Positive emotion skills intervention to reduce burnout in nurses

Making a concerted effort to increase positive emotion shows promise as a way to improve wellness and address burnout in nurses, according to an article in AACN Advanced Critical Care.

Many wellness programs and burnout prevention interventions focus on reducing negative states, such as stress, depression and anxiety. A growing body of evidence highlights the unique and independent role of positive emotion in coping with stress, making it a promising avenue for interventions that aim to reduce burnout and promote well-being among nurses and other healthcare professionals.

"Positive Emotion Skills Intervention to Address Burnout in Critical Care Nurses" offers quick, convenient and relatively inexpensive strategies that can be easily integrated into the busy lives of critical care nurses, with both individual and team applications.

Co-author Elaine Cheung, PhD, is research assistant professor in the Department of Medical Social Sciences at Northwestern University Feinberg School of Medicine and Osher Center for Integrative Medicine at Northwestern Medicine, both in Chicago.

To fully address burnout in nursing, organizational change is necessary. However, such change takes time, resources and effort to implement. In the meantime, individual-level interventions such as ours can help address burnout and compassion fatigue."

Elaine Cheung, PhD, Research Assistant Professor, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine

The intervention teaches several skills for increasing the frequency of positive emotion in daily life:

• Noticing Positive Events: Take time to savor everyday positive moments, such as celebrating a patient reaching a milestone toward recovery or appreciating meaningful interactions.
• Capitalizing: Amplify and extend the impact of positive events to strengthen the connection between the event and the emotions. This skill could include telling a friend about the event, sharing it on social media or writing about it in a journal.
• Gratitude: Nurture a sense of thankfulness and express gratitude to others.
• Positive Reappraisal: Reframe the significance of negative or stressful events in a more positive way.
• Mindfulness: Focus on the present moment, in a nonjudgmental fashion, such as through formal meditation or informal activities that incorporate mindfulness into everyday workplace activities.
• Personal Strengths: Recognize and appreciate one's unique set of strengths, skills and talents, and acknowledge those of colleagues.
• Attainable Goals: Establish and pursue personal and team goals for a greater sense of control in a sometimes hectic and often unpredictable work environment.
• Self-Compassion: Be kind and understanding toward oneself and help create a workplace culture where personal experiences with errors and feelings of inadequacy are openly shared and addressed.
• Compassion Toward Others: Help colleagues with seemingly small gestures that provide emotional support and build an overall culture of collaboration and teamwork.

These elements were originally developed and tested in populations coping with health-related stress. Recently, the authors conducted an extensive modification process to develop a customized pilot program for medical students. The tailored program included four hour long sessions integrated into the mandatory medical school curriculum and access to specific online practice exercises and resources.

The authors suggested adapting the learnings from those interventions to help critical care nurses cope more effectively with workplace stress and sustain a sense of meaning and engagement in their work.

In recognition of nurses' busy schedules, the article includes several examples of brief and practical applications that require a minimal time commitment, are simple and enjoyable to do, and can be easily integrated into everyday workplace activities. In addition, it includes exercises that can be practiced in a team setting to build collegial support and stronger relationships across the healthcare team.

The article is part of a five-article symposium published in the summer 2020 issue of the journal, with a focus on promoting well-being and resilience in critical care nursing. The series includes a timely examination of the recent consensus report, "Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being," from The National Academy of Sciences, Engineering, and Medicine (NASEM).

Meredith Mealer, PhD, served as editor for the symposium. She is associate professor in the Department of Physical Medicine and Rehabilitation at the University of Colorado Anschutz Medical Campus in Aurora.

"The NASEM report is an encouraging step as we try to develop interventions to mitigate symptoms of distress, improve well-being, build resilience, and improve overall clinician and patient satisfaction with the healthcare environment," she said. "We must continue to seek solutions and make caregiver well-being a priority."