Using the THRIVE Program to Teach Self-Care to Oncology Nurses

When nurses think of personal protective equipment (PPE), things like latex gloves come to mind, but a new self-care program being tested at the Arthur G. James Cancer Hospital called THRIVE is trying to alter nurses’ perception of PPE to include the idea of self-care.

“My generation of nurses came to the profession being proud to say that we put everyone ahead of ourselves: patients, family, friends, church, and on and on, with no time left for ourselves,” said Lisa Blackburn, MS, RN, AOCNS, of the Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. “But it can’t be ‘cool’ anymore to be a martyr as a nurse. With the experiences we see on a daily basis, self-care and developing resilience have to be a part of our role or we won’t make it.”

Blackburn recently presented results of a study on the THRIVE Program at the Oncology Nursing Society (ONS) 44th Annual Congress, held April 11–14 in Anaheim, California. The program included an 8-hour retreat designed to teach staff skills for combating compassion fatigue and for promoting resilience. To date, the program has enrolled nurses and other advanced care providers, as well as educators, managers, and, most recently, physical therapists.

As part of the study, participants did a pre- and post-resilience survey to measure whether they effectively learned methods of self-care. Participants completed the Compassion Fatigue Short Scale (CFSS) and the Connor-Davidson Resiliency Scale (CD-RISC) prior to, immediately after, and at 3 and 6 months.

“One of our biggest goals in THRIVE is to give people a whole toolbox of new things they can do,” Blackburn said. “Not every method will resonate with every person, so we teach many things so each person can pick two or three that speak to them.”

Methods taught include things like mindful eating, chair yoga, breathing, art, journaling, guided imagery, and spirituality.

“Something like mindful eating teaches nurses to set aside time to turn over their pager and take 20 to 30 minutes to focus on refilling their own ‘cup’ during the middle of the day,” Blackburn said.

On the pre-assessment, nurse managers showed the greatest degree of burnout, and bedside/chairside nurses showed the greatest degree of secondary trauma.

After the intervention, the greatest improvement in average scores was an increased resilience, with an increase of 72 to 85 (on the 0 to 100 scale, a 10-point increase is considered significant). These scores have been consistent as far as 6 months out, Blackburn said. Additionally, burnout scores decreased from 41 to 23 on post-assessment.

“We keep a waiting list of people to go through the THRIVE program, and I realized by the time I would contact those folks to participate, many of them had left the organization,” Blackburn said. This prompted her to look into turnover among nurses. She said that among Magnet Hospitals, the average turnover was 13.6%, and at Arthur G. James Cancer Hospital it was a bit lower at 9.4%.

“If I looked specifically at participants in THRIVE, the turnover rate was even lower at 6.1%,” she said.

After participants completed the initial THRIVE retreat, Blackburn wanted to create a community where they could turn for motivation to continue to practice self-care. They started a 6-week independent study of a private Facebook group.

“I try to post three challenges a week to the group and they respond with pictures of themselves meeting those challenges or with comments,” Blackburn said. “This gives nurses the opportunity to practice what they learned on the everyday stress of work and home life.”