Resilience Equine Assisted Learning with Undergraduate Nursing Students

Abstract

Background: For many undergraduate nursing students (64%), burnout begins during education. Resilience is a known protective factor to buffer against stress exposure that leads to burnout, but a lack of formal resilience training for undergraduate nursing students persists. Equine-assisted learning interventions promote resilience and decrease stress and burnout in a diversity of populations.Methods: A three-group randomized control trial was used to determine the feasibility of the Resilience Equine-Assisted Learning (REAL) intervention and to explore within-group changes in stress, burnout, and resilience among undergraduate nursing students. University of Nevada Reno nursing students were recruited using in-class presentations and randomized to groups for the intervention duration (6 weeks): REAL intervention, unstructured horse interaction (UHI) control group, and treatment-as-usual (TAU) control group. Participant recruitment, retention, intervention adherence, acceptability, appropriateness, feasibility, fidelity, and safety were compared to benchmarks. Self-report measurement tools quantified stress, burnout, and resilience. Descriptive statistics and non-parametric statistical testing were used to summarize and analyze data. Results: Twenty-two nursing students (48% of benchmark) were recruited and 20 participants (91%) completed all data collection aspects. Intervention adherence in the REAL and UHI groups was poor (<36%); reasons for non-adherence were schedule conflicts (86%) and winter weather conditions (29%). Students in REAL and UHI groups reported high treatment acceptability, appropriateness, and feasibility scores (>15), while the TAU group reported low scores (<15) for acceptability and appropriateness. REAL intervention fidelity was high (>90%) and no adverse events were reported during the interventions. In the REAL group only, post-intervention burnout-exhaustion was decreased from baseline (p=0.02). In post-intervention data, resilience was negatively correlated to burnout-exhaustion scores (r=-0.57, p=0.01) and perceived stress scores (r=-0.60, p=0.01) and a positive correlation between resilience scores and burnout-efficacy (r=0.44, p=0.05) Discussion: Despite a small study sample and adverse weather during the intervention, this study was feasible, appropriate and acceptable. Considering adherence limitations, we found the REAL intervention reduced within-group burnout scores and as resilience increased, burnout and stress decreased. Yet, extra-curricular interventions remain a barrier for participants. Opportunities for design refinement were revealed as a launching pad for future research investigating the REAL intervention to improve nursing student wellness outcomes.