Mediating effect of resilience on association among stress, depression, and anxiety in Indonesian nursing students

Evaluation of a psychological readiness program and final clinical practicum among final year nursing students: A mixed methods study

BACKGROUND

Final year nursing students may experience higher levels of stress owing to the increasing complexity and expectations from their clinical practicums. Enhancing psychological readiness may be a potential strategy to enhance nursing students' transition to the clinical area.

OBJECTIVE

To evaluate the effects of a psychological readiness enhancement for transition to professional practice program and a 10-week clinical practicum on students' psychological wellbeing, resilience, practice readiness and confidence.

DESIGN

A sequential mixed-methods approach comprising of a single-group evaluation and descriptive qualitative study.

SETTING

Final year nursing students enrolled in an undergraduate nursing program from one autonomous university in Singapore was recruited.

PARTICIPANTS

148 final year nursing students participated in the single-group evaluation study. A total of 24 participants who completed the psychological readiness program were recruited in the qualitative study.

METHODS

This study included two phases. Phase I comprised of an evaluation of a blended psychological readiness program and clinical practicum. Data was collected across three waves to assess nursing students' psychological wellbeing, resilience, practice readiness and confidence. In Phase II, a qualitative study using individual semi-structured online interviews was conducted to examine students' experiences of the psychological readiness program and clinical practicum.

RESULTS

The psychological readiness program led to significant changes in students' anxiety and patient centeredness scores. The accumulated effects of the psychological readiness and clinical practicum showed significant improvements in students' practice readiness and confidence. Although there were no significant improvements in depression, stress and resilience scores, there were improvements in the trend across three waves. Students attributed these improvements to the psychological readiness program and sharing by the alumni.

CONCLUSIONS

The findings of this study laid the foundation for the development of psychological readiness programs. However, larger scale studies using randomized controlled trial designs should be used to confirm the effects of these interventions.

Anxiety in Nursing Students during the COVID-19 Pandemic: Systematic Review and Meta-Analysis

OBJECTIVES

To analyse the influence of the COVID-19 pandemic on the development of anxiety in nursing students and the factors involved.

DESIGN

A systematic review and meta-analysis.

DATA SOURCE

PubMed, CINAHL, Scopus and Web of Science.

BACKGROUND

Nursing students are at an increased risk of developing mental overload, due to the presence of many sources of stress during their academic training. Therefore, the COVID-19 pandemic has had an impact on the mental health of the general population, especially on healthcare workers and consequently on students undertaking placements in healthcare settings.

METHODS

A systematic review was conducted using PubMed, CINAHL, Scopus and Web of Science databases. A total of 24 articles were included in the review, and 20 articles were selected for the meta-analysis.

RESULTS

We found that the anxiety scores of nursing students during the COVID-19 pandemic were slightly higher (50%) than before the pandemic. The most influential risk factors for developing anxiety were academics, age, gender, having children, living in urban areas or with family, having an addiction to social networks, and having a fear of becoming infected with COVID-19. Resilience, spiritual support and feelings of happiness protected students against the risk of developing high levels of anxiety.

CONCLUSIONS

The COVID-19 pandemic has led to increased levels of anxiety in nursing students. Thirty-five percent of the meta-analytically analysed sample had elevated levels of anxiety.

Stress, mental health, and protective factors in nursing students: An observational study

BACKGROUND

Nursing students suffer high levels of stress, especially in the first year.

OBJECTIVES

to compare academic stress at the beginning and end of nursing studies; to analyse the relationships between academic stress, mental health, and protective factors; and to examine whether resilience mitigates the effect of academic stress on psychological well-being.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Sample was 370 first- and fourth-year nursing students from Spain (University of Castilla-La Mancha, University of Cantabria, and University of Sevilla).

VARIABLES AND DATA COLLECTION

We assessed academic and clinical stress, coping skills, anxiety, depression, psychological well-being, and resilience were measured.

DATA ANALYSIS

We performed a descriptive analysis of the study sample, as well as correlation and hierarchical regression models. Additionally, mediation models were estimated.

RESULTS

First-year students presented higher academic stress than fourth-year students. Clinical stress, anxiety, depression, and emotional coping predicted academic stress, while academic stress, depression, and coping skills predicted psychological well-being. Mediation models showed a significant path between academic stress, resilience, depression, and psychological well-being.

CONCLUSION

Academic stress has a detrimental effect on the mental health. Coping strategies and resilience may be protective factors that should be encouraged in interventions designed to improve psychological well-being.

Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study

BACKGROUND

Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings.

OBJECTIVE

To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies.

DESIGN

Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis.

SETTING

Simulation laboratories in one university nursing school in Australia.

PARTICIPANTS

21 final year nursing students in seven teams.

METHODS

Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies.

RESULTS

Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness.

CONCLUSIONS

Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.

Promoting Nursing Student Mental Health Wellness: The Impact of Resilience-Building and Faculty Support

BACKGROUND

Being aware of elevated levels of student psychological distress by nursing faculty, and subsequently responding to it, may diminish nursing students' experience of negative mental health well-being.

PURPOSE

Relationships between perceived faculty support, resiliency, and the prevalence of depression, anxiety, and stress among undergraduate nursing students were explored.

METHODS

An exploratory mixed-methods design was used for this descriptive, cross-sectional study. The Depression, Anxiety, and Stress Scale-21, Brief Resilience Scale, Perceived Faculty Support Scale, a demographic questionnaire, and open-ended questions were used to collect data. A convenience sample of 989 undergraduate baccalaureate nursing students from across the United States completed the surveys.

RESULTS

Study results revealed resilience strategies and psychological and functional supportive faculty behaviors and actions are substantial predictors of lower depression, anxiety, and stress in undergraduate baccalaureate nursing students.

CONCLUSIONS

Investments in faculty development to support nursing student resilience may reduce the degree of negative mental health well-being that students exhibit related to nursing education and promote their successful transition to nursing practice.

The Mediating Effect of Resilience on the Relationship Between Symptom Burden and Anxiety/Depression Among Chinese Patients with Primary Liver Cancer After Liver Resection

Purpose

Primary liver cancer (PLC) is a common cancer of the digestive system. Patients with PLC often experience a heavy symptom burden and along with a significant levels of anxiety and depression after liver resection. High levels of symptom burden can lead to increased anxiety and depression, whereas high levels of resilience can alleviate these conditions. Therefore, we aimed to explore the relationships among symptom burden, resilience, and anxiety/depression in Chinese patients with PLC after liver resection and to determine whether resilience mediates the relationship between symptom burden and anxiety/depression.

Patients and Methods

A total of 223 postoperative PLC patients were recruited from two public hospitals in Anhui Province, China. All participants completed the MD Anderson Symptom Inventory (MDASI), Hospital Anxiety and Depression Scale (HADS), and Connor-Davidson Resilience Scale (CD-RISC). The mediating effect of resilience was estimated using the bootstrap method via IBM SPSS AMOS 26.0.

Results

The mean HADS score was 12.37 ± 6.03 points in postoperative PLC patients. Among these patients, 78 (34.98%) had anxiety, and 64 (28.70%) had depression, as indicated by a subscale score ≥ 8. Pearson correlation analysis revealed that anxiety/depression was positively associated with symptom burden (p < 0.05) and negatively associated with resilience (p < 0.05). Furthermore, resilience partially mediated the relationship between symptom burden and anxiety/depression (β = 0.04; 95% confidence interval: 0.01-0.08).

Conclusion

The levels of anxiety and depression in postoperative PLC patients should be decreased. Resilience partially mediated the relationship between symptom burden and anxiety/depression, but the indirect effect was much weaker than the direct effect of symptom burden on anxiety/depression. Consequently, rather than focusing primarily on resilience interventions, joint symptom-psychological interventions focusing on symptoms should be considered for patients with PLC after hepatectomy to reduce the levels of anxiety/depression.

The relationship between uncertainty and acute procedure anxiety among surgical patients in Chinese mainland: the mediating role of resilience

BACKGROUND

Surgery, as one of the main diagnostic and treatment methods, is a routine work in medical settings. Patients undergoing surgery often experience acute procedure anxiety due to uncertainty. There is ample evidence showing that uncertainty is a risk factor for the acute procedure anxiety in surgical patients. However, little is known about the psychological processes mediating this relationship. Therefore, this study aims to evaluate resilience as a mediator of the association between uncertainty and anxiety.

METHODS

A population-based cross-sectional survey with a convenience sampling method was conducted, involving 243 surgical patients in Jiaxing, Zhejiang province of China was carried out. Relevant data were collected by self-reporting questionnaires, including demographic characteristics questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS-C), Mishel's Illness Uncertainty Scale (MUIS), Connor-Davidson Resilience Scale (CD-RISC). Pearson correlation analysis was employed to examine correlations between various variables. A path model was used to assess the mediation effect of resilience with respect to uncertainty and acute procedure anxiety.

RESULTS

In the path model, uncertainty have an indirect effect on acute procedure anxiety through resilience. The results suggest that resilience has a mediating role in uncertainty and acute procedure anxiety among surgical patients.

CONCLUSIONS

These findings call for the development of interventions targeting the role of resilience in effectively predicting and preventing acute procedure anxiety and uncertainty among surgical patients.

Resilience and academic motivation's mediation effects in nursing students' academic stress and self-directed learning: A multicenter cross-sectional study

AIMS

To investigate the mediating role of resilience and academic motivation between academic stress and self-directed learning.

BACKGROUND

Academic stress in nursing students is a well-reported concept that affects resilience, academic motivation and self-directed learning. However, there is a dearth of studies investigating the mediating role of resilience and academic motivation between academic stress and self-directed learning.

DESIGN

Cross-sectional study and mediation analysis.

METHODS

Nursing students (n = 718) were recruited from five nursing schools via convenience sampling. Four self-report scales (Perception of Academic Stress Scale, Connor and Davidson Resilience Scale, Short Academic Motivation Scale and Self-directed Learning Instrument) were used to collect data from August to December 2022. Pearson's r, bivariate analysis and multistage regression analyses were employed to analyze the data.

RESULTS

Academic stress negatively influences nursing students' resilience, academic motivation and self-directed learning. Resilience and academic motivation have a positive impact on self-directed learning. Resilience and academic motivation mediate the relationship between academic stress and self-directed learning, as evidenced by a reduction in the negative impacts of academic stress on nursing students.

CONCLUSION

Resilience and academic motivation, as mediators, reduce the effects of academic stress on self-directed learning. Nursing educators and administrators should promote programs that strengthen resilience and academic motivation. Thus, improving educational and clinical performance.

Academic stress, COVID-19 anxiety, and quality of life among nursing students: The mediating role of resilience

AIM

This study investigated the mediating role of resilience in the relationship between academic stress, COVID-19 anxiety, and quality of life (QoL) among Filipino nursing students during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic has impacted the QoL of nursing students who are experiencing mental health issues. The mediating role of resilience in mitigating the effects of academic stress and COVID-19 anxiety on nursing students' QoL remains understudied.

METHODS

This study employed a correlational cross-sectional design, with a convenience sample of 611 Filipino nursing students. Data were collected using the scales Connor and Davidson Resilience, Brunnsviken Brief Quality of Life, COVID-19 Anxiety, and Perception of Academic Stress and analyzed using Pearson's r, bivariate analysis, and multistage regression analyses.

RESULTS

Academic stress and COVID-19 anxiety negatively correlated with QoL and resilience. Resilience was positively associated with QoL and reduced the effect of academic stress on QoL, indicating that resilience is a crucial mediating variable between academic stress and QoL. Finally, resilience had a significant mediating influence on QoL, as evidenced by a reduction in the effect of COVID-19 anxiety on QoL among nursing students.

CONCLUSIONS

Filipino nursing students' QoL was affected by academic stress and COVID-19-related anxiety. However, resilience mediated this impact, preserving QoL.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing colleges and affiliated hospitals must collaborate to monitor academic stress and pandemic-related anxiety. Nursing students should be provided with programs such as seminars and team-building activities to enhance their resilience.

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.

The moderating role of resilience in the relationship between state and trait anxiety and post-traumatic growth of medical freshmen

BACKGROUND

Psychological distress such as anxiety of medical students especially during the first-year has been widely acknowledged. However, many students could exhibit post-traumatic growth when experiencing anxiety. Previous study demonstrated that anxiety might have impacts on post-traumatic growth, but how anxiety affects post-traumatic growth is still undefined. This study sought to examine whether resilience has a moderating role between state and trait anxiety and post-traumatic growth when medical freshmen are experiencing stressful events.

METHODS

A total of 295 medical freshmen were administered the Post Traumatic Growth Inventory, the State-Trait Anxiety Inventory and the Connor-Davidson Resilience Scale.

RESULTS

Post-traumatic growth was negatively correlated with state anxiety and trait anxiety, with a correlation coefficient of -0.474 and -0.462 (p < 0.01), and positively correlated with resilience, with a correlation coefficient of 0.635 (p < 0.01). Resilience acted as a moderator for the indirect effect of state and trait anxiety on post-traumatic growth.

CONCLUSIONS

These findings demonstrated resilience could be of extreme importance for developing post-traumatic growth, and therapeutic interventions tailored to the medical freshmen to promote their resilience to adapt to life in college.

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.

The impact of social support and stress on academic burnout among medical students in online learning: The mediating role of resilience

Background

As the COVID-19 pandemic continues, online learning and long-term isolation from social and clinical settings has exacerbated mental health problems and symptoms of academic burnout among medical students. However, few studies have discussed symptoms of academic burnout as a result of reduced social support, and increased stress among medical students during the process of online learning. To fill this gap, this study investigated the influencing factors and mechanism of academic burnout in medical students' online learning process. Both the positive inhibition effect of positive factors such as social support, and the negative aggravation effect of negative factors such as stress were explored, while the mediating and protecting role of resilience is also discussed.

Method

We collected survey data from a total of 817 medical students from a medical school in China who participated in online learning during the fall 2021 semester. An online questionnaire was sent to the students in January, 2022. Items adapted from the DASS Scale developed by Lovibond and Lovibond were used to measure medical students' stress levels. The perceived social support of medical students was assessed by the Gregory MSPSS. Resilience was evaluated by the 10-Item Connor–Davidson Resilience Scale (CD-RISC). Items from the Maslach Burnout Inventory–Student Survey (MBI-SS) were used to calculate students' academic burnout. Descriptive analysis, correlation analysis, hierarchical linear regression analysis and structural equation modeling were used to analyze the collected data.

Results

The results identified that in the context of online learning there was a positive correlation between medical students' stress and academic burnout, and their resilience played a partial mediating role. However, social support did not directly affect academic burnout, but inhibited the prevalence of academic burnout through resilience. In addition, stress was negatively related to resilience, while social support was positively related to resilience. Resilience was found to be negatively related to medical students' academic burnout in online learning.

Conclusion

The results of this study can provide a reference for the future development of appropriate educational strategies and coping measures to ameliorate the academic burnout of medical students.

Coping with the Experience of Bad Sleep and Fatigue Associated with the Nursing Clinical Practicum

Nursing students experience anxiety during clinical practicum, which may interfere with their learning of clinical practice. This study explored the practicum anxiety symptom experience of clinical nursing students. The methodology was mixed research design consist of questionnaire and a qualitative research design following a grounded theory approach. Research data were gathered via theoretical sampling from 37 female college nursing students practicing in a Central Taiwan hospital and analyzed using the content analysis method. The mean age of the subjects was 20.7 ± 1.35 years old. The practicum-related anxiety symptom experience was made up of core dimensions associated with the nursing clinical practicum, such as bad sleep and fatigue, and covered six themes. Students first encountered anxiety-inducing situations in the clinical setting, and then they began coping through self-adaptation and teachers' help. In cases of coping failure, students began to have a bad sleep in the night and then felt tired and fatigued all day. These themes became a repeating cycle during the clinical practicum. This conceptual model shows that students experienced bad sleep and fatigue as a result of anxiety symptoms during the clinical practicum. Bad sleep and fatigue are critical anxiety symptoms for nursing students in clinical practice. Nursing teachers should pay attention to bad sleep and fatigue in nursing students and help students to improve their mental and physical health.

Correlation between Positive Orientation and Control of Anger, Anxiety and Depression in Nursing Students in Poland, Spain and Slovakia during the COVID-19 Pandemic

(1) This study analysed the relationship between positive orientation and subjective control of anger, anxiety and depression in nursing students in Poland, Spain and Slovakia during the pandemic. (2) The survey was carried out by the diagnostic survey method in a group of 756 nursing students in Poland, Spain and Slovakia. The empirical data were gathered using an original survey questionnaire, the Positive Orientation Scale and the Courtauld Emotional Control Scale. (3) It was shown that the positive orientation level in Polish students was significantly lower than in students in Spain (p < 0.0001) and Slovakia (p < 0.0001). Low results for positive orientation were obtained in nearly half (47.18%) of the respondents in the Polish sample, whereas it was 34.18% and 31.18% in the Spanish and Slovak samples, respectively (p < 0.0001). A positive orientation was the most important predictor of emotional control among the nursing students at all the sites (p < 0.0001). (4) Positive orientation has been shown to have a significant impact on emotional control in nursing students during the pandemic. Therefore, it is important to carefully monitor students' mental health during the pandemic to determine the demand for psychological and emotional support.

Resilience mediates the influence of hope, optimism, social support, and stress on anxiety severity among Chinese patients with cervical spondylosis

OBJECTIVE

Cervical spondylosis (CS) is a potential stressor threatening mental health among affected individuals. This study was to analyze resilience level and associated factors among cervical spondylosis (CS) patients, and to explore the underlying mechanism of anxiety based on resilience-focused psychological variables.

METHODS

Resilience Scale-14 (RS-14), Zung Self-Rating Anxiety Scale (SAS), Herth Hope Index (HHI), Revised Life Orientation Test (LOT-R), Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Stress Scale-10 (PSS-10) were used in this cross-sectional investigation among 250 CS patients.

RESULTS

The score of resilience was 65.58 ± 16.14. Hierarchical linear regression analysis revealed that hope, optimism, perceived social support, perceived stress, and whether having comorbid chronic diseases were the independent associates of resilience among CS patients, which explained 63.9% of the total variance. The structural equation model showed that hope, optimism, perceived social support and perceived stress affected anxiety via resilience, and hope and optimism also had direct effects on anxiety.

CONCLUSION

Chinese patients with CS had moderate level of mental resilience, which was independently related to hope, optimism, perceived social support, perceived stress, and whether having comorbid chronic diseases. Resilience played a mediating role between various psychological variables and anxiety. Improving the level of resilience, hope, optimism and perceived social support and reducing the level of perceived stress are important strategies to reduce anxiety level. Relevant healthcare professionals should put more focus on the mental problems of Chinese CS patients and help maintain good psychological status by improving their resilience and associated psychological variables thereof.