Teaching Health Profession Students the Skills Needed to Maintain Wellbeing

by Anna Carroll Harris, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Numerous studies have been published exploring burnout among healthcare workers. Health profession students are also prone to burnout due to the vigorous course load required to obtain their degrees. The WHO defines burnout as a syndrome that is directly correlated with an environment that exposes workers or students to chronic stress and where the stressors are not successfully handled. It is characterized by feelings of emotional exhaustion, amplified feelings of negativism towards one’s job, and decreased professional worth.

The occurrence of burnout not only affects those working and learning in the healthcare industry, but also the patients to whom they provide care. For example, pharmacists who are experiencing increased levels of stress and emotional exhaustion may feel a sense of depersonalization towards patients they are caring for. This in turn can lead to medication errors and harmful events for patients.¹ It is imperative that schools and colleges of pharmacy, and other health professional degree programs, help students develop the skillset and positive behavior practices that needed to maintain their wellbeing and prevent burnout throughout their careers.²

Many professional organizations have noted the need to provide health profession students and healthcare practitioners with resources to encourage a state of well-being and prevent burnout. The American Association of Colleges of Pharmacy has published two policies, a 2017 and 2018 statement, in response to the increasing realization that burnout is prevalent. Both statements encourage and hold schools and colleges of pharmacies accountable for effectively promoting wellness and implementing management methods directed to students, faculty, preceptors, and staff.³ In reaction to these statements, schools and colleges of pharmacy across the country are putting programs into place that foster an environment for creating and maintaining well-being. For example, the Ohio State University College of Pharmacy has a “Wellness Corner” dedicated to providing faculty, staff, and students an environment that promotes and protects well-being. They have been recognized across their campus as having a strong culture of wellness by implementing evidence-based wellness strategies and providing tools to achieve a sense of wellbeing.⁴

The University of Kentucky College of Pharmacy completed a study where they “nudged” pharmacy students to adopt well-being behaviors. Over a span of 4 months, a series of optional well-being challenges were embedded in their pharmacy management course. These challenges included limiting smartphone use, emphasizing feelings of gratitude, good sleep hygiene, and engaging in regular exercise. Participants completed a reflection at the end of the course that explored reasons for participation, prior behaviors, and if participants planned to continue to implement the new behaviors after completion of the challenges. The majority of participants indicated that they planned on maintaining the positive behaviors moving forward.⁵

The specific stressors that lead to burnout have been identified in many studies. A study that included pharmacy students in an urban Midwestern region identified strategies that pharmacy students utilized to protect their wellbeing and prevent burnout. Students participating in a social and administrative science course were to write a reflection on factors that they believed had the greatest impact, either positively, negatively or mixed, on their wellbeing during pharmacy school. Four specific themes emerged as strategies that students use to cope with stressors during pharmacy school:⁶

1. Availability and accessibility of institutional resources
2. Personal time management and organizational strategies
3. Personal, mental, and physical health strategies
4. Activities that maintain social relationships

These results provide schools and colleges of pharmacy specific ways they can augment their campuses' attempts to foster wellbeing. Ensuring that institutional resources, such as the medical library and faculty, are readily available to students can help reduce stress and maintain wellbeing. Offering counseling and health services to those who needed them is supportive of students’ wellbeing. A few of the wellness activities mentioned in the Ohio State University College of Pharmacy “Wellness Corner” were a take five-station, a mental timeout area where students could play a game or create a craft, as well as monthly wellness walks. Ensuring that students maintain a healthy balance between schoolwork and leisure activities can reduce stress. Emphasizing the need for students to take time for themselves to socialize with friends and family and maintain hobbies is important.

In the unprecedented times of a pandemic, providing students with resources and teaching them skills to protect their well-being is more essential than ever. With COVID-19 disrupting the lives and wellbeing of so many, health profession students are dealing with the added stressors of helping take care of family members and serving on the frontlines of healthcare, in addition to their demanding coursework.⁷ The loss of person-to-person contact and being isolated away from one’s family has taken a toll on many students. What once provided a means for students to reset and take a break from the rigors of academic coursework is now discouraged.  Schools and colleges need to find creative ways to provide ongoing support to their students, faculty, and staff.  See Table 1.

Table 1: Examples of support during a pandemic

Virtual group exercise	Email check-ins	Virtual mentorships programs
Virtual game nights	Virtual group meditations	PPE drives/mask-making
Virtual book clubs	Virtual dinner dates	Virtual tutoring

As health profession students graduate, they will continue to experience stressful times and emotional exhaustion that can lead down the path of burnout. Health profession programs should work to implement programming and strategies early in their curricula that can provide students with a skillset to prevent burnout. General professional development courses, which are often part of the curriculum, would be a great place to embed lectures about managing stress and including periodic wellbeing challenges for students. These longitudinal courses should be pass/fail due to the nature of the content and should encourage students to adopt and execute tactics that best fit their personal circumstances and needs. Learning about and implementing these healthy habits while in school can help students cope with the stressors they will face throughout their careers.

References

1. World Health Organization. Burn-out an "occupational phenomenon": International Classification of Diseases. Accessed November 18, 2020.
2. Hagemann TM, Reed BN, Bradley BA, et al. Burnout among clinical pharmacists: Causes, interventions, and a call to action. J Am Coll Clin Pharm 2020; 3:832–842.
3. American Association of Colleges of Pharmacy. AACP Statement on Commitment to Clinician Well-being and Resilience. Accessed November 18, 2020. https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/jac5.1256
4. The Ohio State University College of Pharmacy. Wellness Corner. https://pharmacy.osu.edu/wellness-corner. Access November 18, 2020.
5. Cain J. Effectiveness of Issuing Well-being Challenges to Nudge Pharmacy Students to Adopt Well-being Protective Behaviors. Am J Pharm Educ 2020; 84(8) Article 7875.
6. Abraham O, Babal, JC, Brasel KV, Gay S. Strategies first year doctor of pharmacy students use to promote well-being. Currents in Pharmacy Teaching and Learning. 2021; 13:29–35.
7. Schlesselman LS, Cain J, DiVall M. THE COVID-19 PANDEMIC ACROSS THE ACADEMY: Improving and Restoring the Well-being and Resilience of Pharmacy Students during a Pandemic. Am J Pharm Educ 2020; 84 (6) Article 8144.

Community Baby Showers: An Innovative Approach to Teaching New Mothers Sleep Safety

by Megan Carter, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Ahlers-Schmidt C R, Schunn C, Hervey A M, et al. Redesigned community baby showers to promote infant safe sleep. Health Education Journal 2020; 79(8): 888-900.

When looking through the Health Education Journal, this article piqued my interest because I was aware of the importance of safe sleeping habits for infants.  My mom works for the Alabama Department of Public Health and has been reviewing infant death cases for about 15 years.  Although she doesn't reveal details about the cases she reviews, she has shared a couple of particularly heart-wrenching stories regarding babies who died.  Unfortunately, these stories are not rare, as nearly 3500 infant deaths in the USA are due to sleep-related causes. Unfortunately, although we know much more about sleep safety during infancy, this number has not declined in recent years.¹ These kinds of deaths are preventable if parents are properly educated about how to create a safe sleeping environment.  This study aimed to provide sleep safety education to mothers, specifically mothers from low-income communities, in a relaxed environment. The authors assessed a novel approach that could increase knowledge and health-promoting behaviors.

The authors of this study designed their educational intervention — including recruitment, lesson plans, materials, and assessments — around constructs from the Health Beliefs Model.  The intervention was delivered at community "baby showers" conducted in Sedgwick County, Kansas, and targeted women who were pregnant or who had recently delivered.  Upon arrival at the shower, participants were asked to complete a pre-assessment and information card.  Organizers divided the women into tour groups of 3-5 participants with a volunteer guide who led the women around the various vendor and educational booths for brief presentations.  The last stop for each tour group was the Safe Sleep Crib Demonstration.  Certified nurses or safe sleep instructors used a demonstration crib with safety-approved items to demonstrate their effectiveness as well as examples of unsafe items that are a hazard to infants.  Instructors provided tips for removing hazardous items from the infant's sleep environment.  The sessions were not time-constrained, allowing time for participants to ask questions.  After the shower, participants took home a safety-approved portable crib, blanket, and educational handouts/materials.

These events were held twice yearly (March and October) from Spring 2015 to Spring 2019 and recruited women using a variety of means including fliers at churches and clinics, maternal and child health programs, social media posts, and through partner organizations.  The program specifically targeted locations that served low-income communities, as this was the population that was most at-risk for sleep-related infant deaths.  During the study period, nine “community baby shower” events were conducted. The participants came from a range of racial and ethnic backgrounds: Non-Hispanic Black (30.4%), Non-Hispanic White (30.4%), and Hispanics (25.1%).  Greater than 70% of participants had only a high school education or less and greater than 70% were on Medicaid or uninsured.  It is also notable that less than half of participants received prenatal care from a private provider and about 20% received care from a county health department, community center, or received no routine care. The pre-assessment consisted of true/false statements developed around the Health Belief Model constructs on infant sleep safety and were compared to the responses to the same questions given as a post-assessment.  McNemar's test for paired dichotomous variables was used to analyze differences in pre- and post-assessment responses along with the McNemar odds ratio statistic.  The following true/false questions were included on the pre- and post-assessments:

• My baby is at risk of dying of SIDS
• Loose blankets in the crib can cause infant death
• Sleeping with my baby can cause infant death
• Putting my baby alone, on the back in a crib will help protect her
• My baby will choke on his back
• People tell me different things about how my baby should sleep and I don't know what to do.
• I can't keep my baby warm without blankets.
• I don't have room for a crib in my room.

The results of the study demonstrated statistically significance (p<0.001) improvements in the participants' responses in all but two of the assessment questions.  Responses to questions about knowledge and intentions showed changes in sleep positions, sleep locations, crib items, and plans to discuss safe sleep with others.  Overall, these results appear promising and events such as the community baby shower provide an excellent opportunity to teach sleep safety to mothers.

The results look promising, but as with any study, statistically significant results don't always equate to an improvement in outcomes.  This study did have several strengths, as the participants are representative of the target population and the assessment questions were based on the Health Belief Model and evaluated by the Medical Society of Sedgwick County's Safe Sleep Taskforce.  On the flip side, this study was conducted in one community, so may not be generalizable to other communities.  The study also targeted individuals from low-income areas with lower education, so the results may not apply to mothers in higher-income neighborhoods with greater levels of education.  The recruiting methods did yield a diverse participant population but relatively few dates that the event was held likely limited many women from attending.  Another potential issue was the true/false statements included in the assessment.  Several of the statements are subjective and others are potentially confusing, which may have contributed to some of the nonsignificant results.  Improving the clarity of these statements could improve the accuracy and validity of this study.  While the results were promising, I would be interested to see if the participants put their new knowledge into practice.  Are mothers able to identify hazardous materials in their home? Do they remove or replace these items?  Have the rates of infant death or hospital visits due to unsafe sleeping habits improved in this county as a result of the educational intervention?  Additionally, the results could have been biased as the group who developed the program assessed the results.  Moreover, there was no control group who received instruction in a more “traditional” manner.

Overall, this study proves that educational programs that structure their lesson plans around the Health Belief Model and offered in non-traditional environments can lead to changes in behavioral intentions.  It is important to recognize that instructional programs can be implemented outside of the traditional classroom settings and that informal community events can a venue where patients can learn about important health topics in a fun and engaging way.

References

1. About 3,500 babies in the US are lost to sleep-related deaths each year. (2018, January 09). Retrieved November 30, 2020, from https://www.cdc.gov/media/releases/2018/p0109-sleep-related-deaths.html
2. Ahlers-Schmidt C R, Schunn C, Hervey A M, et al. Redesigned community baby showers to promote infant safe sleep. Health Education Journal 2020; 79(8): 888-900.