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.
What this article is about
Quick Answer
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.
Student takeaways
Key Takeaways
- 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.
Student summary
Why This Research Matters
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).
Source abstract
Study Overview
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 )
Evidence appraisal
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.
Practice transfer
Clinical Relevance
- 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.
Faculty notes
Educational Relevance
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?
- What outcome measures would you prioritize in a follow-up randomized controlled trial of STEP, and why?
- How does the persistently elevated post-pandemic burnout rate described in this study's background inform the urgency (or caution) with which findings like these should be adopted into practice?
- What organizational barriers (staffing, cost, scheduling) might limit real-world implementation of an 8-week individual psychotherapy program across a hospital or long-term care system?
- How could future research disaggregate results by occupational role (nurse vs. PSW) or care setting (hospital vs. long-term care) to better understand who benefits most from STEP?
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
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
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
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
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
Rationale: The abstract states: 'Improvements in burnout and work functioning were observed at the three-month follow-up.'
6. Which measures did participants complete as part of the study?
- Burnout, resilience, mood, anxiety, and work and life functioning
- Blood glucose, cholesterol, and blood pressure
- Patient acuity scores and staffing ratios
- Medication error rates and incident reports
Rationale: The abstract states participants 'completed measures of burnout, resilience, mood, anxiety, and work and life functioning.'
7. What best describes the overall study design of this trial?
- A randomized controlled trial with a placebo group
- A single-arm pilot feasibility study with no comparison group
- A retrospective chart review
- A systematic review and meta-analysis
Rationale: The study is described as 'a pilot study' evaluating feasibility, acceptability, and preliminary effectiveness, consistent with a single-arm design without a stated control or comparison group.
8. According to the study's background, what has remained elevated in nurses and PSWs since the COVID-19 pandemic?
- Rates of burnout
- Rates of medication administration errors
- Average patient length of stay
- Nurse-to-patient staffing ratios
Rationale: The abstract states that burnout rates 'have remained elevated since the COVID-19 pandemic.'
9. Where was this pilot study conducted?
- British Columbia
- Ontario
- Quebec
- Nova Scotia
Rationale: The abstract states the pilot study was conducted 'with 35 nurses and PSWs in Ontario.'
10. Why is a control or comparison group important when interpreting the reported improvements in burnout and work functioning?
- Without one, improvements cannot be confidently attributed to the intervention rather than other factors like time or attention effects
- Control groups are only needed for surveys, not psychotherapy trials
- A comparison group is required only when measuring cost, not clinical outcomes
- It is not important, since pilot studies are designed to prove efficacy
Rationale: As a single-arm pilot with no comparison group, this study can establish feasibility and acceptability but cannot isolate the intervention's causal effect from other explanations for change over time.
Study cards
Flashcards
What does STEP stand for in this study?
STEP stands for the Supportive Trauma Exposure Preparation program.
How long is the STEP program intervention?
It is an 8-week program, delivered as 8 weekly psychotherapy sessions.
What format is STEP delivered in?
STEP is delivered virtually, as an 8-week virtual psychotherapy intervention.
Who were the participants in this pilot study?
35 nurses and personal support workers (PSWs) working in Ontario.
What were the three main aims of this study?
To evaluate the feasibility, acceptability, and preliminary effectiveness of the STEP program.
What health problem is STEP designed to address?
Burnout resulting from trauma exposure in nurses and PSWs, which has remained elevated since the COVID-19 pandemic.
At what follow-up interval were outcomes assessed after the intervention?
Outcomes were assessed at three months follow-up.
What five types of outcome measures did participants complete?
Measures of burnout, resilience, mood, anxiety, and work and life functioning.
What did the study find regarding feasibility and acceptability of STEP?
The study demonstrated strong feasibility and acceptability, with high participant engagement and satisfaction.
Which two outcomes showed improvement at the three-month follow-up?
Burnout and work functioning showed improvement at three-month follow-up.
What is the overall conclusion the authors draw about STEP?
STEP shows promise as a novel intervention addressing the unmet need for preventing and managing the effects of trauma exposure among nurses and PSWs.
What is the ClinicalTrials.gov registration number for this study?
NCT04682561.
In which journal was this study published?
The Canadian Journal of Nursing Research.
Who led the research team behind this study?
Aleksandra Lalovic and Sakina J. Rizvi led the research team, along with co-authors Molly Hyde, Yvonne Bergmans, Anna Kiriakidis, Nathania Ebegbare, and Ashley Verduyn.
What type of study design is this, in terms of comparison groups?
It is a single-arm pilot study with no control or comparison group; every enrolled participant received the STEP intervention.
Why can't this study prove that STEP caused the observed improvements in burnout?
Because there was no control group, the design cannot rule out other explanations for change, such as natural fluctuation over time or nonspecific effects of study participation.
What population, beyond registered nurses, was included in this study?
Personal support workers (PSWs) were included alongside nurses.
What kind of intervention delivery model does STEP use, according to its registry description?
Individual, one-on-one psychotherapy sessions delivered remotely by licensed therapists, once weekly for one hour.
What content areas does the STEP program cover?
Stress education, emotional validation of trauma exposure, resilience-building, coping strategies, and preparation for future traumatic events.
What is a key limitation of this study's sample?
The sample size was small (35 participants) and limited to Ontario nurses and PSWs, limiting generalizability.
Search-ready answers
Frequently asked questions
What is the STEP program for nurses?
STEP (Supportive Trauma Exposure Preparation) is an 8-week virtual psychotherapy program developed to help nurses and personal support workers manage the emotional impact of workplace trauma exposure and reduce burnout.
How many nurses and PSWs took part in the STEP pilot study?
The pilot feasibility study enrolled 35 nurses and personal support workers working in Ontario.
Did the STEP program reduce burnout in nurses?
The pilot study found improvements in burnout and work functioning at three-month follow-up, but because it was a single-arm feasibility study without a control group, this cannot be treated as definitive proof of effectiveness.
Is STEP delivered in person or online?
STEP is delivered virtually, as weekly individual videoconference sessions with a licensed therapist over 8 weeks.
What outcomes were measured in the STEP feasibility study?
The study measured burnout, resilience, mood, anxiety, and work and life functioning, along with participant feedback on feasibility and acceptability.
Was the STEP study a randomized controlled trial?
No. It was a single-arm pilot feasibility study; all participants received the STEP program and there was no comparison or control group.
Where was the STEP program study conducted?
The study was conducted with nurses and personal support workers in Ontario, Canada.
What is the registration number for the STEP program clinical trial?
The study is registered on ClinicalTrials.gov under NCT04682561.
Who developed the STEP program?
STEP was developed by a research team including Aleksandra Lalovic, Molly Hyde, Yvonne Bergmans, Anna Kiriakidis, Nathania Ebegbare, Ashley Verduyn, and Sakina J. Rizvi, published through Unity Health Toronto-affiliated research.
What are the main limitations of the STEP pilot study?
Key limitations include a small sample size (35 participants), no control group, an Ontario-only sample, and only three months of follow-up, so long-term and comparative effectiveness remain unknown.