When Nursing Professor Lili Martin noticed that her students seemed unusually stressed, anxious, and depressed – to a degree that they were missing classes and mandatory clinical assignments - she decided to find the cause.
“Students were reporting that their mental health issues were starting to impact their ability to focus, to take exams,” said Martin. “We were increasingly getting requests for accommodations related to mental health issues.”
Martin’s research revealed a national trend: stress, anxiety, and depression are regular accompaniments to the academic rigors of studying nursing.
“There are really intense GPA requirements. Students are witnessing a lot of death and dying in the clinical setting, with complex patient-family dynamics. Patients are sicker than they ever were,” said Martin.
As a result, nursing students have a hard time coping. Accumulated stress can affect sleep and ultimately academic performance. It can increase attrition rates. In extreme cases it can even lead to suicide, said Martin.
A comprehensive literature review on the topic led Martin to a program called the Benson-Henry Institute Stress Management and Resiliency Training (SMART) program, which teaches participants to reduce the harmful impacts of stress by eliciting the relaxation response, building stress awareness, and developing adaptive coping strategies.
The program was shown to reduce stress, anxiety, and depression in medical students, residents, and administrators, but was never tested with nursing students, said Martin.
In a collaboration with Jane Nathan, Ph.D., who is a clinical psychologist and clinical assistant professor of family medicine at the UVM Larner College of Medicine, research director of the Stern Center for Language and Learning, and a Benson Henry Institute (BHI) SMART-Certified Healthcare Practitioner, Martin developed a plan to implement the eight-week stress management and resiliency training program with a group of fourth-year baccalaureate nursing students in Fall 2020, at the height of the pandemic.
“We wanted to evaluate the effectiveness of SMART implementation with nursing students, and we wanted to see how participation in the program impacted students’ mental health and wellbeing long-term,” said Martin.
The results are uplifting.
“Our SMART group had statistically significant decreases in their stress, anxiety, and depression levels. And our control group had statistically significant increases in their stress levels,” said Martin. “The control group, however, had some pretty negative comments about their mental health.” Among them: "Stress like this is unsustainable. My coping mechanisms are misplaced. My mental health has gotten worse."
Students who participated in the stress management program offered positive feedback on their experience, including: “I have time to put myself first,” and “I didn’t know how much I needed this.”
Martin says it’s a fact that nursing students experience stress, anxiety, and depression. But the SMART program can be effective in mitigating these impacts.
“Students were very satisfied with the program,” said Martin. “One hundred percent recommended the training to others.”
Martin now plans to find a way to incorporate the program into the undergraduate nursing curriculum.
The project was supported by a grant from the Frymoyer Scholars Program, funded by the John W. and Nan P. Frymoyer Fund for Medical Education, which supports physicians and nurses who are actively engaged in teaching University of Vermont medical and nursing students and who embody the best qualities of the clinician teacher.
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