Resilience training program may help ICU nurses better handle stressful work environment

A multifaceted approach to teaching coping mechanisms may help critical care nurses better handle their stressful work environment, according to a study in the November issue of American Journal of Critical Care (AJCC).

"Feasibility and Acceptability of a Resilience Training Program for Intensive Care Unit Nurses" documented several strategies important for successfully coping with the constant pressure in critical care units.

High patient mortality and morbidity, frequent ethical dilemmas and a tension-filled atmosphere lead to intensive care units (ICUs) being a stressful place to work.

The pressure contributes to critical care nurses experiencing an increased prevalence of anxiety, depression, burnout syndrome and post-traumatic stress disorder. The pressure also affects retention rates for critical care units, where the annual turnover rate is estimated to exceed 25 percent and may reach as high as 60 percent.

"Helping nurses develop stronger coping strategies may help reduce the high rate of turnover within the ICU," said lead author Meredith Mealer, PhD, assistant professor at the University of Colorado Anschutz Medical Center, Aurora. "Resilience can be strengthened and taught, and this study is an initial step to learn how to structure training programs."

Nurses who develop healthy coping strategies to build resilience are able to adapt to stressful work experiences in a positive manner. Factors already found to encourage resilience include a supportive social network, attention to physical well-being and development of active coping skills.

The study examined a multifaceted resilience training program that incorporated various coping mechanisms, such as mindfulness-based stress-reduction techniques, cognitive behavioral therapy sessions, expressive writing and regular exercise over a 12-week period.

During weekly sessions, participants wrote about topics such as challenges faced at work and received feedback from expressive writing experts. These sessions identified four overarching themes:
•Patient-centric, such as death and dying, justice and interactions with patients and families
•Cognitive processing, such as rumination, guilt and regret
•Work structure, including understaffing and cumulative stress
•Workplace relationships, such as conflict with peers and personal and professional boundaries

Each participant was also asked to attend cognitive behavioral therapy sessions with a licensed counselor after a triggering event, such as a patient death, caring for patients with traumatic injuries or participating in end-of-life discussions with family members. The sessions focused on challenging negative thoughts and promoting resilience through cognitive flexibility and restructuring.

The program began with an educational workshop to introduce study participants to resilience training concepts and activities.