INCREASING KNOWLEDGE 1 Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers: A Quality Improvement DNP Project Sergii Deich and Angela DeVore Michigan State University NUR 997 04/20/2024 Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 2 Outline 1. ABSTRACT ……………………………………………………………………………3 2. INTRODUCTION ……………………………………………………………………3 Project Aim ……………………………………………………………………………6 Problem Statement …………………………………………………………………....6 3. LITERATURE SEARCH …………………………………………………………….……...6 ……………………………………………………………………6 Search Methods Search Strategy ……………………………………………………………………7 Synthesis of Literature ………………………………….………………………………..8 4. METHODS ………………………………………………………………………………….10 5. ANALYSIS and PLAN ……………………………………………………………………..11 Data Analysis ……………………………………………………………………………11 Expected Outcome ………………………………………………………………………12 Timeline …………………………………………………………………………………12 Program Customization, Tailoring and Implementation ……………………...………...13 Post-Intervention Data Collection ……………………………………………………….14 6. RESULTS ……………………………………………………………………………………14 7. DISCSSION …………………………………………………………………………………..15 8. IMPLICATIONS ……………………………………………………………………………..16 9. LIMITATIONS ……………………………………………………………………………….17 10. CONCLUSION …………………………………………………...…………………………20 Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 3 Abstract Work-related stress is a significant challenge impacting employee well-being, particularly among school bus drivers. This project aimed to enhance stress management awareness among school bus drivers through educational interventions focused on awareness of mindfulness and resilience techniques. Pre-intervention surveys revealed baseline awareness levels, while post- intervention surveys showed improvements in understanding stress triggers, mindfulness techniques, resilience principles, and stress reduction programs. The findings suggest that targeted educational interventions effectively increased participants' awareness of stress management strategies. Specifically, participants demonstrated enhanced knowledge of mindfulness and resilience techniques, indicating improved coping abilities in the face of workplace stressors. Additionally, there was an increased awareness of available stress reduction programs, highlighting a greater understanding of resources for managing stress. These results underscore the importance of investing in employee wellness programs to create supportive work environments. By recognizing the significance of stress management and providing employees with practical tools for coping, organizations can foster healthier and more productive workplaces. In conclusion, this project provides valuable insights into stress management among school bus drivers, showing the effectiveness of educational interventions in enhancing awareness and equipping employees with essential stress management skills. Further research and development in this area can lead to ongoing improvements in employee well-being and organizational success. Introduction Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 4 Work-related stress, as defined by the World Health Organization (2020), refers to individuals' response to work demands and pressures that exceed their knowledge and abilities, thereby challenging their coping mechanisms. This type of stress has been extensively studied due to its direct impact on employees' physical and mental well-being (Elahi & Apoorva, 2012). However, despite its prevalence, many individuals find it difficult to manage stress and often deal with it in isolation. A survey by the American Psychological Association (2023) found that approximately three in five adults (62%) choose not to discuss their stress with others to avoid burdening them. Stress, a ubiquitous part of modern life, is often viewed negatively. However, an understanding and awareness of stress is crucial for personal well-being. This is because stress, in its essence, is not inherently detrimental. It is the body’s natural response to challenges or demands, triggering a ‘fight or flight’ response that can help navigate difficult situations (Epel et al., 2018). However, when stress becomes chronic, it can have serious implications for health and well-being (Epel et al., 2018). Chronic stress can lead to a range of physical health problems, including heart disease, digestive problems, sleep disorders, and weight issues. It can also contribute to mental health issues such as depression and anxiety (Elahi, & Apoorva, 2012). Awareness of stress is the first step towards managing it effectively. By recognizing the signs of stress, steps can be taken to address it before it becomes overwhelming (Epel et al., 2018). These signs can be physical such as headaches, insomnia, or frequent illness and emotional such as feelings of overwhelm, irritability, or anxiety, or behavioral such as changes in appetite or procrastination. Moreover, stress awareness can help identify the sources of stress (Epel et al., 2018). These can be external, such as work pressures or financial difficulties or internal, such as high self-expectations or chronic worry. By identifying these sources, a person can work towards Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 5 addressing them directly, whether that means seeking support, making lifestyle changes, or learning new coping strategies. The nature of stress, awareness of stress and management of stress becomes especially pertinent when considering the experiences of school bus drivers, a group pivotal for student access to education. Awareness of stress within this profession, recognizing its impact on mental, emotional, and physical well-being, particularly for this specific occupational group, may be pivotal to begin reducing its impact (Epel et al., 2018). The purpose of this DNP quality improvement project is to increase bus driver awareness on how stress may impact their work. The problem was identified in collaboration with the company that employs the bus drivers and through the narratives expressed by the drivers during exit interviews. The firsthand accounts underscore stress as a pervasive and serious issue, affecting job satisfaction, performance, and overall well-being (School Bus Drivers Health Problems and Solutions, 2019; Smith, 2018; Johnson et al., 2020). The forthcoming project draws insights from these experiences, acknowledging stress as a pivotal factor contributing to dissatisfaction and turnover among school bus drivers (School Bus Drivers Health Problems and Solutions, 2019). These narratives underline the importance of the issue, emphasizing the need for targeted interventions that increase awareness of symptomatic expressions and provide some options for the stress reduction. The recurrent theme in the literature is a mismatch between expectations and the reality of the job further emphasizes the significant stressors faced by school bus drivers (Epel et al., 2018; School Bus Drivers Health Problems and Solutions, 2019). When discussing stress levels with a community liaison at a local transportation company, school bus drivers have specific stressors related to their profession that teachers have Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 6 within their classrooms. The population of school bus drivers employed by the transportation company have reported their stress levels to their employer. The leadership within the company have made it a priority to address stress levels among their employees for benefits related to health, work/life balance, and overall job satisfaction. Providing education about possible stress reduction strategies to the employees may enhance stress reduction techniques for the benefits of their employees (Gold, Smith, Hopper, Herne, Tansey, & Hulland, 2009). Project Aim This project aims to improve the bus drivers’ awareness of how stress impacts their work and life and discuss stress reduction strategies. Problem statement Among school bus drivers at a local transportation company, is there an increased awareness of stress reduction strategies after participating in an educational program designed to enhance awareness of stress reduction within the workplace? Literature Search Search Methods Search methods for this project included data collection from databases PubMed, CINAHL, PsychInfo and Google Scholar using key terms “school support staff”, “teachers”, and “stress management” to reflect the articles for consideration of evidence-based research. A total of 7 articles were used for this QI project (Appendix J). Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 7 The selection criteria was established to identify articles specifically relevant to stress management among school bus drivers. Emphasis was placed on clinical trials, meta-analyses, randomized control trials, and systematic reviews to ensure a robust and evidence-based foundation for our quality improvement project. This focused selection process aimed to align the chosen literature with the specific context and needs of school bus drivers. Search Strategy In establishing the criteria for article selection, a set of inclusion and exclusion criteria were applied to ensure specificity and relevance. The inclusion criteria involved focusing on articles conducted in the United States, Canada, England, and Australia, with a specific emphasis on bus drivers, teachers, and other school personnel as the target group. The studies lacking interventions and those published before 2015 were excluded to capture the most recent and pertinent research. The inclusion criteria were further refined by prioritizing clinical trials, meta- analyses, randomized control trials, and systematic reviews to align with the rigorous standards required for our quality improvement project. The exclusion included studies that focused on students, nurses, physicians, children, adolescents, cancer patients, healthcare professionals, police officers, and cardiovascular patients. Excluding studies focusing on students ensured that the selected literature pertained to working adults, aligning with the demographic of school bus drivers who are typically employed adults rather than students. Excluding studies involving healthcare professionals ensured that the selected literature was not specific to healthcare settings or professions, which may have different stressors and contexts compared to school bus drivers. Excluding studies involving children or adolescents ensured that the selected literature focused on adult populations, as the stressors and Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 8 interventions relevant to children and adolescents may differ significantly from those experienced by adult workers such as school bus drivers. Excluding studies involving patients with specific medical conditions ensured that the selected literature focused on healthy working adults rather than individuals dealing with chronic illnesses, which may introduce confounding variables related to health status and medical treatment. Excluding studies involving police officers ensured that the selected literature focused on occupations more closely related to the transportation industry, such as school bus driving, rather than law enforcement, which may have distinct stressors and occupational challenges. By applying these exclusion criteria, the search strategy aimed to tailor the selection of literature to studies specifically relevant to the target population of school bus drivers, thereby enhancing the relevance and applicability of the findings to the context of the quality improvement project. The literature search identified 165 articles which were reviewed, 92 from PubMed, 44 from CINAHL and 29 from PsychInfo database. Two additional articles were identified through Google Scholar. Total seven studies were included in this project. Synthesis of literature The synthesis of literature on stress management programs for educators reveals consistent themes and valuable insights about stress reduction interventions. From searched articles several studies focused on mindfulness-based interventions, such as the Mindfulness- Based Stress Reduction (MBSR) program and Mindfulness-Based Gratitude Training (MBGTS) (Gold, et al., 2009; Bauer, Playfair, & McCarthy, 2019). These interventions demonstrated Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 9 statistically significant improvements in various outcome measures, including mindfulness, self- compassion, stress, anxiety, gratitude, satisfaction with life, subjective happiness, and quality of life. The interventions typically followed structured formats, such as 8-week courses with weekly sessions lasting around 2.5 hours each (Dave, McClure, Rojas, Lavalette, & Lee, 2020). Participants were often required to engage in daily homework assignments, which primarily involved meditation practice, mindful yoga, and applying mindfulness to everyday situations (Dave, McClure, Rojas, Lavalette, & Lee, 2020). The programs aimed to enhance participants' coping abilities and well-being through regular practice and application of mindfulness techniques. Participants in mindfulness-based interventions reported reductions in stress, burnout, anxiety, and depression (Grossman, Niemann, Schmidt, & Walach, 2004). Additionally, improvements were observed in teacher performance indicators, such as classroom organization, efficacy, and use of positive affective language. Qualitative findings also highlighted positive changes in participants' physical and mental well-being, relationships with others, coping strategies, and teaching practices (Hwang, Bartlett, Greban, & Hand, 2017; Epel, et al., 2018). Studies employed both qualitative and quantitative methods to evaluate the effects of mindfulness interventions. Qualitative data provided insights into participants' experiences, perceptions, and changes resulting from the interventions, while quantitative data demonstrated statistically significant improvements in various outcome measures (Chesak, Khalsa, Bhangra, Jenkins, & Bauer, 2018; Elahi & Apoorva, 2012). Mindfulness interventions encompassed a variety of practices, including meditation, breath awareness, body scans, mindful movements, and awareness of thoughts and emotions. Participants engaged in these practices to cultivate mindfulness, self-awareness, and resilience in dealing with stressors. Some studies included longitudinal follow-up assessments at multiple time points, such as 2 months, 6 months, and 12 Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 10 months post-intervention (Chesak, Khalsa, Bhangra, Jenkins, & Bauer, 2018). These assessments allowed researchers to examine the sustainability of intervention effects over time and assess participants' long-term well-being outcomes (Elahi & Apoorva, 2012). Studies conducted by Chesak et al. (2018), Dave et al. (2020), Von der Embse et al. (2019) provide crucial perspectives on stress management interventions among educators, forming the groundwork for our quality improvement project on awareness of stress management for school bus drivers. The implementation of programs like Stress Management and Resiliency Training (SMART) and Mindfulness-Based Stress Reduction (MBSR) has yielded positive outcomes, showcasing their efficacy in addressing various dimensions of well-being, including reducing levels of depression, anxiety, and burnout among educators (Chesak, Khalsa, Bhangra, Jenkins, & Bauer 2018). These findings underscore the potential of MBIs as valuable tools for enhancing mental health in high-stress professional settings. As we extend this knowledge to school bus drivers, these findings serve as a robust foundation for designing effective stress management strategies tailored to the specific challenges faced by this occupational group. Overall, the emerging themes suggest that mindfulness-based interventions hold promise for improving well-being, reducing stress, and enhancing coping abilities among participants, particularly educators like school bus drivers. The structured nature of these programs, combined with their positive effects on various outcome measures, underscores the potential benefits of integrating mindfulness training into workplace wellness initiatives (Chesak, Khalsa, Bhangra, Jenkins, & Bauer, 2018; Elahi & Apoorva, 2012). Methods Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 11 This quality improvement project for school bus drivers aimed to determine if their awareness of stress reduction strategies improved after participating in an educational program focused on enhancing stress awareness. Employing a pre and post intervention design, the project assessed changes in participants' awareness levels before and after the stress reduction program. The target population for this project was comprised of school bus drivers employed by a midwestern transportation company. The average age of employees is 55, 31% percent of the school bus drivers are between 55 to 64 years old, 63% of the drivers are female and approximately 37% are male (Clinical Nurse Specialist, personal communication, March 23,2024). The project included a convenience sample of 42 participants. A baseline survey/questionnaire (Appendix A) was developed for this project using information presented in the educational power point as a basis of the question to the bus drivers. It was administered to assess the initial awareness of stress reduction strategies among school bus drivers. The stress reduction awareness program was implemented over two educational sessions during a monthly safety meeting with a power point presentation (Appendix C). The power point presentation incorporates education such as the Stress Management and Resiliency Training (SMART) and the Mindfulness Based Stress Reduction (MBSR) programs (Appendix D, Appendix D, and Appendix F). Participants engaged in education on a voluntary basis. Following one week after the intervention, a post-intervention survey (Appendix B) was administered to evaluate the changes in participants' awareness of stress reduction strategies. Analysis and Plan Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 12 Data Analysis The 42 pre-surveys (Appendix G) and 16 post-surveys (Appendix H) were analyzed using appropriate statistical methods, to assess changes in awareness levels from pre- and post- intervention scores. Descriptive statistics, including means, medians, and standard deviations, were calculated to provide a summary of the central tendency and variability in participants' awareness levels of stress reduction strategies. The analysis aimed to determine whether there are changes in participants' awareness levels after engaging in the stress reduction program. The use of SPSS, facilitated the execution of these quantitative analyses, ensuring accuracy and efficiency in handling the datasets. Expected Outcome The implementation of the stress reduction awareness program sought to improve the bus drivers’ understanding of stress reduction strategies and equip them with information about practical tools to manage stressors associated with their demanding profession. The SWOT analysis (Appendix I) was utilized to assist with project planning and implementation. Timeline In the initial week, the project focused on administering the baseline survey (Appendix A) to assess the school bus drivers' initial awareness of stress reduction strategies. This step was completed on January 29, 2024 at a monthly employee safety meeting. The survey was created from information presented in the educational power point that was presented to the bus drivers. Rewordify.com (n.d.) was used to validate the education level of the survey to equal a 6th grade reading level. Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 13 This phase involves careful planning of data collection sessions, ensuring clarity in survey instructions and addressing any potential concerns or questions raised by participants. The baseline data collection aligns with the standard practice in intervention studies to establish a starting point for comparison. A total of 42 pre-intervention surveys were collected on January 29. After collecting the baseline surveys, the school bus drivers were presented with an educational power point presentation (Appendix C) discussing stress reduction techniques. The presentation lasted approximately 15 minutes with time allotted for questions at the end of the presentation. There were two different presentations done on January 29 at both scheduled meeting times. At the conclusion of the presentation, the employees were instructed to practice stress reduction techniques over the next two weeks. The employees were encouraged to be aware of the post intervention surveys that will be available in the break room starting February 12, 2024. Program Customization, Tailoring and Implementation Following the baseline data collection, the subsequent week was dedicated to customizing and tailoring the awareness of the stress reduction education session based on the identified needs and challenges faced by school bus drivers. This involves adapting elements from evidence-based interventions such as the SMART program and MBSR. Interventions discussed in the education included deep breathing exercises and a five senses exercise program to create a mindfulness environment for stress reduction. Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 14 The phase involved delivering a tailored session designed to enhance awareness of stress reduction strategies among school bus drivers. Active program monitoring was in place to address any concerns or challenges that arose during implementation, ensuring program fidelity and participant adherence. During the same week, the awareness of stress reduction education was available to employees with printed education material that were placed in common areas of employees gathering to include various educational posters Appendix C, D, and E). Employees were encouraged to review the educational material at their convenience. Post-Intervention Data Collection Following the completion of the stress reduction program, week four was allocated for post-intervention data collection. During this period, the post-intervention survey (Appendix B) will be administered to assess changes in participants' awareness of stress reduction strategies. Starting February 19, post intervention surveys (Appendix B) were placed in the employee break room. Employees were encouraged to fill out the questionnaire anonymously and only is they filled in pre-survey. Employees were instructed to put the completed surveys in a secure locked box located in the break room. On March 1, the post intervention surveys were collected from the secure locked box in the break room. A total of 16 post-intervention surveys were collected from the lock box. Educational materials continued to be available to the participants in the break room for their convenience. Results Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 15 The following are the results for each question in pre and post surveys. Discussion The post test results indicate an overall positive impact of the intervention on participants' awareness, knowledge, and recall related to stress management. Notable improvements were observed across various dimensions, including awareness of stress reduction techniques, ability to list effective stress management strategies, and reported receipt of training or information on stress reduction. For awareness of mindfulness techniques, the pre-survey indicated a mean awareness score of 3.90, which saw a slight improvement to 4.31 in the post-survey. In awareness of resilience techniques, the participants showed a mean awareness score of 3.67 in the pre-survey, which experienced a slight improvement to 4.13 in the post-survey. In awareness of various stress reduction techniques, the pre-survey revealed a mean awareness score of 3.69, Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 16 which improved to 4.38 in the post-survey. In awareness of stress reduction programs, while the pre-survey showed a mean awareness score of 3.07, there was a moderate improvement to 3.88 in the post-survey. enhancement in this aspect. For ability to list effective stress management strategies, the pre-survey demonstrated a mean score of 3.55, which increased to 4.06 in the post- survey. For receipt of training or information on stress reduction, the pre-survey revealed a mean score of 3.26, which saw an improvement to 3.94 in the post-survey. The intervention successfully contributed to enhancing participants' understanding of mindfulness and resilience techniques. While there was a moderate improvement in awareness of stress reduction programs, further enhancements are encouraged in this area. Overall, the conducted intervention has demonstrated positive changes in participants' attitudes and knowledge regarding stress management. Continued efforts in reinforcing stress management strategies, especially regarding stress reduction programs, could further enhance the overall effectiveness of the intervention. Increasing knowledge of stress reduction strategies for school bus drivers, a quality improvement DNP project, has yielded implications for the well-being of employees within the organizational context. The observed positive alterations in participants' attitudes and knowledge pertaining to stress management indicate a potential to impact the overall welfare of employees. Implication The project has effectively contributed to an increased awareness of mindfulness and resilience techniques among participants. The heightened awareness may lead to possible enhancement in resilience against workplace stressors and an improved state of mental well- being among employees. Despite a consistent mean score in recognizing stress triggers, the Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 17 project reveals that participants consistently maintained a heightened level of self-awareness throughout the study. This heightened self-awareness has the potential to contribute to the formulation of proactive stress management strategies among employees. While there was a moderate improvement in the awareness of stress reduction programs, the project underscores the need for refinement in this area. This presents an opportunity for the organization to concentrate on enhancing and promoting stress reduction programs to achieve greater employee engagement and well-being. The project has positively impacted participants' ability to enumerate effective stress management strategies, suggesting potential implications for heightened overall employee productivity and satisfaction, as employees adeptly apply practical stress coping mechanisms. A notable consequence is the amelioration in participants' awareness of diverse stress reduction techniques, pointing to a possibility of an elevated capacity among employees to proficiently confront and begin working to alleviate workplace stressors, thereby fostering a salubrious work environment. Based on collected data the positive shift in participants reporting increased awareness on stress reduction indicates a successful intervention in augmenting exposure to such resources. This underscores the ongoing importance of efforts in providing training and information to support employees in effectively managing stress. The success of the project reflects the organization's commitment to cultivating a positive and supportive culture concerning employee well-being. This positive organizational culture may extend its influence to broader aspects, including employee morale, retention, and the overall work environment. Limitations Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 18 The project utilized a convenience sample of 42 total participants, which cannot be extrapolated the entire population of school bus drivers. A larger sample size could provide more robust and generalizable findings. Participation in the educational intervention was voluntary, which may have introduced selection bias (Kaźmierczak, Zajenkowska, Rogoza, Jonason, & Ścigała, 2023). Participants who opted to engage with the program might differ from those who did not, potentially affecting the validity of the results. The project relied on self-reported data from surveys that were developed for this project to assess changes in participants' awareness levels. This method is subject to response bias and may not accurately reflect participants' actual behaviors or understanding (Kaźmierczak, Zajenkowska, Rogoza, Jonason, & Ścigała, 2023). The post-intervention survey was administered two weeks after the educational sessions, providing a limited timeframe to assess the sustainability of the intervention's effects. Longer- term follow-up would be necessary to evaluate the persistence of changes in awareness levels over time. The project focused on school bus drivers employed by a specific transportation company in a midwestern region, limiting the generalizability of the findings to other populations or geographic areas. Factors such as organizational culture and job responsibilities may vary across different contexts, impacting the effectiveness of similar interventions (Chesak, Khalsa, Bhangra, Jenkins, & Bauer, 2018; Elahi & Apoorva, 2012). The project employed a pre-post intervention design without a control group, making it challenging to attribute changes in awareness solely to the educational intervention. The absence of a control group limits the ability to control external factors that may have influenced participants' awareness levels (Simkus, 2022). While the project assessed changes in participants' awareness of stress management strategies, it did not evaluate other outcomes such as job satisfaction, stress levels, or performance metrics. Including Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 19 additional outcome measures would provide a more comprehensive understanding of the intervention's impact on employee well-being. Given the limited amount of specific data on stress management techniques tailored for school bus drivers, researchers might turn to studies involving other professions, such as teachers, healthcare workers, or corporate employees (Chen, & Hsu, 2020). However, it's important to recognize that the stressors, work settings, and job demands encountered by school bus drivers can vary significantly from those experienced by individuals in other fields. Consequently, stress management strategies identified in studies with different groups may not be directly applicable to school bus drivers (Alborzkouh, Nabati, Zainali, Abed, & Shahgholy Ghahfarokhi, 2015). Drawing conclusions or making recommendations based on findings from studies involving different professional groups carries the risk of misinterpreting or incorrectly applying interventions. What proves effective in one setting may not necessarily yield the same results in another. Thus, researchers need to proceed cautiously when extrapolating findings across diverse populations. The limitation underscores the importance of conducting targeted research specifically aimed at understanding and addressing stress management needs among school bus drivers. By focusing studies on this population, researchers can gain valuable insights into their distinct stressors, coping mechanisms, and preferences for interventions. This focused approach is crucial for developing interventions that are more effective and tailored to the unique needs of school bus drivers. Addressing these limitations in future research and quality improvement initiatives would enhance the validity, reliability, and generalizability of findings, ultimately contributing to more Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 20 effective interventions for addressing work-related stress among school bus drivers and other occupational groups. Conclusion In summary, the proposal aimed to enhance awareness of stress reduction strategies among school bus drivers, recognizing the pervasive issue of workplace stress and its implications for employee well-being (Chen, & Hsu, 2020). Through targeted interventions such as educational sessions incorporating mindfulness and resilience techniques, we sought to address the specific stressors faced by this occupational group. The findings underscored the importance of acknowledging and addressing workplace stress among school bus drivers. The project highlighted the prevalence of stress and its impact on job satisfaction, performance, and overall well-being, emphasizing the need for proactive interventions (Dave, McClure, Rojas, Lavalette, & Lee, 2020). The importance of the project lies in its potential to improve employee morale, retention, and work environment quality (Von der Embse, Ryan, Gibbs & Mankin, 2019). By prioritizing stress management and providing resources for employee wellness, organizations can create a supportive atmosphere conducive to productivity and satisfaction. Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 21 References Alborzkouh, P., Nabati, M., Zainali, M., Abed, Y., & Shahgholy Ghahfarokhi, F. (2015). A review of the effectiveness of stress management skills training on academic vitality and psychological well-being of college students. Journal of medicine and life, 8(Spec Iss 4), 39–44. American Psychological Association (2023). Stress in America: A Nation Recovering from Collective Trauma. https://www.apa.org/news/press/releases/stress/2023/collective- trauma-recovery Bauer, T., Playfair, E., & McCarthy, C. J. (2019). Mind-Body Group for Teacher Stress: A Trauma-Informed Intervention Program. Journal for Specialists in Group Work, 44(3), 204–221. https://doi-org.proxy2.cl.msu.edu/10.1080/01933922.2019.1634779 Chen, C. F., & Hsu, Y. C. (2020). Taking a Closer Look at Bus Driver Emotional Exhaustion and Well-Being: Evidence from Taiwanese Urban Bus Drivers. Safety and health at work, 11(3), 353–360. https://doi.org/10.1016/j.shaw.2020.06.002 Chesak, S. S., Khalsa, T. K., Bhagra, A., Jenkins, S. M., Bauer, B. A., & Sood, A. (2019). Stress Management and Resiliency Training for public school teachers and staff: A novel intervention to enhance resilience and positively impact student interactions. Complementary Therapies in Clinical Practice, 37, 32–38. https://doi- org.proxy2.cl.msu.edu/10.1016/j.ctcp.2019.08.001 Dave, D. J., McClure, L. A., Rojas, S. R., De Lavalette, O., & Lee, D. J. (2020). Impact of Mindfulness Training on the Well-Being of Educators. Journal of Alternative & Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 22 Complementary Medicine, 36(7), 645–651. https://doi- org.proxy2.cl.msu.edu/10.1089/acm.2019.0451 Elahi, Y. A., & Apoorva, M. (2012). A Detail Study on Length of Service and Role Stress of Banking Sector in Lucknow Region. 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A systematic review of mindfulness interventions for in-service teachers: A tool to enhance teacher wellbeing and performance. Teaching and Teacher Education, 64, 26-42. https://doi.org/10.1016/j.tate.2017.01/015 Kaźmierczak, I., Zajenkowska, A., Rogoza, R., Jonason, P. K., & Ścigała, D. (2023). Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants. PloS one, 18(3), e0281046. https://doi.org/10.1371/journal.pone.0281046 Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 23 Rewordify (n.d.). Rewordify.com: Understanding what you read. https://rewordify.com/index.php School Bus Drivers Health Problems And Solutions. (2019, March 22). School Bus Tracking System with TrackSchoolBus Apps. https://www.trackschoolbus.com/school-bus-drivers- health-problems-solutions/ Simkus, J. (2022, February 22). Control Groups and Experimental Groups | Uses & Examples - Simply Psychology. Www.simplypsychology.org. https://www.simplypsychology.org/control-and-experimental-group-differences.html Von der Embse, N., Ryan, S. V., Gibbs, T., & Mankin, A. (2019). Teacher stress interventions: A systematic review. Psychology in the Schools, 56(8), 1328-1343. doi:https://doi.org/10.1002/pits.22279 World Health Organization (2020). Occupational Health: Stress at the Workplace. https://www.who.int/news-room/questions-and-answers/item/ccupational-health-stress- at-the-workplace Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 24 Appendix A Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 25 Appendix B Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 26 Appendix C Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 27 Appendix C cont Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 28 Appendix C cont Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 29 Appendix C cont Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 30 Appendix C cont Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 31 Appendix C cont Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 32 Appendix D (https://positivepsychology.com) Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 33 Appendix E (https://positivepsychology.com) Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 34 Appendix F (https://positivepsychology.com) Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 35 Appendix G Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 36 Appendix H Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 37 Appendix I SWOT Analysis Strengths Weaknesses ● Targeted Intervention: The project focuses specifically on school bus drivers, addressing a critical need within the transportation industry. ● Evidence-Based Approach: The project builds upon existing research and evidence-based stress management techniques, ensuring its efficacy. ● Organizational Support: The transportation company's leadership prioritizes employee well-being, providing resources and support for the project's implementation. ● Participant Engagement: The project incorporates interactive educational sessions and supplementary materials to engage participants actively. ● Measurable Outcomes: Clear pre- and post-intervention surveys enable the measurement of awareness levels, facilitating the assessment of project effectiveness. ● Limited Resources: The project may face constraints in terms of funding and personnel required for implementation and follow-up. ● Time Constraints: Balancing project activities with drivers' schedules and operational demands may pose challenges in delivering educational sessions and collecting post- intervention data. ● Participant Volatility: Given the voluntary nature of participation, achieving a representative sample size may be difficult, potentially impacting the generalizability of findings. ● Resistance to Change: Some drivers may be resistant to adopting new stress management techniques, requiring additional effort to overcome skepticism and promote participation. ● Dependence on Self-Reporting: The reliance on self-reported data for assessing awareness levels may introduce biases and inaccuracies in measuring project outcomes. Opportunities Threats ● Expansion of Interventions: Successful implementation of the project could lead to the development of additional stress management initiatives for other employee groups within the organization. ● Collaborative Partnerships: Collaborating with external stakeholders such as mental health professionals or academic institutions ● Employee Turnover: High turnover rates among school bus drivers may undermine the sustainability and long- term impact of the project. ● Competing Priorities: Other organizational initiatives or operational challenges may divert attention and resources away from the stress management awareness project. Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 38 can enhance the project's reach and effectiveness. ● Long-Term Impact: Improving stress management awareness among school bus drivers can have far-reaching benefits, including reduced turnover rates, improved job satisfaction, and enhanced employee well-being. ● Continuous Improvement: Ongoing monitoring and evaluation of project outcomes can inform future iterations, allowing for continuous improvement in stress management interventions. ● Knowledge Sharing: Sharing project findings and best practices with other transportation companies or similar organizations can contribute to industry-wide efforts to address employee stress. ● External Factors: Economic downturns, regulatory changes, or unforeseen events such as the COVID- 19 pandemic could disrupt project implementation and hinder participant engagement. ● Lack of Leadership Support: Shifting organizational priorities or changes in leadership may result in reduced support or funding for the project, jeopardizing its success. ● Stigmatization of Mental Health: Negative attitudes towards mental health issues within the organization or broader society may impede participant willingness to engage in stress management activities, limiting the project's effectiveness. Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 39 Appendix J Critical Appraisal of Individual Articles Authors Chesak, Khalsa, Bhangra, Jenkins, & Bauer (2018) Sample n=55 Study Type Pilot Study Dave, McClure, Rojas, Lavalette, & Lee (2020) n=236, K-12 educators Longitudinal non- controlled trial Outcomes 55 participants completed at least one follow up survey with 47 participants completing follow up surveys at 2 months, 50 participants completing follow up surveys at 6 months and 36 participants completing follow up surveys at 12 months Participants completed a baseline and immediate 8 week post-intervention survey Interventions SMART program including stress management and resiliency training program Results Statistically significant improvements in anxiety, stress, gratitude, satisfaction with life, subjective happiness and quality of life for participants 8 week mindfulness-based stress reduction program including Five Facet Mindfulness Questionnaire, Self- Compassion Scale, Maslach Burnout Inventory for Educators, Patient- Reported Outcome Measurement Statistically significant improvements in mindfulness, self- compassion, and personal accomplishment with decreases in isolation, anxiety, fatigue and emotional exhaustion Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 40 Von der Embse, Ryan, Gibbs & Mankin (2019) 24 studies Systematic Literature Review Information System (PROMIS-29) Mindfulness-based studies used meditation for 8 weeks, Holistic Life Yoga, Flow Meditation and the CARE program Small to moderate effect size for meditation, MBSR program trial yielded large effect size, Flow Meditation gave large effect size, CARE program gave a small effect size 4 Primary treatment domains: 8 studies of cognitive- behavioral interventions 5 studies of behavioral interventions 8 studies of mindfulness-based interventions 3 studies of knowledge-based approaches Bauer, T., Playfair, E., & McCarthy, C. J. (2019). Pilot Study In terms of demographic information regarding the participating teachers, 81% of teachers identified as White/Caucasian (n = 13), while the remaining 19% identified as: Hispanic (n = 1), White/Multiple Races (n = 1), and MBGTS appeared to achieve its goals of bringing teachers together into a supportive environment to become better informed about trauma-related stress and to learn mind-body based coping techniques. Preliminary results indicated that The intervention involved three weekly 60-minute sessions across the duration of three consecutive weeks. Each session contained elements of mind-body skills and trauma- informed care practices, based on a thorough literature review The pilot implementation of MBGTS amounted to an overall positive reception by participating teachers within the study. Teachers indicated a desire for more sessions, and reported that the trauma- informed, mind- body skills Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 41 Other (n = 1). Additionally, 81% of teachers reported there ages as 25–59 (n = 13), while the remaining 19% indicated an age of 60 or above (n = 2), or 18–24 (n = 1). All teachers (n = 16) identified as female. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). total of 1605 subjects meta-analytic review teachers found the group to be helpful and informative and that teachers intended to utilize the skills practiced within the group moving forward. The general success of the groups hinged upon several factors: namely, participants’ willingness to engage with the content, and to engage with each other. Teachers seemed genuinely pleased to be part of a program that highlighted their unique experiences as educators, and that worked to serve their specific needs in terms of stress and wellness. Our findings suggest the usefulness of MBSR as an intervention for a conducted by the authors. The literature pointed to specific techniques, outlined below, as most helpful for working with teachers in the context of mind- body practices and trauma-informed care. demonstrated within the group were both practical and useful. Based on these results, there emerges a clear case for the continued implementation of MBGTS. MBGTS will therefore be executed within up to twenty additional public schools receiving mental healthcare services from the previously mentioned in-house mental health clinic. The mindfulness- based stress reduction MBSR is a structured 8–10 week, group Our findings suggest the usefulness of MBSR as an intervention for a Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 42 broad range of chronic disorders and problems. In fact, the consistent and relatively strong level of effect sizes across very different types of sample indicates that mindfulness training might enhance general features of coping with distress and disability in everyday life, as well as under more extraordinary conditions of serious disorder or stress. broad range of chronic disorders and problems. In fact, the consistent and relatively strong level of effect sizes across very different types of sample indicates that mindfulness training might enhance general features of coping with distress and disability in everyday life, as well as under more extraordinary conditions of serious disorder or stress. Another recently published study employing different inclusion criteria and a somewhat divergent strategy also provides additional support for the effectiveness of mindfulness intervention. program with groups usually varying between 10 and 40 participants. Groups may be either heterogeneous or homogeneous with respect to disorders or problem areas of participants. Single weekly sessions are typically 2.5 h, and there is an additional single all-day session per course on a weekend day. Each session covers particular exercises and topics that are examined within the context of mindfulness. These include different forms of mindfulness meditation practice, mindful awareness during yoga postures, and mindfulness during stressful situations Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 43 and social interactions. Because development of mindfulness is predicated upon regular and repeated practice, participants enter upon enrolling into a commitment to carry out daily 45- min homework assignments primarily in the form of meditation practice, mindful yoga and applying mindfulness to situations in everyday life. Modified MBSR course and CARE Program using body scans, breath awareness, mindful movements, and awareness of thoughts and emotions Positive effects on teacher wellbeing included reductions in self-perceived stress and burnout. Teacher performance benefited from mindfulness based interventions to include classroom organization, sense Hwang, Y., Bartlett, B., Greban, M., & Hand, K. (2017) 16 studies, n=652 teachers Systematic Literature Review Qualitative and Quantitative studies reviewed the different mindfulness methods introduced to teachers and the effects on teacher wellbeing, teacher performance and experiences of learning and Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 44 n=11 teachers Pilot study Gold, E., Smith, A., Hopper, I., Herne, D., Tansey, G., & Hulland, C. (2009). practicing mindfulness In sum, our results indicate that benefits may accrue following mindfulness training in terms of personal well- being, reduction in mental health difficulties, achievement of personally relevant goals, and enhanced ability to cope with the demands of teaching in a Participants undertook an 8- week course of Mindfulness-Based Stress Reduction (MBSR) methods. Participants were given information about the course and the importance of taking responsibility for their own well- being throughout the course. The course was delivered of efficacy and use of positive effect words. Experiences of learning and practicing mindfulness yielded teachers using mindfulness as a coping strategy, changing their physical and mental relationships, improved relations with others and changed their teaching practice Most participants experienced reductions in stress, depression, and anxiety as a result of participating in the MBSR course, as shown by changes in the DASS scores. Post- intervention, only four scored within the clinically significant range on any subscale, with two of those only as mildly stressed. Increasing Knowledge of Stress Reduction Strategies for School Bus Drivers 45 modern primary school. immediately following the school day, as 8 × 2.5-h weekly sessions, including a 5-h ‘silent day’ conducted on a Saturday between weeks 5 and 6. One participant reported more anxiety and stress at follow-up, despite achieving their personal goal and feeling that the course had been helpful.