Mobile Stress Management Protocolfor Nurses working with Cancer PatientsA Controlled StudyGiuseppe Riva, ATN-P Lab., Istituto Auxologico ItalianoMilan, Italy - http://www.giusepperiva.com

Outlineof the

presentation

1. Stress in oncology nursing

2. The current solutions3. Our approach: a

Stress Inoculation Training self-help protocol with mobile phones

4. A controlled trial involving 30 female oncology nurses

Stress in nursing

Although all professions are susceptible to work-

related stress, the nursing profession has

been identified as particularly stressful.

Indeed, oncology nursing is often

described as being among the most stressful

specialty areas.

Helping Nurses coping with

stress

Based on existent literature, healthcare professionals clearly need support in addressing the numerous stressors inherent in their work.

The most used strategies are:a) to increase workers’ awareness;b) to reduce the high level of

negative arousal.

Strategies used to reduce negative arousal include relaxation techniques, promotion of a healthy lifestyle (e.g., physical training), and cognitive–behavioral techniques.

OurapproachMobile Self-helpStress Management Training

In this study we investigated the use of the mobile phone in the stress management of nurses.

Using this approach nurses autonomously self-administer clinical content, becoming able to improve their knowledge according to their needs.

More, the multimedia capability of the mobile phone allow the provision of self-help content based on the Stress Inoculation Training.

OurapproachMobile Self-helpStress Management Training

In this study we used the mobile phone most common in the selected sample: Nokia N70, an entry level multimedia phone.

Participants used the N70 mobile phone with a display resolution of 176 x 208 pixels (2.1 inches) and headphones.

Ourapproach

Stress Inoculation

Training

Several studies have shown that skills training, such as in the form of Stress Inoculation Training (SIT; Meichenbaum 1977, 1985), may lead to a reduction in burnout levels by: a) altering the way in which an

individual processes information about stressful situations and;

b) identifying cognitive, emotional, and behavioral coping skills to change unproductive ways of reacting.

SITThe threephases

SIT is a short and structured program that includes three phases:

1. The conceptual phase aims to make clients aware of the transactional nature of stress;

2. The skill acquisition and rehearsal phase aims to teach clients to manage emotions and maladaptive behaviors as well as learn new coping skills;

3. The application and follow-through phase aims increase self-efficacy (Bandura, 2005) through imaginative exercises and simulations.

SITOur

clinicalprotocol

• The self-help protocol lasted four weeks. During this time, nurses received a book about stress and watched eight multimedia videos (10 min each) on the mobile phone, twice a week.

• The first six videos presented different relaxation techniques that the nurse had to practice at least once a day.

• The final two videos - created by combining three different public social advertising campaigns -presented oncology patients suffering from cancer.

The controlled trialSample• 30 female oncology nurses (Mean age = 43; SD = 8.80)

enrolled in the study, with an average of 22 years of experience as a nurse and 9 years of experience in the oncology ward.

• Control group (15 nurses) received the same book and experienced 8 video clip representing natural environments.

• Inclusion criteria included:1. being a current oncology nurse with a minimum of

five years of experience in the oncology ward;2. having a permanent status to avoid sources of stress

related to temporary employment;3. with a cut-off level of stress corresponding to the

higher quartile (Italian normative data), measured using the Measure du Stress Psychologique (MSP) Questionnaire

The controlled trialMeasures

1. The State Trait Anxiety Inventory (STAI; Spielberger, Gorush, & Lushene, 1970) is a 40-item self-reported broken down into two sections: state (or current) and trait (or characteristic or chronic) anxiety.

2. The Brief Coping Orientation to Problems Experienced (COPE) questionnaire (Carver, 1997) is a short version of the original self-reported item that includes 28 items to measure the coping styles used in events management—namely, active coping, positive attitude, external strategies, social support, hedging strategies, and denial.

3. The Job Content Questionnaire (JCQ) proposed by Karasek and Theorell (1990) comprises 35 items evaluating job content in terms of psychological job demands, job decision latitude, and social support.

The controlled trialResults 1

Hypothesis 1: The emotional state (state anxiety reduction) of oncology nurses included in the

experimental group will improve by the end of each session of the protocol.

We found a significant and continuous decrease of

anxiety state (STAI State) at the end of each session for the experimental group, but

not for the control group.

The controlled trialResults 2

Hypothesis 2: The affective state (trait anxiety reduction and acquisition of styles of coping) of

oncology nurses included in the experimental group will improve by the end of the entire protocol.

Significant results were found only for the

experimental group: active coping (taking action to change the situation) increased while denial

(denying the existence of the critical situation)

decreased.

ConclusionsWe reduced anxiety and

improved coping

Results showed a significant decrease in anxiety among those who performed the SIT protocol compared to the control group.

In addition to the significant decrease at the end of each session, the results demonstrated a significant improvement in anxiety trait reduction and coping skills acquisition.

In particular, nurses learned two important coping strategies: the decrease of denial and the increase of active coping,

ConclusionsSelf-help

mobile stress management

is possible

These results suggest the possibility of developing

controllable self-help stress management

mobile experiences for several professions.

Self-management training offers a potential solution

to the demand for efficient, low-cost, and

stigma-reducing interventions for stress,

especially in high-demand professions.

Giuseppe Riva, Ph.D.

• Professor of General Psychology at the Catholic University of Milan,

Italy;• Director, Applied Technology for

Neuro-Psychology Laboratory - ATN-P Lab., Istituto Auxologico

Italiano, Milan, Italy.• President of the International

Association of CyberPsychology, Training, and Rehabilitation (

http://iactor.ning.com)