Latest From the Lab: Facing Burnout? How About Trying a ‘Resilience Bundle’?

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NLI Staff
We can learn how to become more resilient through lessons from emergency department nurses.

Who’s heard of a resilience bundle? Is it something that can be ordered on Amazon and includes a scented candle and bath bomb? No. It’s actually a tailored package of options — such as a serenity room or mindfulness training — that can increase resilience in groups of employees who are prone to burnout and experience high levels of job stress.

Regardless of occupation, people who are subject to overwhelming amounts of work, inadequate resources to perform their jobs, or tight deadlines can suffer from burnout. If the nature of a particular occupation is unlikely to change, then people seek ways to cope with stress and avoid burnout, which can range from healthy interventions such as exercise to harmful ones such as drinking too much alcohol. A positive and adaptive way to cope is by increasing resilience.

Resilience refers to the capacity to withstand and adapt to adverse life experiences. During the height of the COVID-19 pandemic, nurses encountered particularly harsh experiences in the workplace that led to increased stress, distress, secondary trauma (hearing about or witnessing the aftereffects of someone else’s trauma), and lowered morale, resulting in more nurses quitting their jobs than ever before. To slow the flow of exiting nurses and increase well-being, some hospitals experimented with resilience bundles and resilience rooms.

In healthcare, increased resilience has been associated with lower burnout in nurses. When burnout is high, it can contribute to lower psychological, physical, and professional outcomes, such as increased depression, anxiety, suicide, and addiction, as well as decreased job satisfaction, performance, and patient experience.

In a recent study, a group of researchers sought to ascertain whether introducing a resilience bundle to a hospital’s busy emergency department would increase resilience among the nurses and lessen their perceived stress. Surmising that individuals are unique and respond differently to different offerings, researchers provided a variety of interventions rather than just one — hence, the term resilience bundle.

The three offerings were a serenity room, mindfulness, and debriefing. The serenity room served as a quiet and inviting space to relax and decompress. It consisted of a room with a massage chair, peaceful wall art, LED candles, a sound machine, an aromatherapy diffuser, and a vacant or occupied sign. Mindfulness techniques were promoted and explained on posters hung throughout the department. They were also taught by charge nurses, who integrated them into daily shift huddles. In addition to guiding mindfulness activities, charge nurses facilitated debriefing sessions that occurred after particularly acute and distressing events. These sessions allowed nurses to reflect on the impact of these traumatic events and their emotional experience within the safety of the team community, building a sense of relatedness in the process.

The researchers collected data at three timepoints: before the start of the intervention (baseline), six weeks after the start of the intervention (phase 1), and 15 weeks after the start of the intervention (phase 2). The baseline data included demographic information and how many years participants had worked as emergency nurses. At each timepoint, the researchers measured resilience and perceived stress.

The 10-item assessment for resilience included statements such as, “I am able to adapt when changes occur.” Participants were instructed to select an option that indicated the degree to which a particular statement applied to them in the past month. Response options ranged from “not at all true” (0) to “true nearly all the time” (4). Participants could receive a low score of zero and a high score of 40, with a high score indicating increased resilience. The perceived stress measure consisted of four statements such as, “In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?” to which participants could respond on a scale ranging from “never” (0) to “very often” (4). The higher the score, the higher the level of perceived stress. At phases 1 and 2, participants were asked whether they took advantage of each of the offerings and whether they considered the bundle helpful.

The study revealed that emergency nurses reported, on average, an 8% increase in their resilience scores (reaching statistical significance) from baseline to six weeks after the start of the intervention, mirroring the findings of similar studies. Although nurses reported lower levels of stress in phases 1 and 2 compared with the baseline, the differences did not reach statistical significance.

A number of write-in feedback responses were glowing (for example, “Please keep the tranquility room! It’s such a nice break from the hustle and bustle,” and “Love the room! I’m finally able to sit and have lunch now instead of standing in a corner shoveling food in as quick as I can!”). However, some responses were more sobering, including this one:

The mindfulness exercises seemed tone-deaf in the face of such overwhelming adversity, rather like telling someone to smile while they’re drowning. The debriefing forms are somewhat better, but there is very little time or chance to complete them. The serenity room is very beautiful from the glimpses of it I’ve caught running from one end of the ER to the other. Perhaps someday I’ll have time to use it.

Given that the bundles did increase resilience in emergency department nurses, one could surmise that all employers need to do is offer up some serenity rooms to their stressed-out employees. But if stressful conditions persist, and workers’ abilities to slow down and take rejuvenating breaks remain compromised, resilience bundles might act as only a temporary salve. What’s better: If leaders in all professions implement more permanent measures that lead to increased resilience, such as adequate staffing, healthy break time, and ultimately, an acknowledgment of the hard work being done.

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