Staff nurses reveal concerns and preferences regarding MBCT resilience program

Before launching a program to promote resilience and prevent burnout among staff nurses, hospitals and healthcare organizations should identify barriers and concerns relevant to their own clinicians, according to an article in AACN Advanced Critical Care.

The journal article, "Designing a Resilience Program for Critical Care Nurses," reports results from a study of focus groups to determine staff nurse perspectives on a proposed mindfulness-based cognitive therapy (MBCT) program to promote resilience.

The focus groups revealed concerns and preferences regarding an eight-week MBCT resilience program, including barriers and potential incentives. Participants also identified preferred qualifications for instructors and specific didactic content to be covered.

Principal investigator Meredith Mealer, RN, PhD, is an assistant professor at the University of Colorado School of Medicine, Aurora. After recruiting participants from among members of the American Association of Critical-Care Nurses, she moderated 11 focus groups, with a total of 33 participants who were working as critical care nurses in the United States.

"No single design was accepted, suggesting that institutions will need to modify interventions to fit the needs of their staff," Mealer said. "We know that positive coping skills can be learned, but more research is needed to understand which interventions and resources are effective and feasible."

MBCT combines two strategies that can enhance resilience. The mindfulness practices help individuals become aware of negative thoughts and feelings resulting from stress, whereas the cognitive-behavioral therapy aims to help them interrupt those negative thought patterns.

Using the traditional MBCT model, the intervention is delivered over eight weekly two-hour sessions and includes daily homework for another 30 to 60 minutes. It's led by one or two qualified instructors who have been trained on its delivery.

However, the research revealed that the traditional structure may not be feasible for critical care nurses, leading the research team to modify its proposed MBCT resilience program. A nurse with critical care experience and a psychotherapist will now co-facilitate the sessions, and didactic content will include ICU-specific material related to burnout, PTSD and anxiety, as well as depression. Participants will also receive a stipend.

The study is a first step in assessing staff nurse perceptions on which types of formats are likely to be most effective in meeting staff needs. Researchers will use the results to refine a pilot MBCT resilience program, which will be evaluated to identify additional modifications needed. They then plan to conduct a larger trial to determine effectiveness.

The National Institutes of Health provided a grant to fund the research.

The article is part of a symposium, published in the winter 2017 issue of the peer-reviewed journal, that explores the evidence on nurses' responses to stressful situations and opportunities to support nurses in the workplace. Other articles address:

• Behaviors and education to reduce nurse-to-nurse incivility
• Associations between work environments and compassion fatigue
• Responses to trauma experienced by care providers involved in adverse patient events

Nurse scientist and associate professor Mary Fran Tracy, RN, PhD, APRN, CNS, served as editor for the symposium.

"Working in a critical care setting is challenging even on the best of days," Tracy said. "Creating and sustaining healthy work environments is imperative to prevent disrespectful interactions, to decrease instances of moral distress and to increase staff members' abilities to cope within this stressful environment."​