Acceptance and Commitment Coaching for Oncology Healthcare Professionals
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AbstractOncology nurses are an occupational group that experience high stress, increasing risks of chronic outcomes such as burnout and compassion fatigue. This negatively affects staff absenteeism/turnover and the quality of patient care. Current oncology nurse stress-management interventions offer varied insight regarding effectiveness, with little information on how intervention packages are tailored for this population, and how the intervention mechanisms bring about positive change. Acceptance and Commitment Training (ACT) provides a viable platform from which to offer stress management techniques, given both the relevance of mindfulness and values based behaviours to this context, and the availability of process measures to understand mechanisms of change. This thesis aimed to develop and test an ACT-based oncology nurse stress-management intervention following the MRC guidance, given the limited published research using ACT. Online cross-sectional survey research (chapter two) revealed that acceptance, mindfulness and values-based processes are important in shifting work-related wellbeing outcomes in UK nurses, given the large amounts of variance explained by these components. This empirically guided the development of ACTION; a three-session (90 minutes each), group-based ACT intervention. ACTION was tested in three single-case experimental design (SCED) studies (chapters four to six). Intervention acceptability was demonstrated in the first SCED study, with qualitative data informing future development. Systematic changes to each of these trials, such as piloting alternative measures, a lengthier follow-up phase and the inclusion of eligibility screening provided insightful results. ACTION demonstrated effectiveness for psychological flexibility, with improvements mainly observed at follow-up, even for participants receiving an online version of ACTION in response to COVID-19 pressures. Effects on stress were also promising. The implications of using SCED methodology in this context is discussed (e.g. the impact of extraneous factors on stress scores). Qualitative data highlighted the potential utility of ACTION for promoting stress-management self-efficacy. The general self-efficacy scale was, thus, included as an outcome in studies three and four to capture this construct. Lack of sensitivity to change and frequent ceiling effects made demonstrating effectiveness on this variable a difficult process. It highlighted the importance of using a domain-specific self-efficacy measure to test this potential secondary outcome of ACTION, but, to knowledge, no measure existed. To address this gap, the final study of this thesis developed a stress management self-efficacy scale that aimed to reduce the risk of ceiling effects prevalent in previous self-efficacy scales. This study used an item-selection process that combines Classical Test and Item Response Theory. Forty items were reduced to sixteen, offering a scale that cannot only be used in future trials of ACTION, but in any stress-management intervention trial from any occupational context. Various recommendations are outlined in the final chapter, from advice for implementing ACTION in the applied setting, to methodological recommendations for a future Phase II trial.
CitationKent, W. (2022). Acceptance and commitment coaching for oncology healthcare professionals [Unpublished doctoral thesis]. University of Chester.
PublisherUniversity of Chester
TypeThesis or dissertation
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