Stress is a significant and unavoidable issue in nursing education. Stress is defined as a relationship between the person and the environment that is considered personally noteworthy and challenging or exceeding coping resources (Lazarus & Folkman, 1984). Various factors can lead to stress. Existing evidence shows that the two significant causes in nursing students are academic demands and the clinical learning environment (McCarthy et al., 2018).
Academic stress, without proper and timely coping strategies, leads to unpleasant feelings (Ayaz-Alkay & Simones, 2022), and maladaptive behaviors can impede students' ability to complete their nursing education. The effects of stress on nursing student outcomes require schools of nursing to consider potential stress management interventions (Ayaz-Alkay & Simones, 2022). One of every three nursing students reported anxiety or dealing with negative stress during the COVID-19 outbreak (Zukhra et al., 2021).
IDENTIFYING THE PROBLEM
At the start of the pandemic, traditional bachelor of science in nursing (BSN) students at our university were rapidly moved from face-to-face learning to online learning. As the course of their work progressed and online learning remained the standard, the influence of home confinement on lifestyle, mental well-being, nutritional status, and sleeping patterns became evident. Faculty and the leadership team noticed more students reaching out for mental well-being assistance.
Nursing students must be able to cope with stressful situations before entering practice because nursing is a stressful profession. Nurses experience the stress of long hours at work and the need to take on greater and more complex patient loads (Ayaz-Alkay & Simones, 2022). This was our starting point for developing a wellness program from the ground up.
DEVELOPING THE PROGRAM
Three steps were taken to develop the wellness program within the school of nursing. The first step included the identification and onboarding of appropriate stakeholders. This process required an in-depth look into departments directly involved with students that would be impacted if a student experienced a wellness concern. The most obvious were student affairs, programmatic faculty, and the institution's counseling services. These collaborative relationships were crucial to the development of the wellness program.
The second step was to develop an algorithm for all staff and faculty to follow when encountering students with wellness concerns. This step was important to ensure faculty and staff could advise students on the appropriate steps to take. The algorithm allowed faculty to remove themselves from students' personal information as students' academic and personal status were separated. Before we developed the wellness program, the blending of students' personal situations and wellness created moral distress in faculty.
The algorithm allows faculty and students to seek assistance promptly. It consists of three portions - green, yellow, and red. Students who are anxious, need to vent, or have changed sleeping patterns are considered green. Students who request financial and/or counseling resources are considered yellow. And red is used for students who are in immediate danger and threats to themselves or others.
The final step to developing the wellness program was mass delivery and access across the nursing school to a website housed on the learning management system used by all courses. The wellness website hosts a variety of resources available to students and allows students to self-identify needs without disclosing personal information. It provides students with resources to schedule a meeting with a counselor, practice mindfulness online, speak with the office of disability about accommodations, obtain vouchers for free food, and seek financial support at the click of a button. The website can be opened from a mobile device or a computer.
BUILDING PARTNERSHIP
A successful collaborative partnership between academic and student affairs is possible when there is a common purpose; in this case, supporting nursing students in managing stress and mental health challenges as they attempt to be academically successful (Manning et al., 2006). The partnership has allowed for the development of a seamless and interdisciplinary program grounded in the case management of students in need. Through a referral process, the needs of students are managed outside the classroom and are not under the purview of the faculty. This system clearly defines the flow of services provided and by whom. Therefore, all involved understand the algorithm of each possible referral. Such a program reinforces the partnership between academic and student affairs and how the partnership successfully promotes open and effective communication in a team management environment.
FEEDBACK AND STUDENT/FACULTY PERCEPTIONS
The promotion of health and well-being is a holistic concept and much needed among higher education institutions. Developing a wellness program can seem grandiose or unreachable but should be at the forefront of every leadership discussion, especially in nursing schools. The feedback from developing our wellness program was positive overall but not without some challenges.
The team collected real-time data on student wellness at the start of the wellness program. In summer 2020, approximately 91 students were referred; of these, 57 were green, 23 were yellow, and 11 were red. In spring 2021, the number rose to 96 students: 63 green, 27 yellow, and 6 red. The wellness program was developed with an increased number of students being referred and students utilizing the resources.
Students reported that the wellness program and resources assisted in their achieving better health, wellness, and academic success. In addition, students were grateful for the time and attention placed on their mental well-being. Students reported the wellness website to be user-friendly and easily accessible in each academic course. Faculty reported positive experiences immediately with the implementation of the program. Faculty focused on academic concerns, which allowed the separation of academic and personal conversations, although not all cases were separate. Most students who were considered yellow or red per the algorithm were found to also struggle with academics. However, knowing that students would receive aid for personal challenges was a relief for faculty.
There were challenges to starting the wellness program. As the institution's primary mission is to educate future nurses, it was essential to convince leadership and faculty that wellness is a significant component of being a successful student. The team collected real-time data on student wellness and faculty wellness to address this challenge. All referrals were logged and reported to the faculty and leadership teams. The first logs indicated a significant need to formalize the wellness program. Once a quantifiable number was presented to the groups, most of the faculty and leadership were on board to implement the program.
The next challenge was probably the most predicted, that is, funding. The associate dean gave the lead wellness faculty workload release time for tracking students and attending meetings to address funding concerns. Student time and faculty time spent with wellness were tracked and used to approach leadership about creating a position and providing an administrative supplement. The rapid shift to online teaching classes and simulation platforms minimized other costs but led to the most significant challenge the program would face: How does one design a wellness program with virtual encounters? How could we ensure that each student was identified early? Who would check on faculty during this unprecedented time? To respond to these questions, the lead wellness faculty identified a task force of faculty and staff who checked on faculty regularly and ensured that students had the wellness resources they needed. Meetings were conducted via an online video platform, and students were introduced to the wellness program during their orientation.
CONCLUSION
Significant levels of emotional distress can be found at all levels of higher education, but now, more than ever, nursing schools are seeing a wellness crisis that impacts the delivery of material and attrition rates and will ultimately affect the availability of nurses. The normal stressors affecting nursing students, coupled with a worldwide pandemic, support the implementation of wellness programs in all nursing programs (Ayaz-Alkay & Simones, 2022; McCarthy et al., 2018; Zukhra et al., 2021). Undergraduate nursing students are the future of nursing. Investing the time, effort, funding, and resources into wellness programs can only benefit the future of the nursing workforce.
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