Radia El Khamali1,2, Atika Mouaci1,2, Sabine Valera1,2, Marion Cano-Chervel1,2, Camille Pinglis1,2, Céline Sanz1,2, Amel Allal1,2, Valérie Attard1,2, Julie Malardier1,2, Magali Delfino3, Fifina D'Anna3, Pierre Rostini3, Stéphan Aguilard4,5, Karine Berthias5,6, Béatrice Cresta5,7, Frédéric Iride5,8, Valérie Reynaud9, Jérémie Suard5,10, Wlady Syja5,11, Cécile Vankiersbilck1,2, Nicole Chevalier12, Karen Inthavong12, Jean-Marie Forel1,2, Karine Baumstarck2,13, Laurent Papazian1,2. 1. Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France. 2. Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et Qualité, Marseille, France. 3. Centre d'Enseignement des Soins d'Urgence, Assistance Publique-Hôpitaux de Marseille, Marseille, France. 4. Assistance Publique-Hôpitaux de Marseille, Hôpital Timone, Réanimation des Urgences et Médicale, Marseille, France. 5. Aix-Marseille Université, Marseille, France. 6. Assistance Publique-Hôpitaux de Marseille, Hôpital Timone, Réanimation Polyvalente et Neurochirurgicale, Marseille, France. 7. Assistance Publique-Hôpitaux de Marseille, Hôpital Timone, Unité de Réanimation de Chirurgie Cardiovasculaire, Marseille, France. 8. Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation Polyvalente et Traumatologique, Marseille, France. 9. Réanimation Centre Hospitalier, Aix-en-Provence, France. 10. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Réanimation Polyvalente, Marseille, France. 11. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Réanimation Polyvalente et des Pathologies du Foie, Marseille, France. 12. Assistance Publique-Hôpitaux de Marseille, Marseille, France. 13. Assistance Publique-Hôpitaux de Marseille, Unité d'Aide Méthodologique à la Recherche Clinique, Marseille, France.
Abstract
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.
RCT Entities:
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.
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