Pilot Testing of the NURSE Stress Management Intervention

Grit, resilience and growth-mindset interventions in health professional students: A systematic review and meta-analysis

OBJECTIVES

Grit, resilience and a growth-mindset influence students' ability to positively adapt to the challenges of health professional training. However, it is unclear if interventions can improve these traits. This systematic review aimed to explore if interventions can improve these traits in health professional students (primary) and their impact on academic and/or wellbeing outcomes (secondary).

METHODS

A comprehensive search of CINAHL, MEDLINE, Eric and Embase was conducted from inception until 15 March 2023. Randomised or non-randomised controlled trials and single-group intervention studies that aimed to improve health professional students' resilience, grit and/or growth-mindset were eligible for inclusion. Two reviewers independently screened studies for inclusion and evaluated quality using the Mixed Methods Appraisal Tool. Post-intervention data from randomised and non-randomised control trials were pooled using a random-effects model to calculate standardised mean differences (SMD) and 95% confidence intervals (CIs).

RESULTS

Resilience interventions improved resilience by a moderate amount in 13 studies with 990 participants (pooled SMD 0.74, 95%CI 0.03 to 1.46) and a large amount when interventions were greater than one session duration in 10 trials with 740 participants (pooled SMD 0.97, 95%CI 0.08 to 1.85). Grit and growth-mindset interventions improved grit (pooled SMD 0.48, 95%CI -0.05 to 1.00, n = 2) and growth-mindset (pooled SMD 0.25, 95%CI -0.18 to 0.68, n = 2) by a small amount. Resilience interventions decreased perceived stress by a small amount (pooled SMD -0.38, 95%CI -0.62 to -0.14, n = 5).

CONCLUSIONS

Resilience interventions improve resilience and decrease perceived stress in health professional students. Preliminary evidence suggests grit and growth-mindset interventions may also benefit health professional students. Interventions may be most effective when they are longer than one session and targeted to students with low baseline levels of resilience and grit.

The different areas of chronic stress and food addiction: Results from the LIFE-Adult-Study

There is an empirical association between stress and symptoms of food addiction (FA), but it is still not clear which domains of stress are the most relevant when it comes to FA, limiting the ability of researchers and practitioners to address problematic eating-related health outcomes. In order to address this gap in the literature, we analysed how different domains of chronic stress are related to FA. We used data from a subsample of the LIFE-Adult-Study (N = 1172), a German cohort study. We conducted a linear regression analysis with stress domains (Trier Inventory for Chronic Stress, TICS) as predictors of FA (Yale Food Addiction Scale, YFAS). In the second regression analysis we included sociodemographic variables, personality, and smoking as control variables. There was a significant and positive association between Social Overload, Work Discontent, Excessive Demands from Work, and Chronic Worrying and FA. After adding control variables, only Social Overload, Excessive Demands from Work, and Chronic Worrying remained significant predictors. Connections between stress domains and FA can serve as starting points for the development of meaningful interventions that support individuals self-care strategies (Social Overload), complexity management (Excessive Demands from Work), and coping with negative emotions (Chronic Worrying).

Potential resilience treatments for orangutans (Pongo spp.): Lessons from a scoping review of interventions in humans and other animals

Wild orangutans (Pongo spp.) rescued from human-wildlife conflict must be adequately rehabilitated before being returned to the wild. It is essential that released orangutans are able to cope with stressful challenges such as food scarcity, navigating unfamiliar environments, and regaining independence from human support. Although practical skills are taught to orangutans in rehabilitation centres, post-release survival rates are low. Psychological resilience, or the ability to 'bounce back' from stress, may be a key missing piece of the puzzle. However, there is very little knowledge about species-appropriate interventions which could help captive orangutans increase resilience to stress. This scoping review summarises and critically analyses existing human and non-human animal resilience literature and provides suggestions for the development of interventions for orangutans in rehabilitation. Three scientific databases were searched in 2021 and 2023, resulting in 63 human studies and 266 non-human animal studies. The first section brings together human resilience interventions, identifying common themes and assessing the applicability of human interventions to orangutans in rehabilitation. The second section groups animal interventions into categories of direct stress, separation stress, environmental conditions, social stress, and exercise. In each category, interventions are critically analysed to evaluate their potential for orangutans in rehabilitation. The results show that mild and manageable forms of intervention have the greatest potential benefit with the least amount of risk. The study concludes by emphasising the need for further investigation and experimentation, to develop appropriate interventions and measure their effect on the post-release survival rate of orangutans.

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.

Clinical stressors as perceived by first-year nursing students of their experience at Alexandria main university hospital during the COVID-19 pandemic

BACKGROUND

Clinical hospital stressors during the COVID-19 pandemic are one of the problems that affect the quality of education among first-year nursing students, particularly in the first 6 months of their practice.

OBJECTIVE

Assess the types and severity of clinical hospital stressors among first-year nursing students and investigate the relationship between students' clinical stressors and their level of worry from COVID-19.

DESIGN

A descriptive correlational research design. The study was conducted at the Faculty of Nursing, Alexandria's main university hospital. The study included a convenience sample of 200 first-year nursing students.

TOOLS

Socio-demographic and academic data of nursing students. The Perceived Stress Scale (PSS) is used to assess the degree and type of stressors.

RESULTS

The highest reported types of stressors were stress from the clinical hospital (M = 13.54) and stress from a lack of professional knowledge and skills (M = 13). Concerning the overall stressors, all students experienced a severe degree of stress (M = 116.87). Furthermore, students' age, sex, number of study hours/week, number of assignments/week, and worry from COVID 19 were highly statistically significant with degrees of perceived stress as (p = 0.000, 0.030).

CONCLUSION

Clinical hospital stressors had a significant negative impact on the majority of students' education in the hospital. As well as worrying about COVID 19, positively increased the perceived stressors of nursing students.

RECOMMENDATIONS

Implement an educational program for the first-year nursing students about clinical hospital stressors during COVID-19 and trained them how they can cope with these stressors by using stress management.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Evaluation of a Brief Stress Management Workshop for Incoming Nursing Students

The purpose of this study was to evaluate the effectiveness of a brief stress management workshop on nursing students' perceived stress and resilience. Students who received the stress management intervention during orientation had significantly higher resilience scores and lower stress scores 1 year later during COVID-19 than the comparison group.

The effectiveness of interventions and behaviour change techniques to reduce stress in student nurses: A systematic review

BACKGROUND

Student nurses experience stress leading to poor health and course attrition (Lovegrove, 2018).

OBJECTIVES AND DESIGN

This systematic review aimed to evaluate the effectiveness of interventions and 'behaviour change techniques' (BCTs) to reduce student nurse stress. BCTs are active components of interventions that are observable, replicable, irreducible and designed to change behaviour (Michie et al., 2013).

DATA SOURCES

Thirteen databases were searched from inception to May 2020.

REVIEW METHODS

The interventions were classified according to their target: 'stressors', 'coping', 'cognitive reappraisal' or a combination of these (Lazarus and Folkman, 1984). BCTs were coded using the BCT taxonomy: a hierarchical framework of BCTs (Michie et al., 2013).

RESULTS

28 interventions reported in 23 articles were included in the review. A positive effect was identified in 22 interventions. There were no studies addressing the stressors in isolation and the interventions targeting stressors in combination with coping (n = 1) or cognitive reappraisal (n = 1) found no significant effects. In contrast, 74% of those targeting coping alone (n = 14/19), 100% of those addressing coping and cognitive reappraisal together (n = 4/4) and 66% addressing all three targets together (n = 2/3) were successful. The most common BCTs provided students with information and skills relating to stress management, with 18/21 being successful >50% of the time.

CONCLUSIONS

Overall, most interventions aimed to teach students skills to cope with stress, with the majority having a short-term effect. However, as some interventions and BCTs were infrequently used or poorly described and all studies had a medium-high risk of bias, there is a need for longitudinal high-quality studies.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Improving mental health of student and novice nurses to prevent dropout: A systematic review

Aims

To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout‐related outcomes.

Design

Systematic review.

Data sources

Research papers published between January 1971–February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar.

Review methods

We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer‐reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout‐related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta‐analysis of studies was performed.

Results

We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout‐related outcomes. The overall risk of bias was high.

Conclusion

A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high‐quality studies in this field, preferably with a randomized controlled design.

Spiritual Coping with Stress Among Emergency and Critical Care Nurses: A Cross-Sectional Study

A cross-sectional study using Spiritual Coping Questionnaire (SCQ) to explore the spiritual stress coping among Muslim Emergency and Critical Care nurses. 113 Participants were recruited. SCQ demonstrated good validation estimates. Positive religious behavior was the main spiritual coping with job stress. Likewise, spiritual coping was highly perceived as religious. Critical care nurses reported significantly higher positive social coping. Nurses with longer work experiences were significantly better in positive spiritual coping. Spiritual coping practices are highly prevalent in healthcare settings despite still lacking integration of spiritual components in its physical infrastructure, health policy and management.

Exploring the relationship between resilience and grit among nursing students: A correlational research study

BACKGROUND

Nurse turnover is a critical issue around the world. Finding factors that can increase job persistence in nursing can have a positive impact on both the quality and cost of health care. Resilience and grit have been studied as factors that help an individual persist in the pursuit of their goals. Resilience and grit are related terms that have frequently been used interchangeably, although some studies suggest that they are different constructs. Determining if they are different constructs is important as we seek to develop qualities in new nurses that increase their job persistence and satisfaction.

OBJECTIVES

The purpose of this study was to explore the relationship between resilience and grit in pre-licensure nursing students.

DESIGN/SETTING

This descriptive correlational study was conducted at a midsize private University in the United States.

PARTICIPANTS

The convenience sample consisted of students from 3 pre-licensure programs: Traditional Bachelor of Science in Nursing (TBSN), Accelerated Bachelor of Science in Nursing (ABSN) and Direct Entry Masters of Science in Nursing (DEMSN). The final sample was 348 students: 79% TBSN, 7% ABSN and 14% DEMSN.

METHODS

Resilience was measured with the Conner-Davidson Resilience 10 item scale. Grit was measured utilizing the Short Grit Scale.

RESULTS

Inspection of the interfactor correlations suggest that resilience and grit scales are distinct, though tend to correlate well. Notably, the relationship between resilience and the persistent effort component of grit was moderate. That correlation was higher than the relationship between the consistent interest component of grit and resilience.

CONCLUSION

This study concludes that grit and resilience are related concepts but are not synonymous. Being mindful of the difference in these two attributes may be important in the development of educational offerings in both Schools of Nursing and in new nurse residency programs to increase retention in nursing.

Distraction-focused interventions on examination stress in nursing students: Effects on psychological stress and biomarker levels. A randomized controlled trial

BACKGROUND

Nursing students all over the world experience high levels of stress with negative impacts on their health, emotional state and performance.

AIM

This study aimed to investigate the effects of distraction-focused interventions on examination stress and anxiety in nursing students.

METHODS

A randomized controlled, parallel trial design was conducted from January to June 2016. After baseline measurement, 72 participants were randomized to one of the following groups (n = 18 each): (i) animal-assisted therapy; (ii) music therapy; (iii) mandala painting; (iv) control group. Outcomes of all groups in terms of stress-reduction were compared by measuring self-reported perceived stress (STAI-State and visual analogue stress scale) and salivary biomarker levels (Cortisol and Immunoglobulin A).

RESULTS

Fifty-seven complete data sets (n = 12-16 for each group) were analysed. All distraction-focused interventions showed stress and anxiety reduction in everyday school situations. By contrast, on days with examinations, stress reductions did not reach statistical significance in regard to self-reported psychological stress. At the same time, interventions resulted in significantly decreased levels of stress biomarkers (P < .001).

CONCLUSIONS

Our preliminary findings suggest positive but situation-dependent effects of distraction-focused interventions in academic settings. Further research should investigate the complex relationship between physiological and psychological stress parameters.

Not Just Tools to Handle It: A Qualitative Study of Nursing Students' Experiences From Participating in a Cognitive Behavioral Stress Management Intervention

Background. Stress-related problems are an increasing challenge within nurse education since it affects learning, professional development, and mental health negatively. Despite this, knowledge is scarce regarding nursing students' experiences of being in stress management interventions. Aim. This study aimed to describe how nursing students experienced a preventive cognitive behavioral therapy-based stress management intervention. Method. Data were collected through 14 semistructured interviews with nursing students who had participated in a stress management intervention, and analyzed using inductive qualitative content analysis. Results. The analysis yielded one theme, Turning points, which consisted of four categories: (1) more in touch with reality, (2) increased self-confidence, (3) improved communication skills, and (4) a new way of reflecting. Discussion. Findings emphasize the importance of both theoretical and structural aspects when planning a stress management training intervention. A group format delivery in combination with a multicomponent cognitive behavioral intervention can be interrelated elements for positive stress-related changes. Conclusion. Our findings indicate that participants developed new and more adaptive coping strategies, which were attributed to the intervention. The participants expressed that they had increased their ability to reflect, which led to increased insight and self-reflection. The intervention constitutes an example of a contribution to stress management research and provides information for stress management training initiatives in nurse education.

Retention of Nursing Students: An Integrative Review

AIM

The purpose of this integrative review is to identify ways to decrease student attrition in schools of nursing.

BACKGROUND

Many nursing students have anxiety, lack finances, face an absence of faculty or peer support, and have decreased overall satisfaction with the realities of nursing. This integrative review demonstrates that a significant percentage of nursing students leave school before completing their program.

METHOD

Manuscripts were selected for this study to evaluate effective interventions to increase retention rates for first-year nursing students. Seventeen studies met inclusion criteria.

RESULTS

Interventions to decrease attrition include effective teaching methods and styles; utilization of an advisor, clinical coach, or mentor; stress reduction; faculty support; students' background; and perceptions of nursing.

CONCLUSION

Educators have the option of using several supportive measures to decrease attrition in nursing programs.

Academic stress and active learning of nursing students: A cross-sectional study

BACKGROUND

The active role of nursing students is particularly important in the delivery of health care, since playing an active role at the bedside and the use of active and collaborative engagement of students in the nursing activities has been associated with improved student learning. This is consistent with Karasek's learning hypothesis, but it has never been tested on nursing students. This study aimed at investigating whether nursing students in high control conditions reported lower levels of work impairment than students in the conditions with low control, compared them with a group of healthcare workers (HCWs), and tested the moderating role of social support at work.

METHODS

633 nursing students and 160 HCWs completed the Nursing Work Functioning Questionnaire (NWFQ), and the Demand-Control-Support questionnaire (DCS).

FINDINGS

Results showed that nursing students reported higher levels of work impairment and were less likely to be classified as active (high demand/high control) or low strain (low demand/high control) than HCWs, and that social support at work moderated the association between being in active or low strain condition and work impairment.

CONCLUSIONS

Programs to enhance the learning of nursing students must not only fight strain and isolation but must also promote active learning, by increasing the control over the job, team work, and support from teachers.

Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study

Background

Nursing students in the clinical setting experience a high level of stress. The understanding of people involved in nursing education, from coping strategies of nursing students with clinical stress, is highly important for any kind of planning in this field.

Objective

To explore the coping strategies of Iranian nursing students with stress in a clinical setting.

Methods

This qualitative content analysis study was carried out with twenty nursing students who were selected using purposive sampling at the Razi nursing and midwifery school in Kerman, in Iran during a ten-month period in 2016. Data were collected using semi-structured face to face interviews, and analyzed through Graneheim and Lundman's qualitative content analysis method.

Results

"Seeking well-being" as the main theme and three categories of "Active confrontation with stress", "mastering the mind and body" and "avoidance" were obtained from data analysis.

Conclusion

The exploration of nursing students' experiences of coping with clinical stressors, increases students' awareness of their coping strategy. The academic authorities in recognizing the coping strategies of students with stress in clinical setting, can provide necessary training on effective coping strategies for students.