A Mindfulness Based Cognitive Therapy (MBCT) Resiliency Program for Critical Care Nurses
Condition: Burn-Out Syndrome; Work-Related Stress Disorder
MeSH terms: Occupational Stress; Stress Disorders, Traumatic; Burnout, Psychological
Study type: Interventional

Summary: 
      Developed over 10 years ago, Mindfulness Based Cognitive Therapy (MBCT) synergistically
      combines mindfulness training and cognitive behavioral therapy and can increase resiliency.
      In this study, the investigators proposed two aims: Aim #1: To adapt and optimize a MBCT
      resiliency program specifically for ICU nurses. For this aim, the investigators 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, the investigators will also identify the most feasible
      randomization level to minimize contamination between the control and intervention groups.
      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.
    

Detailed description: 
      The Intensive Care Unit (ICU) is a stressful environment for all critical care healthcare
      providers. In the United States, there are more than 500,000 critical care (ICU) nurses that
      treat the most seriously ill patients. These ICU nurses have especially challenging and
      sometimes overwhelming jobs due to high patient mortality and morbidity, and frequent
      encounters with ethical dilemmas. The repetitive exposure to these extreme stressors and the
      inability to adjust to their difficult work environment may cause significant psychological
      stress. The investigator's multidisciplinary research team was one of the first to identify
      that ICU nurses have significantly high rates of psychological distress including: symptoms
      of anxiety and depression, posttraumatic stress disorder (PTSD) and burnout syndrome (BOS).

      Work-induced distress initiates a negative cycle that contributes to the unacceptably high
      ICU nursing turnover rate. Nationally, nursing turnover rates range between 17-20% per year.
      In the ICU, the growing nursing shortage is particularly concerning. Presently, there are no
      interventions to reduce BOS in ICU nurses. Many stresses on ICU nurses are inherent to the
      critical care environment such as performing cardiopulmonary resuscitation and the death of a
      patient. Therefore, the investigators multidisciplinary research group has focused on
      enhancing the ability of ICU nurses to adapt to their work environment.

      Resiliency enables one to thrive in the face of adversity. Humans respond to stress and
      trauma in a variety of ways. Some people are resilient; defined as the ability to succeed, to
      live, and to develop in a positive way despite the stress or adversity that would normally
      involve the real possibility of a negative outcome. In practice, resilient individuals
      believe that what they do can have a positive impact on a situation, that some components of
      the 'system' can be controlled or influenced by one's own actions, that persistent effort is
      worthwhile, and that setbacks or potentially threatening events are inevitable and
      surmountable. A variety of qualities are associated with resiliency including the ability to
      engage the support of others, the belief that stress can be strengthening, and overall
      optimism. Though some individuals are inherently resilient; resiliency can be learned.
      Developing resiliency may be one strategy to prevent and treat symptoms of BOS. The
      investigators have demonstrated that resilient ICU nurses were less likely to have symptoms
      of anxiety, depression, PTSD, and BOS. The investigators also identified methods used by ICU
      nurses to promote resiliency and emotional wellness. The investigators ICU nursing pilot
      program also increased resiliency and decreased symptoms of BOS.

      From the investigators prior studies, mindfulness-based stress reduction (MBSR) and cognitive
      behavioral therapy (CBT) are two modalities currently used by resilient ICU nurses. In the
      investigators most recent national survey, ICU nurses were eager to learn MBSR and CBT
      techniques to help reduce symptoms of BOS. Mindfulness Based Cognitive Therapy (MBCT)
      combines the best of MBSR and CBT, and may build resiliency and reduce BOS symptoms. MBCT was
      developed by integrating the framework and practices of MBSR and CBT. Classically
      incorporated into an 8 week course, MBCT uses mindfulness skills to help individuals become
      aware of negative thoughts and feelings that are activated by stress. MBCT also incorporates
      CBT techniques to develop a different relationship to those thoughts and feelings, and
      interrupt the negative thought patterns.
    

Intervention name(s): Mindfulness-Based Cognitive Therapy; Book Club Active Control Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Mindfulness-Based Cognitive therapy is a 16 in-person hours intervention. The intervention in this population is designed to reduce symptoms of PTSD and BOS and increase resiliency scores.; Participants randomized to the book club active control intervention will meet for 16 in-person hours that are broken into sessions. Books will be assigned to read during homework time and discussions regarding the books will occur during the sessions. The time involved will be similar to the MBCT intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: critical care nurses; mindfulness-based cognitive therapy; Burn-out Syndrome; Post-traumatic Stress Disorder; Cognitive Behavioral Therapy