Short, Proactive Group Program May Mitigate Stress Among New, Shift Workers, Study Suggests

 Sarasota, FL (WorkersCompensation.com) – Fatigue, sleep problems and burnout often result from work-related stress, leading to reduced productivity and employee turnover – especially for people new to the workforce and/or those with shift work. But a new study shows employers can use preventive programs to keep their workers healthy and engaged.

Researchers in Sweden conducted a study on workers especially prone to the negative effects of work stress and found promising results.

“A proactive, group-administered recovery programme could be helpful in strengthening recovery and preventing negative health consequences for newly graduated RNs,” according to the study, published in the BMJ journal Occupational and Environmental Medicine. “Organisations can encourage employees to adopt beneficial strategies for recovery. Sleep and sleep-related outcomes can be improved by such interventions, with the most common being educational interventions that focus on sleep hygiene and fatigue management.”

RN Grads

RNs who are new to the field often face a number of stress factors. Frist, they are new to the profession and, typically, new to the working world. If they are working varying shifts, as many do, they are also at risk for impaired sleep.

“New RNs may often lack effective strategies for managing sleep and fatigue and the strategies used may sometimes be counterproductive,” the researchers said. “RNs also have a high prevalence of burn-out and somatic symptoms early in their careers.”

The reactions to stress can continue after the employee leaves work and the actual stress factors have subsided. Perseverative cognition, in which someone continues to have negative thoughts about past or future events can lead to increased heart rate, blood pressure and cortisol, according to research. In addition, the lack of sleep can lead to a variety of physical and mental conditions, such as depression and cardiovascular disease

“Difficulties letting go of stressful thoughts, together with high work demands and insufficient sleep, have been shown to predict clinical burn-out,” according to the study. “Hence, perseverative cognition could be one mechanism which, if sustained, may lead to health problems.”

With that in mind, researchers conducted a study of newly graduated nurses to see if a recovery intervention could prevent the symptoms.

The Study

“Work, and especially demanding work situations, leads to effort expenditure and a need for recovery¹ that is signified by the manifestation of fatigue,” the authors explained. “Recovery is the process of psychophysiological unwinding after effort, in which mental and physiological resources are replenished. According to the effort-recovery theory, recovery is crucial for preventing adverse health consequences due to stress exposure.”

RNs from several Swedish hospitals were invited to participate in the randomized control trial. The 207 participants were divided into either the intervention or control group.

Those in the intervention group attended three, group-administered recovery session with 2 weeks between each session. They focused on proactive strategies for sleep and recovery in relation to work stress and shift work.

The intervention program focused on promoting strategies for sleep and recovery, and focused on three main themes:

1. Unwinding from stress
2. Promoting sleep according to homoeostatic and circadian factors
3. Handling fatigue by increasing recovery behaviors

‘Recovery behaviors’ were said to be those that supported psychophysiological detachment following exposure to stressors or expenditure of effort. The nurses were encouraged to try listening to music, or engage in physical activity, for example.

Psychoeducative elements were included in the group discussions and exercises and participants were encourage to reflect on their habitual behaviors connected to sleep and recovery along with possible alternatives. They were also encouraged to try strategies of behavior changes of their choice to enhance sleep and recovery, and to share their experiences during the next sessions.

For both groups, researchers used questionnaires to measure the effects on sleep, burn-out, fatigue and somatic symptoms at baseline, post intervention and 6 months later.

There were seven primary outcomes, dealing with sleep problems, burnout and its subindices – fatigue and cognitive weariness, work-induced fatigue during non-working time, and somatic symptoms. Secondary outcomes focused on factors that could help account for changes in the primary outcomes, including perceived stress, listlessness, tension and dysfunctional attitudes about sleep.

The researchers speculated that there would be changes in the primary measures that reflected improvements in well-being.

Findings

“The results indicated a preventive effect on somatic symptoms, as the intervention group showed stable ratings for these symptoms, while the control group showed increased somatic symptoms over time,” the researchers wrote. “Further, promising effects were seen on burn-out measures and on work-induced fatigue during free time at postintervention. However, these latter effects did not persist at follow-up 6 months later.”

The authors said it was “important” that somatic symptoms did not increase among nurses in the intervention group, compared to those in the control group. They also said, however, that the intervention did not have a significant effect on the secondary outcomes of perceived stress, listlessness or tension.

“This may imply that both groups reacted similarly to the challenges they face as new nurses,” the researchers surmised. “Notably, the intent of the recovery programme was not to decrease stress reactions per se, but to improve the quality of recovery and increase the use of recovery behaviours—in line with the theoretical perspective that stress is not necessarily harmful as long as there is sufficient recovery.”

The fact that the intervention was short, proactive and feasible was a major strength. The authors suggested future studies should explore the idea of implementing the program in nursing education, and be adapted for nurses – or other professionals – who are not necessarily new to their careers.

“To conclude,” they wrote, “a short, proactive, group-administered recovery programme was helpful in strengthening recovery for newly graduated RNs, by way of preventing somatic symptoms, and reducing burn-out symptoms and work-induced fatigue, suggesting recovery as a key factor in the prevention of negative health consequences of work stress.”

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