A pilot randomized controlled trial of a stress management and resilience training (SMART) programme to student nurses: A mixed-methods design (Preprint)

Abstract

Resilience is an ‘ability which involves behaviours, thoughts and actions which can be learned and developed in anyone’. The principal investigator of this study found that the institute counsellor conducted 65 counselling sessions for the student nurses in the academic year from 2018/2019 to 2020/2021. Forty-five percent of them were related to clinical issues, and some of the student nurses had even quit the programme due to serious mental problems. Such phenomenon can be explained by the fact that this programme was their first exposure to a complex workplace after completing their secondary education; they needed extra support to overcome the adversities and adapt to the clinical environment. Currently, in the first clinical practicum, student nurses are normally supervised and supported in groups by their schoolteachers and groupmates every minute. In the subsequent clinical practicums, they need to work independently in the ward and are supervised by the ward nurses when necessary. The schoolteachers are their resource persons, and the former visits the latter approximately once bi-weekly. Therefore, this study aims to implement a pilot study on introducing a structured and scientifically proven method, namely, Stress Management and Resilience Training (SMART), to the student nurses before their second clinical practicum, evaluate its effectiveness and explore students’ experience in using it.

• To employ a structured and evidence-based programme, namely, Stress Management and Resilience Training (SMART), to student nurses before their clinical practicum which aims to boost their resilience. • To evaluate the effectiveness of SMART by measuring the changes in nursing students’ resilience and stress levels at three time points by using two self-report questionnaires. They are Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Perceived Stress Scale-10 (PSS-10). • To explore students’ experience in using SMART during their clinical practicum by conducting two semi-structured focus group interviews.

This research is a mixed-method study using a pilot randomised controlled trial (RCT) and focus group interviews. The RCT will be conducted in accordance with the Consolidated Standards of Reporting Trials statement. A total of 100 student nurses will be randomly assigned into control and test groups. A group of experienced professionals will employ Sood’s framework to devise a nursing-based and 8-week SMART programme and will intervene it to 50 student nurses in the intervention group. No intervention will be implemented to the 50 student nurses in the control group. Connor-Davidson Resilience Scale-10 and Perceived Stress Scale-10 will be used to measure students’ resilience and stress levels at three different time points. After the student completed the second clinical practicum, semi-structured focus group interviews will be conducted to collect students’ experience of using SMART. The demographic data will be summarised by descriptive statistics of frequency count, mean and standard deviation. Chi-squared test and Fisher's exact test will be applied to analyse the differences between demographic variables. Given that the outcome measures of both assessment tools are continuous data, dependent t-test will be used to compare the means between time points. Multilevel modelling analysis will be used to investigate the changes in the outcome measures on each time interval with respect to its baseline and assess the effectiveness of the intervention. A two-level model can be built with repeated time points at level 1 and participants at level 2. The significantly different demographic variables between groups and other possible confounders will be adjusted by including them in the main effect model. A pairwise comparison and other hypotheses on the intervention effects can be tested using a generalised Wald test with an adequate degree of freedom from the modelling analysis.

The recruitment for this study will begin in March 2022 and the results are expected to be ready by February 2023.

This protocol outlines a pilot study on introducing a SMART programme to the student nurses and the methods of evaluating its impact.

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