In mid-April, mental health nursing members attended a half-day forum, hosted by the Branch, to hear the promising results of the Promoting Resilience in Nurses (PRiN) program trial. Their response to the findings was overwhelmingly positive.
The evidence-based program – an adaptation specifically for mental health nurses from a successful resilience education program developed more than 20 years ago by Professor Ian Shochet at Queensland University of Technology (QUT) – was designed to:
- improve nurses’ mental health and wellbeing
- build their skills in managing stress
- improve their relationships and management of conflict
- promote their capacity for post-traumatic growth
- support them to be resilient in the face of stress at work and in their personal lives.
ANMF (Vic Branch) collaborated with researchers on the project, which was funded by an Australian Research Council Linkage grant and led by Australian Catholic University’s Professor Kim Foster, in collaboration with NorthWestern Mental Health, and other universities and unions.
A program to get behind, inspired by Nelson Mandela
Via a pre-recorded message, Chief Mental Health Nurse Anna Love invited attendees to hear about the significant findings from the PRiN trial and promoted the program as one possible solution to help support, nurture and sustain our nursing workforce.
‘This is not the be all and end all,’ she said. ‘It’s not the answer to everything. But the evidence is there that it actually makes a difference,’ she added. ‘We all want what’s best for the workforce and I believe that we have a program [here] that we can get behind. Let’s now make this part of what we provide to all mental health nurses across our state.’
QUT professors Ian Shochet and Jane Shakespeare-Finch then gave an outline of the program, and its history. Professor Shochet, who initiated the original research in 1997, began by noting that his inspiration came from Nelson Mandela.
Mandela spent 27 years in prison, in terrible circumstances, ‘and yet he emerged without any bitterness or rancour,’ he said. ‘So the question in my mind was: is Nelson Mandela unique? Or does that capacity for resilience reside in all of us? And the answer to that, from the research, is that we all have the capacity for resilience.’
Salutogenesis and post-traumatic growth
Professor Shochet and his team take a salutogenic approach to resilience and the promotion of positive mental health. As explained by Professor Shakespeare-Finch, a salutogenic approach is the opposite of a pathogenic one.
‘Salotogenesis literally translates to the origin of health,’ she said. ‘Normally we talk about things coming from a pathogenic approach – what is wrong and how do we alleviate suffering? Salotogenesis, however, doesn’t look at deficits; it is focused on strengths and resilience.’
As part of this salutogenic approach, a key focus of the professors’ research is post-traumatic growth. Just as salutogenesis is the opposite of pathogenesis, post-traumatic growth is the opposite of post-traumatic stress.
According to Professor Shakespeare-Finch, post-traumatic growth covers ‘the positive changes that people can perceive as a result, not of the trauma itself, but of the struggle that people can engage in to come to terms with life [post trauma].’
Post-traumatic growth broadly groups into three domains:
- changes in a person’s sense of personal strength
- changes in relationships with other people
- changes in philosophy of life.
‘One of the things that happens alongside post traumatic growth is the development of wisdom,’ Professor Shakespeare-Finch added, ‘and of altruistic actions, of performing service for other people, becoming increasingly compassionate and developing an increasing sense of empathy.’
Significantly, post-traumatic growth is far more common than post-traumatic stress disorder, she said, even though PTSD is far more often discussed. ‘Resilience is the most common outcome of trauma, and post-traumatic growth is much more common than PTSD, depression and/or anxiety.’
The PRiN trial
The project was an Australia-first randomised controlled trial of a resilience education program with mental health nurses. It was conducted over the past couple of years at NorthWestern Mental Health/Royal Melbourne Hospital. Working through the height of the COVID pandemic, the research team recruited 144 registered and enrolled nurses into the study – whose overall feedback about the program was extremely positive.
Professor Kim Foster told the audience that resilience is a process of positive adaptation adaptation leading to recovery of wellbeing following adversity. She also acknowledged there is some resistance to the concept of resilience in some quarters, including critiques that it might be used as a band aid to whitewash systemic organisational stressors in health services.
‘Resilience interventions can’t fix most organisational stressors,’ she explained, ‘but they can help people strengthen their skills in managing the inherent challenges of nursing work, such as dealing with others’ distress and managing conflict.’
Presenting the key findings of the PRiN trial, Professor Foster noted that participants in the program group had significantly higher coping self-efficacy than those in the control group, and they performed better on measures of of psychological distress, wellbeing, resilience and post-traumatic growth.
She concluded that ‘the program was effective in achieving its aims of promoting resilience, increasing mental health and wellbeing and promoting nurses’ capacity for post traumatic growth.’
Participant feedback and recommendations
Sharing de-identified feedback and quotes from program participants in a parallel process evaluation of the PRiN program implementation, PhD candidate Viet Bui noted that the program was very well-received by the nurses who completed it, who were highly satisfied with the program. They reported improvements in their wellbeing, communication, problem-solving skills and in managing stress and conflict.
‘I would like it to be offered to all nurses,’ one participant said, ‘as it has been an exceptional learning experience. I believe all nurses would benefit from this.’
Professor Foster concurred, making recommendations from the trial that the program continues to be offered at NorthWestern Mental Health and that it also be made available to mental health nurses across Victoria, as part of a suite of wellbeing and prevention strategies.