NRS 493 Capstone Project Change Proposal Presentation


NRS 493 Capstone Project Change Proposal Presentation

Content

Problem of burnout in ED nurses

Interventions 

Evidence-based literature

Objectives

Resources needed

Anticipated measurable outcomes

Barriers to implement change

Solutions to barriers

Evaluation of the outcomes

This is the content of the presentation. It begins with the importance of the project change and its problem of burnout in ED nurses. We will look at the project interventions and understand what goals we have in the mind. Further, we will see how EBP literature aid in completing the project and selecting interventions. Then comes objectives of the change proposal and resources that will be needed to implement the change. Further, we look into the different measurable outcomes as well as barriers that we may face during the implementation along with solutions for them. Then we will move to understanding how outcomes will be evaluated to see whether the change was beneficial or not. 

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Problem of burnout in ED nurses

Burnout prevalence rate is increasing

Burnout increases turnover rate 

It reduces quality of care and patient satisfaction

It leads to stress, anxiety, depersonalization, and emotional exhaustion

The problem of burnout is a major health care problem as it affects nurses, their productivity, ability to work, errors committed during the practice (Nowrouzi et al., 2015), and other health care aspects such as poor work environment, quality of care (Ang et al., 2016), satisfaction levels of patients and nurses, and overall outcome. 

Thus, it is important to address the burnout issue in nurses by adopting strategies (Cañadas-De la et al., 2018).

Primary care physicians have among the highest rates of burnout among physician specialties, with more than 60% of those in the United States reporting high levels of burnout as measured by a commonly used scale.

Burnout is a problem in its own right for reasons of concern about the well-being of health care workers. There is also concern that burnout and low engagement in the workplace may adversely affect patient care, destabilize the workforce, and increase turnover.

The study surveyed nearly 800 members of the American Association of Critical-Care Nurses from August 2018 through August 2019. Findings, which were published in the May 2021 issue of American Journal of Critical Care include:

About 61% reported suboptimal physical health. Nurses tend to like working three days per week, but that requires 12-hour shifts with lim­ited breaks to rest properly, often resulting in sleep disruption, headaches, cardiovascular disease, gas­trointestinal symptoms, and musculoskeletal disor­ders.

About 40% screened positive for depressive symptoms and more than 50% screened positive for anxiety.

Those who reported worse health and wellbeing had between a 31% to 62% higher likelihood of making medical errors.

Nurses who reported working in places that provided greater support for wellness were more than twice as likely to have better personal health and professional quality of life compared with those whose workplace provided little or no support.

Stress, anxiety, and depression are likely even higher in the current environment than before the pandemic, when the study was conducted, the authors say.

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Problem of burnout in ED nurses

It increases heath care errors

Increases risk to patient safety

Reduces nurse satisfaction

Increases intention to leave job

Although it is difficult to determine causal relationships, burnout has been associated with increased patient safety incidents, including medical errors, reduced patient satisfaction, and poorer safety and quality ratings.

Burnout lowers nurses’ quality of life, performance level, and organizational commitment and increases their intention to leave the job. … Structural empowerment was found to be important for both nurses’ job satisfaction and quality of patient care as mediated by professional practice environment characteristics.

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Interventions

Increase nurse to patient ratio

Effective staff scheduling

Increasing interprofessional collaboration

Stress management programs

The implementation plan starts from increasing nurse to patient ratio and then educating nurses about the change plan and its objectives to promote effective change (Magtibay et al., 2017). The next step is to create training and education sessions to train nurses to manage self through mindfulness, stress management, active management, self-efficacy, and burnout management programs (ALmutairi & El.Mahalli, 2020). Then creating supportive environment, work culture, and establishing interprofessional collaboration through knowledge-sharing, shared decision-making, and group discussions will be implemented. Further, dynamic scheduling will be implemented (Rees et al., 2019). The plan will be implemented at small scale and then implemented at large scale by evaluating the outcomes (Guixia & Hui, 2020). The outcome measures include turnover rate, cost of care, satisfaction levels of both nurses and patients, quality of care, reduced health care errors, and nurse perception analysis. 

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Interventions

Self-efficacy and resilience

Organizational support

Creating supportive environment

Training and education sessions

There is a significant correlation between teaching self-efficacy, resilience and burnout. More specifically, the results point out that the self-efficacy correlated positively with resilience and negatively with burnout. In the same way, resilience correlated negatively with burnout. Further, the researchers state that building self-efficacy can lead to resilience.

Also, organizational support is important. For example, cost associated with increasing nurse to patient ratio, Yoga instructors, paid leave, incentives for workers, tours to relieve stress, community events, and other stuff. 

following six reasons as the cause for disengagement and burnout:
Work overload

Lacking a sense of control

Insufficient rewards relative to the demand

Breakdown or lack of a sense of community in the workplace

Conflict of values or seeing work as meaningless

Absence of fairness


“In today’s workplace, people and organizations are responding to the challenges of global competition, tightening budgets, and downsizing by working harder instead of smarter, resulting in the exhaustion, cynicism, and ineffectiveness characteristic of burnout,” 

Creating supportive, engaging work environment helps fight employee burnout

Good training programs can help reduce employee burnout as it helps nurses to identity different aspects that increase burnout to manage it succesfully

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Evidence-based literature

Nurse to patient ratio – (Bruyneel et al., 2021), (Guixia & Hui, 2020), & (Gutsan et al., 2018).

Effective staff scheduling – (Patel et al., 2019) (Simone et al., 2019)

Increasing interprofessional collaboration – (ALmutairi & El.Mahalli, 2020), (Cañadas-De la et al., 2018), & (Magtibay et al., 2017).

Stress management programs – (Guixia & Hui, 2020) & (Yao et al., 2018)

Nurse to patient ratio – (Bruyneel et al., 2021), (Guixia & Hui, 2020), & (Gutsan et al., 2018) – The nurse-patient ratio is a direct determinate of the effects of psychological, mental, emotional health and nurse productivity in the workplace which also determines the patients’ overall health. California is the only state that has legally defined required minimum nurse-to-patient ratios to be maintained at all times by unit. For example, the nurse-to-patient ratio in a critical care unit must be 1:2 or fewer at all times, and the nurse-to-patient ratio in an emergency department must be 1:4 or fewer at all times that patients are receiving treatment, the law states.

Effective staff scheduling – (Patel et al., 2019) (Simone et al., 2019) – Organization-directed interventions can involve simple changes in the work schedule and environment, work tasks to reduce stress levels (e.g., reductions in the workload by improved team-work, changes in the work evaluation, increment of participation in decision-making, and supervision to minimize job demand and enhance job control), and more profound improvements in the operation of healthcare organizations. These interventions were associated with a meaningful reduction in emotional exhaustion and depersonalization scores and had more significant effects when compared with individual-directed interventions. 

Increasing interprofessional collaboration – (ALmutairi & El.Mahalli, 2020), (Cañadas-De la et al., 2018), & (Magtibay et al., 2017) – The inter-professional collaboration was the strongest negative predictor in the model of emotional exhaustion. Relations with doctors are an important factor that may yield benefits in terms of nurses’ work engagement and clinical autonomy. Supportive and empowering relations with doctors lead nurses to positive attitudes towards their position

Stress management programs are designed to promote overall wellbeing by providing employers and employees with tools to prevent and reduce workplace stress. They can be delivered in a variety of ways, but are usually made up of educational resources, company policies, digital programs delivered through an app or wellbeing platform, management training or physical changes to the workplace. For example, a designated social area in the workplace for employees to gather and take a break and incentives for completing a mindfulness session could both be a part of a stress management program.

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Evidence-based literature

Self-efficacy and resilience – (Galindo-Domínguez et al., 2020) & (Hu et al., 2020)

Organizational support – (Bruyneel et al., 2021), (Guixia & Hui, 2020), & (Gutsan et al., 2018)

Creating supportive environment (Montgomery et al., 2021) & (Nowrouzi et al., 2015)

Training and education sessions – (Ivanić et al., 2017) & (Kuritsyn & Fomichev, 2020)

Self-efficacy and resilience – (Galindo-Domínguez et al., 2020) & (Hu et al., 2020) – Psychological resilience has been described as the ability of a person to overcome adversity and adjust in a positive manner to maintain their well-being and has been linked to persistence in the nursing workforce as well as in the educational context. As predicted by the model, resilience had a significant influence on the relationship between mindfulness, self-efficacy and coping, and psychological adjustment (burnout scores). Higher mindfulness, higher self-efficacy, and coping scores were associated with lower burnout due to each variables effect on resilience. For mindfulness and self-efficacy, these effects were not moderated by Neuroticism, suggesting that the relationships between variables occur irrespective of a persons score on this personality variable. These findings offer some support for the development of programs for students that teach mindfulness skills, adaptive coping skills and strategies directly designed to bolster self-efficacy as a potentially important approach to strengthening student nurse resilience and thereby potentially preventing burnout.

Organizational support – (Bruyneel et al., 2021), (Guixia & Hui, 2020), & (Gutsan et al., 2018) support organizational support

Creating supportive environment includes discussions, shared decision-making, and support through resources (Montgomery et al., 2021) & (Nowrouzi et al., 2015)

Training and education sessions prepares nurses to manage the work burden and stress  – (Ivanić et al., 2017) & (Kuritsyn & Fomichev, 2020)

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Objectives

Increasing nurse to patient ratio

Creating a supportive interprofessional collaboration

Reduce burnout

Providing organizational support to reduce burnout

Objective 1: Increasing nurse to patient ratio

The objective is critical as one of the major reasons for burnout in nurses is the increased burden on nurses due to high patient count and lower nurse-to-patient ratio (Guixia & Hui, 2020). The burden and stress increase on nurses when they have to care for multiple patients every day and it increases the chances of errors and adverse events (Yao et al., 2018).

Objective 2: Creating a supportive interprofessional collaboration

In health care settings, communication is an important part of the process where nurses, physicians, pharmacists, informatics nurses, and other health care professionals coordinate and collaborate to provide care (Ang et al., 2016). A better and supportive interprofessional collaboration increases burden sharing, knowledge sharing, ethical decision making, and aid in solving complex health care issues. Thus, it will reduce stress and burnout in nurses (Rees et al., 2019). 

Objective 3: Implementing mindfulness, self-efficacy, and stress management strategies to support nurses to manage stress

Self-efficacy is essential in nursing practice as nursing is a dynamic field with an increased workload. Practicing self-efficacy will enable nurses to adapt to demanding situations and implement stress management strategies to reduce burnout (Nowrouzi et al., 2015). Further, support during situations such as COVID-19 or similar situations will reduce stress on nurses (Guixia & Hui, 2020).

Objective 4: Organizational support through incentives, work schedules, and a better work environment

Lower job satisfaction is common in nurses who are subjected to poor work scheduling, hostile or not inclusive work environment, and low wages or incentives. Also, better scheduling will result in better time and nurse management, which is essential in reducing burnout and stress in nurses. 

Objective 5: Training and educating nurses to increase work-life management skills

Burnout is one of the major factors that will affect personal life and professional practice. Also, individual aspects and work environment conditions affect the way nurses practice in health care settings. Thus, training and educating nurses will result in better skills in managing themselves and the demands in the workplace (Guixia & Hui, 2020). 

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Objectives

Training and educating nurses

Increase quality of care and job satisfaction

Reduce turnover rate and health care errors

Autonomy and social justice

Training and educating nurses to increase work-life management skills

Using data from the American Nurses Association’s National Database of Nursing Quality Indicators, researchers discovered that a 25 percent increase in nurse job enjoyment over a two-year span was linked with an overall quality of care increase between 5 and 20 percent.

NRS 493 Capstone Project Change Proposal Presentation

Levels of burnout among primary care clinicians and staff are alarmingly high, and there is widespread belief that burnout and lack of employee engagement contribute to high turnover of the workforce. 

Autonomy and social justice

The proposed change project and objectives advocate for autonomy as nurses will adopt and practice self-efficacy and stress management to adapt to the work environment and improve themselves by concentrating on individual characteristics, needs, and aspects that affect them. Also, nurses will be responsible for their work and managing is burden after the training, education, and implementation of Organizational strategies. Further, the change project also advocates for social justice as it includes better treatment of nurses and health care professionals by increasing nurse to patient ratio to reduce burnout (Nowrouzi et al., 2015). Organizational support, incentives, and a better work environment promote justice for nurses where better-quality life is expected. The project also aims to reduce nursing errors and adverse events during practice, which is essential in increasing safety, quality care, and satisfaction levels in patients and nurses (Magtibay et al., 2017). 

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Resources needed

Organizational level

Nurse leaders

Nurse managers

Psychologists

Trainers to manage stress

Finances to hire more nurses

Quick nap beds and recreational facilities 

Practice

NRS 493 Capstone Project Change Proposal Presentation

Telehealth when needed

Web-based or in-person training

Plan for managing stress and literature and video lessons

As the project plan is to reduce burnout in nurses to increase quality of care, nurse satisfaction, and self-efficacy, and reduce health care errors, depersonalization, and low job satisfaction, the first resource needed is financial support and planning where experts and specialists will be hired to increase self-efficacy and implement stress management strategies (ALmutairi & El.Mahalli, 2020). Also, organizational support is important. For example, cost associated with increasing nurse to patient ratio, Yoga instructors, paid leave, incentives for workers, tours to relieve stress, community events, and other stuff. 

The second key resource is web-based and in-person based education and training for nurses in heath care facilities where the intervention will be applied to test the effectiveness of the multi-modal intervention in reducing stress. Even the use of telehealth resources will be beneficial as nurses can care for a person from remote location (Alotaibi & Federico, 2017).

The third key resource that might be needed is quick nap or power nap beds for nurses along with refreshment unit in health care where nurses can relax and cope up with the increased stress levels in health care (Magtibay et al., 2017). These resources are beneficial in reducing immediate stress levels. The fourth key resource that will be beneficial is psychiatric support unit for nurses who are facing depersonalization and suffering from anxiety and depression (ALmutairi & El.Mahalli, 2020). The resource will be highly beneficial as it allows the nurses to get immediate psychiatric support during crisis or even during day-to-day nursing practice (Wei et al., 2017).

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Anticipated measurable outcomes

Turnover rate

Health care error rate

Quality of care and patient satisfaction levels

Burnout and stress levels in nurses through psychological scales

Turnover rate is defined as the percentage of employees who left a company over a certain period of time. It’s often described in relation to employee retention rate, which measures the number of employees retained from the beginning of a set period until the end. There are two types of turnover.

Maslach Burnout Inventory (MBI) and Coping Methods Checklist (CMC) to collect the data and found that coping methods such as stress management, self-efficacy, and mindfulness strategies were effective in reducing burnout. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and MBI and found that burnout was high in nurses especially during COVID-19 and factors such as nurse to patient ratio, increased work burden, and external aspects such as COVID-19 pandemic increased burnout. 

Outcome 1: reduced turnover ratio in health care

As more nurses will collaborate together and work towards reducing stress in the work environment, turnover ratio decreases as a smaller number of nurses will leave the job (Yao et al., 2018).

Outcome 2: increased nurse to patient ratio in health care

NRS 493 Capstone Project Change Proposal Presentation

As more nurses are recruited to handle the burden and burnout in nurses, nurse to patient ratio will increase and thus, it will further increase quality care (Lahana et al., 2017).

Outcome 3: reduced health care errors 

As number of patients per nurses will be less, then the nurses will have time to manage everything without stress and fatigue, health care errors will be less (Magtibay et al., 2017). 

Outcome 4: reduced burnout in nurses

The stress management, self-efficacy, and support will reduce burnout in nurses as burden sharing, quality interprofessional collaboration, and high nurse to patient ratio will be beneficial (Rees et al., 2019). 

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Barriers to implement change

Resistance to change 

Financial resources

Workforce issue and nurse shortage

Measuring outcome statistically 

There are four key barriers. The first barrier is resistance to change as nurses might feel work burdened due to sessions. The solution is to increase nurse to patient ratio and pay the nurses even during the sessions and educate them about importance of the sessions (Guixia & Hui, 2020). The second barrier is related to financial resources and this can be resolved through crowdfunding, federal support programs, involvement of community, and taking investment or loan. The third barrier is to hire more nurses immediately and this can be solved by hiring new graduates as assistant nurses (Yao et al., 2018). The fourth barrier is measuring outcome statistically and this can be solved by using scaled tools to measures the perceptions on the scale of one to ten. 

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Evaluation of the outcomes

Use of psychological tool to measure perceptions before and after interventions

Statistical pre and post comparison

Improved quality and throughput

Increased patient and nurse satisfaction

Plan for evaluating proposed nursing intervention

The plan is to use the pre and post interventional statistical analysis of number of health care errors, turnover rates, satisfaction levels of nurses and patients, cost of health care, throughput, and quality of care (Cañadas-De la et al., 2018). Further, psychological tool scales will be used to determine whether the nurses and patients experienced positive outcomes of the interventions in improving quality of care and reducing burnout. Also, analyzing and comparing nurses’ perception and before and after intervention will aid in evaluating effectiveness of interventions (Guixia & Hui, 2020).

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Conclusion

Nurse burnout is the state of mental, physical, and emotional exhaustion caused by sustained work-related stressors such as long hours, the pressure of quick decision-making, and the strain of caring for patients who may have poor outcomes. As a result, the proposed multimodal intervention with different strategies to address each aspect is important to achieve desired outcomes is effective.

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References

NRS 493 Capstone Project Change Proposal Presentation

ALmutairi, M., & El.Mahalli, A. (2020). Burnout and coping methods among emergency medical services professionals. Journal Of Multidisciplinary Healthcare, Volume 13, 271-279. https://doi.org/10.2147/jmdh.s244303

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173-1180. https://doi.org/10.15537/smj.2017.12.20631

Ang, S., Dhaliwal, S., Ayre, T., Uthaman, T., Fong, K., & Tien, C. et al. (2016). Demographics and personality factors associated with burnout among nurses in a singapore tertiary hospital. Biomed Research International, 2016, 1-12. https://doi.org/10.1155/2016/6960184

Barrow, J., Annamaraju, P., & Toney-Butler, T. (2016). Change management. Retrieved 28 July 2021, from.

Bruyneel, A., Smith, P., Tack, J., & Pirson, M. (2021). Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium. Intensive And Critical Care Nursing, 65, 103059. https://doi.org/10.1016/j.iccn.2021.103059 

NRS 493 Capstone Project Change Proposal Presentation

Cañadas-De la, G., Ortega, E., Ramirez-Baena, L., De la Fuente-Solana, E., Vargas, C., & Gómez-Urquiza, J. (2018). Gender, marital status, and children as risk factors for burnout in nurses: a meta-analytic study. International Journal Of Environmental Research And Public Health, 15(10), 2102. https://doi.org/10.3390/ijerph15102102

Guixia, L., & Hui, Z. (2020). A Study on burnout of nurses in the period of COVID-19. Psychology And Behavioral Sciences, 9(3), 31. https://doi.org/10.11648/j.pbs.20200903.12

Gutsan, E., Patton, J., Willis, W., & Coustasse, A. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. MGMT Research. Retrieved 29 July 2021, from https://mds.marshall.edu/mgmt_faculty/196/. 

Hussain, S., Lei, S., Akram, T., Haider, M., Hussain, S., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal Of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Ivanić, D., Adam, V., Srzić, I., Stepić, A., & Pintarić, H. (2017). Burnout syndrome in emergency medicine. Hong Kong Journal Of Emergency Medicine, 24(6), 290-297. https://doi.org/10.1177/1024907917740094 

Jang, H., Park, J., Choi, Y., Park, S., & Lim, H. (2016). Effect of general hospital nurses’ perception of patient safety culture and burnout on safety management activities. Journal Of Korean Academy Of Nursing Administration, 22(3), 239. https://doi.org/10.11111/jkana.2016.22.3.239

Kuritsyn, M., & Fomichev, D. (2020). Emotional burnout syndrome in workers of emergency medical services. Medsestra (Nurse), (11), 53-57. https://doi.org/10.33920/med-05-2011-06 

Lahana, E., Papadopoulou, K., Roumeliotou, O., Tsounis, A., Sarafis, P., & Niakas, D. (2017). Burnout among nurses working in social welfare centers for the disabled. BMC Nursing, 16(1). https://doi.org/10.1186/s12912-017-0209-3

Magtibay, D., Chesak, S., Coughlin, K., & Sood, A. (2017). Decreasing stress and burnout in nurses. JONA: The Journal Of Nursing Administration, 47(7/8), 391-395. https://doi.org/10.1097/nna.0000000000000501 

Montgomery, A., Patrician, P., & Azuero, A. (2021). Nurse burnout syndrome and work environment impact patient safety grade. Journal Of Nursing Care Quality, Publish Ahead of Print. https://doi.org/10.1097/ncq.0000000000000574 

NRS 493 Capstone Project Change Proposal Presentation

Nowrouzi, B., Lightfoot, N., Larivière, M., Carter, L., Rukholm, E., Schinke, R., & Belanger-Gardner, D. (2015). Occupational stress management and burnout interventions in nursing and their implications for healthy work environments. Workplace Health & Safety, 63(7), 308-315. https://doi.org/10.1177/2165079915576931

Pfitzner-Eden, F. (2016). Why do I feel more confident? bandura’s sources predict preservice teachers’ latent changes in teacher self-efficacy. Frontiers In Psychology, 7. https://doi.org/10.3389/fpsyg.2016.01486

Rees, C., Eley, R., Osseiran-Moisson, R., Francis, K., Cusack, L., Heritage, B., & Hegney, D. (2019). Individual and environmental determinants of burnout among nurses. Journal Of Health Services Research & Policy, 24(3), 191-200. https://doi.org/10.1177/1355819619840373

Rezaei, S., Karami Matin, B., Hajizadeh, M., Soroush, A., & Nouri, B. (2018). Prevalence of burnout among nurses in Iran: a systematic review and meta-analysis. International Nursing Review, 65(3), 361-369. https://doi.org/10.1111/inr.12426

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ED nurses. Journal Of Emergency Nursing, 43(2), 145-149. https://doi.org/10.1016/j.jen.2016.07.011

Yao, Y., Zhao, S., Gao, X., An, Z., Wang, S., & Li, H. et al. (2018). General self-efficacy modifies the effect of stress on burnout in nurses with different personality types. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3478-y

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