The effectiveness of the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) : A pilot randomized controlled trial

The effectiveness of the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) : A pilot randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effectiveness of the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) : A pilot randomized controlled trial Dong-Xu Shang, Li-Na Wang, Li-Min Shi, Shu-Ying Li, Yu-Fang Guo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4371687/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim This pilot study aimed to measure the feasibility and acceptability of the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse. Background According to the Job Demand-Resource model, enhancing personal and work resources can alleviate job burnout. And Appreciative inquiry (AI) was an effective method to increase personal and work resources. Thus, a nurse-manager dualistic intervention program based on AI had been developed. Methods A pilot randomized controlled trial. The intervention group (n = 23) accepted the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) (lasting for 9 weeks), while the control group (n = 24) did not. Outcomes was job burnout, it tested using generalized estimated equation (GEE), to verify effectiveness. Qualitative interviews were conducted to verify feasibility and improve the NMDI program, thematic analysis was used Golaizzi seven step Analysis. Results The intervention group had statistically lower scores for job burnout than the control group, time effects were significant on job burnout (each p < .05). Qualitative research formed two themes, agreed on the feasibility of the NMDI program and further consideration, were identified with four subthemes, confirmed the NMDI program was feasible and effective, and can helped nurse have positive mindset. Conclusion The NMDI program can reduce job burnout, helped participants establish positive mindset, all participants willing to continue participating in the future. Implications for Nursing Management: The benefits to participating in the NMDI program traversed the individual and organization, nurse managers should support and promote this kind of program and flexible application it in daily nursing management. Trial Registration: This study was approved by the appropriate institutional review board, and Registration No. of Clinical Trial Center: ChiCTR 2100047974, registration date: June 28, 2021. Suggested modifications： 1. Date of registration -Please include the date that your trial was registered in the ‘Trial Registration’ section of the Abstract. 2. Trial registration number -Please include the trial registration number in the ‘Trial Registration’ section of the Abstract. appreciative inquiry job burnout nurse Figures Figure 1 Figure 2 Background Job burnout refers to the state of physical and mental fatigue and exhaustion of individuals under work pressure, including emotional exhaustion, cynicism and reduced personal accomplishment [ 1 ] . Job burnout develops slowly but progressively worsening [ 2 ] . Research shows that job burnout not only causes nurses to have health problems such as headache, insomnia, anxiety, depression, digestive disease, endocrine dysfunction, but also influence their work performance, turnover intention and even care quality [ 3 – 6 ] . According to a report [ 7 ] , the global prevalence of nurses' job burnout can reach to 11.23%. A survey of 1009 nurses in China found that the incidence of nurse burnout has reached 58.8% [ 8 ] , even some regions of China is as high as 64.0% [ 9 ] . The nurses group are highly susceptible to suffer from burnout, it also the largest occupational group in frontline healthcare workers in the World Health Organization (2020) (Chen and Meier 2021). So the nurses' job burnout is a very important problem in the health system, need urgent solve. Now, researchers normally classify the burnout interventions into three categories: individual-focused, organizational interventions, and multi-components programs [ 10 ] . The Individual-focused intervention focuses on improving nurses' working ability and emotion regulation ability (e.g., stress management skills, communication skills training, mindfulness, cognitive behavior therapy, positive emotion regulation, key counseling and intervention emotions.). For example, Lu et al. used abbreviated four-week, twice-weekly mindfulness-based intervention program to intervene with intensive care unit nurses [ 11 ] , found that the intervention significantly improved nurses' mental health and reduced their burnout. Laker et al. implemented the mind management skills for life-program through a structured and group-based self-help intervention [ 12 ] , it lasted eight weeks (one ninety minute-long session per week), this program significantly reduces nurses' job burnout and enhances their wellbeing. According to the report, person-directed interventions has unique advantages in emotional exhaustion [ 13 ] , therefore, it has certain effectiveness in reducing the level of occupational burnout. But, some studies have found that the persistence of individual intervention effects is difficult to guarantee [ 14 ] . Organizational intervention usually changes in work procedures like task restructuring, work evaluation and supervision, to increasing job control or the level of participation in decision making [ 15 – 17 ] . Üstün [ 18 ] used an online support program to intervene with 48 nurses, mainly included sharing and discussing general problems as well as psychological difficulties, sharing information, news and experiences, and increasing self-confidence, etc. The intervention significantly reduced the level of nurse burnout. Partlak Günüşen et al. used the nurse-led intervention program to help nurses improve their professional quality of life (ProQOL) and reduce psychological distress [ 19 ] . The nurse-led intervention program, based on cognitive-behavioral approach, comprised four sessions. The study found that nurses from intervention group reported lower burnout symptoms than nurses from the control group. Research shown that, due to organizational intervention address major risk factors like work overload and effort reward imbalance, it will result in longer lasting positive effects on burnout and worksite mental health than person-directed interventions, but it may overlook the individualized differences of nurses [ 20 ] . Multi-components programs taking into account both personal and organizational factors, this type of intervention improves personal emotions and the work environment simultaneously. Haugland et al. add mindfulness and relaxation techniques to daily shift huddles [ 21 ] , they provided a serenity room, and hold structured debriefing led by charge nurses after a highly stressful or emotional event, such as a death on the client. This study significantly reduced the level of nurses' burnout. Adams et al. used The Cultural Change Toolkit to reduce the nurses' burnout [ 22 ] , the specific intervention content mainly included meaningful recognition, shared decision-making, and increased leadership involvement, this program were effectively alleviating nurses’ burnout. As report, the Multi-components programs will lead to better results on burnout and worksite mental health than either person or organization-directed interventions independently [ 10 , 23 ] . However, existing interventions lack consideration on how to improve the adaptability of nurses to their environment. Therefore, it is difficult to ensure the enthusiasm of nurses to participate in activities and the durability of intervention effects. AI is a new approach to change organizational [ 24 – 25 ] , it consists of "4D" cycle, include discover, dream, design and destiny [ 26 ] . AI helps organization members explore the strengths of individuals and organizations, and give everyone a chance to show and develop their strengths [ 25 ] , not just focuses on solving short-term problems [ 27 ] . Hence, our preliminary study used AI as the basic theory and followed the framework for the development and evaluation of complex interventions developed by MRC, UK, forming the nurse-manager dualistic intervention program based on the appreciative inquiry(NMDI) [ 28 ] . The NMDI program was mainly composed of discovery (inquire the meaning of the nursing profession, discover an existing job and personal resources of nurses, and help nurses to excavate potential resources that goes unnoticed before), dream (create a nursing dream to change the current status and arouse energy and enthusiasm of nurses), design (construct compelling strategies for turning "dreams" into "reality" and essential elements for resources promotion must be in place), and destiny (practice strategies in normal clinical work with organizational support and share the best practical experience). Theoretical Framework The NMDI program aims to improve personal and organizational resources to reduce the nurses' job burnout. Therefore, we have identified the job demand-resources model (JD-R) as the theoretical framework for our research through extensive literature review [ 29 – 31 ] . JD-R was proposed by Demerouti et al. [ 32 ] . In 2004, Schaufeli and Bakker [ 33 ] improved the JD-R theoretical model. They believed that job demand and job resources play a "enhancing" and "reducing" role in job burnout. Increasing the job demand (e.g., work overload, irregular work arrangements, and an unfavorable working environment.) can lead the continuous depletion of employees' physical and mental resources; and job resources can satisfy the basic needs of employees, motivating them to develop positive work attitude. Job resources come from the physical, psychological, organizational, and social aspects of work. For example, the professional training, peer support and trust, job position, work autonomy, etc. Xanthopoulou et al. [ 34 ] extended the JD-R mode, introducing personal resources into the model (e.g., self-efficacy, organizational-based self-esteem, and optimism). When job demands remain unchanged, increasing personal resources and work resources can effectively reduce job burnout. The personal resources and work resources can promote each other. Based on the characteristics of the AI and JD-R mode, we formed a theoretical framework Fig. 1 . The NMDI program starting from the relationship between personal resources, work resources, and job burnout. Improving nurses' work and personal resources through AI to alleviate job burnout. The plan mainly has four core stages, including discover (clarify personal and organizational resources, increase positive cognition), dream (combining the harvest from the dream stage, construct a nursing dream, and form correct self-awareness and work cognition), design (design action plans based on personal dreams, personal and organizational strengths) and destiny (implement the developed action plan and share the experience). 3. Aim The purpose of this study was to optimize the NMDI program and preliminary test of its effectiveness. Methods 4.1 Design This study was a pilot randomized controlled trial. 4.2 Participants Participants for this study were recruited from a tertiary hospital in Baoding, Hebei, China. The inclusion criteria were (a) nurses as measured by The Maslach Burnout Inventory – General Survey (MBI-GS) [ 35 ] , and the total average score is ≥ 1.50, (b) sign labor contract with hospital, (c) have the nurse professional qualification certificate of the Ministry of Health of the People's Republic of China and are within the valid registration period, (d) obtain employment ≥ 3 years, (e) understand the purpose of the study and participate voluntarily. Exclusion criteria were: (a) going out to enhance professional skills, (b) sick leave, (c) maternity leave and recently participated in similar investigation or research. Using the Gpower to predetermine the sample size. According to the similar studies [ 36 ] , used the emotional exhaustion scores was the primary outcome, power calculation was based on a medium size effect, an alpha of 0.05 and power of 0.80. Finally, intervention group and control group each require 27 participants. Some study said that the sample size of the pilot study should be at least 50% of the sample size of the formal experiment. Thus, the sample size of this study should not be less than 37 [ 37 – 38 ] . Finally, 47 nurses were included in this study. 4.3 Procedure A convenience sample of 47 burnout nurse from a tertiary hospital in Baoding between July 2021 and December 2021. The purpose and process of this study were explained to potential participants. All quantitative data were obtained at baseline (T 1), after 5 weeks of implement (T 2), and after the intervention was completed (T 3);the qualitative date were obtained by semi-structured interview after the intervention was completed (only interviewed the intervention group nurses). Nursing managers (e.g., head nurse, vice director, and director of the nursing department) called on nurses was the main method of recruitment for participants. Nurses who had an interest in the study could contact the researchers or the nursing managers by phone or WeChat. A total of 47 nurses were randomly selected from 10 clinical departments, the nursing managers groups the nurses, the specific details are as follows:10 departments were randomly divided into the intervention group and the control group through stochastic tables' law (Before grouping, no group member knows whether they belong to the intervention group or the control group). Therefore, the 47 nurses were randomly divided into the intervention group (n = 23) and the control group (n = 24). Participants and researchers were blinded to the allocation method and process. 4.4 Intervention The intervention group acceptance the NMDI program. The NMDI program consists of six stages: inception, discovery, dream, design, destiny and keep, specific intervention content can be found in Table 1 . Table 1 The Nurse-Manager Dualistic Intervention(NMDI) program based on the appreciative inquiry Intervention time Intervention objectives Intervention content Inception (First week) You and I know each other and go hand in hand 1. To form an intervention group 2. To introduce the aims and contents of the program 3. To construct affirmative themes 1. Organize the first meeting and conduct several ice-breaking games to help nurses know each other; 2. Provide intervention manual and introduce the concepts, theory of AI, the process and consideration of the intervention; 3. Form affirmative themes revolving around overall changing agenda via "brain storm". Discovery (Second week) Exploring professional significance 1. To discover personal resources through self-exploration and peer support; 2. To discover organizational resources through managers and peer support 1. State of peak experience and explore positive characteristics of nurses; 2. Explore personal strengths via character-strengths survey; 3. Communicate with managers and colleagues to list organizational resources that can be used to deal with job-related issues; Dream (Third week) Draw a dream blueprint 1. To develop self-confidence and a positive self-image; 2. To build positive career dreams. 1. Gain new insights through reviewing old material, and enhance participants’ strengths; 2. Build a career dream using personal strengths and organizational resources and record the dream by mails or painting; 3. Share dreams with group members and construct declarations for the dreams; Note: manager participate this process and give suggestion about the dreams Design (Fourth week) Build dreams 1. To design the work plan to strengthen job control; 2. To collaborate with colleagues and managers to get organizational resources. 1. Review the dreams built by participants; 2. Order the goals, personal strengths and organizational resources by importance and figure out work plan to achieve the primary goal with suggestions from managers; 3. Break the work plan into several phases and set short-term goals for each phases. Participants are suggested to record the process of realizing their dreams Destiny (5th to 8th week) Sharing best practices 1. To form a support team to promote participants' work performance; 2. To organize group meetings to share positive experiences and get supports from managers and colleagues. 1. Support teams consist of intervenors and managers. Participants can contact with support team to get suggestions. Meanwhile, support teams need to supervise participants to guarantee their performance followed the work plan; 2. Organize online meetings for participants to share their best experiences and discuss with support team and colleagues to cope with difficulties and frustration; 3. Each participant needs to summarize their gains and give out positive concluding statements. keep (The ninth week) Celebrate progress and sustainable development 1. To strengthen personal and organizational resources via performance feedback; 2. To create a positive work environment via personal competence improvement and good relationships with colleagues and managers; 3. To continue set goals and work plan 1. Celebrate the achievements with group members and work out new goals; 2. Explore new personal strengths by sharing successful experiences; 3. Colleagues and managers summarize participants' positive changes and give out positive feedback and expectations; 4. Intervenors review the intervention process and encourage participants and managers to employ AI-based NMDI into their clinical work in future. Each group consisted of 6–8 participants. The NMDI program was an online and offline mixed burnout intervention program with six sessions, included 5 weekly sessions and one 4-week session (destiny). The weekly session lasts for 120–180 min, for the 4-week destiny, each week hold a 60–90 min online meeting. Group intervention was used in all treatments. The control group didn't receive any intervention from the research assistants during the intervention period. If the effects of this study were good, according to the requirements of the nurses in the control group, the NMDI program were provided to the control group when the study was completed. 4.5 Measure The socio-demographic questionnaire used in this study include participants' age, length of service, gender, marital status, professional title, education level, fertility, shift arrangement, etc. 'Burnout' was assessed by MBI-GS. LI and Shi developed this scale [ 12 ] , the scale had 15 items in total, included three dimensions of emotional exhaustion (EE), cynicism (CY) and lack of professional efficacy (RPE). This scale used a 7-point Likert scale from 'never', 0, to 'everyday', 6, to score the items. The dimension of lack of personal accomplishment is scored inversely. According to Kalimo et al. [ 39 ] , the dimension score is the average score of the items included, and the total score is (EE)× 0.4+(CY)×0.3+(RPE)×0.3, the MBI-GS total score in which 0 ~ 1.49 points are no burnout, 1.50 ~ 3.49 points are mild to moderate burnout, and 3.50 ~ 6.00 points are severe burnout. Qualitative data was collected from the Semi-structured interviews(discussed and formulated by team members), including two questions: (a)Do you think the NMDI program are appropriate (can be evaluated from the perspective of plan content setting, activity team size, intervention form, duration of each activity, intervention frequency, etc.)? If not, what specific aspects do you think need to be improved?; (b) How do you feel about participating in this NMDI program? And if you willing to continue to participate in the future? 4.6 data analysis SPSS 26.0 (International Business Machines Corporation (IBM), Armonk, United States of America) was used for analyzing quantitative data. General sociodemographic data and job burnout level were described by frequency, percentage, standard deviation (SD), etc. The differences between intervention group and control group were tested using one way ANOVA, two independent samples t-test. The influence of the NMDI program on nurses' job burnout were tested using generalized estimated equation (GEE). Interview data were audio-recorded and then transcribed within 24 hours. The result were managed by NVivo 12.0. Two researchers who have received qualitative research training will compare, analyze, and infer word data by reading the article separately. Using the Colaizzi seven-step method, carefully study the interview notes. Extract meaningful statements that align with the research purpose, encoding. Summarize and extract meaning from meaningful statements, and find common features. Then, forming themes and categories. Finally, provide a complete statement of the formed theme. Results A total of 47 nurses were enrolled in this pilot study, three from the the control group withdrew before intervention, finally, 44 nurses completed the entire study (intervention group=20 and control group=24). Figure 2 shows the flow diagram of this study. And 18 nurses (intervention group nurses) completed the semi-structured interviews. The demographic data on these two groups were shown in Table 2 . No significant differences were found between the two groups in terms of demographic characteristics (e.g., sex, age, working seniority, education, marital status, if have children, form of employment, positional title, average monthly income and shift), and job burnout. Table 2 Homogeneity of participants' characteristics at baseline between the two groups (n = 44) item t /x 2 P Intervention group(n = 20) Control group (n = 24) Sex 1.746 0.493 Male 0(0) 2(8.3) Woman 20(100) 22(91.7) Age 27.55 ± 4.48 28.33 ± 3.36 -0.663 0.511 Working seniority 6.30 ± 4.64 9.26 ± 6.05 -1.748 0.081 Education 1.746 0.393 Junior college or below 0(0) 2(8.3) Bachelor degree or above 20(100) 22(91.7) Marital status 5.851 0.054 Unmarried 12(60.0) 6(25.0) Married 7(35.0) 17(70.8) Other 1 (5.0) 1(4.2) If have children 1.131 0.287 Yes 12(60.0) 14(75.0) No 8(40.0) 10(25.0) Form of employment 2.528 0.283 Temporary employment 5(25.0) 6(25.0) continued Personnel agency 10(50.0) 7(29.2) Officially in preparation 5(25.0) 11(45.8) Positional title 1.482 0.477 Nurse 6(30.0) 7(29.2) Nurse practitioner 8(40.0) 6(25.0) Nurse in charge and above 6(30.0) 11(45.2) Average monthly income 3.801 0.434 9000 2(10.0) 0(0) Shift 1.313 0.287 Day shift 8(30.0) 6(25.0) Day and night shift 12(60.0) 18(75.2) Job burnout 2.57 ± 0.64 3.01 ± 0.79 1.987 0.054 5.1 Quantitative results 5.1.1 The effects of NMDI on job burnout. Used GEE to test the effect of the NMDI program. The specific steps were: taken the scores of each evaluation index as the dependent variable. Group, time, group × Inclusion were bring into the model. Selecting "Unstructured" work related matrix. The GEE analysis revealed that the NMDI program significantly decreased job burnout (p < 0.001), the intervention group had statistically lower scores for job burnout than the control group. Time effects were significant on job burnout (p < 0.05), with the scores for job burnout differing between the intervention and control groups during the intervention process (see Table 3 ). Table 3 GEE results for the main effects and interaction effects Wald χ 2 df P Group effect 30.328 1 < 0.001 Time effect 7.864 2 0.020 Group × time effect 0.960 2 0.619 5.2 Qualitative results 18 nurses(intervention group) accepted the semi-structured interviews, see Table 4 for general information. Two themes were identified from the data: agreed on the feasibility of the NMDI program and further consideration. Table 4 Interviewee information(n = 18) Number sex age Work years A 1 female 31 11 A 2 female 32 11 A 3 female 35 16 A 4 female 23 3 A 5 female 33 11 A 6 female 25 3 A 7 female 25 3 A 8 female 24 4 A 9 female 28 5 A 10 female 36 16 A 11 female 24 3 A 12 female 35 12 A 13 female 24 3 A 14 female 24 3 A 15 female 24 3 A 16 female 36 16 A 17 female 35 15 A 18 female 39 20 5.2.1 Theme 1: agreed on the feasibility of the NMDI program Within this theme, participants evaluated the NMDI program, they identified two categories: (a) attitude towards the NMDI program, (b) evaluation of the NMDI program design. Attitude towards the NMDI program All respondents are willing to continue participate if the project is still ongoing. About the benefits of the project, the following words frequently appear: "positive attitude," "optimistic," "positive cognition," "ability promotion," "development" and " discovering Advantages". So, the benefits of the NMDI program were guiding participants to explore their own and organizational strengths, helping them establish positive mindset, and further enhance strength. For many, participated in the NMDI program can improve with colleagues, such as daily mindset, working ability, etc. A nurse mentioned "This project played a supervisory role for me, and I gained growth from it, it was very helpful for my work" (A 6, A 13, A 15). The project also let the participants feel the beauty of the work, the life, and their attitudes became more positive. Some nurses pointed "when I meet difficulties, the strengths can help me overcome them" (A 5), "Overall, my mentality tends to be more optimistic and peaceful" (A 11) . Evaluation of the NMDI program design Within this categories, participants evaluated the NMDI program from five aspects, (a) team size, (b) intervention form, (c) participation time (d) frequency, and (e) the duration of each activity of the NMDI program. "Team size" was closely related to the depth and duration of group discussions. All the surveyed nurses stated that the current number of group members was appropriate, they think had too many participants may costed a lot of time in discussions, but too few participants would led the discussion lack of depth. Some nurses mentioned "I think about five people are suitable, too many people, the activity will take a long time"(A 5, A 9, A 15). Appropriate discussion group size can ensure that members efficiently complete the activity content. "Intervention form", it was applicative by more than half of the surveyed nurses. The combination of online and offline interventions can epidemic prevention and control requirements under the COVID-19 epidemic, providing more choice space for participants, increasing the frequency of participants' participation. A nurse thought "Online mode, I think was good… but offline, we may couldn't participated this project, because our work were too busy…," (A 16, A 18), this can make more nurses who lack time participate in this program. But there were nurses having different view, they thought, online approach is conducive to responding to the requirements of COVID-19 epidemic prevention and control, but offline intervention can ensure the depth of communication, a nurse pointed (A 3). So providing two kinds of from (online and offline interventions) can satisfy the needs of different individuals and respond to emergencies. "Participation time", all nurses believed that the time of participating in the project was acceptable. The nurses believed that selecting specific participation times can give them some freedom of choice. At the same time, it can ensure the number of group members participating in each activity. Two nurses commented, "Now, this kind of activity time selection was quite reasonable. Sometimes I have my own things to do. The relative freedom in time allows me to take this activity seriously" (A 9, A 14), "I think this approach can estimate the number of members participating each time, it an ensure the smooth progress of each activity" (A 5). "Frequency", all nurses stated that once a week was acceptable, It will not disturb their normal work and life. "This frequency was acceptable, not too frequently and the interval between each time was not long." (A 10), a nurse pointed. "The duration of each activity of the NMDI program", it was accepted by all interviewed nurses (the weekly session lasts for 120ཞ180 min, for the 4-week destiny, each week hold a 60ཞ90 min online meeting). The duration of existing participation in activities will not cause a serious burden on participants. All nurses indicated that the time spent within their acceptable range. Some interviewees even expressed that she could invest more time in this program." Sometimes, when we chat happily and speculate, we may chat for a longer time." (A 18). 5.2.2 Theme 2: further consideration Within this categories, the NMDI program should have further consideration, including two aspects, (a) views on Time, and (b) fully understand in the early stage. Views on Time "Time" was the core issue facing in this project. Properly handled the relationship between nurses' busy work, limited rest time, and the participation in activities was the key to the smooth progress the NMDI program. "Time" breakthrough the entire project, the main questions collected in the interview are "increasing time" and "reducing time". In aspect of "increasing time", a respondent pointed out that due to the unique nature of her work, her plan that developed in the project may be hindered, "because of the COVID-19 epidemic, we will add many temporary tasks, I really don't have too much time to do it when I'm busy…" (A1). Another nurse reflected "This phase is short (the destiny stage), my plan may not be completed completely" (A 11). So, the implementation time of the plan is too short, it will affect the expected effect, because the implementation time of the plan is too short, so extending the destiny stage is necessary. In aspect of "reducing time", some nurses also advocated to reduce the number of times that they participate in activities, while ensured the integrity of the activities. In the NMDI program, "dream stage" and "design stage" had close connection, "design stage" was based on "dream stage" to completed, the two stage interwovenness. A nurse thought, "By combining these two stages together (dream and design), we can complete tasks more efficiently, you know we are very busy" (A 9), and it also reduced the time participants spend on the round trip. A nurse pointed out that, "Even if the activity lasts for only two hours, I may still need to spend half a day because the travel may be affected by traffic conditions, distance. " (A 11). Fully understand in the early stage "Fully understand in the early stage", was crucial for the recruitment of participants and the promotion of the project. Making the nurses fully understand the project, accurately attracted suitable client, ensured the smooth progress of the project, and reduced the risk of the client loss. Some interviewees pointed out that she participated in the activity only because of the requirements of the manager, she had some error in the content learned. "ah, is that so? It's not same as what our leaders said" (A 12), a nurse said. Discussion Revision suggestions: Kindly remove Clinical trial amendment points from the main manuscript. point to point reply: The revised content related to the plan has been deleted, the specific deleted parts have been highlighted in red in the article. The aim of this pilot study was to evaluate the feasibility and effectiveness of the NMDI program. Our research results indicated that the NMDI program can be accepted and used by clinical nurses, it significantly alleviated nurses' burnout, helped them maintain a positive attitude. Compared with previous intervention, the NMDI program is one of few intervention to tackles the burnout root of the person and organization mismatch issue. It may become a long-term way to reduce nurses' job burnout. The NMDI program can simultaneously motivate personal strengths and organizational resources to cope with burnout account for the study's comparatively positive results. Research indicates that AI can effectively improve work resources and personal resources [ 40 – 41 ] . The NMDI program guided by AI, helping nurses with burnout active explored their work resources and personal resources. For example, the program requires participants to recall peak experience states and explore the positive characteristics of nurses, it helped nurses discover personal strengths and organizational resources. Actively utilizing advantages, could make advantage growth and harvest positive emotions [ 42 ] . Based on it, in the design stage, the nurse could further enhance advantages and gain positive emotions by using their personal strengths and organizational resources to design the work plan. It also aligns with the JD-R mode. So, the NMDI program could precise enhancement of each nurse's strengths, reduced burnout. It worth mentioned that the participants played the main role in drawing up their action plan, could fully target at the nurses themselves. It is important for enhancing nurses' positive attributes and organizational participation [ 43 ] . The results of the semi-structured interview indicate that the tested nurses generally accepted and recognized the NMDI program. But some content still needed to be revised. The core issue is "time". Providing interventions for a longer or shorter period may all caused the reduction in program effectiveness [ 44 ] , so eliminate those inconsistencies may strengthen the associations between length of interventions and the intervention effects, achieving better intervention outcomes [ 45 ] . However, simply and roughly reducing activity time is not advisable, it should be increased or reduced according to the situation. In our research, we found that the "dream stage" and "design stage" have a better connection. To solve the above issues, we can consider making relevant revisions to the "dream stage" and "design stage". on the other hand, some participants reflected even if the one-hour activity, will also spend nearly half a day (because of the traffic, weather, distance and other factors), some studies have also reflected this problem [ 46 ] . So, when conducting research, we should consider the participants' difficulties, such as the unplanned time spent. Secondly, considering the characteristics of nurses' work, extending the implementation stage may be necessary. Some participants pointed out that, busy and uncertain work condition disrupted their activity plans. The nurses' free time was reduced because of the heavy nursing work [ 47 – 48 ] , and the sudden public health events such as the COVID-19, would made this phenomenon more serious [ 49 ] . These situations led nurses don't have enough time to complete the plan. So, the time pressure needed be taken seriously. Therefore, extending the implementation phase appropriately may bring the following benefits to our research: 1) giving more time to nurses for completing the action plan, 2) reduce psychological pressure on nurses(because don't have enough time to complete the action plan), 3) reduce loss rate. In addition, "Fully understand in the early stage," also need to be noticed. Nurses pointed out, short-term and non-procedural project introductions by nursing managers led the nurses misunderstand the project content (for example, some nurses couldn't fully understand some concepts involved in the intervention process, participating this program only by listening leader's suggestions). In fact, this situation may affected the progress of our intervention activities and increased time cost for participants. Because the researcher needed to explain relevant content again, participants needed to understand the project again. Studies indicated that actively and relatively long-term mobilization activities could effectively improve the participation of team member [ 46 , 50 ] . Thus, in future research, we should promote the project content, mainly including the purpose of the project, implementation methods, participation time, and specific concepts involved. Making participants understand the benefits of the program and potential costs of time. 7. Limitations This study has some limitations. First, as the COVID-19 broke out in the study city, this study was only conducted online, the feasibility and effectiveness of offline implementation still need to be verified. Second, female were the majority of participants, this uneven gender distribution prevents generalizing our findings to male nurse. Third, we only collected the short-term effect, the long-term effect is not clear. Fourth, the pilot study was conducted in a tertiary hospital in China with a small sample size, limiting its generalizability of results to other settings. Conclusion Based on this study, the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) is feasible and effective, can effectively reduce the level of job burnout of nurses. It may a long-term way to reduce nurses' job burnout. In the future, when applying the NMDI program, we need more consideration in terms of the "time" and "Fully understand in the early stage" to ensure the effective implementation of the program. Next, a randomized controlled trial with a larger sample size will be conducted to examine this program's impact and sustainability in reduce job burnout. 9. Implications for nursing management Nurse managers play a pivotal role in help nurses explore personal strengths and organizational resources. They influenced the enthusiasm for nurses to seek personal strengths and organizational resources. Thus, nurse managers are key to help nurses improve. Findings of the present study indicate that the NMDI program is an easy and highly acceptable intervention to relieve nurses' burnout and raise positive emotions. Different nurses' burnout may have different reason, the nurses manager may difficult to fully understand and solve. So, provide a method, let nurses actively utilize their own advantages to solve problems is necessary. Nurse Managers need to realize the positive impact of the NMDI program on nurse growth and organizational change. The NMDI program can suit their culture, background and management models, so the nursing manager can use it based on their situations. In addition, the combination of online and offline methods is recommended, and we also provided. which can adapt to the needs of different organizations and individuals. Finally, we suggest that nursing managers consciously positive resources into organizational management to promote positive development of the organization. Declarations Acknowledgements The authors thank the nursing managers and nurses of the Hebei Provincial Mental Health Center for participating in the pilot study. Author contributions All authors contributed to the design of the methods, data collection tools, and data analysis. D.X.S. collected the data, conducted the initial analysis, and drafted the manuscript, Y.F.G reviewed the data analysis and the final version of the manuscript, N.L.W, Y.S.L, and M.L.S Completing nurse recruitment work. All authors have read, reviewed, and approved the final manuscript for submission. Funding This study was funded by National Natural Science Foundation of China (72004120), Natural Science Foundation of Shandong Province (ZR2020QG058). Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate Approvals were gained from the School of Nursing, Hebei University, and the participating hospital. This study was approved by the appropriate institutional review board, and Registration No. of Clinical Trial Center: ChiCTR 2100047974, registration date: June 28, 2021. All participants signed informed consent forms before participating in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Statement The study adheres to CONSORT guidelines, the completed CONSORT 2010 checklist please refer to additional file. References Maslach, C., Jackson, S.E., 1981. The measurement of experienced burnout. Journal of Organizational Behavior 2 (2), 99-113. Yesil, A., Polat, S., 2023. 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Australian cancer nurses' experiences of burnout: Exploring the job demands and job resources of metropolitan cancer nurses during 2019-2020. Health Care Management Review 48 (1), 61-69. Demerouti, E., Nachreiner, F., Bakker, A.B., Schaufeli, W.B., 2001. The job demands-resources model of burnout. Journal of Applied Psychology 86 (3), 499-512. Schaufeli, W.B., Bakker, A.B., 2004. Job demands, job resources, and their relationship with burnout and engagement: A multi-sample study. Journal of Organizational Behavior 25 (3), 293-315. Xanthopoulou, D., Bakker, A.B., Demerouti, E., Schaufeli, W.B., 2007. The role of personal resources in the job demands-resources model. International Journal of Stress Management 14 (2), 121-141. Maslach, C., Jackson, S.E., 1981. The measurement of experienced burnout. Journal of Organizational Behavior 2 (2), 99-113. Günüşen, N.P., Üstün, B., 2010. An RCT of coping and support groups to reduce burnout among nurses. International Nursing Review 57 (4), 485-492. Cocks, K., Torgerson, D.J., 2013. Sample size calculations for pilot randomized trials: a confidence interval approach. J Clin Epidemiol 66 (2), 197-201. Wittes, J., Brittain, E., 1990. The role of internal pilot studies in increasing the efficiency of clinical trials. Statistics in medicine 9 (1‐2), 65-72. Kalimo, R., Pahkin, K., Mutanen, P., Toppinen-Tanner, S., 2003. Staying well or burning out at work: Work characteristics and personal resources as long-term predictors. Work and Stress 17 (2), 109-122. Khan, B., Rivera, R.R., Manzano, W., Fitzpatrick, J.J., 2018. Appreciative Inquiry: A Program to Enhance Positive Nurse-to-Nurse Interaction. Nurse Leader 16 (1), 54-57. Lazic, J., Radenovic, M., Arnfield, A., Janic, D., 2011. Implementation of a nurse education programme in paediatric oncology using appreciative inquiry: A single center experience in Belgrade, Serbia. European Journal of Oncology Nursing 15 (5), 524-527. Woodworth, R.J., O'Brien-Malone, A., Diamond, M.R., Schüz, B., 2016. Happy Days: Positive Psychology interventions effects on affect in an N-of-1 trial. International Journal of Clinical and Health Psychology 16 (1), 21-29. Reid, R.C., Chappell, N.L., 2017. Family Involvement in Nursing Homes: Are Family Caregivers Getting What They Want? Journal of Applied Gerontology 36 (8), 993-1015. Lee, M., Ryoo, J.H., Crowder, J., Byon, H.D., Wiiliams, I.C., 2020. A systematic review and meta-analysis on effective interventions for health-related quality of life among caregivers of people with dementia. Journal of Advanced Nursing 76 (2), 475-489. Ko, E., Wongvibul, T., Rose, K.M., Jun, J., 2023. The effects of self-guided interventions on stress, burden, and mental health in caregivers of people living with dementia: A systematic review. International Journal of Nursing Studies Advances 5. Tasseron-Dries, P.E.M., Smaling, H.J.A., Doncker, S.M.M.M., Achterberg, W.P., van der Steen, J.T., 2021. Family involvement in the Namaste care family program for dementia: A qualitative study on experiences of family, nursing home staff, and volunteers. International Journal of Nursing Studies 121. Bernales-Turpo, D., Quispe-Velasquez, R., Flores-Ticona, D., Saintila, J., Ruiz Mamani, P.G., Huancahuire-Vega, S., Morales-Garcia, M., Morales-Garcia, W.C., 2022. Burnout, Professional Self-Efficacy, and Life Satisfaction as Predictors of Job Performance in Health Care Workers: The Mediating Role of Work Engagement. J Prim Care Community Health 13, 21501319221101845. Chen, Y.J., Lin, K.P., 2022. Association Among Work Characteristics, Role Transition, and Job Burnout in Nurse Practitioners in Taiwan. Inquiry 59, 469580221081403. Wan, Z., Lian, M., Ma, H., Cai, Z., Xianyu, Y., 2022. Factors associated with burnout among Chinese nurses during COVID-19 epidemic: a cross-sectional study. BMC Nurs 21 (1), 51. McCabe, M.P., Mellor, D., Karantzas, G., Von Treuer, K., Davison, T.E., O'Connor, D., 2017. Organizational factors related to the confidence of workers in working with residents with dementia or depression in aged care facilities. Aging Ment Health 21 (5), 487-493. Additional Declarations No competing interests reported. Supplementary Files CONSORT2010Checklist.doc Semistructuredinterviews.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4371687","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318644323,"identity":"3f3d5952-41fd-4f42-a100-60f9e2c3acf7","order_by":0,"name":"Dong-Xu Shang","email":"","orcid":"","institution":"Affiliated hospital of chengde medical university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dong-Xu","middleName":"","lastName":"Shang","suffix":""},{"id":318644324,"identity":"eaa84285-c29f-45c0-8325-56307489316e","order_by":1,"name":"Li-Na Wang","email":"","orcid":"","institution":"Hebei Provincial 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12:44:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4371687/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4371687/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60198350,"identity":"64d0a420-3e25-4e01-8a22-78f8b02af3d5","added_by":"auto","created_at":"2024-07-13 02:11:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50415,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTheoretical framework for the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003efor AI-based NMDI program targeting in burnout reduction\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4371687/v1/11fb52ac09567b480cf879b4.png"},{"id":60198076,"identity":"2f8abb25-5649-4c7e-a0e9-619817eca9fe","added_by":"auto","created_at":"2024-07-13 02:03:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31957,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of this study\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4371687/v1/a085fede689f86d0046370b8.png"},{"id":60809709,"identity":"125a7ab8-3ca5-475d-b2b4-ad96bb0b368f","added_by":"auto","created_at":"2024-07-22 10:44:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":901276,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4371687/v1/1d81afda-876d-4736-80d8-a03dbbe64b04.pdf"},{"id":60198078,"identity":"5af0c8f8-3cf9-4719-9592-476ec175a463","added_by":"auto","created_at":"2024-07-13 02:03:45","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":220672,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2010Checklist.doc","url":"https://assets-eu.researchsquare.com/files/rs-4371687/v1/b1e2d529cc41cb71a419252d.doc"},{"id":60198351,"identity":"d9d77987-acbf-4f65-875a-133fa8cb0d55","added_by":"auto","created_at":"2024-07-13 02:11:45","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14926,"visible":true,"origin":"","legend":"","description":"","filename":"Semistructuredinterviews.docx","url":"https://assets-eu.researchsquare.com/files/rs-4371687/v1/e8cf09fb895d6ec8dc13cb27.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effectiveness of the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) : A pilot randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eJob burnout refers to the state of physical and mental fatigue and exhaustion of individuals under work pressure, including emotional exhaustion, cynicism and reduced personal accomplishment\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Job burnout develops slowly but progressively worsening\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Research shows that job burnout not only causes nurses to have health problems such as headache, insomnia, anxiety, depression, digestive disease, endocrine dysfunction, but also influence their work performance, turnover intention and even care quality\u003csup\u003e[\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. According to a report\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, the global prevalence of nurses' job burnout can reach to 11.23%. A survey of 1009 nurses in China found that the incidence of nurse burnout has reached 58.8%\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, even some regions of China is as high as 64.0%\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The nurses group are highly susceptible to suffer from burnout, it also the largest occupational group in frontline healthcare workers in the World Health Organization (2020) (Chen and Meier 2021). So the nurses' job burnout is a very important problem in the health system, need urgent solve.\u003c/p\u003e \u003cp\u003eNow, researchers normally classify the burnout interventions into three categories: individual-focused, organizational interventions, and multi-components programs\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The Individual-focused intervention focuses on improving nurses' working ability and emotion regulation ability (e.g., stress management skills, communication skills training, mindfulness, cognitive behavior therapy, positive emotion regulation, key counseling and intervention emotions.). For example, Lu et al. used abbreviated four-week, twice-weekly mindfulness-based intervention program to intervene with intensive care unit nurses\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, found that the intervention significantly improved nurses' mental health and reduced their burnout. Laker et al. implemented the mind management skills for life-program through a structured and group-based self-help intervention\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, it lasted eight weeks (one ninety minute-long session per week), this program significantly reduces nurses' job burnout and enhances their wellbeing. According to the report, person-directed interventions has unique advantages in emotional exhaustion\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, therefore, it has certain effectiveness in reducing the level of occupational burnout. But, some studies have found that the persistence of individual intervention effects is difficult to guarantee\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOrganizational intervention usually changes in work procedures like task restructuring, work evaluation and supervision, to increasing job control or the level of participation in decision making\u003csup\u003e[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. \u0026Uuml;st\u0026uuml;n\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e used an online support program to intervene with 48 nurses, mainly included sharing and discussing general problems as well as psychological difficulties, sharing information, news and experiences, and increasing self-confidence, etc. The intervention significantly reduced the level of nurse burnout. Partlak G\u0026uuml;n\u0026uuml;şen et al. used the nurse-led intervention program to help nurses improve their professional quality of life (ProQOL) and reduce psychological distress\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. The nurse-led intervention program, based on cognitive-behavioral approach, comprised four sessions. The study found that nurses from intervention group reported lower burnout symptoms than nurses from the control group. Research shown that, due to organizational intervention address major risk factors like work overload and effort reward imbalance, it will result in longer lasting positive effects on burnout and worksite mental health than person-directed interventions, but it may overlook the individualized differences of nurses\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMulti-components programs taking into account both personal and organizational factors, this type of intervention improves personal emotions and the work environment simultaneously. Haugland et al. add mindfulness and relaxation techniques to daily shift huddles\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, they provided a serenity room, and hold structured debriefing led by charge nurses after a highly stressful or emotional event, such as a death on the client. This study significantly reduced the level of nurses' burnout. Adams et al. used The Cultural Change Toolkit to reduce the nurses' burnout\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, the specific intervention content mainly included meaningful recognition, shared decision-making, and increased leadership involvement, this program were effectively alleviating nurses\u0026rsquo; burnout. As report, the Multi-components programs will lead to better results on burnout and worksite mental health than either person or organization-directed interventions independently\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. However, existing interventions lack consideration on how to improve the adaptability of nurses to their environment. Therefore, it is difficult to ensure the enthusiasm of nurses to participate in activities and the durability of intervention effects.\u003c/p\u003e \u003cp\u003eAI is a new approach to change organizational\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e, it consists of \"4D\" cycle, include discover, dream, design and destiny\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. AI helps organization members explore the strengths of individuals and organizations, and give everyone a chance to show and develop their strengths\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e, not just focuses on solving short-term problems\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Hence, our preliminary study used AI as the basic theory and followed the framework for the development and evaluation of complex interventions developed by MRC, UK, forming the nurse-manager dualistic intervention program based on the appreciative inquiry(NMDI)\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. The NMDI program was mainly composed of discovery (inquire the meaning of the nursing profession, discover an existing job and personal resources of nurses, and help nurses to excavate potential resources that goes unnoticed before), dream (create a nursing dream to change the current status and arouse energy and enthusiasm of nurses), design (construct compelling strategies for turning \"dreams\" into \"reality\" and essential elements for resources promotion must be in place), and destiny (practice strategies in normal clinical work with organizational support and share the best practical experience).\u003c/p\u003e"},{"header":"Theoretical Framework","content":"\u003cp\u003eThe NMDI program aims to improve personal and organizational resources to reduce the nurses\u0026apos; job burnout. Therefore, we have identified the job demand-resources model (JD-R) as the theoretical framework for our research through extensive literature review\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eJD-R was proposed by Demerouti et al.\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. In 2004, Schaufeli and Bakker\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e improved the JD-R theoretical model. They believed that job demand and job resources play a \u0026quot;enhancing\u0026quot; and \u0026quot;reducing\u0026quot; role in job burnout. Increasing the job demand (e.g., work overload, irregular work arrangements, and an unfavorable working environment.) can lead the continuous depletion of employees\u0026apos; physical and mental resources; and job resources can satisfy the basic needs of employees, motivating them to develop positive work attitude. Job resources come from the physical, psychological, organizational, and social aspects of work. For example, the professional training, peer support and trust, job position, work autonomy, etc. Xanthopoulou et al.\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e extended the JD-R mode, introducing personal resources into the model (e.g., self-efficacy, organizational-based self-esteem, and optimism). When job demands remain unchanged, increasing personal resources and work resources can effectively reduce job burnout. The personal resources and work resources can promote each other.\u003c/p\u003e\n\u003cp\u003eBased on the characteristics of the AI and JD-R mode, we formed a theoretical framework Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The NMDI program starting from the relationship between personal resources, work resources, and job burnout. Improving nurses\u0026apos; work and personal resources through AI to alleviate job burnout. The plan mainly has four core stages, including discover (clarify personal and organizational resources, increase positive cognition), dream (combining the harvest from the dream stage, construct a nursing dream, and form correct self-awareness and work cognition), design (design action plans based on personal dreams, personal and organizational strengths) and destiny (implement the developed action plan and share the experience).\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\n \u003ch2\u003e3. Aim\u003c/h2\u003e\n \u003cp\u003eThe purpose of this study was to optimize the NMDI program and preliminary test of its effectiveness.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Design\u003c/h2\u003e \u003cp\u003eThis study was a pilot randomized controlled trial.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Participants\u003c/h2\u003e \u003cp\u003e Participants for this study were recruited from a tertiary hospital in Baoding, Hebei, China. The inclusion criteria were (a) nurses as measured by The Maslach Burnout Inventory \u0026ndash; General Survey (MBI-GS)\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e, and the total average score is \u0026ge;\u0026thinsp;1.50, (b) sign labor contract with hospital, (c) have the nurse professional qualification certificate of the Ministry of Health of the People's Republic of China and are within the valid registration period, (d) obtain employment\u0026thinsp;\u0026ge;\u0026thinsp;3 years, (e) understand the purpose of the study and participate voluntarily. Exclusion criteria were: (a) going out to enhance professional skills, (b) sick leave, (c) maternity leave and recently participated in similar investigation or research.\u003c/p\u003e \u003cp\u003eUsing the Gpower to predetermine the sample size. According to the similar studies\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e, used the emotional exhaustion scores was the primary outcome, power calculation was based on a medium size effect, an alpha of 0.05 and power of 0.80. Finally, intervention group and control group each require 27 participants. Some study said that the sample size of the pilot study should be at least 50% of the sample size of the formal experiment. Thus, the sample size of this study should not be less than 37\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Finally, 47 nurses were included in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Procedure\u003c/h2\u003e \u003cp\u003eA convenience sample of 47 burnout nurse from a tertiary hospital in Baoding between July 2021 and December 2021. The purpose and process of this study were explained to potential participants. All quantitative data were obtained at baseline (T 1), after 5 weeks of implement (T 2), and after the intervention was completed (T 3);the qualitative date were obtained by semi-structured interview after the intervention was completed (only interviewed the intervention group nurses).\u003c/p\u003e \u003cp\u003e Nursing managers (e.g., head nurse, vice director, and director of the nursing department) called on nurses was the main method of recruitment for participants. Nurses who had an interest in the study could contact the researchers or the nursing managers by phone or WeChat. A total of 47 nurses were randomly selected from 10 clinical departments, the nursing managers groups the nurses, the specific details are as follows:10 departments were randomly divided into the intervention group and the control group through stochastic tables' law (Before grouping, no group member knows whether they belong to the intervention group or the control group). Therefore, the 47 nurses were randomly divided into the intervention group (n\u0026thinsp;=\u0026thinsp;23) and the control group (n\u0026thinsp;=\u0026thinsp;24). Participants and researchers were blinded to the allocation method and process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Intervention\u003c/h2\u003e \u003cp\u003eThe intervention group acceptance the NMDI program. The NMDI program consists of six stages: inception, discovery, dream, design, destiny and keep, specific intervention content can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Nurse-Manager Dualistic Intervention(NMDI) program based on the appreciative inquiry\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention objectives\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInception\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(First week)\u003c/p\u003e \u003cp\u003eYou and I know each other and go hand in hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. To form an intervention group\u003c/p\u003e \u003cp\u003e2. To introduce the aims and contents of the program\u003c/p\u003e \u003cp\u003e3. To construct affirmative themes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Organize the first meeting and conduct several ice-breaking games to help nurses know each other;\u003c/p\u003e \u003cp\u003e2. Provide intervention manual and introduce the concepts, theory of AI, the process and consideration of the intervention;\u003c/p\u003e \u003cp\u003e3. Form affirmative themes revolving around overall changing agenda via \"brain storm\".\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscovery\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Second week)\u003c/p\u003e \u003cp\u003eExploring professional significance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. To discover personal resources through self-exploration and peer support;\u003c/p\u003e \u003cp\u003e2. To discover organizational resources through managers and peer support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. State of peak experience and explore positive characteristics of nurses;\u003c/p\u003e \u003cp\u003e2. Explore personal strengths via character-strengths survey;\u003c/p\u003e \u003cp\u003e3. Communicate with managers and colleagues to list organizational resources that can be used to deal with job-related issues;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDream\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Third week)\u003c/p\u003e \u003cp\u003eDraw a dream blueprint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. To develop self-confidence and a positive self-image;\u003c/p\u003e \u003cp\u003e2. To build positive career dreams.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Gain new insights through reviewing old material, and enhance participants\u0026rsquo; strengths;\u003c/p\u003e \u003cp\u003e2. Build a career dream using personal strengths and organizational resources and record the dream by mails or painting;\u003c/p\u003e \u003cp\u003e3. Share dreams with group members and construct declarations for the dreams;\u003c/p\u003e \u003cp\u003eNote: manager participate this process and give suggestion about the dreams\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDesign\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Fourth week)\u003c/p\u003e \u003cp\u003eBuild dreams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. To design the work plan to strengthen job control;\u003c/p\u003e \u003cp\u003e2. To collaborate with colleagues and managers to get organizational resources.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Review the dreams built by participants;\u003c/p\u003e \u003cp\u003e2. Order the goals, personal strengths and organizational resources by importance and figure out work plan to achieve the primary goal with suggestions from managers;\u003c/p\u003e \u003cp\u003e3. Break the work plan into several phases and set short-term goals for each phases. Participants are suggested to record the process of realizing their dreams\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDestiny\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(5th to 8th week)\u003c/p\u003e \u003cp\u003eSharing best practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. To form a support team to promote participants' work performance;\u003c/p\u003e \u003cp\u003e2. To organize group meetings to share positive experiences and get supports from managers and colleagues.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Support teams consist of intervenors and managers. Participants can contact with support team to get suggestions. Meanwhile, support teams need to supervise participants to guarantee their performance followed the work plan;\u003c/p\u003e \u003cp\u003e2. Organize online meetings for participants to share their best experiences and discuss with support team and colleagues to cope with difficulties and frustration;\u003c/p\u003e \u003cp\u003e3. Each participant needs to summarize their gains and give out positive concluding statements.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ekeep\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(The ninth week)\u003c/p\u003e \u003cp\u003eCelebrate progress and sustainable development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. To strengthen personal and organizational resources via performance feedback;\u003c/p\u003e \u003cp\u003e2. To create a positive work environment via personal competence improvement and good relationships with colleagues and managers;\u003c/p\u003e \u003cp\u003e3. To continue set goals and work plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Celebrate the achievements with group members and work out new goals;\u003c/p\u003e \u003cp\u003e2. Explore new personal strengths by sharing successful experiences;\u003c/p\u003e \u003cp\u003e3. Colleagues and managers summarize participants' positive changes and give out positive feedback and expectations; 4. Intervenors review the intervention process and encourage participants and managers to employ AI-based NMDI into their clinical work in future.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEach group consisted of 6\u0026ndash;8 participants. The NMDI program was an online and offline mixed burnout intervention program with six sessions, included 5 weekly sessions and one 4-week session (destiny). The weekly session lasts for 120\u0026ndash;180 min, for the 4-week destiny, each week hold a 60\u0026ndash;90 min online meeting. Group intervention was used in all treatments. The control group didn't receive any intervention from the research assistants during the intervention period. If the effects of this study were good, according to the requirements of the nurses in the control group, the NMDI program were provided to the control group when the study was completed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Measure\u003c/h2\u003e \u003cp\u003eThe socio-demographic questionnaire used in this study include participants' age, length of service, gender, marital status, professional title, education level, fertility, shift arrangement, etc.\u003c/p\u003e \u003cp\u003e'Burnout' was assessed by MBI-GS. LI and Shi developed this scale\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, the scale had 15 items in total, included three dimensions of emotional exhaustion (EE), cynicism (CY) and lack of professional efficacy (RPE). This scale used a 7-point Likert scale from 'never', 0, to 'everyday', 6, to score the items. The dimension of lack of personal accomplishment is scored inversely. According to Kalimo et al.\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e, the dimension score is the average score of the items included, and the total score is (EE)\u0026times; 0.4+(CY)\u0026times;0.3+(RPE)\u0026times;0.3, the MBI-GS total score in which 0\u0026thinsp;~\u0026thinsp;1.49 points are no burnout, 1.50\u0026thinsp;~\u0026thinsp;3.49 points are mild to moderate burnout, and 3.50\u0026thinsp;~\u0026thinsp;6.00 points are severe burnout.\u003c/p\u003e \u003cp\u003eQualitative data was collected from the Semi-structured interviews(discussed and formulated by team members), including two questions:\u003c/p\u003e \u003cp\u003e(a)Do you think the NMDI program are appropriate (can be evaluated from the perspective of plan content setting, activity team size, intervention form, duration of each activity, intervention frequency, etc.)? If not, what specific aspects do you think need to be improved?;\u003c/p\u003e \u003cp\u003e(b) How do you feel about participating in this NMDI program? And if you willing to continue to participate in the future?\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.6 data analysis\u003c/h2\u003e \u003cp\u003eSPSS 26.0 (International Business Machines Corporation (IBM), Armonk, United States of America) was used for analyzing quantitative data. General sociodemographic data and job burnout level were described by frequency, percentage, standard deviation (SD), etc. The differences between intervention group and control group were tested using one way ANOVA, two independent samples t-test. The influence of the NMDI program on nurses' job burnout were tested using generalized estimated equation (GEE).\u003c/p\u003e \u003cp\u003eInterview data were audio-recorded and then transcribed within 24 hours. The result were managed by NVivo 12.0. Two researchers who have received qualitative research training will compare, analyze, and infer word data by reading the article separately. Using the Colaizzi seven-step method, carefully study the interview notes. Extract meaningful statements that align with the research purpose, encoding. Summarize and extract meaning from meaningful statements, and find common features. Then, forming themes and categories. Finally, provide a complete statement of the formed theme.\u003c/p\u003e \u003c/div\u003e"},{"header":" Results","content":"\u003cp\u003eA total of 47 nurses were enrolled in this pilot study, three from the the control group withdrew before intervention, finally, 44 nurses completed the entire study (intervention group=20 and control group=24). Figure \u003cspan\u003e2\u003c/span\u003e shows the flow diagram of this study. And 18 nurses (intervention group nurses) completed the semi-structured interviews.\u003c/p\u003e\n\u003cp\u003eThe demographic data on these two groups were shown in Table \u003cspan\u003e2\u003c/span\u003e. No significant differences were found between the two groups in terms of demographic characteristics (e.g., sex, age, working seniority, education, marital status, if have children, form of employment, positional title, average monthly income and shift), and job burnout.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eHomogeneity of participants' characteristics at baseline between the two groups (n = 44)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eitem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1719825012.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e/x\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention group(n = 20)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n = 24)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e1.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e22(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.55 ± 4.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e28.33 ± 3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking seniority\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.30 ± 4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e9.26 ± 6.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e1.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior college or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e22(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e5.851\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e17(70.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIf have children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e1.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eForm of employment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"5\"\u003e\n \u003cp\u003e2.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTemporary employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003econtinued\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePersonnel agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOfficially in preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositional title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003e1.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse in charge and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage monthly income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"6\"\u003e\n \u003cp\u003e3.801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3001–5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5001–7000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7001–9000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 9000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eShift\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e1.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDay shift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDay and night shift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(75.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob burnout\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.57 ± 0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.01 ± 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003e5.1 Quantitative results\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003e5.1.1 The effects of NMDI on job burnout.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUsed GEE to test the effect of the NMDI program. The specific steps were: taken the scores of each evaluation index as the dependent variable. Group, time, group × Inclusion were bring into the model. Selecting \"Unstructured\" work related matrix. The GEE analysis revealed that the NMDI program significantly decreased job burnout (p \u0026lt; 0.001), the intervention group had statistically lower scores for job burnout than the control group. Time effects were significant on job burnout (p \u0026lt; 0.05), with the scores for job burnout differing between the intervention and control groups during the intervention process (see Table \u003cspan\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eGEE results for the main effects and interaction effects\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWald χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup × time effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003e5.2 Qualitative results\u003c/h2\u003e\n \u003cp\u003e18 nurses(intervention group) accepted the semi-structured interviews, see Table \u003cspan\u003e4\u003c/span\u003e for general information. Two themes were identified from the data: agreed on the feasibility of the NMDI program and further consideration.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eInterviewee information(n = 18)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWork years\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA 18\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003e5.2.1 Theme 1: agreed on the feasibility of the NMDI program\u003c/h2\u003e\n \u003cp\u003eWithin this theme, participants evaluated the NMDI program, they identified two categories: (a) attitude towards the NMDI program, (b) evaluation of the NMDI program design.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003eAttitude towards the NMDI program\u003c/h2\u003e\n \u003cp\u003eAll respondents are willing to continue participate if the project is still ongoing. About the benefits of the project, the following words frequently appear: \"positive attitude,\" \"optimistic,\" \"positive cognition,\" \"ability promotion,\" \"development\" and \" discovering Advantages\". So, the benefits of the NMDI program were guiding participants to explore their own and organizational strengths, helping them establish positive mindset, and further enhance strength.\u003c/p\u003e\n \u003cp\u003eFor many, participated in the NMDI program can improve with colleagues, such as daily mindset, working ability, etc. A nurse mentioned \"This project played a supervisory role for me, and I gained growth from it, it was very helpful for my work\"\u003c/p\u003e\n \u003cp\u003e(A 6, A 13, A 15). The project also let the participants feel the beauty of the work, the life, and their attitudes became more positive. Some nurses pointed \"when I meet difficulties, the strengths can help me overcome them\" (A 5), \"Overall, my mentality tends to be more optimistic and peaceful\" (A 11) .\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003eEvaluation of the NMDI program design\u003c/h2\u003e\n \u003cp\u003eWithin this categories, participants evaluated the NMDI program from five aspects, (a) team size, (b) intervention form, (c) participation time (d) frequency, and (e) the duration of each activity of the NMDI program.\u003c/p\u003e\n \u003cp\u003e\"Team size\" was closely related to the depth and duration of group discussions. All the surveyed nurses stated that the current number of group members was appropriate, they think had too many participants may costed a lot of time in discussions, but too few participants would led the discussion lack of depth. Some nurses mentioned \"I think about five people are suitable, too many people, the activity will take a long time\"(A 5, A 9, A 15). Appropriate discussion group size can ensure that members efficiently complete the activity content.\u003c/p\u003e\n \u003cp\u003e\"Intervention form\", it was applicative by more than half of the surveyed nurses. The combination of online and offline interventions can epidemic prevention and control requirements under the COVID-19 epidemic, providing more choice space for participants, increasing the frequency of participants' participation. A nurse thought \"Online mode, I think was good… but offline, we may couldn't participated this project, because our work were too busy…,\" (A 16, A 18), this can make more nurses who lack time participate in this program. But there were nurses having different view, they thought, online approach is conducive to responding to the requirements of COVID-19 epidemic prevention and control, but offline intervention can ensure the depth of communication, a nurse pointed (A 3). So providing two kinds of from (online and offline interventions) can satisfy the needs of different individuals and respond to emergencies.\u003c/p\u003e\n \u003cp\u003e\"Participation time\", all nurses believed that the time of participating in the project was acceptable. The nurses believed that selecting specific participation times can give them some freedom of choice. At the same time, it can ensure the number of group members participating in each activity. Two nurses commented, \"Now, this kind of activity time selection was quite reasonable. Sometimes I have my own things to do. The relative freedom in time allows me to take this activity seriously\" (A 9, A 14), \"I think this approach can estimate the number of members participating each time, it an ensure the smooth progress of each activity\" (A 5).\u003c/p\u003e\n \u003cp\u003e\"Frequency\", all nurses stated that once a week was acceptable, It will not disturb their normal work and life. \"This frequency was acceptable, not too frequently and the interval between each time was not long.\" (A 10), a nurse pointed.\u003c/p\u003e\n \u003cp\u003e\"The duration of each activity of the NMDI program\", it was accepted by all interviewed nurses (the weekly session lasts for 120ཞ180 min, for the 4-week destiny, each week hold a 60ཞ90 min online meeting). The duration of existing participation in activities will not cause a serious burden on participants. All nurses indicated that the time spent within their acceptable range. Some interviewees even expressed that she could invest more time in this program.\" Sometimes, when we chat happily and speculate, we may chat for a longer time.\" (A 18).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\"\u003e\n \u003ch2\u003e5.2.2 Theme 2: further consideration\u003c/h2\u003e\n \u003cp\u003eWithin this categories, the NMDI program should have further consideration, including two aspects, (a) views on Time, and (b) fully understand in the early stage.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\"\u003e\n \u003ch2\u003eViews on Time\u003c/h2\u003e\n \u003cp\u003e\"Time\" was the core issue facing in this project. Properly handled the relationship between nurses' busy work, limited rest time, and the participation in activities was the key to the smooth progress the NMDI program. \"Time\" breakthrough the entire project, the main questions collected in the interview are \"increasing time\" and \"reducing time\".\u003c/p\u003e\n \u003cp\u003eIn aspect of \"increasing time\", a respondent pointed out that due to the unique nature of her work, her plan that developed in the project may be hindered, \"because of the COVID-19 epidemic, we will add many temporary tasks, I really don't have too much time to do it when I'm busy…\" (A1). Another nurse reflected \"This phase is short (the destiny stage), my plan may not be completed completely\" (A 11). So, the implementation time of the plan is too short, it will affect the expected effect, because the implementation time of the plan is too short, so extending the destiny stage is necessary.\u003c/p\u003e\n \u003cp\u003eIn aspect of \"reducing time\", some nurses also advocated to reduce the number of times that they participate in activities, while ensured the integrity of the activities. In the NMDI program, \"dream stage\" and \"design stage\" had close connection, \"design stage\" was based on \"dream stage\" to completed, the two stage interwovenness. A nurse thought, \"By combining these two stages together (dream and design), we can complete tasks more efficiently, you know we are very busy\" (A 9), and it also reduced the time participants spend on the round trip. A nurse pointed out that, \"Even if the activity lasts for only two hours, I may still need to spend half a day because the travel may be affected by traffic conditions, distance. \" (A 11).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\"\u003e\n \u003ch2\u003eFully understand in the early stage\u003c/h2\u003e\n \u003cp\u003e\"Fully understand in the early stage\", was crucial for the recruitment of participants and the promotion of the project. Making the nurses fully understand the project, accurately attracted suitable client, ensured the smooth progress of the project, and reduced the risk of the client loss. Some interviewees pointed out that she participated in the activity only because of the requirements of the manager, she had some error in the content learned. \"ah, is that so? It's not same as what our leaders said\" (A 12), a nurse said.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\"\u003e\n \u003cdiv id=\"Sec23\"\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eRevision suggestions: Kindly remove Clinical trial amendment points from the main manuscript.\u003c/p\u003e\u003cp\u003epoint to point reply: The revised content related to the plan has been deleted, the specific deleted parts have been highlighted in red in the article.\u003c/p\u003e\u003cp\u003eThe aim of this pilot study was to evaluate the feasibility and effectiveness of the NMDI program. Our research results indicated that the NMDI program can be accepted and used by clinical nurses, it significantly alleviated nurses' burnout, helped them maintain a positive attitude. Compared with previous intervention, the NMDI program is one of few intervention to tackles the burnout root of the person and organization mismatch issue. It may become a long-term way to reduce nurses' job burnout.\u003c/p\u003e\u003cp\u003eThe NMDI program can simultaneously motivate personal strengths and organizational resources to cope with burnout account for the study's comparatively positive results. Research indicates that AI can effectively improve work resources and personal resources\u003csup\u003e[\u003cspan\u003e40\u003c/span\u003e–\u003cspan\u003e41\u003c/span\u003e]\u003c/sup\u003e. The NMDI program guided by AI, helping nurses with burnout active explored their work resources and personal resources. For example, the program requires participants to recall peak experience states and explore the positive characteristics of nurses, it helped nurses discover personal strengths and organizational resources. Actively utilizing advantages, could make advantage growth and harvest positive emotions\u003csup\u003e[\u003cspan\u003e42\u003c/span\u003e]\u003c/sup\u003e. Based on it, in the design stage, the nurse could further enhance advantages and gain positive emotions by using their personal strengths and organizational resources to design the work plan. It also aligns with the JD-R mode. So, the NMDI program could precise enhancement of each nurse's strengths, reduced burnout. It worth mentioned that the participants played the main role in drawing up their action plan, could fully target at the nurses themselves. It is important for enhancing nurses' positive attributes and organizational participation\u003csup\u003e[\u003cspan\u003e43\u003c/span\u003e]\u003c/sup\u003e. The results of the semi-structured interview indicate that the tested nurses generally accepted and recognized the NMDI program. But some content still needed to be revised. The core issue is \"time\". Providing interventions for a longer or shorter period may all caused the reduction in program effectiveness\u003csup\u003e[\u003cspan\u003e44\u003c/span\u003e]\u003c/sup\u003e, so eliminate those inconsistencies may strengthen the associations between length of interventions and the intervention effects, achieving better intervention outcomes\u003csup\u003e[\u003cspan\u003e45\u003c/span\u003e]\u003c/sup\u003e. However, simply and roughly reducing activity time is not advisable, it should be increased or reduced according to the situation. In our research, we found that the \"dream stage\" and \"design stage\" have a better connection. To solve the above issues, we can consider making relevant revisions to the \"dream stage\" and \"design stage\". on the other hand, some participants reflected even if the one-hour activity, will also spend nearly half a day (because of the traffic, weather, distance and other factors), some studies have also reflected this problem\u003csup\u003e[\u003cspan\u003e46\u003c/span\u003e]\u003c/sup\u003e. So, when conducting research, we should consider the participants' difficulties, such as the unplanned time spent.\u003c/p\u003e\u003cp\u003eSecondly, considering the characteristics of nurses' work, extending the implementation stage may be necessary. Some participants pointed out that, busy and uncertain work condition disrupted their activity plans. The nurses' free time was reduced because of the heavy nursing work\u003csup\u003e[\u003cspan\u003e47\u003c/span\u003e–\u003cspan\u003e48\u003c/span\u003e]\u003c/sup\u003e, and the sudden public health events such as the COVID-19, would made this phenomenon more serious\u003csup\u003e[\u003cspan\u003e49\u003c/span\u003e]\u003c/sup\u003e. These situations led nurses don't have enough time to complete the plan. So, the time pressure needed be taken seriously. Therefore, extending the implementation phase appropriately may bring the following benefits to our research: 1) giving more time to nurses for completing the action plan, 2) reduce psychological pressure on nurses(because don't have enough time to complete the action plan), 3) reduce loss rate.\u003c/p\u003e\u003cp\u003eIn addition, \"Fully understand in the early stage,\" also need to be noticed. Nurses pointed out, short-term and non-procedural project introductions by nursing managers led the nurses misunderstand the project content (for example, some nurses couldn't fully understand some concepts involved in the intervention process, participating this program only by listening leader's suggestions). In fact, this situation may affected the progress of our intervention activities and increased time cost for participants. Because the researcher needed to explain relevant content again, participants needed to understand the project again. Studies indicated that actively and relatively long-term mobilization activities could effectively improve the participation of team member \u003csup\u003e[\u003cspan\u003e46\u003c/span\u003e, \u003cspan\u003e50\u003c/span\u003e]\u003c/sup\u003e. Thus, in future research, we should promote the project content, mainly including the purpose of the project, implementation methods, participation time, and specific concepts involved. Making participants understand the benefits of the program and potential costs of time.\u003c/p\u003e\u003ch2\u003e7. Limitations\u003c/h2\u003e\u003cp\u003eThis study has some limitations. First, as the COVID-19 broke out in the study city, this study was only conducted online, the feasibility and effectiveness of offline implementation still need to be verified. Second, female were the majority of participants, this uneven gender distribution prevents generalizing our findings to male nurse. Third, we only collected the short-term effect, the long-term effect is not clear. Fourth, the pilot study was conducted in a tertiary hospital in China with a small sample size, limiting its generalizability of results to other settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on this study, the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) is feasible and effective, can effectively reduce the level of job burnout of nurses. It may a long-term way to reduce nurses' job burnout. In the future, when applying the NMDI program, we need more consideration in terms of the \"time\" and \"Fully understand in the early stage\" to ensure the effective implementation of the program. Next, a randomized controlled trial with a larger sample size will be conducted to examine this program's impact and sustainability in reduce job burnout.\u003c/p\u003e\u003ch2\u003e9. Implications for nursing management\u003c/h2\u003e\u003cp\u003eNurse managers play a pivotal role in help nurses explore personal strengths and organizational resources. They influenced the enthusiasm for nurses to seek personal strengths and organizational resources. Thus, nurse managers are key to help nurses improve.\u003c/p\u003e\u003cp\u003eFindings of the present study indicate that the NMDI program is an easy and highly acceptable intervention to relieve nurses' burnout and raise positive emotions. Different nurses' burnout may have different reason, the nurses manager may difficult to fully understand and solve. So, provide a method, let nurses actively utilize their own advantages to solve problems is necessary. Nurse Managers need to realize the positive impact of the NMDI program on nurse growth and organizational change. The NMDI program can suit their culture, background and management models, so the nursing manager can use it based on their situations. In addition, the combination of online and offline methods is recommended, and we also provided. which can adapt to the needs of different organizations and individuals. Finally, we suggest that nursing managers consciously positive resources into organizational management to promote positive development of the organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the nursing managers and nurses of the Hebei Provincial Mental Health Center for participating in the pilot study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the design of the methods, data collection tools, and data analysis. D.X.S. collected the data, conducted the initial analysis, and drafted the manuscript, Y.F.G reviewed the data analysis and the final version of the manuscript, N.L.W, Y.S.L, and M.L.S Completing nurse recruitment work. All authors have read, reviewed, and approved the final manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by National Natural Science Foundation of China (72004120), Natural Science Foundation of Shandong Province (ZR2020QG058).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApprovals were gained from the School of Nursing, Hebei University, and the participating hospital. This study was approved by the appropriate institutional review board, and Registration No. of Clinical Trial Center: ChiCTR 2100047974,\u0026nbsp;registration date: June 28, 2021.\u0026nbsp;All participants signed informed consent forms before participating in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adheres to CONSORT guidelines, the completed CONSORT 2010 checklist please refer to additional file.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMaslach, C., Jackson, S.E., 1981. The measurement of experienced burnout. 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Aging Ment Health 21 (5), 487-493.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"appreciative inquiry, job burnout, nurse","lastPublishedDoi":"10.21203/rs.3.rs-4371687/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4371687/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis pilot study aimed to measure the feasibility and acceptability of the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the Job Demand-Resource model, enhancing personal and work resources can alleviate job burnout. And Appreciative inquiry (AI) was an effective method to increase personal and work resources. Thus, a nurse-manager dualistic intervention program based on AI had been developed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA pilot randomized controlled trial. The intervention group (n = 23) accepted the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) (lasting for 9 weeks), while the control group (n = 24) did not. Outcomes was job burnout, it tested using generalized estimated equation (GEE), to verify effectiveness. Qualitative interviews were conducted to verify feasibility and improve the NMDI program, thematic analysis was used Golaizzi seven step Analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention group had statistically lower scores for job burnout than the control group, time effects were significant on job burnout (each p \u0026lt; .05). Qualitative research formed two themes, agreed on the feasibility of the NMDI program and further consideration, were identified with four subthemes, confirmed the NMDI program was feasible and effective, and can helped nurse have positive mindset.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe NMDI program can reduce job burnout, helped participants establish positive mindset, all participants willing to continue participating in the future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Nursing Management:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe benefits to participating in the NMDI program traversed the individual and organization, nurse managers should support and promote this kind of program and flexible application it in daily nursing management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the appropriate institutional review board, and Registration No. of Clinical Trial Center: ChiCTR 2100047974, registration date: June 28, 2021.\u003c/p\u003e\n\u003cp\u003eSuggested modifications：\u003c/p\u003e\n\u003cp\u003e1. Date of registration -Please include the date that your trial was registered in the ‘Trial Registration’ section of the Abstract.\u003c/p\u003e\n\u003cp\u003e2. Trial registration number -Please include the trial registration number in the ‘Trial Registration’ section of the Abstract.\u003c/p\u003e","manuscriptTitle":"The effectiveness of the nurse-manager dualistic intervention program guided by appreciative inquiry on job burnout of nurse (NMDI) : A pilot randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-13 02:03:40","doi":"10.21203/rs.3.rs-4371687/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c13424bc-19aa-4576-90fd-7956d40b51fc","owner":[],"postedDate":"July 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-22T10:36:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-13 02:03:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4371687","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4371687","identity":"rs-4371687","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}