Resilience, stress and burnout in student midwives

Traumatic experiences, quality of life, and organizational commitment among midwives: A cross-sectional study

BACKGROUND

The work of midwives is emotionally challenging. Midwives share moments of joy, when a baby is born, and attend complex events of loss and trauma. Exposure to childbirth complications, emergencies, and loss can affect their professional quality of life and functioning. This aspect of midwives' practice has not been sufficiently researched.

AIM

To examine the associations between exposures to traumatic events, post-traumatic symptoms, and personal resilience with professional quality of life and organizational commitment among hospital midwives.

METHODS

Participants in this cross-sectional study conducted in 2020 included 131 midwives from three large hospitals in central Israel. Data were collected using a structured self-administered questionnaire that examined socio-demographic characteristics, exposure to traumatic events during childbirth, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment.

RESULTS

The three most traumatic events for midwives were: neonatal death or feared death, maternal death or feared death, and stillbirth. The more frequent the exposure to traumatic events, the more numerous and intense the post-traumatic symptoms. The more numerous and intense the post-traumatic symptoms, the higher the level of professional burnout and compassion fatigue and the lower the compassion satisfaction. Higher compassion satisfaction and lower professional burnout were associated with higher organizational commitment. Personal resilience, country of birth, post-traumatic symptoms, and organizational commitment predicted compassion satisfaction.

CONCLUSIONS

Midwives' exposure to traumatic events is associated with the onset of post-traumatic symptoms, impaired professional quality of life, and reduced organizational commitment, and is accompanied by burnout and compassion fatigue. There is a need to address this issue in training programs and to develop organizational support and policies to improve midwives' well-being and quality of care.

Exploring the determinants of student midwives' wellbeing during their studies: A qualitative study

PROBLEM

Student wellbeing is a global concern in the aftermath of the COVID pandemic. Students in healthcare often are exposed to academic, clinical, and psychosocial factors of stress, in particularly student midwives, as they are exposed to other people's intimate life experiences. The aim of this study was to identify factors which help and hinder student midwives in their studies.

BACKGROUND

Midwifery students in the Netherlands must complete 35-50 % of their bachelor's degree with placements in community and hospital-based maternity care.

METHODS

An exploratory qualitative study was conducted, using the Job-Demands-Resources model. Data were collected through semi-structured individual and group interviews with Bachelor student midwives from the Netherlands.

FINDINGS

During coursework students found the high workload and lack of recovery time demanding. During placements, their sense of being constantly assessed, having to be available on call and being away from home were experienced as demands. The relationships with teachers as supportive. Support from their placement supervisors and peers were also resourceful if available and positive. In other cases, peer pressure and grand expectations from supervisors were demanding. Personal demands were setting ambitious standards and feeling alone during their placements, and personal resources were positive attitude towards to becoming a midwife.

DISCUSSION

The academic programme for student midwives seemed highly demanding, with a stark difference between the learning environment in the faculty coursework and in the placements. Positive support from placement supervisors in a culture that values learning and development, can contribute to student midwives' socialization into midwifery.

Stress perception, coping behaviors and work-privacy conflict of student midwives in times of COVID-19 pandemic: the "Healthy MidStudents" study in Germany

BACKGROUND

Student midwives deliver care for women under challenging job demands, which may affect their mental health- thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany.

METHODS

Data were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions.

RESULTS

Results revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = - 0.25, p =.001, social support: ß = - 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students).

CONCLUSIONS

Key findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives' stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions.

Understanding the Role of Empathy and Gender on EMS Clinician Occupational Stress and Mental Health Outcomes

BACKGROUND

Emergency Medical Service (EMS) clinicians experience high levels of occupational stress due to long hours, short staffing, and patient deaths, among other factors. While gender has been partially examined, little is known regarding the role of empathy on occupational stress and mental health (MH) outcomes among EMS clinicians. Therefore, the current study examines the moderating role of empathy and, separately, gender on associations between occupational stress and mental health.

METHODS

A cross-sectional examination of EMS clinician occupational and personal wellbeing was conducted via an anonymous, electronic survey. Information on clinician demographics, and validated measures of occupational stress, burnout, and MH outcomes were collected. Empathy was assessed using the Toronto Empathy Scale (TEQ). Descriptive/bivariate statistics were conducted for variables of interest. Separate multivariable regression models evaluated associations between occupational stress and mental health outcomes. Empathy and gender were examined as potential moderators using interactions.

RESULTS

A total of 568 EMS clinicians completed the survey. High levels of mental health difficulties were reported (34.0% anxiety, 29.2% depression, 48.6% burnout). Increased occupational stress was associated with increased anxiety (OR =1.08, 95% CI 1.05-1.10), depression (OR = 1.09, 95% CI 1.06-1.10), and burnout (OR = 1.10, 95% CI 1.07-1.12). No moderation analyses were significant. Greater resilience was associated with lower depression, anxiety, and burnout.

CONCLUSION

EMS clinicians, much like other first responders, experience considerable occupational stress, of which is associated with mental health difficulties and burnout. Findings underscore the need for intervention programs aimed at reducing the impact of occupational stress and the promotion of resilience. Continuing to understand the full scope of EMS mental health, including the role of resilience, is imperative, particularly in light of future public emergencies.

The process and indicators of resilience among nursing students in clinical practicum in Taiwan: A qualitative study

Background

Resilience is essential for managing stress and maintaining equilibrium. During the clinical practicum, nursing students may experience tremendous physical and mental stress, and these negative experiences are considered a source of resilience for students. However, no universal definition of resilience among nursing students exists in the literature, occasioning the need to define the processes and indicators of resilience.

Purpose

This study aims to explore the resilience process and indicators among nursing students in clinical practicum in Taiwan. Participants: Fifteen fifth-year junior college nursing students in Northeastern Taiwan who had completed the clinical practicum were interviewed, including 12 females and three males. All participants were aged 20.3 ± 0.61 years and all participants had clinical practicum experiences over four months.

Methods

A qualitative descriptive study, using purposive and snowball sampling methods, was conducted to collect the experience of the nursing students in their internship. Data were collected using a semi-structured guide and deep interviews, and analyzed through the content analysis method by Waltz, Strickland, & Lenz (2010).

Results

Based on the participants' practical experiences during their clinical practicum, three main themes and nine indicators were identified. The resilience of nursing students is considered a process. The main themes are (1) uncontrolled clinical practical stress, (2) Maintain learning-life balance, (3) Positive attitude toward nursing.

Conclusions

Resilience is a critical factor to stabilize nursing students and enable them to recover from adversity. Both positive and negative experiences significantly impacted the students' attitudes and confidence levels during the clinical practicum. The findings will provide faculty to adapt their teaching method to various situations of nursing students.

Exploring the Relationship Between Stress and Satisfaction During Clinical Training Among Respiratory Therapy Students: A Nationwide Cross-Sectional Survey

Background

Although clinical training is an important component of healthcare education, it is nevertheless a significant source of stress for students. There is limited information on stress and satisfaction perceived by clinical-level undergraduate students studying respiratory therapy (RT) in Saudi Arabia.

Methods

A descriptive, cross-sectional study design with an online questionnaire was employed to conduct this study. Data collection occurred during the academic year 2022-2023 among RT students throughout Saudi Arabia. Patricians responded to demographic questions, the Students Stress Scale and Students Professional Satisfaction questionnaires. Descriptive, inferential, and correlational statistics were used to analyze the collected responses.

Results

A total of 1001 undergraduate RT students completed the online survey. RT students and interns had an overall moderate to high stress level (mean (SD); 3.55 (0.49)), while satisfaction was perceived as mild to moderate (mean (SD): 2.56 (0.65)). In addition, 38% of the study participants have considered quitting the RT program. Female students showed higher stress levels in the following domains: inadequate knowledge and training, adverse and embarrassing experiences, clinical supervision, patients' pain, and Education-reality conflict (p<0.005) compared to male students. Additionally, students who considered quitting the RT program revealed higher stress levels in all domains (p<0.005). There were negative correlations between satisfaction and stress domains: inadequate knowledge and training (r = -0.32; p = 0.001), adverse and embarrassing experience (r = -0.31; p = 0.025), close supervision (r = -0.24; p = 0.001), insufficient hospital resources (r = -0.30; p 0.002), patients' pain and suffering (r = 0.28; p = 0.04), and education - reality conflict (r = -0.30; p = 0.001).

Conclusion

During clinical training, respiratory therapy students experience moderate to high-stress levels and low satisfaction. There need to be tailored interventions to reduce stress and intention to quit and increase students' clinical experience satisfaction.

The role of social support and social identification on challenge and threat cognitive appraisals, perceived stress, and life satisfaction in workplace employees

There is an emergent literature highlighting the positive role of social support and social identification in buffering against the deleterious effects of psychological stressors. Yet, we have limited understanding of how exactly these social factors fit within contemporary stress and coping theory. To advance and gain a greater understanding of these social factors, we explore the associations of social support and social identification on individuals' challenge and threat cognitive appraisals and how this then relates to perceived stress, life satisfaction, turnover intentions, and job performance. A total of 412 workplace employees from private and public sector occupations completed state measures around a recent most stressful experience at work. Results revealed atemporal associations between cognitive resource appraisals with both social support and social identification. Specifically, greater identification with colleagues and lower threat were related to less perceived stress, while having greater social identification (with colleagues and organisation), social support, and lower threat, were related to greater life satisfaction. Greater perceived stress, and lower social identification and life satisfaction, were also related to greater turnover intentions. While greater identification with the organisation and life satisfaction, along with lower perceived stress were related to greater job performance. Taken together, this research provides evidence that social support and social identification play a positive role when trying to promote more adaptive responses to stressful situations.

Emotional wellbeing of student midwives during COVID-19

BACKGROUND

Mental health of students in higher education was affected during the COVID-19 pandemic.

AIM

To examine the emotional wellbeing of midwifery students in the Netherlands and Flanders (Belgium) during COVID-19.

METHODS

A cross-sectional online-based survey with 619 Dutch and Flemish midwifery students. Sociodemographic details were obtained. Anxiety and depression were measured twice (T1, T2) during the COVID-19 pandemic.

FINDINGS

Flemish students had significantly higher mean depression and anxiety scores than Dutch students during the total period of study (p < .001; p < .001). Total group mean depression and anxiety scores were significantly higher at T2 compared to T1 (p < .001; p < .001). In the Dutch student group, there was a significant increase of depression from T1 to T2 (p < .001). In the Flemish student group, both depression and anxiety scores significantly increased from T1 to T2 (p < .001; p < .001). A history of psychological problems predicted both depression and anxiety, irrespective of COVID-19 period or country (p < .001; p < .001). Being single (p.015) and having a job (p.046) predicted depression, irrespective of period or country. A history of psychological problems predicted depression (p.004; p < .001) and anxiety (p.003; p.001) during the total period of study. Being single also predicted depression during T2 (p.024).

CONCLUSION

These findings inform how emotional wellbeing of midwifery students was affected during the COVID-19 pandemic and identify those students that might need extra attention after the pandemic, during another pandemic or similar situations with social restrictions.

Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis

BACKGROUND

Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students.

OBJECTIVE

This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience.

METHODS

We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis.

RESULTS

A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD -0.41, 95% CI -0.59 to -0.23; P<.001) and alleviating anxiety (SMD -0.29, 95% CI -0.50 to -0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD -0.14, 95% CI -0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD -0.33, 95% CI -0.53 to -0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI -0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The "without company support" group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the "with company support" group (SMD 1.17, 95% CI -0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD -0.06, 95% CI -0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low.

CONCLUSIONS

MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585.

Exploring the Relationship Between Burnout, Resilience, and Dropout Intention Among Nursing Students During Clinical Training in Saudi Arabia

Background

The issue of burnout syndrome among health discipline students is gaining heightened attention due to its serious effects, which causes them to have the intention to quit. Despite this, limited studies are available on the extent of burnout and its association with resilience and intention to drop out among clinical-level nursing students.

Objective

To explore the relationship between burnout, resilience, and intention to quit among nursing students.

Methods

An online questionnaire was used to conduct a cross-sectional study, targeting nursing students at the clinical level through a nonprobability sample. The participants were required to provide their sociodemographic, Maslach Burnout Inventory, and Connor-Davidson Resilience Scale. Data was analyzed using descriptive, inferential, and correlation tests.

Results

The study included a group of 564 nursing students and interns, the majority of whom were female at a percentage of 78.9%. Among this group, 65% experienced a high level of burnout, with 42% experiencing emotional exhaustion, 54% experiencing depersonalization (DP), and 77% reporting low personal achievement. A total of 48% of clinical-level students were considering quitting the nursing program. Moreover, the students reported low scores of resilience, with negative correlations observed with DP (r = -.12, p = .04) and positive correlation with low personal achievement (r = .43, p < .001).

Conclusion

Nursing students and interns faced a significant amount of burnout and showed a desire to drop out nursing program. Their level of resilience was moderately low, and it correlated with burnout subscales DP and personal accomplishment. A collaborative intervention is needed to promote resiliency and alleviate burnout symptoms during clinical training.

Stress and Resilience of Nursing Students in Clinical Training During the COVID-19 Pandemic: Palestinian Perspective

Introduction

Stress reduces nursing students' capacity to think critically, impedes decision-making, and eventually lowers academic performance and limits success. The circumstances surrounding the COVID-19 outbreak drove students into new virtual learning settings, adding stress to their academic responsibilities.

Objectives

The purpose of this study was to assess the perceived stress and resilience among nursing students in clinical training during the COVID-19 pandemic.

Method

A cross-sectional study was conducted on 315 students studying nursing. Data collection utilized the Perceived Stress Scale and the Connor-Davidson Resilience Scale.

Results

The analysis revealed that the stress score mean was 75.2 ± 6.6 and the resilience score mean was 26.0 ± 3.4. Also, there was a weak negative association between nursing students' stress and their resilience (p < 0.05). Additionally, the results indicated statistically significant differences between stress and gender, study year level, and age (p < 0.05).

Conclusion

Stress was high and resilience was moderate during the COVID-19 pandemic among nursing students.

An integrative review of resilience among nursing students in the context of nursing education

AIM

This integrative review aimed to examine empirical research on resilience among nursing students in the context of nursing education. Resilience helps nursing students handle challenges, such as changing learning styles and experiencing their first clinical practice.

DESIGN

An integrative review.

METHODS

The search terms focused on resilience and health in nursing students and nursing education. The database used in this review were CINAHL Plus, PubMed and MEDLINE. The Mixed Methods Appraisal Tool appraised the studies' quality.

RESULTS

This study explored 52 records and revealed three current research focuses related to nursing students' resilience: (1) the concept and description of resilience, (2) the characteristics affecting resilience and (3) the mediating role of resilience in maintaining holistic health. Recommendations include adding a resilience topic to the nursing curriculum, providing resilience enhancement programs, examining the relationship between resilience and holistic health and exploring the influence of resilience about global health crises.

PUBLIC CONTRIBUTION

Resilience among nursing students plays a vital role in helping them to overcome adversities during their nursing education. Additionally, after graduation, nursing students can continue contributing to society as resilient Registered Nurses in the future.

Analysis of Nurses' Attitudes toward Patient Death

(1) The aim of the study was to analyze nurses' attitudes toward a patient's death, taking into account the emotions they experience and the general perception of death. (2) The study involved 516 nurses from the West Pomeranian Voivodeship in Poland. The research was carried out using the diagnostic survey method using The Death Attitudes Profile Revisited (DAP-R-PL), the Scale of Fear and Fascination with Death, and a demographic questionnaire. (3) Research has shown that nurses accept the phenomenon of death as a natural process of human life; however, they adopt the attitude of fear of death. Most of the respondents experienced: sadness (73.4%), helplessness (58.5%), and regret (43.6%) due to the patient's death. (4) Both age, sex, marital status, and place of residence significantly influenced the attitudes of nurses toward the patient's death. Therefore, it is important to provide psychological support or special education in the case of dealing with the fear of death.

A scoping review and evaluation of instruments used to measure resilience among post-secondary students

As mental health problems continue to increase among post-secondary populations, the need to develop effective initiatives designed to bolster students' resilience has increasingly been identified as a priority. Therefore, access to valid tools with which to measure the efficacy of these interventions is imperative. To date, a comprehensive assessment of existing instruments used to evaluate the construct of resilience among post-secondary student populations has not been conducted. The purpose of this study was to fill this gap by conducting a scoping review of literature detailing the use of resilience instruments and evaluating their quality based on suitability for use in the post-secondary setting and associated psychometric evidence. We identified a total of 78 records published between 2010 and 2022, extracting a total of 12 instruments. Using detailed criteria frameworks, each instrument was assessed in terms of suitability and quality of associated psychometric evidence for validity and reliability. The results of our study suggest that many of the instruments currently being used to assess resilience among post-secondary students may not be appropriate. The majority of the instruments included in our review were developed for use among general adult populations and not specifically designed for use in the post-secondary setting. Most instruments did not assess resilience in a comprehensive, holistic matter that addressed the ability to bounce back from adversity by drawing upon psychological, social, cultural, and environmental resources, as defined by recent research. Further, no instruments included in our review had published evidence in support of a complete psychometric analysis. The results of our evaluation suggest that the Connor-Davidson Resilience Scale (CD-RISC) is the most suitable instrument for measuring resilience among post-secondary populations due to its suitability, comprehensive assessment of the construct of resilience, and demonstrably strong psychometric properties for both the 25- and 10-item versions of the tool.

Mental health conditions and academic burnout among medical and non-medical undergraduates during the mitigation of COVID-19 pandemic in China

The outbreak of the novel coronavirus disease 2019 (COVID-19) has posed a great impact on people's mental health, especially for undergraduate students. This study aimed to compare the mental health conditions and academic burnout between medical and non-medical undergraduates in China when the COVID-19 pandemic is mitigating. A cross-sectional online survey was conducted among 4,972 undergraduates between October 2020 and April 2021, when the pandemic was basically under control. The survey included basic demographics information and standardized scales to evaluate depression, anxiety, perceived stress, daytime sleepiness, alcohol abuse/dependence, quality of life, fatigue, and academic burnout. Compared with medical undergraduates, non-medical undergraduates had higher rates of moderate to severe depression symptoms (29.1% vs. 17.9%, P < 0.001), moderate to severe anxiety symptoms (19.7% vs. 8.9%, P < 0.001), alcohol abuse/dependence (16.3% vs.10.3%, P < 0.001), excessive daytime sleepiness (47.4% vs. 43.4%, P = 0.018), high perceived stress (34.7% vs. 22.2%, P < 0.001), high level of fatigue (51.8% vs. 42.2%, P < 0.001), low QOL (35.8% vs. 21.4%, P < 0.001), and higher academic burnout score (59.4 vs. 57.5, P < 0.001). Being non-medical undergraduates, depression, alcohol abuse/dependence, excessive daytime sleepiness, and high perceived stress were positively associated with academic burnout, while high QOL was negatively associated with the burnout (all P < 0.001). Excessive daytime sleepiness was the strongest predictor for academic burnout.

Midwifery students' experiences of objective structured clinical examinations: A qualitative evidence synthesis

OBJECTIVES

To identify and synthesise the evidence of midwifery students' views and experiences of Objective Structured Clinical Examinations (OSCEs).

DESIGN

A qualitative evidence synthesis was undertaken using Thomas and Harden's synthesis methods and reported according to the ENTEREQ guidelines.

DATA SOURCES

PubMED, CINAHL Plus, Embase, ERIC, PsycINFO, Social Science Citation Index (via Web of Science) and Scopus were searched from inception to 19th February 2020 and an updated search was performed on 12th May 2021 to identify qualitative and mixed method studies, reporting qualitative data of undergraduate midwifery students' views and experiences of OSCEs.

REVIEW METHODS

Studies were independently screened by title and abstract according to a predetermined inclusion and exclusion criteria. Full text review was then conducted independently by two authors. Studies providing qualitative data on undergraduate midwifery students' views and experiences of OSCEs during their midwifery registration education programmes were included. Quality appraisal was performed using the Critical Appraisal Skills Programme (CASP) tool. Data synthesis was performed using Thomas and Harden's thematic synthesis method.

RESULTS

Eleven studies were identified and included. Thematic synthesis identified 13 descriptive themes which translated into four analytical themes that represented midwifery students' views and experiences of OSCEs: the preparation phase, the assessment phase, the feedback phase and the translation phase.

CONCLUSIONS

This synthesis offers insight into undergraduate midwifery students' views and experiences of OSCEs and how they are experienced across four phases. This is determined to be a useful structure to guide midwifery educators and researchers in their consideration of the student experience of OSCEs in the future. Midwifery students in this synthesis reported high levels of nervousness, anxiety, and stress during the OSCE process. The findings reveal that there are a number of controllable factors impacting on midwifery students' feelings of safety in the assessment environment, and that these should be addressed to maximise the advantages that the OSCE has to offer in terms of learning and preparation for clinical practice.

Effects of mobile-based mindfulness meditation for mental health of nurses: a protocol for systematic review and meta-analysis

INTRODUCTION

Existing studies have shown that mobile-based mindfulness meditation (MMM) can have a certain impact on nurses' mental health problems, but its specific effect and the effect on specific mental health problems such as stress, anxiety, depression, mindfulness, well-being and resilience are not clear.

METHODS AND ANALYSIS

This study protocol follows the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines. Electronic search through PubMed, Web of Science, EBSCO, Cochrane Library, CINAHL, PsycINFO, ERIC, Embase and three Chinese databases namely CNKI, Wan Fang and Chinese Biology Medicine disc. The inclusion criteria follow the PICO principle, which is defined translate the question into a searchable and answerable question . P (patient/population): clinical characteristics of patients; I (intervention or exposure): treatment measures or exposure factors of concern; C (comparison): control measure.; O (outcome): outcome indicator of concern. Registered nurses, preregistered nurses, midwives and nursing students will all be included, studies using MMM as intervention to improve mental health of nurses, compared with waitlist controls or traditional methods groups, outcomes assessment of stress, anxiety, depression, mindfulness, well-being and resilience will meet the inclusion criteria. Studies designed randomised controlled trails (RCTs) of quasiexperimental and written in English or Chinese will be eligible. Search time was from inception of each database to July 2022. Two reviewers screen and assess studies for inclusion and extract data independently; any dispute will be settled through discussion. If the discussion still fails, the third author will make a decision. For RCT, risk of bias will be assessed using Cochrane risk-of-bias tool for randomised trials (RoB 2), and for non-RCT studies, risk of bias in non-randomised studies of interventions (ROBINS-I) tool will be performed. Meta-analysis will be performed using RevMan software if sufficient number of comparable studies are retrieved.

ETHICS AND DISSEMINATION

This is a study protocol of meta-analysis; no primary data will be collected, and no ethics assessment is required. The study results will be presented in a peer-reviewed scientific publication.

PROSPERO REGISTRATION NUMBER

CRD42021277932.

Associations between academic burnout, resilience and life satisfaction among medical students: a three-wave longitudinal study

BACKGROUND

Research shows that there are connections among academic burnout, resilience, and life satisfaction in medical students. However, no study has yet examined the temporal relationships between academic burnout, resilience, and life satisfaction among medical students. This longitudinal study aimed to examine the temporal associations between academic burnout, resilience, and life satisfaction and to explore the possible mediating role of resilience in the relationship between academic burnout and life satisfaction among medical students.

METHODS

This is a three-wave longitudinal study covering the preclinical education period of 20 months. From October 2018 to June 2020, a total of 190 students majoring in clinical medicine filled out the Chinese College Student Academic Burnout Inventory (CCSABI), the Connor-Davidson Resilience Scale (CD-RISC) and the Satisfaction With Life Scale (SWLS) three times. Cross-lagged models were constructed to examine the temporal relationships between academic burnout, resilience, and life satisfaction and longitudinal mediation models were constructed to explore the possible mediating role of resilience in the association of academic burnout with life satisfaction.

RESULTS

Among medical students, resilience uni-directionally and positively predicted life satisfaction, while academic burnout uni-directionally and negatively predicted life satisfaction. However, the temporal association between resilience and academic burnout was negative and somewhat bidirectional. Resilience had a significant mediating effect on the relationship between academic burnout and life satisfaction in medical students.

CONCLUSIONS

Medical educators need to identify and take effective measures to combat academic burnout problems which can lead to reduced life satisfaction among medical students. Resilience-based interventions may be promising in buffering the negative impacts of academic burnout and improving life satisfaction. It is recommended that effective resilience-promotion interventions be developed and implemented in medical education to help enhance medical students' psychological well-being.

Humanistic caring ability of midwifery students in China and its associated factors: A multi-centre cross-sectional study

BACKGROUND

Research regarding humanistic caring has proliferated to enable person-centred and holistic care. Empirical evidence investigating the humanistic caring ability is largely derived from studies recruiting general nursing students. Midwifery students, however, remain underrepresented.

OBJECTIVES

To assess the humanistic caring ability of midwifery students in China and investigate its associated factors.

DESIGN

A multi-centre cross-sectional descriptive study.

SETTINGS

Five medical colleges spreading across Eastern, Central and Southern China.

PARTICIPANTS

Secondary vocational, higher vocational and undergraduate midwifery students (N = 303).

METHODS

The Caring Ability Inventory (CAI), the Jefferson Scale of Physician Empathy for Nursing Students (JSPE-NS), the Connor-Davidson Resilience Scale (CD-RISC) and the Professional Identity Scale for Nursing Students (PISNS) were used to measure humanistic caring ability, empathy, resilience and professional identity, respectively. Stepwise multiple linear regression was used to explore associated factors.

RESULTS

The midwifery students' total mean CAI score was 184.63 ± 19.88. In the multiple linear regression analysis, empathy (β = 0.394, p < 0.001), resilience (β = 0.233, p < 0.001) and professional identity (β = 0.161, p = 0.002) were positively associated with the humanistic caring ability of midwifery students. The humanistic caring ability was also influenced by educationl level, perceived concern from peers and recognition of caring ability as a prerequisite for midwifery profession.

CONCLUSIONS

Midwifery students in China have poor humanistic caring ability, which needs to be further improved. Interventions that cultivate the empathy, resilience and professional identity have the potential to advance the humanistic caring ability of midwifery students. Promoting a supportive and caring atmosphere among peers is also important.

Relação entre Perfil, Hábitos, Vivências Acadêmicas e Resiliência de Universitários

Resumo A falta de recursos para lidar com situações desafiadoras pode dificultar o ajuste do estudante à universidade e aumentar o risco de fracasso acadêmico. Pensando nisso, o objetivo deste estudo foi verificar se há relação entre o perfil, os hábitos de vida, as vivências acadêmicas e a resiliência de graduandos das áreas da saúde e Psicologia. Trata-se de um estudo transversal e inferencial. Participaram 361 graduandos dos cursos de Biomedicina, Educação Física, Enfermagem, Farmácia, Fisioterapia, Medicina, Nutrição, Terapia Ocupacional e Psicologia, matriculados em três instituições federais de Ensino Superior do interior de Minas Gerais. Utilizou-se um questionário sociodemográfico e de hábitos de vida, a Escala de Resiliência e o Questionário de Vivências Acadêmicas - versão reduzida -, respondidos de forma on-line pelos universitários, bem como análises descritivas e correlacionais. Os resultados mostraram resiliência média para a maioria dos universitários e boa adaptação ao contexto universitário, além de relações entre a resiliência e o período cursado, estar em psicoterapia, avaliar positivamente a própria saúde e todas as dimensões das vivências acadêmicas. Conclui-se que a resiliência é uma capacidade importante para enfrentar as demandas da graduação e que é possível desenvolvê-la, especialmente durante o começo da graduação e com a adoção de intervenções focadas no autoconhecimento, na autoeficácia e em boas estratégias de enfrentamento. Desenvolver a resiliência nos estudantes pode colaborar para a promoção da saúde desta população e a redução da evasão no Ensino Superior.

The psychological effects of working in the NHS during a pandemic on final-year students: part 1

Resilience in nursing and midwifery involves being able to manage ethically adverse situations without suffering moral distress and is key to mental wellbeing, staff retention and patient safety. The aim of this research was to ask what the psychological effects were for nursing and midwifery students who had been deployed to work in the NHS during the COVID-19 pandemic. This study looked at the incidence of burnout in a small cohort of nursing and midwifery students who were employed as band 4 aspirant nurses and midwives in acute NHS trusts in the south of England. The findings suggested that student midwives reported higher levels of emotional exhaustion and depersonalisation than student nurses but overall, both cohorts of students reported moderate levels of burnout. Part 2 will present the lived experience of deployment as described by students.

The lived experience of being an undergraduate midwifery student in the neonatal unit

OBJECTIVE

The objective of this study is to examine the experience of undergraduate student midwives in the neonatal unit.

BACKGROUND

Clinical experience is an essential component of education for the development of competent midwives. Literature has highlighted the pivotal effects of precepting and how it contributes to student experience. Although there is a plethora of research examining undergraduate student midwives' experience, to our knowledge this is the first study exploring their experience in the neonatal unit.

DESIGN

Based in phenomenology, eight semi-structured interviews were conducted producing rich data.

METHODS

Following informed consent and ethical approval, post transcription, the data were coded using Colaizzi's (1978) framework.

RESULTS

Significant themes and sub-themes emerged such as course design, environmental experience, sources of stress and preceptor experience. The student experience very much depends on the preceptor, how busy the environment is and if appropriately staffed.

CONCLUSIONS

Based on these findings there are suggested recommendations including adjusting the timing and length of the placement and how to improve the environment based on the preceptor-student relationship. Also, suggestions on how consistency and communication can be improved are proposed.

Systematic review of noncognitive factors influence on health professions students' academic performance

Increased importance has been placed on noncognitive skills in professional development and by accrediting bodies of health professions programs in recent years. Therefore, the purpose of this study was to conduct a comprehensive systematic review of evidence examining effects of academic resilience, grit, perceived stress, locus of control, and Big Five Personality Traits on academic performance of health professions students. A literature search of peer-reviewed, English-language articles describing select noncognitive factors was performed using seven databases. Searches were performed from the earliest index date through May 2020. The following data from included studies were extracted and summarized: research design hierarchy, hierarchy of study outcomes (modified from Kirkpatrick), association between noncognitive factors and academic outcomes, and quality assessment criteria. 149 articles met inclusion criteria. Almost 80% of studies were Level III (observational). Medical students were the most frequently studied population (n = 73 articles). The most studied academic outcome was grade point average (n = 61). Perceived stress and Big Five Personality Traits accounted for greater than 50% of studies. Most studies were rated as fair to good quality. Associations between noncognitive factors and academic outcomes were largely inconsistent, although greater perceived stress was generally associated with poorer academic performance outcomes, while higher conscientiousness, academic resilience, and grit were generally associated with better outcomes. This systematic review represents a large body of evidence concerning select noncognitive factors and their association with academic performance of health professions students. Support services addressing noncognitive factors should be deliberated and tailored for specific health professions education programs and student populations.

Fear of death and its relationship to resilience in nursing students: A longitudinal study

AIM

Taking a corpus of nursing students enrolled in the 2017-2021 nursing degree, we aim to analyse how students' levels of resilience and fear of death evolve in the first three years of the degree and whether there are differences between students based on age and gender. In addition, we aim to describe the relationship between resilience and fear of death.

BACKGROUND

Throughout their training, nursing students will encounter situations of grief and death that may generate reactions of rejection, anxiety and emotional imbalance. Recognising and controlling these emotions through specialised training in end-of-life care and fostering resilience is essential.

DESIGN

Comparative, correlational and longitudinal study.

METHODS

Our corpus comprised 100 nursing students who were followed through the first three years of their training. Data were collected using a sociodemographic questionnaire, the Collet-Lester Fear of Death Scale and the Resilience Scale.

RESULTS

The corpus reported medium-high levels of fear of death overall. Patterns were similar for all academic years: fear of other people's death was invariably the highest scoring subscale; and while individual dimensions of the Collet-Lester scale correlated directly and significantly with each other they were found to be inversely related to student age. High levels of resilience were recorded and were highest in the final year.

CONCLUSIONS

In this sample of student nurses, fear of death and resilience do not appear to be related to each other. Nursing education must include training specifically targeted at increasing levels of resilience and decreasing fear of death to improve end-of-life care.

Nursing Students’ Coping for Burnout and Fatigue Online Learning during Coronavirus Disease 2019 Pandemic

BACKGROUND: The nursing students should ideally represent relevant and skillful behavior in developing science. Recently, the classical teaching and learning process involving interaction between students was shifted into online learning due to the coronavirus disease 2019 (COVID-19) pandemic. That ideal condition could not be reached. As a result, the online learning during the COVID-19 pandemic triggers students to deal with stressors such as academic assignments, the difficulty in adapting to home environment, no face-to-face meeting with the fellow students. AIM: The researcher was aimed to analyze students’ coping strategies for burnout and fatigue from online learning during the COVID-19 pandemic. METHODS: It was a quantitative research with a descriptive correlation design and cross-sectional approach. The population of the research was the students in the second semester of the undergraduate program in nursing Universitas Muhammadiyah Semarang. The sample of the research was 83 respondents, which were taken using a purposive sampling technique. RESULTS: Most of the nursing students were positive coping with 47 respondents (56.6%), severe burnout with 71 respondents (85.5%), and fatigue was found in 40 respondents (48.2%); meanwhile, the rest 43 respondents (52.8%) did not experience fatigue. Base on Pearson test, there was a significant correlate between nursing students coping and fatigue (0.00) with moderate correlation at 0.518, although no correlation coping with burnout. CONCLUSION: It is expected for the institution to conduct training about more interactive online learning accessible by the student and train a positive coping mechanism to cope with burnout and fatigue.

A cross sectional study of midwifery students' experiences of COVID-19: Uncertainty and expendability

The impact of COVID-19 on midwifery students is anticipated to be multi-faceted. Our aim was to explore Australian midwifery students' experiences of providing maternity care during the COVID-19 pandemic. In a cross-sectional study 147 students were recruited through social media. Data were collected through an online survey and semi-structured interviews. Surveys were analysed using descriptive statistics; interviews and open text responses were interpreted through qualitative analysis. Findings revealed students found communication from hospitals and universities to be confusing, inconsistent and they relied on mass media and each other to remain updated. Moving to online learning and being isolated from peers made learning difficult. During clinical placements, students felt expendable in terms of their value and contribution, reflected in essential equipment such as personal protective equipment not always being available to them. Witnessing perceived compromised midwifery care increased students' emotional burden, while personal household responsibilities and financial concerns were problematic. One silver lining witnessed was women's appreciation of an improved ‘babymoon’, with fewer visitors, allowing uninterrupted time to establish breastfeeding and connection with their baby. Findings may guide management of midwifery education during future pandemics or health crises for universities and hospitals.

Learning to be a midwife: Midwifery students' experiences of an extended placement within a midwifery group practice

AIM

To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice.

METHODS

Focus groups were conducted with fifteen third - year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia.

RESULTS

Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice.

DISCUSSION AND CONCLUSION

Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned 'how to be a midwife'. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital.

IMPLICATIONS AND RECOMMENDATIONS

Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates' capabilities and competencies 3-5 years post registration should be conducted.

Novice nurse's transitioning to emergency nurse during COVID-19 pandemic: A qualitative study

AIM

To explore the experiences and perceptions of recent nursing graduates working in emergency departments during the COVID-19 outbreak.

BACKGROUND

Overcrowding in emergency departments has been one of the most prominent issues arising in these units for more than 20 years. However, it has become even more problematic due to the novelty of the coronavirus pandemic, which has forced hospitals to recruit larger numbers of beginner nursing staff as the number of quarantined health professionals increases.

METHODS

Sixteen semi-structured interviews were conducted in Spanish emergency departments, which were analysed and synthesized using content analysis.

RESULTS

Three major themes emerged from the data analysis: (a) Fears and concerns, (b) Organisational issues and (c) Support for novice nurses.

CONCLUSIONS

Our findings may help to understand how shadowing periods as a learning programme for nurses, continuing professional development, evidence-based apps and better planning are needed to ensure both novice nurses' confidence in emergency departments and expert emergency room nurses' ability to cope with complications in critical situations.

IMPLICATIONS FOR NURSING MANAGEMENT

Training periods that include shadowing expert emergency room nurses, along with evidence-based technology, provide an opportunity to support novice nurses' transition into the workplace. These measures would provide a safety net and would increase novice nurses' confidence as well as high-quality care.