A Psychoeducational Group Intervention for Nurses: Rationale, Theoretical Framework, and Development.

OBJECTIVE: Nursing is a demanding profession with constant stressors, which makes nurses vulnerable to the detrimental effects of high stress, burnout, and compassion fatigue. There is a need for a multidimensional group intervention facilitated by a licensed mental health professional to improve mental health and well-being in nurses. An intervention called RISE, which is an acronym for resilience, insight, self-compassion, and empowerment, was developed to promote self-care, protect against burnout, and improve indicators of well-being among nurses. We explain the rationale, theoretical framework, and development of RISE. METHODS: RISE is based on an integrative theoretical framework of mindfulness, acceptance and commitment therapy, and cognitive-behavioral therapy. It consists of eight psychoeducational group sessions with topics related to the four RISE themes of resilience, insight, self-compassion, and empowerment. RESULTS: RISE is a contribution to the literature on well-being interventions for nurses. It will further the understanding of effective interventions to mediate the detrimental effects of stress and burnout in nursing and to improve the mental health and well-being of nurses amid the complex interplay of factors at the individual, unit, and organizational levels. CONCLUSIONS: As an approach that combines education with therapeutic process and support to improve coping and well-being inside and outside of the workplace, RISE addresses the underlying causes and effects of high stress, burnout, and compassion fatigue.

Resilience, Insight, Self-Compassion, and Empowerment (RISE): A Randomized Controlled Trial of a Psychoeducational Group Program for Nurses.

BACKGROUND: Nurses tend to be vulnerable to burnout and compassion fatigue due to constant workplace stressors. There is a need to provide advocacy, education, programming, and resources in the areas of positive coping and self-care to reduce burnout symptoms and promote well-being. RISE is an 8-week psychoeducational group intervention for nurses with four themes: resilience, insight, self-compassion, and empowerment. AIMS: This randomized controlled trial examined the effects of RISE on mental well-being. METHODS: The sample included 75 registered nurses who work in a hospital-based setting. Outcomes included resilience, insight, self-compassion, empowerment, stress mind-set, perceived stress, and burnout. Independent-samples t tests were conducted to compare outcomes between intervention and wait-list control groups at baseline and 1-month follow-up, as well as at 3-month follow-up. Supplemental analyses included paired-samples t tests and linear mixed models to compare the outcomes of the intervention group participants at baseline to 1-month follow-up, as well as at 3-month and 6-month follow-ups. RESULTS: Participants in the intervention group showed improved levels of insight (i.e., engagement in self-reflection), perceived stress, and burnout (i.e., emotional exhaustion) when compared with the control group and improved levels of resilience, self-compassion, stress mind-set, and perceived stress when compared with their baseline. CONCLUSIONS: This study informs how RISE affects nurse well-being and may be an effective intervention for reducing burnout and stress. This type of whole-person intervention can support nurses to improve their well-being and ability to cope amid the complex interplay of factors at the individual, unit, and organizational levels.

Employment Status of Nurses After a Psychoeducational Group Intervention: A Matched Case-Control Study.

OBJECTIVE: This matched case-control study compared the long-term employment status of direct care nurses based on participation in a psychoeducational group intervention and calculated the estimated cost savings. BACKGROUND: Chronic stress, in addition to lack of support and low autonomy, can lead to burnout among nurses. Burnout is a common reason for job dissatisfaction and turnover. Interventions combining education with therapeutic processing and peer support may lead to healing and growth in nurses already experiencing the effects of chronic stress and burnout. The COVID-19 pandemic also contributed to stress among nurses. METHODS: Fifty-four direct care nurses who participated in the intervention were paired with 54 direct care nurses who did not participate, matched on the following variables: age, gender, race, work setting, and campus. RESULTS: This study found a higher percentage of direct care nurses who participated in the intervention remained employed compared with the matched control subjects who did not participate. CONCLUSION: At a relatively low cost compared with the cost of turnover by each nurse, the psychoeducational group intervention may provide an opportunity to improve retention among nurses.

Clinical Leader Series: A Virtual Mental Well-being Initiative for Nurse Leaders During the COVID-19 Pandemic and Beyond.

OBJECTIVE: A virtual mental well-being initiative was developed for nurse leaders to provide education about mental health and to teach self-care skills. BACKGROUND: Because of substantial demand placed on nurse leaders during the COVID-19 pandemic, organizations must address stress and burnout by providing a continuum of care to include education, support, and intervention. METHODS: All levels of nurse leaders at a multicampus healthcare system were invited to attend. Data were collected on coping, empowerment, burnout, and quality of life. Participant responses to discussion prompts were compiled and reviewed. RESULTS: Although the independent parallel comparison did not show significant improvements, scores on the coping, empowerment, burnout, and quality-of-life measures were maintained. Discussion prompts yielded valuable insights into nurse leader experiences and session effectiveness. CONCLUSIONS: This type of education, as well as psychological support, will continue to be needed after the pandemic due to burnout, moral injury, and primary or secondary trauma. Findings are applicable to future crisis situations.

A mixed-methods pilot study of a psychoeducational group programme for nurse managers during the COVID-19 pandemic.

AIM: This mixed-methods pilot study aimed to measure the feasibility and acceptability of a psychoeducational group programme and determine its impact on mental well-being. BACKGROUND: The programme was developed to promote self-care, growth and adaptive coping for nurse managers. The programme themes were resilience, insight, self-compassion and empowerment. METHODS: The sample included 19 hospital-based nurse managers. Outcomes included post-traumatic growth, resilience, insight, self-compassion, empowerment, perceived stress, burnout and job satisfaction. Paired samples t tests were conducted to compare outcomes at baseline to follow-up. Qualitative interviews were conducted. Thematic analysis was used to code the qualitative responses by keyword, which were then aggregated into themes. RESULTS: Participants reported higher post-traumatic growth and psychological empowerment after the intervention. The following six themes emerged most consistently from the qualitative interviews: feasibility of the programme, benefits of peer support, sources of stress, barriers to self-care, sources of strength and sustainability of effects. CONCLUSIONS: The results support the acceptability and feasibility of the psychoeducational group programme. IMPLICATIONS FOR NURSING MANAGEMENT: Health care organizations can support and promote the implementation of programmes to alleviate burnout and improve mental well-being amid the complex demands of nursing management (ClinicalTrials.gov: NCT04987697).

Work-related perceptions and coping strategies of acute care chaplains: a qualitative analysis.

Hospital-based chaplains provide crucial spiritual and emotional care to patients, families, and staff during times of intense life changes and crises. Chaplains are regularly exposed to suffering and their work may result in personal mental and emotional health challenges. To understand chaplains' perceptions of the impact of their work and methods to cope, a secondary analysis of a mixed-methods study on chaplain well-being was undertaken. Qualitative interviews were conducted with nine hospital-based chaplains and data were coded and analyzed using thematic analysis. Results revealed that participants perceive their work as offering both trials and rewards, and their efforts to cope with trials include interpersonal support, intrapersonal resources, and spiritual resilience. Personal insights into chaplains' experiences may help inform organizational interventions to support these essential members of the care team.

The Impact of a Psychoeducational Group Program on the Mental Well-Being of Unit-Based Nurse Leaders: A Randomized Controlled Trial.

This randomized controlled trial examined the impact of a psychoeducational group program on the mental well-being of unit-based nurse leaders, specifically nurse managers and assistant nurse managers. The program was developed around the themes of resilience, insight, self-compassion, and empowerment to fight burnout and enhance purposeful adaptive coping to reduce distress and improve mental wellbeing. The sample included 77 unit-based nurse leaders. Outcomes included post-traumatic growth, resilience, insight, self-compassion, empowerment, perceived stress, burnout, and job satisfaction. Paired samples t-tests and repeated measures ANOVA tests were conducted to compare outcomes at baseline to the follow-up timepoints of endpoint, one-month follow-up, three-month follow-up, and six-month follow-up. The intervention group participants showed significant improvement in post-traumatic growth between baseline and all follow-up timepoints compared to the waitlist control group. Among intervention group participants, there were also significant improvements in self-reflection and insight, self-compassion, psychological empowerment, and compassion satisfaction, as well as significant reductions in perceived stress, burnout, and secondary traumatic stress. This study extends existing evidence that this psychoeducational group program can be an effective intervention for improving and protecting mental wellbeing. Among nurse leaders, it can reduce stress and burnout and improve post-traumatic growth, self-reflection and insight, self-compassion, psychological empowerment, and compassion satisfaction.

A Mixed-Methods Pilot Study of a Well-Being Intervention for Healthcare Chaplains.

This mixed-methods pilot study explored the psychological and emotional experiences of chaplains and the feasibility, acceptability, and impact of workshops designed to support chaplain well-being. After the workshops, scores on a measure of self-compassion increased, while secondary traumatic stress and burnout scores decreased. Qualitative data reflected the range of experiences of chaplaincy as well as the benefits of the workshops. This pilot study supports further exploration of organizational interventions to promote chaplain well-being.

A Virtual Inpatient Psychiatry Unit in a Multicampus Health Care System During the COVID-19 Pandemic.

A virtual, telehealth-based inpatient psychiatric unit was implemented in a multicampus health care system to care for patients involuntarily admitted under emergency hold laws who tested positive for COVID-19. Through a multidisciplinary approach, these patients received proper general medical and psychiatric treatments. This column describes the development and operationalization of the unit in terms of team structure, patient referral and admission, patient and staff safety, general medical and psychiatric treatments, and discharge planning. The results of this virtual approach to caring for patients with both COVID-19 and acute mental illness illustrate the potential of a multidimensional approach for improving care efficiency during public health emergencies.

Accelerated differentiation of human induced pluripotent stem cells to blood-brain barrier endothelial cells.

BACKGROUND: Due to their ability to limitlessly proliferate and specialize into almost any cell type, human induced pluripotent stem cells (iPSCs) offer an unprecedented opportunity to generate human brain microvascular endothelial cells (BMECs), which compose the blood-brain barrier (BBB), for research purposes. Unfortunately, the time, expense, and expertise required to differentiate iPSCs to purified BMECs precludes their widespread use. Here, we report the use of a defined medium that accelerates the differentiation of iPSCs to BMECs while achieving comparable performance to BMECs produced by established methods. METHODS: Induced pluripotent stem cells were seeded at defined densities and differentiated to BMECs using defined medium termed E6. Resultant purified BMEC phenotypes were assessed through trans-endothelial electrical resistance (TEER), fluorescein permeability, and P-glycoprotein and MRP family efflux transporter activity. Expression of endothelial markers and their signature tight junction proteins were confirmed using immunocytochemistry. The influence of co-culture with astrocytes and pericytes on purified BMECs was assessed via TEER measurements. The robustness of the differentiation method was confirmed across independent iPSC lines. RESULTS: The use of E6 medium, coupled with updated culture methods, reduced the differentiation time of iPSCs to BMECs from thirteen to 8 days. E6-derived BMECs expressed GLUT-1, claudin-5, occludin, PECAM-1, and VE-cadherin and consistently achieved TEER values exceeding 2500 Ω × cm2 across multiple iPSC lines, with a maximum TEER value of 4678 ± 49 Ω × cm2 and fluorescein permeability below 1.95 × 10-7 cm/s. E6-derived BMECs maintained TEER above 1000 Ω × cm2 for a minimum of 8 days and showed no statistical difference in efflux transporter activity compared to BMECs differentiated by conventional means. The method was also found to support long-term stability of BMECs harboring biallelic PARK2 mutations associated with Parkinson's Disease. Finally, BMECs differentiated using E6 medium responded to inductive cues from astrocytes and pericytes and achieved a maximum TEER value of 6635 ± 315 Ω × cm2, which to our knowledge is the highest reported in vitro TEER value to date. CONCLUSIONS: Given the accelerated differentiation, equivalent performance, and reduced cost to produce BMECs, our updated methods should make iPSC-derived in vitro BBB models more accessible for a wide variety of applications.