• Radia El Khamali, Atika Mouaci, Sabine Valera, Marion Cano-Chervel, Camille Pinglis, Céline Sanz, Amel Allal, Valérie Attard, Julie Malardier, Magali Delfino, Fifina D'Anna, Pierre Rostini, Stéphan Aguilard, Karine Berthias, Béatrice Cresta, Frédéric Iride, Valérie Reynaud, Jérémie Suard, Wlady Syja, Cécile Vankiersbilck, Nicole Chevalier, Karen Inthavong, Jean-Marie Forel, Karine Baumstarck, Laurent Papazian, and SISTRESSREA Study Group.
• Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France.
• JAMA. 2018 Nov 20; 320 (19): 198819971988-1997.

ImportanceNurses working in an intensive care unit (ICU) are exposed to occupational stressors that can increase the risk of stress reactions, long-term absenteeism, and turnover.ObjectiveTo evaluate the effects of a program including simulation in reducing work-related stress and work-related outcomes among ICU nurses.Design, Setting, And ParticipantsMulticenter randomized clinical trial performed at 8 adult ICUs in France from February 8, 2016, through April 29, 2017. A total of 198 ICU nurses were included and followed up for 1 year until April 30, 2018.InterventionsThe ICU nurses who had at least 6 months of ICU experience were randomized to the intervention group (n = 101) or to the control group (n = 97). The nurses randomized to the intervention group received a 5-day course involving a nursing theory recap and situational role-play using simulated scenarios (based on technical dexterity, clinical approach, decision making, aptitude to teamwork, and task prioritization), which were followed by debriefing sessions on attitude and discussion of practices.Main Outcomes And MeasuresThe primary outcome was the prevalence of job strain assessed by combining a psychological demand score greater than 21 (score range, 9 [best] to 36 [worst]) with a decision latitude score less than 72 (score range, 24 [worst] to 96 [best]) using the Job Content Questionnaire and evaluated at 6 months. There were 7 secondary outcomes including absenteeism and turnover.ResultsAmong 198 ICU nurses who were randomized (95 aged ≤30 years [48%] and 115 women [58%]), 182 (92%) completed the trial for the primary outcome. The trial was stopped for efficacy at the scheduled interim analysis after enrollment of 198 participants. The prevalence of job strain at 6 months was lower in the intervention group than in the control group (13% vs 67%, respectively; between-group difference, 54% [95% CI, 40%-64%]; P < .001). Absenteeism during the 6-month follow-up period was 1% in the intervention group compared with 8% in the control group (between-group difference, 7% [95% CI, 1%-15%]; P = .03). Four nurses (4%) from the intervention group left the ICU during the 6-month follow-up period compared with 12 nurses (12%) from the control group (between-group difference, 8% [95% CI, 0%-17%]; P = .04).Conclusions And RelevanceAmong ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program. Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective.Trial RegistrationClinicalTrials.gov Identifier: NCT02672072.

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