healthcare Article Burnout, Attachment and Mentalization in Nursing Students and Nurse Professionals Giulia Bordoagni 1 , Edita Fino 2, * and Alessandro Agostini 2   Citation: Bordoagni, G.; Fino, E.; Agostini, A. Burnout, Attachment and Mentalization in Nursing Students and Nurse Professionals. Healthcare 2021, 9, 1576. https:// doi.org/10.3390/healthcare9111576 Academic Editor: Alyx Taylor Received: 24 October 2021 Accepted: 15 November 2021 Published: 18 November 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Infermi Hospital of Rimini, 47923 Rimini, Italy; giulibordo96@gmail.com 2 Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, 40138 Bologna, Italy; alessandro.agostin11@unibo.it * Correspondence: edita.fino@unibo.it; Tel.: +39-051-209-1330 Abstract: (1) Background. In caretaking professions, attachment style and mentalization capacities are essential factors for establishing an effective caretaker–patient relationship and for buffering burnout. While attachment avoidance and dependency are considered risk factors for burnout, impairment in mentalization capacity is associated with psychological distress and ineffective emotion regulation. (2) Objective: Evaluating the attachment style and mentalization capacity in nurse professionals and nursing students. We further investigated the impact of these factors on burnout in professional nurses. (3) Method: 94 nursing students and 94 controls and 34 professional nurses completed the Attachment Style Questionnaire (ASQ) and the Reflective Functioning Questionnaire (RFQ). For pro- fessional nurses, the Maslach’s Burnout Inventory (MBI) was also administered. (4) Results: Nursing students exhibited lower scores in secure attachment and higher scores in anxiety over relationships compared to controls while no difference in mentalization capacity was found between both groups. Importantly, attachment anxiety resulted a significant predictor of burnout in professional nurses. (5) Conclusions: Nursing students might compensate their attachment insecurity with high mental- ization. Attachment security may play a protective role against burnout in the professional nurses. Education programs aimed at enhancing mentalizing abilities might facilitate nursing students’ entrance in the forthcoming clinical environment and practice. Implementing training strategies based on attachment theory may contribute to burnout prevention in nurse professionals. Keywords: nursing students; professional nurses; attachment style; mentalization; burnout 1. Introduction The ability to establish positive and trusting therapeutic relationships with patients is widely recognized as an essential component of nursing practice and effective delivery of care [1]. Among other factors, attachment style and mentalizing capacities have emerged as salient individual factors involved in the development of the therapeutic caretaking relationship [2,3]. Attachment style refers to a characteristic orientation to the other person in an interpersonal relationship that originates in early relationships with parents or other key figures and is broadly categorized as secure or insecure [4]. A secure attachment develops if caregivers are experienced as reliably available and responsive to one’s needs and is characterized by an inner sense of safety and effective regulation of affects. In contrast, when caregivers are experienced as unavailable or inconsistently responsive an insecure attachment style develops which is characterized by two fundamental dimensions labeled as anxiety over relationships and avoidance or discomfort with closeness [4–7]. Early infant–caregiver attachment relationships serve as a foundation for the development of other critical capacities such as mentalization, which denotes the ability to think about one’s own emotions and desires, as well as to empathize and reflect on feelings and needs of others [8]. Otherwise known by the term reflective functioning, mentalization capacities mature over the course of development through sustained interpersonal relationships and are crucial for caregiving relationships. Indeed, research shows that securely attached Healthcare 2021, 9, 1576. https://doi.org/10.3390/healthcare9111576 https://www.mdpi.com/journal/healthcare