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.
BeckA. T. (1976). Cognitive therapy and the emotional disorders. Penguin.
5.
BeckJ. S. (1964). Cognitive therapy: Basics and beyond. Guilford Press.
6.
BlakeH.LloydS. (2008). Influencing organisational change in the NHS: Lessons learned from workplace wellness initiatives in practice. Quality in Primary Care, 16(6), 449-455.
7.
BrownK. W.RyanR. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848. https://doi.org/10.1037/0022-3514.84.4.822
8.
BrowningA. M. (2013). Moral distress and psychological empowerment in critical care nurses caring for adults at end of life. American Journal of Critical Care, 22(2), 143-151. https://doi.org/10.4037/ajcc2013437
9.
Cañadas-De la FuenteG. A.VargasC.San LuisC.GarcíaI.CañadasG. R.De la FuenteE. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240-249. https://doi.org/10.1016/j.ijnurstu.2014.07.001
10.
CarayonP.GursesA. P. (2008). Nursing workload and patient safety: A human factors engineering perspective. In HughesR. G. (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Chapter 30). Agency for Healthcare Research and Quality.
Cohen-KatzJ.WileyS. D.CapuanoT.BakerD. M.KimmelS.ShapiroS. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holistic Nursing Practice, 19(1), 26-35. https://doi.org/10.1097/00004650-200501000-00008
13.
CoreyM. S.CoreyG.CoreyC. (2014). Groups: Process and practice (9th ed.). Brooks/Cole.
14.
DavisD. M.HayesJ. A. (2011). What are the benefits of mindfulness? A practice review of psychotherapy-related research. Psychotherapy, 48(2), 198-208. https://doi.org/10.1037/a0022062
15.
DyrbyeL. N.ShanafeltT. D.SinskyC. A.CiprianoP. F.BhattJ.OmmayaA.WestC. P.MeyersD. (2017). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care (NAM Perspectives; Discussion Paper). National Academy of Medicine. https://doi.org/10.31478/201707b
16.
FigleyC. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner/Routledge.
17.
FillionL.DuvalS.DumontS.GagnonP.TremblayI.BairatiI.BreitbartW. S. (2009). Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses. Psychooncology, 18(12), 1300-1310. https://doi.org/10.1002/pon.1513
18.
FisherD. M.RagsdaleJ. M.FisherE. C. (2018). The importance of definitional and temporal issues in the study of resilience. Applied Psychology, 68(4), 583-620. https://doi.org/10.1111/apps.12162
19.
GermerC. K.NeffK. D. (2013). Self-compassion in clinical practice. Journal of Clinical Psychology, 69(8), 856-867. https://doi.org/10.1002/jclp.22021
20.
GhawadraS. F.AbdullahK. L.ChooW. Y.PhangC. K. (2019). Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. Journal of Clinical Nursing, 28(21-22), 3747-3758. https://doi.org/10.1111/jocn.14987
21.
GilmartinH.GoyalA.HamatiM. C.MannJ.SaintS.ChopraV. (2017). Brief mindfulness practices for healthcare providers: A systematic literature review. American Journal of Medicine, 130(10), 1219.e1-1219.e17. https://doi.org/10.1016/j.amjmed.2017.05.041
HayesS. C.LuomaJ. B.BondF. W.MasudaA.LillisJ. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006
24.
HayesS. C.StrosahlK. D.WilsonK. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
25.
HenshallC.DaveyZ.JacksonD. (2020). Nursing resilience interventions – A way forward in challenging healthcare territories. Journal of Clinical Nursing, 29(19-20), 3597-3599. https://doi.org/10.1111/jocn.15276
26.
HindererK. A.VonRuedenK. T.FriedmannE.McQuillanK. A.GilmoreR.KramerB.MurrayM. (2014). Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. Journal of Trauma Nursing, 21(4), 160-169. https://doi.org/10.1097/JTN.0000000000000055
27.
HülshegerU. R.AlbertsH. J. E. M.FeinholdtA.LangJ. W. B. (2012). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98(2), 310-325. https://doi.org/10.1037/a0031313
28.
HunsakerS.ChenH.MaughanD.HeastonS. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194. https://doi.org/10.1111/jnu.12122
29.
IJntemaR. C.BurgerY. D.SchaufeliW. B. (2019). Reviewing the labyrinth of psychological resilience: Establishing criteria for resilience-building programs. Consulting Psychology Journal: Practice and Research, 71(4), 288-304. https://doi.org/10.1037/cpb0000147
30.
InfurnaF. J.LutharS. S. (2018). Re-evaluating the notion that resilience is commonplace: A review and distillation of directions for future research, practice, and policy. Clinical Psychology Review, 65, 43-56. https://doi.org/10.1016/j.cpr.2018.07.003
JoyceS.ShandF.TigheJ.LaurentS. J.BryantR. A.HarveyS. B. (2018). Road to resilience: A systematic review and meta-analysis of resilience training programmes and interventions. BMJ Open, 8(6), e017858. https://doi.org/10.1136/bmjopen-2017-017858
34.
Kabat-ZinnJ. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156. https://doi.org/10.1093/clipsy.bpg016
35.
KashdanT. B.RottenbergJ. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865-878. https://doi.org/10.1016/j.cpr.2010.03.001
KerlinM. P.McPeakeJ.MikkelsenM. E. (2020). Burnout and joy in the profession of critical care medicine. Critical Care, 24(1), 98. https://doi.org/10.1186/s13054-020-2784-z
KhamisaN.PeltzerK.OldenburgB. (2013). Burnout in relation to specific contributing factors and health outcomes among nurses: A systematic review. International Journal of Environmental Research and Public Health, 10(6), 2214-2240. https://doi.org/10.3390/ijerph10062214
40.
LaschingerH. K. S.NoskoA.WilkP.FineganJ. (2014). Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: A time-lagged study. International Journal of Nursing Studies, 51(12), 1615-1623. https://doi.org/10.1016/j.ijnurstu.2014.04.010
MelnykB. M.KellyS. A.StephensJ.DhakalK.McGovernC.TuckerS.HoyingJ.McRaeK.AultS.SpurlockE.BirdS. B. (2020). Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review. American Journal of Health Promotion, 34(8), 929-941. https://doi.org/10.1177/0890117120920451
43.
MoodyK.KramerD.SantizoR. O.MagroL.WyshogrodD.AmbrosioJ.CastilloC.LiebermanR.SteinJ. (2013). Helping the helpers: Mindfulness training for burnout in pediatric oncology—A pilot program. Journal of Pediatric Oncology Nursing, 30(5), 275-284. https://doi.org/10.1177/1043454213504497
44.
MossM.GoodV.GozalD.KleinpellR.SesslerC. (2016). Burnout syndrome in critical care healthcare professionals: A call for action. American Journal of Respiratory and Critical Care Medicine, 194(1), 106-113. https://doi.org/10.1164/rccm.201604-0708ST
45.
NeffK. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101. https://doi.org/10.1080/15298860309032
46.
NeffK. D.LongP.KnoxM.DavidsonO.KucharA.CostiganA.WilliamsonaZ.RohlederbN.Tóth-KirálycI.BreinesJ. (2018). The forest and the trees: Examining the association of self-compassion and its positive and negative components with psychological functioning. Self and Identity, 17(6), 627-645. https://doi.org/10.1080/15298868.2018.1436587
47.
OrlyS.RivkaB.RivkaE.DoritS. E. (2012). Are cognitive-behavioral interventions effective in reducing occupational stress among nurses?Applied Nursing Research, 25(3), 152-157. https://doi.org/10.1016/j.apnr.2011.01.004
48.
ÖzbaşA. A.TelH. (2016). The effect of a psychological empowerment program based on psychodrama on empowerment perception and burnout levels in oncology nurses: Psychological empowerment in oncology nurses. Palliative & Supportive Care, 14(4), 393-401. https://doi.org/10.1017/S1478951515001121
RobertsonI. T.CooperC. L.SarkarM.CurranT. (2015). Resilience training in the workplace from 2003 to 2014: A systematic review. Journal of Occupational and Organizational Psychology, 88(3), 533-562. https://doi.org/10.1111/joop.12120
51.
SalyersM. P.BonfilsK. A.LutherL.FirminR. L.WhiteD. A.AdamsE. L.RollinsA. L. (2017). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine, 32(4), 475-482. https://doi.org/10.1007/s11606-016-3886-9
52.
SchaufeliW. B.LeiterM. P.MaslachC. (2009). Burnout: 35 years of research and practice. Career Development International, 14(3), 204-220. https://doi.org/10.1108/13620430910966406
53.
SeibertS. E.WangG.CourtrightS. H. (2011). Antecedents and consequences of psychological and team empowerment in organizations: A meta-analytic review. Journal of Applied Psychology, 96(5), 981-1003. https://doi.org/10.1037/a0022676
54.
ShanafeltT.SwensenS. J.WoodyJ.LevinJ.LillieJ. (2018). Physician and nurse well-being. Journal of Healthcare Management, 63(6), 363-369. https://doi.org/10.1097/JHM-D-18-00209
55.
SpreitzerG. M. (1995). Psychological empowerment in the workplace: Construct definition, measurement, and validation. Academy of Management Journal, 38(5), 1442-1465. https://doi.org/10.5465/256865
56.
ThomasR. V.PenderD. A. (2008). Association for specialists in group work: Best practice guidelines 2007 revisions. Journal for Specialists in Group Work, 33(2), 111-117. https://doi.org/10.1080/01933920801971184
57.
TugadeM. M.FredricksonB. L.BarrettL. F. (2004). Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of Personality, 72(6), 1161-1190. https://doi.org/10.1111/j.1467-6494.2004.00294.x
58.
WarrenR.SmeetsE.NeffK. D. (2016). Self-criticism and self-compassion: Risk and resilience for psychopathology. Current Psychiatry, 15(12), 18-32.
59.
YalomI. D. (1995). The theory and practice of group psychotherapy (4th ed.). Basic Books.
