Cognitive Behavioral Therapy
Third Wave Cognitive Behavioral Therapy: A Possible Solution to Nurse Burnout
The burnout profession, otherwise known as bedside nursing, has lost a significant hit to its workforce numbers over the past decade, especially the last three years. Nurses have been retiring early, quitting due to emotional stress, or physically cannot continue due to what the World Health Organization (WHO) (Berg, 2019) deems an “occupational phenomenon.” Despite a national shortage of nurses, no one talks about the cause or permanent solution to nursing burnout. In this post, the writer will discuss the severity of nurse burnout and the impact of the third wave of cognitive-behavioral theory (CBT) and explore its applicability as a solution to nurse burnout.
Prevalence and Impact of Nursing Burnout
While nursing can be a rewarding profession, it also can cause anxiety, depression, and other mental health disorders; this is due to the intense stress and emotional aspects of the job. Nurses frequently encounter work-related stressors such as code blues, emotional abuse from patients and other hospital staff, and patient death. These stressors place bedside nurses at an increased risk for developing burnout, depression, anxiety, and emotional stress when hearing about another person's trauma; this is called secondary stress disorder (Favorod et al., 2018).
The impact of burnout on nurses’ mental health and personal life is severe. It can seep into every aspect of nurses’ personal life, having an adverse effect on their relationships and attitude towards life. In a study completed by Papathanasiou (2015), over twenty-six percent of the two-hundred nurses studied stated that they were diagnosed with a mental health disorder after two years in the nursing profession. This number increased when surveying nurses who worked in higher acuity settings, such as a neonatal intensive care unit (NICU) or emergency department (ED). Favorod et al. (2018) completed a survey of over ninety nurses, over half of which reported being diagnosed with a mental health disorder or experiencing high levels of emotional exhaustion after they joined the profession.
Despite burnout causing an increase in mental health disorders in nursing staff, historically, this has not been enough for hospitals and researchers to address the issue. For twenty consecutive years, the nursing profession has been ranked the number one most trusted in the Gallup poll (Yale, 2022). What if something jeopardized this, something that nurses have very little power over? While burnout is well understood as a negative “experience” for nurses, it can also significantly impact patient health.
A study completed by Soroush et al. (2016) found that nurses experiencing burnout also experience a temporary decrease in their ability to perform crucial clinical skills adequately. Clinical skills can range from minor communication and charting skills to critical blood administration or chest tube management skills. When compromised, nurses’ lack of clinical competency negatively impacts their ability to provide quality patient care, thus placing their patients at an increased risk for injury or death. The significant presence of burnout in the nursing community is no longer just a nurse issue; instead, it is a national health emergency.
Burnout has always been prevalent in nursing. A national study completed by Jose et al. (2020) focused on the mental health of nurses and found over fifteen percent of bedside nurses report experiencing some level of burnout throughout their career. The focus of this paper, though, discusses the problem that if burnout is not a new concept or concern for the nursing workforce, why has no one been effectively addressing it.
Third-Wave Cognitive Behavioral Therapy to Manage Nurse Burnout
Current best practices for addressing nurse mental health and burnout are insufficient. It is time to adopt an approach that turns away from simply restoring nurses to their baseline stress level instead of providing them with the tools to help manage their stress. One new way of doing this is the use of third-wave CBT.
There have been minimal extensive research efforts focused on the correlation between nurse burnout and resilience. However, the few studies that have examined this correlation have found a negative relationship between nurses’ resilience and the presence of burnout symptoms. According to Guo et al. (2018), nurses who had a higher resilience were better protected from burnout symptoms, such as emotional exhaustion and poor physical and emotional health. Because of the high impact nurses’ resilience can have on nurses’ potential to experience burnout, the intervention must address nurse burnout by attempting to impact nurses’ resilience positively; third-wave CBT can adequately address both.
According to Emmons and Prasek (2022), traditional cognitive behavioral therapy (CBT) is a way to focus one’s mind by managing negative thoughts. The general understanding of CBT is that it integrates an individual's values and beliefs into behaviorism therapy; to understand and change the behavior associated with negative/intrusive thinking (i.e., depression and anxiety). However, the third wave of CBT teaches individuals to observe their negative emotions from a distance without attempting to change them. Third-wave CBT aims to create resilient people by teaching them how to live with mental health disorders, such as depression and anxiety, without allowing them to control their lives.
The third wave of CBT looks more like a version of mindfulness, requiring individuals to observe their harmful or destructive thoughts from a distance. The use of mindfulness with CBT allows individuals to be aware that they are experiencing negative thoughts and letting those thoughts exist, rather than attempting to ignore negative thoughts or change the behaviors associated with them. According to Emmons and Prasek (2022), applying mindfulness alongside CBT creates a state of open-mindedness and a form of “flexible attention,”; Meaning individuals can act as bystanders in their minds, focusing on the context and process of their negative thoughts instead then reacting; creating internal awareness. Having internal awareness allows people to become more resilient by providing individuals with a tool for understanding their mental illness and not letting it derail their healing.
During the coronavirus nineteen (Covid-19) pandemic, the world saw nurses rally to support the public's health and well-being. However, the world saw these nurses burn out after a short while. One good thing to come out of the Covid-19 pandemic is that it shed light on the abnormally high prevalence of mental health diseases and burnout amongst healthcare workers, especially nurses. Weiner et al. (2020) developed a third-wave CBT program called “My Health Too”; this program was designed to help address nurses during the Covid-19 pandemic. The program focused on managing nurses’ immediate (perceived) stress and any new psychological disorder diagnoses. “My Health Too” was comprised of seven online, twenty-minute video sessions which focused on the following five components; (1) mindfulness, (2) acceptance, (3) motivational and personal barriers, (4) self-compassion, and (5) the ability to self soothe when experiencing difficult emotions (Weiner, 2020). While this study is currently in the active treatment phase, initial findings have been promising, and it is an excellent first step to adequately addressing nurse burnout and mental health.
Many professions are high stress in nature and have the potential to become burnt out. However, when nurses experience burnout, it is not only their mental health that is impacted but also the quality of critical care skills and patients’ lives. It is time that the healthcare industry starts taking the psychological harm many nurses experience seriously. Addressing nurses' mental health can improve job satisfaction and patient care. Third-wave cognitive-behavioral therapy (CBT) can decrease burnout significantly and mental health disorders in nurses. It may take a while for nursing to no longer be considered the burnout profession; educating nurses on third-wave CBT can help push healthcare in the right direction and create a more resilient nurse workforce.
References
Berg, S. (2019, July 23). WHO adds burnout to ICD-11. What it means for physicians. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/who-adds-burnout-icd-11-what-it-means-physicians
Emmons, H., & Prasek, A. (2022). Reimagining mental health: Lessons from the Joy Lab. Psych 360-24 Friday Forum. Metropolitan State University, St. Paul.
Favrod, C., Jan du Chêne, L., Martin Soelch, C., Garthus-Niegel, S., Tolsa, J. F., Legault, F., Briet, V., & Horsch, A. (2018). Mental Health Symptoms and Work-Related Stressors in Hospital Midwives and NICU Nurses: A Mixed Methods Study. Frontiers in psychiatry, 9, 364. https://doi.org/10.3389/fpsyt.2018.00364
Guo, Y. F., Luo, Y. H., Lam, L., Cross, W., Plummer, V., & Zhang, J. P. (2018). Burnout and its association with resilience in nurses: A cross-sectional study. Journal of clinical nursing, 27(1-2), 441–449. https://doi.org/10.1111/jocn.13952
Jose, S., Dhandapani, M., & Cyriac, M. C. (2020). Burnout and Resilience among Frontline Nurses during COVID-19 Pandemic: A Cross-sectional Study in the Emergency Department of a Tertiary Care Center, North India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 24(11), 1081–1088. https://doi.org/10.5005/jp-journals-10071-23667
Papathanasiou I. V. (2015). Work-related Mental Consequences: Implications of Burnout on Mental Health Status Among Health Care Providers. Acta informatica medica: AIM: journal of the Society for Medical Informatics of Bosnia & Herzegovina: casopis Drustva za medicinsku informatiku BiH, 23(1), 22–28. https://doi.org/10.5455/aim.2015.23.22-28
Soroush, F., Zargham-Boroujeni, A., & Namnabati, M. (2016). The relationship between nurses' clinical competence and burnout in neonatal intensive care units. Iranian journal of nursing and midwifery research, 21(4), 424–429. https://doi.org/10.4103/1735-9066.18559
Ugwu, C. V., Medows, M., Don-Pedro, D., & Chan, J. (2020). Critical Event Debriefing in a Community Hospital. Cureus, 12(6), e8822. https://doi.org/10.7759/cureus.8822
Yale. (2022). Gallup: Nurses are most trusted profession for 20th straight year. Yale School of Nursing. Retrieved from https://nursing.yale.edu/news/gallup-nurses-are-most-trusted-profession-20th-straight-year