# The importance of self-care and contextual factors: A process evaluation of a recovery intervention for new nurses

## TL;DR

This study explores how a recovery program helps new nurses manage stress and burnout by examining how the program works and what factors influence its success.

## Contribution

The study identifies mechanisms of a recovery program and contextual factors affecting its implementation for new nurses.

## Key findings

- The program increased knowledge about sleep and motivation for recovery strategies.
- Contextual factors like workload and work schedules significantly influenced recovery opportunities.
- Booster sessions and reminders were suggested to maintain recovery strategies post-program.

## Abstract

Newly graduated nurses often face demanding working conditions including high workload, stress, and irregular working hours. During the first years of practice, burnout symptoms are common. Recovery, including sleep, can be seen as a key protective factor in the associations between stress, shift work and negative health outcomes. Previously, a proactive, group-based intervention (recovery programme) for new nurses, promoting individual strategies for recovery, decreased burnout and fatigue symptoms post-intervention and showed preventive effects on somatic symptoms over time. To optimise the implementation and outcomes of an intervention, it is important to understand its mechanisms of impact (i.e., how it produces change) as well as to identify contextual factors influencing its implementation.

To deepen the understanding of the recovery programme’s mechanisms of impact and to explore how its implementation, including participants’ opportunities for recovery and the feasibility of recovery strategies, was influenced by the context.

Qualitative descriptive design.

Twelve nurses (nine women) who had participated in the intervention at four Swedish hospitals, between 12 and 25 months (M = 19) after participation.

Semi-structured individual telephone interviews were conducted and analysed using thematic analysis.

The programme’s proposed mechanisms of impact, including increased knowledge about sleep, enhanced motivation for behavioural change, and the use of recovery strategies, were confirmed. Motivation to apply recovery strategies was supported by a shift in mind-set regarding the importance of self-care; to improve readability; and follow-up on the behavioural change process during sessions. Contextual factors influencing recovery opportunities and the feasibility of strategies were related to both the work context and the individual. These factors included demanding schedules, extended and disrupted working hours, workload, opportunities for recovery at work, social norms, the organisation of work procedures, private life circumstances, and the deprioritisation of personal recovery needs. Booster sessions and reminders were suggested to facilitate the continued use of recovery strategies after the programme.

When supporting nurses in developing individual recovery strategies, it is important to provide opportunities to share experiences with other new nurses and to follow-up on their behavioural change process. Importantly, several organisational factors should also be considered. Organisations should work systematically with the planning and management of working hours that promote recovery, create opportunities for recovery during work shifts, organise work procedures with recovery in mind, and continuously monitor and manage employees’ stress and fatigue symptoms. Together, such efforts could promote a social norm that supports recovery.

Nurses’ recovery can be supported through knowledge, individual strategies, follow-up, group reflections and organisational adaptations