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. 2023 May 12;2023(5):CD002892. doi: 10.1002/14651858.CD002892.pub6

Dahlgren 2022.

Study characteristics
Methods Study design: randomised controlled trial
Study grouping: parallel group
Participants Baseline characteristics
Proactive recovery programme

  • Age (mean ± SD): 27.5 ± 5.3

  • Sex (N (% female)): (NR) 85%

  • Sample size: 99

  • Years of experience (mean ± SD): 2.8 ± 2.1


Control (no intervention)

  • Age (mean ± SD): 27.0 ± 5.1

  • Sex (N (% female)): (NR) 91%

  • Sample size: 108

  • Years of experience (mean ± SD): 3.3 ± 2.7


Overall

  • Age (mean ± SD): NR

  • Sex (N (% female)): NR

  • Sample size: 207

  • Years of experience (mean ± SD): NR


Included criteria: RNs with less than 12 months’ work experience were eligible to participate.
Excluded criteria: NR
Pretreatment: no significant differences were observed between the two groups at baseline for any of the background variables or any of the outcome measures at baseline.
Compliance rate: 36 of the 99 (36%) participants randomised to the intervention group participated in two of the three sessions.
Response rate: 45% (207/461)
Type of healthcare worker: exclusively nurses
Interventions Intervention characteristics
Proactive recovery programme

  • Type of the intervention: Intervention type 2 ‐ to focus one’s attention away from the experience of stress

  • Description of the intervention: The sessions had three main focus': (1) unwinding from stress, including detach‐ment from thoughts of work during free time; (2) supporting sleep in relation to homoeostatic and circadian processes; and (3) handling fatigue and increasing recovery behaviours (see table1). Psycho‐educative elements were interspersed with group discussions and exercises. Participants were encouraged to reflect on their habitual behaviours connected to sleep and recovery and possible alternatives. Between sessions, the participants were encouraged to try strategies or behaviour changes of their choice, with the aim of enhancing sleep and recovery. During the second and third sessions, participants reflected on the experience of trying new strategies. All participants received written material covering the content of each session, as well as online access to an adapted version of a bio‐mathematical model (ArturNurse). ArturNurse evaluated fatigue risk levels based on their work schedules25 and provided suggestions of strategies from the programme on how to optimise sleep in relation to different shifts.

  • The number of sessions: 3

  • Duration of each session on average: 2.5 hours

  • Duration of the entire intervention: 4 weeks

  • Duration of the entire intervention short vs long: Short

  • Intervention deliverer: Authors (Bachelor of applied psychology)

  • Intervention form: Group, face‐to‐face


Control (no intervention)

  • Type of the intervention: NA

  • Description of the intervention: NA

  • The number of sessions: NA

  • Duration of each session on average: NA

  • Duration of the entire intervention: NA

  • Duration of the entire intervention short vs long: NA

  • Intervention deliverer: NA

  • Intervention form: NA
Outcomes Perceived Stress Scale (PSS)

  • Outcome type: Continuous Outcome


Shirom‐Melamed Burn‐out Questionnaire (SMBQ) ‐ Global

  • Outcome type: ContinuousOutcome
Identification Sponsorship source: This study was funded by AFA Försäkring (150024)
Country: Sweden
Setting: Eight Swedish hospitals
Comments: NR
Authors name: Anna Dahlgren
Institution: Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Solna, Sweden
Email: anna.dahlgren@ki.s
Address: NR
Time period: 2017‐2018
Notes PSS included in analysis 2.1 and 2.2
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) High risk Excel generator for random allocation to groups was used by the research team. Based on a previous feasibility study, adjustments to the process of random group allocation were made if many nurses from the same ward were initially allocated to one group. Twenty adjustments were also made for participants who were randomised to the intervention group but knew that they could not attend the group sessions. They were moved to the control group and replaced by a random participant from the control group.
Allocation concealment (selection bias) High risk Quote: "parallel randomised control trial was designed to include 100 participants in each group (intervention and wait list control) to detect moderate effect sizes (Cohen’s d = 0.5) resulting in a power of 0.94. Excel generator for random allocation to groups was used by the research team. Based on a previous feasibility study, adjustments to the process of random group allocation were made if many nurses from the same ward were initially allocated to one group. Twenty adjustments were also made for participants who were randomised to the intervention group but knew that they could not attend the group sessions. They were moved to the control group and replaced by a random participant from the control group. Adjustments were made for 24 participants. Masking was not applicable. After the follow‐up measure the control group received the intervention."
Blinding of participants and personnel (performance bias)
All outcomes High risk 'Masking was not possible'. Participants were not blinded.
Blinding of outcome assessment (detection bias)
All outcomes High risk Participants were not blinded whereas outcomes are self‐reported.
Incomplete outcome data (attrition bias)
All outcomes High risk 130 of the 207 randomised participants (63%) completed 6 months follow‐up. Reasons not provided as well as whether it was at random.
Selective reporting (reporting bias) High risk Trial registration (https://clinicaltrials.gov/ct2/show/NCT04246736). In the trial registration many other stress outcomes were mentioned, which were not mentioned in this study, i.e.

  1. Change in stress and energy (subjective measures) [Time Frame: In order to detect change measures were made at baseline and four weeks after the intervention.]

  2. Stress‐Energy rating questionnaire: Minimum score 0, maximum score 5. Higher scores indicate more stress and more energy.

  3. Change in stress symptoms (subjective measures) [Time Frame: In order to detect change measures were made at baseline and four weeks after the intervention.]

  4. Self‐ratings of stress symptoms/absence of stress symptoms (single items): "Tense"; "Irritated"; "Exhausted"; "Hard to disconnect from thoughts of work during spare time"; "Emotional burden"; "Relaxed/calm" on a scale ranging from 1 = not at all, and 5 = very much. Measured every day during seven days at baseline and seven days at follow‐up.

  5. Change in diurnal levels of stress (subjective measures) [Time Frame: In order to detect change measures were made at baseline and four weeks after the intervention.]

  6. Self‐rated stress scale for repeated measurement, measured one a nine‐graded scale with values ranging from 1 = very low stress to 9 = very high stress. Measured every third hour during wake time seven days at baseline and seven days at follow‐up.

  7. Change in stress (objective measures) [Time Frame: In order to detect change measures were made at baseline and four weeks after the intervention.]

  8. Hair cortisol based on 2 cm segments (pg/mg)
Other bias Unclear risk Judgement Comment: Low response rate 207/461 (45%)