Background
Quality of life, as a multidimensional, extensive, and complex concept, is widely discussed in various fields, including health and medicine [1, 2]. This concept evaluates overall functioning, expectations, standards, concerns, and individual well-being and directly correlates with the sense of well-being in life [3, 4]. Numerous factors influence the quality of life. Age, culture, gender, education, socioeconomic status, illness, and social environment, along with behavioral factors, job stress, and inadequate coping resources, can lead to physical and mental health problems in individuals, ultimately reducing their quality of life [5‐8]. Quality of life can be associated with physical, psychological and social problems [9]. The importance of health status and quality of life is such that some proponents consider improving quality of life the primary goal of therapeutic interventions [10]. In constantly changing medical environments, professional stress has continuously increased, leading to an analysis of an individual’s quality of life. Among all healthcare professions, nurses, due to the physical and mental stressors associated with patient care, are more exposed to occupational burnout, fatigue, decreased satisfaction, and reduced quality of life [11]. Healthcare professionals face unpredictable challenges in a complex work environment due to factors such as high workload, shift work, low staff numbers, and high stress levels, which may affect their job satisfaction and professional quality of life [6, 12‐15]. Healthcare workers may experience psychiatric symptoms such as anxiety and sleep disturbances. These symptoms can negatively impact problem-solving skills and worsen their quality of life [16]. Work-related factors, social and demographic factors can have complex and multifaceted effects on the quality of life of nurses [17]. In their study, Ying et al. stated that nurses experiencing depression had a lower quality of life [18]. In the study by Caputo et al., stressors in clinical environments were identified as a risk factor for fatigue, reduced quality of life, and work motivation among nurses [5]. Therefore, considering the conditions and determining factors in the relationship between health and work, it is impossible to separate an individual’s physical and mental health from his/her professional activities and work environment [19]. Among healthcare professionals, operating room nurses are susceptible to various occupational hazards, including prolonged standing, awkward positioning during surgery, continuous performance of repetitive and monotonous tasks, rapid movements in emergencies, direct contact with patients’ blood or body fluids, and lifting heavy objects, which may lead to increased occupational stress [20, 21] .Indeed, the high volume of workload and long hours spent on complex procedures [22] and performing emergency procedures during night shifts place operating room nurses under high levels of physical and mental stress [20]. The operating room is a high-risk, dynamic environment with high responsibilities, where multidisciplinary professional teams are responsible for providing safe and effective treatment to patients [22, 23] Operating room nursing, as defined by the Association of Perioperative Registered Nurses (AORN), encompasses nursing activities before, during, and after surgical procedures [24] In the surgical environment, nurses play a key role in delivering patient-centered care using best practices [25] .Therefore, increased support for operating room nurses to employ safe surgical techniques and achieve better outcomes is essential [26]. Despite the importance of the quality of life in improving nursing skills and social functioning, few non-pharmacological interventions, including psychological-behavioral interventions, mindfulness, and yoga, have been conducted at the national and international levels. Relaxation techniques are among the accessible treatment options for nursing, which have recently received considerable attention [27‐30]. Among these interventions is Benson’s relaxation technique, introduced by Herbert Benson [31] Benson’s relaxation technique is a non-pharmacological method that has been investigated for its effects on sleep quality [32‐35], working life [36], pain reduction [37, 38], depression, anxiety, and stress [39‐42], fatigue [43, 44], Quality of life in cancer patients [34], acceptance and understanding of hemophilic patients [45], and preoperative anxiety [46] .This technique may also be effective in improving the quality of life of operating room nurses. However, in recent literature reviews, no published studies have been conducted in this area. Operating room nurses are under both physical and psychological stress [47]. The present study was conducted to determine the effect of Benson’s relaxation technique on the quality of life of operating room personnel.
Methods
Study design
This randomized controlled trial was conducted at Namazi, Faghihi, Khalili, Rakaia, and Chamran hospitals affiliated with Shiraz University of Medical Sciences (SUMS), Iran, from December 2021 to March 2022.
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Participants
Participants included operating room nurses who were willing to participate in the study, had obtained a quality-of-life score of less than 50% before the intervention, and had not participated in interventional studies such as therapeutic massage, relaxation therapy, and similar interventions during the past three months. The exclusion criteria included incomplete questionnaire responses and self-reported participants’ exposure to known psychiatric illnesses such as depression, anxiety, and psychosis, as well as encountering crises such as mourning or divorce (as these factors could affect the participants’ focus and proper execution of the Benson’s relaxation technique).
Sample size calculation
Based on a similar previous study using Number Cruncher Statistical System (NCSS) version 23 software, with α = 0.05, a power of 80% [45], and considering µ1-µ2 equal to 20.95 and δ equal to 12.31 and 13.63 in the control and intervention groups, respectively, the maximum sample size of 180 individuals (90 individuals in each group) was considered. The following formula was used to determine the sample size.
$$\:\varvec{n}=\frac{{({\varvec{Z}}_{1-\raisebox{1ex}{$\varvec{\alpha\:}$}\!\left/\:\!\raisebox{-1ex}{$2$}\right.}+{\varvec{Z}}_{1-\varvec{\beta\:}})}^{2}\:({\varvec{\sigma\:}}_{1}^{2}+{\varvec{\sigma\:}}_{2}^{2})\:}{{({\varvec{\mu\:}}_{1}-{\varvec{\mu\:}}_{2})}^{2}}$$
$$\:\varvec{n}=\frac{{(1/96+0/84)}^{2}\:({63/13}^{2}+{31/12}^{2})\:}{{(52/95-32)}^{2}}$$
Sample size
At the beginning of the study, 198 individuals were assessed. However, 18 participants were excluded from the study due to failure to meet the inclusion criteria (n = 13), refusal to participate (n = 2), and other reasons (n = 3) (Fig. 1). Ultimately, 90 individuals were included in each of the control and intervention groups for analysis.
Fig. 1
CONSORT flow chart of the participants
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Sampling method
In this study, a weighted stratified sampling method was used. Sampling was done in 5 Namazi, Faghihi, Khalili, Rajaei and Chamran hospitals. Each hospital was considered as a floor, and the volume of participants on each floor was determined according to the number of operating room personnel. In order to calculate the sample size, the total number of operating room personnel of 5 hospitals was calculated (600 personnel). Then the number of personnel of each hospital was divided by 600 and multiplied by 180 (the total number of participants) to obtain the size of each floor. Based on this, the sample size was obtained in Namazi Hospital with 200 people, 60 staff members. The volume of each floor in other hospitals was calculated in the same way.
Procedure
Random allocation
The random allocation method in this study will be the permutation block randomization method, such that “A” represents the intervention group and “B” represents the control group. This block was created using a sealed randomization list (https://www.sealedenvelope.com/simple-randomiser/v1/lists). This method is based on 45 blocks in 4 permutations (4*45 = 180), taking into account all possible quadruple permutations (AABB, ABAB, ABBA, BAAB, BBAA and BABA) and assigning zero to nine (according to a random number table) to each of these permutations, Runs. (AABB Code 0, BABA Code 1, AABB Code 2, BBAA Code 3, BAAB Code 4, and ABBA Code 5 to 9).
Then, using a random number table, 45 randomly selected (rows or columns) are selected, and the assigned permutation is written to each number. (The order of placing permutations next to each other is left to right respectively) and how all 180 people will be assigned to two groups A and B.
After random allocation, the questionnaire was given to both groups. Subsequently, the Benson relaxation technique program was implemented in the intervention group. It is noteworthy that those involved in data collection and analysis were blinded to the study groups.
Intervention group
To commence the intervention, we prepared an instructional pamphlet for the intervention group, defining and emphasizing the importance of the quality of life, explaining the implementation of the Benson relaxation technique, and highlighting the significance of regular practice. Participants were given two days to study the pamphlet and mentally prepare. Following the pamphlet study, a practical session was conducted collectively for male and female participants, where a consultant explained the technique and participants practiced it. For the correct implementation of the exercises, the training video of the correct implementation of this technique was also played for the intervention group. The participants in the intervention group received individual Benson relaxation technique training.
Participants were then positioned comfortably in a dark room, lying or sitting on a comfortable bed or sofa. Their bodies were kept warm with appropriate blankets or additional clothing, if necessary. Participants closed their eyes and focused away from any tension, concentrating on positive thoughts. A sound file containing instrumental music along with the Benson relaxation technique was played for 20 min. Participants were instructed to consciously control their breathing through their noses calmly and naturally while listening to the music. The instructions were as follows: “Breathe in through the nose, then exhale slowly through the mouth and say the number 1 while exhaling.” Breathing should be natural and comfortable. They were reassured that they should not worry about deeply relaxing and should allow relaxation to occur naturally. Next, they were asked to relax their body muscles from the soles of their feet and gradually advance to the face. In this technique, people were advised to try to relax their muscles completely. Finally, after 20 min, people remained in the same state of relaxation with their eyes closed for a few minutes and then opened their eyes. Any queries or concerns raised by the participants were addressed during this session. Also, a copy of this film along with a picture booklet was given to each person in the intervention group to use at home.
The Benson relaxation technique was to be performed regularly twice a day for eight weeks, with a gap of 4–6 h between each session [48]. During the weekdays, the participants did the exercises individually at home using the audio file. Participants recorded their practice in a daily log provided beforehand. The method of completing the log was explained during the practical training session. The performance of Benson’s sedation technique was followed up by the researcher over the phone to answer related questions. If a participant forgot to perform the intervention on any occasion, the log would remain blank. Recording the time and date of the relaxation sessions served three purposes: preventing forgetfulness during the eight weeks, ensuring better timing coordination for the participants, and allowing the researcher to verify the number of relaxation sessions conducted during the eight weeks, thereby ensuring a complete and reliable sample size in this regard.
Control group
The control group did not receive any relaxation interventions. To prevent contamination, no information about the intervention was provided to the control group participants, and those in the intervention group were instructed not to share any information about the Benson relaxation technique with the control group. After eight weeks, the relevant questionnaire was again provided to participants in both the control and intervention groups for completion. The control group subjects were given a CD containing Benson’s relaxation technique at the end of the eighth week. Subsequently, the collected data were analyzed using SPSS version 21.
Data collection tools: 1. Demographic information
The research data were collected using a demographic information form covering age, gender, marital status, number of children, educational level, work field, shift type, employment status, work experience, history of specific diseases, genetic diseases, working hours per week, night shifts per month, and double shifts per day (long shift) per month, as well as the SF-36 questionnaire to assess the quality of life.
Quality of life questionnaire
SF-36 Health Survey: The SF-36 questionnaire, consisting of 36 items, was designed by Ware and Sherbourne in 1992 in the United States, and its validity and reliability were assessed in various groups of patients [49]. This questionnaire evaluates eight different domains of health (general health, physical functioning, role dysfunction due to physical problems, role dysfunction due to emotional problems, pain, social functioning, energy, and emotional well-being). It assesses the quality of life of individuals, with the lowest score being zero and the highest 100. In the study carried out by Zhang et al., the correlation coefficients (r > 0.50) of the items in various domains were relatively high, indicating the good structural validity of this scale. Additionally, the reliability of this questionnaire was reported to be 0.79 according to Cronbach’s alpha coefficient [50]. The validity and reliability of the Persian version of this questionnaire have also been confirmed in Iran. Montazeri et al. reported the reliability of this questionnaire as 0.87, with internal consistency coefficients of the 8 sub-scales ranging from 0.70 to 0.85. Test-retest reliability with a one-week interval ranged from 0.43 to 0.79. Convergent validity results showed correlations between 0.58 and 0.95. Factor analysis identified two main components that together accounted for 65.9% of the variance [51]. In the study by Bashiri Nejadian et al., the reliability of this questionnaire was also calculated using Cronbach’s alpha method of 0.85 [52] In the current study, Cronbach’s alpha was 0.92 for the total questionnaire.
Data analysis
Mean (standard deviation) is used to describe quantitative data and frequency (percentage) is used to describe qualitative data. To measure the difference between the two groups, chi-square and Fisher’s exact tests were used for qualitative variables, and Mann-Whitney test was used for quantitative variables. Wilcoxon test was used to measure the difference between the times in each group. SPSS version 21 software is used for data analysis. Also, a significance level of 0.05 is considered.
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Ethical considerations
The present study commenced after obtaining ethical approval from the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1398.1331). At the outset, the study objectives were explained to the operating room nurses who participated in the study, and written informed consent was obtained. Additionally, the participants were assured of the confidentiality of their information and the voluntary nature of their participation.
Results
The mean age of the participants in the intervention group was 32.7 years, while it was 32.44 years in the control group. 45 (50%) the individuals in the control group were single, and 47 (52.2%) of those in the intervention group were married. 45 (50%) in both control and intervention groups were employed in general surgery. Moreover, 87(96.7%) in control group and 89 (98.9%) in intervention group had a bachelor’s degree. The work experience of participants in the intervention group was 8.67, compared to 9.18 in the control group. Overall, the two groups were homogeneous in terms of demographic characteristics (P > 0.05) (Table 1).
Table 1
The participants’ characteristics (n = 180)
Individual Characteristics | Control Group Number (percentage) / Mean ± Standard Deviation | Intervention Group Number (percentage) / Mean ± Standard Deviation | Significance Level | |
|---|---|---|---|---|
Gender | Male | 41 (45.6) | 43 (47.8) | 0.765 |
Female | 49 (54.4) | 47 (52.2) | ||
Marital Status | Single | 45 (50) | 43 (47.8) | 0.766 |
Married | 45 (50) | 47 (52.2) | ||
Hospital Name | Khalili Hospital | 17 (18.9) | 19 (21.1) | 0.994 |
Namazi Hospital | 19 (21.1) | 17 (18.9) | ||
Faghihi Hospital | 18 (20) | 18 (20) | ||
Rajaei Hospital | 18 (20) | 18 (20) | ||
Chamran Hospital | 18 (20) | 18 (20) | ||
Education Level | Diploma | 1 (1.1) | 0 (0) | 0.621 |
Bachelor’s | 87 (96.7) | 89 (98.9) | ||
Master’s | 2 (2.2) | 1 (1.1) | ||
Work Field | Orthopedics | 33 (36.7) | 41 (45.6) | 0.266 |
Urology | 17 (18.9) | 17 (18.9) | ||
Neurology | 34 (37.8) | 31 (34.4) | ||
General | 45 (50) | 45 (50) | ||
Women | 7 (7.8) | 5 (5.6) | ||
Eye | 14 (15.6) | 18 (20) | ||
Ear, Nose, and Throat | 14 (15.6) | 13 (14.4) | ||
Work Shift Type | Fixed | 13 (14.4) | 14 (15.6) | 0.835 |
Rotating | 77 (85.6) | 76 (84.4) | ||
Employment Status | Formal Employment | 54 (60) | 62 (68.9) | 0.539 |
Contractual | 5 (5.6) | 6 (6.7) | ||
Semi-Contractual | 2 (2.2) | 2 (2.2) | ||
Company | 1 (1.1) | 0 (0) | ||
The Post-Graduation Obligatory Service in Nursing | 28 (31.1) | 20 (22.2) | ||
Age | 32.44 ± 7.1 | 32.7 ± 6.01 | 0.412 | |
Work experience (years) | 8.67 ± 7.58 | 9.18 ± 6.85 | 0.418 | |
Weekly Working Hours | 49.02 ± 9.97 | 49.15 ± 9 | 0.909 | |
Number of Night Shifts per Month | 2.65 ± 2.09 | 2.73 ± 2.26 | 0.876 | |
Number of Double Shifts per Month | 10.45 ± 3.83 | 10.28 ± 3.35 | 0.811 | |
The comparison of the quality of life of operating room personnel between the two control and intervention groups before Benson relaxation was not significant Furthermore, the findings indicated that the quality of life of operating room personnel in both control and intervention groups became significant after Benson relaxation (P < 0.05). On the other hand, the comparison between the control and intervention groups showed that Benson relaxation resulted in increased quality of life in the intervention group (P < 0.0001). In terms of the dimensions of quality of life between the control and intervention groups after Benson relaxation, disorders related to physical problems (P < 0.05), emotional problems (P < 0.05), general health (P < 0.05), pain (P < 0. 0001), and social functioning (P < 0.05) were significant. However, physical functioning, energy, and emotional well-being were not significant. On the other hand, the comparison between the two control and intervention groups showed that Benson relaxation led to improvement in disorders related to physical problems (P < 0.05), emotional problems (P < 0.0001), energy (P < 0.0001), emotional well-being (P < 0.0001), social functioning (P < 0.0001), pain (P < 0.0001), and general health (P < 0.05) in the intervention group (Table 2).
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Table 2
Determination and comparison of the Mean scores for dimensions and total quality of Life Questionnaire between and within the intervention and control groups before and after the intervention
Variable | Group | Effect Size | P-value between groups | ||
|---|---|---|---|---|---|
Intervention | Control | ||||
Physical Functioning | Before | 75.05 ± 22.19 | 75.44 ± 20.52 | 0.01 | 0.904 |
After | 83.61 ± 16.81 | 80.66 ± 18.90 | 0.16 | 0.294 | |
P-value within the group | < 0.0001** | 0.045* | |||
Role Dysfunction Due to Physical Problems | Before | 54.72 ± 36.12 | 55.83 ± 35.95 | 0.03 | < 0.0001** |
After | 66.01 ± 30.73 | 53.88 ± 35.92 | 0.36 | 0.026* | |
P-value within the group | 0.002* | 0.616 | |||
Role Dysfunction Due to Emotional Problems | Before | 41.48 ± 36.14 | 53.70 ± 38.28 | 0.32 | 0.002* |
After | 66.29 ± 34.07 | 51.48 ± 38.43 | 0.40 | 0.010* | |
P-value within the group | < 0.0001** | 0.597 | |||
Energy | Before | 53.27 ± 18.77 | 56.66 ± 19.35 | 0.17 | < 0.0001** |
After | 61.72 ± 13.63 | 57.11 ± 17.25 | 0.29 | 0.078 | |
P-value within the group | < 0.0001** | 0.750 | |||
Emotional Well-being | Before | 58.80 ± 19.05 | 62.57 ± 18.06 | 0.20 | < 0.0001** |
After | 67.60 ± 14.29 | 63.60 ± 15.49 | 0.26 | 0.087 | |
P-value within the group | < 0.0001** | 0.923 | |||
Social Functioning | Before | 55.97 ± 21.13 | 59.44 ± 21.39 | 0.16 | < 0.0001** |
After | 65.41 ± 16.01 | 55.97 ± 18.57 | 0.5 | 0.001** | |
P-value within the group | < 0.0001** | 0.098 | |||
Pain | Before | 60.61 ± 20.33 | 63.22 ± 22.68 | 0.12 | < 0.0001** |
After | 72.63 ± 19.14 | 58.86 ± 22.44 | 0.66 | < 0.0001** | |
P-value within the group | < 0.0001** | 0.025* | |||
General Health | Before | 57.55 ± 18.10 | 60.05 ± 18.04 | 0.13 | 0.400 |
After | 65.05 ± 14.49 | 60.27 ± 14.44 | 0.33 | 0.038* | |
P-value within the group | 0.001** | 0.962 | |||
A comparison of the mean differences before and after the intervention between the groups showed that the mean quality of life score increased after the intervention (P < 0.0001). Furthermore, the comparison of mean differences before and after the intervention between the groups regarding dimensions of disorders related to physical problems (P = 0.001), emotional problems (P < 0.0001), energy (P < 0.0001), emotional well-being (P < 0.0001), social functioning (P < 0.0001), pain (P < 0.0001), and general health (P < 0.05) indicated improvement in each of these dimensions after the intervention (Table 3).
Table 3
Comparison of the Mean differences before and after the intervention between the groups
Variable | Group | Effect Size | P-value | |
|---|---|---|---|---|
Control | Intervention | |||
Physical Functioning | 5.22 ± 15.91 | 8.55 ± 20.46 | 0.18 | 0.093 |
Physical Role Dysfunction Due to Physical Problems | -1.94 ± 37.33 | 11.29 ± 33.94 | 0.26 | 0.001** |
Emotional Role Dysfunction Due to Emotional Problems | -2.22 ± 42.92 | 24.81 ± 37.58 | 0.67 | < 0.0001** |
Energy | 0.44 ± 16.29 | 8.44 ± 14.85 | 0.51 | < 0.0001** |
Emotional Well-being | 1.02 ± 15.43 | 8.80 ± 14.00 | 0.52 | < 0.0001** |
Social Functioning | -3.74 ± 21.20 | 9.44 ± 21.30 | 0.62 | < 0.0001** |
Pain | -4.36 ± 20.31 | 12.02 ± 21.67 | 0.77 | < 0.0001** |
General Health | 0.22 ± 20.60 | 7.50 ± 21.04 | 0.34 | 0.018* |
Discussion
The aim of the present study was to investigate the effect of Benson relaxation on the quality of life of operating room personnel. According to the results of this study, the implementation of the Benson relaxation technique led to an improvement in the quality of life of the intervention group. Nurses who performed the Benson relaxation technique reported a higher quality of life. Additionally, in the present study, the Benson relaxation technique improved the scores of the quality-of-life questionnaire and its subscales related to physical problems, emotional problems, social functioning, pain, and general health in operating room nurses.
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Similarly, it has been shown that the Benson relaxation technique enhances the quality of life in various dimensions in the healthcare domain [53‐55]. The results of multiple studies indicate the impact of the Benson relaxation technique on reducing patient pain [45, 56, 57]. It seems that the Benson relaxation technique helps individuals reduce negative thoughts and feelings associated with pain by accepting illness and unchangeable life conditions, consequently reducing pain severity [56]. Thus it is possible physical performance will also improve to some extent by reducing the intensity of pain. On the other hand, based on the results of Mehta et al.‘s study, the use of sedatives can be effective in reducing pain levels [58]. This may not reveal results that indicate the relative effectiveness of the Benson relaxation technique, or may display unrealistic results that affect the quality of the overall results. It seems that the selection and careful examination of the entry criteria for the classification of eligible participants is highly necessary [59]. The study of Abu maloh et al. showed that emotional fluctuations will affect the quality of the findings and cause the level of pain experienced by patients to increase. These situations can affect the participants’ ability to concentrate or practice relaxation techniques [38]. Therefore, it seems necessary to exclude the effects of such events in order to obtain accurate findings about the effectiveness of this technique. Furthermore, the Benson relaxation technique has a significant effect on reducing disorders related to physical problems and emotional problems, including anxiety and depression, and improving general health [53, 60]. Veiga et al. examined the effects of occupational stress and burnout on nurses and identified the influence of physical and mental health on these healthcare professionals. The results showed that occupational safety hazards and other workplace problems may affect the nurses’ social functioning, job satisfaction, and general health. Moreover, the lack of essential resources such as equipment, medications, and laboratory facilities, as well as any sense of insecurity, can lead to increased job stress and poor outcomes for patients [61]. It seems that Benson’s relaxation, by improving autonomic nervous system activity through muscle relaxation, improves individual and social performance and ultimately increases positive feelings in individuals [62]. One of the important dimensions that physiologically plays an important role in maintaining a person’s health is the quality of sleep [35]. In this regard, Rambod et al. recommended educating the nurses and implementing this technique to improve the quality of sleep. They stated that using this technique can reduce physical discomfort, create muscle relaxation, and alleviate anxiety disorders, which can be effective in improving individuals’ sleep quality [63]. The quality of sleep is affected by many variables, including a balanced diet, daily exercise, genetics and environmental factors. Not getting enough sleep can affect physical performance and quality of life [35, 64]. Therefore, the use of Benson’s relaxation technique, among other interventions such as yoga, deep breathing relaxation, music therapy, meditation, etc., is considered one of the standard relaxation techniques [44]. In summary, it seems that the Benson’s relaxation technique, as a complementary therapy, supports a comprehensive and extensive self-care program encompassing the physical, emotional, mental, and spiritual aspects of individuals.
Working in an environment with high-risk and critically ill patients, occupational stressors such as high workload, stress from infection risk, and many other factors can have many adverse effects and consequences that can affect the quality of life of nurses [65]. Borzoee et al. showed that performing relaxation techniques reduces the nurses’ anxiety levels after the intervention [66]. Additionally, Hassanzadeh et al. found that the Benson relaxation technique improved attention, a wide range of physical and mental symptoms, pre-stress symptoms, anxiety, mood, and self-confidence [67]. By affecting the levels of neurotransmitters and stimulating the release of calcium, Benson’s relaxation increases the release of dopamine and acetylcholine in the body. All these factors play a role in maintaining nervous functions, improving positive mood, increasing the level of cognitive performance and reducing level of pain [68].
Based on the results of multiple studies, stress management strategies such as Benson’s relaxation technique can help reduce occupational stress and improve patient outcomes [53, 66, 67, 69]. Although the outcome variables in the mentioned studies and the present study are different, it can be concluded that the use of relaxation techniques in individuals can lead to improvement in various dimensions of their mental, physical, emotional, and social aspects. Our findings may provide some evidence to support the effects of psychological interventions and relaxation techniques on the quality of life, filling in some of the missing evidence. However, more studies are needed to expand the existing knowledge about the impact of employing the Benson’s relaxation technique on the quality of life of nurses, especially operating room nurses.
One of the strengths of this study was that the implementation of Benson’s relaxation technique resulted in an improvement in the quality of life in various dimensions among operating room nurses. Therefore, this technique can be recommended as a complementary method for improving the quality of life of operating room nurses. One limitation of this study was that the participants were limited to operating room nurses, so the results cannot be generalized to other nurses in different clinical settings. Another limitation of the study was the short intervention and follow-up periods. It is suggested that longer, longitudinal studies should be conducted on this topic. Furthermore, it is recommended that this intervention should be used for all nursing groups in various clinical settings. Also in the present study to avoid contamination, no information about the intervention was provided to the control group participants, and the intervention group subjects were instructed not to share any information about the Benson relaxation technique with the control group. This issue can be considered as another limitation of the study. One of the solutions to this problem could be that the hospitals were randomly divided into three hospitals of the intervention group and two hospitals of the control group, in order to prevent the connection between the control and intervention groups. It is suggested to use this solution in future studies to prevent data contamination.
Conclusions
The study results demonstrated that Benson’s relaxation technique led to an improvement in the quality of life among operating room nurses across various dimensions. To enhance evidence-based practice, further studies on this subject are recommended. Moreover, the impact of Benson’s relaxation technique on other occupational outcomes of operating room nurses, such as the levels of stress and anxiety, sleep quality, physical activity, and self-efficacy, is suggested for investigation in future studies.
Acknowledgements
This project was conducted under approved grant of 20070 and ethics code of IR.SUMS.REC.1398.1331 at Shiraz University of Medical Sciences. The authors express their gratitude to the Vice Chancellor for Research and Technology of Shiraz University of Medical Sciences, the Clinical Research Development Center of Namazi Hospital and Dr Nasrin Shokrpour for editorial assistance, and the operating room personnel who participated in the study.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by Institutional Review Board (IRB) of Committee on Ethics at Shiraz University of Medical Sciences with code number: " IR.SUMS.REC.1398.1331”. The participants delivered their written informed consent ahead of conducting the study. Furthermore, the participation in the study was voluntary and the participants could be excluded at any stage of the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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