Health care providers are challenged to build and maintain a sense of wellness and resiliency for personal health and well-being. The importance of wellness is widely recognized and emphasized for health care providers in the workplace. Recent studies have demonstrated that wellness enhancement reduces professional burnout, compassion fatigue, and negative patient outcomes related to errors. Additional positive effects of wellness include enhanced mental health, job satisfaction, performance, and overall efficiency with a positive impact on patient care quality.1

Wellness strategies to build and maintain healthy lifestyles and habits are learned behaviors that can be adopted at any age or stage of life. The academic setting is an ideal environment to build wellness-based knowledge and skills into the health care provider's core identity. A focus on the value and methods of wellness during this formative stage can build personal and professional resiliency.

Graduate nursing students commonly describe their educational experience as highly stressful. There are common reasons for this. First, the overall academic climate is highly competitive. Students vie for admission to a nursing program. As they perform academically in their classes, they compete for grades, rank, and financial support (eg, scholarships), which may affect self-esteem and self-worth. Second, the process of learning is highly complex, multifaceted, and dynamic requiring committed time and more highly developed study and learning skills. Outside the immediate environment and learning requirements, there are many competing priorities for the student's time and attention, which undermine engagement and learning.

Time requirements of jobs and family are sources of stress for many students. According to the Georgetown Report,2 approximately 40% of undergraduates and 76% of graduate students work at least 30 hours a week, 25% of all working learners are employed full-time and enrolled in college programs full-time, and approximately 20% of all working learners also have children. Along with traditional family and job obligations, recent external stressors such as the global pandemic, political unrest, and economic uncertainty have posed additional challenges for graduate learners.

Virtual education methods have increased reliance on technology and related literacy skills. Technology-based learning can pose barriers to the formation of relationships among students and between students and faculty. This requires additional effort and specific communication strategies to build and maintain supportive connectedness.3

These factors can undermine commitment, time, energy, and motivation for self-care in any of the wellness domains. The American College Health Association conducted a national survey in 2018, asking graduate college students to identify aspects of their lives that have affected college performance. Leading responses were stress, anxiety, sleep difficulties, and depression. A majority also claimed feeling exhausted or overwhelmed, and more than half reported feeling hopeless, lonely, sad, and/or overwhelmingly anxious, further compromising wellness.4

Integrating wellness education into the classroom and nursing curriculum is a valuable strategy to promote students' success and develop knowledge, skills, and attitudes to carry forward personally and professionally. Combining evidence-based characteristics of effective teaching with focused activities that incorporate the dimensions of wellness creates and builds a foundation for the concept of classroom wellness (Supplemental Digital Content, http://links.lww.com/NE/A957, Figure).

Integrating Wellness Into the Graduate Nursing Classroom

An assignment for graduate nurse practitioner (NP) students was created to develop a toolbox of wellness strategies and activities. The "Walking the Wellness Talk" initiative was designed to incorporate brief wellness activities into work and everyday life routines for students' personal health benefits while building a culture of classroom wellness. These same strategies can be used in future clinical practice with patients, families, and peers.

Thirty-one graduate NP students in the final clinical courses of their program volunteered to lead a 1- to 2-minute "focus" (mental or thought-oriented) or "energizer" (movement-oriented) activity during synchronous class sessions. All class members, including faculty, participated in the wellness activities. Focus activities were generally conducted at the beginning of class to help students "arrive" and "being mindfully present." Some examples included deep breathing, mindfulness, yoga, coloring, use of essential oils, music therapy, pet therapy, and gratitude. Energizer activities were conducted mid-class to increase alertness, physical movement, and energy levels. Examples included jumping jacks, chair exercises, dancing, stretching, lunging, and marching or jogging in place.

Students volunteered to be the activity leaders. In preparation, they gathered supportive evidence and outlined directions for their peers to follow. During a class session, they presented a single infographic slide summarizing the evidence with references and then led the class group to perform the brief activity. Student leader participation was incentivized with a bonus point on the final examination. The wellness presentation slides were catalogued for the class' future reference.

To evaluate the effectiveness of the assignment, an 8-item Likert score pre and post survey was administered to the students. Responses were anonymous. Data were analyzed using Fisher's exact test of relationships between time and level of agreement. In the postdata survey, 4 of the 8 survey items were found to be statistically significant (P < .01). Significant items included having wellness strategies to use during class; strategies that specifically enhance mental focus and increase physical movement, both of which help attentiveness and engagement with class material; and a wellness toolbox.

Qualitative feedback was gathered at the end of semester using written reflections. Student wellness goals and personal perspectives of self-care were analyzed. A common statement illustrating both attitudinal change and a behavioral goal was "to make self-care a priority." Additional goals included performing mental health exercises with meditation and gratitude, breathing, and maintaining mindfulness; performing physical exercise regularly; and increasing quantity and quality of sleep. Student reflections demonstrated increased interest in the overall benefits of wellness activities. Active learning assignments (rather than faculty presentations) improved students' classroom participation and buy-in. Activities broke up long class sessions. In both in-person and virtual class environments, students' participation in wellness activities fostered both engagement and participation while having fun.

Summary

Overall, the Walking the Wellness Talk assignment was beneficial in contributing to a culture of classroom wellness in addition to providing students with a self-care toolbox. Active participation in wellness activities that incorporated brief, evidence-based, teaching-learning strategies positively impacted classroom wellness. The exercise of searching and summarizing the literature and then presenting evidence-based rationale for a chosen activity demonstrated translational science in wellness care. This initiative emphasized the importance of self-care in building personal and professional resiliency, which ultimately contributes to quality patient care. Although this assignment was completed in a graduate nursing program, it can be used in all levels of nursing education in both the in-person and virtual learning environments.

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