deposit, which was
refunded at the end of the course. All 25 available spaces were filled;
however, because of the long timeframe from expressions of interest
to starting the course, some participants' (n = 2) circumstances chan-
ged, and therefore, they did not commence the course. Prior to
starting the course, participants were asked to complete personal
demographics via an online survey platform using a unique and anony-
mous participant number.
2.6 | Participants
Of the 23 nurses included in the baseline sample for this study, all par-
ticipants (100%) were nursing staff, and 87% were female. The mean
age was 35.4 years, with a mean length of experience of 7.4 years.
The range of age and experience is wide, representing a varied popu-
lation recruited. A total of 96% of participants were registered nurses.
Experienced ACCU nurses were the majority, with 43% being Sister/
Charge Nurses and 30% Senior Sister/Charge Nurses. This contributes
to 83% having completed a postgraduate course in critical care. Rep-
resentation from the cardiothoracic ICU 1 and 2 and General ICU was
balanced with similar numbers. There was only one nurse from the
high dependency unit in the group. The ACCU employs nurses from a
variety of backgrounds from both the United Kingdom and interna-
tionally (Table 1).
2.7 | Ethical considerations
The study took place on NHS property in 2018 involving NHS nursing
staff. The need for ethical approval must be ascertained before con-
ducting any study that may fall into a research paradigm.21 Permission
from the Senior Nurse (Band 8B) and the Medical Director for ACCU
within the Trust to conduct the Analysis of Healthcare Provision and
introduce the intervention was sought and granted. A meeting was
arranged with the Trusts' Director of Research who advised that the
study did not require Trust ethical approval. NHS Research Ethics
Committee (NHS REC) ethical approval was not needed after consult-
ing the NHS REC decision tool. All participants were given an informa-
tion sheet for the study, and consent was obtained.

TABLE 1 Demographics of baseline sample

3 | RE SU LT S
Variable Total (n = 23)
Gender
Psychometric effects of the MBSR training were assessed using self-
Male n = 3 (13%)
report questionnaires administered at the face-to-face sessions. The
Female n = 20 (87%) mean score of the SWLS pre-course was 22.58, which improved to
Age Mean = 35.4 (SD = 7.6) 26.55 post-course at week 8 but reduced to 25.69 at month 4. For
Range = 24-58 years PSS, the mean pre-test score was 21.67, which improved to 13.70
Critical care experience (y) Mean = 7.4 (SD = 4.5) immediately post-course. This reduction in perceived stress was
Range = 1-21 years maintained and decreased further at the 4-month mark to 12.25. For
Band and job title MAAS, the pre-course score of 3.21 in the participants increased in
2 health care assistant n = 1 (4%) week 8 and month 4 to 4.03 and 4.25, respectively. Figure 1 shows

5 staff nurse n = 5 (22%)

positive trends and similarities between scores at the three time
points.
6 sister/charge nurse n = 10 (43%)
Tests were run on the raw data to detect significance. It was
7 senior sister/charge nurse n = 7 (30%)
noted that the histograms for the SWLS, PSS, and MAAS were not
Postgraduate ICU course
always symmetrical around the mean. Therefore, to address the issue
Not completed n = 4 (17%)
of non-normality on the results, a bootstrap analysis (Table 2) was
Completed n = 19 (83%)
conducted. The results from the bootstrap were similar to those of
Current ACCU base the Bonferroni paired comparison tests, and the overall findings of sig-
CTICU 1 n = 7 (30%) nificance remain unaltered.
CTICU 2 n = 9 (39%)
HDU n = 1 (4%)
GICU n = 6 (26%) 3.1 | Sickness and absence
Abbreviations: ACCU, adult critical care unit; CTICU, cardiothoracic inten-
sive care unit; GICU, general intensive care unit; HDU, high dependency Average total hours of sickness for all participants were analysed in a
unit; ICU, intensive care unit. 6-month period pre- and post-intervention. The mean number of
ANDERSON 5

F I G U R E 1 Mean scores of Mean Scores of Satisfaction with Life Score, Percieved Stress S

cale, 
satisfaction with life score (SWLS), and Mindful Attention Awareness Scale over the 3 time points 
perceived stress scale (PSS), and mindful 30
attention awareness scale (MAAS) at each
25
time point

20

Mean Scores 
15 SWLS
PSS
10
MAAS
5

0
Pre Course 8 weeks 4 months
Time point

T A B L E 2 Differences between time

Bonferroni
points (Stata bootstrap)
Measure Time Point Mean diff. SE z P>z (95% CI)
SWLS Week 8 vs pre-course 3.92* 0.90 4.38 <.001 1.78 6.07
4 months vs pre-course 3.24 2.11 1.54 .37 −1.81 8.29
4 months vs week 8 −0.68 2.19 −0.31 1.00 −5.94 4.57
PSS Week 8 vs pre-course −7.85* 1.36 −5.78 <.001 −11.10 −4.60
4 months vs pre-course −8.69* 1.71 −5.09 <.001 −12.78 −4.61
4 months vs week 8 −0.85 1.19 −0.71 1.00 −3.69 2.00
MAAS Week 8 vs pre-course 0.83* 0.21 4.02 <.001 0.34 1.32
4 months vs pre-course 0.99* 0.22 4.53 <.001 0.47 1.51
4 months vs week 8 0.16 0.14 1.12 .78 −0.18 0.49

Abbreviations: CI, confidence interval; diff, difference; MAAS, mindful attention awareness scale;
PSS, perceived stress scale; SWLS, satisfaction with life score.
*The mean difference is significant at the .05 level.

sickness hours claimed was 51.33 hours pre-course compared with
39.85 hours post-course. There was no significant difference between
sickness absences in the 6-month period pre-intervention compared
with the 6-month period post-intervention based on the Wilcoxon
signed-rank test (P = .69).
Imbalances of sick leave taken between participants were noted.
Participants 4, 3, 12, and 23 took higher-than-average numbers of
sickness days. Participant 23 took 571 hours of sickness absence in
the 6-month period pre-intervention, which—compared with the
mean score of 51.33 hours—is disproportionate. Figure 2 shows box
plots with data outliers with comparisons.
Therefore, the Wilcoxon signed-rank test was repeated with Par-
ticipant 23 excluded to determine if there was any significant differ-
ence for the remaining participants. Similarly, the mean and median
sickness levels did not differ significantly between pre- and post-
course (P = .39).
4 | DI SCU SSION
Home life and general well-being was measured using the scales of
the SWLS. At the immediate post-course mark, there was a significant
difference when compared with the pre-course scores (P < .001).
However, at the 4-month follow-up point, the significance had
dropped (P = .412) when comparing with the pre-course scores. Com-
paring the 4-month follow-up scores with the 8-week immediate
post-course scores, no improvement was detectable (P = 1.000). The
effects of the MBSR in this study on home life and general well-being
were therefore insignificant at the 4-month follow up. One explana-
tion is that general well-being and life satisfaction are complex
domains with multiple facets on which MBSR has limited influence. In
contrast to this study, Dos Santos22 and Mackenzie et al23 both con-
cluded that life satisfaction improved after MBSR training; however,
some positive effects were lost at the 6-week follow-up period in the
6 ANDERSON
Dos Santos22 study, and the Mackenzie et al23 study only measured
life satisfaction immediately post-intervention. It is therefore also pos-
sible that these positive effects were lost in the period following com-
pletion of the intervention.
The PSS and MAAS are both related to workplace stress, and the
mean scores at the different time points were used to ascertain
changes in stress levels. Promisingly, in both the PSS and the MAAS,
the scores from pre-course to immediately post-course at week
8 showed a significant improvement (P < .001) and again at the
4-month mark (P < .001). Many studies concur with this study and
found significant reductions in stress levels following MBSR training
for registered nurses in various worldwide locations22,24-26 and more
specifically for critical care nurses in Malaysia.27 Daigel et al28 and
29
Valley and Stallones both highlight that a reduction in stress levels
in nurses can increase patient safety and reduce cognitive failures.
This is promising given the significant reduction in perceived stress
and increase in mindfulness awareness in this critical care nursing
cohort.
The long-term effects of the intervention were measured at
4 months post-completion of the course, and there was a significant
improvement in both PSS and MAAS at month 4 compared with pre-
intervention (P < .001). This indicates that the positive effect of MBSR
training persisted in the PSS and MAAS at month 4. However, when
comparing differences in scores between the immediate post-
intervention period at week 8 to the 4-month mark, there were no
further improvements in either the PSS or the MAAS (P = 1.000 and
P = .787, respectively). There are limited examples in the literature
that have collected follow-up data on completion of the MBSR train-
ing in order to determine lasting effects. Two studies that did collect
25,30
follow-up data both concluded that improvements in stress per-
sisted when following up participants at 3 months and 1 month,
respectively. Cervolo and Raines31 concluded similarly that, while the
positive effects of MBSR were similar immediately post-intervention
compared with the 3-month follow up, the follow-up scores were still
significantly improved compared with pre-intervention. This matches
the findings of this study.
F I G U R E 2 Pre- and post-intervention
sickness hours box plots with outliers
Analysis of average hours of sick leave pre-intervention vs post-
intervention demonstrated that there was no significant improvement
in sickness scores of nurses following the MBSR programme (P = .69).
Even though some of the sickness in this cohort was caused by mus-
culoskeletal pain, it was difficult to relate this study to the Lopes
et al32 study, which showed an improvement in sickness caused by
Musculoskeletal pain alone. The findings did, however, agree with the
Steinberg et al33 study, which also concluded that there were no sig-
nificant differences in ICU nurses' sickness scores after an MBSR pro-
gramme. Interestingly, it was noted that one participant took
excessive hours of sick leave in the pre-intervention period, and when
these data were excluded from the analysis, mean levels of sickness
increased slightly post-intervention, although this increase is likely to
be coincidental and unrelated to the MBSR programme.
Attrition was noted on day 1 of the course, with two nurses (9%)
unable to attend because of sickness and therefore not completing
the pre-test questionnaires and not receiving the face-to-face intro-
ductory session and instructions on how to access the online sessions.
This left 21 active participants. At week 8, an additional participant
withdrew because of an inability to engage with the programme. At
month 4, one participant had resigned, and three participants did not
respond to the final questionnaire and were presumed to have
stopped practicing mindfulness. The overall retention rate was there-
fore 70% (n = 16).
4.1 | Implications for management/practice
The findings of this study have significance for leaders of health care,
especially those managing critical care teams. Nurses using mindful-
ness techniques in everyday practice can redirect negative thinking
and reframe difficult situations. An MBSR intervention demonstrates
a feasible method to build a more mindful, content, and productive
workforce, thus improving patient care. Providing nurses with the
support and resources to attend MBSR training, as well as ongoing
support to enable these learned behaviours to be maintained, is
ANDERSON
essential. Health and well-being of staff is especially important since
COVID19 impacted critical care teams globally in 2020. NHS leaders
must be aware of the availability of such programmes and be prepared
to implement them when possible. By offering training programmes
such as MBSR, an organization provides a clear message that it care
about the health and well-being of its employees.
4.2 | Limitations
Limitations were acknowledged during the implementation and con-
duction of this study. It is difficult to generalize the findings of this
study to nursing populations external to this study, especially nurses
working outside critical care and other multi-professional groups. The
study sample was selected using a convenience sampling method, and
there were no exclusion criteria set. This therefore caused a potential
lack in heterogeneity in the study population.
Response bias could be a factor because of the nature of the
self-report questionnaires of the SWLS, PSS, and MAAS that were
completed with the mindfulness teacher present pre-course and
immediately post-course. Paid study time was given to the partici-
pants to attend the face-to-face sessions at week 1 and week 8.
Further attrition was noted at the 4-month mark where the partici-
pants were asked to complete the questionnaires in their spare time,
indicating participants may have perceived being paid to attend the
face-to-face sessions as an incentive.
The author of this paper had to rely on the three measures
(SWLS, PSS, MAAS) that the mindfulness teacher already used to
evaluate the programme, which was a significant limitation. More
measures used in published research, such as the Maslach Burnout
Inventory, measuring job satisfaction, could not be used to analyse
effects. This project was an MSc dissertation and had time con-
straints. Therefore, it was not possible to follow up the participants at
a later date to further analyse the long-term effects of the MBSR
programme.
The findings of this study are comparable with other international
studies concerning MBSR interventions for nurses. Future studies are
needed to evaluate the effects of an MBSR training programme with a
larger sample size, more stringent recruitment methods, and a control
group to further determine psychometric effects following an MBSR
intervention.
5 | C O N CL U S I O N S
This study demonstrated that SWLS, PSS, and MAAS were all signifi-
cantly improved immediately following the MBSR intervention in this
cohort of ACCU nurses. Scores for PSS and MAAS also significantly
improved at month 4. This has implications for staff morale, patient
safety, and the overall well-being of ICU nurses. No improvements in
sickness rates were detected following the intervention. Develop-
ment and implementation of any future programmes involving MBSR
7
must take into consideration the limitations and lessons learned in
this project.
OR CID
Neil Anderson https://orcid.org/0000-0003-3275-5769
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How to cite this article: Anderson N. An evaluation of a
mindfulness-based stress reduction intervention for critical
care nursing staff: A quality improvement project. Nurs Crit
Care. 2020;1–8. https://doi.org/10.1111/nicc.12552