Integration and Impact of Stress Management and Resiliency Training (Smart) in a Nurse Residency Program: A Feasibility Study

Abstract

Nursing is recognized widely as a highly stressful profession, and the time of orientation is identified as the most stressful time in a nurse's career. Innovative strategies are needed to assist new registered nurses in the management and prevention of stress as a result of transitioning into the complex and challenging healthcare environment. The purpose of this study was to assess the feasibility and impact of integrating a Stress Management and Resiliency Training (SMART) program within a nurse residency program for new nurses at an academic medical center. Additional aims were to assess the effects of the program on participants' levels of stress, anxiety, mindfulness and resilience in relationship to a comparison group. Focus group interviews were conducted at 12 weeks post the initial intervention to identify the impact of the program on participants. Quantitative outcome measures were taken at baseline and 4 and 12 weeks post the initial intervention and included: Perceived Stress Scale (PSS), Generalized Anxiety Disorder (GAD-7), Mindful Attention Awareness Scale (MAAS), and Connor-Davidson Resilience Scale (CD-RISC). The convenience sample consisted of n = 27 for the intervention group and n = 39 for the comparison group. The nurse residents exhibited compliance with the SMART program as demonstrated by high recruitment and attendance levels; however, they were not adherent to the intervention according to the pre-determined parameters for percentage of days practicing the principles of the program (>60% of study days). A mixed model analysis of the instrument scores revealed a decrease in stress for both groups over time with no significant group by time interaction (F = 1.19, p = .19); a decrease in anxiety for both groups over time with no significant group by time interaction (F = .17, p = .68); an improvement in resilience for the intervention group and decline for the comparison group with no significant group by time interaction (F = .37, p = .55); and an improvement in mindfulness for both groups with no significant group by time interaction (F = .07, p = .79). Focus group interviews revealed the impact of the program and aspects of the program that were the most and least helpful to participants. Themes that emerged included: 1) Enhanced Personal and Professional Development, 2) Sensitivity to Learner Needs, and 3) Fostering the Principles of Mindfulness. The outcomes provide tentative support of integration of the SMART program within a nurse residency program. It is recommended that such a program continue to be implemented for nurse residents and a wider audience of nurses. Future studies are needed with larger numbers to further explore the efficacy of the SMART program and to determine an adequate level of adherence to the intervention.