Ambulatory Blood Pressure and Ecological Momentary Assessment of Occupational Stress in Spiritual Health Clinicians Open Access

Abstract

Introduction: Healthcare professionals, including Spiritual Health Clinicians (also known as

healthcare chaplains [SHCs]), experience high rates of occupational stress and burnout,

contributing to adverse health outcomes. Physiological indices such as blood pressure (BP)

provide an objective marker of autonomic stress reactivity. Combining ecological momentary

assessment (EMA) with ambulatory blood pressure monitoring allows for the examination of

time-synchronized associations between workplace experiences and physiological

responses. This study investigated associations between psychosocial workplace experiences and

daytime BP patterns among SHCs.

Methods: SHCs from Emory Healthcare completed baseline surveys assessing demographics,

anxiety, depression, and burnout, etc. Participants wore an ambulatory blood pressure (ABP)

monitor for three consecutive workdays during work hours. Participants also received four-daily

EMA prompts assessing workplace connectivity, team support, professional fulfillment, and

incivility using Likert scales. Descriptive statistics were generated to evaluate global well-being,

group and individual-level EMA, and group and individual-level ABP measures.

Results: Six participants completed the study. Participants demonstrated high protocol

adherence, completing 89.9% of ABP readings and 84.1% of EMA prompts. Mean systolic BP

was 126.3 mmHg (±15.7), diastolic BP 75.3 mmHg (±8.4), and heart rate 76.6 bpm (±8.3).

Baseline self-report measures indicated generally favorable psychological well-being and low

stress, anxiety, and depression, with relatively high compassion satisfaction. EMA assessments

revealed high momentary well-being, including connection with colleagues (6.3 ±0.9),

connectivity with patients (5.8 ±1.55), team support (6.2 ±0.9), and professional fulfillment (5.5

±1.6), alongside low momentary burnout (2.0 ±1.7). Two participants reported a single instance

of incivility, once from a patient and once from a colleague. All EMA composites demonstrated

acceptable internal consistency (Cronbach’s α ≥ 0.78).

Conclusions: The collection of ambulatory self-report and blood pressure data from SHCs

during three days of workplace monitoring was feasible, with high protocol adherence and

acceptability reported. Descriptive findings revealed generally favorable global and momentary

well-being among SHCs. Ambulatory cardiovascular measures demonstrated meaningful within-

person variability over the monitoring period, reflecting the dynamicity of ABP in response to

psychosocial workplace experiences. These insights demonstrate the utility and tolerability of

combined EMA and ABPM protocols in HCP populations.

Table of Contents

I. Background ................................................................................................................................. 1

Occupational Stress ..................................................................................................................... 1

Stress Physiology and the Autonomic Nervous System ............................................................. 2

Ambulatory Blood Pressure Monitoring ..................................................................................... 3

Ecological Momentary Assessment ............................................................................................ 5

The Population and Spiritual Health Clinicians .......................................................................... 5

Motivation ................................................................................................................................... 8

Aims & Objectives ...................................................................................................................... 9

II. Methods .................................................................................................................................... 10

Overview ................................................................................................................................... 10

Participants ................................................................................................................................ 10

Recruitment ........................................................................................................................... 10

Inclusion and Exclusion Criteria ........................................................................................... 11

Pre-Monitoring Measures ......................................................................................................... 11

Demographics ....................................................................................................................... 12

MINI-Z 2.0 ............................................................................................................................ 12

Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep

Disturbance: Short Form ....................................................................................................... 13

Professional Quality of Life Version 5 (ProQOL-5) ............................................................ 13

Perceived Stress Scale (PSS-10) ........................................................................................... 14

Generalized Anxiety Disorder (GAD-7) ............................................................................... 15

Patient Health Questionnaire (PHQ-9) ................................................................................. 15

Mental Health Continuum Short Form (MHC-SF) ............................................................... 16

Ecological Momentary Assessment .......................................................................................... 16

Study Orientation ...................................................................................................................... 17

Ambulatory Blood Pressure Monitoring ................................................................................... 18

Description of Criteria Used to Consider a Continuous 24-Hour ABPM Recording

Complete ............................................................................................................................... 19

Post-Monitoring Measures ........................................................................................................ 21

Daily Substance Use Questionnaire ...................................................................................... 21

Obtrusiveness and Compliance Questionnaire ..................................................................... 22

Compensation ........................................................................................................................... 23

Data Analysis ............................................................................................................................ 24

III. Results ..................................................................................................................................... 26

Aim 1: Feasibility, Protocol Compliance, and Acceptability ................................................... 26

Aim 2: Descriptive Statistics of Global Well-Being, EMA, and ABPM .................................. 29

IV. Discussion ............................................................................................................................... 44

V. Limitations ............................................................................................................................... 50

VI. Future Directions .................................................................................................................... 52

VII. References ............................................................................................................................. 54

VIII. Appendix .............................................................................................................................. 69

Daily Substance Use Questionnaire .......................................................................................... 69

Obtrusiveness and Compliance Questionnaire ......................................................................... 70

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Spirituality Psychology, Physiological Health Sciences, Occupational Health and Safety
Keyword	Spiritual Health Clinicians Occupational Stress Ambulatory Blood Pressure Monitoring Ecological Momentary Assessment
Committee Chair / Thesis Advisor	Mascaro, Jennifer, Emory University
Committee Members	Ashe, Jason, Emory University Kaplan, Deanna, Emory University

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