Professor Kim Foster. Photo: Christopher Hopkins
Since 2022, ANMF (Vic Branch) has supported research – led by Australian Catholic University’s Professor Kim Foster in collaboration with NorthWestern Mental Health – working on a world-first evidence-based trial of resilience in mental health nurses.
Conducted over five years, the Promoting Resilience in Nursing (PRiN) program trial was a randomised controlled trial designed to:
- Improve mental health nurses’ own 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.
The trial results were officially published in the International Journal of Nursing Studies in November 2024 (read the full paper online or download a PDF) but in summary the trial participants showed improved coping self-efficacy, wellbeing, resilience, post-traumatic growth and emotional intelligence.
Recently, the final paper from the trial – the first qualitative paper on nurses’ experiences of trauma – was published in the Journal of Psychiatric and Mental Health Nursing. The findings presented in that paper are new in the field, and offer some insights into how nurses could be better supported in healthcare organisations, as well as future directions for research.
Key among these are that mental health nurses who experience personal trauma are at risk of re-traumatisation through workplace events, and that while these nurses are expected to provide trauma-informed care for consumers they do not necessarily receive trauma-informed care education, nor recognition of their own need for trauma-informed support and self-care.
The findings indicate that mental health nurses have specific needs in relation to their trauma experiences, in the context of the mentally and emotionally demanding nature of their interpersonal work with consumers, and the high levels of violence in healthcare settings. Rather than viewing nurses simply as providers of trauma-informed care in mental health settings, the researchers recommend they are placed at the centre of organisational philosophy and approaches to trauma.
A trauma-informed climate has been found to predict lower staff burnout and secondary traumatic stress. To support staff wellbeing and reduce the risk of re-traumatisation, they recommend mental health services take a trauma-informed organisational approach that is staff-centred as well as consumer-centred.
This approach includes trauma recognition for new/transition-to-practice nurses, and professional development that emphasises personal wellbeing and includes trauma-informed self-care strategies to support nurses’ own trauma recovery. The provision of adequate resources to do their work, and reduction of avoidable traumas such as violence is critical.
Trial background: be more like Nelson Mandela
The project grew from an adaptation of a successful program developed more than 20 years ago at Queensland University of Technology (QUT) – and that program was inspired by Nelson Mandela!
Mandela spent 27 years in prison, in terrible circumstances, ‘and yet he emerged without any bitterness or rancour,’ QUT professor Ian Shochet, the original researcher, has explained of his inspiration. ‘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 clearly that the capacity for resilience lies in all of us.’
A key focus of the PriN trial, specifically focused on mental health nurses, were two not commonly understood concepts: salutogenesis and post-traumatic growth.
A salutogenic approach is the opposite of a pathogenic one; it doesn’t look at deficits; it focuses on strengths. And just as salutogenesis is the opposite of pathogenesis, post-traumatic growth is the opposite of post-traumatic stress.
The PriN trial, which was conducted at NorthWestern Mental Health/Royal Melbourne Hospital (RMH) with 144 registered and enrolled nurses, proved so successful that even once it was officially finished RMH continued to offer the PRiN program to a further 42 staff across RMH, Western and Northern Health.
