Nursing Tales From the Bedside: The Impact of Peer-Supported Storytelling on Nurse Resilience

During the COVID-19 pandemic, nurses experienced secondary trauma that placed them at risk for compassion fatigue and burnout. In the 20-bed medical intermediate care unit of the Penn State Milton S. Hershey Medical Center, bedside nurses experienced this heightened trauma when the unit suddenly transitioned to a COVID-19 unit. With the increasing stress, staff in the unit who experienced deep trauma struggled to recover through traditional debriefing support. Because evidence shows that storytelling is a useful therapeutic intervention and had been used successfully in our institution’s graduate nurse residency program, we initiated facilitator-led, peer-supported storytelling sessions—Tales From the Bedside—to increase coping and resiliency of bedside nurses impacted by COVID-19 in the unit.Nurses are known to experience secondary trauma related to mounting distress, challenging cases, workplace demands, staffing issues, and staff assaults, which can lead to increasing amounts of compassion fatigue, burnout, and turnover. As evidenced during the pandemic, nurses experienced secondary trauma related to their everyday work, placing them at an even higher risk for compassion fatigue and burnout.1Tales From the Bedside began when a clinical nurse in the medical intermediate care unit observed that peers were not OK after several distressing events. Simple debriefings were not enough to mitigate against the intense impact of these events. Nurses needed to share in detail their nursing stories in a therapeutic environment with supportive and structured guidance. Structured peer-supported storytelling has been identified as a therapeutic intervention that can help nurses process distressing events and experience hope, guidance, and healing.2 It can lead to insights into personal trauma by giving nurses control of the story so that healing can begin; it moves participants beyond simple debriefing to the work of processing the impact of distressing events in their life and practice. Tales From the Bedside is a directed intervention that facilitates this much-needed therapeutic processing of traumatic experiences.Tales From the Bedside was developed at the Penn State Milton S. Hershey Medical Center, a not-for-profit, 634-licensed-bed academic medical center affiliated with the Penn State College of Medicine and Penn State University. The university hospital employs approximately 2200 nurses and has 34 000 annual admissions. The intervention was initially tested in the medical intermediate care unit, and because of the great success in mitigating stress for the nurses on that unit, the intervention later was expanded to the acute care and intensive care settings. For the intervention, clinical nurses partnered with hospital chaplains to form peer-supported storytelling groups consisting of 4 nurses per group. Each nurse came prepared to share a crisis story involving a bedside encounter. Facilitators trained in empathetic listening conducted the debriefings. After each participant’s telling of their story, facilitators guided the group through 2 questions for the listeners—What feelings did you identify in the story? What in the story resonated with your experiences?—and 2 questions for the storytellers—What did you lose? What did you gain? They then conducted a ceremony in which participants wrote down a burden they hoped to release and placed the paper in a container of water to dissolve. The ceremony was concluded at the hospital’s Peace Tree, where participants poured out the water to nurse and nurture the tree, symbolizing the turning of sorrows into future life.Seven sessions were conducted over 12 months with 26 nurses in 2021 as part of the pilot study. Participants completed 2 evaluations, 1 immediately after the session to measure the immediate impact of the intervention and then another 3 months later to ascertain if nurses had a different perception of their ability to cope with workplace challenges, reach out for support in a future crisis, and obtain further professional counseling as needed.No changes were made to the initial intervention based on the results of the first survey, which measured the quality of the intervention. Through the session evaluations, participants reported the intervention to be an effective way to express feelings (100% [16 of 16]), change knowledge and attitude (100% [16 of 16]), and experience stress relief (100% [16 of 16]), with 56% (9 of 16) of respondents reporting a change in their practice. Nurses described the experience as validating, creating a safe space to let go of emotions free of judgment. Through the 3-month postintervention survey, participants revealed increased self-awareness (100% [8 of 8]); new insights into individual perceptions of stress (100% [8 of 8]); feelings of less isolation at work (75% [6 of 8]); more openness to expressing thoughts, questions, and feelings with colleagues (63% [5 of 8]); and new insights into the distress facing their colleagues (63% [5 of 8]).Because of the study, nursing managers were trained and advised to use immediate debriefings after a crisis event to assess staff—using a stress first aid guide—who likely would experience long-term effects from the crisis event. These managers then referred the impacted staff to a future session of Tales From the Bedside to receive further support and intervention.Scheduling challenges remain the most substantial barrier to sustaining a therapeutic peer storytelling intervention. The intervention requires 3 to 4 storytellers in each session to achieve the peer feedback that provides the therapeutic value the intervention intends, which means that commitment from leaders and participants to promote and engage in the intervention is essential. The intervention can be sustained with advanced regular scheduling of peer storytelling groups. Furthermore, it requires a commitment from unit leaders to identify staff who would benefit the most from the intervention and allocate time for them to attend and additional staffing to cover for their absence. This intervention relied on chaplains already trained in debriefing and therapeutic listening, though institutions without such readily available resources will need to develop or locate facilitators trained in therapeutic listening.With growing awareness of health care worker stress, health care organizations implemented various interventions to increase staff resiliency, such as after-action reviews, critical incident stress debriefing, mindfulness-based stress reduction, and resiliency training. Peer-supported storytelling should be added to this arsenal of interventions, given that it has been shown to reduce isolation and increase self-awareness and it draws from the internal strength and resilience of the individual, directs the individual to draw from the strength of colleagues, and screens for deeper psychological stress that can help direct health care workers to further appropriate therapeutic interventions.Studies have shown that debriefing sessions alone are limited in the therapeutic processing they provide3 and may, in fact, increase the effects of trauma if further processing does not occur.4 Peer-supported storytelling has been shown to provide this therapeutic effect, as was demonstrated by this study. Peer-supported storytelling was adapted and structured into the hospital environment in a way that offered distressed nurses a place to process high-impact cases and situations. More real-time therapeutic interventions are needed to help nurses draw from their own resiliency, process challenging events, and lean on the strength and wisdom of their colleagues. Tales From the Bedside demonstrates the effectiveness of such interventions.The author thanks Eric R. Messner, PhD, FNP-BC, Program Director of Nursing Research and Innovation at the Milton S. Hershey Medical Center, for his expertise and assistance during the development, writing, and editing of the manuscript.