Mobile Stress Management Protocolfor Nurses working with Cancer Patients: A Controlled Study MMVR 2012 Presentation by Daniela VIllani and Giuseppe Riva

1. Mobile Stress Management Protocol
for Nurses working with Cancer Patients
A Controlled Study
Giuseppe Riva, ATN-P Lab., Istituto Auxologico Italiano
Milan, Italy - http://www.giusepperiva.com

2. Outline
of the
presentation
1. Stress in oncology
nursing
2. The current solutions
3. Our approach: a
Stress Inoculation
Training self-help
protocol with mobile
phones
4. A controlled trial
involving 30 female
oncology nurses

3. Stress in
nursing
Although all professions
are susceptible to work-
related stress, the
nursing profession has
been identified as
particularly stressful.
Indeed, oncology
nursing is often
described as being
among the most stressful
specialty areas.

4. Helping Nurses
coping with
stress
Based on existent literature,
healthcare professionals clearly need
support in addressing the
numerous stressors inherent in
their work.
The most used strategies are:
a) to increase workers’ awareness;
b) to reduce the high level of
negative arousal.
Strategies used to reduce negative
arousal include relaxation techniques,
promotion of a healthy lifestyle (e.g.,
physical training), and cognitive–
behavioral techniques.

5. Our
approach
Mobile
Self-help
Stress
Management
Training
In this study we investigated
the use of the mobile phone in
the stress management of
nurses.
Using this approach nurses
autonomously self-administer
clinical content, becoming able
to improve their knowledge
according to their needs.
More, the multimedia capability
of the mobile phone allow the
provision of self-help content
based on the Stress Inoculation
Training.

6. Our
approach
Mobile
Self-help
Stress
Management
Training
In this study we used the
mobile phone most common in
the selected sample: Nokia
N70, an entry level multimedia
phone.
Participants used the N70
mobile phone with a display
resolution of 176 x 208 pixels
(2.1 inches) and headphones.

7. Our
approach
Stress
Inoculation
Training
Several studies have shown that
skills training, such as in the form
of Stress Inoculation Training (SIT;
Meichenbaum 1977, 1985), may
lead to a reduction in burnout
levels by:
a) altering the way in which an
individual processes
information about stressful
situations and;
b) identifying cognitive,
emotional, and behavioral
coping skills to change
unproductive ways of reacting.

8. SIT
The three
phases
SIT is a short and structured program
that includes three phases:
1. The conceptual phase aims to
make clients aware of the
transactional nature of stress;
2. The skill acquisition and rehearsal
phase aims to teach clients to
manage emotions and maladaptive
behaviors as well as learn new
coping skills;
3. The application and follow-through
phase aims increase self-efficacy
(Bandura, 2005) through
imaginative exercises and
simulations.

9. SIT
Our
clinical
protocol
• The self-help protocol lasted four
weeks. During this time, nurses
received a book about stress and
watched eight multimedia videos (10
min each) on the mobile phone, twice
a week.
• The first six videos presented different
relaxation techniques that the nurse
had to practice at least once a day.
• The final two videos - created by
combining three different public social
advertising campaigns -presented
oncology patients suffering from
cancer.

10. The controlled trial
Sample
• 30 female oncology nurses (Mean age = 43; SD = 8.80) enrolled
in the study, with an average of 22 years of experience as a
nurse and 9 years of experience in the oncology ward.
• Control group (15 nurses) received the same book and
experienced 8 video clip representing natural environments.
• Inclusion criteria included:
1. being a current oncology nurse with a minimum of five years
of experience in the oncology ward;
2. having a permanent status to avoid sources of stress related
to temporary employment;
3. with a cut-off level of stress corresponding to the higher
quartile (Italian normative data), measured using the Measure
du Stress Psychologique (MSP) Questionnaire

11. The controlled trial
Measures
1. The State Trait Anxiety Inventory (STAI; Spielberger, Gorush,
& Lushene, 1970) is a 40-item self-reported broken down into
two sections: state (or current) and trait (or characteristic or
chronic) anxiety.
2. The Brief Coping Orientation to Problems Experienced
(COPE) questionnaire (Carver, 1997) is a short version of the
original self-reported item that includes 28 items to measure
the coping styles used in events management—namely,
active coping, positive attitude, external strategies, social
support, hedging strategies, and denial.
3. The Job Content Questionnaire (JCQ) proposed by Karasek
and Theorell (1990) comprises 35 items evaluating job
content in terms of psychological job demands, job decision
latitude, and social support.

12. The controlled trial
Results 1
Hypothesis 1: The emotional state (state anxiety reduction)
of oncology nurses included in the experimental group will
improve by the end of each session of the protocol.
We found a significant and
continuous decrease of anxiety
state (STAI State) at the end of
each session for the
experimental group, but not for
the control group.

13. The controlled trial
Results 2
Hypothesis 2: The affective state (trait anxiety reduction and
acquisition of styles of coping) of oncology nurses included
in the experimental group will improve by the end of the
entire protocol.
Significant results were found
only for the experimental group:
active coping (taking action to
change the situation) increased
while denial (denying the
existence of the critical
situation) decreased.

14. Conclusions
We reduced
anxiety and
improved
coping
Results showed a significant
decrease in anxiety among those
who performed the SIT protocol
compared to the control group.
In addition to the significant decrease
at the end of each session, the
results demonstrated a significant
improvement in anxiety trait reduction
and coping skills acquisition.
In particular, nurses learned two
important coping strategies: the
decrease of denial and the increase
of active coping,

15. Conclusions
Self-help
mobile stress
management
is possible
These results suggest the
possibility of developing
controllable self-help stress
management mobile
experiences for several
professions.
Self-management training
offers a potential solution to
the demand for efficient, low-
cost, and stigma-reducing
interventions for stress,
especially in high-demand
professions.

16. Giuseppe
Riva, Ph.D.
• Professor of General Psychology
at the Catholic University of Milan,
Italy;
• Director, Applied Technology for
Neuro-Psychology Laboratory -
ATN-P Lab., Istituto Auxologico
Italiano, Milan, Italy.
• President of the International
Association of CyberPsychology,
Training, and Rehabilitation
(http://iactor.ning.com)