Effects of a Multi modal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units: A Randomized Clinical Trial

This article by El Kharnali and colleagues as part of the SISTRESSREA Study Group was published in JAMA during October 2018.
Importance:  Nurses working in an intensive care unit (ICU) are exposed to occupational stressors that can increase the risk of stress reactions, long-term absenteeism, and turnover.
Objective:  To evaluate the effects of a program including simulation in reducing work-related stress and work-related outcomes among ICU nurses.
Design, Setting, and Participants:  Multicenter randomized clinical trial performed at 8 adult ICUs in France from February 8, 2016, through April 29, 2017. A total of 198 ICU nurses were included and followed up for 1 year until April 30, 2018.
Interventions:  The ICU nurses who had at least 6 months of ICU experience were randomized to the intervention group (n = 101) or to the control group (n = 97). The nurses randomized to the intervention group received a 5-day course involving a nursing theory recap and situational role-play using simulated scenarios (based on technical dexterity, clinical approach, decision making, aptitude to teamwork, and task prioritization), which were followed by debriefing sessions on attitude and discussion of practices.
Main Outcomes and Measures:  The primary outcome was the prevalence of job strain assessed by combining a psychological demand score greater than 21 (score range, 9 [best] to 36 [worst]) with a decision latitude score less than 72 (score range, 24 [worst] to 96 [best]) using the Job Content Questionnaire and evaluated at 6 months. There were 7 secondary outcomes including absenteeism and turnover.
Results:  Among 198 ICU nurses who were randomized (95 aged ≤30 years [48%] and 115 women [58%]), 182 (92%) completed the trial for the primary outcome. The trial was stopped for efficacy at the scheduled interim analysis after enrollment of 198 participants. The prevalence of job strain at 6 months was lower in the intervention group than in the control group (13% vs 67%, respectively; between-group difference, 54% [95% CI, 40%-64%]; P < .001). Absenteeism during the 6-month follow-up period was 1% in the intervention group compared with 8% in the control group (between-group difference, 7% [95% CI, 1%-15%]; P = .03). Four nurses (4%) from the intervention group left the ICU during the 6-month follow-up period compared with 12 nurses (12%) from the control group (between-group difference, 8% [95% CI, 0%-17%]; P = .04).Conclusions and Relevance:  Among ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program. Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective.
The print copy of this issue JAMA is available in the Healthcare Library on D Level of Rotherham General Hospital.


Acute Physiologic Stress and Subsequent Anxiety Among Family Members of ICU Patients

This article by Beesley and colleagues was published in “Critical Care Medicine” in November 2017.  The full text of the article can be accessed via this link.
Objectives:  The ICU is a complex and stressful environment and is associated with significant psychologic morbidity for patients and their families. We sought to curtains-1854110_960_720

determine whether salivary cortisol, a physiologic measure of acute stress, was associated with subsequent psychologic distress among family members of ICU patients.
Design:  This is a prospective, observational study of family members of adult ICU patients.
Setting:  Adult medical and surgical ICU in a tertiary care centre.
Subjects:  Family members of ICU patients.
Interventions:  Participants provided five salivary cortisol samples over 24 hours at the time of the patient ICU admission. The primary measure of cortisol was the area under the curve from ground; the secondary measure was the cortisol awakening response. Outcomes were obtained during a 3-month follow-up telephone call. The primary outcome was anxiety, measured by the Hospital Anxiety and Depression Scale-Anxiety. Secondary outcomes included depression and post-traumatic stress disorder.
Measurement and main Results:  Among 100 participants, 92 completed follow-up. Twenty-nine participants (32%) reported symptoms of anxiety at 3 months, 15 participants (16%) reported depression symptoms, and 14 participants (15%) reported post-traumatic stress symptoms. In our primary analysis, cortisol level as measured by area under the curve from ground was not significantly associated with anxiety (odds ratio, 0.94; p = 0.70). In our secondary analysis, however, cortisol awakening response was significantly associated with anxiety (odds ratio, 1.08; p = 0.02).
Conclusions:  Roughly one third of family members experience anxiety after an ICU admission for their loved one, and many family members also experience depression and post-traumatic stress. Cortisol awakening response is associated with anxiety in family members of ICU patients 3 months following the ICU admission. Physiologic measurements of stress among ICU family members may help identify individuals at particular risk of adverse psychologic outcomes.




Coping with the stress in the cardiac intensive care unit: Can mindfulness be the answer?

Mothers of infants with complex congenital heart disease are exposed to increased stress which has been associated with numerous adverse health outcomes. The coping mechanisms these mothers use critically effect the familial illness adaptation and most likely infant outcomes | Journal of Pediatric Nursing


Currently no data-based strategies have been developed for mothers to facilitate their coping, and proactively promote their adaptation in the critical care settings. A potential strategy is mindfulness which is currently used in other clinical settings with stress-reduction effects.


  • Mothers use emotion-regulatory coping mechanisms during the CICU stay.
  • Both active and passive strategies are used by mothers to cope with the stress.
  • Mindfulness is an acceptable and feasible approach to reduce mothers’ stress.
  • Early, tailored interventions can potentially provide long-term stress relief.

Full reference: Golfenshtein, N. et al. (2017) Coping with the stress in the cardiac intensive care unit: Can mindfulness be the answer? Journal of Pediatric Nursing. Published online: August 11, 2017

Burnout and health among critical care professionals

To analyse the mediational role of resilience in relationships between burnout and health in critical care professionals; to determine relationships among resilience level, three burnout dimensions, and physical/mental health | Intensive & Critical Care Nursing


Participants/setting: A total of 52 critical care professionals, mainly nurses, were recruited from an intensive care unit of Madrid (Spain).

Conclusions: Resilience minimises and buffers the impact of negative outcomes of workplace stress on mental health of critical care professionals. As a result, resilience prevents the occurrence of burnout syndrome. Resilience improves not only their mental health, but also their ability to practice effectively. It is therefore imperative to develop resilience programs for critical care nurses in nursing schools, universities and health centres.

Full reference: Arrogante, O & Aparicio-Zaldivar, E. (2017) Burnout and health among critical care professionals: The mediational role of resilience. Intensive & Critical Care Nursing. DOI: http://dx.doi.org/10.1016/j.iccn.2017.04.010