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

职业倦怠综合症(BOS)是一种与工作相关的心理健康状况，由三个人定义 维度：情绪衰竭、去人格化和个人成就感降低。 随着工作场所日益增长的期望和内在压力的增加，BOS 在医疗保健行业达到流行病的比例。成为一名重症监护护士是一种 由于患者死亡率高，职业挑战性强，有时甚至无法承受 发病率，以及与伦理困境的日常对抗。我们的多学科研究团队 它结合了重症监护医学、护理、精神病学和心理学的专业知识，使 精液观察显示，重症监护病房(ICU)护士的 焦虑和抑郁症状、创伤后应激障碍(PTSD)和BOS。这些 疾病引发了一个负面循环，导致令人无法接受的高ICU护理流失率 每年至少17-20%。ICU护理周转费用昂贵，超过65,000美元 每位新聘用的重症监护护士。ICU护理人员更替也降低了护理工作效率， 员工士气和病人护理质量。目前，还没有减少BOS的干预措施 重症监护室的护士。因为ICU护士的许多压力都是护理危重病人所固有的 患者，我们的多学科小组致力于提高ICU护士的适应能力 到他们的工作环境。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，复原力是可以学习的。10多年前开发的，以正念为基础 认知疗法(MBCT)协同结合了正念训练和认知 行为疗法，可以提高复原力。我们假设基于MBCT的弹性 该计划将建立弹性，降低BOS，并最终降低ICU护理的高比率 营业额。在这个R34应用程序中，我们提出了三个目标：目标1：调整和优化 专门针对ICU护士的MBCT复原力计划。为了这个目标，我们将参与多个 利益攸关方团体协助议定书适应。目标2：进行一项试点临床试验 确定MBCT复原力计划和控制干预措施的可接受性。在这个目标中， 我们还将确定最可行的随机化水平，以最大限度地减少 对照组和干预组。目标3：通过对ICU护士进行离职访谈，我们 将确定BOS对ICU护士离职率的可归因贡献。 总的来说，这项提议将为妥善设计的大型多中心试验铺平道路。 MBCT复原力计划(MBCT-ICU)，以确定其减轻BOS症状的能力；以及 让护士在充满挑战的ICU环境中更有效地护理病人。

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.