Research Article| Volume 68, ISSUE 3, P324-336, May 2020

Download started.


The Community Resiliency Model® to promote nurse well-being

Published:November 15, 2019DOI:


      • Burnout and secondary traumatic stress are widespread among nurses.
      • We report on a randomized controlled trial of a new sensory mindfulness model.
      • Over 1/3 of nurses had high rates of poor mental health, secondary stress, and burnout.
      • The intervention group showed improved well-being, resiliency, and secondary stress.
      • Healthcare organizations must support institutional and individual resiliency.



      Rising rates of secondary traumatic stress and burnout among nurses signal a crisis in healthcare. There is a lack of evidence regarding effective interventions to improve nurse well-being and resiliency.


      This study used a randomized controlled trial parallel design to test the effectiveness of a 3-hour Community Resiliency Model® (CRM) training, a novel set of sensory awareness techniques to improve emotional balance.


      Registered nurses in two urban tertiary-care hospitals were invited to participate, which entailed attending a single 3-hour “Nurse Wellness and Well-being” class; 196 nurses consented and were randomized into the CRM intervention or nutrition education control group to determine if the CRM group would demonstrate improvement in well-being and resiliency, secondary traumatic stress, burnout, and physical symptoms.


      Pre/post data were analyzed for 40 CRM and 37 nutrition group members. Moderate-to-large effect sizes were demonstrated in the CRM group for improved well-being, resiliency, secondary traumatic stress, and physical symptoms. Participants reported using CRM techniques for self-stabilization during stressful work events.


      CRM shows promise as a brief resiliency training for hospital-based nurses.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. American Nurses Association. (2019). Healthy nurse healthy nation. Retrieved May 14, 2019, from ANA website:

        • Borritz M.
        • Christensen K.B.
        • Bültmann U.
        • Rugulies R.
        • Lund T.
        • Andersen I.
        • Kristensen T.S.
        Impact of burnout and psychosocial work characteristics on future long-term sickness absence. Prospective results of the Danish PUMA Study among human service workers.
        Journal of Occupational and Environmental Medicine. 2010; 52: 964-970
        • Boutron I.
        • Altman D.G.
        • Moher D.
        • Schulz K.F.
        • Ravaud P.
        CONSORT NPT Group. CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts.
        Ann Intern Med. 2017; 167: 40-47
        • Bride B.E.
        Prevalence of secondary traumatic stress among social workers.
        Social Work. 2007; 52: 63-70
        • Campbell-Sills L.
        • Stein M.B.
        Psychometric analysis and refinement of the Connor–Davidson resilience scale (CD-RISC): Validation of a 10-item measure of resilience.
        Journal of Traumatic Stress. 2007; 20: 1019-1028
      2. Centers for Disease Control. (2018). Well-being concepts | HRQOL | CDC. Retrieved May 14, 2019, from

        • Chau J.P.C.
        • Lo S.H.S.
        • Choi K.C.
        • Chan E.L.S.
        • McHugh M.D.
        • Tong D.W.K.
        • Lee D.T.F.
        A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals.
        BMC Health Services Research. 2015; 15: 538
        • Chesak S.S.
        • Cutshall S.M.
        • Bowe C.L.
        • Montanari K.M.
        • Bhagra A.
        Stress management interventions for nurses: Critical literature review.
        Journal of Holistic Nursing. 2019; 898010119842693
        • Christodoulou-Fella M.
        • Middleton N.
        • Papathanassoglou E.D.E.
        • Karanikola M.N.K.
        Exploration of the association between nurses’ moral distress and secondary traumatic stress syndrome: Implications for patient safety in mental health services.
        BioMed Research International. 2017; 2017: 1-19
        • Cimiotti J.P.
        • Aiken L.H.
        • Sloane D.M.
        • Wu E.S.
        Nurse staffing, burnout, and health care–associated infection.
        American Journal of Infection Control. 2012; 40: 486-490
        • Citron S.
        • Miller-Karas E.
        Final CRM Innovation Evaluation Report.
        (September) Trauma Resource Institute, 2013
        • Cleary M.
        • Kornhaber R.
        • Thapa D.K.
        • West S.
        • Visentin D.
        The effectiveness of interventions to improve resilience among health professionals: A systematic review.
        Nurse Education Today. 2018; 71: 247-263
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. N.J: L. Erlbaum Associates, Hillsdale1988
      3. Davidson, J. (2018). The Connor-Davidson Resilience Scale (CD-RISC). Retrieved May 14, 2019, from

        • Davidson J.E.
        • Zisook S.
        • Kirby B.
        • DeMichele G.
        • Norcross W.
        Suicide prevention: A healer education and referral program for nurses.
        The Journal of Nursing Administration. 2018; 48: 85-92
        • Davidson J.
        • Mendis A.R.
        • Stuck G.
        • DeMichele G.
        • Zisook S.
        Nurse suicide: Breaking the silence. NAM Perspectives. Discussion Paper.
        National Academy of Medicine, Washington, Dc2018 (
        • Delgado C.
        • Roche M.
        • Fethney J.
        • Foster K.
        Workplace resilience and emotional labour of Australian mental health nurses: Results of a national survey.
        International Journal of Mental Health Nursing. 2019; (inm.12598)
        • Flinkman M.
        • Salanterä S.
        Early career experiences and perceptions—A qualitative exploration of the turnover of young registered nurses and intention to leave the nursing profession in Finland.
        Journal of Nursing Management. 2015; 23: 1050-1057
        • Gierk B.
        • Kohlmann S.
        • Kroenke K.
        • Spangenberg L.
        • Zenger M.
        • Brähler E.
        • Löwe B.
        The somatic symptom scale–8 (SSS-8): A brief measure of somatic symptom burden.
        JAMA Internal Medicine. 2014; 174: 399
        • Gierk B.
        • Kohlmann S.
        • Toussaint A.
        • Wahl I.
        • Brünahl C.A.
        • Murray A.M.
        • Löwe B.
        Assessing somatic symptom burden: A psychometric comparison of the patient health questionnaire-15 (PHQ-15) and the somatic symptom scale-8 (SSS-8).
        Journal of Psychosomatic Research. 2015; 78: 352-355
        • Gogolla N.
        The insular cortex.
        Current Biology: CB. 2017; 27: R580-R586
        • Hanson R.
        Hardwiring happiness: The new brain science of contentment, calm, and confidence.
        First edition. Harmony Books, New York2013
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • Elliott V.
        • Fernandez M.
        • O'Neal L.
        • Consortium REDCap
        The REDCap consortium: Building an international community of software platform partners.
        Journal of Biomedical Informatics. 2019; 95103208
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support.
        Journal of Biomedical Informatics. 2009; 42: 377-381
        • Hedeker D.R.
        • Gibbons R.D.
        Longitudinal data analysis.
        Wiley-Interscience, Hoboken, N.J2006
        • Kristensen T.S.
        • Borritz M.
        • Villadsen E.
        • Christensen K.B.
        The Copenhagen Burnout Inventory: A new tool for the assessment of burnout.
        Work & Stress. 2005; 19: 192-207
        • Lang A.J.
        Mindfulness in PTSD treatment.
        Current Opinion in Psychology. 2017; 14: 40-43
        • Leitch L.
        • Miller-Karas E.
        A case for using biologically-based mental health intervention in post-earthquake China: Evaluation of training in the trauma resiliency model.
        International Journal of Emergency Mental Health. 2009; 11: 221-233
        • Leitch M.L.
        Somatic experiencing treatment with tsunami survivors in Thailand: Broadening the scope of early intervention.
        Traumatology. 2007; 13: 11-20
        • Leitch M.L.
        • Vanslyke J.
        • Allen M.
        Somatic experiencing treatment with social service workers following Hurricanes Katrina and Rita.
        Social Work. 2009; 54: 9-18
        • Letvak S.A.
        • Ruhm C.J.
        • Gupta S.N.
        Original research: Nursesʼ presenteeism and its effects on self-reported quality of care and costs.
        American Journal of Nursing. 2012; 112: 30-38
        • Levine P.A.
        Waking the tiger: Healing trauma: the innate capacity to transform overwhelming experiences.
        North Atlantic Books, Berkeley, Calif1997
        • Mcdonald G.
        • Jackson D.
        • Vickers M.H.
        • Wilkes L.
        Surviving workplace adversity: A qualitative study of nurses and midwives and their strategies to increase personal resilience.
        Journal of Nursing Management. 2016; 24: 123-131
        • Miller-Karas E.
        Building resilience to trauma: The trauma and community resiliency models.
        Taylor & Francis Group, New York: Routledge2015
        • Parker C.
        • Doctor R.M.
        • Selvam R.
        Somatic therapy treatment effects with Tsunami survivors.
        Traumatology. 2008; 14: 103-109
        • Payne P.
        • Levine P.A.
        • Crane-Godreau M.A.
        Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy.
        Frontiers in Psychology. 2015; 6: 93
        • Pipe T.B.
        • Buchda V.L.
        • Launder S.
        • Hudak B.
        • Hulvey L.
        • Karns K.E.
        • Pendergast D.
        Building personal and professional resources of resilience and agility in the healthcare workplace: Building resilience.
        Stress and Health. 2012; 28: 11-22
        • Reith T.P.
        Burnout in United States healthcare professionals: A narrative review.
        Cureus. 2018;
        • Rodrigues M.F.
        • Nardi A.E.
        • Levitan M.
        Mindfulness in mood and anxiety disorders: A review of the literature.
        Trends in Psychiatry and Psychotherapy. 2017; 39: 207-215
        • Rizzo L.H.
        Suicide among nurses: what we don't know might hurt us.
        American Nurse Today. 2018; 13: 10-15
        • Shanafelt T.D.
        • Dyrbye L.N.
        • West C.P.
        Addressing physician burnout: The way forward.
        JAMA. 2017; 317: 901-902
        • Shoji K.
        • Lesnierowska M.
        • Smoktunowicz E.
        • Bock J.
        • Luszczynska A.
        • Benight C.C.
        • Cieslak R.
        What comes first, job burnout or secondary traumatic stress? Findings from two longitudinal studies from the U.S. and Poland.
        PLoS One. 2015; 10e0136730
        • Stephens T.M.
        • Smith P.
        • Cherry C.
        Promoting resilience in new perioperative nurses.
        AORN Journal. 2017; 105: 276-284
        • Tang Y.-Y.
        • Hölzel B.K.
        • Posner M.I.
        The neuroscience of mindfulness meditation.
        Nature Reviews Neuroscience. 2015; 16: 213-225
        • Tang Y.-Y.
        • Tang R.
        • Posner M.I.
        Mindfulness meditation improves emotion regulation and reduces drug abuse.
        Drug and Alcohol Dependence. 2016; 163: S13-S18
        • Taylor R.A.
        Contemporary issues: Resilience training alone is an incomplete intervention.
        Nurse Education Today. 2019; 78: 10-13
        • Topp C.W.
        • Østergaard S.D.
        • Søndergaard S.
        • Bech P.
        The WHO-5 well-being index: A systematic review of the literature.
        Psychotherapy and Psychosomatics. 2015; 84: 167-176
        • Tubbert S.J.
        Resiliency in emergency nurses.
        Journal of Emergency Nursing. 2016; 42: 47-52
        • Virkstis K.
        • Herleth A.
        • Langr M.
        Cracks in the foundation of the care environment undermine nurse resilience.
        The Journal of Nursing Administration. 2018; 48: 597-599
        • Wasserstein R.L.
        • Schirm A.L.
        • Lazar N.A.
        Moving to a world beyond “ p < 0.05.
        The American Statistician. 2019; 73: 1-19
        • Webb C.
        Analysing qualitative data: Computerized and other approaches.
        Journal of Advanced Nursing. 1999; 29: 323-330
        • Williams M.
        • Teasdale J.
        • Segal Z.
        • Kabat-Zinn J.
        The mindful way through depression: Freeing yourself from chronic unhappiness.
        Guilford Press, New York2007