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

倦怠综合征（BOS）是一种与工作有关的心理健康状况， 维度：情绪衰竭、人格解体和个人成就感降低。 随着工作场所的期望值和内在压力的增加，BOS 在医疗保健行业达到流行病的程度。作为一名重症监护护士， 由于患者死亡率高， 病态，以及每天面对道德困境。我们的多学科研究团队 它结合了重症监护医学、护理、精神病学和心理学方面的专业知识， 精液观察重症监护室（ICU）护士有显着较高的比率， 焦虑和抑郁的症状，创伤后应激障碍（PTSD）和BOS。这些 疾病引发了一个负面的循环，导致不可接受的高ICU护理周转率， 每年至少17-20%。ICU护理人员的流动是昂贵的，成本超过65,000美元， 每一个新雇的重症监护护士ICU护理人员的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，没有任何干预措施来减少BOS， 重症监护室护士因为ICU护士的许多压力是照顾危重病人所固有的， 病人，我们的多学科小组的重点是提高ICU护士的适应能力， 他们的工作环境。复原力是一种多维度的心理特征， 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，弹性是可以学习的。10年前开发的，基于正念 认知疗法（MBCT）协同结合正念训练和认知 行为疗法，可以增加弹性。我们假设基于MBCT的弹性 该计划将建立弹性，减少BOS，并最终降低ICU护理的高比率 周转在这个R34应用程序中，我们提出了三个目标：目标#1：适应和优化 MBCT弹性计划专门为ICU护士。为了实现这一目标，我们将与多个 利益攸关方团体协助《议定书》的适应工作。目标#2：进行试点临床试验， 确定MBCT恢复力计划和控制干预的可接受性。在这一目标下， 我们还将确定最可行的随机化水平，以尽量减少 控制组和干预组。目标#3：通过与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，该提案将为适当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;以及 使护士能够在具有挑战性的ICU环境中更有效地护理患者。

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.