Effects of a multimodal program including simulation on job strain among nurses working in intensive care units a randomized clinical trial.

Details

• Personal Author:
  Aguilard S ; Allal A ; Attard V ; Baumstarck K ; Berthias K ; Cano-Chervel M ; Chevalier N ; Cresta B ; D'Anna F ; Delfino M ; El Khamali R ; Forel J-M ; Inthavong K ; Iride F ; Malardier J ; Mouaci A ; Papazian L ; Pinglis C ; Reynaud V ; Rostini P ; Sanz C ; Suard J ; Syja W ; Valera S ; Vankiersbilck C
• Description:
  IMPORTANCE Nurses working in an intensive care unit (ICU) are exposed to occupational stressors that can increase the risk of stress reactions, long-term absenteeism, and turnover. OBJECTIVE To evaluate the effects of a program including simulation in reducing work-related stress and work-related outcomes among ICU nurses. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial performed at 8 adult ICUs in France from February 8, 2016, through April 29, 2017. A total of 198 ICU nurses were included and followed up for 1 year until April 30, 2018. INTERVENTIONS The ICU nurses who had at least 6 months of ICU experience were randomized to the intervention group (n = 101) or to the control group (n = 97). The nurses randomized to the intervention group received a 5-day course involving a nursing theory recap and situational role-play using simulated scenarios (based on technical dexterity, clinical approach, decision making, aptitude to teamwork, and task prioritization), which were followed by debriefing sessions on attitude and discussion of practices. MAIN OUTCOMES AND MEASURES The primary outcome was the prevalence of job strain assessed by combining a psychological demand score greater than 21 (score range, 9 [best] to 36 [worst]) with a decision latitude score less than 72 (score range, 24 [worst] to 96 [best]) using the Job Content Questionnaire and evaluated at 6 months. There were 7 secondary outcomes including absenteeism and turnover. RESULTS Among 198 ICU nurses who were randomized (95 aged ≤ 30 years [48%] and 115 women [58%]), 182 (92%) completed the trial for the primary outcome. The trial was stopped for efficacy at the scheduled interim analysis after enrollment of 198 participants. The prevalence of job strain at 6 months was lower in the intervention group than in the control group (13% vs 67%, respectively; between-group difference, 54% [95% CI, 40%-64%]; P < .001). Absenteeism during the 6-month follow-up period was 1% in the intervention group compared with 8% in the control group (between-group difference, 7% [95% CI, 1%-15%]; P = .03). Four nurses (4%) from the intervention group left the ICU during the 6-month follow-up period compared with 12 nurses (12%) from the control group (between-group difference, 8% [95% CI, 0%-17%]; P = .04). CONCLUSIONS AND RELEVANCE Among ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program. Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective. [Description provided by NIOSH]
• Subjects:
  Absenteeism Behavior Education Health Personnel Occupational Health Safety Stress, Psychological
• Keywords:
  Nurses; Nursing; Job stress; Intervention effectiveness; Absenteeism; Attitude; Behavior; Psychological factors; Education; Work experience; Psychosocial factors
• ISSN:
  0098-7484
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 6 ; Texas
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  320
• Issue:
  19
• NIOSHTIC Number:
  nn:20065291
• Citation:
  JAMA 2018 Nov; 320(19):1988-1997
• Contact Point Address:
  Laurent Papazian, MD, PhD, Médecine Intensive-Réanimation, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
• Email:
  laurent.papazian@ap-hm.fr
• Federal Fiscal Year:
  2019
• Performing Organization:
  University of Texas Health Science Center, Houston
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of the American Medical Association
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:6835fa027f7eb52c92fdb6cddee5df2296d9425d9cd354d52e022d66a07571c55e7a21b91b27bd479dc9fa59e909fe04601518de364f87b1e8efd0926e0526c3
• Download URL:
  https://stacks.cdc.gov/view/cdc/249387/cdc_249387_DS1.pdf
• File Type:
  [PDF - 400.67 KB ]