Introduction
High burnout rates are detrimental for the United States healthcare system, causing major losses in both finances and lives. The most suitable approach to their reduction can play a critical part in uplifting the quality of care to the desired standards, especially considering the current increase in pressure on nursing personnel. Whether or not a team-based approach is more suitable for burnout reduction, this issue poses a looming threat to the integrity of society.
Purpose
This evidence-based project will present the data that aims to evaluate the efficiency of team-based anti-stress therapy sessions and compare it with standard self-care practices in a hospital setting.
Relevance
Burnout rates among nursing personnel across the healthcare settings do not only cause higher expenditures but also the loss of life. High levels of stress among healthcare workers are the reason for a significant reduction in the quality of provided care (De Oliveira et al., 2019). Approximately 74% of all nurses in the United States exhibit symptoms of chronic stress stemming from burnout (Thomas et al., 2019). With the COVID-19 pandemic, this issue has grown into a life-threatening crisis, as isolation and depersonalization became even more apparent. Nonetheless, the selection of solutions varies greatly from one organization to another, while their efficiency is rarely taken into account.
The focus during such a selection must lie on the resolution of the majority of issues. The most common reasons for burnout in hospital nurses are the fear of loss of patients, unappreciation for performed work, and the loss of personal life/work balance (Thomas et al., 2019). These factors tend to cause mental health issues, such as low self-esteem, the rise of cynicism, depression, and anxiety, among others (Thomas et al., 2019). Many studies regarding the impact of each type of intervention reveal the positive effects of both individual and organizational solutions to the issue (Aryankhesal et al., 2019). However, these discussions rarely compare the differences in the outcomes for each approach in an attempt to promote either type or synthesize a hybrid approach to achieve the highest efficiency.
At the same time, such a comparison might bring up critical differences that could make benefits more apparent and develop new functions for organization-level stress-related policies. Group therapy sessions enable organizations to adjust strategies on the fly by introducing new measures, such as appreciation events or assistance from a psychiatrist (DeCaporale-Ryan et al., 2020). It is also vital to consider the secondary effects of both self-care and team-based approaches and their indirect impact on stress levels. Aryankhesal et al. (2019) state that “training and improving communication skills” are considered to be the most efficient ways to reduce burnout rates (p. 7). Lighter workload, which is one of the individual-oriented solutions to stress-related issues, does not resolve disengagement from organizational goals (Montgomery et al., 2019). Self-care might be less optimal, as some individual coping strategies can be deemed inefficient without proper training.
Group therapy sessions give coping strategies a different role in a hospital setting. The emotional struggles of each team are unique to their facility and unit, making such sessions especially efficient in resolving stress from the lack of understanding (DeCaporale-Ryan et al., 2020). Instead of merely growing personal resilience to the environmental factors that induce stress, workers can change their work environment to become less pressuring.
Potential Outcomes
Team-based solutions might present just the right approach that also has a multitude of benefits aside from stress reduction. There are two distinct outcomes that are expected to occur with the widespread implementation of team-based therapy sessions aimed to reduce stress. By accepting a team-based approach as a default solution for high burnout rates, organizations can assist groups of employees through empathetic and reassuring discussions that will cover the most common reasons for burnout. Their lift people’s moods and give them an outlet for expression that is otherwise might be misunderstood by others, thus increasing nurses’ overall well-being (De Oliveira et al., 2019). In the long term, this approach has the potential to integrate social support generated during the therapeutic sessions into a workplace environment, boosting teamwork and improving attitudes towards cooperation. Therefore, group sessions can decrease turnover rates not only for the teams that visit them but for all staff members.
This format of communal training gives employees a chance to build closer relationships. Thankful events, group psychiatric sessions, and regular meetings for sharing experiences provide an opportunity for work teams to bond with each other, improving their cooperation and mutual support at a workplace (Aryankhesal et al., 2019; Montgomery et al., 2019). There is evidence that such an approach increases interoperability among teams within the same hospital, stemming from a less competitive and more friendly work environment (Montgomery et al., 2019). Loneliness, which is one of the primary outcomes of the busy hospital units, such as acute care, can be completely negated by a supportive team.
Clinical Question
In hospital nursing personnel, what is the effectiveness of group therapy sessions compared with self-care practices, such as meditation and schedule self-management, on the burnout rates reduction?
Review of Literature and Synthesis of Evidence
The PICO question ” in hospital nursing personnel, what is the effectiveness of group therapy sessions compared with self-care practices, such as meditation and schedule self-management, on the burnout rates reduction?” was reviewed with the help of several peer-reviewed articles found through online databases. Keywords that led to the articles used in this paper were “burnout self-care,” “burnout interventions comparison,” “burnout prevention strategies,” “stress coping,” and “burnout team-based therapy.” The following databases were searched: ScienceDirect, PubMed Central, Wiley Online Library, Multidisciplinary Digital Publishing Institute, and APA PsycINFO. Additional criteria for the articles were peer-reviewed, posted in 2018 or earlier, written in English, with mandatory inclusion of the “nursing” keyword in all papers. Eight out of eleven relevant articles consisting of meta-analyses, scoping reviews, systematic reviews, and two case studies were selected to be utilized for this paper. Their levels of evidence were analyzed in accordance with Melnyk’s hierarchy of evidence (Melnyk & Fineout-Overholt, 2015). The majority of the articles present a review of the existing evidence, compiling the information from multiple sources.
Common Themes in Literature
The majority of the articles discussed the impact of nurses’ burnout on the quality of healthcare and presented a collection of common factors contributing to this phenomenon in a hospital setting. Some of the articles have focused on either self-care or organizational interventions that aim to alleviate the issue. However, many systematic reviews have taken into account both individual resilience training and group mindfulness sessions, although without their direct comparison.
Definition and impact of nurses’ burnout. The articles clearly outline the adverse effects of the decreased mental status of healthcare personnel. Several papers present data regarding the quality of care and its apparent decrease due to a high-stress work environment. Burnout in nurses can be summarized as a state of mental and physical exhaustion stemming from work-related conditions (De Oliveira et al., 2019; Sultana et al., 2020). Articles often describe how this impediment affects nurses’ workplaces, leading to adverse outcomes among patients (Aryankhesal et al., 2019; Barrientos-Trigo et al., 2018 ; Sultana et al., 2020). The reduction of this impact is the primary objective for intended interventions.
Primary psychological stressors in hospitals. The factors that are essential to alleviate in order to improve nurses’ working conditions are commonly in the focus. The key sources of stress are identified as the following: depersonalization, accomplishments perceived as unsatisfactory, emotional exhaustion, high demand of positive outcomes, low control over job tasks, insecurity of career, and irregular work hours (De Oliveira et al., 2019; Gray et al., 2019; Thomas et al., 2019). Many interventions focus on either one or several stress factors by utilizing various wellness techniques from psychology (Prudenzi et al., 2021; Thomas et al., 2019).
Group-based stress reduction interventions. The application of organization-wide interventions is a primary topic for the two case studies that are selected for the paper, as well as the discussed option in reviews. Group therapy is defined as an intervention that focuses on teams from the same setting and have shared work-related stress sources (Montgomery et al., 2019; Prudenzi et al., 2021; Sultana et al., 2020). Several articles focus specifically on this topic to present a valid point for changes in the role a healthcare facility in the wellbeing of its employees (Montgomery et al., 2019; Prudenzi et al.).
The role of self-care in burnout prevention. The topic of self-care is widely covered within the presented articles, giving a clear picture of how healthcare personnel can benefit from such techniques (Barrientos-Trigo et al., 2018; De Oliveira et al., 2019). Articles do present evidence that nurses can build individual resilience without any external support. Such papers suggest that these interventions increase the feeling of control in employees (Barrientos-Trigo et al., 2018; Gray et al., 2019). Nonetheless, focusing on a single individual may be disruptive for an organization.
Identified Gaps in Knowledge
The following gaps were identified: the lack of comparison between anti-stress methods, no standardized measure for different approaches, and no clear statements regarding the necessary changes in an organizational culture. Despite presenting an overwhelming amount of data regarding the usefulness of each technique, many studies did not get deep into the comparison of different interventions. As a result, there are implications for the necessity of further research on this topic. There are different scales for measuring burnout rates, which are not compatible with each other, requiring further development of a standard method for burnout measurement.
Strategies presented in the articles are not equally represented in the sample healthcare facilities, implying the need to observe the outcomes on a larger scale. The impact of each method on the organizational culture is not clearly outlined, which may present a critical factor in the decision-making process for each hospital. There are disputes regarding the most suitable approach, as many authors mention that there are factors that prevent the generalization of their findings (Barrientos-Trigo et al., 2018; Gray et al., 2019). Additional trial interventions may assist with resolving these gaps, and systematic reviews that put self-care and communal therapy up for comparison would assist with achieving the highest level of evidence regarding the topic.
Findings
The majority of the articles have determined that most, if not all, types of stress reduction interventions successfully decrease stress in nurses. Moreover, they reveal the inconsistencies in the outcomes for each type of anti-stress approach, making their insight highly valuable for resolving the issue presented in this paper. It is clearly outlined within the papers that there are significant improvements to both stress levels and organizational cohesion that followed the implementation of group-based therapies. Their basis can be utilized as the foundation for the PICO question.
PICO Question: in hospital nursing personnel, what is the effectiveness of group therapy sessions compared with self-care practices, such as meditation and schedule self-management, on the burnout rates reduction?
Keywords: burnout self-care, burnout team-based therapy, stress coping, burnout prevention strategies, burnout interventions comparison.
Databases Searched: ScienceDirect, PubMed Central, APA PsycINFO, Wiley Online Library, Multidisciplinary Digital Publishing Institute.
Table 1: Summary of Reviewed Evidence
Plan for Implementation
Alas, the current situation at the Advocate Christ Hospital puts its nursing personnel under a high amount of stress, leading to high turnover rates and rampant absenteeism cases. With no burnout prevention strategies in place, this intervention will benefit the hospital despite whether group therapy sessions will be more beneficial or not. Both individual and group therapy will be attempted as a possible mediator for the chronic stress among the local nursing personnel that currently consists of 32 nurses.
Implementation of this project is expected to take a significant amount of time since the reduction of stress levels is not a rapid process. Moreover, nurses will yet remain in a highly stressful work environment that negates a portion of the progress due to the circumstances out of their control. At the core of the successful realization of this project lies the Promoting Action on Implementation Research in Health Services (PARIHS) framework. This concept presents the idea that three primary elements are responsible for a project’s future: evidence, context, and facilitation (Harvey & Kitson, 2020). These parts rely on the proper assessment of involved variables. They include the involved individuals (nurses) and their receptiveness for changes, the support for a project from the facility managerial staff, and the strength of the presented evidence that addresses the need for intervention (Harvey & Kitson, 2020). The specifics of the work environment in the Advocate Christ Hospital must be taken into consideration, especially due to the lack of proper anti-stress practices at this moment. Facilitation will depend severely on the input from both nurses and hospital administration.
Stakeholders
The active stakeholders in the implementation of this project are the nurses of the Advocate Christ Hospital. However, the managerial personnel who will be set onto analyzing and determining the best outcome, as well as working on implementing meaningful changes in the nurses’ anti-stress practices, will count as passive stakeholders. The finance department and the human resources department take a significant part in some of the project’s steps, making them passive stakeholders as well.
However, both departments must be presented with sufficient evidence for the project approval first. Aside from the hospital administration, there will be the need to convince nurses to cooperate with each other on the resolution of any disputes that might have arisen during their work that prevent their efficient communication. They will be notified regarding the implementation of this project after its initial approval, as there might be necessary adjustments depending on the resources that the hospital will be willing to provide. The ten charge nurses will be given the necessary explanation of the intervention’s details to convince them of the necessity of this project.
The hospital’s human resources (HR) department can gain a significant benefit from being introduced to the evidence and the outcomes of this program. In case of a successful intervention, group therapy sessions can become a new norm for future nurses who face similar challenges at the workplace, and the HR team can work on its further integration. Furthermore, the positive outcomes of this intervention would decrease turnover rates, giving the HR department more freedom in terms of nurse training programs.
Organizational Fit
This evidence-based project aims to assist the nursing personnel of the Advocate Christ Hospital with establishing the most efficient anti-stress policy. This project aligns perfectly with the mission of the hospital and the unit participating in it. The hospital’s goal is to satisfy the health needs of people, which does not exclude its own personnel from this statement (“Mission, values & philosophy,” n.d.). As the hospital values compassion and cooperation, this project will be a perfect addition to the facility’s policies. Healing is the focus of all the presented sources, which lie at the basis of the hospital’s philosophy (“Mission, values & philosophy,” n.d.). It will alleviate the burden of healthcare personnel and improve the quality of care, which is the final goal of this intervention. At this moment, there are no similar activities that have been performed within the facility. This notion has led many nurses to quit their jobs already, with many more struggling significantly with the high levels of stress.
Barriers to EBP Implementation
There are several barriers to the implementation of a new approach, which lie primarily in the work environment and the hospital’s organizational culture. Currently, there are no measures taken against burnout, leading to a wide array of issues within nursing teams. This notion may lead to an initial lack of confidence in the proposed measures, which need to be reassured via an educational course and promotional materials. Another barrier is the potential unwillingness of nurses to communicate with each other for a prolonged period. Since the Advocate Christ Hospital presents a highly stressful work environment, some nurses may be unwilling to participate in communal therapy and choose to partake in self-care instead. There will be the need to select nurses for each therapy at random to ensure more statistically meaningful results.
Facilitation Strategies for EBP Implementation
It will be critical to conduct measurements of the progress to link the evidence on both individual and group anti-stress techniques and adjust the strategy on the fly. The Maslach Burnout Inventory questionnaire, the Professional Quality of Life Scale questionnaire, and similar tools must be employed during the sessions for continuous assessment of stress levels among personnel (Suleiman-Martos et al., 2020). Practice change may require significant structural changes, as the current state of the hospital’s work environment leaves nursing personnel in a vulnerable state. Feedback from the participants shall be used by a psychotherapist involved in the process, as well as the HR team, to assess the need for adjustments in the nurses’ schedules.
Resources Needed
There will be the need to provide nurses with the necessary financial resources in order to conduct this intervention successfully. First of all, it is vital to provide a short course with a psychotherapist for training self-care techniques to the self-care group. Another part of the financial expenses is the space and educational resources for group therapy sessions. Meetings among nurses must be conducted within an environment that would promote friendly, assuring conversations and activities. The average length of such interventions takes approximately nine months to produce meaningful results, such as the reduced rates of chronic depression and emotional exhaustion (Aryankhesal et al., 2019). These meetings may be performed on-site, although there might be the need to rent a community space for nurses to feel less stressed by the environmental factors.
Another critical issue that needs to be resolved prior to the implementation of this project is the working hours of nursing personnel that need to be adjusted in order to fit the following intervention. In this hospital, there is a significant deficit of free time among nurses, as there is a constant shortage of personnel. For a team, the educational resources must be available for constant checking of the most successful practices. In order to secure these resources, initial proposals must present sufficient evidence at an appropriate scale for this hospital.
Table 2: Estimated Timetable Blueprint for Implementation
Plan for Evaluation
Evaluation of stress levels requires a complex approach that can cause additional confusion if not supported by evidence and performed with assistance from a qualified professional. In order to assess the impact of the proposed intervention, several tools are necessary for consideration. First of all, it is essential to select an appropriate stress measurement tool that will reflect all the specifics of common factors among nurses. For this part, there are several examples ready for examination from the studies regarding burnout, such as the Professional Quality of Life Scale (ProQoL) questionnaire and the Maslach Burnout Inventory (MBI) questionnaire (Suleiman-Martos et al., 2020; Sultana et al., 2020). These tools provide a clear overview of individual stress factors, as well as the overall stress level among the surveyed population.
Baseline Data
The current situation in the hospital must be assessed correctly prior to the intervention. By using the Maslach Burnout Inventory, nursing team leaders will collect the baseline data for burnout rates among nursing personnel. The second key parameter that reflects the nurses’ issues with attitude towards work that stem from overworking is compassion fatigue. The intended usage of ProQoL is explained by its unique and compact survey that can reveal an overall willingness of nurses to improve people’s lives (ProQOL, n.d.). The Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ) will be employed for the measurement of the last parameter to reveal how patients rate nurses’ attentiveness, support, and empathy (Karaca & Durna, 2019). These measurements need to be drawn to the unit’s average rating for further comparison.
Compliance Data
The collection of compliance data will be crucial for the accurate representation of the intervention’s outcomes. Nurses who perform self-care will be asked to collect and share their daily meditation routines, including time, frequency, and their selected method. Their logs will be collected by nursing team leaders and analyzed by a psychotherapist for further utilization in the program. The team leaders among nursing personnel who attend group therapy sessions will count the attendees. In case there are many cases of absenteeism among nurses who were selected to visit group therapy, it will be necessary to take proper measures against such behavior. Each incident of non-compliance must be analyzed for its severity, such as chronic absenteeism and background causes. Non-compliant nurses will be appointed for individual meetings with the off-site professional for additional explanations on the necessity and benefits of this intervention. In case of such an approach does not help, the HR department should be notified regarding the most severe non-compliance cases. There is a chance for the intervention to be undermined by such behavior, making it absolutely vital for unit staff to understand the reasons behind this project.
Interpretation of Data
To complete the study, merely reaching the lessened stress levels is not a sufficient goal. There is the need to compare data from both test groups to determine each method’s efficiency. The improvement in the quality of care shall be analyzed with the help of patient satisfaction scores that will be collected in accordance with the selected survey methods. The continuous analysis of the stress measurements in accordance with the MBI and ProQoL questionnaires should be utilized for making necessary adjustments to the intervention.
The following indicators will prove to be helpful in determining the answer to the presented PICO question: burnout rates, compassion fatigue, and patient satisfaction. They will reveal all the aspects of stressful factors that nurses experience in their workplaces. It is crucial to understand that compassion fatigue differs from burnout. The first factor represents the attitude of nurses towards their patients, while the second one shows how nursing personnel is dealing with stress. Patient satisfaction will be measured as well in order to compare the improvements in hospital performance stemming from the intervention. Judging from similar studies, the improvements are expected to be within the range of 20-33% of the baseline scores across the examined parameters (Suleiman-Martos et al., 2020). However, there is a process of value transfer between improvements in stress levels among nurses and their performance in their workplaces, which puts patient satisfaction in a lower position than stress reduction and compassion fatigue.
In the middle of the trial, there will be a set measurement of critical indicators that will be utilized for potential adjustments to the program to promote well-being among nurses in the most meaningful way. The baseline data will be compared with the results from questionnaires taken at this point and presented to the psychologist for further analysis. In the end, the measurements throughout the entire intervention period will be utilized to generate the results of the intervention and discuss their implications.
Table 3: EBP Evaluation Plan
Conclusions
In conclusion, this intervention can significantly improve the lives of nurses and the quality of provided care in the Advocate Christ Hospital. High burnout rates which are present in the studied facility pose a severe danger to both nurses and their patients. This intervention should be sufficient in determining which method will be more suitable for the hospital. The necessary proposals should be made based on the outcome data analysis conducted by the professional and confirmed by the evidence that will be presented to the hospital administration. Evidence from the articles suggests that there are significant differences in outcomes between group therapy sessions and self-care mindfulness techniques. However, there is a distinct lack of comparison between all available methods, making it troublesome for healthcare facilities to select the most suitable one.
Recommendations/Implications
With absolutely zero anti-stress measures in place, the Advocate Christ Hospital, the situation is expected to improve immensely independent of the outcome of the study. However, the result of this intervention can provide a hint on how to achieve lower stress levels in the most efficient way. There are obstacles in the implementation of said measures that can partially negate the impact of the project. It will be essential to consider how evidence regarding the subject reveals the lack of generalization and tailor this approach to the needs of the unit’s nurses. Moreover, the current state of discord among nursing personnel may lead to low attendance rates. Nonetheless, it is highly recommended for the facility in question to put the nurses who show signs of stress into the program.
High levels of stress are a constant reminder to all hospitals on how challenging such a workplace can be. Evidence from this project can alleviate many stress factors that cause high turnover rates and cost significant expenses to the United States’ healthcare system. There is a clear need for strategy adjustment, as workplace conditions affect nursing personnel with severity unmatched in the majority of other professions. Additional peer-reviewed studies regarding the best burnout prevention approach are critical for the steady development of healthcare facilities.
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