Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington.
Cambia Palliative Care Center of Excellence, University of Washington, Seattle.
JAMA Netw Open. 2022 Jul 1;5(7):e2220677. doi: 10.1001/jamanetworkopen.2022.20677.
Health care workers face serious mental health challenges as a result of ongoing work stress. The COVID-19 pandemic exacerbated that stress, resulting in high rates of anxiety, depression, and burnout. To date, few evidence-based programs targeting mental health outcomes in health care workers have been described.
To assess the feasibility, acceptability, and preliminary outcomes of a skills-based coaching program designed to reduce stress and build resilience.
DESIGN, SETTING, AND PARTICIPANTS: A pilot cohort study was conducted between September 2020 and April 2021 using preprogram and postprogram assessments and a mixed-methods analysis. Duration of follow-up was 7 weeks. The coaching program was delivered via video conferencing. Participants were health care workers and staff from a large urban health system.
The Promoting Resilience in Stress Management (PRISM) program, a manualized, skills-based coaching program originally developed for adolescents and young adults with serious/chronic illness, was adapted to support health care workers and staff ("PRISM at Work"). It included 6 weekly 1-hour group sessions.
Feasibility was defined a priori as 70% completion rates. Acceptability was defined quantitatively (satisfaction scores) and qualitatively (open-ended questions regarding experience with program). Preliminary outcomes were assessed with preprogram and post program assessments of self-reported resilience, stress, anxiety, and burnout using validated instruments. Descriptive statistics summarized demographic variables and feasibility and acceptability. Linear mixed effects regression models examined preliminary outcomes, controlling for relevant covariates.
A total of 153 participants (median [SD] age, 40.6 [10.1] years; 142 [92%] were female; 128 [84%] identified as having White race; 81 [53%] were in patient-facing roles) enrolled. Of the 132 health care workers who provided follow-up surveys, 120 (91%) had completed the program, and 116 (88%) reported being satisfied. Answers to open-ended questions suggested that participants wanted more PRISM either with longer or additional sessions. Participant-reported resilience (β = 1.74; 95% CI, 1.00-2.48), stress (β = -2.40; 95% CI, -3.28 to -1.51), anxiety (β = -2.04; 95% CI, -2.74 to -1.34), and burnout-exhaustion (β = -0.37; 95% CI, -0.56 to -0.18) improved after the program.
Results of this study suggest that PRISM at Work may have utility for health care workers and staff in that the program was found to be feasible, acceptable, and associated with improved outcomes.
由于持续的工作压力，医护人员面临严重的心理健康挑战。COVID-19 大流行使这种压力加剧，导致焦虑、抑郁和倦怠的发生率很高。迄今为止，针对医护人员心理健康结果的循证方案为数甚少。
评估一项基于技能的辅导计划的可行性、可接受性和初步结果，该计划旨在减轻压力和建立韧性。
设计、地点和参与者：2020 年 9 月至 2021 年 4 月期间进行了一项试点队列研究，使用预方案和后方案评估以及混合方法分析。随访时间为 7 周。辅导计划通过视频会议进行。参与者是来自一个大型城市卫生系统的医护人员和工作人员。
最初为患有严重/慢性疾病的青少年和年轻人开发的、以技能为基础的辅导计划“促进压力管理中的韧性（PRISM）”被改编以支持医护人员和工作人员（“PRISM at Work”）。它包括每周 6 次 1 小时的小组会议。
可行性是事先定义的，即完成率达到 70%。可接受性通过定量（满意度评分）和定性（关于对方案的体验的开放性问题）来定义。使用经过验证的工具，通过预方案和后方案评估自我报告的韧性、压力、焦虑和倦怠来评估初步结果。描述性统计总结了人口统计学变量以及可行性和可接受性。线性混合效应回归模型控制了相关协变量，以检验初步结果。
共有 153 名参与者（中位数[标准差]年龄，40.6[10.1]岁；142[92%]为女性；128[84%]为白种人；81[53%]为面向患者的角色）入组。在提供后续调查的 132 名医护人员中，有 120 名（91%）完成了该计划，有 116 名（88%）表示满意。对开放性问题的回答表明，参与者希望更多的 PRISM 无论是更长时间还是更多的课程。参与者报告的韧性（β=1.74；95%置信区间，1.00-2.48）、压力（β=-2.40；95%置信区间，-3.28 至-1.51）、焦虑（β=-2.04；95%置信区间，-2.74 至-1.34）和倦怠-衰竭（β=-0.37；95%置信区间，-0.56 至-0.18）在该计划后得到改善。
这项研究的结果表明，PRISM at Work 可能对医护人员和工作人员具有实用性，因为该计划被认为是可行的、可接受的，并与改善结果相关。
