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NUR3643 Research and Theory Evidence-Based Proposal

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NUR3643 Research and Theory Evidence-Based Proposal

Problem in Practice

During my clinical experience at Rasmussen University, I observed many nurses who expressed exhaustion and stress from their jobs. I’ve seen depersonalization happen in the ICU, causing nurses not to treat the patient with empathy and instead to be task-oriented. These characteristics are a result of chronic work-related stress, also known as burnout (Mohr et al., 2021).

Burnout has a financial impact on the patient, the nurses, and the facility. Nurse burnout is common in critical care units because they are frequently exposed to complex patient care, moral distress, dying patients, and perceived delivery of inappropriate care (Mohr et al., 2021). Burnout can result in a longer length of stay, higher infection rates, lower patient satisfaction, lower employee satisfaction, and higher turnover rates (Mohr et al., 2021).

According to a study conducted by Mohr et al., employees in facilities with higher burnout rates had lower employee satisfaction, significantly higher turnover intention, and stayed longer than expected (2021). Registered nurse turnover costs a hospital between $3.6 million and $6.5 million per year, and the average hospital could save $270,800 for every percentage reduction in turnover (2021 NSI National, 2021).

Question for Research

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

Nurses who work in critical care

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

Intervention: Self-care education

Educating nurses on self-care strategies would give them the tools they need to help reduce burnout caused by work-related stress. Basic self-care, such as eating well, sleeping well, and exercising, is neglected by burnout nurses, and this neglect of self-care worsens the symptoms of burnout (Couser, 2020). Spirituality, mindfulness, art therapy, breathing techniques, yoga, guided imagery, aromatherapy, acupressure, self-massage, music therapy, journaling, or finding an enjoyable hobby are some other self-care strategies (Blackburn et al., 2020). The facility will provide education using evidence-based self-care strategies.

Education on self-care versus no education

The intervention would be compared to not providing self-care education. This comparison could be completed by surveying the nurses prior to delivering the intervention to assess for burnout symptoms and perceived burnout experience. This comparison is the most effective way to assess the intervention’s success.

Reduced burnout as a result

This question’s outcomes include decreased, increased, or no change in burnout. The intervention outcomes could be determined by measuring burnout symptoms, perceived burnout feelings, and burnout-related turnover rates before and after the intervention. Personal accomplishment, emotional exhaustion, and depersonalization questions would be used to assess the nurses’ perceived burnout and symptoms.

Evidence Retrieval Team

Members of the Professional

To create or find the questions to be asked in the questionnaires given to the nurses, a psychiatrist or someone with at least a Master’s level education in psychology would be used. Questionnaires would be used to collect evidence on the efficacy of the intervention. The questions and scales in the questionnaires would be more precise and include the relevant information if they were guided by a professional with a psychology education.

Clinical research nurses would be part of the team to collect and evaluate evidence. Clinical research nurses ensure the accuracy of data collection, data management, and study implementation and compliance (Hastings, 2009). A medical librarian would help with evidence retrieval. Medical librarians are trained to conduct searches and can help nurses learn the best ways to use databases and make data retrieval more efficient (Ho et al., 2016). Nurses would assist in the retrieval of data through database searches and would use their clinical knowledge to evaluate the evidence. Nurse managers would hand out questionnaires to the nurses participating in the study.

Strategy for Search

I used Rasmussen University’s Discovery Search to find evidence related to this practice issue. This search engine makes a wide range of databases available to me. I began my search with the keywords “self-care burnout critical care nurse,” limiting the results to full-text and scholarly (peer-reviewed) journals and limiting the publication date to 2017-2021. This search yielded 81 articles, including evidence reviews, a letter to the editor, a qualitative descriptive study, and a cross-sectional, descriptive survey. I was able to find information about burnout in critical care nurses and self-care strategies to reduce burnout through this search.

To find programs educating nurses about self-care strategies, I had to narrow my search to the keywords “self-care burnout program nurse” in order to find research studies on implementing self-care education programs for nurses. I also broadened my search by changing the date range from 2010 to 2021. This enabled me to locate additional articles on the subject, such as quantitative studies, qualitative studies, and article reviews. I used the keywords “critical care nurse burnout” to find evidence of the prevalence of burnout among critical care nurses.

Evaluation of Evidence

Critical care nurses are more vulnerable to stress and burnout, with burnout affecting up to 45% of critical care nurses (Holle & Karakashian, 2018). Burnout is a problem in the healthcare industry because it causes physical and psychological illness, as well as compassion fatigue. This can result in nurses missing work, increased staff turnover, decreased efficiency and productivity, depersonalization, emotional exhaustion, job dissatisfaction, decreased patient care quality, and increased patient care costs (Holle & Karakashian, 2018).

In 2020, the “THRIVE program” was used to educate oncology nurses on self-care strategies to reduce burnout. This educational program consisted of an eight-hour retreat teaching self-care strategies, a six-week interaction with participants via a private Facebook group, and a two-hour closing session (Blackburn et al., 2020). Surveys were used by the researchers to conduct pre-and post-program evaluations. The findings revealed a significant increase in resiliency as well as a significant 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 17.1% average for hospitals in the United States (Blackburn et al., 2020). Guided imagery, art therapy, breathing techniques, music therapy, mindfulness, yoga, aromatherapy, and self-massage were among the self-care techniques taught (Blackburn et al., 2020).

A 2010 study used the intervention of educating nurses on positive self-care behaviours and used a survey to assess burnout before and after the intervention (Kravitz et al., 2010). The intervention was a six-hour class that taught the importance of self-care, various self-care strategies, and how to create a wellness plan for the individual (Kravitz et al., 2010). This study found a 10% reduction in emotional exhaustion and a 3% decrease in feeling disconnected from the work experience (Kravitz et al., 2010). Both of these studies, which used educational programs to teach nurses about self-care strategies, found that they reduced burnout.

Implementation Plan

Key Stakeholders

Past and present critical care nurses, charge nurses, nurse managers, and past and present critical care patients would be key stakeholders for this research question. Previous critical care nurses could share their experiences with the facility’s previous burnout and self-care policies and work environment. They could share what they thought was useful, what they thought worked, and what they would have liked to have had during their time at the facility for self-care education.

The most important stakeholders for this research question would be the facility’s current critical care nurses. They would be able to offer suggestions and their perspectives on what they would like to see in a self-care educational program. They would also be able to indicate how much time they would be willing to devote to a class on this subject. Charge nurses would be able to contribute to what they see as the most serious issue among their nurses in terms of burnout symptoms. They are impacted because when nurses are burnt out, they must pick up any extra slack that may occur.

Nurse managers and administrative personnel must deal with the fallout from critical care nurses’ burnout. Nursing turnover, workplace incidents, and patient complaints are all examples. They would be able to provide information and complaints from patients to provide insight into how burnout has impacted patient care. Past and present patients are affected by nurse burnout and would be able to provide specific ways in which they believe they have been impacted by the care they have received.

Proposed Timetable

The research team will complete an evidence retrieval in the first week by evaluating previous research studies and evidence-based practices. This will allow the team to comprehend the literature and research question. The research team will collect evidence from stakeholders in the second week through meetings, interviews, and questionnaires. During the third and fourth weeks, the research team will go over the information gathered from stakeholders as well as the literature review in order to develop the education program. After developing the educational program, the research team will submit it to the facility for approval and acquire the resources and personnel required to implement it.

Evaluation Planning

Goals 

The emergency care Six months after the self-care educational program, nurses will report fewer burnout symptoms.

Six months after the educational session, the critical care nurses will report using the self-care strategies they learned in the course.

Data Required for Evaluation

To evaluate the educational course, nurses participating in the intervention would need to complete a questionnaire before, immediately after, six months, and twelve months after the intervention. This questionnaire would include questions about the course itself, their burnout symptoms, and how they use self-care strategies. Patients would also be asked to complete surveys at regular intervals to assess the quality of their care. Before and during the first year following the intervention’s implementation, nurse managers and administrators would provide data on nursing errors and patient complaints.

Data Examination

Questions about depersonalization, emotional exhaustion, and personal accomplishment would be included in questionnaires given to critical care nurses to assess burnout (Couser, 2020). They would also ask about their self-care practices and strategies. These questions would be answered in true or false formats, with answers ranging from strongly agree to strongly disagree (Couser, 2020). These responses would be collected and converted into percentages to determine the success of the intervention.

The surveys distributed to patients would be collected and analyzed in the same manner as those distributed to critical care nurses. The data provided by the nurse managers and administrators will be analyzed by looking at the trend of errors, patient complaints, and turnover rate. This data would be used to see if the errors and complaints were related to reports of burnout symptoms.

Sustaining Practice Change

The facility would need to hire a team to conduct these self-care educational courses in order to sustain this intervention. They would need a psychology degree and the ability to revise the course based on participant feedback. Another resource that would sustain the educational course’s benefits would be to provide informational tools to the staff. These informational tools could include self-care manuals distributed at the course for participants to take home, self-care posters in break rooms, and self-care reminders at nurses’ stations. These resources would serve as daily reminders to nurses to continue to practice the strategies they learned between courses.

Critical care nurses reporting a significant decrease in burnout symptoms would be one key indicator of continuous quality improvement for this research question. This includes less emotional exhaustion, less depersonalization, and more personal accomplishment. Reduced turnover rates after the intervention’s implementation would also indicate that the intervention was successful. Other indicators would be lower nursing errors, higher patient satisfaction, and more reports of quality care.

The research team would analyze the data gathered during the year following the education course’s implementation to determine what needed to be reevaluated, changed, or remained the same. The nurses who participated in the intervention would aid in determining what changes should be made to improve the intervention. This would enable the team to make those changes and create a course manual to be distributed to other facilities in order to start a self-care educational course. The data gathered would also allow the researchers to determine how frequently the nurses should take the course and what additional informational tools outside of the course were useful.

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 the 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

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Question 

Purpose of Assignment:

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.

NUR3643 Research and Theory Evidence-Based Proposal

Course Competency:

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

Explain the relationship between research, theory, and evidence-based practice.

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-base practice solution.

Format:

Template for the Course Project

Resources

 

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