Acceptance and Commitment Therapy for promoting psychological well-being among new graduate nurses: a pilot randomized controlled trial

Student thesis: PhD

Abstract

Background. New graduate nurses (NGN) are at high risk of stress, depression, burnout, and other psychological health issues due to increased challenges of role transition from students to qualified nurses, specifically the first year after graduation. Major transition challenges include increased nursing responsibility, unfamiliar clinical environment, and socialization with new colleagues. Such difficult situations affect psychological well-being of NGN and hence result in stronger psychological inflexibility which leads to psychological dysfunction and reduced quality of life. Mental health promotion in NGN has been little addressed in previous research on role transition programmes that generally focus on service outcomes, clinical knowledge, and skill training. Acceptance and commitment therapy (ACT) has been identified as an empirically support intervention for people with various mental illnesses. As it focuses on psychological flexibility (PF), it has been proposed to be an appropriate mental health promotion intervention. Thriving NGN with PF through ACT may help them to accept difficult thoughts and feelings and to shield them from psychological problems.
Objectives. This single-blind, two-arm parallel-group randomized control trial with assessments at baseline, post-intervention and 3-month after intervention aimed (i) to assess the feasibility of the study, and (ii) to investigate the preliminary efficacy of an online group-based ACT intervention combined with career information seminar in comparison to a control group received online career information seminar only for promoting psychological well-being of NGN.
Setting and Participants. Pre-licensure undergraduate final year student nurses were conveniently recruited at two universities via face-to-face or online publicizing activities.
Randomization. Eligible participants were randomly assigned either to an intervention group (one 2-hour online career information seminar combined with five 2-hour consecutive weekly online ACT sessions) or a control group (one 2-hour online career information seminar). Block randomization was done by using an online computer-generated random number with an allocation ratio of 1:1.
Intervention conditions. Participants of the control group received information of nursing career pathway and suggested preparation for new role. Six core processes of ACT were introduced and practised in the five 2-hour online ACT sessions for participants assigned to the ACT intervention group. These participants also received the same career seminar as participants in the control group. All ACT sessions were led by a trained nurse educator and supervised by an experienced ACT facilitator.
Primary and Secondary Outcome Measures. Generalized estimating equations (GEE) were conducted to investigate the time-by-condition interactions for primary outcomes, i.e., psychological well-being (as measured by Psychological Well-being Scale-18, PWBS-18; and World Health Organization Well-being Index, WHO-5), secondary outcomes, i.e., perceived stress and professional quality of life (as measured by Perceived Stress Scale, PSS-10; and Professional Quality of Life, ProQOL) and process outcomes, i.e., psychological flexibility and dispositional mindfulness (as measured by Acceptance and Action Questionnaire, AAQ-II; and Mindfulness Attention Awareness Scale, MAAS). All assessments were conducted online at baseline, post-intervention, and 3-month after intervention. Regarding feasibility of this study, recruitment rate, programme completion rate and assessment completion rate was assessed.
Results. A total of 64 NGN joined the study (ACT n=32, Control n=32). Significant time-by-condition interactions for subjective well-being (WHO-5) (Wald X2= 8.286, p = 0.016) and burnout (ProQOL-BO) (Wald X2 = 6.130, p = 0.047) in intention-to-treat (ITT) sample were found. Within control group, significant increased burnout (ProQOL-BO) (Mdiff = 6.90, 95% CI [6.94, 6.87], p =.002) together with significant reductions in subjective well-being (WHO-5) (Mdiff = -7.80, 95% CI [-7.77, -7.80], p = .037) and decreased compassion satisfaction (ProQOL-CS) (Mdiff = -5.60, 95% CI [-5.27, -5.94], p =.032) were found across the three measurement time points from baseline to 3-month after intervention. However, no significant changes were found for these outcome measures within the ACT group. The between-group comparisons found that when compared to NGN who attended only career information seminar, NGN who attended ACT sessions and career information seminar became more psychological flexible (AAQ-II) (Mdiff = -2.84, 95% CI [-3.13, -2.56], p = .045, d = .373) at post-intervention, and had lesser secondary traumatic stress (ProQOL-STS) (Mdiff = -5.89, 95% CI [-5.34, -6.44], p = .044, d = .631) at 3-month after intervention.
The study appeared feasible. The recruitment rate was 14.2%. The programme completion rate of ACT group and control group was 50% and 100% respectively. The online assessment completion rate ranged from 79.7% (3-month after intervention) to 100% (baseline). All online ACT sessions and career information seminar were run smoothly and in-order.
Conclusion. Overall, these results provided preliminary support for the feasibility of a novel online group-based ACT role transition programme for NGN. By nourishing NGN with ACT skills and strengthening ACT processes may inoculate NGN against stress and burnout, and a decline in compassion satisfaction can be prevented. This study adds more support to the ACT model as a useful intervention for promoting psychological well-being and suggests future research with full-powered trial and a larger sample size. Given the intervention was delivered by a trained nurse educator at school via an online group-based approach, it has its practical advantages in both school and, maybe, clinical settings, with little resources implications.

Date of Award25 Apr 2024
Original languageEnglish
SupervisorYim Wah Mak (Supervisor) & Sau Fong Leung (Supervisor)

Keywords

  • acceptance and commitment therapy
  • new graduate nurses
  • psychological wellbeing
  • pilot RCT

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