The aim of our internet-based intervention study was to find out whether healthcare professionals can autonomously down-regulate the stress they experience at their workplace, using an established self-regulation tool called Mental Contrasting with Implementation Intentions (MCII). Applying MCII to reduce stress implied for our participants to repeatedly engage in a mental exercise that (1) required specifying a wish related to reducing stress, (2) identifying and imagining its most desired positive outcome, (3) detecting and imagining the obstacle that holds them back, and (4) coming up with an if-then plan on how to overcome it. We recruited on-line nurses employed at various health institutions all over Germany, and randomly assigned participants to one of three groups. In the MCII group (n = 33), participants were taught how to use this exercise via email and the participants were asked to engage in the exercise on a daily basis for a period of 3 weeks. As compared to two control groups, one being a no-treatment control group (n = 35) and the other a modified MCII group (n = 32), our experimental MCII group showed a reduced stress level and an enhanced work engagement. We discuss the strengths and weaknesses of the present study as well as ways to intensify MCII effects on stress reduction.
... The sample size of the included studies varied widely, from 14 participants (Palumbo et al., 2012) to 249 participants (Ghawadra et al., 2020). Participant work settings included hospitals (McElligott et al., 2003;Cohen-Katz et al., 2005;Walker, 2006;Moeini et al., 2011;Kurebayashi et al., 2012;Orly et al., 2012;Palumbo et al., 2012;Villani et al., 2013;Hersch et al., 2016;Bahmanzadeh and Haji Alizadeh, 2017;Calder Calisi, 2017;Singh and Jain, 2017;Wang et al., 2017;Prado et al., 2018;Hwang and Jo, 2019;Lary et al., 2019;Lin et al., 2019;Bernburg et al., 2020;Ghawadra et al., 2020;Niva et al., 2020), settings that focus on mental health (Collier et al., 2018;Yang et al., 2018;Bernburg et al., 2019;Hsieh et al., 2020), intensive care units (Nazari et al., 2015), and health care institutions with different organizational and hierarchical structures (Gollwitzer et al., 2018;Alkhawaldeh et al., 2020). ...
... Fifteen studies used a randomized controlled trial to study the effects of the treatment on nurses' stress level (Kurebayashi et al., 2012;Palumbo et al., 2012;Nazari et al., 2015;Hersch et al., 2016;Calder Calisi, 2017;Collier et al., 2018;Gollwitzer et al., 2018;Prado et al., 2018;Bernburg et al., 2019Bernburg et al., , 2020Hwang and Jo, 2019;Lin et al., 2019;Alkhawaldeh et al., 2020;Ghawadra et al., 2020;Niva et al., 2020). However, only three studies employed blind procedures (Prado et al., 2018;Alkhawaldeh et al., 2020;Bernburg et al., 2020). ...
... As for the modalities, the most common interventions were technology-delivered interventions for stress management and mental health. Particularly, three studies implemented self-help programs guided by a website (Hersch et al., 2016;Gollwitzer et al., 2018;Ghawadra et al., 2020) and three additional interventions investigated the effectiveness of mobile phonedelivered programs for stress management (Villani et al., 2013;Hwang and Jo, 2019;Hsieh et al., 2020). Other commonly used modality types included mindfulness-based programs (Cohen-Katz et al., 2005;Walker, 2006;Wang et al., 2017;Yang et al., 2018;Lin et al., 2019), cognitive-behavioral interventions (Moeini et al., 2011;Orly et al., 2012;Bahmanzadeh and Haji Alizadeh, 2017), self-care interventions (Singh and Jain, 2017;Lary et al., 2019;Alkhawaldeh et al., 2020), auriculotherapy (Kurebayashi et al., 2012;Prado et al., 2018), massage (McElligott et al., 2003Nazari et al., 2015), psychological competence trainings combined with cognitive-behavioral components (Bernburg et al., 2019(Bernburg et al., , 2020, breathing exercises (Calder Calisi, 2017), chanting mantras (Niva et al., 2020), physical activity training (Palumbo et al., 2012) and multisensory environmental therapy (Collier et al., 2018). ...
Background: Nurses are facing unprecedented amounts of pressure because of the ongoing global health challenges. Improving nurses' resilience to job-related stress and enhancing their strategies to cope effectively with stressors are key issues facing many health care institutions during the COVID-19 pandemic. This literature review aimed to: a) provide a thorough overview of individual-level interventions for stress management among nurses, b) identify measurement tools utilized to evaluate nurses' stress level, and c) provide the best evidence-based recommendations for future research and practice adapted to the current restrictions.
Design: Systematic review.
Data Sources: Studies published between January 2000 and October 2020 were retrieved from the following sources: EBSCOhost, Dortmund University Library, PubMed, Medline, Google Scholar, Applied Nursing Research , and reference lists from relevant articles.
Review methods: Individual-level interventions with a control group or a placebo intervention were included in the final sample. Primary outcome was defined as a change in individual stress level or stress symptoms which were measured by objective or subjective instruments with evidence of validity. Articles published in English or German were included in the present review.
Results: In total, 27 relevant studies were included into the current review. There are some indications that technology-delivered interventions with relaxation and stress management interventions comprising cognitive-behavioral components might be effective in decreasing stress among nurses and improving their well-being. Furthermore, although there were some attempts to collect objectively measured parameters for assessing the primary outcome of stress, the majority of the interventions utilized self-reported stress scales.
Conclusion: A wide range of interventions are available for nurses. However, it is of utmost importance to develop and implement stress management programs that are conveniently accessible in the workplace and above all, meet the current restrictions for minimizing human contacts. To this end, innovative interventions delivered through digital technology, such as virtual reality, seem to be a promising solution for combating the detrimental impact of stress on nurses. Special attention should be also paid to applying standardized objective measurement tools to allow the assessment of sensitive physiological indices and the generalizability of scientific knowledge.
... This tool is highly accessible (i.e., brief, little-to-no cost, delivered online) and customizable to personal needs. MCII has been effective across life domains including the health domain (Stadler et al., 2010;Gollwitzer et al., 2018;Valshtein et al., 2020). This thoughtbased strategy contains two complementary phases-mental contrasting (MC) and implementation intentions (II)-that facilitate binding goal commitments and goal-directed action. ...
... Our results suggest this may be the case but are not conclusive. The condition effect at low-SES, though not statistically significant, is consistent with prior findings that MCII helps individuals facing challenging circumstances (e.g., Gawrilow et al., 2013;Gollwitzer et al., 2018;Wittleder et al., 2019;Mutter et al., 2020) and extends prior research on MCII among individuals of low-SES into the domain of smoking reduction. ...
Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions (MCII) as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control (n = 161) or MCII condition (n = 164). Data were collected via MTurk, during the U.S.’ initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low—but not high—in subjective-SES, MCII (vs. control) improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive (p = 0.11). Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant (p = 0.11). Per an exploratory analysis, we observed that stress significantly moderated the condition effect (p = 0.01), such that MCII (vs. control) facilitated reduction among those experiencing high (p = 0.03), but not low stress (p = 0.15). Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools.
... For instance, "If situation Y is encountered, then I will initiate the goal directed behavior X!". This strategy has medium to large effect sizes on behavior observed across various populations, modes of delivery (e.g., internet-or laboratory based interventions) and behaviors and has been confirmed as successful in the context of stress reduction in general (Gollwitzer, 1999;Gollwitzer & Sheeran, 2006;Hagger & Luszczynska, 2014) as well as concerning work-related stress (Gollwitzer et al., 2018). Further, research indicates that one-time performed planning interventions are effective for behavior changes (Hagger & Luszczynska, 2014). ...
Occupational stress is one of the main sources of stress in apprentices with physical and psychological health consequences. Just-in-time planning interventions (JITPIs) are one opportunity to deliver intervention components at the right times and locations to optimally support apprentices in stressful situations. The aim of this study was to test the proximal effect of a mobile phone-delivered JITPI to reduce occupational stress in 386 apprentices within a planning intervention.
An AB/BA crossover design in which participants were randomly allocated to (A) the planning intervention or (B) the assessment only condition was implemented.
The analyses of the study "ready4life", multilevel modeling, revealed no significant effect of the planning intervention on occupational stress reduction.
Possible reasons for the missing effect might be the low stress level of participants or the type of the intervention delivery. Since apprenticeships in Switzerland differ considerably, future studies should enable more adapted interventions for the apprentices and consider individual circumstances of stress. Further, the intervention should focus on apprentices with high occupational stress levels or a high-risk of stress. Studies should investigate exactly when and why a person needs support regarding her/his occupational stress. Therefore, objective measurements of stress could be helpful.
... Especially in organising the work processes with networked route planning and service recording, digitalisation is described as a possible solution to some problems, such as skipping breaks due to a lack of time to complete work tasks . Studies on inpatient care services have demonstrated that digitalisation represents an opportunity for the implementation of workplace health promotion, since programmes for stress prevention as well as for occupational health management with integrated optimisation of work processes have been proven successful in randomised controlled trials . In addition, the COVID-19 pandemic poses a particular challenge for the implementation of workplace health promotion measures, since, for example, infection protection measures such as distance regulations make it difficult to implement group-based offers such as sports courses. ...
Working conditions in the care sector, especially under the increased strain during COVID-19, make it difficult for outpatient caregivers to adhere to health-promoting behaviours. Research on workplace health promotion (WHP) and COVID-19 support measures in outpatient care services is limited. The aim of this pilot study was to characterise the current situation of WHP and COVID-19 support measures in outpatient care services and to explore how to offer WHP support measures targeted for a specific group. A web-based cross-sectional survey was conducted with outpatient caregivers (N = 171) in northern Germany. The results showed that 60.2% of the study participants were offered WHP support measures, with significantly higher work engagement when WHP support measures were available (Z = 4279.50, p < 0.01) and that 77.2% received specific support from their employer during the COVID-19 pandemic. Although spending a break in a break room was significantly associated with longer breaks as compared with being in a car (Z = 39.10, padj. = 0.01), a break room was neither available in all outpatient care services, nor did it appear to be feasible. Overall, WHP in outpatient care services is insufficiently covered. In order to be able to offer WHP support measures that are targeted to outpatient caregivers, cooperation among local care services, feasibility, and digital measures should be examined.
... Implementation intentions are helpful in showing a specific desired behavior because they make the situation in which the undesired behavior usually occurs cognitively more accessible (Achtziger et al., 2012;Webb & Sheeran, 2004) and because they create an association between the situation and the desired behavior (Webb & Sheeran, 2007. There is strong empirical evidence that implementation intentions are an effective volitional strategy within a broad range of life domains (Gollwitzer & Sheeran, 2006), such as healthy eating (Adriaanse, Vinkers, et al., 2011), physical exercise (Bélanger-Gravel et al., 2013), and job-stress reduction (Gollwitzer et al., 2018). Although most research has examined the effects of implementation intentions with experimental study designs (Gollwitzer & Sheeran, 2006), people also form implementation intentions in everyday life without being explicitly instructed to do so. ...
Although habits are a well-researched topic within psychology, habits enacted at the workplace received limited attention in the organizational literature. In this article we examine habits that employees show at the workplace. Because workplace habits are not always functional for performance or affective outcomes, and because employees themselves may regard specific habits as undesirable, it is important to identify ways of how employees can abandon such unwanted habits. We report findings from a daily-survey study (N = 145 persons) in which we examined if self-regulatory processes predict disengagement from undesirable habits and engagement in more desirable alternative behaviors. Multilevel path analysis showed that day-specific implementation intentions and day-specific vigilant monitoring were negatively related to day-specific habitual behavior and positively related to day-specific alternative behaviors, both in the morning and in the afternoon. Analysis of follow-up data (N = 126 persons) showed that change in habit strength was stable over a 2-month period, suggesting that implementation intentions, vigilant monitoring, and the associated enactment of alternative behavior indeed may help to disengage from unwanted habits, particularly with respect to task-related habits and when consistency in vigilant monitoring is high. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... First, five interventions were delivered through an online format (Ouweneel et al., 2013;Dyrbye et al., 2016;Muuraiskangas et al., 2016;Gollwitzer et al., 2018;Kloos et al., 2019). These were app-or web-based and focused on individual exercises that the participants completed online, tasks that they undertook in their everyday working life, and educational elements. ...
Background: Promoting work engagement is of interest to organizations across sectors due to the associated positive outcomes. This interest warrants research on the evidence of work engagement interventions. Intervention research increasingly advocates a bottom-up approach, highlighting the role of employees themselves. These workplace interventions often encourage employees to identify, develop, and make use of workplace resources. The aim of this systematic review and meta-analysis is to investigate the effectiveness and potential underlying mechanisms of these bottom-up, resource-developing interventions. Method: Systematic searches were conducted in the online databases Web of Science, Academic Search Complete, Business Source Ultimate, PsycInfo, PsycArticles, SCOPUS, and Google Scholar. Publication year range was 2000–2020. Eligibility criteria were defined using PICOS. To be eligible for the systematic review, the intervention study identified had to aim at promoting working individuals’ work engagement by developing workplace resources from bottom-up. Work engagement had to be measured using the Utrecht Work Engagement Scale. The systematic review included one-, two-, or multiple-armed – randomized or non-randomized – intervention studies with various study designs. Further, a meta-analysis was conducted on a sub-set of the studies included in the systematic review. To be eligible for the meta-analysis, the studies had to be two- or multiple-armed and provide the information necessary to compute effect sizes. Results: Thirty-one studies were included in the systematic review. The majority reported that overall work engagement increased as an effect of the intervention. The evidence regarding the sub-components of work engagement was scattered. Potential underlying mechanisms explored were intervention foci, approach, and format. Dimensions of satisfaction and performance were identified as secondary outcomes. Participant experiences were generally described as positive in most of the studies applying mixed methods. The meta-analysis showed a small but promising intervention effect on work engagement (24 studies, SMD: −0.22, 95% CI: −0.34 to −0.11, with I2=53%, indicating moderate inconsistency in the evidence). Conclusion: The synthesized evidence suggests that bottom-up, resource-developing interventions are effective in the promotion of work engagement. The meta-analysis suggests that focusing on strengths use or mobilizing ego resources and adopting a universal approach increase intervention effectiveness.
Due to ongoing demographic changes, the need for care is increasing in Germany. The number of outpatient care services is also rising, and with it, the number of employees in outpatient care, who are also continuously becoming older. Workplace health promotion (WHP) becomes relevant in this context, as it can reduce negative strain reactions and promote employees’ health. The aim of this study was (1) to reveal implemented WHP interventions in German outpatient care services; (2) to examine the potential challenges regarding a successful implementation of WHP measures; and (3) to illuminate further requests and needs experienced by outpatient careworkers. In qualitative field research, 30 semi-structured individual interviews were conducted with German caregivers, using the problem-centered interview method. The collected data were deductively and inductively evaluated and interpreted, using qualitative content analysis according to Mayring. Outpatient caregivers reported various WHP measures known from their workplaces, such as the provision of fruit baskets, programmes to increase physical activity, or a subsidy for a personal gym. They further reported WHP, such as back training, known from other care services. However, the respondents spoke of the challenges regarding the implementation or the use of WHP interventions in general. The most frequently named barriers were a lack of time after work and interventions that were only offered in their leisure time. In the same course, the participants still needed offers to increase physical activity, joint activities, or relaxation techniques. However, respondents highlighted that they preferred the interventions to take place during working hours. This way, they would also be more likely to take advantage of the interventions. The results of this study provide an insight into various WHP measures that already exist, or that are desirable for implementation with regard to caregivers’ needs. Subjectively perceived challenges for a successful implementation of WHP measures represent the importance of adjustments in the work organization of caregivers. It becomes clear that WHP is not yet established in the ambulant care sector, although it appears to be imperative for keeping caregivers healthy. Considering the different needs of employees, the results can provide a basis for the development of needs-based health promotion measures for caregivers.
In this module, participants are encouraged to take personal inventory of changing and shifting balance, whether it be physically, emotionally, cognitively, or performance-based. We discuss current practices to shift or change balance when needed. As this is the last module of the curriculum, participants will identify areas in everyday life activities where mindfulness can come into play and brainstorm goals and strategies for maintaining mindful practice beyond the course.
Studies of clinician-patient communication have used varied, ad hoc measures for communication efficacy. We developed and validated the Self-Efficacy for Medical Communication (SEMC) scale as a standard, quantitative measure of clinician-reported skills in communicating difficult news.
Using evidence-based scale development guidelines, we created two 16-item forms of the SEMC, one assessing communication with patients and one assessing communication with families. Clinicians providing oncological care in four organisations were invited to participate and provided consent. Participant demographics, responses to the SEMC items and responses to convergent and discriminant measures (those expected to relate strongly and weakly to the SEMC) were collected online. We performed analyses to determine the convergent and discriminant validity of the SEMC as well as its reliability and factor structure.
Overall, 221 oncology clinicians (including physicians, residents, fellows, medical students, nurses, nurse practitioners and physician assistants) participated. The patient and family forms both demonstrated high internal consistency reliability (alpha=0.94 and 0.96, respectively) and were strongly correlated with one another (r=0.95, p<0.001). Exploratory factor analysis demonstrated that the SEMC measures a unitary construct (eigenvalue=9.0), and its higher mean correlation with convergent (r=0.46) than discriminant (r=0.22) measures further supported its validity.
Our findings support the SEMC's validity and reliability as a measure of clinician-rated communication skills regarding conducting difficult conversations with patients and families. It provides a useful standard tool for future research in oncology provider-patient serious illness communication.
Contemplative practices promote well-being, work engagement and resilience among health care providers. We examined the impact of The Pause, a brief contemplative intervention, on health care providers’ physiological stress response. Participants were randomly assigned to either The Pause or the control group. They participated in a high-fidelity, stressful medical simulation. Following the simulation, intervention group practiced The Pause. Outcome measures were heart rate variability, heart rate, and blood pressure. We adjusted for baseline physiological variables, sociodemographic variables, self-care practices, and perceived stress. Participants in the intervention group had a standard deviation of the normal-to-normal RR intervals (heart rate variability indicator) that was 13.8 (95% CI 4.0, 23.5; p < .01) points higher than those in the control group. There were no significant effects of The Pause on heart rate or blood pressure. The Pause may reduce stress reactivity, increase heart rate variability, and enhance resilience in health care providers.