Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study

AimTo determine the efficacy of an online mindfulness intervention in reducing anxiety and stress levels in nursing students during clinical simulations.BackgroundClinical simulation as a learning strategy has many benefits but the high levels of stress and anxiety it produces in participants can compromise learning, motivation or performance.DesignA quasi-experimental study with a non-equivalent control group design is presented. Forty-two undergraduate nursing students from a natural group were divided into: an experimental group (n = 21) and a control group (n = 21).MethodsBefore conducting a clinical simulation, the experimental group followed a 10-day intensive online mindfulness intervention. All students received the same information and training. Instruments used were: Self-administered Analogue Stress Scale, State-Trait Anxiety Inventory and Five Facet Mindfulness Questionnaire. In addition, physiological data (blood pressure and heart rate) were collected at baseline, pre-briefing and debriefing.ResultsPhysiological variables increased in the prebriefing phase but remained statistically significantly lower in the experimental group (diastolic blood pressure p = .032 and heart rate p = .048). Levels of stress (p = .029) and anxiety (p = .016) were also managed better. Both groups in the debriefing session showed a statistically significant decrease in the different physiological variables, stress and anxiety. No changes in mindfulness were observed.ConclusionsThe clinical simulation is indicated to generate stress and anxiety in nursing students. Therefore, measures must be adopted to control it. The intensive online mindfulness intervention proposed in this study reduced physiological parameters, stress and anxiety in the clinical simulation.     

Comment « défusionner » de la scène traumatique ? La pratique du « défusing » : trente ans de discours spécialisé psychiatrique et psychologique

BackgroundNotably organized by the medical-psychological emergency cells (CUMP) in France, the immediate care offered after confronting a potentially psychotraumatic event has been able to spill a lot of ink between those who adulate them or those who hate them, as much in the specialized press as through the media intended for the general public. Indispensable practice aimed at treating psychological wounds for some, charlatanism providing worsening of post-traumatic symptoms for others, medico-psychological recommendations have long remained cryptic in the face of the absence of studies of enough level of scientificity. Thirty years after its first formalizations, no study has offered a critical synthesis of the notion of “defusing”.ObjectivesOur main objective is to study the specialized discourse concerning “defusing” as defined and relayed by psychiatrists and psychologists in French-language journals. We seek to identify the stages of the construction of this treatment time, the maturation of its practice by synthesis of the “defusing type” and the theorization of its therapeutic mechanisms.MethodsFrench-language articles published between January 1, 1990 and December 31, 2019 were selected from the entry of the keyword “defusing” in five search engines as well as in the thesauri of the interuniversity library of medicine and the central library of the army health service. The extracted data combine: the number of article (s) per year of publication, the names of the journals and the authors (research team, place of practice, statutes). The titles, summaries and body of texts were examined by three speech analysis software programs with quantification of textual units and facilitation of return to text by keyword.ResultsLess than 30 articles mention the notion of “defusing” in French-speaking literature, of which only 2 are in their titles and finally, no reference is fully dedicated to it. Compared to the adjacent chapters dealing with the organization of CUMPs, the emergency clinic, and debriefing, the articles referenced do little to address the notion of “defusing”. If the conception of psychological trauma is popularized by its clinical and etiopathogenic dimensions (essentially psychopathological, ignoring neurobiological or socio-anthropological aspects), immediate treatment is only sketched out (by its organizational, theoretical and practical developments). All these notions turn out to be approached in a segmental fashion via adjacent paragraphs with no obvious links between them. Very few articulations are advanced with the concepts of psychiatry or general psychology, or the inclusion of defusing within a global theory of psychotherapy. Materializing numerous literal repetitions from one article to another, the synthesis organizing the qualitative data revealing the practical definition of defusing is rather brief. All references combined, only a few sentences briefly addressing the notions of language recovery and capacities of levels of representation can enlighten us on the supposed therapeutic processes. In addition, certain areas are barely addressed: little mention of family traumas, relative silence concerning specificities in children, absence of scientific studies concerning the effectiveness of defusing.DiscussionIn the referenced texts, if the part devoted to the organization of care is significant in terms of volume, it is because it participates conceptually in the appeasement by restitution of an environment allowing to get out of the traumatic scene. Then, the apparent simplicity of the therapeutic concepts in reality reveals cardinal prerequisites: clinical analysis, permanent adjustment of the right relational distance, ability to receive the suffering of others, sustained attention over time, technical skill in particular inter-transferential mobilizations, ability to develop adaptive skills. The attitude and words of the practitioner are based above all on their experiences in clinical analysis and psychotherapeutic care in general. This is undoubtedly the main reason for the absence of scientific studies on defusing facing the same material difficulties as the evaluation of psychotherapy. While only the nonspecific factors of effectiveness of psychotherapies appear to be recognized today, first and foremost the flexibility of the practitioner in the face of his theoretical references, would it be possible to recognize principles specifically effective in the treatment of post-traumatic symptoms?ConclusionWhile several authors still bring together defusing and debriefing to the point of speaking of “immediate and post-immediate debriefing”, the confusion induced is perhaps only relative in view of specific therapeutic mechanisms aimed at appeasing dissociation. Speech constitutes the tool, the cement allowing to bridge dissociative fractures, to connect the psychic, neuropsychic and social spaces which were previously disjointed. Prompted or even guided by the practitioner, this therapeutic word deserves to be qualified as “maieutics”, from the name of the science of childbirth: thought is not developed here prior to its elocution, but the inaugural word, as it arises, as it is expressed, creates thought. By “giving” his word, by “lending” his language, the practitioner actively listens to the mentally injured person and guides them to find the words that they are not able to speak spontaneously. Thanks to the development of a partly common discourse, resulting from intersubjectivity, the capacities of singular elaborations and mentalizations are enhanced, on the side of the patient, and on the side of the practitioner, without the created senses necessarily being the same.     

Commentary on "Issues in the Debriefing Debate for the Emergency Services: Moving Research Outcomes Forward"

Tuckey's (2007) article explores reasons why the debate on psychological debriefing has persisted for two decades without apparent resolve. One of its strengths lies in the focus on the methodology of the research literature (rather than findings), and problems are discussed without favor to either side. This disciplined approach has enabled delineation of flaws in the data as well as conclusions drawn on the basis of findings. The author uses her analysis of "what not to do" when you are conducting research in this area to develop research guidelines on what should be done. The present commentary begins with a historical précis of the debate on psychological debriefing and then explores some of the issues raised by Tuckey.     

A special courage: dealing with the Paddington rail crash

Supporting traumatized employees requires special skills and techniques if it is to be effective. Unfortunately, there is little to inform or guide organizations on how this should be achieved. The present controversy over the use of trauma management systems and debriefing has not been helpful in informing organizations on the best way to take care of employees who become traumatized during the course of their work. This paper looks at how Sainsbury's Supermarkets Ltd managed traumatization through the activation of its Violence at Work policy and procedures, and finally presents the results of an evaluation exercise that was undertaken following the Paddington rail crash.