Reducing perceived and objectively measured levels of stress in emergency nurses using an end of shift debrief – a research protocol

Ms Lucinda Mithen1, Dr Kerry Inder2, Dr Rohan Walker3

1University Of Newcastle, Nsw Australia, Newcastle, Australia, 2University of Newcastle, NSW Australia, Newcastle, Australia, 3University of Newcastle, NSW Australia, Newcastle, Australia

Background: Emergency Registered Nurses (ERNs) work in highly demanding environments involving significant exposure to uncontrollable, unpredictable and sometimes threatening events. These situations can provoke robust psychological stress responses which in the short term can be adaptive, but if repeated, can result in undesirable outcomes including lower mood, fatigue and burnout.  Effective management of high stress loads has the potential to enhance psychological resilience and improve the quality of occupational life and reduce turnover and resignation rates.

Aim: To assess the effectiveness of the Brief Action Review Debrief (BARD) strategy compared to Critical Incident Debriefing (CID) in reducing perceived and objectively measured levels of stress in ERNs.

Method: Using a cluster randomised controlled trial design ERNs will be invited to participate from four emergency departments (EDs), two level 1 trauma centres and two regional centres. EDs will be randomised to BARD plus CID (intervention group) or CID alone (usual care). BARD is a 15-minute debrief at the end of each shift asking ERNs six simple questions that encourage sharing and learning.  Local Health District and University Human Research Ethics Committee approval will be obtained prior to commencement of the study. Duration of the intervention is six months.

Outcome Measures: Objective measures of stress will include hair cortisol +/- saliva alpha-amylase. Perceived stress will be measured using the validated Depression Anxiety Stress Scale. Outcomes will be measured at baseline, during the intervention, post intervention and at 3-month follow-up.

Discussion: The presentation will outline the proposed process for undertaking this research, briefly describe the statistical methods and discuss the feasibility including the role of ED workplace engagement.

Conclusion: The purpose of the proposed research is to improve resilience among first line ERNs and if effective will help ERNs cope better with their work environment which may impact on retention rates in the profession.


I am an early career researcher who is embarking on my PhD candidature.  My passion is Emergency Nursing and I worked in several Emergency Departments  in New South Wales spanning 18 years.  My topic of interest is the well-being of Emergency Nurses and how to improve the levels of stress they experience in the work place. I am excited to try new measurement techniques for stress and new strategies for managing work place stress.