Effects of mobile mindfulness on emergency department work stress: A randomised controlled trial
Open accessAbstract
Objective: High‐occupational stress among ED staff has a detrimental impact on both staff wellness and patient care. The objective of the study is to determine whether 4 weeks of smartphone app‐guided mindfulness practice reduces stress levels of ED staff. Methods: This two‐arm randomised controlled trial was conducted in two Australian EDs in 2019–2020. Eligible participants were randomly assigned (1:1) to either an App group or a Wait to Treat group to practice daily 10 min app‐guided mindfulness for 4 weeks. Online surveys were collected for both groups at three time periods: before (T1), immediately after (T2) and 3 months after cessation (T3). Then the Wait to Treat group received the same intervention, followed by surveys immediately after the intervention (T4) and 3 months later (T5). Primary outcome was measured using the Perceived Stress Scale. Secondary outcomes were measured using the Maslach Burnout Inventory (three subscales: emotional exhaustion, depersonalisation and personal accomplishment), Mindfulness Attention Awareness Scale and Warwick‐Edinburgh Mental Well‐being Scale. Both intention‐to‐treat and per‐protocol analysis were performed. Repeated measurement data were analysed by the linear mixed model. Results: Of 148 enrolled participants 98 completed all the surveys, but only half (48%) reported continuous use of the app. Based on the results of the intention‐to‐treat analysis, there was a statistically significant improvement of perceived stress levels ( F = 15.70, P < 0.001), all three components of burnout (emotional exhaustion [ F = 14.22, P < 0.001], depersonalisation [ F = 3.62, P = 0.030], personal accomplishment [ F = 7.51, P < 0.001]), mindfulness ( F = 8.83, P < 0.001) and wellbeing levels ( F = 10.71, P < 0.001) from pre‐intervention to 3 months later with small effect sizes. Conclusion: Results of the present study demonstrate that brief mindfulness training via innovative digital technology had a small positive effect in improving emergency staff stress, burnout, mindfulness and wellbeing.
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Independence of time and place for use, accessibility and embedding into daily routines were mentioned as advantages most often.
“particularly the independence of time and place for use, accessibility and embedding into daily routines were mentioned as advantages most often [17, 31, 39, 46, 51].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
The Discussion describes accessibility and use at any time and place as advantages of the app. It does not say these advantages were mentioned most often, and it describes incorporating the practice into daily life as a challenge rather than an advantage. No page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredTwo studies concluded that infection risks were reduced, which was essential during the COVID-19 pandemic.
“Furthermore, two studies concluded that infection risks also were reduced, which was essential during the COVID-19 pandemic [32, 39].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
The Discussion (page unavailable) says the app may be better suited to COVID-19 social-distancing requirements, and Implications says digital interventions can be useful when isolation is required. The paper does not conclude that the intervention reduced infection risks; its reported outcomes concern stress, burnout, mindfulness and wellbeing. (LLM, conf=0.82)
Experimental — accuracy not yet measuredFlexibility due to 24-hour availability and independence of time and place was appreciated by participants in a study on truck drivers.
“This flexibility, due to 24-hour availability and independent of time and place, was appreciated by the participants in a study on truck drivers, who typically are difficult to reach in terms of local health promotion measures [34, 39, 52].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
The Discussion says the mindfulness app could be used at any time and in any place. But the Setting, participants and recruitment section identifies the study participants as emergency department staff, not truck drivers, and the paper does not report that participants specifically appreciated the app’s flexibility. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTruck drivers typically are difficult to reach in terms of local health promotion measures.
“This flexibility, due to 24-hour availability and independent of time and place, was appreciated by the participants in a study on truck drivers, who typically are difficult to reach in terms of local health promotion measures [34, 39, 52].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
The Implications section says busy healthcare workers can be hard to reach through traditional face-to-face interventions. But the study recruited emergency-department staff, not truck drivers, and does not establish that truck drivers are difficult to reach through local health-promotion measures. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNine studies focussed on nurses or healthcare employees.
“Nine studies focussed on nurses or healthcare employees [29, 31, 33, 35, 37, 39, 41, 49, 56].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
Some studies used commercially available apps not tailored to companies to test their effectiveness among their target group, and effectiveness in stress perception, perceived mindfulness and perceived well-being could be demonstrated.
“Furthermore, some studies used commercially available apps (and, thus, ones not tailored to companies) to test their effectiveness among their target group. Examples of these apps are the Calm app [43, 57] and Headspace. Effectiveness in terms of, e.g., stress perception, perceived mindfulness and perceived well-being could be demonstrated [27, 34, 39, 40].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
Users' curiosity (leading to use) and the advantage of supporting the user's autonomy and self-guided learning were mentioned fairly often.
“Furthermore, factors such as users’ curiosity (leading to use) [24, 52, 53, 58] and the advantage of supporting the user’s autonomy and self-guided learning were mentioned fairly often [9, 30, 35, 39, 41, 54].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
Compared with ordinary on-site programmes, various authors found ease of use and convenience to be advantageous factors.
“Compared with ordinary on-site programmes, various authors in their investigations found ease of use and convenience to be advantageous factors [26, 27, 39].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [39]
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Joshi, R., Marwah, G., Raman, S., Jones, K., Gan, C. C. R., & HOCKLEY, J. M. (2026) · Australian Critical Care · doi:10.1016/j.aucc.2026.101703
Khan, M. A., AlTeneiji, A., Almekhaini, L. A., Adam, H., Kieu, A., Rangraze, I., & Amiri, S. (2026) · Journal of Medical Internet Research · doi:10.2196/preprints.105075
- Authors
- Xu, H. (., Eley, R., Kynoch, K., & Tuckett, A.
- Affiliations
- The University of Queensland (AU)
- Mater Health Services (AU)
- Corresponding author
- Xu, Hui (Grace)
- Venue
- Emergency Medicine Australasia
- Publisher
- Wiley
- Published
- 2021-08-10
- Volume
- 34
- Issue
- 2
- Pages
- 176-185
- ISSN
- 1035-6851 (ISSN-L)
- 1742-6731
- 1742-6723
- OpenAlex
- W3192078766
- Cited by
- 42
- References
- 42
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 13 · 2023: 3 · 2022: 5
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Emergency Medicine Australasia (publishedVersion)
- PubMed (publishedVersion)
- QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by-nc)
- Griffith Research Online (submittedVersion)
- Funders
- Emergency Medicine Foundation (EMJS‐323R31‐2019‐XU)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- occupational stress, burnout, emotional exhaustion, depersonalization, personal accomplishment, psychological well-being, emergency department staff, healthcare worker well-being, digital mental health interventions
- MeSH terms
- Occupational Stress, Australia, Burnout, Professional, Emergency Service, Hospital, Humans, Mindfulness
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