[Skip to Content]
Outline
Claim CME
PDF
Medical Education

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
JAMA Network Open
Published Online: July 1, 2022
Original Investigation
Joyce P. Yi-Frazier, PhD1,2;
Maeve B. O’Donnell, PhD1,2;
Elizabeth A. Adhikari, MSW1;
Chuan Zhou, PhD3,4;
Miranda C. Bradford, MS1,5;
Samantha Garcia-Perez, BS1;
Kelly J. Shipman, MS1;
Samantha E. Hurtado, BA1;
Courtney C. Junkins, PsyD1;
Alison O’Daffer, BA1;
Abby R. Rosenberg, MD, MS, MA1,2,6
Author Affiliations
  • 1Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
  • 2Cambia Palliative Care Center of Excellence, University of Washington, Seattle
  • 3Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
  • 4Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
  • 5Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children’s Research Institute, Seattle, Washington
  • 6Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
Read article on JAMA Network

MOC/CME Information

editorial comment icon
Editorial
Comment
 related articles icon
Related
Articles
 author interview icon
Interviews
 multimedia icon
Multimedia
Read Article Claim 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.

Abstract

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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

See More About

Anxiety Disorders Medical Education and Training Psychiatry and Behavioral Health Health Policy Medical Education Professional Well-being Coronavirus (COVID-19)
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.

References
1.
Reith  TP .  Burnout in United States healthcare professionals: a narrative review.   Cureus. 2018;10(12):e3681. doi:10.7759/cureus.3681 PubMedGoogle ScholarCrossref
2.
Aiken  LH , Clarke  SP , Sloane  DM ,  et al.  Nurses’ reports on hospital care in five countries.   Health Aff (Millwood). 2001;20(3):43-53. doi:10.1377/hlthaff.20.3.43 PubMedGoogle ScholarCrossref
3.
Holmes  EG , Connolly  A , Putnam  KT ,  et al.  Taking care of our own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions.   Acad Psychiatry. 2017;41(2):159-166. doi:10.1007/s40596-016-0590-3 PubMedGoogle ScholarCrossref
4.
Shanafelt  TD , Boone  S , Tan  L ,  et al.  Burnout and satisfaction with work-life balance among US physicians relative to the general US population.   Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199 PubMedGoogle ScholarCrossref
5.
Cai  CZ , Lin  YL , Hu  ZJ , Wong  LP .  Psychological and mental health impacts of COVID-19 pandemic on healthcare workers in China: a review.   World J Psychiatry. 2021;11(7):337-346. doi:10.5498/wjp.v11.i7.337 PubMedGoogle ScholarCrossref
6.
Gilleen  J , Santaolalla  A , Valdearenas  L , Salice  C , Fusté  M .  Impact of the COVID-19 pandemic on the mental health and well-being of UK healthcare workers.   BJPsych Open. 2021;7(3):e88. doi:10.1192/bjo.2021.42 PubMedGoogle ScholarCrossref
7.
Cyr  S , Marcil  MJ , Marin  MF ,  et al.  Factors associated with burnout, post-traumatic stress and anxio-depressive symptoms in healthcare workers 3 months into the COVID-19 pandemic: an observational study.   Front Psychiatry. 2021;12:668278. doi:10.3389/fpsyt.2021.668278 PubMedGoogle ScholarCrossref
8.
López Steinmetz  LC , Herrera  CR , Fong  SB , Godoy  JC .  A longitudinal study on the changes in mental health of healthcare workers during the COVID-19 pandemic.   Psychiatry. 2022;85(1):56-71. doi:10.1080/00332747.2021.1940469 PubMedGoogle ScholarCrossref
9.
Norman  SB , Feingold  JH , Kaye-Kauderer  H ,  et al.  Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning.   Depress Anxiety. 2021;38(10):1007-1017. doi:10.1002/da.23205 PubMedGoogle ScholarCrossref
10.
Kim  SC , Sloan  C , Chechel  L , Redila  M , Ferguson  J .  Severe burnout and poor mental health among healthcare workers 6 months after COVID-19 pandemic declaration: What can we learn for future emergencies?   J Nurs Adm. 2021;51(11):554-560. doi:10.1097/NNA.0000000000001063 PubMedGoogle ScholarCrossref
11.
Gualano  MR , Sinigaglia  T , Lo Moro  G ,  et al.  The burden of burnout among healthcare professionals of intensive care units and emergency departments during the COVID-19 pandemic: a systematic review.   Int J Environ Res Public Health. 2021;18(15):8172. doi:10.3390/ijerph18158172 PubMedGoogle ScholarCrossref
12.
Manchia  M , Gathier  AW , Yapici-Eser  H ,  et al.  The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: a critical review across waves.   Eur Neuropsychopharmacol. 2022;55:22-83. doi:10.1016/j.euroneuro.2021.10.864 PubMedGoogle ScholarCrossref
13.
Lamb  D , Simms  A , Greenberg  N , Withnall  RDJ .  Caring for the carers: a COVID-19 psychological support programme.   BMJ Mil Health. 2022;168(2):153-159. doi:10.1136/bmjmilitary-2021-001854 PubMedGoogle ScholarCrossref
14.
Limoges  J , Anzola  JD , Kolla  NJ .  Effects of COVID-19 on Healthcare Providers: opportunities for education and support (ECHOES).   Nurs Leadersh (Tor Ont). 2021;34(2):62-74. doi:10.12927/cjnl.2021.26528 PubMedGoogle ScholarCrossref
15.
Rosenberg  AR , Yi-Frazier  JP .  Commentary: resilience defined: an alternative perspective.   J Pediatr Psychol. 2016;41(5):506-509. doi:10.1093/jpepsy/jsw018 PubMedGoogle ScholarCrossref
16.
Rosenberg  AR , Bradford  MC , McCauley  E ,  et al.  Promoting resilience in adolescents and young adults with cancer: results from the PRISM randomized controlled trial.   Cancer. 2018;124(19):3909-3917. doi:10.1002/cncr.31666 PubMedGoogle ScholarCrossref
17.
Rosenberg  AR , Bradford  MC , Barton  KS ,  et al.  Hope and benefit finding: results from the PRISM randomized controlled trial.   Pediatr Blood Cancer. 2019;66(1):e27485. doi:10.1002/pbc.27485 PubMedGoogle ScholarCrossref
18.
Rosenberg  AR , Yi-Frazier  JP , Eaton  L ,  et al.  Promoting Resilience in Stress Management: a pilot study of a novel resilience-promoting intervention for adolescents and young adults with serious illness.   J Pediatr Psychol. 2015;40(9):992-999. doi:10.1093/jpepsy/jsv004 PubMedGoogle ScholarCrossref
19.
O’Donnell  MB , Adhikari  EA , Rosenberg  AR , Yi-Frazier  JP .  Promoting resilience for pediatric health care workers in the era of COVID-19: The PRISM at Work Program.   J Palliat Med. 2021;24(2):168-169. doi:10.1089/jpm.2020.0584 PubMedGoogle ScholarCrossref
20.
Yi-Frazier  JP , Fladeboe  K , Klein  V ,  et al.  Promoting Resilience in Stress Management for Parents (PRISM-P): an intervention for caregivers of youth with serious illness.   Fam Syst Health. 2017;35(3):341-351. doi:10.1037/fsh0000281 PubMedGoogle ScholarCrossref
21.
Toprak  D , Nay  L , McNamara  S , Rosenberg  AR , Rosenfeld  M , Yi-Frazier  JP .  Resilience in adolescents and young adults with cystic fibrosis: a pilot feasibility study of the promoting resilience in stress management intervention.   Pediatr Pulmonol. 2020;55(3):638-645. doi:10.1002/ppul.24574 PubMedGoogle ScholarCrossref
22.
Fast Co. The most innovative health projects of 2020. September 30, 2020. Accessed January 3, 2022. https://www.fastcompany.com/90547947/health-innovation-by-design-2020
23.
Connor  KM , Davidson  JR .  Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).   Depress Anxiety. 2003;18(2):76-82. doi:10.1002/da.10113 PubMedGoogle ScholarCrossref
24.
Campbell-Sills  L , Stein  MB .  Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience.   J Trauma Stress. 2007;20(6):1019-1028. doi:10.1002/jts.20271 PubMedGoogle ScholarCrossref
25.
Cohen  S , Kamarck  T , Mermelstein  R .  A global measure of perceived stress.   J Health Soc Behav. 1983;24(4):385-396. doi:10.2307/2136404 PubMedGoogle ScholarCrossref
26.
Cohen  S , Williamson  G , eds.  Perceived Stress in a Probability Sample of the United States. Sage. Soc Psychol Health; 1988.
27.
Barbosa-Leiker  C , Kostick  M , Lei  M ,  et al.  Measurement invariance of the perceived stress scale and latent mean differences across gender and time.   Stress Health. 2013;29(3):253-260. doi:10.1002/smi.2463 PubMedGoogle ScholarCrossref
28.
Spitzer  RL , Kroenke  K , Williams  JBW , Löwe  B .  A brief measure for assessing generalized anxiety disorder: the GAD-7.   Arch Intern Med. 2006;166(10):1092-1097. doi:10.1001/archinte.166.10.1092 PubMedGoogle ScholarCrossref
29.
Leiter  MP , Maslach  C .  Latent burnout profiles: a new approach to understanding the burnout experience.   Burn Res. 2016;3:89-100. doi:10.1016/j.burn.2016.09.001Google ScholarCrossref
30.
Maslach  C , Jackson  SE , Leiter  MP , Schaufeli  WB , Schwab  RL . Maslach Burnout Inventory Manual. 4th ed. Mind Garden Inc; 2018.
31.
Kalliath  TJ , O’Driscoll  MP , Gillespie  DF , Bluedorn  AC .  A test of the Maslach Burnout Inventory in three samples of healthcare professionals.   Work Stress. 2000;14:35-50. doi:10.1080/026783700417212Google ScholarCrossref
32.
Kanste  O , Miettunen  J , Kyngäs  H .  Factor structure of the Maslach Burnout Inventory among Finnish nursing staff.   Nurs Health Sci. 2006;8(4):201-207. doi:10.1111/j.1442-2018.2006.00283.x PubMedGoogle ScholarCrossref
33.
Snyder  CR , Harris  C , Anderson  JR ,  et al.  The will and the ways: development and validation of an individual-differences measure of hope.   J Pers Soc Psychol. 1991;60(4):570-585. doi:10.1037/0022-3514.60.4.570 PubMedGoogle ScholarCrossref
34.
Michel  G , Taylor  N , Absolom  K , Eiser  C .  Benefit finding in survivors of childhood cancer and their parents: further empirical support for the Benefit Finding Scale for Children.   Child Care Health Dev. 2010;36(1):123-129. doi:10.1111/j.1365-2214.2009.01034.x PubMedGoogle ScholarCrossref
35.
Antoni  MH , Lehman  JM , Kilbourn  KM ,  et al.  Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer.   Health Psychol. 2001;20(1):20-32. doi:10.1037/0278-6133.20.1.20 PubMedGoogle ScholarCrossref
36.
Tomich  PL , Helgeson  VS .  Is finding something good in the bad always good? benefit finding among women with breast cancer.   Health Psychol. 2004;23(1):16-23. doi:10.1037/0278-6133.23.1.16 PubMedGoogle ScholarCrossref
37.
Steger  MF , Dik  BJ , Duffy  RD .  Measuring meaningful work: The Work and Meaning Inventory (WAMI).   J Career Assess. 2012;20:322-337. doi:10.1177/1069072711436160Google ScholarCrossref
38.
O’Brien  BC , Harris  IB , Beckman  TJ , Reed  DA , Cook  DA .  Standards for reporting qualitative research: a synthesis of recommendations.   Acad Med. 2014;89(9):1245-1251. doi:10.1097/ACM.0000000000000388PubMedGoogle ScholarCrossref
39.
Fladeboe  KM , O’Donnell  MB , Barton  KS ,  et al.  A novel combined resilience and advance care planning intervention for adolescents and young adults with advanced cancer: a feasibility and acceptability cohort study.   Cancer. 2021;127(23):4504-4511. doi:10.1002/cncr.33830 PubMedGoogle ScholarCrossref
40.
Shanafelt  TD .  Physician well-being 2.0: where are we and where are we going?   Mayo Clin Proc. 2021;96(10):2682-2693. doi:10.1016/j.mayocp.2021.06.005 PubMedGoogle ScholarCrossref
41.
Jackson  D , Firtko  A , Edenborough  M .  Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review.   J Adv Nurs. 2007;60(1):1-9. doi:10.1111/j.1365-2648.2007.04412.x PubMedGoogle ScholarCrossref
42.
Giorgi  G , Lecca  LI , Alessio  F ,  et al.  COVID-19-related mental health effects in the workplace: a narrative review.   Int J Environ Res Public Health. 2020;17(21):7857. doi:10.3390/ijerph17217857 PubMedGoogle ScholarCrossref
43.
Jiménez-Giménez  M , Sánchez-Escribano  A , Figuero-Oltra  MM ,  et al.  Taking care of those who care: attending psychological needs of health workers in a hospital in Madrid (Spain) during the COVID-19 pandemic.   Curr Psychiatry Rep. 2021;23(7):44. doi:10.1007/s11920-021-01253-9 PubMedGoogle ScholarCrossref
44.
Pollock  A , Campbell  P , Cheyne  J ,  et al.  Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review.   Cochrane Database Syst Rev. 2020;11:CD013779. doi:10.1002/14651858.CD013779PubMedGoogle ScholarCrossref
45.
Choi  HJ , Yang  CM , Lee  SY , Lee  HJ , Jang  SH .  Mental health and quality of life for healthcare workers in a university hospital under COVID-19.   Psychiatry Investig. 2022;19(2):85-91. doi:10.30773/pi.2021.0307 PubMedGoogle ScholarCrossref
46.
Alameddine  M , Clinton  M , Bou-Karroum  K , Richa  N , Doumit  MAA .  Factors associated with the resilience of nurses during the COVID-19 pandemic.   Worldviews Evid Based Nurs. 2021;18(6):320-331. doi:10.1111/wvn.12544 PubMedGoogle ScholarCrossref
47.
Rosenberg  AR .  Cultivating deliberate resilience during the coronavirus disease 2019 pandemic.   JAMA Pediatr. 2020;174(9):817-818. doi:10.1001/jamapediatrics.2020.1436 PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

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.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Close
Want full access to the AMA Ed Hub?
Become an AMA member now
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
Become an AMA member now
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue