• Stress Reduction in Student Registered Nurse Anesthetists via a Semi-Structured Peer Mentor Program

    Author(s): Jennifer Keshishian; Shaquitta Bell; Jarrod Moulds; Srinidhi Vittal; Edwin Aroke, PhD, CRNA University of Alabama at Birmingham

    Background: According to numerous peer-reviewed articles and systematic reviews, nursing students experience higher levels of stress with more physical and psychological symptoms compared to majors in other health-related disciplines. Student registered nurse anesthetists (SRNAs), in particular, have reported perceived stress levels of 7.2 out of 10 while Certified Registered Nurse Anesthetists (CRNAs) had scores of 4.7 out of 10. At the institution where this quality improvement project was implemented, graduate students in health professional programs are the largest consumers of counseling services. In a population that is already at risk for mental health symptoms, adding stress of a global pandemic may lead to both physical and mental illness. Students may have feelings of isolation and anxiety due to social distancing, the transition from in-person to online studies, and limited access to psychiatric care. This quality improvement project aims to reduce SRNA stress through a semi-structured peer mentor program implemented over the course of the Summer 2020 semester.

    Method: A semi-structured peer mentorship program was developed to reduce SRNA stress during a major transition in the nurse anesthesia (NA) program. Upon initiation of the quality improvement project, Counseling Services representatives gave a presentation on stress reduction techniques to potential mentee participants. Following this presentation, interested mentee participants completed the Perceived Stress Scale so that baseline perceived stress scores were established. Each mentee was paired with a volunteer mentor from the senior NA class, forming 15 mentor-mentee pairings. During the intervention period, mentor-mentee communication took place at least twice a month. The duration of the mentorship intervention was 2 months beginning June 26, 2020 and ending August 26, 2020. Following conclusion of the intervention, the Perceived Stress Scale was re-administered. Mean perceived stress scores pre- and post-intervention were analyzed using R. In addition, descriptive statistics were run in Microsoft Excel.

    Results: The project took place in the school of nursing at a large southeastern university. Of the 40 students in the NA cohort of interest, 15 students consented to take part in the mentorship program; 11 were female and 4 were male. Participants were majority Caucasian ranging from 20-43 years of age. When surveyed on the impact COVID-19 has had on their schooling, 9 out of 13 students report that COVID-19 has moderately or severely hindered their ability to learn clinical anesthesia skills and their preparedness for the transition to clinical practice. Perceived stress scores were evaluated on a scale from 0 to 4 and prior to mentorship averaged 1.855 (SD = 0.48). A midpoint check-in revealed 6 of 9 responding mentees have been in regular communication with their mentor, and 8 of 9 found their mentor relationship to be helpful. Post-intervention perceived stress scores averaged 1.282 (SD = 0.47). A Welch two sample t-test revealed a statistically significant difference in mean perceived stress scores pre- and post-intervention (P = 0.00989).

    Discussion: Key findings include a handful of mentees who reported that although they have not explicitly needed their mentor, they felt it was reassuring to have someone should the need arise. This demonstrates that while students may be self-sufficient, a network of peers to “fall back on” is comforting. In addition, findings demonstrate the clear negative impact of COVID-19 on students’ transition to clinical practice. Amplified efforts to ease SRNA stress during this unprecedented time are imperative, and peer support through mentorship appears to be an effectual first step. Although efforts were made to standardize communication across pairings through distribution of a mentor preparation packet and check-in reminders sent via a GroupMe chat, there exists an inherent inability to ensure uniform communication across pairings. This is a function of mentor’s engagement with the program, their comfort level with their assigned mentee, and perhaps also the mentee’s involvement with mentor. Project outcomes included attenuating SRNA stress, improved clinical performance, and student satisfaction with the mentor program. Furthermore, positive interactions between junior and senior SRNAs improved rapport and inter-cohort relations. Project results may support the implementation of a peer-mentoring program for the entirety of the NA program rather than an abbreviated period.

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