Capstone Project Change Proposal
Capstone Project Change Proposal
In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Background
Problem statement
Purpose of the change proposal
PICOT
The literature search strategy employed
Evaluation of the literature
Applicable change or nursing theory utilized
Proposed implementation plan with outcome measures
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
Appendix section, if tables, graphs, surveys, educational materials, etc. are created
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
SOLUTION
Capstone Project Change Proposal
Background
Since the early years, the nursing profession has been associated with workplace stress, due to the nature of the profession, in regards to physical labor, human suffering, and long work hours and limited staffing. However, in recent decades, the stress has intensified due to the increasing use of new and unfamiliar technology, continuing rise in health care costs and turbulence within the work environment (Cho, Mark, Knafl, Chang & Yoon, 2017).This Long term stress has been found to result in a syndrome, referred to as burnout.
Nursing Burnout, therefore, refers to mental, physical, and emotional exhaustion, depersonalization, and reduced personal accomplishment. It is caused by a combination of factors. These include: long working shifts, selflessness that comes along with nursing, that makes them neglect their own needs, busy and high stress environment characterized by diverse emotions. Some nurses have to juggle between their busy work schedule, education and family responsibility .
The stress is especially more on the female gender because nursing is a predominantly female profession. Burnout can lead to nurses’ illness, dull emotions, and detachment. It undermines the nurse’s motivation and morale, leading to decreased efficiency; therefore, high error probability, thus threatening the patient’s safety .this results in decreased patient satisfaction.
Consequently, the organization’s financial stability is affected as the center of Medicare now attaches Medicare reimbursement to patients’ satisfaction scores (Dall’Ora, Griffiths & Ball, 2016).It also contributes to absenteeism and turnover, both of which influence the quality of care. With the increased need for acute care due to the rise in the elderly population, there is a need to implement strategies to eliminate nurse burnout.
Problem Statement
Research shows that burn out among critical care nurses is on the rise. Advanced medical technology has increased life expectancy, therefore a consequent increased demand for critical care nurses. Around 25 to 33% of nurses in critical care manifest severe burnout symptoms (Galletta, Portoghese, D’Aloja, Mereu, Contu, Coppola & Campagna, 2016). This is because working in the ICU is stressful due to frequent encounters of patient mortality and morbidity and ethical issues, which can be traumatizing.
The burnout affects nurse morale as well as cognitive functions and attention to details, thus undermining the accuracy and endangering the patient life. This has been attributed to rising medical errors and hospital-acquired infections. The burnout also results affects nurses’ health, putting them at risk of depression and cardiovascular conditions. It also causes decreased job satisfaction, and consequent high turnover rate.it has been blamed for the rising nurse shortage. If the burnout issue is not addressed, the shortage is estimated to double in the next five years.
Purpose of the Change Proposal
The goal of this project is to identify causes of nurse burnout and propose strategies for reducing stress among nurses, to achieve lower levels of burnout. This aims at achieving better mental and physical nursing health, improved job satisfaction, improved quality of care, and organizational growth.
PICOT
In critical care nursing, do nurses who receive stress management education portray lower levels of burnout compared to nurses who do not receive stress management education within three months of training?
Literature Search Strategy Employed
The literature review utilized a total of 8 articles. The articles were obtained from PubMed, Lilacs, Medline, Scielo, and Science Direct databases. The search term was nursing burn out and nursing stress. The inclusion criteria were articles published between 2015 and 2018, in the English language. Based on these criteria, eight studies were selected for analysis. The rationale for the time scope was that factors contributing to nursing burnout are very dynamic; thus, only recent studies would provide relevant information.
Evaluation of the Literature
The issue of burnout has gained a lot of attention in the past decade because of its prevalence and its threat to nursing wellbeing, patient safety, and organizational stability. It is important to ensure that the problem is addressed effectively because it impacts the health outcome of the patients. Several previous studies have focused on evaluating the most effective strategies to eradicate this problem. This section compares the different articles that were utilized for the literature review.
The literature review utilized eight previous studies. The research questions of all the articles aimed at establishing how stress affects nurse burnout and how health providers can cope and manage stress to help prevent nurse burnout. The research question of the second article aimed at establishing how healthcare workers in trauma perceive stress, what triggers stress and burnout are, and how to cope and manage stress (Berg, Harshbarger, Ahlers-Schmidt & Lippoldt, 2016).
The research question of this article was similar to that of the third article that aimed at identifying the risk factors for nurses’ burnout. The research question of the first and fourth article are similar. They aim at evaluating how different interventions can be used to manage stress among health providers to help reduce burnout. The research question of the first article aimed at establishing whether optimism and proactive coping would aid in decreasing burnout among nurses (Chang & Chan, 2015).
On the other hand, the research question of the fourth article aimed at finding out whether yoga is effective in eradicating nurse burnout (Alexander, Rollins, Walker, Wong & Pennings, 2015).The fifth and sixth articles have almost similar research questions. The research questions of the fifth article aimed at finding out how the work environment influence nurse burnout while the research question of the sixth article aimed at establishing whether there was a direct relationship between managerial coping strategies and decreased nurses’ role overload and burnout (Mohamed,2016).
Most of the study participants in the selected studies were health professionals. The first article used a sample population of 314 nurses from a hospital in Taiwan. The fourth article used a sample population of forty nurses from an urban 560-bed teaching hospital. The sixth and eighth studies used 100 and 362 nurses’ participants, respectively (Mark, Knafl, Cho, Chang & Yoon, 2017).
The fifth and seventh articles used a systematic review of previous studies. The fifth article reviewed 30 articles from MEDLINE PubMed and Cochrane Library databases. The seventh article utilized 36 articles from CINAHL, PubMed, and PsycINFO databases (Holdren, Paul III, Denise, Albieri, Melanda, Mesas, Alberto Durán González, Flávia & Selma Maffei, 2017).
One common limitation in most of the studies that were analyzed was the use of a small sample population. A small sample size usually has a negative impact on the final results and can cause the researchers to draw wrong conclusions, which can be misleading to the users. In the third article, the researchers used a non-randomized sample and a design that makes it impossible to draw concrete conclusions regarding causal relations (Cañadas-De la Fuente, Vargas, San Luis, García, Cañadas & Emilia, 2015).
Article four lacked a control group. The limitation of the fifth article was that the researchers focused mainly on studies that had been carried in the United States, thus leading to biased outcomes.
From the research findings of the analyzed studies, stress management can help reduce the rate of burnout among nurses. Among measures that can help in stress management include, higher levels of proactive coping behaviors, nurse optimism, and Yoga activities. It is also evident that the poor nurse work environment and limited nurse staffing contribute to nursing burnout. It is therefore essential to ensure health workers operate in a friendly environment.
The impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurse’s burnout. One of the recommendations for future research is to find out the various personality factors that increase the level of stress among the nurses and the various strategies that can be implemented to help control the stress level among the health providers. Another recommendation for further research is finding out how educating health providers on how to recognize various stressors themselves can help increase their efficiency.
Applicable Change or Nursing Theory Utilized
The theory utilized in this project is Structural Power theory, developed by Rosabeth Kanter. It argues that job satisfaction, commitment, trust, decreased job burnout and therefore, organizational performance can be increased through empowering employees. The empowerment should entail providing certain conditions to employees.
These include opportunity for advancement, access to information, support and resources, formal power through enabling independent decision making, Informal Power through allowing relationships to building and alliances among colleagues. These can be achieved through training. This creates a conducive work environment. Kanter’s theory is based on the idea that individual work behaviors are responses to work conditions and situations; therefore, burnout can result from the unconducive work environment (Bird, 2017).
Proposed Solution
A key strategy for combating the burnout syndrome is to create and sustain a healthy work environment by educating nurses on stress management strategies. These strategies include: adoption of collaborative nursing to avoid overwhelming responsibilities and ensured shared burden, adoption of effective communication skill to ensure better relationships with patients and colleagues, effective and accurate decision making to prevent medical errors that can have psychological stress on nurses, Managing and avoiding conflict in the care environment, utilization of stress detection skills for early recognition of burnout risk factors.
Proposed Implementation Plan with Outcome Measures
External stress management experts will be hired to collaborate with behavioral therapists within the organization in offering training on stress management. The training will be offered to all registered critical care nurses. They will receive training on effective collaborative nursing, effective communication skills, effective decision-making process, conflict resolution, and symptoms of stress and burnout.
To measure the outcomes, only nurses that have undergone stress management training will be deployed in the critical care wards. After three months of implementation, trained nurses will be required to fill questioners on their general experience during the three months after training. The data will be subjected to qualitative analysis and compared to the qualitative analysis of identical questions filled by the participants before the training. This will determine whether the training was successful in eradicating nurse burnout.
Potential Barriers to Plan Implementation
One potential barrier in the implementation difficulty in gathering all critical care nurses in one room for training due to busy hospital schedules. It will be mitigated through delivering the training through e-learning means and recorded video tutorials. It will ensure nurses access the training at their convenient time, from any location.
References
Alexander, G. K., Rollins, K., Walker, D., Wong, L., & Pennings, J. (2015). Yoga for self-care and burnout prevention among nurses. Workplace health & safety, 63(10), 462-470
Berg, G. M., Harshbarger, J. L., Ahlers-Schmidt, C. R., & Lippoldt, D. (2016). Exposing compassion fatigue and burnout syndrome in a trauma team: A qualitative study. Journal of Trauma Nursing, 23(1), 3-10.
Bird, M. (2017). Rosabeth Moss Kanter: A Kaleidoscopic Vision of Change. The Palgrave Handbook of Organizational Change Thinkers, 647-663.
Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & Emilia, I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International journal of nursing studies, 52(1), 240-249.
Chang, Y., & Chan, H. J. (2015). Optimism and proactive coping in relation to burnout among nurses. Journal of Nursing Management, 23(3), 401-408.
Cho, S. H., Mark, B. A., Knafl, G., Chang, H. E., & Yoon, H. J. (2017). Relationships between nurse staffing and patients’ experiences, and the mediating effects of missed nursing care. Journal of Nursing Scholarship, 49(3), 347-355.
Dall’Ora, C., Griffiths, P., & Ball, J. (2016). Twelve-hour shifts: burnout or job satisfaction?. Nursing times, (3), 1-2.
Holdren, P., Paul III, D. P Denise Albieri, J. S., Melanda, F. N., Mesas, A. E., Alberto Durán González, Flávia, L. G., & Selma Maffei, d. A. (2017). Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One, 12(10) doi:http://dx.doi.org.lopes.idm.oclc.org/10.1371/journal.pone.0185781
Mark, B. A., Knafl, G., Cho, S. H., Chang, H. E., & Yoon, H. J. (January 01, 2017). Relationships Between Nurse Staffing and Patients’ Experiences, and the Mediating Effects of Missed Nursing Care. Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing, 49, 3, 347-355.
Mohamed, F. R. (2016). Relationship among nurses’ role overload, burnout and managerial coping strategies at intensive care units. International Journal Of Nursing Education, 8(2), 39-45. doi:10.5958/0974-9357.2016.00044.1.
Also check: NURS 6531 Practicum Experience Journal
Appendices
Conceptual Model
| Dependent Variable
Training on stress management skills
|
| Independent variable
· Effective collaborative nursing · Effective communication skill · Effective independent decision making · Conflict resolution · Ability to identify symptoms of stress and burnout · Relationships building and alliances among colleagues |
| Questionnaire
1. How has stress management training impacted your nursing experience? 2. Would you recommend stress management training to your colleagues? 3. How has the rate of critical ward mortality and morbidity of your assigned patients changed since you enrolled for the training? 4. How your job morale and absenteeism changed since you enrolled for the training? |
Educational materials
- Stress management educators
- IT specialist
- organizational social media sites
