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NUR 3643-Module 9 Course Project Assignment-Significance of Identified Practice Problem

Perkins

NUR 3643-Module 9 Course Project Assignment-Significance of Identified Practice Problem

Throughout my clinical experience at Rasmussen University, I have seen many nurses who expressed the exhaustion and stress they feel from their jobs. I have witnessed depersonalization occur specifically in the ICU, causing the nurses not to treat the patient with empathy and solely be task-oriented. These characteristics are a response to persistent work-related stress called burnout (Mohr et al., 2021).

Burnout affects the patient, the nurses, and the facility financially. Burnout in nurses can frequently happen in critical care units because they are commonly subjected to complex patient care, moral distress, dying patients, and perceived delivery of inappropriate care (Mohr et al., 2021). Burnout can cause delayed recovery, increased length of stay, higher infection rates, lower patient satisfaction, lower employee satisfaction, and higher turnover rates (Mohr et al., 2021).

A study conducted by Mohr et al. showed that in facilities with higher burnout rates, their staff had lower employee satisfaction, significantly higher turnover intention, and a longer-than-expected length of stay (2021). Registered nurse turnover costs a hospital between $3.6 million and $6.5 million annually, and $270,800 could be saved by the average hospital by each percentage the turnover is reduced (2021 NSI National, 2021).

Research Question

 Does providing education on self-care to critical care nurses reduce burnout?

Population: Critical care nurses

Critical care nurses have one of the highest burnout rates in the field of nursing (Mohr et al., 2021). Critical care nurses take care of patients with life-threatening injuries or illnesses, which requires them to think critically and clearly in a fast-paced environment for long periods (NURSEJOURNAL STAFF, 2021). Nurses in this field must also communicate clearly with the patient, their family, other nurses, and interdisciplinary teams to provide quality care and stabilize the patient (NURSEJOURNAL STAFF, 2021). Critical care nurses typically work in intensive care units (ICU) and step-down units.

Intervention: Education on self-care

Providing education on self-care strategies would provide nurses with the tools needed to help reduce the burnout they experience from work-related stress. Basic self-care, such as eating well, sleeping, and exercising, is neglected in nurses who experience burnout, and this neglect of self-care increases the symptoms of burnout (Couser, 2020). Other self-care strategies include practising spirituality, mindfulness, art therapy, breathing techniques, yoga, guided imagery, aromatherapy, acupressure, self-massage, music therapy, journaling, or finding an enjoyable hobby (Blackburn et al., 2020). The education is to be provided by the facility with the use of evidence-based self-care strategies.

Comparison: Education on self-care to no education

The intervention would be compared to not providing education about self-care strategies. This comparison could be completed by surveying the nurses before delivering the intervention to assess for symptoms of burnout and perceived experience of burnout. This comparison is the best way to determine the success of the intervention.

Outcome: Reduce burnout

The outcomes of this question include reduced, increased, or no change in burnout. The intervention outcomes could be determined by measuring the symptoms of burnout, perceived feelings of burnout, and turnover rates related to burnout before and after the intervention.

Questions about personal accomplishment, emotional exhaustion, and depersonalization would be used to measure the nurses’ perceived burnout and symptoms.

Evidence Retrieval

 Professional Team Members

 A psychiatrist or someone with at least a Master’s level education in psychology would be utilized to create or find the questions to be asked in the questionnaires given to the nurses. To gather evidence on the efficacy of the intervention, questionnaires would be used. With guidance from a professional with education in psychology, the questions and scales in the questionnaires would be more precise and ensure the relevant information is included.

Clinical research nurses would be included on the team to gather and appraise evidence. Clinical research nurses ensure that data collection is accurate, management of the data, and support the implementation and compliance of the study (Hastings, 2009). A medical librarian would assist in the retrieval of evidence. Medical librarians are trained in conducting searches and can make retrieving data more efficient and help train the nurses in searching for evidence on the best ways to use databases (Ho et al., 2016). Nurses would help retrieve data through database searches and use their clinical knowledge to appraise the evidence. Nurse managers would distribute questionnaires to the nurses involved in the study.

Search Strategy

 I used the Discovery Search for Rasmussen University to locate evidence related to this practice issue. This search engine includes a large variety of databases available to me. I started my search using the keywords “self-care burnout critical care nurse,” limiting my publication date to 2017-2021 and limiting the results to full text and scholarly (peer-reviewed) journals. This search brought 81 articles, and I found results that included evidence reviews, a letter to the editor, a qualitative descriptive study, and a cross-sectional, descriptive survey.

Through this search, I was able to find information about burnout in critical care nurses and self-care strategies to reduce burnout.

To find programs educating nurses about self-care strategies, I had to change my search to the keywords “self-care burnout program nurse” to find research studies on implementing education programs on self-care for nurses. I also widened my search by changing the date limiter to 2010-2021. This allowed me to find more articles on this subject, including quantitative studies, qualitative studies, and article reviews. To find evidence on the prevalence of burnout amongst critical care nurses, I searched the keywords “critical care nurse burnout.”

Evidence Appraisal

 Critical care nurses are more susceptible to stress and burnout, with up to 45% of critical care nurses affected by burnout (Holle & Karakashian, 2018). Burnout is an issue in the healthcare field because it negatively affects the nurses through physical and psychological illness and compassion fatigue. This can cause the nurses to miss work, create staff turnover, reduce efficiency and productivity, depersonalization, emotional exhaustion, job dissatisfaction, reduce the quality of patient care, and generate higher costs for patient care (Holle & Karakashian, 2018).

A study conducted in 2020 utilized the “THRIVE program” to educate oncology nurses on self-care strategies to reduce burnout. This educational program included an eight-hour retreat teaching self-care strategies, a six-week interaction with the participants through a private group on social media, and a two-hour closing session (Blackburn et al., 2020). The researchers conducted a pre and post-program assessment through the completion of surveys. The results showed a significant increase in resiliency and a substantial decrease in burnout and secondary trauma (Blackburn et al., 2020). The participants also had a turnover rate of 6.1%, which was significantly lower than the average U.S. hospital turnover rate of 17.1% (Blackburn et al., 2020). The self-care strategies taught included guided imagery, art therapy, breathing techniques, music therapy, mindfulness, yoga, aromatherapy, and self-massage (Blackburn et al., 2020).

A study completed in 2010 used the intervention of educating nurses on positive self-care behaviours and evaluated burnout before and after the intervention through a survey (Kravitz et al., 2010). The intervention was a six-hour class teaching about the significance of self-care, different self-care strategies, and creating a wellness plan for the individual (Kravitz et al., 2010). This study showed a 10% decrease in emotional exhaustion and a 3% reduction in feeling distant from the work experience (Kravitz et al., 2010). Both of these studies that implemented educational programs to teach nurses about self-care strategies showed positive outcomes on burnout.

Plan for Implementation

 Key Stakeholders

 The key stakeholders for this research question would include past and present critical care nurses, charge nurses, nurse managers, and past and present critical care patients. Past critical care nurses would provide insight into what their experiences were with the facility’s past policies and work environment related to burnout and self-care. They could provide what they thought was helpful, what they thought worked, and what they would have wanted during their time at the facility related to self-care education.

Current critical care nurses working in the facility would be the most important stakeholders for this research question. They would be able to give suggestions and their perspective on what they would want to see in an educational program for self-care strategies. They would also be able to give insight into how much time they would be willing to spend in a class about this subject. Charge nurses would be able to contribute to what they see as the biggest problem among their nurses when it comes to burnout symptoms. They are impacted because when the nurses experience burnout, they have to pick up that extra slack that may occur.

Nurse managers and administration personnel have to deal with the repercussions of critical care nurse burnout, including turnover, work-related incidents, and patient complaints. They would be able to provide the information and complaints they have received from patients to give insight into how burnout has affected patient care. Past and present patients are affected by burnout from the nurses and would be able to give specific ways they feel that they have been impacted through the care they have received.

Proposed Timeline

 In the first week, the research team will complete an evidence retrieval by evaluating past research studies and evidence-based practices. This will allow the team to have an understanding of the literature and research question. In the second week, the research team will gather evidence from the stakeholders through meetings, interviews, and questionnaires. During the third and fourth weeks, the research team will go through the information they received from the stakeholders and the literature review to create the education program. Once the educational program is created, the research team will propose their program to the facility for approval and acquire the resources and personnel needed to implement the program.

NUR 3643-Module 9 Course Project Assignment-Significance of Identified Practice Problem

Plan for Evaluation

Goals 

Data Necessary for Evaluation 

To evaluate the educational course, a questionnaire would need to be completed by the nurses participating in the intervention before, immediately after, six months, and twelve months after the intervention. This questionnaire would include questions evaluating the course itself, their symptoms of burnout, and their use of self-care strategies. Patients would also complete surveys at the same time intervals to evaluate the quality of patient care. Nurse managers and administrators would provide data on nursing errors and patient complaints before and throughout the first year after the implementation of the intervention.

Data Analysis

 Questionnaires given to critical care nurses to evaluate burnout would include questions about depersonalization, emotional exhaustion, and personal accomplishment (Couser, 2020). They would also include questions about their self-care habits and strategies used. These questions would be answered in formats of true or false and a range of answers between strongly agree to disagree (Couser, 2020). These answers would be collected and put into percentages to be analyzed to determine the success of the intervention.

The surveys given to the patients would be collected and analyzed in the same fashion as those given to the critical care nurses. The information provided by the nurse managers and administrators would be analyzed by looking at the trend of errors, complaints of the patients, and rate of turnover. This data would evaluate if the errors and complaints correlate with the reports of burnout symptoms.

Plan to Sustain Practice Change

 To sustain this intervention, the facility would need to hire a team to conduct these self-care educational courses. They would need to have an education in psychology and be able to revise the course based on participant feedback. Another resource that would sustain the benefits of the educational course would be to provide informational tools to the staff. These informational tools could include self-care manuals provided at the course to take home, posters about self-care in the break rooms, and self-care reminders at the nurse’s stations. These resources would provide everyday reminders to the nurses of the strategies they learned between their courses and to continue to practice them.

One key indicator that shows continuous quality improvement of this research question would be critical care nurses reporting a significant decrease in symptoms of burnout. This would include decreased emotional exhaustion, decreased depersonalization, and increased personal accomplishment. Turnover rates decreasing after the implementation of the intervention would also indicate that the intervention is successful. Other indicators would include decreased nursing errors, increased patient satisfaction, and increased reports of quality care.

The research team would take the data collected during that year after implementation of the education course and determine what needs to be reevaluated, changed, or stayed the same.

These nurses who have participated in the intervention would help with determining changes that need to be taken to improve the intervention. This would allow the team to make those changes and create a course manual to provide to other facilities to begin a self-care educational course. The data collected would also allow the researchers to determine how often the nurses should take the course and what extra informational tools outside of the course were helpful.

References

Blackburn, L., Thompson, K., Frankenfield, R., Harding, A., & Lindsey, A. (2020). The thrive© program: Building oncology nurse resilience through self-care strategies. Oncology Nursing Forum, 47(1), E25-E34. https://doi.org/10.1188/20.ONF.E25-E34

Couser, G. (2020). Developing a course to promote self-care for nurses to address burnout.

Online Journal of Issues in Nursing, 25(3). https://doi.org/10.3912/OJIN.Vol25No03PPT55

Hastings, C. (2009, April). Nursing at the NIH Clinical Center: Clinical research nursing. https://clinicalcenter.nih.gov/nursing/crn/crn_2010.html

Ho, G. J., Liew, S. M., Ng, C. J., Hisham shunmugam, R., & Glasziou, P. (2016). Development of a search strategy for an evidence-based retrieval service. PLOS ONE, 11(12), e0167170. https://doi.org/10.1371/journal.pone.0167170

Holle, M. N., & Karakashian, A. L. (2018). Burnout in critical care nursing staff. CINAHL Nursing Guide. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=nup&AN=T904150&site=eds- live&custid=s9076023

Kravits, K., Mcallister-black, R., Grant, M., & Kirk, C. (2010). Self-care strategies for nurses: A psycho-educational intervention for stress reduction and the prevention of burnout.

Applied Nursing Research, 23(3), 130-138. https://doi.org/10.1016/j.apnr.2008.08.002 Mohr, D. C., Swamy, L., Wong, E. S., Mealer, M., Moss, M., & Rinne, S. T. (2021). Critical care nurse burnout in veterans health administration: Relation to clinician and patient outcomes. American Journal of Critical Care, 30(6), 435-442. https://doi.org/10.4037/ajcc2021187

NURSEJOURNAL STAFF. (2021, November 12). Critical care nurse career overview. https://nursejournal.org/careers/critical-care-nurse/

2021 NSI national health care retention & RN staffing report. (2021). NSI Nursing Solutions. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Re tention_Report.pdf

Professional nurses must be able to identify relevant practice issues, appraise literature and integrate credible evidence into innovative, evidence-based practice solutions for positive outcomes.

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Question 

NUR 3643-Module 9 Course Project Assignment-Significance of Identified Practice Problem

Course Competency:

Propose an evidence-based solution aligned with an evidence-based practice question.

Instructions:

Content:

Applying The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care, create a written proposal for these two components of a proposal for an evidence-based practice solution.

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