Second Victim Experiences of Health Care Learners and the Influence of the Training Environment on Postevent Adaptation.

Objective: To investigate the experience of medical and graduate learners with second victim experience (SVE) after medical errors or adverse patient outcomes, including impact on training and identification of factors that shape their postevent recovery. Patients and Methods: The validated Second Victim Experience and Support Tool-Revised (SVEST-R), Physician Well-Being Index, and supplemental open-ended questions were administered to multidisciplinary health care learners between April 8, 2022, and May 30, 2022, across a large academic health institution. Open-ended responses were qualitatively analyzed for iterative themes related to impact of SVE on the training experience. Results: Of the 206 survey respondents, 144 answered at least 1 open-ended question, with 62.1% (n=91) reporting at least 1 SVE. Participants discussed a wide range of SVEs and indicated that their postevent response was influenced by their training environment. Lack of support from supervisors and staff exacerbated high stress situations. Some trainees felt blamed and unsupported after a traumatic experience. Others emphasized that positive training experiences and supportive supervisors helped them grow and regain confidence. Learners described postevent processing strategies helpful to their recovery. Some, however, felt disincentivized from seeking support. Conclusion: This multidisciplinary study of learners found that the training environment was influential in postevent recovery. Our findings support the need for the inclusion of education on SVEs and adaptive coping mechanisms as part of health care professional educational curriculums. Educators and health care staff may benefit from enhanced education on best practices to support trainees after stressful or traumatic patient events.

Efficacy of resilience interventions for dyads of individuals with brain injury and their caregivers: A systematic review of prospective studies.

BACKGROUND: Acquired brain injury (BI) is associated with negative mental health outcomes for both people with BI, their caregivers (CG), and patient-CG dyads, which may be mitigated through increased resilience. However, little is known regarding the efficacy of resilience interventions focused on CGs of individuals with BI, as well as dyads, which may be instrumental for positive outcomes. OBJECTIVE: To systematically review the evidence of the efficacy of resilience interventions focused on CGs and/or dyads of individuals with BI. METHODS: A search of MEDLINE, Embase, APA PsycINFO, CINAHL with Full Text, Scopus, SCIE, and ESCI was conducted. Each title and abstract were screened by two authors independently. Each full text review, study data extraction, and study quality assessment was performed independently by two authors. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. RESULTS: Out of 11,959 articles retrieved, 347 full text articles were assessed for review and 18 met inclusion criteria for data extraction and quality assessment. Resilience interventions were stratified into 5 different categories based on the type of intervention. CONCLUSION: This systematic review suggests that dyadic/CG resilience interventions may improve mental health related outcomes, but conclusions were limited secondary to heterogenous outcomes and lack of a standardized resiliency construct. Future efforts are compulsory to create a standardized resiliency construct and associated outcomes focused on persons with BI, their CGs, and dyads.

Feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor and their family caregivers.

BACKGROUND: Practice guidelines and research results emphasize the need for dyadic interventions targeting psychosocial outcomes such as depression, anxiety, social function, physical function, and health-related quality of life. Resilience interventions have been proposed as one strategy to influence these outcomes. OBJECTIVE: The objective of this observational pilot study was to determine the feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor (BT) admitted for comprehensive acute inpatient rehabilitation and/or their family caregivers. A secondary aim was to gather preliminary data to assess the effects of the program on quality of life, stress, anxiety, physical function, sleep disturbance, fatigue, resilience, dyadic coping, and caregiver role overload. METHODS: The Resilient Living program is a psychosocial intervention with a focus on building resilience skills. Feasibility and acceptability outcomes were assessed at the end of the study. Quantitative outcome measures were collected at baseline, 12 weeks, and 6 months post the intervention. RESULTS: Eight patients and eight caregivers completed the study. The intervention was feasible with this population. Participants found the intervention useful and appreciated the flexibility of an online program; however, finding time to engage in it was challenging. Recruitment of eligible patients with acquired brain disorders and their caregivers as a dyad was challenging. CONCLUSION: The study confirms prior research suggesting that interventions targeting resilience are feasible, but larger studies with more rigorous methods are needed to appreciate the influence of resilience interventions in persons with brain disorders and their caregivers. Further research is needed to identify the characteristics of those most likely to benefit from resilience interventions and the optimal timing of such interventions.

Experiences of Gender Inequity Among Women Physicians Across Career Stages: Findings from Participant Focus Groups.

Background and Purpose: Gender inequity in academic medicine persists despite efforts to the contrary. Even with increasing representation of women physicians in academic medicine, leadership positions and promotion to tenure are still not representative. This study describes the experiences of women physicians at various stages of their careers, uncovering current challenges and potential areas for improvement toward gender equity. Methods: Three focus groups were conducted (n = 28) as part of a national professional development conference: Growth, Resilience, Inspiration, and Tenacity (GRIT) for Women in Medicine: GRIT. We thematically analyzed participant responses to assess perspectives on the impact of experiences, barriers to professional growth, opportunities for improvement, and definitions of success. Results: The major issues the participants faced included subthemes of (1) systemic barriers to success, (2) implicit biases, (3) self-advocacy, and (4) burnout and stress. Solutions for issues that were discussed included (1) fostering supportive communities, (2) encouraging personal and professional development, and (3) the need for system-wide policy changes. We found that most women needed or benefited from the fostering of communities and desired opportunities for developing professional skills. Participants felt institutional transparency for grievances determined the level of support and confidence in reporting instances of mistreatment. Participants tended to define success according to (1) personal success and (2) leaving a legacy. Conclusions/Implications: Despite policy advancements and a social evolution away from discrimination against women, women in medicine continue to experience inequities across career stages. Potential solutions include fostering supportive communities, encouraging personal and professional development, and system-wide policy changes.

Outcomes of a Stress Management and Resiliency Training (SMART) Program for Family Caregivers of Individuals With Advanced Head and Neck Cancer.

OBJECTIVES: To conduct a single-arm prospective pilot study examining the feasibility, acceptability, and preliminary effectiveness of a Stress Management and Resiliency Training (SMART) intervention among family caregivers (FCGs) of individuals with head and neck cancer (HNC). SAMPLE & SETTING: This study was conducted with 26 FCGs of individuals with HNC receiving chemotherapy in the medical oncology clinic at the Mayo Clinic Comprehensive Cancer Center. METHODS & VARIABLES: The SMART intervention consisted of in-person and online components. Measurements included feasibility, acceptability, self-compassion, resilience, perceived stress, anxiety, and mindfulness. RESULTS: Results support acceptability of the SMART program and provide recommendations to improve feasibility. Data indicate significant improvements in self-compassion (p = 0.03) and anxiety (p = 0.02), with positive trends for resilience, stress, and mindfulness. IMPLICATIONS FOR NURSING: This study warrants further research with larger, more diverse samples testing the efficacy of the program, its mechanism of action, and potential synergistic effects among individuals receiving oncology care, FCGs, and nurses.

A practice-based model to guide nursing science and improve the health and well-being of patients and caregivers.

AIMS AND OBJECTIVES: The purpose of this paper is to describe a model to guide nursing science in a clinical practice-based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature. BACKGROUND: Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence-based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice-based settings. DESIGN: Model development and description. METHODS: Mayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD-prepared nurse scientists engage in practice-based research as an integral component of Mayo Clinic's mission. A practice-based nursing research model was developed with the intent to advance nursing research in a clinical setting. RESULTS: The components of the Mayo Clinic Nursing Research model include symptom science, self-management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers. CONCLUSIONS: While clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice. RELEVANCE TO CLINICAL PRACTICE: The Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well-being of patients and caregivers.

GRIT: Women in Medicine Leadership Conference Participants' Perceptions of Gender Discrimination, Disparity, and Mitigation.

OBJECTIVE: To assess demographic characteristics and perceptions of female physicians in attendance at a medical conference for women with content focused on growth, resilience, inspiration, and tenacity to better understand major barriers women in medicine face and to find solutions to these barriers. PATIENTS AND METHODS: A Likert survey was administered to female physicians attending the conference (September 20 to 22, 2018). The survey consisted of demographic data and 4 dimensions that are conducive to women's success in academic medicine: equal access, work-life balance, freedom from gender biases, and supportive leadership. RESULTS: All of the 228 female physicians surveyed during the conference completed the surveys. There were 70 participants (31.5%) who were in practice for less than 10 years (early career), 111 (50%) who were in practice for 11 to 20 years (midcareer), and 41 (18.5%) who had more than 20 years of practice (late career). Whereas participants reported positive support from their supervisors (mean, 0.4 [SD 0.9]; P<.001), they did not report support in the dimensions of work-life balance (mean, -0.2 [SD 0.8]; P<.001) and freedom from gender bias (mean, -0.3 [SD 0.9]; P<.001). CONCLUSION: Female physicians were less likely to feel support for work-life balance and did not report freedom from gender bias in comparison to other dimensions of support. Whereas there was no statistically significant difference between career stage, trends noting that late-career physicians felt less support in all dimensions were observed. Future research should explore a more diverse sample population of women physicians.

Perceptions of Barriers and Facilitators to Becoming a Medical Professional Among Underrepresented Undergraduate and Postbaccalaureate Learners.

OBJECTIVE: To assess underrepresented undergraduate and postbaccalaureate learners' perceptions of (1) the medical field, (2) barriers that might prevent individuals from pursuing professional medical careers, and (3) resources that assist in overcoming these barriers. PARTICIPANTS AND METHODS: A qualitative study with focus groups was designed to achieve the objective. Participants were recruited from a community initiative to provide early exploration of the medical field to disadvantaged and minority individuals. Thirty-five individuals voluntarily participated in semistructured interviews. Audio from the interviews was analyzed using a qualitative descriptive approach and thematic analysis. This study was conducted from October 20, 2018, to April 6, 2019. RESULTS: Participants identified multiple characteristics related to the health care work environment and desirable attributes of health care personnel. The following barriers were identified: financial burden, lacking knowledge of the path to becoming a medical professional, inadequate social support, and lacking the metrics of a competitive candidate. Resources identified by participants to overcome barriers included professional networks and programmatic considerations. CONCLUSION: The study participants discussed negative and positive aspects of the health care environment, such as implicit and explicit biases and attributes that promote or sustain success. Participants expounded on financial, academic, social, and personal factors as barriers to success. In regard to resources that were believed to be helpful to mitigate barriers and promote success, participants commented on activities that simulate a professional medical environment, include networking with medical personnel, support well-being, and provide exposure to structured information on the process of obtaining professional medical training.

Challenges and Solutions for Physician Mothers: A Critical Review of the Literature.

Physician mothers face unique challenges related to family planning, pregnancy, childcare, work-life integration, inequities, and biases that may have serious widespread implications. There is a paucity of available information on the extent and ramifications of such challenges and related solutions. The purpose of this critical review of the literature was to identify and summarize challenges and solutions pertaining to physician mothers. A comprehensive literature search of databases (PubMed, CINAHL, EBSCO MegaFILE, and APA PsycInfo on Ovid) from January 1, 2008, to December 31, 2018, identified empirical articles that addressed challenges, policies, or solutions specific to physician mothers. Search terms included: physician, doctor, surgeon, specialist, hospitalist, pediatrician, woman, female, gender, mom, mother, maternity, breastfeed, pregnant, baby, infant, parent, parenthood, child,bias, status, stigma, inequity, discrimination, equal, unequal, justice, childcare, daycare, babysit, and nanny in various combinations. Seventy-one articles met inclusion criteria and were analyzed to identify categories and themes related to challenges and solutions for physician mothers. Themes for challenges were categorized by level of influence (individual, organizational and health care system, and societal); themes for solutions were categorized by approach and intervention (mentorship, childbearing and child-rearing support, addressing barriers to career satisfaction and work-life integration, and identification and reduction of maternal bias in medicine). Physician mothers face challenges that have negative implications for individuals, organizations and the health care system, and society. Clear understanding of associated challenges and potential solutions is a critical first step to address biases and barriers affecting physician mothers.

Stress, Resilience, and Coping of Healthcare Workers during the COVID-19 Pandemic.

OBJECTIVE: To estimate the health care workers (HCWs) self-reported stress, resilience, and coping during the COVID-19 pandemic, and to determine inter-professional differences. PARTICIPANTS AND METHODS: An email survey was sent to 474 HCW at a Midwestern HealthCare facility between April 9, 2020 and April 30, 2020. A total of 311 (65.6%) responses were received by May 31, 2020. The survey utilized 3 validated instruments: Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), Brief Resilience Coping Scale (BRCS). RESULTS: Of the 311 responses, 302 were evaluated: 97 from nonmedical staff with patient contact (NMPC); 86 from nonmedical staff with no patient contact (NMNPC); 62 from medical doctors (MD), physician assistants (PA) and nurse practitioners (NP); and 57 from nurses. Significant differences were noted across job categories for stress and resilience, with nurses reporting highest PSS scores (effect estimates: -2.72, P = .009 for NMNPC; -2.50, P = .015 for NMPC; -3.21, P = .006 for MD/NP/PA respectively), and MD/NP/PA group with highest BRS scores: nurses (-0.31, P = .02); NMPC (-0.3333, P = .01); and NMNPC (-0.2828, P = .02). Younger personnel had higher stress (-1.59 per decade of age, P < .01) and more resilience (0.11 per decade of age, P = .002). CONCLUSION: These self-reported data indicate that MD/NP/PA had the highest resilience scores and the nurses had highest stress levels. Efforts are warranted to include all HCWs in systematic stress mitigating interventions with particular attention to understand specific factors contributing to stress for the nursing team.

Feasibility and efficacy of integrating resiliency training into a pilot nurse residency program.

The high stress associated with the nursing profession can negatively affect the health of nurses and the quality of patient care that they provide. This quasi-experimental study aimed to 1) assess the feasibility of integrating a Stress Management and Resiliency Training (SMART) program within a nine-month pilot nurse residency program and 2) assess the effects of the program on participants' stress, anxiety, mindfulness, and resilience relative to a comparison group. A pre- and post-intervention survey design was used, with measurements taken at baseline and at 1, 3, 9, and 12 months after baseline. We enrolled 51 registered nurses (intervention group, n = 23; comparison group, n = 28) at a Midwestern US academic medical center. Nurses in the intervention group had a participation rate of 93%-100% with SMART program events. Despite the relatively limited adherence to the protocol by intervention group participants, significant improvements were noted for stress (P < .001), mindfulness (P < .001), and resilience (P < .001) in the intervention group compared with the comparison group. The SMART program can potentially be successfully integrated into a nurse residency program and positively impact nurse stress, mindfulness, and resilience. Further research is needed to determine the proper dose of the intervention and methods to enhance adherence.

Burnout Among Women Physicians: a Call to Action.

PURPOSE OF REVIEW: The purposes of this discussion are to describe what is known about burnout among women physicians and identify contributing factors, categories of impact, and methods for mitigating the phenomenon. The authors conclude with current gaps in research. RECENT FINDINGS: Although there are a lack of investigations analyzing and reporting physician burnout data by gender, there is evidence to suggest that women physicians experience stress and burnout differently than their men counterparts. Women physicians are more likely to face gender discrimination, gender biases, deferred personal life decisions, and barriers to professional advancement, all of which may contribute to burnout. Interventions specific to preventing physician burnout in women should include (1) addressing barriers to career satisfaction, work life integration, and mental health; (2) identification and reduction of gender and maternal bias; (3) mentorship and sponsorship opportunities; (4) family leave, lactation, and child care policies and support. In addition, gaps in research must be addressed in an effort to inform best practices for measuring and addressing burnout among women physicians.

Authentic Connections Groups: A Pilot Test of an Intervention Aimed at Enhancing Resilience Among Nurse Leader Mothers.

BACKGROUND: Nurse leaders who are mothers are at significant risk for experiencing stress, burnout, and occupational fatigue. Authentic Connections (AC) Groups is an intervention shown to be effective for fostering resilience among at-risk moms, including physicians; however, it has not previously been tested with nurse leaders. AIMS: Our aims were to test the feasibility and acceptability of the AC Groups intervention with nurse leader mothers and examine its effects on participant resilience, as measured by increased self-compassion and decreased distress, depression, perceived stress, and burnout. METHODS: A randomized controlled trial design was employed for this pilot study, with 36 nurse leaders at Mayo Clinic. AC participants attended group sessions for an hour per week for 12 weeks. Control group members were provided 1 hr per week of free time over 12 weeks. Multiple self-report psychological measures were completed at baseline, post-intervention, and 3-month follow-up. RESULTS: The AC Groups intervention was feasible and well-received by nurse leaders. Session attendance rates averaged 92%. Despite the small n's, repeated measures of Analysis of Variance showed significantly greater improvements (p < .05) for participants in the AC Groups than control condition for depression, self-compassion, and perceived stress, with large effect sizes ( η p 2 0.18-0.22). In addition, effect sizes for anxiety and feeling loved approximated the moderate range ( η p 2 0.05 and .07). LINKING EVIDENCE TO ACTION: The AC intervention shows promise as a feasible intervention for mitigating nurse leader mothers' stress by positively impacting indices of well-being, including depression, self-compassion, and perceived stress. Given, the prevalence of stress and burnout among nurse leaders, the effectiveness of the AC intervention in fostering resilience in this population has significant implications for research and practice. Further research is warranted with larger numbers from multiple sites, longer follow-up periods, and biomarker measures of stress.

Stress Management and Resiliency Training in a Nurse Residency Program: Findings From Participant Focus Groups.

Stress is a well-recognized phenomenon in the nursing profession, particularly for new nurses. This study (a) assessed nurse residents' experience with a stress management program and (b) informed adjustments to the program. Analysis of qualitative data revealed three themes: (a) enhanced personal and professional development, (b) sensitivity to learner needs, and (c) fostering the principles of mindfulness. A stress management program has the potential to positively enhance the new nurse's transition to work.

Stress Management and Resiliency Training for public school teachers and staff: A novel intervention to enhance resilience and positively impact student interactions.

BACKGROUND: Burnout in teachers has been linked to decreased effectiveness as educators, and suboptimal interactions with students. The purpose of this pilot study was to assess the outcomes of a brief Stress Management and Resiliency Training (SMART) program for public school staff. MATERIALS AND METHODS: This single-arm, prospective trial involved an investigation of the effects of a brief SMART program on participant stress, anxiety, resilience, gratitude, happiness, life satisfaction, and quality of life (QOL). RESULTS: Significant improvements were noted in participant anxiety (P < 0.001), stress (P = 0.003), gratitude (P = 0.001), happiness (P < 0.001), life satisfaction (P < 0.001), and QOL (P < 0.001). Most participants reported that the skills learned positively affected interactions with students (77.2%) and coworkers (72.2%). CONCLUSIONS: The SMART program showed promising effectiveness for improving anxiety, stress, gratitude, happiness, life satisfaction and QOL. Given the prevalence and impact of teacher burnout, larger, controlled trials and broader dissemination of the intervention are warranted.

Stress Management Interventions for Nurses: Critical Literature Review.

Background: The nursing literature contains numerous studies on stress management interventions for nurses, but their overall levels of evidence remain unclear. Holistic nurses use best-available evidence to guide practice with self-care interventions. Ongoing discovery of knowledge, dissemination of research findings, and evidence-based practice are the foundation of specialized practice in holistic nursing. This literature review aimed to identify the current level of evidence for stress management interventions for nurses. Method: A systematic search and review of the literature was used to summarize existing research related to stress management interventions for nurses and recommend directions for future research and practice. Results: Ninety articles met the inclusion criteria for this study and were categorized and analyzed for scientific rigor. Various stress management interventions for nurses have been investigated, most of which are aimed at treatment of the individual versus the environment. Contemporary studies only moderately meet the identified standards of research design. Issues identified include lack of randomized controlled trials, little use of common measurement instruments across studies, and paucity of investigations regarding organizational strategies to reduce nurses' stress. Conclusion: Future research is indicated to include well-designed randomized controlled trials, standardized measurement tools, and more emphasis on interventions aimed at the environment.

Mindfulness: Assessing the Feasibility of a Pilot Intervention to Reduce Stress and Burnout.

PURPOSE: To examine the feasibility of a brief mindfulness intervention and to reduce nurse stress and burnout in an inpatient medical unit. DESIGN: Single-arm, pre/post test study design. METHOD: Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and pre/post demographic questionnaires given at pre-intervention (baseline) and 6 weeks post-intervention. Intervention effectiveness was compared between the pre-survey ( N = 52) and post-survey ( N = 33). Five choices were offered to inpatient staff: a guided mindfulness CD, soothing sounds machine with a breathing technique instructional, mindfulness prompts, a journal, and water/snacks during six consecutive weekends. FINDINGS: The mean PSS score did not improve and demonstrated a slight increase during the six-weekend intervention. However, mean MBI scores for the subscales of emotional exhaustion and depersonalization did demonstrate improvement as evident by decreased scores. Additionally, the mean MBI score for the subscale of personal accomplishment also improved with increased scores. Qualitative themes were positive and included relaxation, nourishment, and refocus. Majority of participants (75%) perceived the intervention as being effective or very effective in reducing stress at work. Respondents were "interested" or "very interested" in continuing a similar intervention in the future (84.9%). CONCLUSION: The improvement in scores for the MBI measures were a positive finding. The intervention was low cost, individualized, and accessible. The feasibility and perceptions of the intervention's effectiveness has positive implications for the well-being of nurses.

Decreasing Stress and Burnout in Nurses: Efficacy of Blended Learning With Stress Management and Resilience Training Program.

OBJECTIVE: The study's purpose was to assess efficacy of blended learning to decrease stress and burnout among nurses through use of the Stress Management and Resiliency Training (SMART) program. BACKGROUND: Job-related stress in nurses leads to high rates of burnout, compromises patient care, and costs US healthcare organizations billions of dollars annually. Many mindfulness and resiliency programs are taught in a format that limits nurses' attendance. METHODS: Consistent with blended learning, participants chose the format that met their learning styles and goals; Web-based, independent reading, facilitated discussions. The end points of mindfulness, resilience, anxiety, stress, happiness, and burnout were measured at baseline, postintervention, and 3-month follow-up to examine within-group differences. RESULTS: Findings showed statistically significant, clinically meaningful decreases in anxiety, stress, and burnout and increases in resilience, happiness, and mindfulness. CONCLUSIONS: Results support blended learning using SMART as a strategy to increase access to resiliency training for nursing staff.

Enhancing resilience among new nurses: feasibility and efficacy of a pilot intervention.

BACKGROUND: Orientation is one of the most stressful times in a registered nurse's career. Little information is available regarding the efficacy of stress management approaches among new nurses. The purpose of this study was to examine outcomes of the implementation of a brief Stress Management and Resiliency Training (SMART) program within a nurse orientation program. METHODS: In this randomized controlled pilot study, self-reported measures of stress, mindfulness, anxiety, and resilience were measured at baseline and 12 weeks following the intervention. For each group, the mean change from baseline to week 12 was evaluated using the paired t test. The change from baseline was compared between groups using the 2-sample t test. Feasibility of integrating the SMART program into the nurse orientation program was also analyzed. RESULTS: Of the 55 participants enrolled, 40 (73%) completed the study. Mindfulness and resilience scores improved in the intervention group and declined in the control group, while stress and anxiety scores decreased in the intervention group and increased in the control group. The between-group change in each outcome, however, was not statistically significant. CONCLUSIONS: Integrating the SMART program within the nurse orientation program is feasible. While changes between groups were not significant, trends in the results indicate that the program has the potential for efficacy. Future research with larger numbers is indicated with a revised version of the program to increase its effect size.