Evidence-Based Resilience Intervention for Nursing Students: a Randomized Controlled Pilot Trial

Effectiveness of a resilience-focused educational program for promoting resilience in nursing students: A systematic review and meta-analysis

AIM

To evaluate the effectiveness of a resilience-focused educational program to promote resilience among the forming year's BSN students.

BACKGROUND

Resilience is a resource for the well-being and growth of nursing students. Lack of resilience is a high-risk condition for psychosocial health problems that hinder students' academic and professional growth during the BSN program.

DESIGN

A systematic review and meta-analysis are reported using PRISMA guidelines. The review was registered at the PROSPERO with the ID number: CRD42023475098.

METHODS

A primary search was done on the most relevant databases: PubMed, CINAHL, and PsycINFO while a secondary search was done on the Wiley Online Library, HEC Digital Library, and Science Direct for studies in the English language that assessed resilience-building interventions in forming years (1st and 2nd year) undergraduate nursing students till Oct 2023. Both quasi-experimental studies (QESs) and randomized control trial studies (RCTs) were included in this review. The meta-analysis was performed on three QESs and two RCTs that provided information about a pooled estimate of resilience promotion.

RESULTS

Of 596 identified records, six were found eligible comprising four QESs and two RCTs with a total of 472 participants. Studies were found with variability in sample size, intervention strategy, teaching-learning activities, intervention content and duration, measurement scales, and statistical analysis of the main outcome. Meta-analysis of QESs showed no effects between pre-and post-intervention resilience scores, the standardized mean difference (SMD) of 0.04 [95 % CI -0.22, 0.30]. The RCTs immediately after intervention showed a non-significant effect, SMD 0.35 [95 % CI -0.06, 0.75]; however, at follow-up of one month, it showed a statistically significant effect in favor of the experimental group, SMD 0.54 [95 % CI 0.12, 0.95].

CONCLUSION

This review has provided evidence of a delayed effect of educational intervention to improve resilience among nursing students. The resilience-focused educational intervention has the potential to improve the resilience of nursing students. However, because of the time-bound and multi-faceted nature of resilience, a need to develop an inclusive multi-dimensional approach for resilience building is recommended for future studies.

REPORTING METHOD

The manuscript has been written in adherence with PRISMA guidelines for the systematic review and meta-analysis.

Factors That Influence Resilience among First-Year Undergraduate Nursing Students: A Cross-Sectional Descriptive Study

During their transition from basic to higher education, first-year undergraduate nursing students need to balance theoretical and clinical requirements, as well as their social life. A significant number of them struggle with this, due to a lack of coping mechanisms due to poor resilience. This study aimed to determine factors that influence resilience among first-year undergraduate nursing students at a South African university. A cross-sectional descriptive research design was followed, with stratified convenient sampling. Data were collected during August 2023 using an adapted self-administered online questionnaire. The reliability and validity of the adapted version was ensured in the context of this study. Principal component analysis and varimax rotation were used to analyse data. A total of 123 participants (47.2% from campus A and 52.8% from campus B) completed the questionnaire. The majority (88%) were females. This study showed that resilience can be dependent on various factors, such as lecturer support, parental support, academic achievement, peer and mentor support, optimism about the future, and self-determination. It is recommended that higher education institutions should consider incorporating the factors presented in this study as part of the broader orientation of first-year undergraduate nursing students when they first arrive at university.

The impact of the Systematic Assessment for Resilience (SAR) framework on students' resilience, anxiety, depression, burnout, and academic-related stress: a quasi-experimental study

BACKGROUND

Medical students face significant psychological stress, impacting their academic performance and well-being. The Systematic Assessment for Resilience (SAR) framework is designed to enhance resilience and mitigate stress among medical students, addressing the need for interventions within the assessment system in medical education. The aim of this study was to evaluate the implementation of SAR framework on medical students' resilience, anxiety, depression, burnout, and academic stress.

METHODS

This study employed a quasi-experimental design with pre- and post-testing. It involved the training of course coordinators in implementing the SAR framework and its integration into the daily learning activities. Fourth-year medical students were assessed before and after the intervention using standardized measures of resilience, anxiety, depression, burnout, and academic stress. Data were analyzed using quantitative methods and thematic analysis for qualitative feedback.

RESULTS

Post-intervention, students demonstrated a significant increase in resilience scores (p < 0.001) and a notable decrease in measures of anxiety, depression, and academic stress (p < 0.001). The burnout types were also statistically different (p < 0.001) except client-related burnout (p > 0.05). Qualitative feedback of the course coordinators highlighted an improved learning environment, increased coping strategies, and a more supportive academic culture.

CONCLUSION

The SAR framework significantly contributes to enhancing medical students' resilience and reducing psychological distress. Its implementation suggests a promising approach to fostering a supportive educational environment that not only addresses the psychological challenges faced by medical students but also enhances their academic performance and overall well-being. Further research is warranted to explore the long-term impacts of SAR across different medical education contexts.

Umbrella Review: Stress Levels, Sources of Stress, and Coping Mechanisms among Student Nurses

Prelicensure nursing students face significant stress from their education and clinical placements, highlighting the crucial need for the development of effective coping mechanisms with which to manage both academic and clinical responsibilities, ultimately enhancing the wellbeing and academic performance of these students. This umbrella review aims to evaluate and synthesize existing review articles that examine stress levels and coping mechanisms among student nurses during their education and training. Five databases (PsycINFO, PubMed, CINAHL, Scopus and Web of Science) were searched for review articles published from 2010 onwards. This review includes twelve articles, encompassing 189 studies. The review findings demonstrate that student nurses experience moderate-to-high levels of stress during their nurse education. Major sources of stress include academic demands, patient care responsibilities, and interactions with nursing staff and faculty. Commonly utilized coping skills involve problem-solving behaviors, transference, and maintaining an optimistic outlook. Given the adverse consequences of stress, nurse educators play a critical role in the development of strategies with which to reduce stress and enhance coping skills among student nurses. This study was not registered.

Effective Interventions for Nursing Student Burnout: A Scoping Review

BACKGROUND

Burnout in nursing students negatively impacts students' health, decreases academic success, increases attrition, and threatens the quality of patient care.

PURPOSE

To identify empiric research evaluating the effectiveness of interventions to prevent nursing student burnout.

METHODS

This scoping review examined the PubMed, CINAHL, PsycINFO, and Google Scholar databases to identify original studies evaluating burnout interventions in nursing students.

RESULTS

Of the 258 studies identified in the primary search, 208 were screened and 29 were selected for full-text review. Five quantitative reports and 1 qualitative study met the inclusion criteria. Effective interventions included recreational music-making, mindfulness-based and resilience education, integral-caring-holistic-science curriculum, Acceptance and Commitment Training, and progressive muscle relaxation. Statistically significant reductions in burnout were reported in all 5 of the quantitative studies.

CONCLUSION

This review demonstrates a need for further research. Burnout interventions should be embedded in the nursing curriculum to yield a more sustainable profession.

Promoting academic resilience through peer support in a new pre-registration nursing programme

Nursing students can experience increased levels of stress while studying for their registration. It is acknowledged that higher education institutions should incorporate mechanisms to try to reduce these stress levels and build up resilience towards the difficult situations students may encounter during their studies. A bespoke method was created within a new part-time 4-year pre-registration nursing programme to support part-time junior (part 1) nursing students by implementing action learning sets within the programme. These sessions were delivered by part-time senior (part 3) nursing students who had already gone through similar experiences. Both the junior and senior students reported that they had gained benefits from this innovation, increasing their confidence and improving their ability to cope with some of the stressors of the programme. Building the resilience of nursing students within this pilot project was positively evaluated and could be developed further into other nursing programmes. This part-time programme was developed to retain nurses in Wales and was aimed at healthcare support workers with prior experience of providing the fundamentals of nursing care within local health boards.

A scoping review of the literature of interventions for enhancing nurses' resilience in acute care settings

PURPOSE

The aim of this study was to identify and evaluate interventions shown to improve nurse resilience in the acute care settings.

DESIGN/METHODOLOGY/APPROACH

The study was a systematically conducted scoping review of the literature. Databases including MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emerald insight and Google Scholar were searched and this complemented by reviews of the reference lists.

FINDINGS

In total, 13 papers were included in the review but there was limited evidence of the effectiveness of individual programs. The authors found that resilience training programs for individuals reviewed provided some evidence for the effectiveness of the training. However, the context of job design, work risks and leadership require attention.

ORIGINALITY/VALUE

Resilience is an important requirement for nursing staff that helps to mitigate the stress of the working environment, particularly in the acute care setting. However, the managerial strategies required to build resilience are not well known or applied. The findings of this research may help to design cohesive and comprehensive management programs to promote and preserve nursing resilience in acute care settings. Any such program needs to reflect the four key themes that appear to underpin resilience: relationships, motivation, emotions and well-being.

A Profession Disrupted: Looking Back to Go Forward

Nurses face unprecedented harms from the COVID-19 pandemic. A survey by AMN Healthcare found that registered nurses experienced significantly elevated levels of stress, burnout, and other challenges that led nearly 1 million to consider leaving nursing altogether. Despite the challenges, a confluence of positive factors present great confidence that the nursing profession can bounce back and become much stronger due to lessons learned and hardships overcome during the pandemic. There is near-universal awareness that solving the significant challenges to nursing is vitally important, because the health of the American people depends on the health of the nation's nurses.

Fostering Resilience in Nursing Students in the Academic Setting: A Systematic Review

BACKGROUND

Nursing students experience similar stress-related health issues as RNs and have been identified as a group of health professionals who may be unable to cope effectively with stress. Studies have emphasized the need to incorporate resilience programs at higher education institutions for nursing students. However, it is important to identify strategies that increase resilience to ensure future programs are effective and follow an evidence-based approach.

METHOD

This mixed-methods systematic review was conducted using Joanna Briggs Institute (JBI) methodology. A comprehensive literature search was conducted using JBI Critical Appraisal Checklists for assessment and quality appraisal. Data were extracted and synthesized thematically.

RESULTS

Category intervention strategies were identified and used to cluster three intervention strategy themes. Three outcome themes also were synthesized to examine strategy effectiveness.

CONCLUSION

Findings indicate multicomponent interventions that include information sharing, skill application, and reflective learning are effective in helping nursing students manage stress and increase resilience. [J Nurs Educ. 2022;61(5):229-235.].

Self-Care for Advanced Practice Nursing Students in Rural Primary Care

BACKGROUND

Advanced practice RNs (APRNs) working in rural primary care provide a spectrum of health care needs that can lead to professional burnout. As a preventative for burnout, the Institute of Medicine developed a strategy focused on self-care. Understanding the importance of self-care as a preventive for building professional resilience to manage workplace stressors during students' academic years may improve retention.

METHOD

Twenty-two APRN students participated in a rural primary care immersion course with a specific component on self-care. Preand postsurveys, student journaling, class discussions, and a posttraining focus group were used to assess students' progress.

RESULTS

Students reported strengthening patient and team relationships, enhanced interpersonal communication, and increased self-awareness of stressors for managing their emotions. These self-imposed processes improved student confidence, job satisfaction, and workplace resilience.

CONCLUSION

Heath-promoting behaviors via self-care during APRN students' formal education may assist them in their clinical practice as rural primary care providers. [J Nurs Educ. 2022;61(4):187-191.].

A multi-level examination of nursing students' resilience in the face of the COVID-19 outbreak: A cross-sectional design

AIMS

To examine nursing students' stress and coping with the coronavirus disease 2019 (COVID-19) pandemic through an ecological model of resilience. Specifically, to examine the relative contribution of different resilience levels in decreasing nursing students' strain symptoms: at the individual level, resilience trait; at the relational level, students' coping strategies; at the university level, nursing students' perceptions on their university's readiness to handle the virus outbreak; and at the national level, nursing students' trust in policymakers' decisions.

DESIGN

The study used a cross-sectional design.

METHODS

Undergraduate students of five universities were recruited via an electronic link sent to their emails during the first months of the COVID-19 outbreak: May-July 2020. Of them, 492 participants completed the research questionnaire.

RESULTS

Hierarchical Regression Analysis revealed that nursing students' resilience, as a multi-level factor, decreased the students' level of strain symptoms above and beyond their stress levels and control variables. Specifically, the nursing students' trait resilience, perceptions of their university's positive response to the pandemic and trust in their national policymakers were negatively associated with their strain symptoms. Conversely, disengagement-in-emotion coping strategies was positively associated with the students' strain symptoms.

CONCLUSIONS

Nursing students' resilience should be seen as a flexible resource that can be developed and influenced by their academic and clinical training, and by the intentions and actions of their university and the nursing administration at the Ministry of Health (MOH).

IMPACT

The findings call for the nursing administration at the MOH and for the university deans and department heads to prepare in advance a crisis plan that could be rapidly and effectively implemented when needed. Furthermore, topics such as developing flexible coping strategies should be integrated into the nursing curricula. These would allow students to prepare and cope better with adversity in their routine and in times of crisis.

Application of Evidence-Based Nursing Intervention in the Treatment of Advanced Squamous Cell Carcinoma of the Lung by Erlotinib Combined with Tegafur, Gimeracil, and Oteracil Potassium and Its Influence on Quality of Life

Objective

To explore the application of evidence-based nursing intervention in the treatment of advanced squamous cell carcinoma of the lung by erlotinib combined with tegafur, gimeracil, and oteracil potassium (TS-1) and its influence on quality of life (QOL).

Methods

Clinical data of 92 patients with advanced squamous cell carcinoma of the lung treated with erlotinib and TS-1 in our hospital (January 2017-January 2021) were retrospectively analyzed. Forty-six patients receiving conventional nursing were set as the control group (CG), and other 46 patients receiving evidence-based nursing intervention additionally were set as the study group (SG). The clinical observation indexes of the two groups were compared and analyzed.

Results

No obvious difference in general data between both groups (P > 0.05). According to EORTC QLQ-C30, compared with the CG, the scores of role function, physical function, social function, cognitive function, and emotional function in the SG were remarkably higher (P < 0.05). After intervention, scores of VAS of patients were obviously lower than those before intervention (P < 0.05), and scores of VAS in the SG after intervention were obviously lower than those in the CG (P < 0.05). After intervention, scores of SAS and SDS were lower than those before intervention, and those of the SG were obviously lower than those of the SG (P < 0.05). Compared with the CG, incidences of adverse reactions such as diarrhoea, nausea and vomiting, erythra, pressure sores, and leukopenia in the SG were obviously lower (P < 0.05). Compared with the CG, "very satisfied" and total satisfaction in the SG were obviously higher (P < 0.05).

Conclusion

Application of evidence-based nursing intervention in the treatment of advanced squamous cell carcinoma of the lung by erlotinib combined with TS-1 can help patients to relieve pain, improve their psychological state, reduce the incidence of adverse reactions, significantly improve the QOL, and also enhance the satisfaction of clinical nursing.

The predictive role of nursing students' individual characteristics and psychological resilience in psychological distress

PURPOSE

This study aims to determine the predictive role of nursing students' individual characteristics and psychological resilience in psychological distress.

DESIGN AND METHODS

This study is a descriptive cross-sectional study. The study sample included 652 nursing students. Binary logistic regression analysis was used for analysis.

FINDINGS

It has been determined that 65.3% of nursing students have psychological distress. Having a chronic disease, being a woman, poor academic success, choosing the profession so as not to be unemployed, being single and low psychological resilience are factors that affect psychological distress.

PRACTICE IMPLICATIONS

It is recommended to screen nursing students for psychological distress to increase interventions that improve the psychological resilience of risky students.

Impacts of Coping Mechanisms on Nursing Students' Mental Health during COVID-19 Lockdown: A Cross-Sectional Survey

The COVID-19 pandemic and consequent lockdown have precipitated significant disruption in the educational system. Nursing students are known to have higher levels of stress and anxiety than other non-nursing students, but there is a dearth of evidence regarding the impacts of the COVID-19 lockdown on their mental health and coping mechanisms.

PURPOSE

The aim of this study was to explore the influence of coping mechanisms as predictors of stress, anxiety, and depression among nursing students during the COVID-19 lockdown.

METHODS

A cross-sectional online survey was conducted from 20 April to 10 May 2020 among 173 nursing students at a private university in Southern California, USA.

RESULTS

Self-reported stress, anxiety, and depression were significantly higher during the lockdown compared to the pre-lockdown period (p < 0.001). Almost a quarter of participants reported high stress, while more than half reported moderate-to-severe symptoms of anxiety and depression. High resilience was negatively associated with high stress (Odds Ratio (OR) = 0.46; 95% Confidence Interval (CI) = 0.22-0.98; p = 0.045), moderate-to-severe anxiety (OR = 0.47; 95%CI = 0.25-0.90; p = 0.022), and moderate-to-severe depression (OR = 0.50; 95%CI = 0.26-0.95; p = 0.036). Similarly, high family functioning was negatively associated with high stress (OR = 0.41; 95%CI = 0.20-0.86; p = 0.018), moderate-to-severe anxiety (OR = 0.41; 95%CI = 0.21-0.80; p = 0.009), and moderate-to-severe depression (OR = 0.41; 95%CI = 0.20-0.81; p = 0.011). High spiritual support was negatively associated with moderate-to-severe depression (OR = 0.48; 95%CI = 0.24-0.95; p = 0.035).

CONCLUSIONS

During the COVID-19 lockdown, nursing students experienced remarkable levels of poor mental health. High levels of resilience and family functioning were associated with 2- to 2.4-fold lower risk of stress, anxiety, and depression, whereas high spiritual support was associated with 2-fold lower risk of depression. As the pandemic evolves, fostering these coping mechanisms may help students to maintain their psychological wellbeing.