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

Chinese version of the 10-item Perceived Stress Scale (PSS-10-C )

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.

Perceived Stress -Safety Culture Subscale.

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.

Nursing Burnout Scale (NBS)

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.

Actigraphy-Based Sleep Quality Index

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.

Sleep quality. Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-TC )

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.

Cognitive Function - Visual Pursuit Test (VTS-LVT)

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).

Cognitive Function - Determination Test (VTS-DT)

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).

Blood Pressure Monitoring Device - Omron HEM-907XL

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.