Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Faculty of Social Work, Health Care and Nursing, Esslingen University of Applied Sciences, Esslingen, Germany.
Int J Nurs Stud. 2022 Oct;134:104312. doi: 10.1016/j.ijnurstu.2022.104312. Epub 2022 Jun 16.
Given the chronic work-related stressors experienced by nursing staff in today's healthcare systems, international evidence suggests an elevated risk of developing stress-related mental symptoms. Therefore, identifying effective methods to foster resilience (i.e., maintenance or fast recovery of mental health despite stressor exposure) seems crucial. To date, little is known about the efficacy of these interventions in nurses.
This systematic review aimed at summarizing the evidence on the pre-pandemic efficacy of psychological interventions to foster resilience, to improve mental symptoms and well-being as well as to promote resilience factors in nurses. Based on training programs with evidence for positive effects on resilience and mental health in meta-analyses, we aimed at identifying important and helpful intervention techniques.
Systematic review and meta-analyses based on a Cochrane review on pre-pandemic resilience interventions in healthcare professionals.
MEDLINE, Embase, CENTRAL and 11 other databases were searched until June 2020 to identify eligible randomized controlled trials. Trial registers, reference lists and contact with authors were additional sources.
Two reviewers independently assessed study eligibility and extracted data. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias of included studies. We conducted random-effects pairwise meta-analyses for five primary outcomes, including resilience. The intervention contents and techniques were narratively synthesized.
Of 39,794 records retrieved, 24 studies were included in the review (N = 1879 randomized participants), 17 in meta-analyses (n = 1020 participants). At post-intervention, we found very-low certainty evidence of moderate effects in favor of resilience training for resilience (standardized mean difference [SMD] 0.39; 95% CI [confidence interval] 0.12-0.66) and well-being (SMD 0.44; 95% CI 0.15-0.72), while there was no evidence of effects on symptoms of anxiety, depression and stress. The improvement of well-being was sustained in the short-term (≤3 months), with additional delayed benefits for anxiety and stress. There was no evidence of effects at later follow-ups, with the caveat of only three available studies. Among nine programs with evidence of positive moderate effect sizes, intervention contents included mindfulness and relaxation, psychoeducation, emotion regulation, cognitive strategies, problem-solving and the strengthening of internal and external resources.
Given the chronic stressor exposure in nursing staff, our findings may guide both the design and implementation of nurse-directed resilience interventions. To improve the certainty of evidence, more rigorous high-quality research using improved study designs (e.g., larger sample sizes, longer follow-up periods) is urgently needed.
PROSPERO 2017 CRD42017082827.
鉴于当今医疗体系中护理人员长期面临的工作压力源，国际证据表明他们面临着更高的压力相关精神症状风险。因此，寻找有效的方法来培养韧性（即，尽管存在压力源，但仍能保持或快速恢复心理健康）似乎至关重要。迄今为止，我们对这些干预措施在护士中的效果知之甚少。
本系统评价旨在总结护理人员在大流行前韧性干预措施的有效性证据，这些干预措施旨在改善精神症状和幸福感，并促进护士的韧性因素。基于具有元分析中对韧性和心理健康产生积极影响的培训计划，我们旨在确定重要且有用的干预技术。
基于对大流行前医疗保健专业人员韧性干预措施的 Cochrane 综述的系统评价和荟萃分析。
我们检索了 MEDLINE、Embase、CENTRAL 和其他 11 个数据库，以确定合格的随机对照试验，直至 2020 年 6 月。试验登记处、参考文献列表和与作者的联系也是额外的信息来源。
两位评审员独立评估研究的合格性并提取数据。使用 Cochrane 偏倚风险评估工具评估纳入研究的偏倚风险。我们对五个主要结果（包括韧性）进行了随机效应成对荟萃分析。干预内容和技术以叙述性方式进行综合。
从 39794 条记录中，我们共纳入了 24 项研究（N=1879 名随机参与者），其中 17 项研究进行了荟萃分析（n=1020 名参与者）。在干预后，我们发现，韧性训练对韧性（标准化均数差 [SMD] 0.39；95%置信区间 [CI] 0.12-0.66）和幸福感（SMD 0.44；95% CI 0.15-0.72）具有中等程度的高度确定性证据，这是有利的，但对焦虑、抑郁和压力症状没有证据表明有效果。幸福感的改善在短期（≤3 个月）内持续存在，对焦虑和压力的延迟获益更大。在后续随访中没有证据表明有效果，但仅有的三项可用研究存在局限性。在有证据表明具有中度积极效果的九个方案中，干预内容包括正念和放松、心理教育、情绪调节、认知策略、解决问题以及增强内部和外部资源。
鉴于护理人员长期面临压力源，我们的发现可能为护士主导的韧性干预措施的设计和实施提供指导。为了提高证据的确定性，迫切需要使用改进的研究设计（例如，更大的样本量、更长的随访期）进行更严格的高质量研究。
PROSPERO 2017 CRD42017082827。
