Commentary
Collaboration between universities and nursing placement providers is essential to ensure the well-being of the future nursing workforce 10.1136/ebnurs-2021-103444 Anne Mills Medical Sciences and Public Health, Bournemouth University, Bournemouth BH8 8GP, UK Correspondence to: Dr Anne Mills, Human Sciences and Public Health, Bournemouth University, Bournemouth BH8 8GP, UK; amills@ bournemouth.ac.uk Commentary on : Aloufi MA, Jarden RJ, Gerdtz MF, Kapp S. Reducing stress, anxiety and depression in undergraduate nursing students: systematic review. Nurs Ed Today 2021;102:104877. 1 Implications for practice and research ► ► Joint initiatives between educational settings and placement provid- ers are required to promote student nurse well-being. ► ► Future research must ensure rigorous study design with planned long-term follow-up, to support the development of a robust body of evidence. Context Extensive research has identified the demands of nursing on emotional and physical well-being 2 and acknowledges that mental health concerns are often reported by nurses, especially student nurses, which far exceed the stress and anxiety levels reported by other students. 3 Good health and well-being within the profession is essential for the safe delivery of quality healthcare, 4 and the use of effective interventions to reduce stress, anxiety and depressed mood among staff are necessary. Methods The study 1 used a systematic review, using the Joanna Briggs Institute 5 guidelines, to investigate the effectiveness of interventions in improving mental health outcomes for nursing students. Studies published in English between 2008 and 2018 on interventions to address stress, anxiety and depressed mood in undergraduate nursing students were included. The study incorporated randomised and non-randomised control trials, experimental, quasi-experimental and pretest and post-test. A three- step search strategy was employed. The first stage refined the search terms using the MEDLINE and CINAHL databases, the second involved a comprehensive search for relevant studies across all databases, while the third searched all the references in all the included papers. Two reviewers working independently assessed studies, which met the inclusion criteria, a third reviewer was called on to resolve disagreements. Findings 1579 citations were initially found and through a process of elimination 22 papers, from 11 countries, form the basis of the study. The sample size ranged from n=34 to n=181. A range of interventions was studied, of
differing durations, using various measurement tools. Statistically signif- icant decreases in stress or anxiety or depressed mood were noted in 18 studies. Studies incorporating mindfulness mediation, emotional freedom technique or biofeedback training were seen to be effective for both stress and anxiety, while mindfulness-based stress reduction and stress management programmes were seen to be effective for stress, anxiety and depression. Commentary Although there is extensive recognition of the mental health concerns among nursing students and acknowledgement that many of the inter- ventions in this review were effective, the overall study sample size was small, frequently the activity was only delivered once and often there was a lack of longer-term evaluation, which provided little understanding of the intervention’s enduring benefits. Interventions which seek to address multiple well-being concerns may be more valuable in terms of resourcing and outcomes, although appropriately trained experts must be employed, especially for interventions such as mindfulness programmes. Given the extent of student nurses’ experiences of stress, anxiety and depression, the research base for this topic is small and therefore necessitates the development of a stronger more rigorous body of evidence. The importance of staff mental health and well-being within health- care is well recognised 6 with universities seeking to deliver learning envi- ronments which enhance well-being among nursing students. However, nurse education utilises multiple and varied settings to ensure students gain a wide range of both theoretical and practical learning experiences. Therefore, the responsibility for addressing stress, anxiety and depressed mood among student nurses must be shared by both educational and placement providers. Currently, interventions are frequently based in either educational or clinical settings. And therein lies the organisational challenge. To effectively develop a wellness programme to improve student mental health, it is essential that nursing educational institutions and practice placements work collaboratively at all levels, in all processes and settings to support the well-being of the current student population; as a means of contributing to a future healthy workforce. Competing interests None declared. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. References 1 Aloufi MA , Jarden RJ, Gerdtz MF, et al . Reducing stress, anxiety and depression in undergraduate nursing students: systematic review. Nurse Educ Today 2 Sawbridge Y , Hewison A. Thinking about the emotional labour of nursing-- supporting nurses to care. J Health Organ Manag 2013; 27 :127–33. 3 Bartlett ML , Taylor H, Nelson JD. Comparison of mental health characteristics and stress between baccalaureate nursing students and non-nursing students. J Nurs Educ 2016; 55 :87–90. 4 Grønkjær LL . Nurses’ experience of stress and burnout: a literature review. Klin Sygepleje 2013; 27 :15–26. 5 Joanna Briggs Institute . Joanna Briggs Institute reviewers’ Manual . 2014 ed. Australia: Joanna Briggs Institute, 2014. 6 NHS England and Health Education England . 2018 integrated urgent care / NHS 111 workforce blueprint. workforce mental health and wellbeing. Available: https:// www.england.nhs.uk/wp-content/uploads/2018/03/workforce-mental-health- wellbeing.pdf [Accessed 15 Jul 2021].
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Evid Based Nurs Month 2021 | volume 0 | number 0 |
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