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Assessment of Resilience Training for Hospital Employees in the Era of COVID-19

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Is a group-coaching program designed to reduce stress and teach resilience skills feasible, acceptable, and preliminarily useful for health care workers during the COVID-19 pandemic?

Findings  In this pilot cohort study of 153 health care workers and hospital employees from a single health system, the group-coaching program was feasible and acceptable, as demonstrated by high demand, retention, and satisfaction. Measured according to validated scales, self-reported resilience, stress, anxiety, and burnout improved among participants.

Meaning  Results of this study suggest that resilience-building programs may support improved mental health outcomes.


Importance  Health care workers face serious mental health challenges as a result of ongoing work stress. The COVID-19 pandemic exacerbated that stress, resulting in high rates of anxiety, depression, and burnout. To date, few evidence-based programs targeting mental health outcomes in health care workers have been described.

Objective  To assess the feasibility, acceptability, and preliminary outcomes of a skills-based coaching program designed to reduce stress and build resilience.

Design, Setting, and Participants  A pilot cohort study was conducted between September 2020 and April 2021 using preprogram and postprogram assessments and a mixed-methods analysis. Duration of follow-up was 7 weeks. The coaching program was delivered via video conferencing. Participants were health care workers and staff from a large urban health system.

Intervention  The Promoting Resilience in Stress Management (PRISM) program, a manualized, skills-based coaching program originally developed for adolescents and young adults with serious/chronic illness, was adapted to support health care workers and staff (“PRISM at Work”). It included 6 weekly 1-hour group sessions.

Main Outcomes and Measures  Feasibility was defined a priori as 70% completion rates. Acceptability was defined quantitatively (satisfaction scores) and qualitatively (open-ended questions regarding experience with program). Preliminary outcomes were assessed with preprogram and post program assessments of self-reported resilience, stress, anxiety, and burnout using validated instruments. Descriptive statistics summarized demographic variables and feasibility and acceptability. Linear mixed effects regression models examined preliminary outcomes, controlling for relevant covariates.

Results  A total of 153 participants (median [SD] age, 40.6 [10.1] years; 142 [92%] were female; 128 [84%] identified as having White race; 81 [53%] were in patient-facing roles) enrolled. Of the 132 health care workers who provided follow-up surveys, 120 (91%) had completed the program, and 116 (88%) reported being satisfied. Answers to open-ended questions suggested that participants wanted more PRISM either with longer or additional sessions. Participant-reported resilience (β = 1.74; 95% CI, 1.00-2.48), stress (β = −2.40; 95% CI, −3.28 to −1.51), anxiety (β = −2.04; 95% CI, −2.74 to −1.34), and burnout-exhaustion (β = −0.37; 95% CI, −0.56 to −0.18) improved after the program.

Conclusions and Relevance  Results of this study suggest that PRISM at Work may have utility for health care workers and staff in that the program was found to be feasible, acceptable, and associated with improved outcomes.

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Article Information

Accepted for Publication: May 19, 2022.

Published: July 1, 2022. doi:10.1001/jamanetworkopen.2022.20677

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Yi-Frazier JP et al. JAMA Network Open.

Corresponding Author: Abby R. Rosenberg, MD, MS, MA, Palliative Care and Resilience Lab, Seattle Children’s Research Institute, 1920 Terry Ave, CURE-4, Seattle, WA 98101 (abby.rosenberg@seattlechildrens.org).

Author Contributions: Dr Yi-Frazier had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Yi-Frazier, Adhikari, Zhou, Junkins, Rosenberg.

Acquisition, analysis, or interpretation of data: Yi-Frazier, O'Donnell, Adhikari, Zhou, Bradford, Garcia-Perez, Shipman, Hurtado, O'Daffer, Rosenberg.

Drafting of the manuscript: Yi-Frazier, O'Donnell, Adhikari, Bradford, Garcia-Perez, Shipman, Hurtado, O'Daffer, Rosenberg.

Critical revision of the manuscript for important intellectual content: Yi-Frazier, O'Donnell, Zhou, Shipman, Junkins, Rosenberg.

Statistical analysis: Zhou, Bradford.

Obtained funding: Yi-Frazier, Rosenberg.

Administrative, technical, or material support: Yi-Frazier, O'Donnell, Adhikari, Garcia-Perez, Shipman, Hurtado, Junkins, O'Daffer, Rosenberg.

Supervision: Yi-Frazier, Junkins, Rosenberg.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by an internal grant sponsored by the Seattle Children’s Research Institute COVID funds. Dr Yi-Frazier has received funds for unrelated work from the National Institutes of Health. Dr Rosenberg has received grants for unrelated work from the National Institutes of Health, the American Cancer Society, Arthur Vining Davis Foundations, Cambia Health Solutions, Conquer Cancer Foundation of ASCO, CureSearch for Children’s Cancer, the National Palliative Care Research Center, and the Seattle Children’s Research Institute.

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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