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A Mindfulness Based Cognitive Therapy (MBCT) Resiliency Program for Critical Care Nurses

针对重症监护护士的正念认知疗法 (MBCT) 弹性计划

基本信息

批准号：
9346579
负责人：
MARC MOSS
金额：
$ 27.89万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2019-09-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9346579
关键词：
Admission activity Back Beds Cardiopulmonary Resuscitation Cessation of life Characteristics Clinical Trials Cognitive Therapy Critical Care Critical Illness Depersonalization Dimensions Discipline of Nursing Disease Distress Emotional Environment Epidemic Ethics Exposure to Health Care Costs Health Personnel Healthcare Hospitals Individual Inpatients Intensive Care Units Interdisciplinary Study Intervention Interview Learning Medical Medication Errors Medicine Mental Depression Mental Health Methods Modality Morale Morbidity - disease rate Multi-Institutional Clinical Trial Multicenter Trials Nurses Occupations Operative Surgical Procedures Patient Care Patients Positioning Attribute Post-Traumatic Stress Disorders Productivity Protocols documentation Psychiatry Psychological Stress Psychology Quality of Care Randomized Reporting Research Design Research Personnel Self Efficacy Seminal Strategic Planning Stress Surveys Symptoms Syndrome Techniques Testing Therapeutic Intervention Training Trauma United States Work Workplace anxiety symptoms base burnout collaborative environment cost critical care nursing depressive symptoms design exhaustion expectation experience group intervention mindfulness mindfulness based cognitive therapy mindfulness-based stress reduction mortality multidisciplinary nurse performance nursing care quality programs psychologic psychological distress reduce symptoms resilience stressor

项目摘要

Burnout Syndrome (BOS) is a work related mental health condition defined by three dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. As mounting expectations and inherent stresses have increased in the workplace, BOS is reaching epidemic proportions in the healthcare profession. Being a critical care nurse is a challenging and sometimes overwhelming profession due to high patient mortality and morbidity, and daily confrontations with ethical dilemmas. Our multidisciplinary research team that combines expertise in critical care medicine, nursing, psychiatry, and psychology made the seminal observation that intensive care unit (ICU) nurses have significantly higher rates of symptoms of anxiety and depression, posttraumatic stress disorder (PTSD), and BOS. These disorders initiate a negative cycle resulting in an unacceptably high ICU nursing turnover rate of at least 17-20% per year. ICU nursing turnover is expensive costing in excess of $65,000 for each newly hired critical care nurse. ICU nursing turnover also diminishes nursing productivity, staff morale, and patient quality of care. Presently, there are no interventions to reduce BOS in ICU nurses. Because many of the stresses on ICU nurses are inherent to caring for critically ill patients, our multidisciplinary group has focused on enhancing the ability of ICU nurses to adapt to their work environment. Resiliency is a multidimensional psychological characteristic that enables one to thrive in the face of adversity and bounce back from hardships and trauma. Importantly, resiliency can be learned. Developed over 10 years ago, Mindfulness Based Cognitive Therapy (MBCT) synergistically combines mindfulness training and cognitive behavioral therapy and can increase resiliency. We hypothesize that a MBCT based resiliency program will build resiliency, reduce BOS, and ultimately diminish the high rate of ICU nursing turnover. In this R34 application, we propose three aims: Aim #1: To adapt and optimize a MBCT resiliency program specifically for ICU nurses. For this aim, we will engage multiple stakeholder groups to assist the protocol adaptation. Aim # 2: To conduct a pilot clinical trial to determine acceptability of the MBCT resiliency program and the control intervention. In this aim, we will also identify the most feasible randomization level to minimize contamination between the control and intervention groups. Aim #3: By performed exit interviews with ICU nurses, we will determine the attributable contribution of BOS to the turnover rate for ICU nurses. Collectively, this proposal will pave the way for a properly designed large multi-center trial of a MBCT resiliency program (MBCT-ICU) to determine its ability to decrease BOS symptoms; and allow nurses to more effectively care for patients in the challenging ICU environment.

倦怠综合症 (BOS) 是一种与工作相关的心理健康状况，其定义为以下三个方面：维度：情绪疲惫、人格解体和个人成就感下降。随着工作场所的期望不断提高和固有压力不断增加，BOS 正在在医疗保健行业达到流行病的程度。成为一名重症监护护士是由于高患者死亡率和发病率以及每天面临的道德困境。我们的多学科研究团队结合了重症监护医学、护理、精神病学和心理学方面的专业知识，开创性的观察表明，重症监护病房 (ICU) 护士的发生率明显更高焦虑和抑郁、创伤后应激障碍 (PTSD) 和 BOS 的症状。这些疾病引发负循环，导致 ICU 护理人员流失率高得令人无法接受每年至少 17-20%。 ICU 护理人员流动率非常昂贵，花费超过 65,000 美元每个新雇用的重症监护护士。 ICU 护理人员流动也会降低护理效率，员工士气和患者护理质量。目前，没有任何干预措施可以减少 BOS 重症监护室护士。因为 ICU 护士的许多压力都是护理危重病人所固有的对于患者，我们的多学科小组致力于增强 ICU 护士的适应能力他们的工作环境。弹性是一种多维的心理特征，使人能够在逆境中茁壮成长，并从困难和创伤中恢复过来。重要的是，韧性是可以习得的。十多年前开发，基于正念认知疗法（MBCT）将正念训练和认知疗法协同结合行为疗法可以提高弹性。我们假设基于 MBCT 的弹性该计划将增强弹性，减少 BOS，并最终降低 ICU 护理率高的情况周转。在此 R34 应用程序中，我们提出了三个目标：目标 #1：适应和优化专门针对 ICU 护士的 MBCT 弹性计划。为了这个目标，我们将联合多方利益相关者团体协助协议调整。目标#2：进行试点临床试验确定 MBCT 弹性计划和控制干预的可接受性。为了这个目标，我们还将确定最可行的随机化水平，以尽量减少之间的污染对照组和干预组。目标#3：通过对 ICU 护士进行离职面谈，我们将确定 BOS 对 ICU 护士流动率的贡献。总的来说，该提案将为正确设计的大型多中心试验铺平道路 MBCT 弹性计划 (MBCT-ICU) 以确定其减少 BOS 症状的能力；和让护士能够在充满挑战的 ICU 环境中更有效地护理患者。