The Community Resiliency Model® to promote nurse well-being

Interventions to promote resilience and passion for work in health settings: A mixed-methods systematic review

Background

Resilience and passion for work are associated with better psychosocial wellbeing and professional quality of life for healthcare workers.

Objective

To evaluate the characteristics and efficacy of interventions to promote resilience and passion for work in health settings.

Methods

A comprehensive search was conducted across six databases (MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and PsycINFO) for articles published between January 2003 and February 2023. Studies utilizing both quantitative and qualitative methodologies were included. Methodological quality assessment was performed using the Mixed Methods Appraisal Tool. Data from the included studies were analyzed using a convergent mixed methods design.

Results

A total of 33 studies met the inclusion criteria. All reported on interventions designed to enhance resilience for healthcare workers. None reported on interventions to enhance passion for work. Interventions included mindfulness-based programs, psychoeducation workshops, stress management techniques, and professional coaching. Interventions varied widely in terms of delivery modality, format, content, intensity, duration, and outcomes. Of the studies reporting quantitative data, most (21/29) reported statistically significant improvements in resilience. Of the studies reporting qualitative data, all reported a positive impact of the intervention on resilience and psychological well-being.

Conclusions

Overall, interventions designed to enhance resilience in health care settings appear to be effective across a variety of healthcare settings. The diversity of effective intervention approaches, delivery formats, intensity and duration suggest that brief, light-touch or self-directed online interventions may be equally as effective as more intensive, lengthy, in-person or group-based interventions. This provides health care organisations with the opportunity to select and flexibly implement interventions that align with organisational, and staff needs and preferences. Future research needs to explore effective approaches to building passion for work.

COVID-19 Stressors and Resilience Among Nurse Leaders

The COVID-19 pandemic introduced many new stressors to nurses in general, yet little is known about COVID-19-related stressors and resilience among nursing leaders. The aims of this study were to explore (1) the COVID-19-related stressor and resilience by personal and work demographics, (2) the relationship between COVID-19 stressors and resilience, and (3) resilience strategies used by leaders and their recommendations to other nurse leaders. This descriptive, cross-sectional study employed an electronic survey to measure COVID-19-related stressors and resilience and included qualitative open-ended questions. A total of 57 nurse leaders responded to the survey. Nurse leaders who were female, African American, chief nurse executive or nursing director, and had more than 10 years of experience reported highest COVID-19 stress in most of subscales. Nurse leaders who were male, African American, chief nurse executive or nursing director, and had more than 10 years of experience reported highest resilience scores. Nurse leaders with higher resilience levels had lower levels of COVID-19 stress in all subscales. Nurse leaders reported the top 3 resilience strategies as (1) prayer and faith, (2) social support, and (3) self-care and the top 3 recommendations to other nurse leaders as (1) disconnect, (2) positive and creative thinking, and (3) self-care.

Can Patient-centered Education and Pain Management Delivered by Coaches Improve Pain Outcomes After Orthopaedic Trauma? A Randomized Trial

BACKGROUND

Pain after orthopaedic trauma is complex, and many patients who have experienced orthopaedic trauma are at increased risk for prolonged opioid utilization after the injury. Patient-centered interventions capable of delivering enhanced education and opioid-sparing pain management approaches must be implemented and evaluated in trauma care settings to improve pain outcomes and minimize opioid-related risks.

QUESTIONS/PURPOSES

Does personalized pain education and management delivered by coaches (1) improve pain-related outcomes, (2) reduce opioid consumption, and (3) improve patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] scores) compared to written discharge instructions on pain management and opioid safety?

METHODS

This clinical trial aimed to examine the effect of a personalized pain education and management intervention, delivered by paraprofessional coaches, on pain-related outcomes and opioid consumption compared with usual care (written discharge instructions on pain management and opioid safety). Between February 2021 and September 2022, 212 patients were randomized to the intervention (49% [104]) or control group (51% [108]). A total of 31% (32 of 104) and 47% (51 of 108) in those groups, respectively, were lost before the minimum study follow-up of 12 weeks or had incomplete datasets, leaving 69% (72 of 104) and 53% (57 of 108) for analysis in the intervention and control group, respectively. Patients randomized to the intervention worked with the paraprofessional coaches throughout hospitalization after their orthopaedic injury and at their 2-, 6-, and 12-week visits with the surgical team after discharge to implement mindfulness-based practices and nonpharmacological interventions. Most participants in the final sample of 129 identified as Black (73% [94 of 129]) and women (56% [72 of 129]), the mean Injury Severity score was 8 ± 4, and one-third of participants were at medium to high risk for an opioid-use disorder based on the Opioid Risk Tool. Participants completed surveys during hospitalization and at the 2-, 6-, and 12-week follow-up visits. Surveys included average pain intensity scores over the past 24 hours measured on the pain numeric rating scale from 0 to 10 and PROMIS measures (physical functioning, pain interference, sleep disturbance). Opioid utilization, measured as daily morphine milligram equivalents, was collected from the electronic health record, and demographic and clinical characteristics were collected from self-report surveys. Groups were compared in terms of mean pain scores at the 12-week follow-up, daily morphine milligram equivalents both during inpatient and at discharge, and mean PROMIS scores at 12 weeks of follow-up. Additionally, differences in the proportion of participants in each group achieving minimum clinically important differences (MCID) on pain and PROMIS scores were examined. For pain scores, an MCID of 2 points on the pain numeric rating scale assessing past 24-hour pain intensity was utilized.

RESULTS

We found no difference between the intervention and control in terms of mean pain score at 12 weeks nor in the proportions of patients who achieved the MCID of 2 points for 24-hour average pain scores (85% [61 of 72] versus 72% [41 of 57], respectively, OR 2.2 [95% confidence interval (CI) 0.9 to 5.3]; p = 0.08). No differences were noted in daily morphine milligram equivalents utilized between the intervention and control groups during hospitalization, at discharge, or in prescription refills. Similarly, we observed no differences in the proportions of patients in the intervention and control groups who achieved the MCID on PROMIS Physical Function (81% [58 of 72] versus 63% [36 of 57], respectively, OR 2.2 [95% CI 0.9 to 5.2]; p = 0.06). We saw no differences in the proportions of patients who achieved the MCID on PROMIS Sleep Disturbance between the intervention and control groups (58% [42 of 72] versus 47% [27 of 57], respectively, OR 1.4 [95% CI 0.7 to 3.0]; p = 0.31). The proportion of patients who achieved the MCID on PROMIS Pain Interference scores did not differ between the intervention and the control groups (39% [28 of 72] versus 37% [21 of 57], respectively, OR 1.1 [95% CI 0.5 to 2.1]; p = 0.95).

CONCLUSION

In this trial, we observed no differences between the intervention and control groups in terms of pain outcomes, opioid medication utilization, or patient-reported outcomes after orthopaedic trauma. However, future targeted research with diverse samples of patients at increased risk for poor postoperative outcomes is warranted to ascertain a potentially meaningful patient perceived effect on pain outcomes after working with coaches. Other investigators interested in this interventional approach may consider the coach program as a framework at their institutions to increase access to evidence-based nonpharmacological interventions among patients who are at increased risk for poor postoperative pain outcomes. Smaller, more focused programs connecting patients to coaches to learn about nonpharmacological pain management interventions may deliver a larger impact on patient's recovery and outcomes.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Fostering Moral Resilience: Evaluating a High-Fidelity Ethics Simulation With Prelicensure Nursing Students in Their Practice as New Graduates

BACKGROUND

Despite the high prevalence of moral distress in nursing, empirical evidence is lacking about the best educational approaches to foster moral resilience.

PURPOSE

This study evaluates the effectiveness of an ethics simulation in a prelicensure program, 6 months into nursing practice.

METHODS

We used an exploratory design, including 2 instruments and open-ended questions. One instrument measured moral distress, the other measured moral resilience. Alumni who participated in the simulation were compared to alumni who received didactic teaching only.

RESULTS

Six months into practice, the quantitative data from this study did not show a statistical significance between those who received didactic training only and those who received a simulation, except for one element of the moral resilience scale (relational integrity), in which the control group had a higher score. Open-ended questions confirmed that alumni recognized the positive impact of the simulation in practice.

CONCLUSIONS

Further study is needed to determine the best educational strategies for teaching ethics in prelicensure nursing programs, with a focus on improving retention and resilience in practice.

Effects of interventions to promote resilience in nurses: A systematic review

BACKGROUND

Various trials are investigating the effect of digital and face-to-face interventions on nurse resilience; however, it remains unclear whether these interventions have immediate, short-term or long-term effects.

OBJECTIVE

The objective of the systematic review is to identify the types of interventions and assess the immediate (<3 months), short-term (3-6 months), and long-term (>6 months) effects of these interventions on nurse resilience.

DESIGN

This systematic review was registered in the International Prospective Register of Systematic Reviews (Registered Number: CRD 42023434924), and results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol.

METHODS

Data were collated from the databases of CINAHL, Cochrane Library, Embase (OVID), Medline, and Scopus between March and May 2023. The research protocol was determined following the framework of population, exposure, outcomes, and type of study. The articles with full text published between 2000 and 2023 were included. Studies were included if they (1) involved the nurses who provided patient care directly, (2) utilised digital or face-to-face interventions, (3) reported resilience outcomes, and (4) were randomised controlled trials or clinical trials. The JBI critical appraisal tool was utilised to assess the risk of bias for the studies collected.

RESULTS

A total of 18 studies met the criteria and were analysed. Pooled results demonstrated that digital interventions had a statistically significant positive effect on nurse resilience at 4-5-month follow-ups (standardised mean difference [SMD] = 0.71; 95 % CI = 0.13, 1.29; P = 0.02) compared to no interventions. Additionally, pooled data showed no effect on nurse resilience at all the follow-ups, compared to no interventions. No significant results were observed in comparisons of digital or face-to-face interventions between the intervention and control groups.

CONCLUSIONS

The review assessed digital and face-to-face resilience interventions in nurses across 18 trials. Digital methods showed a short-term impact within 4-5 months, whilst face-to-face interventions had no effect during follow-ups. Realistic expectations, ongoing support, and tailored interventions are crucial for nurse resilience enhancement.

TWEETABLE ABSTRACT

It was identified digital interventions had a short-term impact on nurse resilience, whilst face-to-face interventions had no effect during follow-ups @fionayyu.

Improving Self-Regulation: Resiliency Skills in the Classroom

PURPOSE

The impact of daily living often results in unimaginable stress for children, which can be exhibited as lack of self-control. Children with decreased self-regulation are often not successful in school. Many schools do not have the resources needed to employ professionals who could provide programs to improve self-regulation. Creative programs that can be implemented into the classroom without disrupting the school day are needed. The current article describes a resiliency program that was implemented in a school setting to increase self-regulation.

METHOD

This pilot project used descriptive statistics to analyze the feasibility of incorporating resiliency skills into an elementary school curriculum and the resulting impact on self-regulation among school-aged children.

RESULTS

Improvements were identified in self-esteem, compassion, and classroom behavior.

CONCLUSION

Implementing resiliency skills into the curriculum can result in positive outcomes by improving self-regulation in school-aged children. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

A Pilot Study of a Trauma Resiliency Protocol for Law Enforcement Officers With Posttraumatic Stress Disorder Symptoms

OBJECTIVE

The aim of the study is to test the efficacy of the 22ZERO Trauma Resiliency Protocol (TR-P) on posttraumatic stress disorder (PTSD) symptom severity among current and former law enforcement officers.

METHODS

The study used a retrospective, pre/post intervention design to test the effects of the TR-P on measures of self-reported symptom severity.

RESULTS

One hundred twenty-eight current and former law enforcement officers were exposed to the TR-P treatment. All participants were administered the PTSD Checklist for DSM-5 PTSD Checklist and other psychological assessments before and after exposure. Participants experienced a significant reduction in symptom severity, suggesting that exposure to the TR-P reduced the effects of PTSD in this sample of law enforcement officers.

CONCLUSIONS

The 22ZERO TR-P may be an efficacious mechanism for reducing PTSD symptom severity among current and former law enforcement officers. It should be tested using a randomized trial and a longer follow-up period.

The relationship between organizational support, professional quality of life, decent work, and professional well-being among nurses: a cross-sectional study

BACKGROUND

Nurses often face challenges such as inadequate welfare protection, injustice, and workplace adversity including violence, bullying, and sexual harassment. In this context, providing sufficient support to nurses is crucial for the promotion of their professional well-being. This study examines the direct and indirect effects of perceived organizational support on nurses' well-being, particularly highlighting the mediating roles of professional quality of life and the perception of decent work.

METHODS

A cross-sectional survey design was employed in this study. Convenience sampling was used to survey 792 nurses from five tertiary A-grade hospitals in Shanxi Province in January 2024. Data collection tools included a custom demographic survey, the Perceived Organizational Support Scale, Professional Quality of Life Scale, Decent Work Perception Scale, and Nurse Occupational Well-being Questionnaire. Descriptive statistics, correlation analysis, and mediation effect analyses were performed.

RESULTS

The findings demonstrate that perceived organizational support has a direct impact on nurses' occupational well-being (β = 0.323, p < 0.001). Additionally, professional quality of life and the perception of decent work play chain mediating roles between perceived organizational support and nurses' well-being (β = 0.019, BootLLCI = 0.010, BootULCI = 0.030).

CONCLUSIONS

This study highlighted the importance of organizational support in enhancing nurses' well-being. Professional quality of life and decent work were key mediators. Healthcare institutions should prioritize support measures to improve nurses' well-being. Future research should explore additional mediators and mechanisms to develop effective strategies for nursing policymakers and administrators.

Resilience, Burnout and Mental Health in Nurses: A Latent Mediation Model

Background/Objectives: The burnout syndrome in nurses has been related to the development of mental health problems. On the contrary, resilience is related to adequately coping with stressful situations and better mental health. The objective was to analyze the relationship between resilience and mental health problems in nurses and estimate the proportion mediated by burnout in the association. Methods: In 2021, a total of 1165 Spanish nurses were selected through a stratified random sampling method. Participants anonymously filled in the Resilience Scale (RS-14), the Maslach Burnout Inventory Survey, and the General Health Questionnaire. To test the hypothesis proposed and explain the mediating effect of burnout empirically, structural equation modeling (SEM) was applied. A latent mediation model was computed. Results: Resilience was negatively related to burnout and mental health problems. The direct relationship between burnout and the latent health variable was positive. In addition, in view of the total effect of resilience on mental health problems and the magnitude of the indirect effect, we stated that the proportion of this effect mediated by burnout ranged from 0.486 to 0.870. Conclusions: This study reveals that fostering resilience in nurses directly and indirectly reduces burnout and improves their mental health. The implementation of resilience programs and supportive institutional policies is recommended to improve working conditions and the quality of patient care.

Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis

Background

Growing evidence attests to the efficacy of mindfulness-based interventions (MBIs), but their effectiveness for healthcare workers remains uncertain.

Aims

To evaluate the evidence for MBIs in improving healthcare workers' psychological well-being.

Methods

A systematic literature search was conducted on Medline, Embase, Cumulative Index for Nursing and Allied Health Literature, PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords 'healthcare worker', 'doctor', 'nurse', 'allied health', 'mindfulness', 'wellness', 'workshop' and 'program'. Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion. R V.4.0.3 was used for data analysis, with the standardised mean difference as the primary outcome, employing DerSimonian and Laird's random effects model. Grading of Recommendations, Assessment, Development and Evaluation framework was used to evaluate the quality of evidence. Cochrane's Risk of Bias 2 tool was used to assess the risk of bias in the included studies.

Results

A total of 27 studies with 2506 participants were included, mostly from the USA, involving various healthcare professions. MBIs such as stress reduction programmes, apps, meditation and training showed small to large effects on anxiety, burnout, stress, depression, psychological distress and job strain outcomes of the participants. Positive effects were also seen in self-compassion, empathy, mindfulness and well-being. However, long-term outcomes (1 month or longer postintervention) varied, and the effects were not consistently sustained.

Conclusions

MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers. The review also highlights limitations such as intervention heterogeneity, reduced power in specific subgroup analyses and variable study quality.

PROSPERO registration number

CRD42022353340.

Embedding Mindfulness-Based Resiliency Curricula Into Surgical Training to Combat Resident Burnout and Improve Wellbeing

Surgery residents are at a higher-than-average risk of burnout syndrome, which is characterized by emotional exhaustion, depersonalization, and a sense of ineffectiveness. This risk of burnout can translate to increased stress and distress in trainees, poor performance, as well as worse patient outcomes. Therefore, developing and implementing burnout reduction strategies that are feasible, acceptable, and effective among surgical residents is paramount. Studies demonstrate that inherent mindfulness is associated with improved resiliency, reduced stress and burnout, as well as improved cognitive and motor skill performance. Fortunately, mindfulness is a skill that can be developed and maintained through targeted mindfulness-based interventions embedded within surgical education curriculum. Here, we present the data supporting the use of mindfulness as an integral part of burnout reduction efforts in surgical trainees as well as highlight evidence-based strategies for implementation in diverse surgical training environments.

Psychological Group Interventions for Reducing Distress Symptoms in Healthcare Workers: A Systematic Review

Healthcare workers exposed to emergencies and chronic stressors are at high risk of developing mental health problems. This review synthesized existing studies of group psychological therapy to reduce distress symptoms in healthcare workers (i.e., as complex and heterogeneous emotional states, characterized by the presence of symptoms associated with post-traumatic stress disorder, burnout, anxiety, depression and moral injury). Searches were conducted using PRISMA guidelines and databases such as PubMed, PsycINFO, Medline and Web of Science, along with manual searches of reference lists of relevant articles. The search returned a total of 1071 randomized trials, of which 23 met the inclusion criteria. Of the total studies, nine were mindfulness interventions, seven were cognitive behavioural programmes, one was a programme based on acceptance and commitment therapy, one was an EMDR protocol and two focused on systemic and art therapy. Most studies aimed to reduce burnout, anxiety and depression; only three focused on post-traumatic stress disorder, and no studies were found that addressed moral injury. The results suggested that group interventions could be an effective tool to improve the mental health of healthcare workers and reduce their symptoms of distress, although many of the studies have methodological deficiencies. Limitations and future directions are discussed.

Increasing nurses' occupational well-being: the role of career shocks, job crafting and supervisor autonomy support

BACKGROUND

This study aims to explore the influence of career shocks on nurses' occupational well-being through job crafting and the moderating role of supervisor autonomy support.

METHOD

The present study used a cross-sectional design. And the study included 714 frontline nurses in China, and we used structural equation modelling (SEM) to test our hypotheses.

RESULTS

Job crafting mediated both the relationship between positive career shocks and occupational well-being and the relationship between negative career shocks and occupational well-being. Supervisor autonomy support moderated the indirect relationships.

CONCLUSIONS

Positive and negative career shocks could increase and impair nurses' occupational well-being through job crafting, respectively. We contribute to helping nurses make sense of career shocks and preparing for career shocks, and hospital administrators and nurses' direct supervisors can help nurse better cope with career shocks in attending job crafting activities and providing more autonomy supports.

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

Effects of mindfulness-based interventions on reducing psychological distress among nurses: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

Nurses increasingly use mindfulness as an effective mental health intervention to reduce psychological distress. The effectiveness of mindfulness-based interventions remains inconclusive, which may lead to implementation of interventions in an inefficient or ineffective manner. This study aimed to examine the effects of mindfulness-based interventions on reducing stress, anxiety, and depression among nurses.

DESIGN

Systematic review and meta-analysis.

METHODS

Randomized controlled trials (RCTs) were searched using six databases published through May 20, 2023, which evaluated the effects of mindfulness-based interventions on reducing psychological distress among nurses. To assess the quality of methodology included in the RCTs, version 2 of the Cochrane risk-of-bias instrument for RCTs with five domains was used. Standardized mean difference (SMD) with 95% confidence interval (CI) were calculated using the random-effects model in the meta-analyses. Publication bias was assessed using Egger's regression test. Further, the robustness effect size of the pooled analysis was assessed using leave-one-out sensitivity analysis.

FINDINGS

A total of 16 RCTs were included in the final analysis. Overall, the modalities appeared to alleviate stress (pooled SMD: -0.50 [95% CI: -0.82 to -0.18]; p < 0.001) and depression (pooled SMD: -0.42 [95% CI: -0.78 to -0.06]; p = 0.02) among nurses.

CONCLUSION

Mindfulness-based interventions appear to alleviate stress and depression in nurses. Future research evaluating mindfulness-based interventions among working nurses with more rigorous methodological and larger sample size.

CLINICAL RELEVANCE

Support for nurses' mental health must be included while implementing personal and professional development plans.

Utilizing a HRSA Training Grant to Promote PMHNP Student Resilience: Answering the Call to Enhance Trauma-Informed Teaching and Learning Practices in Nursing Education

Nursing burnout has reached a new level of prevalence among professionals and is rising among nursing students and can impact student success in the classroom and clinical areas. Among advanced practice nurses, psychiatric-mental health nurse practitioners have the least favorable combination of low compassion satisfaction and high secondary traumatic stress, placing them at even greater risk for burnout compared to other specialties. Trauma informed teaching and learning principles can serve to prevent burnout and have a positive impact on learning outcomes. Through these teaching methods, nurse educators have the opportunity to both support students during their nursing education and prepare students for the professional stressors that contribute to burnout. This quality improvement project involved implementation and evaluation of a HRSA funded program to train PMHNP students interested in working in rural and underserved areas. The training intervention included didactic curricular enhancements, a trauma resiliency training and a longitudinal clinical practicum. Qualitative program outcomes indicated that trainees were implementing trauma-informed principles and skills with patients and for self-care during their nursing training and at one year follow-up. The program may offer practical upstream solutions for nurse educators and future studies should explore concepts more formally to develop best practice models.

Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis

BACKGROUND

A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives.

METHODS

A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit.

RESULTS

Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion.

CONCLUSIONS

This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

The impact of the Community Resiliency Model (CRM) on the mental well-being of youth at risk for violence: A study protocol

PURPOSE

Assess the effect of a brief, somatic awareness resiliency training, the Community Resiliency Model (CRM)®, on the mental well-being of incarcerated youth. SPECIFIC AIM 1: Explore the relationship between youth demographics and justice history to baseline well-being scores and response to treatment. Q1: How do personal variables, including length of time in juvenile justice, relate to baseline mental health scores and response to the wellness skills intervention? SPECIFIC AIM 2: Examine the mental health scores over time to determine effectiveness of participating in CRM training while incarcerated. Hypothesis 1: Well-being scores will increase after CRM training. Hypothesis 2: Emotional distress will decrease after participating in a CRM training. Hypothesis 3: Pro-social feelings and behaviors will increase after participating in a CRM training.

Better Together: Collaboration to Enhance the Nursing Workforce

Nursing is a demanding profession that calls for nurses to devote time, energy, advocacy, and compassion to improving clients' lives while providing safe, efficient care. Nurses make personal sacrifices to meet their clients' needs, which do not come without costs to their well-being. An increased migration of novice nurses out of the profession and the need to increase the volume of the nursing workforce by an average of 8% annually to address the projected nursing shortage presents a compelling need for immediate action. Reimagining the concept of academic-service partnerships to provide exposure to opportunities that can equip and empower novice nurses as they emerge into professional practice cannot be underestimated. Implementing approaches to assess, support, and nurture the health and well-being of nurses and health care organizations is foundational to retention.

The levels and related factors of mental workload among nurses: A systematic review and meta-analysis

AIM

The aim was to determine the overall levels and related factors of mental workload assessed using the NASA-TLX tool among nurses.

BACKGROUND

Mental workload is a key element that affects nursing performance. However, there exists no review regarding mental workload assessed using the NASA-TLX tool, focusing on nurses.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, MEDLINE, Web of Science, EMBASE, PsycINFO, Scopus, CINAHL, CNKI, CBM, Weipu and WanFang databases were searched from 1 January 1998 to 30 February 2022.

REVIEW METHODS

Following the PRISMA statement recommendations, review methods resulted in 31 quantitative studies retained for inclusion which were evaluated with the evaluation criteria for observational studies as recommended by the Agency for Healthcare Research and Quality. The data were pooled and a random-effects meta-analysis conducted.

RESULTS

Findings showed the pooled mental workload score was 65.24, and the pooled prevalence of high mental workload was 54%. Subgroup analysis indicated nurses in developing countries and emergency departments experienced higher mental workloads, and the mental workloads of front-line nurses increased significantly during the COVID-19 pandemic.

CONCLUSION

These findings highlight that nurses experience high mental workloads as assessed using the NASA-TLX tool and there is an urgent need to explore interventions to decrease their mental workloads.

Paws to Care: Implementation of a Novel Medical Dog Office Hours Program to Foster Pediatric Health Care Staff Resilience and Joy

Burnout and resiliency are significant challenges among health care workers. Animal-assisted therapy (AAT) has shown to improve patient-level outcomes; however, AAT research involving hospital staff is limited. Our novel Medical Dog ("MD") Office Hours Program aimed to provide support to pediatric hospital staff and explore the program's impact on burnout. Participant surveys described work role and years of experience, well-being, and emotional/physical descriptions and symptoms. Of 149 participants, 85% endorsed baseline distress/burnout; nearly half had at-risk Well-Being Index scores. Compared with baseline, postintervention participants endorsed significantly fewer negative (more positive) emotions; greater feelings of comfort and energy; and decreased tiredness and pain (P < .0001). Readiness to return to work scores were high (M = 78.1, SD = 18.4). Our Medical Dog ("MD") Office Hours Program resulted in improvements in emotional descriptions and physical symptoms among pediatric health care staff. Leveraging AAT among health care staff may help mitigate burnout and increase resiliency.

The Community Resiliency Model, an interoceptive awareness tool to support population mental wellness

The objective of this article is to describe the Community Resiliency Model (CRM)®, a sensory-focused, self-care modality for mental well-being in diverse communities, and CRM's emerging evidence base and neurobiological underpinnings as a task-sharing intervention. Frieden's Health Impact Pyramid (HIP) is used as a lens for mental healthcare interventions and their public health impact, with CRM examples. CRM, a sensory awareness model for self-care and mental well-being in acute and chronic stress states, is supported by neurobiological theory and a growing evidence base. CRM can address mental wellness needs at multiple levels of the HIP and matches the task-sharing concept to increase access to mental health resources globally. CRM has the potential for making a significant population mental health impact as an easily disseminated, mental health, self-care modality; it may be taught by trained professionals, lay persons, and community members. CRM carries task-sharing to a new level: scalable and sustainable, those who learn CRM can share the wellness skills informally with persons in their social networks. CRM may alleviate mental distress and reduce stigma, as well as serve a preventive function for populations facing environmental, political, and social threats.

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.

Individual-level interventions for reducing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions.  OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms.  SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms.  DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);  2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);  3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above.  The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended).  MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised.  The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants.  Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention  Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention.  A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type  Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

AUTHORS' CONCLUSIONS

Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

A rapid review of evaluated interventions to inform the development of a resource to support the resilience of care home nurses

BACKGOUND

Nurses working in care homes face significant challenges that are unique to that context. The importance of effective resilience building interventions as a strategy to enable recovery and growth in these times of uncertainty have been advocated. The aim of this rapid review was to inform the development of a resource to support the resilience of care home nurses. We explored existing empirical evidence as to the efficacy of resilience building interventions. undertaken with nurses.

METHODS

We undertook a rapid review using quantitative studies published in peer reviewed journals that reported resilience scores using a valid and reliable scale before and after an intervention aimed at supporting nurse resilience. The databases; Cumulative Index to Nursing and Allied Health Literature, Medline and PsychInfo. and the Cochrane Library were searched. The searches were restricted to studies published between January 2011 and October 2021 in the English language. Only studies that reported using a validated tool to measure resilience before and after the interventions were included.

RESULTS

Fifteen studies were included in this rapid review with over half of the studies taking place in the USA. No studies reported on an intervention to support resilience with care home nurses. The interventions focused primarily on hospital-based nurses in general and specialist contexts. The interventions varied in duration content and mode of delivery, with interventions incorporating mindfulness techniques, cognitive reframing and holistic approaches to building and sustaining resilience. Thirteen of the fifteen studies selected demonstrated an increase in resilience scores as measured by validated and reliable scales. Those studies incorporating 'on the job,' easily accessible practices that promote self-awareness and increase sense of control reported significant differences in pre and post intervention resilience scores.

CONCLUSION

Nurses continue to face significant challenges, their capacity to face these challenges can be nurtured through interventions focused on strengthening individual resources. The content, duration, and mode of delivery of interventions to support resilience should be tailored through co-design processes to ensure they are both meaningful and responsive to differing contexts and populations.

Mixed-methods study protocol for exploring the perception of nurses' resilience in the COVID-19 pandemic: Designing, implementing and evaluation of intervention

BACKGROUND

While the necessity for interventions to build resilient nurses in the COVID-19 pandemic is recognized, there is disagreement about the effective methods for achieving this.

AIM

We present our research protocol that describes plans to design and test an interventional program for promoting nurses' resilience.

DESIGN

This sequential exploratory interventional mixed-methods study is conducted in three phases (qualitative, intervention design, and quantitative).

METHODS

It was funded from May 2021 for 24 months. In phase 1, we explored strategies for promoting resilience in the COVID-19 pandemic from nurses' perspectives (through semi-structured interviews). In phase 2, we will design an interventional program for promoting nurses' resilience (using the qualitative phase and literature review results). We will assess the program's effectiveness on nurses' resilience in a randomized controlled trial in phase 3.

DISCUSSION

Given the different experiences of nurses of resilience in COVID-19, our innovative program can guide future research to enhance nurses' resilience based on specific situations.

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.

Practical resiliency training for healthcare workers during COVID-19: results from a randomised controlled trial testing the Community Resiliency Model for well-being support

Objective

To introduce the Community Resiliency Model (CRM) as mental well-being support for healthcare workers working through the height of the COVID-19 pandemic.

Design

Randomised controlled trial with a no treatment control group.

Setting

Two large urban health systems in the Southern United States between October 2020 and June 2021.

Participants

Eligible participants were currently employed as healthcare workers within the participating healthcare systems. 275 employees registered and consented electronically in response to email invitations. 253 participants completed the baseline survey necessary to be randomised and included in analyses.

Intervention

Participants were assigned 1:1 to the control or intervention group at the time of registration. Intervention participants were then invited to 1-hour virtual CRM class teaching skills to increase somatic awareness in the context of self and other care.

Main outcome measures

Self-reported data were collected rating somatic awareness, well-being, symptoms of stress, work engagement and interprofessional teamwork.

Results

Baseline data on the total sample of 275 (53% nurses) revealed higher symptoms of stress and lower well-being than the general population. The intervention participants who attended a CRM class (56) provided follow-up survey data at 1 week (44) and 3 months (36). Significant improvement for the intervention group at 3 months was reported for the well-being measures (WHO-5, p<0.0087, d=0.66; Warwick-Edinburgh Mental Well-Being Scale, p<0.0004, d=0.66), teamwork measure (p≤0.0002, d=0.41) and stress (Secondary Traumatic Stress Scale, p=0.0058, d=46).

Conclusion

Baseline results indicate mental health is a concern for healthcare workers. Post intervention findings suggest that CRM is a practical approach to support well-being for healthcare workers during a crisis such as this pandemic. The simple tools that comprise the model can serve as a starting point for or complement self-care strategies to enhance individual resilience and buffer the effects of working in an increasingly stressful work environment.

What do psychiatric nurse practitioners need to know about trauma?

PURPOSE

The purpose of this article is to describe Trauma and Resilience Competencies for Psychiatric Nurse Practitioners and to propose a trauma and resilience informed framework for nursing practice.

CONCLUSIONS

Trauma and Resilience Competencies for Nursing Education have been developed and validated, yet to date, these have not been widely disseminated.

PRACTICE IMPLICATIONS

It is essential that all nurses have competency in trauma and resilience to provide care for their patients as well as for their own well-being. The Psychiatric Nurse Practitioner who practices from a trauma-informed framework ensures the delivery of safe, quality care for all patients.

Interventions to foster resilience in nursing staff: A systematic review and meta-analyses of pre-pandemic evidence

BACKGROUND

Given the chronic work-related stressors experienced by nursing staff in today's healthcare systems, international evidence suggests an elevated risk of developing stress-related mental symptoms. Therefore, identifying effective methods to foster resilience (i.e., maintenance or fast recovery of mental health despite stressor exposure) seems crucial. To date, little is known about the efficacy of these interventions in nurses.

OBJECTIVE

This systematic review aimed at summarizing the evidence on the pre-pandemic efficacy of psychological interventions to foster resilience, to improve mental symptoms and well-being as well as to promote resilience factors in nurses. Based on training programs with evidence for positive effects on resilience and mental health in meta-analyses, we aimed at identifying important and helpful intervention techniques.

DESIGN

Systematic review and meta-analyses based on a Cochrane review on pre-pandemic resilience interventions in healthcare professionals.

DATA SOURCES

MEDLINE, Embase, CENTRAL and 11 other databases were searched until June 2020 to identify eligible randomized controlled trials. Trial registers, reference lists and contact with authors were additional sources.

REVIEW METHODS

Two reviewers independently assessed study eligibility and extracted data. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias of included studies. We conducted random-effects pairwise meta-analyses for five primary outcomes, including resilience. The intervention contents and techniques were narratively synthesized.

RESULTS

Of 39,794 records retrieved, 24 studies were included in the review (N = 1879 randomized participants), 17 in meta-analyses (n = 1020 participants). At post-intervention, we found very-low certainty evidence of moderate effects in favor of resilience training for resilience (standardized mean difference [SMD] 0.39; 95% CI [confidence interval] 0.12-0.66) and well-being (SMD 0.44; 95% CI 0.15-0.72), while there was no evidence of effects on symptoms of anxiety, depression and stress. The improvement of well-being was sustained in the short-term (≤3 months), with additional delayed benefits for anxiety and stress. There was no evidence of effects at later follow-ups, with the caveat of only three available studies. Among nine programs with evidence of positive moderate effect sizes, intervention contents included mindfulness and relaxation, psychoeducation, emotion regulation, cognitive strategies, problem-solving and the strengthening of internal and external resources.

CONCLUSIONS

Given the chronic stressor exposure in nursing staff, our findings may guide both the design and implementation of nurse-directed resilience interventions. To improve the certainty of evidence, more rigorous high-quality research using improved study designs (e.g., larger sample sizes, longer follow-up periods) is urgently needed.

REGISTRATION

PROSPERO 2017 CRD42017082827.

The experiences of clinical nurses coping with patient death in the context of rising hospital deaths in China: a qualitative study

Background

Chinese clinical nurses are increasingly confronting patient death, as the proportion of hospital deaths is growing. Witnessing patient suffering and death is stressful, and failure to cope with this challenge may result in decreased well-being of nurses and impediment of the provision of “good death” care for patients and their families. To our knowledge, few studies have specifically explored clinical nurses’ experiences coping with patient death in mainland China. 

Objective

We aimed to explore nurses’ experiences coping with patient death in China in order to support frontline clinical nurses effectively and guide the government in improving hospice care policy.

Methods

Clinical nurses were recruited using purposive and snowball sampling between June 2020 and August 2020. We gathered experiences of clinical nurses who have coped with patient death using face-to-face, semi-structured, in-depth interviews. Audio recordings were transcribed verbatim and analyzed using thematic analysis.

Results

Three thematic categories were generated from data analysis. The first was “negative emotions from contextual challenges.” This category involved grief over deaths of younger persons, pity for deaths without family, and dread related to coping with patient death on night duty. The second category was “awareness of mortality on its own.” Subthemes included the ideas that death means that everything stops being and good living is important because we all die and disappear. The third category was “coping style.” This category included focusing on treating dying patients, recording the signs and symptoms, and responding to changes in the patient’s condition. It also involved subthemes such as avoiding talk about death due to the grief associated with dying and death, and seeking help from colleagues.

Conclusions

Clinical nurses’ emotional experiences are shaped by intense Chinese filial love, charity, and cultural attitudes towards death. Reasonable nurse scheduling to ensure patient and staff safety is a major priority. “Good death” decisions based on Chinese ethical and moral beliefs must be embedded throughout hospital care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01054-8.

Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers: A Randomized Clinical Trial

IMPORTANCE

Health care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress.

OBJECTIVE

To assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period.

DESIGN, SETTING, AND PARTICIPANTS

This single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group).

INTERVENTIONS

The TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources.

MAIN OUTCOMES AND MEASURES

The primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale).

RESULTS

Among 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (-5.6 points vs -3.8 points; between-group difference, -1.8 points; 95% CI, -4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: -8.0 points vs -2.6 points; between-group difference, -5.4 points; 95% CI, -9.2 to -1.6 points; P = .006), insomnia (Insomnia Severity Scale score: -4.1 points vs -1.9 points; between-group difference, -2.2 points; 95% CI, -4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: -3.1 points vs -0.9 points; between-group difference, -2.2 points; 95% CI, -3.8 to -0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04632368.

Cohort Study on the Effect of Psychological Education for Nurses in Psychiatric Department

With the deepening of the medical and health system, high-quality nursing service with the reform of nursing service model and the provision of holistic nursing care for patients as the core connotation is being comprehensively carried out. With the continuous improvement of medical quality, people's awareness of health has gradually increased. They have put forward higher requirements for medical quality, nursing service quality, and medical care safety. Under the influence of these conditions, the workload and work pressure of clinical nurses continue to increase, and mental health problems become increasingly prominent. According to relevant data, the detection rate of occupational stress among nurses was 100%, and the proportion of nurses who perceived considerable stress was 60.9%, which seriously affected their work efficiency and quality of life. However, the physical and mental health of the frontline nurses working in psychiatric hospitals is not optimistic. This study explored the effects of psychological education among nurses in the department of psychiatry. The results showed that psychological education intervention among nurses in the department of psychiatry could alleviate their professional tiredness, effectively improve their psychological elasticity and happiness index, and thus improve sleep quality and promote their physical and mental health development.

Enhancing the well-being of front-line healthcare professionals in high pressure clinical environments: A mixed-methods evaluative research project

BACKGROUND

The last few years have witnessed a growing concern with the well-being of healthcare professionals internationally because of increasing recognition of its impact on patient outcomes and staff retention. The COVID-19 pandemic, which has placed additional and substantial pressure on frontline healthcare professionals, gives added urgency to the topic. While numerous, and successful, interventions have been developed to address compromised well-being among healthcare professionals, they have not always been able to support the needs of frontline staff, specifically those working in high-pressure environments.

OBJECTIVE

This paper presents findings of an evaluative research study of an intervention, named the Resilience and Well-being Training Programme, developed and implemented within an Acute Assessment Unit in a hospital in the UK. The 8 week-long programme followed a combined approach (both person-directed and work-directed), with mindfulness training as well as lectures and discussions to deepen participants' understanding of organisational life. The training, delivered from January to July 2018, involved a total of 72 healthcare professionals from a wide range of levels (UK bands 2-8), trained in three cohorts.

DESIGN

The research followed a pre-post design to explore participants' experiences of working on the Unit, the programme and its impact on themselves and their working life.

SETTING

The study was conducted in a large NHS district general hospital in South London, UK.

PARTICIPANTS

Participants included healthcare assistants and nurses who had completed their preceptorship, worked in the hospital's acute assessment unit, and had undertaken the resilience and well-being training programme.

METHODS

The study employed mixed methods (online questionnaire, face-to-face focus groups/interviews) to collect data.

RESULTS

Findings showed participants' positive experience with the programme, however it had limited positive impacts on aspects of compromised well-being at the personal level and a statistically significant enhancement of the quality of relationships and communication on the Unit, with medium effect size (Cohen's D). The programme had a positive impact on the culture of the Unit.

CONCLUSIONS

Results highlight the demand for and value of programmes designed in ways that enable this group of professionals to take part, because these professionals are often not able to participate in such programmes. A strong commitment from the leadership to enable staff attendance in time-protected programmes is one approach that works well in the short-term. However, this may be challenging to accomplish and raises issues of sustainability.

Communication competence and resilience are modifiable factors for burnout of operating room nurses in South Korea

Background

Burnout negatively impacts the personal and professional life of nurses. Job stress and resilience have been determined to be associated with nurse burnout. Given the importance of communication competence in operating room (OR) nurses, the associations of job stress, resilience, and communication competence with burnout have not been examined.

Purpose

To determine the relationships of job stress, resilience, and communication competence to burnout of OR nurses in South Korea.

Methods

This was a cross-sectional, descriptive study of 146 OR nurses. A series of self-reported questionnaires was used to assess job stress, resilience, communication competence, and burnout. Pearson correlation coefficient and a hierarchical linear regression were used for data analysis.

Results

Communication competence was correlated with resilience (r = 0.65, p < .001) and burnout (r = -0.44, p < .001), and resilience was correlated with burnout (r = -0.48, p < .001). Resilience (β = -0.22, p = .027) and communication competence (β = -0.33, p < .001) were associated with burnout of OR nurses in a hierarchical linear regression (F = 6.28, p < .001).

Conclusions

Increased resilience and communication competence were associated with lower burnout of perioperative nurses. To prevent and reduce burnout of OR nurses, it is necessary to develop and implement a program targeting for communication competence and resilience.

Implications for nursing management

Nurse leaders should provide programs fostering communication competence and resilience to OR nurses and encourage them to actively participate in such job trainings.

Introducing a Resiliency Bundle for Home Care Nurses

Home healthcare (HHC) nurses are experiencing stress and burnout related to high workloads, isolation on the job, and COVID-19 restrictions. A literature review found numerous interventions effective in reducing nurse burnout through building resiliency and decreasing moral distress. The purpose of this evidence-based project was to improve resiliency and decrease the risk of burnout in HHC nurses through the introduction of a resiliency bundle. The following resiliency bundle interventions were implemented: a) gratitude strategies, b) connecting with co-workers, c) storytelling, and d) resiliency training. Duffy's Quality-Caring Model and Neal's Theory of Home Health Nursing Practice framed the project. The interventions were implemented in an HHC department at a large Midwestern pediatric hospital. Outcomes were measured using a pre- and postimplementation resiliency and burnout survey, which used a Likert scale to allow for quantitative analysis. Fourteen nurses completed the presurvey, 11 completed the postsurvey, and 10 completed both pre- and postsurveys. Results showed no statistically significant change in resiliency or burnout after implementation; however, nurses expressed desire to continue using the bundle pieces, especially the gratitude strategies, connecting with co-workers, and sharing stories. Leadership should take burnout risk in HHC nurses seriously and look for innovative ways to promote resiliency.

A Nurse-Led, Well-Being Promotion Using the Community Resiliency Model, Atlanta, 2020-2021

The wrath of COVID-19 includes a co-occurring global mental health pandemic, raising the urgency for our health care sector to implement strategies supporting public mental health. In Georgia, a successful nurse-led response to this crisis capitalized on statewide organizations' existing efforts to bolster well-being and reduce trauma. Partnerships were formed and joint aims identified to disseminate a self-care modality, the Community Resiliency Model, to organizations and communities throughout the state. (Am J Public Health. 2022;112(S3):S271-S274. https://doi.org/10.2105/AJPH.2022.306821).

Integration of Life Care Specialists Into Orthopaedic Trauma Care to Improve Postoperative Outcomes: A Pilot Study

BACKGROUND

  AIM: This pilot study assessed the feasibility and impact of integrating a Life Care Specialist (LCS) into orthopaedic trauma care.

DESIGN

This was a prospective feasibility single group pilot study at a level 1 trauma center.

METHOD

The LCS is a paraprofessional behavior-based "pain coach" and delivered patient-centered opioid safety education, trained participants on nonpharmacologic pain management approaches, conducted opioid risk assessments, and coordinated care. Numeric Rating Scale pain scores were assessed on admission, at discharge, and at 2-week follow-up. Daily morphine milligram equivalents (MME) during hospitalization, opioid medication use at 2-weeks, and patient satisfaction were recorded. T test compared mean morphine milligram equivalents (MME) to historical orthopaedic trauma patient population's mean dosage at discharge from the study site. Generalized linear models assessed pain scores over time.

RESULTS

Twenty-two percent of 121 total participants met criteria for moderate to severe risk of opioid misuse at initial hospitalization. On average, 2.8 LCS pain management interventions were utilized, most frequently progressive muscle relaxation (80%) and sound therapy (48%). Mean inpatient MME/day was 40.5, which was significantly lower than mean historical MME/day of 49.7 (p < .001). Pain scores improved over time from admission to 2-weeks postoperatively (p < .001). Nearly all participants agreed that the LCS was helpful in managing pain (99%).

CONCLUSIONS

The findings indicate feasibility to integrate LCS into orthopaedic trauma care, evident by participant engagement and satisfaction, and that LCS serve as valuable resources to assist with pain management and opioid education.

Promoting Spiritual Well-Being Among Nurses

Health care organizations are facing the fallout from inadequate nurse staffing in addition to the emotional and spiritual tolls of the COVID-19 pandemic. Organizations must strategically differentiate themselves by novel methods of recruitment and retention, including care of the nurse as a whole person. Tactical strategies can be implemented by nurse leaders to promote the spiritual well-being of the nursing workforce. These strategies include incorporating spirituality and soft skills into nursing orientation, developing and providing interventions to support spiritual well-being, and implementing methods to provide spiritual care of patients by nurses.

The project ECHO first responder resiliency program: curriculum development, listening groups and lessons learned to support providers virtually during a pandemic

The First Responder (FR) Resilience ECHO Program continues as a virtual telementoring platform supporting FRs both within New Mexico and internationally. The program began initially to support FRs through the opioid epidemic, and as the COVID-19 pandemic grew, the curriculum and audience broadened to include self-care and resilience skills to participants around the world. The notion of a FR was changed as providers everywhere were facing new challenges in their front-facing experience, whether this be a sense of overwhelm, an experience of detachment or of overload. The curriculum was altered with ongoing input from participants to address the needs of those working to help others during the COVID-19 pandemic, and included didactics in psychological first aid, self-care and resilience, peak performance skills, communication methods, diagnostic and systems descriptions, as well as the development of effective peer support programs around the nation. Perhaps the most important innovation was the development of listening groups, where participants could connect with one another in breakout rooms (15-20 min) to witness one another's account of their current situation. Project ECHO is a well-established and renowned telementoring program that assists clinicians in the treatment of disease through the demonopolization of knowledge. The FR Resiliency ECHO Program grew out of the core ECHO model to assist FRs in developing skills to work with various crises that our society currently faces, in particular, the opioid epidemic and later, the COVID-19 pandemic. The project created a unique online experience and curriculum to facilitate both skill development and a sense of ongoing connection to a community of peers. This article describes the curriculum, the development of the listening group experience, and the feedback received from participants through focus groups.

The effect of a Life Care Specialist on pain management and opioid-related outcomes among patients with orthopedic trauma: study protocol for a randomized controlled trial

BACKGROUND

Orthopedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopedic trauma.

METHODS

In total, 200 orthopedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2, 6, and 12 weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education.

DISCUSSION

There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid-related risk-mitigation in high-risk populations, including the orthopedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04154384 . Registered on 11/6/2019 (last updated on 6/10/2021).

Resilience Training Programs in Organizational Contexts: A Scoping Review

The importance of resilience for employees' well-being and performance at work has grown steadily in recent years. This development has become even more pronounced through the recent COVID-19 pandemic and its consequences, including major changes in occupational settings. Although there is increasing interest in resilience in general and a growing number of publications focusing on the development of resilience in particular, many questions remain about resilience training, especially in organizational contexts. The purpose of this scoping review is to uncover what is known about resilience training in organizational contexts. A systematic search of four databases for articles published through 2021 was conducted. A total of 48 studies focusing on resilience training programs in organizational contexts were included in this review. The review provides relevant insights into resilience training programs by focusing on program characteristics, target group, study design, and outcomes. Based on the results, the main aspects that concern the development of resilience training programs for organizational settings and requirements for the study design for empirical investigation were summarized. The results of the review highlight possible directions for future research and offer useful insights for resilience-enhancing training programs in organizations.

The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review

The mental health of nurses including burnout is an important issue. The purpose of this systematic review was to evaluate whether mind-body modalities improve burnout and other mental health aspects of nurses. A comprehensive search was conducted using six electronic databases. Randomized controlled trials using mind-body modalities on the mental health of nurses, up to January 2021, were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Seventeen studies were included in the review. Data on mindfulness-based interventions (MBIs) and yoga were available for burnout, and there was no evidence that multimodal resilience programs including MBIs statistically significantly improved burnout levels compared to no intervention or active control groups. However, one study reported that yoga could significantly improve emotional exhaustion and depersonalization, which are subscales of burnout, compared to usual care. In addition, the effects of MBIs, relaxation, yoga, and music on various mental health outcomes and stress-related symptoms have been reported. In conclusion, there was some evidence that yoga was helpful for improvement in burnout of nurses. However, due to the heterogeneity of interventions and outcomes of the studies included, further high-quality clinical trials are needed on this topic in the future.

Role of Community Resiliency Model Skills Trainings in Trauma Healing Among 1994 Tutsi Genocide Survivors in Rwanda

Background

Mental health among survivors of the 1994 Tutsi genocide in Rwanda remains poor, even after multiple efforts to assist those recovering from this trauma. The Community Resilience Model (CRM) is a biologically based set of skills that can be delivered in community settings by trained lay persons and has shown to significantly improve mental health in a number of settings and populations, though it has not been used with genocide survivors in Rwanda. This study assessed if the CRM training was able to improve mental health among genocide survivors.

Methods

A quasi-experimental design was used to evaluate the CRM intervention among Tutsi genocide survivors from the Huye, Nyamagabe and Nyaruguru districts in Southern Rwanda. Consenting participants completed a questionnaire before and six months after the training to assess their level of trauma, secondary traumatic stress, depression and skills to teach CRM skills to others.

Results

The findings revealed significant improvements across all trauma symptoms between the intervention and control group (t = 37, p<0.001). The CRM trainings also resulted in significant within-person declines of depressive symptoms (p < 0.001), perceived secondary traumatic stress (p = 0.003) and trauma-related symptoms (p = 0.002). Training participants also reported significant increases in perceived CRM benefits and satisfaction (p < 0.001).

Conclusion

The CRM intervention was found to be effective for improving mental health in 1994 Tutsi genocide survivors. Since CRM can be delivered by trained persons to groups of persons in community settings, it has a high potential for successful broader implementation and sustainability, which is critically important in an environment with few mental health resources.