What this article is about
In brief
A pilot study of the 8-week virtual STEP psychotherapy program for 35 Ontario nurses and PSWs found strong feasibility and acceptability, plus early improvements in burnout and work functioning at three months, though the single-arm design without a control group limits causal conclusions.
For nursing students
Study summary
Nurses and personal support workers (PSWs) are exposed to trauma as a routine part of their work: sudden deaths, violent incidents, medical emergencies, and the ongoing strain of caring for very sick patients. Most workplaces do not give staff structured tools to process this exposure, and the result has been persistently high burnout, a problem that researchers say has stayed elevated since the COVID-19 pandemic. This Canadian Journal of Nursing Research article reports a pilot feasibility study of a new intervention designed to close that gap: the Supportive Trauma Exposure Preparation (STEP) program.
STEP is an 8-week virtual psychotherapy program built specifically for healthcare workers rather than adapted from general workplace wellness content. Based on the study registration for this trial (ClinicalTrials.gov NCT04682561), STEP is delivered one-on-one by a licensed therapist in weekly one-hour sessions over videoconference, so participants do not need to travel or take time away from shift work to attend in person. The program's content focuses on stress education, validating the emotional impact of trauma exposure, building resilience skills, teaching coping strategies, and preparing workers for future traumatic events they may encounter on the job, rather than only treating symptoms after the fact.
The research team, based at Unity Health Toronto and led by Aleksandra Lalovic and Sakina J. Rizvi, recruited 35 nurses and PSWs working in Ontario hospitals and long-term care settings to test whether the program was feasible and acceptable, and whether it showed early signs of effectiveness. Participants completed all 8 sessions and then were followed up three months later. Throughout the study, they completed standardized measures of burnout, resilience, mood, anxiety, and how well they were functioning at work and in daily life, and they gave direct feedback about their experience of the program.
The results were encouraging on the questions the study was actually designed to answer. The authors report strong feasibility and acceptability: participants engaged consistently with the weekly sessions and reported being satisfied with the program. This matters because many wellness interventions for healthcare workers struggle with low uptake or high drop-out, given how overstretched staff already are. STEP's individual, flexible, remote format appears to have supported participation. Beyond simply being tolerable, the pilot also picked up preliminary effectiveness signals: participants showed improvements in burnout and in work functioning by the three-month follow-up point.
It is important to understand what kind of study this is before drawing conclusions. This was a single-group pilot feasibility study, meaning every participant received the STEP program and there was no comparison group who received usual care or a different intervention. That design is well suited to answering "can this program be delivered, and do people engage with it and like it?" but it cannot tell us with confidence whether STEP itself caused the burnout and work-functioning improvements, since other factors (season, workplace changes, natural fluctuation, or simply extra attention from a study team) could also explain change over time. The sample of 35 is also small, drawn from Ontario only, and the abstract does not report separately how nurses versus PSWs responded, so we cannot say whether the program works the same way across these two distinct roles.
For nursing students and current nurses, this study is a useful example of how new mental health supports for healthcare workers get built and tested in careful stages. Before a larger trial can test whether STEP actually reduces burnout compared to no intervention, researchers first need to know the program can be delivered as designed and that people will actually use it. This pilot answers that first question. It also models a broader clinical idea worth remembering in your own practice and self-care: preparing for trauma exposure before it happens, and having a structured way to process it afterward, may be more protective than waiting until burnout is already severe. As you read studies like this, get comfortable distinguishing what a pilot study can responsibly claim (feasibility, acceptability, promising early signals) from what only a larger, controlled trial can establish (proof that the intervention itself caused a measurable clinical benefit, and how durable that benefit is beyond three months).
Original publication
Source abstract and study details
Read the source abstract
Background Nurses and personal support workers (PSWs) frequently face trauma in their work without sufficient resources to manage the resulting emotional stress. This contributes to high rates of burnout, which have remained elevated since the COVID-19 pandemic. Purpose To address the need for effective interventions that mitigate the impact of trauma exposure in the healthcare workplace, we developed the Supportive Trauma Exposure Preparation (STEP) program, an 8-week virtual psychotherapy intervention. The aim of this study was to evaluate the feasibility, acceptability, and preliminary effectiveness of the STEP program in reducing burnout and enhancing resilience. Methods A pilot study was conducted with 35 nurses and PSWs in Ontario assessing the feasibility, acceptability, and preliminary effectiveness of the STEP program at three months follow-up. Participants attended 8 weekly psychotherapy sessions, provided feedback on their experiences, and completed measures of burnout, resilience, mood, anxiety, and work and life functioning. Results The study demonstrated strong feasibility and acceptability, with high participant engagement and satisfaction with the STEP program. Improvements in burnout and work functioning were observed at the three-month follow-up. Conclusions The STEP program shows promise as a novel intervention addressing the critical unmet need for preventing and managing the detrimental effects of trauma exposure among nurses and PSWs in the healthcare workplace. ClinicalTrials.gov Registration # NCT04682561 (URL: https://clinicaltrials.gov/study/NCT04682561 )
Reviewed findings
Main findings
- The STEP program, an 8-week virtual psychotherapy intervention, was piloted with 35 nurses and personal support workers in Ontario to test feasibility, acceptability, and preliminary effectiveness.
- The study demonstrated strong feasibility and acceptability, with high participant engagement and satisfaction with the STEP program.
- Improvements in burnout and work functioning were observed at the three-month follow-up.
- Participants completed measures of burnout, resilience, mood, anxiety, and work and life functioning across the study period.
- The authors conclude that STEP shows promise as a novel intervention addressing the unmet need for preventing and managing the effects of trauma exposure in nurses and PSWs.
Using the findings
Practice considerations
- Structured, therapist-led psychoeducation and coping-skill programs delivered before or alongside trauma exposure may offer a more proactive alternative to reactive, post-incident debriefing models.
- Remote, individual delivery formats may improve accessibility and completion for shift-working nurses and PSWs who face scheduling barriers to in-person mental health support.
- Given the pilot's positive engagement signal, nurse leaders and occupational health teams may consider similar structured, multi-week resilience programs as one option within a broader wellness strategy, while awaiting controlled-trial evidence of efficacy.
- Because this was a feasibility study without a control group, clinicians and administrators should not yet treat STEP as a proven method for reducing burnout; it should be framed as a promising early-stage intervention pending confirmatory research.
- The program's focus on both nurses and PSWs highlights that trauma-exposure support strategies should be designed to reach the full frontline care team, not only regulated nursing staff.
For educators
Teaching and appraisal notes
This pilot feasibility study, published in the Canadian Journal of Nursing Research, evaluates the Supportive Trauma Exposure Preparation (STEP) program, an 8-week virtual, one-on-one psychotherapy intervention developed by a team at Unity Health Toronto (Lalovic, Hyde, Bergmans, Kiriakidis, Ebegbare, Verduyn, and Rizvi) to address trauma exposure and burnout among nurses and personal support workers (PSWs). The study is registered on ClinicalTrials.gov (NCT04682561) and is well suited for teaching students how early-phase intervention research is designed, reported, and appropriately interpreted.
Design and sample: This was a single-arm pilot study (no comparison/control group), enrolling 35 nurses and PSWs working in Ontario hospitals and long-term care facilities. According to the trial registration, eligible participants were 18 or older, English-speaking, working at least one shift weekly, and not concurrently enrolled in other psychotherapy. Participants completed 8 weekly one-hour individual sessions delivered remotely by licensed therapists, then were reassessed at a 3-month follow-up. The intervention content spans stress education, emotional validation of trauma exposure, resilience-building, coping-skill acquisition, and anticipatory preparation for future traumatic events — a prophylactic/preparatory framing distinct from post-incident debriefing or standard EAP counselling models.
Outcomes and measures: Standardized instruments assessed burnout, resilience, mood, anxiety, and work and life functioning, alongside qualitative/satisfaction feedback on the participant experience. The primary study aims — feasibility and acceptability — were met: the authors report high engagement and satisfaction. The secondary, preliminary-effectiveness aim showed improvements in burnout and work functioning at 3-month follow-up; the abstract does not report effect sizes, specific instrument scores, or whether improvements reached statistical significance, and full details on resilience, mood, and anxiety outcomes specifically are not broken out in the available abstract.
Teaching points for discussion: This is a strong exemplar for teaching students to distinguish feasibility/pilot trial objectives from efficacy trial objectives. A single-arm, pre-post pilot with no control group cannot isolate the intervention's causal effect from regression to the mean, natural symptom fluctuation, seasonal effects, or non-specific attention/support effects of being enrolled in a monitored program — points worth raising explicitly with students who may over-read "improvements were observed" as proof of efficacy. It is also a good case for discussing appropriate next steps in an intervention-development pipeline: this pilot logically motivates a future randomized controlled trial with an active or waitlist comparator and a longer follow-up window to test durability beyond 3 months.
The study is timely and locally relevant for Canadian nursing programs given its Ontario, post-pandemic context and its direct engagement with the profession's persistently elevated burnout rates. It also offers a useful comparison point against similar international programs (e.g., the UK's Reboot coaching program for critical care nurses) for cross-context discussion of workplace trauma-resilience interventions.
Limitations for classroom emphasis: small sample (n=35) limits statistical power and generalizability beyond Ontario nurses/PSWs; absence of a control group; the abstract does not disaggregate results by occupational role (nurse vs. PSW) or report specific quantitative outcome data for resilience, mood, or anxiety; and the reliance on self-report measures and self-selected, motivated participants (who agreed to 8 weeks of individual psychotherapy) may limit applicability to the broader, more burned-out or disengaged segment of the workforce this intervention ultimately aims to reach.
Critical appraisal
Limitations
- Small sample size (35 participants) limits statistical power and the ability to detect effects reliably.
- The study used a single-arm, pre-post pilot design with no control or comparison group, so improvements cannot be firmly attributed to the intervention itself rather than other factors.
- The sample was drawn only from Ontario nurses and PSWs, limiting generalizability to other provinces, healthcare settings, or countries.
Classroom use
Discussion Questions
- Why is it important to distinguish a feasibility/pilot study from a full efficacy trial when interpreting claims that a program 'improved burnout'?
- What specific threats to internal validity exist in a single-arm, pre-post design like this one, and how might a future trial address them?
- How might the remote, one-on-one, therapist-led format of the STEP program have contributed to its reported high feasibility and acceptability?
- What are the practical and ethical considerations in offering the same intervention to both regulated nurses and unregulated personal support workers?
- In what ways does a prevention/preparation-focused model like STEP differ from traditional post-incident critical incident stress debriefing, and what are the potential advantages of each?
- Why might self-selected participants who agree to 8 weeks of individual psychotherapy differ systematically from the broader population of burned-out healthcare workers, and how could this affect generalizability?
Knowledge check
Quiz
1. What is the STEP program evaluated in this study?
- An 8-week virtual psychotherapy intervention for nurses and PSWs
- A one-day in-person workshop on burnout
- A mobile app for tracking sleep quality
- A hospital policy change regarding shift scheduling
Show answer and rationale
Rationale: The abstract states the researchers developed 'the Supportive Trauma Exposure Preparation (STEP) program, an 8-week virtual psychotherapy intervention.'
2. How many participants were enrolled in this pilot study?
- 15
- 35
- 75
- 150
Show answer and rationale
Rationale: The abstract states: 'A pilot study was conducted with 35 nurses and PSWs in Ontario.'
3. What was the primary aim of this study?
- To compare STEP against a control intervention for efficacy
- To evaluate the feasibility, acceptability, and preliminary effectiveness of the STEP program
- To determine the cost-effectiveness of psychotherapy in hospitals
- To survey nurses about their general job satisfaction
Show answer and rationale
Rationale: The abstract states the aim 'was to evaluate the feasibility, acceptability, and preliminary effectiveness of the STEP program in reducing burnout and enhancing resilience.'
4. At what follow-up point were preliminary effectiveness outcomes assessed?
- One week
- One month
- Three months
- One year
Show answer and rationale
Rationale: The abstract notes the pilot study assessed feasibility, acceptability, and preliminary effectiveness 'at three months follow-up.'
5. Which outcomes were reported as improved at three-month follow-up?
- Sleep quality and appetite
- Burnout and work functioning
- Blood pressure and heart rate
- Patient satisfaction scores
Show answer and rationale
Rationale: The abstract states: 'Improvements in burnout and work functioning were observed at the three-month follow-up.'