Stress Management and Resiliency Training for Healthcare Professionals: A Mixed-Methods, Quality-Improvement, Cohort Study

Effect, feasibility, and acceptability of a Comprehensive Active Resilience Education (CARE) program in emergency nurses exposed to workplace violence: A quasi-experimental, mixed-methods study

BACKGROUND

Workplace violence (WPV) against emergency nurses has been common but unavoidable. Promoting resilience may mitigate the subsequent health harms of workplace violence. Current interventions mainly focused on internal factors related to resilience, though the external factors can influence personal growth.

AIM

To test the effect, feasibility, and acceptability of a Comprehensive Active Resilience Education (CARE) program on promoting resilience in emergency nurses exposed to workplace violence.

DESIGN

This is a two-armed quasi-experimental using mixed methods, following the TREND checklist.

METHODS

This study was conducted from March 2023 to July 2023 in a tertiary hospital in Shanghai, China. Emergency nurses exposed to workplace violence were recruited using cluster sampling and allocated to the intervention and control groups. The intervention group received the CARE program. The control group received no intervention.

RESULTS

71participants were recruited and no participants withdrew during the intervention. The resilience and anxiety scores displayed a significant effect in the group*time interaction effect. After four months, the intervention group demonstrated a significant improvement in resilience and anxiety scores. The intervention group showed greater improvement in coping, perceived organizational support, and depression scores compared to the control group. Two themes of joyful engagement experience and effective intervention were identified from qualitative interviews with the intervention group.

CONCLUSION

The Comprehensive Active Resilience Education (CARE) program was effective, feasible, and acceptable in increasing resilience in emergency nurses exposed to workplace violence. The CARE program we developed can be replicated and integrated into systematic education programs for all nurses to help them maintain their mental health and good job performance while dealing with workplace violence.

Trait emotional intelligence as a predictor of resilience among undergraduate nursing students: A structural equation modelling approach

BACKGROUND

There is a growing interest in understanding the role of trait emotional intelligence and resilience. However, few studies have examined the relationships between the various factors of trait emotional intelligence and resilience.

OBJECTIVE

To examine the factors of trait emotional intelligence and resilience using a structure equation modelling approach.

DESIGN

A quantitative exploratory design using structural equation modelling approach.

SETTING

One university in Singapore.

PARTICIPANTS

A total of 300 undergraduate nursing students were included in this study.

METHOD

A quantitative exploratory study using the structural equation modelling technique was conducted. The Trait Emotional Intelligence Questionnaire and Brief Resilience Scale were used to examine the relationships between trait emotional intelligence and resilience. The data analyses were conducted using SPSS and AMOS software.

RESULTS

The structural equation model found relationships between the various factors of trait emotional intelligence. There were associations between self-control, sociability, and emotionality scores with well-being scores. In addition, there is a relationship between emotionality and well-being scores on resilience scores.

CONCLUSIONS

The findings from this study illustrate the complex relationships between the various factors of trait emotional intelligence, and specifically how these factors are related to each other and resilience. The findings of this study propose that emotional intelligence are associated with one's resilience. For this reason, these findings will be important in the development of future resilience programs.

Mindfulness-Based Group Medical Visits: Strategies to Improve Equitable Access and Inclusion for Diverse Patients in Cancer Treatment

Background

Mindfulness-based interventions (MBIs) are supported by clinical practice guidelines as effective non-pharmacologic interventions for common symptoms experienced by cancer patients, including anxiety, depression, and fatigue. However, the evidence predominately derives from White breast cancer survivors. Racial and ethnic minority patients have less access to integrative oncology care and worse cancer outcomes. To address these gaps, we designed and piloted a series of mindfulness-based group medical visits (MB-GMVs), embedded into comprehensive cancer care, for racially and ethnically diverse patients in cancer treatment.

Methods

As a quality improvement project, we launched a telehealth MB-GMV series for patients undergoing cancer treatment, delivered as four weekly 2-hour visits billable to insurance. Content was concordant with evidence-based guidelines and established MBIs and adapted to improve cultural relevance and fit (eg, access-centered, trauma-informed, with inclusive communication practices). Program structure was adapted to address barriers to participation, with ≥50% slots per series reserved for racial and ethnic minority patients. Intake surveys incorporated a demographic questionnaire and symptom assessments. Evaluations were sent following the visits.

Results

In our first ten cohorts (n = 78), 80% of referred patients enrolled. Participants were: 22% Asian, 14% Black, 17% Latino, 45% non-Latino White; 65% female; with a median age of 54 years (range 27-79); and 80% had metastatic cancer. Common baseline symptoms included lack of energy, difficulty sleeping, and worrying. Most patients (90%) attended ≥3 visits. On final evaluations, 87% patients rated the series as "excellent"; 81% "strongly agreed" that they liked the GMV format; and 92% would "definitely" recommend the series to others. Qualitative themes included empowerment and connectedness.

Conclusion

Telehealth GMVs are a feasible, acceptable, and financially sustainable model for increasing access to MBIs. Diverse patients in active cancer treatment were able to participate and reported high levels of satisfaction with this series that was tailored to center health equity and inclusion.

Decision Fatigue in Emergency Medicine: An Exploration of Its Validity

Emergency physicians face a relentless stream of complex, high-stakes decisions in a fast-paced and dynamic environment. The concept of decision fatigue, a phenomenon characterized by a decline in the quality of decision-making after a long sequence of choices, has garnered increasing attention within healthcare. Several investigations show that the number and complexity of decisions made during prolonged shifts correlate with increased self-reported fatigue; however, the effect on clinical decision quality is uncertain. Conversely, a subset of studies found no clear relationship between decision fatigue and errors in clinical judgment. Importantly, some researchers argue that decision fatigue may be mitigated by factors such as experience, training, and support systems. This narrative review highlights the existing literature on decision fatigue among emergency physicians and explores whether this concept holds as a valid concern or remains a myth in the context of their practice.

Complementary and integrative health therapies in whole person resilience research

Complementary and integrative health approaches can improve health and well-being, as well as play an important role in disease prevention. The concept of whole person health builds on these concepts by empowering individuals, families, communities, and populations to improve their health in multiple interconnected domains: biological, behavioural, social, and environmental. Research on whole person health involves studies of interconnected biological systems and complex approaches to prevention and treatment. Some of these approaches may involve methods of diagnosis and therapy that differ from those used in conventional Western medicine. Of growing interest is how complementary, integrative, and whole person health approaches contribute to resilience. This brief commentary describes an integrated framework for mapping the connections between various complementary and integrative health therapeutic inputs onto aspects of resilience, including the ability to resist, recover (partially or fully), adapt, and/or grow in response to a following a stressor. The authors present selected examples of research studies supported by the National Institutes of Health that test whether complementary and integrative health approaches can promote some aspect of resilience. We conclude with a discussion of the challenges and opportunities in incorporating the study of resilience in complementary, integrative, and whole person health research.

The Relationship between Perceived Social Support and Life Satisfaction: The Chain Mediating Effect of Resilience and Depression among Chinese Medical Staff

Medical staff are direct providers of medical services and a key element in the development of health services, and their life satisfaction is important to both their work satisfaction and their patients' satisfaction, subsequently influencing the quality of medical care in general. This cross-sectional study aimed to explore the mechanisms underlying the influence of perceived social support on medical staff's life satisfaction. Convenience sampling was used to recruit participants from two non-tertiary hospitals in Shaoguan City, Guandong Province, China. A total of 533 medical staff completed the Multidimensional Scale of Perceived Social Support, the Satisfaction with Life Scale, the Connor and Davidson Resilience Scale, and the depression subscale of the Depression, Anxiety, and Stress Scales (DASS-21). The results showed that perceived social support could influence medical staff's life satisfaction not only through the separate effects of resilience and depression, but also through the chain mediation effect of resilience and depression. This study suggests that reducing the depressive symptoms of medical staff and improving their perceived social support as well as resilience could help to enhance their life satisfaction.

Qualitative Findings for Supporting Newly Graduated Nurse and Teacher Sleep During Their First Year

BACKGROUND

New graduate role transition for nurses and teachers is stressful. Poor adaptation may manifest as insomnia, which has implications for the new professionals, their employers, and the public served. This study examines factors that impact new graduate sleep, with the aim of identifying perceived helps and hindrances to sleep-during-transition.

METHODS

Targeted content analysis of transcripts from a larger longitudinal mixed methods study comparing new graduate sleep during their first year of practice. Study participants (N = 21) answered questions in the final interview regarding the most positive and negative impact(s) on sleep during the transition year. Transcripts were analyzed and compared based on the new graduate sleep typology (i.e., Got Better, Got Worse, Stayed Varied) which emerged from the parent study.

FINDINGS

Most participants, regardless of sleep type, identified a person/group as most positively impacting sleep. They identified work thoughts, stress/anxiety, people, work hours/sleep schedules, and environmental factors as negatively impacting sleep. Work thoughts and stress/anxiety were mentioned together and most frequently by participants in all three sleep types.

CONCLUSION/APPLICATIONS TO PRACTICE

This study provided insight into new graduate nurse and teacher sleep during transition. Support persons and/or groups may be essential regardless of sleep type. Thought management/stress mitigation strategies and good sleep hygiene may also improve the sleep experiences of these new professionals. Occupational health nurses can support sleep-during-transition among new nurses and teachers by acting as sleep advocates. They may also identify a need for medical intervention and/or sleep specialists and should promote fatigue risk mitigating policies.

Frontline healthcare workers' mental distress, top concerns, and assessment on hierarchy of controls in response to COVID-19: a cross-sectional survey study

BACKGROUND

The existing studies showed that frontline healthcare workers during an epidemic experienced unusual stressors and mental distress which even lasted for years after the crisis. It is important to learn about their concerns early to mitigate the negative impact as well as to evaluate disease control from experiences on the front lines for improving responses to the outbreak. The study aimed to provide insights on how to strengthen public health responses to protect healthcare workers both physically and mentally, and effectively control the disease in light of hierarchy of controls.

METHODS

A cross-sectional survey was distributed online via Qualtrics to frontline healthcare workers during the COVID-19 through a university's nursing program and received 267 valid responses from 103 certificated nursing assistants, 125 nurses, and 39 other health professionals. A descriptive data analysis with a Chi-square test at a two-sided 0.05 level of significance was performed on factors that potentially affected mental health of healthcare workers and effectiveness of disease control at workplace in five domains. The themes were summarized on open-ended questions.

RESULTS

About 30% of the respondents showed the symptom of depression and needed a further investigation. The influencing factors in five domains were examined. Engineering and administrative controls, as well as PPE were widely used in response to COVID-19. The respondents assessed the state and workplace responses to COVID-19 better than the federal government responses. The workplace responses were considered most effective. Multiple factors with a statistically significant correlation with effectiveness of the disease control at workplace were identified.

CONCLUSIONS

The study suggested that timely responses at policy level will be more effective than other measures in early prevention and control of the pandemic, mental distress should be addressed in addition to PPE, and nursing programs should consider providing a situation-specific career coaching or counseling for students. A longitudinal study at a larger scale is warranted to capture the variation of time change with the disease control evolvement and across geographic regions.