Care for the Caregiver


The Johns Hopkins Hospital – Baltimore, MD

Program Leaders

Janel D. Sexton, Ph.D., MA

Janel D. Sexton, Ph.D., MA is a social and health psychologist and Assistant Professor in the Department of Anesthesia and Critical Care Medicine at The Johns Hopkins University. She received graduate training in Counseling from San Diego State University and completed her doctoral work in psychology at The University of Texas at Austin. Her work focuses on how people cope with upheavals, and the role that expressive writing can play in helping caregivers move beyond traumatic and stressful events. Her research and expertise also include diversity issues.

How the Program Came to Be

In 2004, the Josie King Foundation sponsored a visit to the Johns Hopkins Hospital from Dr. James W. Pennebaker, a renowned psychologist and chair at The University of Texas at Austin. In the early 1980s, Dr. Pennebaker published the earliest work on the therapeutic potential of expressive writing. At his visit to Hopkins, Dr. Pennebaker gave two talks on the topic- one lecture and one small group discussion. His work showed the benefits that expressive writing has in diverse populations such as college students, maximum security prisoners, laid off employees, and patients with chronic medical conditions. Researchers at Hopkins wanted to study how expressive writing effects caregivers. Caregivers everywhere share the goal of delivering safe and effective care in a healthcare system that is neither safe nor efficient. They often work under demanding and stressful conditions, where life hangs in the balance. It is not uncommon for caregivers to experience stressors and emotional upheavals that are difficult to talk about openly, even with friends and family.As the Josie King Foundation considers improving nursing resiliency as essentially related to improving patient safety, the study aligned with the Foundation’s funding priorities.

Program Description

The Care for the Caregivers program is a coping intervention that uses a self-administered expressive writing technique with a 20-year history in psychology research and practice. This practical tool can help caregivers cope not just with harm, but with a diverse array of job-related stressors and emotional upheavals. The ultimate goal is to enhance caregiver resilience for those who seek help in coping so that they can come to their jobs feeling whole.In Phase I of the program, an ICU nursing unit is taught how to practice expressive writing to respond to on-the-job stressors. The nurses regularly write about stressful situations at work. The research team performs pre-intervention and post-intervention assessments of the nurses’ relationship to their work. A separate nursing unit will serve as a control group.In Phase II, the research team will analyze the data and refine an expressive writing tool for caregivers.

Who is on the Team

Janel Sexton leads the research project, and a research assistant helps with the project’s administration. Two ICU nursing units make up the study group. One unit is briefed on expressive writing, and regularly uses expressive writing to reflect on job-related stressors; there is no intervention in the other control unit.

Goals for the Program

The research program is underway. In six months, Janel and her team expect to analyze the results of the study and begin developing a toolkit that other health care institutions and individual caregivers can access via this website to implement at other sites.

Sample Expressive Writing Prompt

First, find a quiet place where you won’t be disturbed. Then, for the next 20 minutes write about a stressful situation or event related to your job. This may be a medical error, a stressful work environment, difficult interactions with co-workers, job burnout, and/or issues having to do with death and dying or pain and suffering. Try to really let go and explore your very deepest emotions and thoughts. You do not need to limit your writing only to one event, and you can also write about other major conflicts or problems that you have experienced or are experiencing now. You might also tie your experience to other parts of your life. How is it related to your career, your relationships with others, your childhood, your parents, who you are, or who you want to be? Whatever you choose to write about, however, it is critical that you really delve into your deepest emotions and thoughts. Feel free to give details of the event to the extent that you would like, or to simply focus on your feelings and reactions to the event.Although people sometimes feel sad briefly, immediately after they write, there are positive long-term gains. Studies using this approach have found that when people write in this manner over 3 or 4 sessions, their emotional and physical health improves. The writing experience is useful for anyone affected by a trauma or upheaval and the content of the writings need not be shared with anyone. In fact, destroy the writings upon completion if you wish – the important thing is to put these experiences that are difficult to talk about into your own words. This jumpstarts your healing and coping process.

Why It Makes Sense

According to Janel, “Sorrel and I were sitting at a meeting together listening to frontline caregivers talk about what happens after harm occurs in a patient care area. What we learned was somewhat shocking: there is typically no set procedure or other on-the-spot intervention to help caregivers cope with the emotional fallout of being involved in patient harm. People are expected to carry on with their jobs, continue through their shift caring for patients, and not talk about what happened. The act of “not talking” about something upsetting might limit the legal exposure of an institution, but it turns the well-intentioned caregivers involved into new victims of the harm. There are insufficient resources and options available to caregivers in these situations, and the resources that are available are often unknown, distrusted, or stigmatizing (e.g., seeing the same “shrink” who talks to the staff about verbal abuse or behavioral problems).”

Next Steps

The Nursing Journal- a therapeutic writing journal based on the findings of the Care for the Caregiver research program- is now available! Please email for more information.

How the Josie King Foundation Contributes

In 2006, the Josie King Foundation awarded $20,000 to fund the Care for the Caregiver study.

For More Information

Please contact