Methods: This study was conducted under IRB# 1604017521. To explore what current self-care practices and health promoting behaviors and lack thereof are employed by staff members in the CTICU, a town hall meeting was held by the investigators. A Replenish at Work curriculum was created to be performed at the workplace employing an initial 20-min training session followed by a 10-min experiential session and then subsequent 10-min experiential sessions over the course of the study period. Prior to the intervention stage all participants were asked to fill out a 10-minute survey assessing levels of compassion fatigue, burnout and resilience. The intervention stage began in April 2016 and lasted four weeks. All participants received the initial 30-minute session in a quiet space to cover curriculum and meet objectives. Education was delivered 1:2 instructors/staff. Staff members received support coverage by a supplemental float RN on the unit during the time sessions were in progress. The intervention team was able to provide initial sessions to 75% of the staff over the course of 2 weeks. The curriculum covered principles of mindfulness, emotional intelligence, an overview of the Healthy Mind Platter (Siegel, Rock, 2014) and concluded with a 10 minute practice utilizing mindful awareness, gentle yoga stretches, and self-reflection. The environment was enhanced with soothing music, fruit infused water and aromatherapy lotion. The next two weeks participants received 10-minute follow-up sessions to implement experiential exercise. Pre- and Post- intervention surveys were constructed using a combination of the Oldenburg Burnout Inventory (OLBI), the Depression Anxiety Stress Scale (DASS), and the Mindful Attention Awareness Scale (MAAS). Qualitative indicators of “Engagement,” “Contentment,” and “Mindfulness” were assigned a point value to responses for each question, with “3” indicating most healthy to “0” indicating least healthy in order to quantify the data and multiple linear regression models as well as logistic linear regression models were used to analyze the data.
Results:Our study population consisted of 69 individuals recruited by word of mouth and email solicitation. All participants were part of the ICU staff. 96% women, and 70% were between the ages of 18-54. Staff were evenly distributed for number of years worked at institution (range <1 to >15years) with the majority having worked between 3-15 years. Average number of sessions attended was 2 over the course of the intervention, and the max attended was 7. An individual session saw about 13 staff in attendance. 33% of participants attended 1 session; 27% attended 2 sessions; 19% attended 3 sessions; 14% attended 4 sessions; 7% attended 5 sessions or more. Participants increased their total baseline health scores by 2.73 points (4% growth); engagement score by 2.43 (11.5% growth); contentment score by 0.715 (2.6% growth). All respondents affirmed that this intervention should be shared across departments. An institutional employee engagement survey conducted 2 months post intervention showed a 14.3% improvement compared to the previous year. Furthermore, a recent Press Ganey survey shows continued decline in engagement without any follow up or further interventions in this area.
Discussion:The majority of the participants found the intervention helpful in promoting self-care at work and found this to be an overall positive experience. Levels of stress were improved after the intervention and most notably the employees felt appreciated and valued institutional support. Employee engagement data improved with a decrease in disengagement. They were particularily satisfied with the effectiveness of the yoga stretches as seen in other studies (Hartfiel et al., 2012). It was important to the ICU personnel that their patients were fully supported by a supplemental float nurse while they attended the sessions. There was a strong interest in onsite self-care programs among staff with the resources and support to sustain the practices. The present study supports the need for further development of meaningful interventions to promote self-care in the workplace to reduce burnout and improve engagement.