Promoting resilience in mental health nurses: A partially clustered randomised controlled trial.

BACKGROUND: There is a critical global shortage of nurses in mental health, with workforce attrition due in large part to workplace stressors. Proactive strengths-based interventions to strengthen nurses' capacity to manage stress and improve mental health, wellbeing and resilience may also support workforce retention. OBJECTIVE: To determine the effects of a resilience-building programme on mental health nurses' coping self-efficacy (primary outcome), and psychological distress, wellbeing, resilience, posttraumatic growth, emotional intelligence behaviours, workplace belonging, and turnover intention (secondary outcomes). DESIGN: Partially clustered randomised controlled trial. SETTING: Large tertiary metropolitan mental health service in Australia. PARTICIPANTS: A total of 144 registered and enrolled nurses working clinically ≥0.6 full-time equivalent (73/intervention, 71/control), with 122 completing 3-month follow-up. METHODS: The Promoting Resilience in Nurses programme is an evidence-based workplace intervention delivered by trained facilitators across two workshops. Surveys were administered online upon registration and prior to randomisation (Time 1) into Intervention or Control (no intervention) arms, and immediately after the final workshop (Time 2), and at three months follow-up (Time 3). Linear mixed models for outcome measures were fitted to Time 2 and 3 responses. RESULTS: There were seven intervention groups, with seven to 13 participants per group. Coping self-efficacy improved at Time 2 (estimated intervention effect 21.2 units, 95 % Confidence Intervals: 13.3 to 29.0) and Time 3 (12.1 units, 4.7 to 19.6), as well as wellbeing (Time 2: 9.2 units, 5.0 to 13.4), resilience (Time 2: 0.24 units, 0.01 to 0.46) and posttraumatic growth (Time 2: 16.1 units, 7.0 to 25.3). Psychological distress reduced (Time 2: -3.7 units, -6.2 to -1.31). All were sustained at three months. Emotional intelligence behaviours were improved (Time 2: 3.5 units, 0.6 to 6.5) but not sustained. Workplace belonging improved at Time 3 (0.34 units, 0.02 to 0.65) only. No statistically significant effects for turnover intention. CONCLUSIONS: Despite major contextual challenges, the Promoting Resilience in Nurses programme achieved the aims of promoting nurses' efficacy to cope with stress and regulate their emotions and improving mental health and wellbeing. The findings support the programme as a feasible and successful intervention for nurses across other settings and contexts. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12620001052921). Registered 15/10/2020. First recruitment 04/02/2021. TWEETABLE ABSTRACT: Promoting Resilience in Nurses intervention improved coping self-efficacy, wellbeing, resilience, posttraumatic growth, emotional intelligence and psychological distress.

Psychological distress, well-being, resilience, posttraumatic growth, and turnover intention of mental health nurses during COVID-19: A cross-sectional study.

Mental health nurses (MHNs) experience a range of stressors as part of their work, which can impact their well-being and turnover intention. There is no prior evidence, however, on MHNs' mental health, well-being, resilience, and turnover intention during the COVID-19 pandemic. The aims of this online survey-based cross-sectional study, conducted during the pandemic, were to explore the psychological distress, well-being, emotional intelligence, coping self-efficacy, resilience, posttraumatic growth, sense of workplace belonging, and turnover intention of n = 144 Australian mental health registered and enrolled nurses; and explore relationships between these variables, in particular, psychological distress, well-being, and turnover intention. There was a higher percentage of MHNs with high (27.78%) and very high psychological distress (9.72%) compared to population norms as measured by the K10. Emotional intelligence behaviours were significantly lower than the population mean (GENOS-EI Short). Coping self-efficacy was mid-range (CSES-Short). Resilience was moderate overall (Brief Resilience Scale), and posttraumatic growth was mid-range (Posttraumatic Growth Inventory; PTGI). Sense of workplace belonging was moderate, and turnover intention was low. Higher levels of psychological distress were associated with higher turnover intention, and lower workplace belonging, coping self-efficacy, well-being, resilience, and emotional intelligence behaviours. Despite the levels of psychological distress, nearly half the sample (n = 71) was 'flourishing' in terms of well-being (Mental Health Continuum Short-Form). To help prevent staff distress in the post-pandemic period, organisations need to proactively offer support and professional development to strengthen staff's psychological well-being, emotional intelligence, and resilience skills. These strategies and group clinical supervision may also support lower turnover.

Mental health nurses' experience of resilience during COVID-19: A qualitative inquiry.

The COVID-19 pandemic created unprecedented demands and additional stress for nurses in mental health settings. There is no prior evidence on nurses' experience of building and maintaining resilience in the context of work during COVID-19. The aim of this study was to explore the experience and impacts of the COVID-19 pandemic on the resilience of nurses in mental health settings. Data from semi-structured interviews with 20 nurses from an Australian mental health service were analysed using reflexive thematic analysis. Four main themes were generated: experiencing significant disruptions; making sense of shared chaos; having professional commitment; and growing through the challenges. Nurses' practice and teamwork were disrupted by COVID-19 related changes to care models and infection prevention policies. They successfully adjusted by having awareness of self and others' emotions, using mental and emotional self-regulatory strategies, engaging in self-care, using 'bricolage' to create different ways to provide care, and having mutually supportive relationships. Nurses connected to their sense of purpose and professional commitment to fuel their therapeutic work and sustain care delivery. They experienced personal and professional growth with an increased understanding of their strengths and resilience. In the post-pandemic period, although the challenges presented by the pandemic have lessened, there are ongoing negative impacts on nurses' wellbeing. To maintain and strengthen their wellbeing and practice, the findings indicate the importance of professional development in emotional regulation skills, and strategies to strengthen self-care and build collegial relationships in teams. Resilience education can be implemented to support nurses' resilient practice skills.

Resilience and mental health nursing: An integrative review of updated evidence.

Mental health nursing work is challenging, and workplace stress can have negative impacts on nurses' well-being and practice. Resilience is a dynamic process of positive adaptation and recovery from adversity. The aims of this integrative review were to examine and update understandings and perspectives on resilience in mental health nursing research, and to explore and synthesize the state of empirical knowledge on mental health nurse resilience. This is an update of evidence from a previous review published in 2019. Using integrative review methodology, 15 articles were identified from a systematic search (July 2018-June 2022). Data were extracted, analysed with constant comparison method, synthesized narratively and then compared with the findings from the original review. As an update of evidence, mental health nurse resilience was moderate to high across studies, was positively associated with psychological well-being, post-traumatic growth, compassion satisfaction and negatively associated with burnout, mental distress and emotional labour. Lack of support and resources from organizations could negatively impact nurses' ability to maintain resilience and manage workplace challenges through internal self-regulatory processes. A resilience programme improved mental health nurses' awareness of personal resilience levels, self-confidence, capacity to develop coping skills and professional relationships. Some studies continue to lack contemporary conceptualizations of resilience, and methodological quality varied from high to low. Further qualitative and interventional research is needed to investigate the role of resilience in mental health nursing practice, personal well-being, workforce sustainability and the ongoing impacts of the COVID-19 pandemic.

Protocol for a mixed methods process evaluation of the Promoting Resilience in Nurses (PRiN) trial.

Mental health nurses are exposed frequently to occupational stress and can experience a range of negative impacts on their well-being and intention to stay in the nursing workforce. Promoting Resilience in Nurses (PRiN) is a strength-based resilience education programme that incorporates evidence-based cognitive behavioural and interpersonal approaches with post-traumatic growth theory. A partially clustered randomized controlled trial at a large public mental health service will be used to examine the effects of PRiN on mental health nurses' coping self-efficacy, resilience, well-being, mental health, emotional regulation, post-traumatic growth, workplace belonging, and turnover intention as compared to controls. Process evaluations are increasingly used to help understand and interpret trial results for complex interventions. This paper describes the protocol for an embedded mixed methods process evaluation that aims to evaluate the PRiN programme implementation and identify factors that may explain variation in participant outcomes in the trial. Data collection includes a programme participant satisfaction survey; a follow-up semi-structured interview with selected programme participants; a unit/team manager survey on barriers and facilitators to staff recruitment and programme participation; and a fidelity checklist completed by programme facilitators. Normalisation Process Theory will be used to inform data analysis and integration. The findings will provide insights into factors that affect programme implementation, particularly in the context of the COVID-19 pandemic and may help explain differences in participant outcomes. Findings will also inform post-trial programme sustainability as well as potential future upscale and adaptation for implementation across healthcare settings.

Parental Preference for Treatment Location and Inclusion in Decision Making in Painful Pediatric Procedures: Towards an Evidence-Based Clinical Guideline.

PURPOSE: To determine parental preference for treatment location of painful procedures for pediatric patients, and the involvement of parents in decision-making about procedure location. DESIGN AND METHOD: A descriptive survey design was applied. Parents of hospitalized children were asked what procedures their child had undergone, where the procedures were performed, who decided on the location, what their preference was, and why. Data was collected over a twelve-day period in seven wards of a tertiary pediatric hospital. RESULTS: Of 312 different procedures, 244 (78%) were performed in the patient's room. The treatment room was reserved for complex procedures such as lumbar punctures. Seventy-three percent of parents surveyed indicated a strong preference for procedures to be performed in the patient's room, with the most common reason being 'comfortability'. Parents were only involved in procedure location decision-making in 50% of the reported cases. CONCLUSIONS: For parents, the patient's room is the preferred location for many procedures. The opinion of parents was not always taken into consideration by health care professionals, in contrary to the principles of patient-centered care. These findings are important for health care professionals in pediatric settings to reconsider the location of procedures and how parents are involved in decision making.

Fast and safe: Optimising multiple sclerosis infusions during COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic challenges multiple sclerosis services to be innovative in delivering infusible therapies. To reduce time in clinical settings, and potential staff or space losses, we implemented rapid infusion protocols for selected patients. OBJECTIVE: To analyse the rate of infusion related reactions and patient experience of rapid infusions of natalizumab and ocrelizumab. To document time reduction patients spent in clinical settings during the COVID-19 pandemic. METHODS: Patients with prior exposure to at least three natalizumab or two 300mg ocrelizumab infusions were approved for rapid protocols. A retrospective audit and survey were completed. RESULTS: We analysed 269 rapid natalizumab infusions and 100 rapid ocrelizumab infusions. Infusion related reactions during the natalizumab or ocrelizumab infusions occurred in two patients (1.52%) and eight patients (8%), respectively. All infusion related reactions were mild to moderate and did not require infusion discontinuation. No infusion reactions occurred during the post-infusion observation. Patient experience was positive. CONCLUSION: Frequency or severity of infusion related reactions in rapid infusions were no different compared to published data. In the setting of COVID-19, pandemic rapid infusion protocols could potentially save hospital resources and limit patient exposure to a high-risk clinical setting while still maintaining ongoing treatment of multiple sclerosis.