Effects of a Multimodal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units: A Randomized Clinical Trial.

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. Trial Registration: ClinicalTrials.gov Identifier: NCT02672072.

[Advanced practice nursing implementation strategies in hospital: a review of the literature]. / Stratégies d'implantation d'un infirmier de pratique avancée en milieu hospitalier : une revue de littérature.

Objective: To analyse the factors of success and the obstacles to implementation of advanced practice nursing in the French health system. Methods: Review of the international literature concerning implementation of advanced practice nursing published between 2010 and 2016. Results: Of the 503 articles reviewed, 14 were included in this analysis, which showed that obstacles to implementation can be potentially transformed into advantages. Only one guideline was identified, the PEPPA (Participatory, Evidence-based, Patient-focused process for Advanced Practice Nursing (APN) role development). Four factors of successful implementation and evaluation of advanced practice nursing were identified: involvement of medical and paramedical personnel, supervisor and material support from administrative authorities, implementation of policies and regulation mechanisms and postgraduate university training. Conclusion: Implementation of advanced practice nursing in France should take into account the PEPPA guidelines used in Canada, in order to promote the success of these new roles in clinical practice.