From Classroom to Community: Teaching Stress First Aid
Submitted by Veronica Betts, DNP, RN, CMGT-BC & Courtney Reinisch, DNP, RN, APN-C, DCC
Tags: first aid mental health Nurse Education Stress among Nurses wellbeing
Abstract
This narrative describes an initiative to teach nursing students the Stress First Aid model to promote mental wellbeing and resilience in future nurses. Students found the value in SFA, they taught older adults stress management skills they learned and the older adults shared their learning with a subsequent cohort of students. The goal of this educational initiative is to promote healthy workforce environments to enhance nursing retention.
Introduction
This narrative describes an initiative to teach nursing students the Stress First Aid (SFA) model. Students were provided training and opportunity for discussion on how best to apply the model to their personal lives and clinical experiences. Together, the team learned to check in with one another, normalize the discussion of stress to reduce stigma, and identify resources to address stress injuries. These actions help to prevent minor stressors from escalating to mental injury or illness states. This experience was so meaningful to the students they elected to share it with community dwelling older adults. Background Stress first aid is an evidence-based leadership and peer support model which promotes mental wellness, resilience, and prevention of stress injury (Watson & Westphal, 2020). SFA is applied on the individual, unit, and organizational level. It originated with the military and due to the stress of the global pandemic it was expanded to address the needs of health care workers (Bellehsen et al., 2024).
The goal of SFA training is to provide support in response to stress related events. In this case the goal is to prepare future nurses with the skills needed to successfully navigate the stressors associated with a career in nursing and build a healthy work force environment. Nurses suffered stress injuries during the global pandemic and the workforce has experienced tremendous losses to retirements and attrition. Nurses are leaving the profession, especially new graduates (Balcuk, 2024). First year nurses’ turnover rates are nearing 30% (NSI, 2025). New Jersey introduced an initiative to better prepare nurses for managing the stress of a nursing career and promote wellness. NJ Nurses Emotional Well Being (NJ NEW) trains nurses in SFA to serve as peer leaders within their organizations to identify early signs of stress injuries and provide support and resources to their colleagues (NJ NEW, 2025). New providers trained in the SFA model bring their experience to the organization promoting culture change.
Organizational leadership can support SFA by providing resources to units and teams that allow for the application of the model. Thereby promoting a healthy work environment that destigmatizes the effects of stress on mental and physical health. Faculty at a school of nursing sought support from administration to attend training to become providers of SFA. Faculty who were trained in the SFA model for nursing shared information with nursing faculty peers to gain stakeholder buy in of the value of the SFA program for both faculty and students. The premise was promoting a culture of wellness with in the nursing school. Nursing students trained in SFA build a community through a shared learning experience (Heemskerk et al., 2021). They may then support student peers during the nursing school experience and subsequently lead culture change in the health care organizations. Building a strong foundation of caring in nursing school can translate to a healthy work culture. Students can serve as the roots of the tree to grow change in health care teams and environments. Stress first aid training was provided to a group of prelicensure nursing students at the beginning of their community health clinical rotation. Students were taught about stress injuries, the stress continuum, and the application of the SFA model for prevention, support, and recovery from stress injuries. A post teaching evaluation was completed to assess students’ attitudes, knowledge, and behaviors regarding stress and stress injuries. Results demonstrated high levels of understanding of the applicability of the model at the individual, team, and organizational level. Students demonstrated an increased knowledge of resources for addressing stress, stress injuries, mental health challenges, and the application of the model in providing peer support. Resilience promoting approaches are presented during the SFA training. Students identify meaningful ways to build resilience tailored to their personal preferences and lived experiences. Students willing share their own stress management techniques with peers during the training. Students learn ways to take care of themselves through time management skills, scheduling, and reflective practices. Strategies discussed with the students included journaling, mediation, exercise, socializing, eating, shopping, and seeking professional support. The concept of stress injuries is introduced during the SFA training. Stress injuries can be rooted in loss, threat to life, moral conflict, and wear and tear over time. Students are given the opportunity to reflect on past experiences which may have caused stress or stress injury.
Faculty provide examples and scenarios that may result in stress injury. Methods Key components of the SFA model include the stress thermometer, the stress continuum, and the application of stress first aid for prevention, support, and recovery from stress injuries. Students were taught in a classroom environment for a three-hour session about the key components and processes involved in SFA. This included interactive engagement and opportunities for teach back. This education initiation was approved with exempt status by the institutional review board. As part of a clinical experience, students participated in a community-based teaching event. Students met with independent living older adults who choose to attend programming organized through Senior Services of a local health department (LHD). The university and LHD have a memorandum of understanding agreement in place to allow for students to provide health promotion activities to older adults living in the community. Results Students in a prelicensure community clinical practicum elected to teach older adults about stressors and techniques they learned from SFA training. Older adults were able to replicate breathing techniques initially taught by the students. Their ability to successfully practice the techniques was accessed using teach back. Both students and the older adults reported high levels of satisfaction with the teaching and learning session.
The following semester when the next group of community clinical students were assigned to provide health promotion activities to the same senior program. The participating older adults discussed their prior learning about techniques from SFA. Older adults reported their success using the breathing techniques and visualizations during stress provoking situations. The older adults shared these findings with the students unsolicited. Discussion Stress first aid (SFA) is an evidence-based leadership and peer support model which promotes mental wellness, resilience, and prevention of stress injury. SFA has been used in multiple areas including those involved in military service, survivors of natural disasters, and healthcare environments. This application of SFA was offered to nursing students to support their management of the stress associated with nursing school. Students learned stress reducing techniques provided by the SFA model and program. They demonstrated their understanding of the techniques through teach back. Nursing students exhibited their ability to teach others stress management skills. This process of students sharing knowledge with older adults solidified the students’ understanding and appreciation for SFA. It built their confidence and resilience. Older adults benefited from the intergenerational engagement and they used the skills taught by the students. Older adults shared their experience with SFA skills with a subsequent group of students which supported their continued sense of value and self-efficacy. Sense of purpose, value, and self-efficacy build resilience for those involved and prepare them for the management of future stressors.
Conclusions
Stress first aid was taught to prelicensure nursing students to support their success during their nursing education. The intention of teaching SFA to nursing students was to prepare them to face the stressors associated with a career in nursing. This program demonstrates that the value extends beyond the nursing students to the communities they will serve. Future investigation and formalized polling of the users of the SFA model is indicated for better understanding and expanding the use of SFA. This program supports teaching nursing students the SFA model to support their success while completing their nursing educational programs of study.
References
- Balcuk, J.R. (2024). The impact of Stress First Aid on perceived stress levels of new graduate nurses. Nursing Economic$, 42(4), 191-201. https://doi.org/10.62116/NEC.2024.42.4.191
- Bellehsen, M. H., Cook, H. M., Shaam, P., Burns, D., Peter D’Amico, Goldberg, A., … & Schwartz, R. M. (2024). Adapting the Stress First Aid Model for Frontline Healthcare Workers during COVID-19.
- International Journal of Environmental Research and Public Health, 21(2), 171. https://doi.org/10.3390/ijerph21020171
- Heemskerk,Q.M., Dauphin, S.L.M. , van Dorst, M.A., Bussemaker, M., & Wallner,C. (2021). A learning community within nursing practice: The value created by the activities and interactions during the early stage of community development. Nurse Education in Practice, Volume 57, https://doi.org/10.1016/j.nepr.2021.103242.
- New Jersey Nursing Emotional Well Being Institute (NJNEW, 2024). Stress First Aid. https://njnew.org/programs/stress-first-aid/.
- Nursing Solutions Inc. (2025) 2025 NSI National Health Care Retention & RN Staffing Report. https://nsinursingsolutions.com/. Watson, P., & Westphal, R.J. (2020). Stress First Aid for Health Care Workers. National Center for PTSD. Available on: www.ptsd.va.gov.