Background

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.

Objective

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.

Design

Systematic review and meta-analyses based on a Cochrane review on pre-pandemic resilience interventions in healthcare professionals.

Data sources

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.

Review methods

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.

Results

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.

Conclusions

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.

Registration

PROSPERO 2017 CRD42017082827.

中文翻译：

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培养护理人员复原力的干预措施：对大流行前证据的系统回顾和荟萃分析

背景

鉴于当今医疗保健系统中护理人员长期承受与工作相关的压力源，国际证据表明出现与压力相关的精神症状的风险增加。因此，确定有效的方法来培养复原力（即，在压力源暴露的情况下保持或快速恢复心理健康）似乎至关重要。迄今为止，关于这些干预措施对护士的疗效知之甚少。

客观的

本系统评价旨在总结大流行前心理干预在培养心理弹性、改善心理症状和幸福感以及提高护士的弹性因素方面的功效的证据。基于在荟萃分析中有证据表明对恢复力和心理健康有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。

设计

系统评价和荟萃分析基于 Cochrane 对医疗保健专业人员大流行前恢复力干预措施的评价。

数据源

截至 2020 年 6 月，对 MEDLINE、Embase、CENTRAL 和其他 11 个数据库进行了搜索，以确定符合条件的随机对照试验。试验登记、参考文献列表和与作者的联系是额外的来源。

审核方法

两名评价员独立评估研究资格并提取数据。Cochrane偏倚风险评估工具用于评估纳入研究的偏倚风险。我们对包括弹性在内的五个主要结果进行了随机效应成对元分析。干预内容和技术以叙事方式综合。

结果

在检索到的 39,794 条记录中，24 项研究被纳入审查（N  = 1879 名随机参与者），17 项纳入荟萃分析（n  = 1020 名参与者）。在干预后，我们发现非常低质量的证据表明，有利于弹性训练对弹性（标准化均值差 [SMD] 0.39；95% CI [置信区间] 0.12–0.66）和幸福感（SMD 0.44； 95% CI 0.15–0.72)，而没有证据表明对焦虑、抑郁和压力症状有影响。幸福感的改善在短期内持续（≤ 3 个月), 对焦虑和压力有额外的延迟好处。没有证据表明在后来的随访中有影响，但需要注意的是只有三项可用的研究。在九个具有正中等效应量证据的项目中，干预内容包括正念和放松、心理教育、情绪调节、认知策略、解决问题和加强内部和外部资源。

结论

鉴于护理人员长期暴露于压力源，我们的研究结果可能会指导以护士为导向的复原力干预措施的设计和实施。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。

登记

PROSPERO 2017 CRD42017082827。