Nursing Stress Reduction: Evidence-Based Project

Introduction

The potential project will address the issue of stress reduction among nurses. Stress is acknowledged as an inevitable component of nursing practice. However, it is a negative factor that can disrupt nurses’ work, affect their health, and ultimately damage the quality of provided health care overall. That is why there is a need for identifying and recommending on the institutional level some practices that help cope with stress more effectively. One of such practices is mindfulness-based stress reduction (MBSR) (Bazarko, Cate, Azocar, & Kreitzer, 2013; Botha, Gwin, & Purpora, 2015; Smith, 2014). Research shows that MBSR helps reduce the perceived level of stress. Below, the issue is addressed from the PICOT perspective for the purpose of properly planning the potential project.

Problem Statement

Stress can evoke negative outcomes for both nurses and patients. Studies show that work-related stress is associated with altered physical and psychological health, increased ailment, absence from work, poor job performance, decreased job satisfaction, and increased turnover (Bazarko et al., 2013; Botha et al., 2015; Smith, 2014). All these factors contribute to the worsening of the quality of patient care and, ultimately, to the lowering of the quality of health care overall in given communities. Researchers acknowledge that stress is an inevitable component of providing nursing care, which is why stress itself is not the problem of interest. Rather, there is a growing recognition of the necessity to overcome and relieve stress successfully. This recognition is associated with the debate on effectiveness and ineffectiveness of coping (Smith, 2014). Within recent decades, scholars and health care providers have been exploring effective coping strategies, one of which is MBSR.

PICOT Question

Can mindfulness-based stress reduction meditation significantly reduce perceived work-related stress in the oncology nurse residency program?

Population of Interest

The population of interest is new oncology nurses with less than three years in the nurse residency program. The choice is justified by two major considerations. First, health care provision in the sphere of oncology is particularly associated with stress-inducing factors, such as dealing with patients who are in pain, encountering terminal cases, and facing more deaths than averagely in nursing practice. All this makes oncology nurses eligible for stress-related studies. Second, new nurses are chosen because they presumably have not yet developed strong coping strategies. Strong existing coping strategies would make examining the effectiveness of particular stress reduction methods more complicated because the intervention would be obstructed.

Intervention(s) of Interest

The intervention of interest is mindfulness-based stress reduction (MBSR) meditation. Studies have shown that MBSR practices can be regarded in the context of effective coping with work-related stress (Bazarko et al., 2013; Botha et al., 2015; Smith, 2014). According to Smith (2014), MBSR is beneficial for health care providers in terms of increasing concentration on work, empathy with patients and each other, and improving their mood. Also, such indicators as levels of anxiety and burnout are decreased as a result of MBSR. The reason for these positive outcomes is more effective coping with stress.

Similar results were obtained by Bazarko et al. (2013), who applied innovative MBSR techniques, such as telephonic sessions. Among participants of the study, the effect of the group telephonic sessions was established to be the improvement in general health, decreased stress, and decreased work burnout. Particular advantages of this intervention that the authors stress are low cost and availability.

Another relevant study was conducted by Botha et al. (2105), as they addressed the issue of measuring perceived stress in the context of stress reduction through mindfulness-based programs. In their study among registered nurses, the authors observed lower levels of perceived stress in those participants who practiced mindfulness meditation.

These examples from academic literature demonstrate the relevance of regarding MBSR interventions for studies of work-related stress in nurses. There are various forms of these interventions, but their common fundamental feature is that a recipient of an intervention should relax through clearing his or her mind and concentrating on organoleptic experiences in a given moment, such as sounds or smells.

Comparison of Interest

For comparison purposes, the standard nurse residency program will be considered. It does not imply the presence of MBSR practices and generally does not incorporate any solid measures toward encouraging nurses’ coping strategies and efforts. In order to estimate the effect of MBSR intervention on perceived work-related stress, which is the issue of interest (see PICOT Question), it is necessary to compare the results of measuring perceived stress among the recipients of intervention to the results of those who do not practice MBSR. The comparison will allow exposing the benefits of mindfulness meditation and strengthening the recommendation for nurses and residency programs to employ it.

Outcome(s) of Interest

The expected outcome of the intervention is reduced perceived work-related stress. The notion of reduced perceived work-related stress will be used for brevity; however, for clarity purposes, it should be noted that the expected positive result is not as much that participating nurses think that they face less stress as that they encounter less adverse consequences of stress accumulation, such as unresolved anxiety, depressive moods, concentration problems, and irritation. The perceived stress level will be measured through a survey. Questionnaires will encompass a certain amount of data sufficient for a quantitative examination of perceived stress (Bazarko et al., 2013). The measuring scales for this project have been employed in previous similar studies, their validity has been verified, and their use has been justified by scholars.

Timeframe

The timeframe for the potential project will be eight weeks. The same timeframe was adopted by Bazarko et al. (2013), as they found this period of time sufficient for applying the intervention and providing participants with some time to practice “on their own, outside of the instructor-led retreats and teleconferences” (p. 117). The proposed timeframe includes only the implementation stage, i.e. the planning and data analysis are excluded.

Project Planning

The planning stage of the project is important because its successful conduction will ensure proper data collection and analysis. The following sections will address various issues associated with planning, such as organizational support, feasibility and barriers, and resources.

Organizational Support

One of the purposes of the project is to observe the outcome of the intervention (MBSR meditation) for participating nurses under conditions that are close to those of real day-to-day practice. Therefore, it is preferable to try to refrain from disturbing the organizational process of nurses’ work while implementing the project. However, some assistance from the staff will be needed. Particularly, the DNP nurse practitioner and nursing professional development specialist will be involved in the project. In their positions, they are entitled to address various aspects of nurses’ work, including dealing with stress, stress-inducing factors, and consequences of stress accumulation, as these aspects are integral parts of nursing practice and major contributors to professional development, although often overlooked by formal organizational policies.

Project Feasibility

A major barrier recognized in this project is the introduction of verified mindfulness practices. It has been emphasized by researchers that MBSR meditation can be challenging to some to master within a short period of time (Bazarko et al., 2013; Smith, 2014). If meditation is not practiced by participating nurses as it is supposed to be practiced, the validity of results will be questionable. Therefore, it is necessary to ensure that the instructions on how the interventions are to be performed should be clearly and comprehensively communicated to the recipients. Apart from this, with the cooperation of the staff in the form of organizational support, the project appears feasible, which is confirmed by previously described studies (see Intervention of Interest) conducted within similar timeframes.

Resources Needed

The potential project will require assistance from authorized staff members (see Organizational Support). Certain time will need to be spent on instructing participants on the nature of the proposed intervention, i.e. explaining how MBSR meditation is to be practiced. Also, for the data collection stage, questionnaires are to be designed, printed, and distributed, which will require certain monetary funds. Finally, the participating nurses’ time and dedication are regarded to be a significant resource. Participants should be willing to spend some time outside of their work to contribute to the project. To achieve this and guarantee their commitment, it is necessary to communicate the purposes of the project correctly to the participants before the implementation phase starts. It should be emphasized for the nurses that their participation in the project does not only pursue theoretical value but also contributes to their own development as they learn about better ways to deal with work-related stress.

Evidence Summary

Evidence shows that MBSR meditation can decrease perceived stress. There are various components in this correlation, and certain indicators can be identified that are associated with work-related stress, its ineffective relieving, and its accumulation. For example, perceived consequences of poor coping with stress are depressive moods, irritation, decreased performance and absence, lack of concentration, anxiety, and adverse effects on general health, such as ailment or sleep disorders. Mindfulness meditation encompasses regular practices where the recipient of intervention relaxes, tries not to think about anything and not pass judgments, stops ruminating, and focuses on comprehending perceptions such as touch, sound, or smell. Studies described above show that such meditation practices help relieve a significant amount of stress, allowing the person to feel better and overcome the outcomes of stress more effectively. The evidence base is strong enough to highlight the necessity for change: more nurses should adopt MBSR techniques, and such techniques should be encouraged among registered nurses on the institutional level, i.e. be incorporated into residency programs.

Conclusion

A review of relevant academic literature confirms that MBSR techniques can contribute to lowering the level of perceived stress. The potential project, which is meant to be conducted among new oncology nurses, will help collect valuable data about the effectiveness of mindfulness meditation for stress reduction under the conditions of strong stress-inducing factors. Moreover, the project will provide nurses with a possibly unfamiliar tool for coping with stress. On a larger scale, the project will present evidence for the necessity to make a change in practice by introducing MBSR practices to nurses of different specializations for making their work less stressful and thus safer and more gratifying.

References

Bazarko, D., Cate, R. A., Azocar, F., & Kreitzer, M. J. (2013). The impact of an innovative mindfulness-based stress reduction program on the health and well-being of nurses employed in a corporate setting. Journal of Workplace Behavioral Health, 28(2), 107-133.

Botha, E., Gwin, T., & Purpora, C. (2015). The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(10), 21-29.

Smith, S. A. (2014). Mindfulness-based stress reduction: An intervention to enhance the effectiveness of nurses’ coping with work-related stress. International Journal of Nursing Knowledge, 25(2), 119-130.