Problem Statement: Quality Improvement Project: Does a Mindfulness-based Stress Reduction (MBSR) psycho-educational training program increase resiliency in bedside nurses to deal with burnout as evidenced by self-reported capacity to cope with negative workplace stressors and increased ability to perform self-care activities compared to nurses who are not given such an intervention.
Intervention: This proposed project involves using a Mindfulness-based Stress Reduction (MBSR) psycho-educational training program aimed at increasing individual resiliency and coping strategies to deal with stressors commonly associated with burnout with nurses on medical-surgical floors at the Veterans Affairs Hospital in Salt Lake City.
Theoretical Model: The Neuman Systems Model (NSM), is a theoretical model based on Neuman’s theory, which has been in use by nurses since the 1970s, takes a holistic approach on the wellness of individuals, examining the causes of stress within the context of the wider environment within which the stress occurs. This includes considering the multiple ways in which stress can impact and individual; physiological, psychological, sociological, sociocultural, developmental, and cultural, all of which are interdependent and variable. NSM considers the way in which an individual reacts to stress due to factors that could make them vulnerable or resilient to stressors, for example their support group, or personal factors such as prior experience with stress. NSM provides a framework to organize findings on environmental and external stressors and the impact they have on an individual, while underlining the importance of recognizing the various inter, intra and extra personal factors that are also occurring in the wider system within which they are constantly interacting (Skalski, Digerolamo, & Gigliotti, 2006).
NSM works well within the 5 stages of the nursing process; assessment, diagnosis, planning, implementing, and evaluation making it a good fit for research into modern nursing practice. NSM was developed with the aim to help develop nursing interventions that could focus on relieving and reducing stress in clients’ or patients’ lives via interventions that sought to strengthen their lines of defense at the primary, secondary or tertiary level (Turner, & Kaylor, 2015). Lines of defense serve as buffers that protect the individual from stressors in their environment and are not fixed but rather fluid. Interventions aimed at strengthening resiliency in the face of stressors is aimed at these lines of defense. Primary interventions involve the identification of stressors and prevention of their occurrence, which requires awareness of stressors within the environment. Secondary interventions involve helping the client to work on their own resiliency to prevent the stressor from becoming problematic. Tertiary interventions involve addressing the stressor after it has already caused stress and helping the client to reframe the problem and build their lines of defense and work on resilience to cope with the stressor in a more productive manner.
Population: Nurses on medical-surgical Floors at the Veterans Affairs Hospital Salt Lake City who are willing participants and able to commit to the time needed to complete the necessary components of the MBSR intervention. All levels of experience and full and part time employees will be invited to join the project.
Methodology: The cohort will be evaluated using pre- and post-intervention self-administered surveys consisting of adapted versions of the Maslach Burnout Inventory (MBI), the Compassion Fatigue Short Scale (CFSS), and The Resiliency Scale (RS). RS has been shown to demonstrate validity in terms of measuring resilience, self-esteem and self-efficacy and negative correlation between high resiliency scores and experiences of PTSD (van der Meer, Brake, van der Aa, Dashtgard, Bakker, & Olff 2018). These will ascertain what the level of burnout, risk for compassion fatigue the nurses face, their intent to leave, as well as their baseline level of resiliency. Data from Human Resources will provide information as to the level of staff turnover in the past three years on the medical-surgical floors at the VA, where the nurses work. The nurses will then be given the opportunity to participate in a 4 lesson Mindfulness Based Stress Reduction (MBSR) program aimed at increasing their resiliency and self-care abilities. Koen, van Eden & Wissing (2011) state that “resilient individuals have the potential not only to return to previous levels of functioning after experiencing adversity, but manifest gains in self-esteem, self-efficacy, autonomy and a change in life perspective that serve to make them stronger than they were before”. Activities from the learning interventions will provide qualitative data for the project. The Intervention will be a combination of take-home assignments as well as short classroom-based format with support via text and email, it will take approximately 4-6 hours to complete. They will be given post-surveys after the intervention is completed to determine the usefulness of the intervention. The surveys will be administered at the VA to nurses before and after shifts, per the RN's convenience in September, the intervention will begin in October and post surveys will be administered in November.
Results: The data will be collated and anonymity will be maintained as the RNs will be assigned an identification number. The data will be quantitative, from the surveys, and qualitative, from the classroom based activities, and will be analyzed using descriptive statistics and logistic regression modelling for data gathered via Likert scales. Data on absenteeism, turnover and staffing levels for the units will be gathered via HR and not linked to individual nurses. The information will be considered in light of the Neuman Systems Model of nursing burnout, examining the individual nurses’ relationships with stress and their reactions to it as a dynamic and flexible situation, rather than a discrete and concrete concept. Previous work with MBSR has normally involved a longer intervention of 8 weeks and has taken place in the corporate sector (Bazarko, Cate, Azocar, & Kreitzer, 2013), however given the financial pressures facing the VA, a publicly funded health system, if a streamlined 4 hour intervention yields success, it is more likely to be considered for adoption by managers who are under pressure to produce outcomes with reduced input. This project aims to highlight the experience of burnout of nurses within this setting as well as offer a potential and reproducible solution.