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EVIDENCE-BASED PRACTICE PROJECT REPORT Submitted to the School of Nursing and Health Professions of Colorado Christian University Lakewood, Colorado in partial fulfillment of the requirements For the degree of DOCTOR OF NURSING PRACTICE Abstract The work of a registered nurse can be rewarding. However, nurses may experience burnout because of long hours, challenging patient situations, and a potential lack of teamwork and communication. The literature review showed that 15-40% of nurses experience burnout each year (Well-Being Index, 2018). Burnout can lead to nurses leaving their current positions or potentially leaving the nursing profession altogether. Resiliency training and support can counteract burnout and increase staff retention. A resiliency toolkit to help decrease burnout was implemented with 10 nurses on a medical-surgical unit in a mid-size acute care hospital. The toolkit contained six tools utilized over 5 weeks. The tools included mandalas (coloring sheets), a stress ball, bubbles, exercises, You Matter encouragement, and a journal with weekly prompts. Three survey tools were deployed to assess resiliency, burnout, and areas of work life. The most favored tool in the toolkit was the mandalas. Participants felt more relaxed yet more productive. The least beneficial tool was the bubbles. A two-tailed paired samples t-test showed a decrease in Maslach Burnout Inventory emotional exhaustion. Significant correlations between several variables were found with Pearson and Spearman correlational coefficient tests. Newer nurses' values were strongly correlated with organizational values. Increased depression at work was strongly correlated with years of experience in the profession. Seasoned nurses demonstrated an increase in adaptation and flexibility, but showed a decrease in coping. Lastly, nurses who hold a higher academic degree (BSN/MSN) demonstrated a decrease in personal accomplishment. This project has uncovered simple tools that will help decrease emotional exhaustion. Keywords resiliency, burnout, toolkit, journaling, mandala, evidenced-based practice, medical-surgical, registered nurse, nurse
Nationally, front-line nurses report increased workplace burnout and decreased resiliency due to factors such as poor management, lack of teamwork, staffing, mandatory overtime, and lack of resources (Bakhamis et al., 2019). A gap analysis at Intermountain Healthcare identified a need for a Doctorate in Nursing Practice (DNP) project that addressed resiliency skills and early identification of workplace burnout of front-line nurses. This process improvement project involved front-line nurses and nurse managers from the six rehabilitation units at Intermountain Healthcare. Front-line nurses participated in a 20-minute training on recognizing low resiliency and self-care measures. Nurse managers participated in a two-part training on resiliency coaching. In addition, front-line nurse participants were asked to complete baseline and follow- up surveys that measured resiliency and burnout. A resiliency coaching program can positively impact a front-line nurse's resiliency, engagement, confidence, and knowledge. However, a focus on resiliency does not necessarily equate to improved burnout symptoms and decreased turnover.
Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.
" Burnout is best described as the prolonged psychological reaction to chronic emotional and interpersonal stressors on the job, and is associated with increased demands with limited resources in the workplace. The presence of the Coronavirus-19 (COVID-19) pandemic has exacerbated the presence of burnout among nurses in the healthcare setting. This project investigated if the introduction of mindfulness practices such as body scans and grounding techniques would impact the rates of stress and burnout among Registered Nurses (RNs) working on a Medical-Surgical (Med-Surg) unit. The project included a total of 21 RNs who participated in individual body scan and grounding sessions over the course of a ten-week program. Outcomes were measures using the Oldenburg Burnout Inventory (OBLI) to assess burnout, with higher values indicating a higher level of burnout. The effect on stress was assessed through both the Perceived Stress Scale (PSS), with higher values indicated lower levels of stress; blood pressures and heart rates of participants were also obtained immediately before and after each session. The project showed a reduction on the OBLI from 39.0667 points to 37.1333 after completion of the program, indicating the interventions were effective in reducing burnout. The mean PSS scores also increased from 27.12 to 29.15 (p
"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/
This book tackles the most common challenges that medical students experience that lead to burnout in medical school by carefully presenting guidelines for assessment, management, clinical pearls, and resources for further references. Written by national leaders in medical student wellness from around the country, this book presents the first model of care for combating one of the most serious problems in medicine. Each chapter is concise and follows a consistent format for readability. This book addresses many topics, including general mental health challenges, addiction, mindfulness, exercise, relationships and many more of the important components that go into the making of a doctor. Medical Student Well-being is a vital resource for all professionals seeking to address physician wellness within medical schools, including medical students, medical education professionals, psychiatrists, addiction medicine specialists, hospitalists, residents, and psychologists.
The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
Properly performing health care systems require concepts and methods that match their complexity. Resilience engineering provides that capability. It focuses on a system’s overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. This book contains contributions from international experts in health care, organisational studies and patient safety, as well as resilience engineering. Whereas current safety approaches primarily aim to reduce the number of things that go wrong, Resilient Health Care aims to increase the number of things that go right.
Suffering is an unavoidable reality in health care. Not only are patients and families suffering but also the clinicians who care for them. Commonly the suffering experienced by clinicians is moral in nature, in part a reflection of the increasing complexity of health care, their roles within it, and the expanding range of available interventions. Moral suffering is the anguish that occurs when the burdens of treatment appear to outweigh the benefits; scarce human and material resources must be allocated; informed consent is incomplete or inadequate; or there are disagreements about goals of treatment among patients, families or clinicians. Each is a source of moral adversity that challenges clinicians' integrity: the inner harmony that arises when their essential values and commitments are aligned with their choices and actions. If moral suffering is unrelieved it can lead to disengagement, burnout, and undermine the quality of clinical care. The most studied response to moral adversity is moral distress. The sources and sequelae of moral distress, one type of moral suffering, have been documented among clinicians across specialties. It is vital to shift the focus to solutions and to expanded individual and system strategies that mitigate the detrimental effects of moral suffering. Moral resilience, the capacity of an individual to restore or sustain integrity in response to moral adversity, offers a path forward. It encompasses capacities aimed at developing self-regulation and self-awareness, buoyancy, moral efficacy, self-stewardship and ultimately personal and relational integrity. Clinicians and healthcare organizations must work together to transform moral suffering by cultivating the individual capacities for moral resilience and designing a new architecture to support ethical practice. Used worldwide for scalable and sustainable change, the Conscious Full Spectrum approach, offers a method to solve problems to support integrity, shift patterns that undermine moral resilience and ethical practice, and source the inner potential of clinicians and leaders to produce meaningful and sustainable results that benefit all.
The Future of the Nursing Workforce in the United States: Data, Trends and Implications provides a timely, comprehensive, and integrated body of data supported by rich discussion of the forces shaping the nursing workforce in the US. Using plain, jargon free language, the book identifies and describes the key changes in the current nursing workforce and provide insights about what is likely to develop in the future. The Future of the Nursing Workforce offers an in-depth discussion of specific policy options to help employers, educators, and policymakers design and implement actions aimed at strengthening the current and future RN workforce. The only book of its kind, this renowned author team presents extensive data, exhibits and tables on the nurse labor market, how the composition of the workforce is evolving, changes occurring in the work environment where nurses practice their profession, and on the publics opinion of the nursing profession.