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：
9161921
负责人：
MARC MOSS
金额：
$ 27.9万
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/9161921
关键词：
Admission activity Back Beds Cardiopulmonary Resuscitation Caring 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 Left 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 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 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.

倦怠综合征（BOS）是与三个工作定义的工作有关的精神健康状况维度：情绪疲惫，人格化和减少个人成就。随着工作场所越来越不断增加的期望和固有的压力增加，BOS是达到医疗职业的流行比例。成为重症监护护士是由于患者的死亡率高，具有挑战性，有时是压倒性的职业发病率，每天与道德困境对抗。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，使开创性观察，重症监护病房（ICU）护士的率明显更高焦虑和抑郁，创伤后应激障碍（PTSD）和BOS的症状。这些疾病引发了负周期，导致不可接受的ICU护理周转率不可接受每年至少17-20％。 ICU护理营业额的昂贵成本超过65,000美元每个新雇用的重症监护护士。 ICU护理营业额也降低了护理生产率，员工士气和患者护理质量。目前，没有干预措施来减少BOS ICU护士。因为ICU护士的许多压力是照顾重病的固有的患者，我们的多学科小组致力于增强ICU护士适应的能力到他们的工作环境。弹性是一种多维心理特征使一个人在面对逆境中蓬勃发展，并从艰辛和创伤中反弹。重要的是，可以学习弹性。十多年前开发，基于正念认知疗法（MBCT）协同结合正念训练和认知行为疗法并可以提高弹性。我们假设基于MBCT的弹性计划将增强弹性，降低BOS，并最终降低ICU护理的高率周转。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。为此，我们将参与多个利益相关者群体协助协议适应。目标＃2：进行试验临床试验确定MBCT弹性计划和控制干预的可接受性。在这个目标中我们还将确定最可行的随机化水平，以最大程度地减少污染控制和干预组。 AIM＃3：通过与ICU护士进行的退出访谈，我们将确定BOS对ICU护士周转率的可归因贡献。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）确定其降低BOS症状的能力；和允许护士在具有挑战性的ICU环境中更有效地护理患者。