Today, changes related to natural disasters or pandemics turn out to be critical issues for discussions around the globe. Many healthcare facilities try to get themselves prepared for changes and protect the staff, as well as patients. Safety in hospitals may gain a variety of forms, and one of them is the development of programs for nurses to deal with clinical stress, promote work satisfaction, and improve care quality offered to patients. In this paper, the problem, background conditions, change intervention, and research methods will be introduced through the prism of a well-organized PICOT question.
In addition to a variety of diseases and challenges, healthcare employees have to recognize threats that are rooted in the environment. Modern people may be exposed to natural disasters and pandemics, and the Centers for Disease Control and Prevention (2019) recommend conducting surveillance, assessing health effects, and cooperating with affected populations. However, in addition to a number of patients who undergo personal, emotional, and financial changes, nurses and other medical employees are at risk of having serious problems (Cedar & Walker, 2020; Toner, 2017). Burnout, emotional and work stress, dissatisfaction, and high expectations of high morbidity/mortality patients influence nurses and determine the quality of their work (Trifiletti et al., 2017). Nurses are in need of interventions and programs to stabilize their health and predict complications, and attention should be paid to available options under the conditions of natural disasters and pandemics.
Need for Change
Nowadays, the coronavirus epidemic continues challenging the whole globe, and even the citizens of the most isolated countries could die because of pneumonia of poorly investigated origin. Mass critical care is an obligatory step for hospitals to take in order to provide thousands of patients with care (Rose et al., 2017). However, limited protected physical space, lack of knowledge about control and prevention, and workload provoke new difficulties (Qiu et al., 2020). Stress influences nurses’ health and determines the quality of care offered to patients at risk of mortality (Mo et al., 2020; Sarafis et al., 2016). Therefore, to predict complications among patients and stabilize a safe working environment, nurses should change the style of work and learn how to protect themselves against outside threats like pandemics and unpredictable patient behaviors.
The purpose of the proposed DNP project is to investigate a mindfulness meditation program as an opportunity to reduce work stress levels among nurses who work with high mortality/morbidity patients. Compared to similar projects where nurse burnout is investigated, this work focuses on specific conditions when populations are challenged by the outcomes of pandemics. It is not enough to prove the importance of intervention but to explain its implementation and evaluation details in a specific practicum site.
Among nurses who care for high morbidity/mortality patients during periods of pandemics (P), would a mindfulness meditation program (I) compared to no intervention (C) reduce the level of work stress (O) in two months (T)?
To develop a DNP project on the basis of the offered PICOT question, the choice of participants plays an important role. It is expected to cooperate with a local hospital and offer them a meditation program to be implemented as a part of a nursing working day. To achieve success, communication with a hospital administrator is obligatory to identify available opportunities. Twenty nurses will be invited to participate in intervention after they sign informed consent approved by the appropriate research ethics committee. Inclusion criteria are work with high morbidity/mortality patients, a pandemic being locally identified (coronavirus), and the use of English as a speaking language. Excluding criteria are vacation/sick leaves and the presence of diseases among nurses. In other words, this project requires cooperation with healthy English-speaking nurses who take care of patients at a high risk of mortality during a pandemic.
The EBP intervention that is recommended to implement is a mindfulness meditation program for nurses who have to work with high-risk patients. This practice has already been implemented in many facilities where nurses who work under specific conditions (Gilmartin et al., 2017; Orellana-Rios et al., 2018; Penque, 2019; Stanulewicz et al., 2020). A team of nurses is introduced to a consciousness discipline that lasts two hours (three times per week) when people are able to pay enough attention to their lives. Gilmartin et al. (2017) and van der Riet et al. (2018) discuss the mindfulness-based stress reduction model and the description of physical tasks. This intervention is taught by the same instructor and includes 30 minutes of sitting activities (focus and awareness mindfulness), 30 minutes of physical activities (breathing, body scan, and walking), 30 minutes of mindful stretching, and 30 minutes of simple watching.
Feasibility of the Project and Barriers
The feasibility of this project within 16 weeks is possible in case the required number of participants (at least 20 nurses) are found and approved. Two weeks are used for preparations, about ten weeks (2-3 months) are spent on the intervention itself, and two weeks are for the analysis of the results. In addition, two weeks can be used for some unpredictable purposes to cooperate with participants or search for some information. The main barrier in this intervention is the unwillingness of nurses to participate in the intervention due to the nature of their work and the unpredictable impact of a pandemic. To overcome these problems, the development of communication skills and the use of informative flyers with recommendations and preventive measures are encouraged.
To measure the impact of this intervention, work stress levels among nurses have to be identified before and after the procedure. The Expanded Nursing Stress Scale (ENSS), the Health Survey SF-12, and a self-administrated survey (to gather personal information) are the instruments for consideration (Sarafis et al., 2016). A five-point Likert scale in the ENSS identifies the measurable outcomes in work with patients, cooperation with employees, emotional needs, peer-related problems, and conflicts with leaders. This test is characterized by high validity and reliability because the same intervention and the same symptoms will be used among different people working under the same conditions (correlation coefficient is about 0.8). SF-12 includes 12 questions about physical functioning, limitations, and general health perceptions. It identifies emotional problems and behavioral changes among participants. Its reliability and validity are high because the results are obtained from a small group of people with clearly identified problems and expected outcomes.
Descriptive statistics are used to analyze the information obtained from a self-administrated survey. A multiple linear regression analysis will be conducted to assess the results of the SF-12 test, and Pearson correlation analysis will be applied to the results of the ENSS test (Mo et al., 2020). The comparison between an experimental group and a control group is based on t-tests and ANOVA with SPSS (p<0.05 is proved to be statistically significant).
In general, this project proves the importance of mindfulness meditation programs for nurses who have to work with difficult patients under specific conditions. There is a threat of high levels of stress among the personnel, and the identification of psychological and physiological changes by means of tests should show if a program with meditation practices could help nurses improve their mental and physical health. It is expected to observed positive improvements after the implementation of the intervention within three months of work.
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