This measurement aims to understand the effect of self-acupressure on the Shenmen Point (神門) and (內關) points on the hand on emotional distress, anxiety, depression, stress, work fatigue and adaptability of clinical nurses. The main questions it aims to answer are: Whether acupressure can reduce emotional distress, anxiety, depression, stress and work fatigue in nursing staff. Participants will: 1\. Enforcement measures: 1. Acupressure group: Perform self-acupressure twice a day, each time for about 2 minutes, and record the acupressure records every day for 2 consecutive weeks. 2. Original method group: followed the original self-coping method. 2. After the intervention began, participants completed study questionnaires weekly for two months.
1. Purpose of the Study: The goal of this study is to understand emotional distress, anxiety, depression, stress, workplace fatigue, and resilience among clinical nurses, as well as the factors related to these conditions. Investigators also want to evaluate the effects of different coping methods-either by self-pressing specific acupuncture points (Shenmen and Neiguan on the hand) or using usual ways of managing stress and anxiety. 2. About the Acupressure Points: • Shenmen Point (神門): Shenmen, located on the inner wrist, is a key point on the Heart Meridian. It's often used in traditional Chinese medicine to calm the mind, ease anxiety, help with sleep problems, headaches, and emotional fatigue. • Neiguan Point (內關): Neiguan is located on the inner forearm. Pressing this point can help relieve stress, reduce bloating, calm palpitations, and improve sleep. It's often used when feeling tense or anxious. • Usual Coping Methods: If participants are assigned to this group, participants will simply continue handling stress and anxiety the way you normally do. 3. Who Can Join the Study: Participants can join this study if: * A clinical nurse aged 20 or older. * Participants screening results show a distress score of 3 or above, or a mood thermometer score of 4 or above. * Participants are willing and able to fill out questionnaires at specific times over the next two months. Participants cannot join this study if: * Participated in a similar study within the last month. * Currently work in administrative or non-patient care units (like the supply center). * Are currently pregnant. 4. Study Procedures: If participants agree to participate and sign the consent form, researchers will ask participants to fill out several questionnaires. These will cover basic info, emotional distress, mood, depression, anxiety, work stress, fatigue, and resilience. It takes about 10-20 minutes to complete. If participants distress score is 3 or higher, or your mood score is 4 or higher, participants will be randomly assigned to one of two groups: • Acupressure Group: Participants will learn how to press the Shenmen and Neiguan acupoints on their hands and press them twice a day (about 2 minutes each time) for 2 weeks. participants will also keep a simple daily log of your acupressure practice. • Usual Care Group: Participants will continue with usual ways of coping and fill out a short daily emotional self-assessment form. Investigators will check in with participants every week using the same set of questionnaires to track changes for two months. In total, participants will be asked to fill out the survey 9 times. 5. Possible Side Effects and How to Handle Them: • From the Acupressure: When pressing the Shenmen or Neiguan points, participants might feel a sensation like soreness, tingling, pressure, or slight pain-this is normal and usually tolerable. There's no research showing any harmful side effects from pressing these points. If it ever feels too uncomfortable, participants can adjust the pressure. • From Participation: The risks of participating in this study were similar to participants' normal, everyday experiences. Participants were free to stop at any time if they felt sick or uncomfortable during the study. Participants can also contact the program's emergency contacts. 6. Expected Benefits: Past research and traditional practice have shown that pressing the Shenmen and Neiguan points can help reduce anxiety, stress, insomnia, and related symptoms. While the researchers cannot guarantee that this study will help individual participants, it may help healthcare professionals understand ways to better support caregivers and could benefit others in the future. 7. The researcher's requirements for participants during the study: * Please do not participate in other similar clinical studies while participating in this clinical study. * Please fill in the daily log on time and truthfully. * Provide accurate information in the questionnaire. 8. Participants' privacy is protected: Researchers will only collect information necessary for this study. All personal data and survey responses of participants will remain confidential. The researcher will not use the participant's name or personal identification, but will assign a code to the participant so that the participant's identity remains anonymous in all records.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
160
Participants in this group will receive instruction on how to perform self-acupressure targeting two specific acupoints on the hands: Shenmen and Neiguan. The acupressure protocol includes pressing each acupoint approximately 15 times (about 30 seconds), with a total of four acupoints per session (both hands), for approximately 2 minutes per session. Pressure should be applied until a sensation of soreness, numbness, fullness, or slight pain is felt (equivalent to about 3 kg of pressure). Participants are asked to perform self-acupressure twice daily (once in the afternoon and once before bedtime, adjustable based on personal schedule) for a total of 2 weeks. They will record their practice using a daily log and continue to complete psychological and emotional outcome questionnaires weekly over a 2-month follow-up period.
Kaohsiung Veterans General Hospital
Kaohsiung City, Zuoying District, Taiwan
Depressive Symptoms
Depressive symptoms were assessed using the Taiwanese Depression Scale, which has demonstrated strong psychometric properties in Taiwanese populations. The TDS consists of 18 items rated on a 4-point Likert scale: 0 = none or seldom (less than one day per week), 1 = sometimes (one to two days per week), 2 = often (three to four days per week), and 3 = almost always (five to seven days per week). Total scores range from 0 to 54, with higher scores indicating greater severity of depressive symptoms. The results from Lee et al. (2000) demonstrated that the TDS had excellent reliability and validity. The Cronbach's alpha coefficient was 0.90, and the area under the receiver operating characteristic (ROC) curve was 0.92. The TDS also showed good concurrent validity, with a sensitivity of 0.89 and specificity of 0.92 at a cutoff score of 19. In the present study, the TDS demonstrated excellent internal consistency, with a Cronbach's alpha of .94.
Time frame: At baseline(weeks 0) and once weekly for 8 weeks(weeks 1-8)
Psychological Distress
Psychological distress was measured using the Brief Symptom Rating Scale-5 (BSRS-5), a validated screening tool for general psychological distress. The BSRS-5 assesses the subjective severity of the following symptoms: (1) anxiety, (2) depression, (3) hostility, (4) low self-esteem, and (5) insomnia. Each symptom was scored on a 5-point Likert scale, ranging from 0 ("not at all") to 4 ("extremely"), with a total score ranging from 0 to 20 points. Higher scores indicate more severe psychological distress. Studies have shown that a total score of 3-4 is the optimal threshold for identifying clinically relevant distress based on receiver operating characteristic (ROC) curve analysis. The BSRS-5 showed high accuracy (AUC = 0.92) and good sensitivity (0.83) and specificity (0.86). Therefore, this study used a BSRS-5 total score ≥4 as one of the inclusion criteria to ensure that participants with at least mild psychological distress were included in the study.
Time frame: At baseline(weeks 0) and once weekly for 8 weeks(weeks 1-8)
Resilience
This scale assesses an individual's ability to adapt and recover from stress and adversity. Each item is rated on a 5-point Likert scale, ranging from 1 ("strongly disagree") to 5 ("strongly agree"), with a total score ranging from 10 to 50, with higher scores indicating greater resilience. Initial validation studies demonstrated strong psychometric properties, including good model fit in confirmatory factor analysis (GFI = 0.973) and excellent internal consistency (Cronbach's α = .91). All instruments used in this study were authorized by their original developers and have been psychometrically validated in previous studies. All scales demonstrated good to excellent internal consistency, with Cronbach's α values ranging from 0.84 to 0.95.
Time frame: At baseline(weeks 0) and once weekly for 8 weeks(weeks 1-8)
Anxiety
Anxiety levels were assessed using the state subscale of the State-Trait Anxiety Inventory (STAI-S). Studies have confirmed the multidimensional factor structure of the Chinese version of the scale and demonstrated good psychometric properties, including adequate convergent and discriminant validity. In this sample, the STAI-S demonstrated excellent internal consistency (Cronbach's α = .95). The STAI-S consists of 20 items that assess anxiety-related feelings, thoughts, and behaviors at the time of assessment. Each item is rated on a 4-point Likert scale ranging from 1 ("not at all") to 4 ("very much"). Items 1, 2, 5, 8, 10, 11, 15, 16, 19, and 20 are reverse-scored. The total score ranges from 20 to 80, with scores between 20 and 39 indicating mild anxiety, 40 to 59 indicating moderate anxiety, and 60 to 80 indicating severe anxiety.
Time frame: At baseline(weeks 0) and once weekly for 8 weeks(weeks 1-8)
Job Stress
Perceived job stress was measured using the 14-item Work Pressure Inventory developed by Huang et al. (2017), which has demonstrated good internal consistency. The scale comprises three dimensions: low self-development, workload, and job characteristics. Each item is rated on a 5-point Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"), with total scores ranging from 14 to 70. Higher scores indicate greater perceived occupational stress. In the original validation study, the Cronbach's α coefficients for the three subscales were 0.81, 0.73, and 0.77, respectively. In the present study, the Work Pressure Inventory showed good overall internal consistency (Cronbach's α = .84).
Time frame: At baseline(weeks 0) and once weekly for 8 weeks(weeks 1-8)
Occupational Burnout
Occupational burnout was assessed using the Chinese version of the Copenhagen Burnout Inventory (CBI), which has demonstrated good psychometric properties in Taiwanese populations. The scale consists of four subscales: personal burnout, work-related burnout, client-related burnout, and overcommitment to work. Each item is rated on a five-point frequency scale: "always" (100), "often" (75), "sometimes" (50), "rarely" (25), and "never" (0). Subscale scores are calculated as the average of the items within each domain, ranging from 0 to 100, with higher scores indicating more severe occupational burnout. The original validation study reported Cronbach's α values above 0.84 across all subscales. In the present study, the scale demonstrated excellent internal consistency (Cronbach's α = .95).
Time frame: At baseline(weeks 0) and once weekly for 8 weeks(weeks 1-8)
Emotional Distress
Emotional distress was measured using the Distress Thermometer (DT), a single self-report screening instrument with a score range of 0 (no distress) to 10 (extreme distress), with higher scores indicating greater emotional distress. The DT demonstrated good psychometric properties in validation studies, with sensitivities ranging from 0.50 to 1.00 (median = 0.83) and specificities ranging from 0.36 to 0.98 (median = 0.68). This study used a DT cutoff score of ≥3 as the inclusion criterion. Other studies have shown that the optimal DT cutoff score varies across settings, typically ranging from 3 to 5, while thresholds of ≥4 or ≥5 are commonly used in clinical practice. The use of a score of ≥3 in this study was intended to maximize sensitivity and minimize the risk of underidentifying caregivers considered at high risk for psychological distress.
Time frame: At baseline(weeks 0) and once weekly for 8 weeks(weeks 1-8)
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