Abstract
Overall, this senior project aims to propose a method for reducing the incidence of nursing burnout, which has been linked to poor patient outcomes. What is more, the recommended intervention in the capstone project will improve the outcomes for the nurses. With the COVID pandemic on the rise, it is more important than ever to deal with the negative impacts of nurse burnout on patient care. In light of this, it is recommended that MBSR (Mindfulness-Based Stress Reduction) be included in each shift in the intensive care unit. Consistent with these objectives are increasing nurse satisfaction, decreasing burnout, and improving patient care. Reducing nurse burnout lowers the costs associated with readmissions and prescription errors. Because of how detrimental burnout is to nurses’ mental and physical health, action is required. As a result of burnout, nurses may experience decreased job satisfaction, increased turnover, and poor treatment of patients. Reduced nurse burnout and improved quality of care for patients are the two most important results of this capstone project. The purpose of this study is to provide a three-month mindfulness-based curriculum to hospital nurses working in critical care units. Specifically, the researchers want to learn how ICU nurses respond to mindfulness training regarding stress, self-care, and burnout.
Organizational Changes
A mindfulness-based stress reduction (MBSR) program is offered as an organizational reform. One of the objectives of this study is to increase nurse satisfaction by lowering burnout rates with Mindfulness-Based Stress Reduction (MBSR). In addition to improving patient happiness, efficiency, and safety, the intervention will decrease nurse burnout.
Introduction
High rates of burnout and stress among healthcare workers, particularly nurses, result from the demands of the industry and the nature of their jobs. Nurses have had and continue to deal with fewer resources, fewer personnel, more complex patient needs, and a general sense of helplessness. Due to these expanding pressures, nurses are more likely to experience burnout, ineffective coping, reduced job satisfaction, increased error rates with worse patient outcomes, and greater turnover rates. Learning to manage the stress and burnout of the nursing profession is just as vital as learning to manage patients. The detrimental effects of burnout and chronic stress on patient safety and satisfaction have been related to cognitive processing and problem-solving impairments. There is an increased emotional toll for nurses who work in high-stress settings because of the very nature of such settings. Compared to their less demanding-setting counterparts, nurses who work in psychiatry, critical care, or the emergency department are more likely to feel burnout and stress.
The COVID-19 epidemic has made preexisting issues like exhaustion, discontentment, and quitting more widespread. Direct and vicarious trauma from violence, traumatic patient events, and ICU congestion contribute to the emergency medicine faced by registered nurses working in the ICU. Nurses whose mental health suffers due to these demands at work may have problems providing the highest quality and safest care to their patients, despite their best intentions. Hospitals and other healthcare facilities have implemented several policies and programs to alleviate the extra pressures that nurses in high-stress environments, such as critical care units, face. There is an issue since no measures have been taken to aid people in dealing with mental oppression. Evidence suggests that nurses experiencing burnout and stress at work may benefit from Mindfulness training. Mindfulness-based programs have been shown to help healthcare professionals by decreasing burnout, stress, and a lack of self-care.
Problem Statement (PICOT)
Nursing burnout is a serious issue since it negatively impacts nurses and patients (Aryankhesal et al., 2019). Many hospitals and clinics have been forced to run at maximum capacity due to the inflow of COVID-19 epidemic patients. As a result, nurses are increasingly working harder (Sulosaari, Unal, & Cinar, 2022). The fact that there was already a nursing shortage in the United States before the outbreak has worsened the issue. There need to be more nurses to go around, so those who work long hours have many patients to take care of (Alhawatmeh et al., 2022). Because of their increasing workload, nurses are more prone to get stressed and burn out. Nurse burnout and stress should be a concern for the healthcare institution as they may impact patient care. This negatively affects nurses and might be a factor in the high turnover rates (Sulosaari, Unal, & Cinar, 2022). Therefore, it is crucial to develop effective methods for preventing and managing nursing stress and burnout (McNulty, LaMonica-Way & Senneff, 2022). During the COVID-19 period, there have been more allegations of burnout among nursing personnel, which has harmed both nurses and patients.
Need Statement
Because of the demands of their profession and the challenging environments in which they must work, nurses are particularly prone to burnout and stress (Alhawatmeh et al., 2022). The risk of burnout for intensive care unit nurses is increased by traumatic events, unexpected shifts, staff hostility, and, most recently, the COVID-19 requirements (Alhawatmeh et al., 2022). So that they may continue to provide outstanding care to their patients in the long run, nurses must learn how to manage their stress at work. To reduce their levels of work burnout, nurses may learn to incorporate mindfulness into their daily routines (Sulosaari, Unal, & Cinar, 2022). Because it may lessen burnout, mindfulness training has been the focus of many studies. One may develop a state of mindfulness by paying attention to their internal and external sensations in the present now without passing judgment on them (Garmaise-Yee & LeBlanc, 2022). Mindfulness-based therapies’ stress-relieving and awareness-raising benefits have helped the general populace and specific groups, such as healthcare professionals.
PICOT Question
For the ICU nursing team (P), how effective are MBSR programs (I) in comparison with self-care, resilience, and stress reduction training programs (C) in lessening nursing burnout (O) for three months?
Population-ICU nursing team
Intervention- MBSR program
Comparison- self-care, resilience, and stress reduction training programs
Outcomes- lessening nursing burnout (O)
Time- three month
Population and Setting
The intended audience for this campaign is ICU nurses (Sulosaari, Unal, & Cinar, 2022). The major problems related to nursing burnout are why this issue is being explored. For nurses, burnout is physically and emotionally draining (Garmaise-Yee & LeBlanc, 2022). The paper emphasized MBSR programs to reduce self-reported burnout among critical care unit staff members (McNulty, LaMonica-Way & Senneff, 2022). The decision to focus on the critical care unit was made because of the extremely high strain that nurses in this area place on the institution.
Intervention overview
Implementing mindfulness-based stress reduction (MBSR) during shifts has been suggested as a viable technique to lessen nursing burnout (Alhawatmeh et al., 2022). Including them in quality improvement initiatives hopes to lower the burnout and stress that ICU nurses report experiencing (Celik & Klnç, 2022). Mindfulness meditation has been found to reduce stress among students studying for health-related professions (Zhang et al., 2020). Mindfulness meditation practice may help keep stress levels steady and maybe lower the rate at which stress builds up (Urso et al., 2022). Success in many facets of life, including health, pleasure, and productivity, depends on effective stress management. Regular mindfulness meditation has been demonstrated to aid stress management and lower burnout (Penque et al., 2019). As part of mindfulness training, learning new breathing methods may be beneficial for infusing awareness into daily living.
Mindfulness meditation classes like Mindfulness-Based Stress Reduction (MBSR) may assist nurses in managing their professions’ stressors, maintaining a happy and healthy staff, and enhancing patient outcomes by teaching them to be more present while doing their job in the clinic (Alhawatmeh et al., 2022). Mindfulness-Based Stress Reduction (MBSR) course emphasizes mindfulness practices’ psychological and physical benefits, including Hatha yoga and meditation (Penque et al., 2019). A full-day retreat and 2.5 hours of weekly instruction from 3 qualified instructors are both included in the 8-week MBSR course. Students often use what they learn in class to solve problems in the real world.
Comparison of Approaches
Classes on coping strategies, such as stress management and self-care, are among the alternative therapies (Garmaise-Yee & LeBlanc, 2022). Hospital administrators should carefully consider providing intensive resilience training to ICU personnel. The health sector’s hospital administrators may provide their registered nurses with in-person or online education on self-care, resilience, and the reduction of burnout (Alhawatmeh et al., 2022). This intervention will help nurses maintain attention and boost their mental acuity by reducing stress and anxiety. By encouraging nurses to be present, manage their emotions, and think positively, resilience training helps nurses deal with stress and avoid burnout (Mulianda et al., 2022). Exercises need a longer alternative intervention, but it is more typical of the population being studied.
Intended Results
If the hospital incorporates MBSR programs, the number of burnout complaints from ICU nurses may decrease (Urso et al., 2022). As a result, the quality of treatment provided to patients will increase. Reduced burnout will substantially impact patient care and hospital management effectiveness (Alhawatmeh et al., 2022). Lowering the number of nurses who suffer burnout would ease stress and worry since that number is increasing (Sulosaari, Unal, & Cinar, 2022). If this is done, the nurses’ physical and emotional health and the quality of patient care would all improve. The proposed framework may enhance the quality of healthcare provided in healthcare institutions (Mulianda et al., 2022). Organizational problems, including workplace relationships and business culture, have been linked to burnout.
Time Estimate
The implementation process is anticipated to take around 90 days (Sulosaari, Unal, & Cinar, 2022). A statistically meaningful sample of ICU nurses working in Minnesota hospitals will provide results in two weeks. Once the second month starts, the important performance indicators selected at the beginning of the first month will be examined. All nurses’ data will be assembled into Excel sheets, and the outcomes will be examined next month (Urso et al., 2022). Lack of nurse enthusiasm, restrictive government regulations, and a nursing staffing shortage are all potential barriers to the strategy’s adoption.
Multiprofessional Care to Enhance Quality and Safety
Working together across disciplines might improve patient outcomes and lessen the cost of readmissions (Sulosaari, Unal, & Cinar, 2022). The use of mindful meditation methods by nurses, particularly those in critical care, may help them cope with their jobs’ emotional and physical strain. As a result, nurses’ enhanced ability for cooperation and information exchange benefits interdisciplinary teams (Sulosaari, Unal, & Cinar, 2022).
Healthcare Policies that Affect the Methodology Used to Deal with the Determined Need
The Affordable Care Act is one program that has addressed the issue of the high prevalence of burnout among nurses (Nurse Journal Staff, 2020). According to the law, if the Affordable Care Act were to cover millions more people, the demand for medical care would skyrocket. Because of these factors, nurses are now in charge of more patients at once and must spend more time with each other than ever (Weissner, 2020). The number of patients needing treatment in critical care units has increased due to the Affordability Care Act, which has increased the need for nurses. The hospital established a distinct outpatient care center for those with less urgent medical requirements because of the Affordable Care Act (Weissner, 2020).
Literature Review
Alhawatmeh et al. (2022) sought to determine how frequent practice of mindfulness meditation changed nursing students’ trait mindfulness, perception of stress, serum cortisol, and serum C-reactive proteins (CRP). According to the research, practicing mindfulness meditation significantly decreased subjective stress and blood levels of the stress hormone cortisol. Even though the benefits were not statistically significant, mindfulness meditation reduced C-reactive protein and trait mindfulness. Nursing programs should consider using mindfulness meditation to help this at-risk population lower stress and strengthen their immune systems.
Aryankhesal et al. (2019) ‘s goal was to close certain information gaps regarding the outcomes of interventions intended to reduce burnout among hospital physicians and nurses. Medical staff can prevent burnout with the right assistance, which enhances patient care. Burnout may be lessened by enhancing collaboration, communication, participation activities, and psychological therapy (mindfulness, yoga, and meditation). The consequences of these therapies may eventually be advantageous to mental health. Burnout calls for a diverse approach to therapy due to its complexity.
A randomized controlled trial research by Elik & Klnç (2022) examined the effects of laughing yoga on nurses’ stress, burnout, and general well-being during the pandemic. Laughter yoga may improve people’s health and happiness while easing the tension caused by the pandemic and its aftereffects. Nursing professionals may enhance their quality of life while reducing stress and burnout by practicing laughter yoga. Laughter yoga is a great approach to increasing sentiments of happiness in one’s life while also reducing stress and weariness.
Garmaise-Yee & LeBlanc (2022) evaluated the impact of stress and mindfulness training among nursing students in this exploratory study. People’s stress levels generally decreased, albeit this was not statistically significant. Post-test mindfulness ratings substantially increased (p =.000) and persisted at an elevated level four weeks later (p =.012). Improvements in attentive awareness were correlated with significant decreases in stress.
Green and Kinchen (2021) conducted a critical examination of the literature to determine what is known about the benefits of mindfulness meditation on nurses’ stress and burnout, where there needs to be more evidence, and what routes we believe future research should go. The findings suggest that nurses reduce stress and avoid burnout by practicing mindfulness meditation. Nurses who use mindfulness-based treatments have discovered that they lower stress, improve all aspects of burnout, and increase compassion satisfaction and self-compassion. Since mindfulness meditation has been found to reduce stress and burnout by encouraging resilience, compassion, and emotional control and minimizing the negative consequences of self-judgment and excessive identification with an experience, nurses may benefit from it.
In their 2022 study, Kavurmaci & Bahcecioglu Turan looked at how yoga affected academic nurses’ perceptions of burnout and professional satisfaction. As an experimental design clinical trial, this investigation is being carried out. There was a statistically significant difference between the experimental and control groups on the post-test measures of overall satisfaction, extrinsic satisfaction, and personal success. Regular yoga practitioners among academic nurses report lesser burnout and increased job satisfaction.
McNulty, LaMonica-Way, and Senneff (2022) examined the results of adding mindfulness training to a nursing residency program. Using a pre/post design, this research evaluated the intervention and control nursing residency cohorts on burnout, stress, and mindfulness measures. The residency program’s first three months featured mindfulness training four times. At six months, participants in the intervention group had significantly greater mindfulness scores and reduced levels of stress and burnout. It is possible to integrate mindfulness training into an existing nursing residency program to make it easier for recently graduated nurses to transition to practice and avoid burnout.
A quasi-experimental one-group pre-posttest design was employed by Mulianda et al. in 2022. When BA, ME, and LKME were used, stress levels among respondents dropped from a mean of 16.66 to 14.76. Since the dependent t-p-value test was 0.000, it was established that there had been a statistically significant difference in stress levels between the two time periods under study (before and after the intervention) (p 0.05). A paired difference t-test revealed a 1.90 difference between the means (p 0.05). Nursing students in Indonesia are urged to employ BA, MEs, and LKME as stress-coping methods during the present COVID-19 outbreak.
Penque (2019) asserts that the stress that comes with working in the medical industry may be harming our medical professionals. Investigations are made on the effects of MBSR on work-related outcomes, such as burnout, overtime, job satisfaction, and mindfulness. Mindfulness-based programs also help nurses feel better about themselves, minimize burnout, avoid needless overtime, and increase happiness at work and home by teaching nurses coping mechanisms for dealing with clinical stress.
By selecting appropriate treatments and gauging their effects, Sulosaari, Unal, and Cinar (2022) evaluated the effect of mindfulness-based therapies on nurses’ mental health. Their settings and work expectations may be detrimental to nurses’ mental health. The mental health of nurses may be improved through mindfulness-based treatment. The use of mindfulness-based treatments may enhance the health of nurses. RCTs are required in order to evaluate the effectiveness of mindfulness training. These studies must have strict designs, constant endpoints, and larger sample sizes.
Modeling Interventions
Primary Elements of the Intervention
The program known as Mindfulness-Based Stress Reduction (MBSR) is substantially included in the therapeutic approach (Sofia Di Mario et al., 2023). Nurses may benefit from mindfulness meditation and related techniques to prevent burnout. MBTs (mindfulness-based interventions) have effectively been shown to decrease burnout in PHCCs in experimental settings. Being mindful is consciously focusing on the now and refraining from passing judgment (Nassim et al., 2021). In MBI, people are taught to pay more attention to daily life via meditation and other mindfulness techniques.
As a consequence, people develop more emotional stability and self-confidence. It has been shown that self-awareness in the therapeutic context benefits both doctors’ and their patients’ health (Witarto et al., 2022). According to research, MBIs help PHCCs by enhancing their feeling of competence and self-worth and decreasing their levels of emotional exhaustion and depersonalization. MBI has been demonstrated to improve doctor-patient relationships, which are crucial for enhancing health outcomes.
MBIs are designed to improve PHCPs’ self-awareness and ability to cope with stress and unpleasant feelings at work (Bhattacharya & Hofmann, 2023). Since mindfulness training improves one’s ability for self-awareness, empathy, and happiness, it is crucial for primary healthcare professionals (Sofia Di Mario et al., 2023). Additionally, because emotional weariness (a core component of burnout) is linked to suicidal ideation in this group of healthcare workers, mindfulness training may help prevent and limit suicidal ideation among primary care doctors (Molero et al., 2020). MBIs in PHCCs are anticipated to have other positive effects, including more professionalism and empathy toward patients and coworkers, reduced stress levels, improved self-care habits, increased emotional, mental, and social stability, and overall better health.
The intervention works as intended when utilized as intended. Because of their workplace, ICU nurses are under continual strain. There are various approaches to increasing the efficacy of nurses (Nassim et al., 2021). Meditation improves nurses’ present-moment awareness, emotional control, and constructive thought patterns, which helps them deal with stress and avoid burnout.
By implementing the plan, the service providers can perfect every element of the intervention, increasing the likelihood that nurse burnout will be reduced and other health outcomes will improve (Molero et al., 2020). The hospital can determine whether or not the strategy’s adoption has increased nurse and patient well-being. This technique, which seeks to improve patient-centered care and health outcomes, depends on improvements in nurse-patient communication (Wasson, Barratt, & O’Brien, 2020). The intervention is the greatest choice for addressing the problem of nursing exhaustion and enhancing health outcomes since it will lessen burnout, can be evaluated by comparing pre-and post-implementation results, and enhances patient and population-centered care.
Impact of Cultural Needs on the Intervention
The qualifications of the nurses and the resources available at the hospital where they work will impact the outcome of this intervention. Researchers are looking for nurses with various experiences and viewpoints to participate in this study. Many different types of nurses work in medical facilities. There are several ethnic groups, including Muslims, Latinos, Hispanics, Whites, and Blacks (Voskuil, 2021). The majority of the sample’s participants are female. Patients at the hospital may come from various ethnic backgrounds, each with its dialect, customs, and traditions. Therefore, medical institutions need staff who are sensitive to diverse cultures. You need to be sensitive and knowledgeable to provide patients from all walks of life with great treatment.
This helps nurses get influenced by their cultural identities (Sofia Di Mario et al., 2023). The origins of the nurses’ cultures must be considered while creating an intervention strategy. The intervention’s design must take these demands into account. For instance, nurses should be assigned patients based on their skill sets and cultural preferences. One or two nurses could feel morally conflicted about a certain procedure (Voskuil, 2021). The senior management needs to maintain this. If people’s needs are satisfied with the care, their happiness, nurses’ effectiveness, and general well-being may all enhance. Nurses should only be assigned intervention-related duties with previous experience and training (Schmiedhofer et al., 2021). If these actions were taken, nurses would be happier and more productive at work. The fundamental premise is that by putting these measures in place, nurses’ decision-making will advance, nurses’ faith in the hospital will rise, and there will be a reduction in the number of burned-out nurses.
The needs and cultural traits unique to intensive care units (ICUs) vary from those of other hospital departments. These clinics may provide ongoing treatment to certain individuals with acute medical needs and chronic diseases. The burden for the nursing staff may rise due to ongoing patient care (Schmiedhofer et al., 2021). Emphasis is placed on a method for applying mindfulness-based stress reduction (MBSR).
Analyzing Theoretical Methods
The Conservation of Resource Theory is used to study the impact of burnout on nurses (Wu & Lee, 2020). Per scientific theory, burnout happens when people face a constant load at work. Energy, things, circumstances, and character qualities are the categories into which the study separates the resources (Wu & Lee, 2020). According to the theory, these four factors interact with leading to burnout. Putting this idea into practice could increase nurse and patient safety by preventing burnout. According to the Conservation of Resources principle, reducing the number of patients each nurse is assigned might help prevent burnout. The benefit of this theory is that it clarifies the elements that influence and contribute to nursing burnout (Wu & Lee, 2020). Although this has to be addressed, the productivity of nurses may mediate the relationship between nurse burnout and patient safety.
Justification of the Components of the Intervention
The remedy, which outlines the negative impacts of nursing burnout on patient care, staff morale, and organizational effectiveness, is supported by the conservation of resource theory model (Wu & Lee, 2020). One of the initiative’s objectives is to adopt Mindfulness-Based Stress Reduction (MBSR) programs. Patient satisfaction, fewer nursing mistakes, and cost savings are all positive outcomes. The main goal of the intervention is to reduce nurse burnout by adopting practices like exercise and meditation.
Stakeholders, Policy, and Regulations
Everyone will be seen as a stakeholder, including patients, physicians, members of the community, hospital personnel, accountants, and auditors (Wang et al., 2020). Concentrating on raising service standards, making patients happy, and facilitating simpler access to reliable medical data is crucial. By addressing the various needs of several patients at once, mindfulness-based stress reduction (MBSR) might lessen nurse burnout and stress in healthcare settings (Bhattacharya & Hofmann, 2023). By lowering their stress levels and enabling them to concentrate more intently on their patients’ needs, MBSR helps nurses provide better treatment. Nurses should have greater autonomy over their schedules, influence organizational decisions, and care more devoted to their physical and emotional well-being (Sharma & Rani, 2020). Managers should improve their management, cooperation, leadership, and communication skills. A mindfulness-based stress reduction (MBSR) is necessary to satisfy the demands of all parties since nurses are essential to providing high-quality patient care and pursuing other interests.
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act promotes lowering nurse burnout (Viscardi et al., 2022). It will result in increased nurse productivity, a decrease in medication mistakes, and fewer readmissions to hospitals. As a result, there will be less money lost due to medical mistakes and readmissions.
Legal and Ethical Consequences
Burnout among critical care unit nurses is linked to poor patient outcomes and ethical quandaries, claim Rushton et al. (2022). Their ignorance directly contributes to poor patient care, inaccurate medical results, and inadequate service. Due to the possibility of expensive readmissions and blunders, the stakes are greater for the hospital and the patient. Burnout rates in healthcare settings are correlated with greater levels of moral distress and staff turnover (Antonsdottir et al., 2022). Reduced productivity among nurses and within health institutions may lead to legal difficulties, such as medical mistakes or unethical decision-making (Manzano Garca & Ayala Calvo, 2021). The high occurrence of burnout in American hospitals and other healthcare institutions is a sign of pervasive issues and necessitates an ethical evaluation of present procedures. Employee burnout costs businesses and governments billions of dollars every year. An impairment in mental and physical health has been connected to burnout among psychotherapists. Burnout has been related to workplace dishonesty and reduced treatment effectiveness (Manzano Garca & Ayala Calvo, 2021). Burnout thus affects nurses’ capacity to carry out their responsibilities to patients and employers.
Implementation of Plan Designs
Leadership and Management and Proposed Techniques
It is possible to apply the intervention strategy utilizing transformational and laissez-faire leadership strategies (Krumwiede et al., 2023). Everyone participates in the ultimate decision-making process in a democratic environment. Every member of the team has to be thought of as a prospective investor for interprofessional collaboration to be successful. With this approach, the affected nurses can discuss their burnout symptoms with their management and provide suggestions for hospital-wide treatment.
To improve the state of the company, a transformational leader unites and inspires people to work toward a common objective (Sinclair et al., 2021). Because of this, under transformational leadership, each team member focuses on achieving a single objective. As a result, it is simpler for skilled medical personnel to provide interdisciplinary care while keeping patients safe (Farrell et al., 2022). The company and the individual get financial savings when patient safety is raised. Everyone has an equal voice in decision-making when democratic procedures are used (Curtin, Richards & Fortune, 2022). A democratic leader involves everyone interested in the result of a decision to promote collaboration across disciplines. Nursing personnel that is burned out will openly discuss their concerns with nurse supervisors who use transformational methods (Krumwiede et al., 2023). They might also provide recommendations for pain relief.
Effects of the Change Caused by the Suggested Strategies
Techniques for Enhancing Care Quality
Two successful transformational leadership techniques are interdisciplinary support for better healthcare service and motivating nursing education (Jeamjitvibool et al., 2022). Motivational exercises like gratitude celebrations and professional identity development courses may help nurses feel happier, more rested, and more passionate about providing excellent patient care. The quality of life for patients and their loved ones is anticipated to improve due to improved chances for treatment, information, and communication with healthcare professionals (Roth & Altmann, 2022). Democratically driven solutions will provide equitable treatment to all patients to lower the readmission rate.
When there is less nurse burnout, patients spend less on healthcare (Curtin, Richards & Fortune, 2022). Patients are less likely to forego critical medical treatment out of financial worry when insurance and other financial assistance alternatives are easily accessible (Paine & Prochnow, 2022). The level of care will also be impacted by the professional nursing principles of compassion, dependability, humility, and responsibility (Jeamjitvibool et al., 2022). Nurses who care for their patients effectively communicate with their doctors and do their duties more quickly. The highest patient outcomes and least burnout are reported by nurses who can put themselves in their patient’s shoes (Torti et al., 2022). The same criteria that apply to every other service determine how successful it is: trust. A doctor-patient connection is fostered and strengthened by the patient’s faith in the physician. By encouraging people to take charge of their health, we can save money since doing so will encourage patients to speak up about their issues, which will assist doctors in making an accurate diagnosis and planning their care (Torti et al., 2022). By adopting proactive measures like altering their food habits and increasing their physical activity, patients may help lower healthcare expenditures.
Delivery and Technologies
Suitable Delivery Methods
The healthcare institution should develop a plan to implement this intervention strategy (Roth & Altmann, 2022). A team of nurses and office managers may carry out the intervention. The management team and the stakeholders concerned would provide input while the intervention strategy was being prepared. The transition away from the intervention will be supervised by hospital management (Farrell et al., 2022). To carry out the strategy, several nurse supervisors will be engaged. They will continue to direct the nurses and monitor their development as necessary. The hospitals will all adhere strictly to the plan’s instructions. It is vital to remember that factors like finances, caring customs, and rules may affect how a project is carried out. Teams comprising nurses, stakeholders, administrators, and patients may be able to assess the suitability of the selected delivery method and the degree to which the project’s quality has been improved (Farrell et al., 2022). By filling up any knowledge gaps, collaboration and communication among specialists increase the success of a plan.
Technological Alternatives
Technology integration into the distribution method can considerably boost the entire implementation’s effectiveness (Saraswat et al., 2022). It is necessary to set up a centralized operations center so that staff members can immediately assess if patient volume, staffing levels, and care coordination are under control. Staff members can make choices that increase operational efficiency and clinical quality when previously scattered activities are combined (Grigorovich et al., 2021). All authorized nurses will be assigned assignments on the system, where all subsequently provided communication and instructions will also be issued.
Computers and other systems that can learn and become better at their jobs in a way that is startlingly close to how humans think are referred to as having artificial intelligence (AI) (Grigorovich et al., 2021). There are various techniques to show the existence of AI. AI assistants, chatbots, and recommendation engines might all be used to improve scheduling, provide better customer service, and help us find the most effective answers to difficult problems (Saraswat et al., 2022). Intelligent assistants’ ability to streamline scheduling by incorporating crucial data from large free-text databases into artificial intelligence has greatly influenced delivery techniques.
Assessments of Current and Emerging Technologies
If the strategy takes advantage of cutting-edge technological advancements, patients and healthcare organizations will benefit more from it (Grigorovich et al., 2021). A cutting-edge management approach that broadens the viewpoints of nurses and patients is provided through a learning management system (LMS). Giving nurses access to a large, current knowledge base might enhance nursing instruction and practice. Cutting-edge technology will revolutionize information sharing by enabling nurse management through digital channels. Nurses, for instance, may use the online portal to obtain important patient information (Grigorovich et al., 2021).
Given that they will have fewer jobs, they will be less worried and exhausted. The quality of treatment provided to patients will improve as burnout rates drop. Healthcare businesses may make total financial savings by avoiding errors and needless hospital stays.
Additionally, the innovative use of artificial intelligence (AI) may enhance current distribution tactics (Saraswat et al., 2022). Artificial intelligence (AI) is a technology that aims to imitate human intellect by modeling the evolution of its thinking after human reasoning when it comes to digesting and making sense of information.
Stakeholders, Policies, and Regulations
Participants’ Impact
Key participants include community people, patients, their families, and employees from the healthcare institution, including hospital administrators, physicians, nurse managers, and nurses (Grigorovich et al., 2021). Stakeholders must effectively communicate with one another, patients, and employees. They must also be accessible to staff, participate in decisions, keep their knowledge and skills up to date, and maintain a healthy work-life balance (Clark-Snow & Rittenberg, 2021). The intervention technique may be enhanced by considering the requirements of the various parties involved. The patients are our main stakeholders since they can influence the intervention favorably or adversely. Patient monitoring is essential to regulate the growing patient population in hospitals (Paine & Prochnow, 2022). If nurses follow the provided implementation guideline and make any necessary adjustments, they may alter the intervention plan.
The expectations and requirements of nurses include the chance to participate in decision-making, work successfully in teams, build connections with patients and colleagues, and maintain a balance between work and home life (Grigorovich et al., 2021). Leadership, team-building, communication, and problem-solving skills are essential for managers. When put into practice, the intervention plan will help everyone’s needs be met.
Impacts of Policies and Regulations
The two most significant pieces of health regulatory legislation that will impact the plan’s implementation are the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act and the Affordable Care Act (ACA). Nurse burnout may rise if more individuals have access to health insurance, but these issues have already been resolved. If more people have access to healthcare, there will be more nurse burnout due to the increasing patient load. The Affordable Treatment Act suggested geographic isolation between inpatient and outpatient treatment venues as one approach to the problem.
Combating nurse burnout is one of the main objectives of the ACA. By promoting the creation of specialized outpatient care facilities while protecting hospitalization for patients with serious illnesses, the ACA has helped to achieve this aim. Offering outpatient care outside of hospitals may be advantageous for nursing staff.
Plan Assessment
Defining Outcomes
The top priorities are reduced nurse burnout and improved patient care (Pogorzelska, Marcinowicz, & Chlabicz, 2023). The intervention seeks to improve nurses’ emotional and physical well-being by creating a less stressful working environment. The nursing profession will benefit from this since it will improve patient outcomes. If successful, the method will lessen the burden on nurses and improve patient outcomes (Sarköse & Göktepe, 2021). Mindfulness-based treatments have improved patient outcomes and nursing satisfaction (MBIs). Medication mistakes decrease when the intervention is implemented, which is good for patient safety (Haddad, Annamaraju, & Toney-Butler, 2022). Better patient care and enhanced efficiency in the hospital will come from a nursing staff that is both mentally and physically healthy.
Improved nurse productivity in providing high-quality care indicates that the intervention works (O’Connor, 2022). For the sake of themselves and their patients, nurses should maintain good mental and physical health while on the job. To improve these domains, it is necessary to deal with the prevalent issue of nurse burnout, leading to worse treatment quality. Mindfulness-based interventions (MBIs) are crucial if the desired outcome (reduced nurse burnout) is to be achieved (Schwenker, 2022). Nurses are less prone to burnout if they can devote more of their time to providing direct care to patients instead of paperwork (Helminski et al., 2022). Nurses may anticipate successful outcomes from their efforts to improve patient safety since MBIs result in fewer medical mistakes and better patient outcomes.
Establishing Evaluation Plan
A study of nurses and patients is being conducted to ascertain the efficacy of mindfulness-based interventions (MBIs) in reducing burnout. A dashboard, forms, and surveys will be used to collect the data (Helminski et al., 2022). Additionally, hospital dashboards are useful tools for tracking the development of KPIs within a certain context.
Nurses will be asked questions and interviewed extensively (Helminski et al., 2022). The data will also come from patient surveys and monthly dashboard updates. In order to assess the quality of care, nursing surveys are essential. As part of the assessment procedures for these studies, nurses, patients, and family members will all be questioned and given questionnaires to fill out (Verma & Abdel-Salam, 2019). The poll’s findings might be used by upper management to gauge the plan’s success or failure and pinpoint problem areas. Possible information sources that might provide light on the intervention’s efficacy include the nurses’ viewpoints, the patient’s medical records, and the patients’ accounts of their experiences with mindfulness-based treatments (MBTs) (Zhuang et al., 2022). This information will be stored in the hospital’s electronic health records and management dashboards for future reference.
By assessing the efficacy of the intervention in detail, hospital administration may make more informed decisions (Crevacore et al., 2022). The dashboard will be updated after the hospital’s administration decides on a metric for gauging the intervention’s real results. In order to determine whether or not the dashboard is meeting these requirements, data collected over 15 days will be analyzed. Mindfulness-based interventions (MBIs) may be used effectively and safely in various medical settings (Yoon, 2022). The extent to which objectives are being met may be determined by comparing nurses’ survey results with patient comments.
Technology in medicine, such as electronic medical records (EMRs), is a key part of the solution. This kind of technology will be helpful through the process of refining the approach. Through the use of electronic medical records, we will collect information on patients before and after we implement the strategy. Similarly, managers may evaluate the plan’s efficacy by contrasting data collected through the dashboard before and after its implementation (Helminski et al., 2022). In order to measure the success of the intervention, online questionnaires will be sent to both nurses and patients. Electronic health records (EHR) and dashboards were proposed as a means to efficiently gather and monitor data from patients and hospitals by Helminski et al. (2022).
Discussion
Advocacy
Nurses on the front lines are crucial to improving the healthcare system (Crevacore et al., 2022). Once in command, they may make any necessary adjustments. Successful leaders uniting their supporters around a common objective are priceless. They are in a prime position to contribute to interdisciplinary teams because of their proximity to patients. “Huddles,” or safety gatherings, and open communication among specialists are two tried-and-true methods for encouraging greater teamwork (Yoon, 2022). Potentially raising both therapeutic standards and patient results, these methods are worth exploring. There will be benefits to both the nursing profession and the role of nurses if they make the effort to embrace mindfulness-based treatments (MBTs). There is a higher chance that the nursing profession will improve as a consequence of the intervention if it is widely implemented and has a good effect on nurses’ mental health, burnout, and morale (Crevacore et al., 2022). Thanks to nurse leaders’ efforts, nurses’ duties have expanded beyond giving basic medical attention to patients.
It has been shown that primary caregiver burnout and stress may be reduced by using mindfulness-based treatments (MBIs). The program’s primary objective is to decrease nurse burnout; however, secondary benefits include enhanced productivity, attention, and patient results (Yoon, 2022). Mentally strong nurses are better equipped to work in teams and report to higher authorities. Increased productivity among nurses positively affects the hospital’s bottom line and patient outcomes.
Nurse Role Analyses
Nurses play a vital leadership role when it comes to influencing good change and ensuring high-quality care (National Academies of Sciences et al., 2021). A change in approach or leadership might have an impact on healthcare reform. For instance, they may play the part of transformative leaders. Leaders who can effect change in their followers may be more likely to meet their demands, increasing output (Labrague & Obeidat, 2022). Collaboration between nurses and other medical professionals can potentially improve the quality and satisfaction of patient treatment. The team’s performance relies heavily on the experts who see the most patients regularly (Labrague & Obeidat, 2022). Primary caregivers may provide high-quality care by being transparent with patients and taking the initiative.
Effects of the Intervention on Nursing and Interdisciplinary Collaborations
Mindfulness-based interventions (MBIs) may help businesses boost output and retain valuable employees (Khatatbeh et al., 2022). That means nurses may focus more intently on their jobs and get more done. MBIs, or mindfulness-based interventions, may be used to encourage workers to practice mindfulness and strengthen their capacity to collaborate for optimal results. By reducing nurse anxiety and burnout, mindfulness-based interventions (MBIs) may enhance the quality of patient care (Yoon, 2022). These new factors show why the suggested intervention method will benefit the company.
Future Steps
One strategy to increase an intervention’s success is to consider cultural differences (Hegarty et al., 2022). Healthcare providers caring for patients of different cultural backgrounds must be sensitive to those patients’ needs. Like any other profession, nursing is one where education and training may aid in improving performance. Redesigning the project will improve health outcomes for patients at hospitals just in time for culturally competent treatment (Pogorzelska, Marcinowicz, & Chlabicz, 2023). In the management realm, tools like dashboards and electronic health records will improve record-keeping by making it easier to track data and keep it safe from unauthorized access. There should be no trouble in locating the necessary records for the assessment. These innovations make it possible to gather evaluation data in near real time. “Team Nursing,” or “T.N.” for short, is a method of providing care in the nursing profession that emphasizes cooperation among many nurses working together under the direction of a manager or coordinator (Cattaneo, Antonietti & Rauseo, 2022). Successful patient treatment results are guaranteed by leaders who can make fundamental organizational changes.
Present Project Improvements
Incorporating lessons from cultural competence training might be beneficial to the present effort. For instance, patients of all ethnicities need to have nurses who pay special attention to their needs assigned to them. Yoong et al. argue that this will enable hospital administration to deal with cultural sensitivity and linguistic barriers in patient care (2022). The hospital’s online forms and dashboard information should be more effectively integrated into the intervention approach to improve patient outcomes. These advancements will facilitate the collection of accurate project assessment data, allowing management to allocate resources where they will have the most impact. Coding technologies and electronic medical record (EMR) systems are two recent innovations that might benefit the project (O’Connor, 2022). Management and medical staff may benefit from real-time access to data on patient outcomes, readmission rates, and release dates with the use of these solutions. Noting these factors before and after an intervention helps management evaluate its success. Providers may choose from several delivery models, including team nursing (T.N.). A strategic leader must include nurses in the plan (Cattaneo, Antonietti, & Rauseo, 2022). When the team has a clear goal to work toward and competent leadership, they may accomplish their goals and safeguard the patients’ wellbeing.
Reflection
This capstone project has given me the tools I need to become a successful project manager and a leader in healthcare reform. Knowing the value of transformational leadership in any change effort has helped me develop further as a leader. Because of this, I am now a better team leader. Transformative leadership will help me manage change and lead transformational initiatives in my next position. I can foster teamwork by facilitating better communication and encouraging more participation from all team members in decision-making.
As a result of participating in the research, I will be more equipped to advocate for an optimal nurse-to-patient ratio at my workplace. It will help me become an even more effective nursing leader. Implementing the change in a healthcare setting would enhance the quality of care provided to patients by lowering the prevalence of nurse burnout and its negative consequences on other aspects of medical provision.
References
Alhawatmeh, H. N., Rababa, M., Alfaqih, M., Albataineh, R., Hweidi, I., & Abu Awwad, A. (2022). The benefits of mindfulness meditation on trait mindfulness, perceived stress, cortisol, and C-reactive protein in nursing students: A randomized controlled trial. Advances in Medical Education and Practice, 47-58. https://www.tandfonline.com/doi/full/10.2147/AMEP.S348062
Antonsdottir, I., Rushton, C. H., Nelson, K. E., Heinze, K. E., Swoboda, S. M., & Hanson, G. C. (2022). Burnout and moral resilience in interdisciplinary healthcare professionals. Journal of clinical nursing, 31(1-2), 196-208. https://doi.org/10.1111/jocn.15896
Aryankhesal, A., Mohammadibakhsh, R., Hamidi, Y., Alidoost, S., Behzadifar, M., Sohrabi, R., & Farhadi, Z. (2019). Interventions on reducing burnout in physicians and nurses: A systematic review. Medical journal of Medicine Sciences, 33, 77.
https://doi.org/10.34171/mjiri.33.77
Bhattacharya, S., & Hofmann, S. G. (2023). Mindfulness-based interventions for anxiety and depression. Clinics in Integrated Care, 16, 100138. https://doi.org/10.1016/j.intcar.2023.100138
Cattaneo, A. A., Antonietti, C., & Rauseo, M. (2022). How digitalized are vocational teachers? Assessing digital competence in vocational education and looking at its underlying factors. Computers & Education, 176, 104358. https://doi.org/10.1016/j.compedu.2021.104358
Crevacore, C., Jacob, E., Coventry, L. L., & Duffield, C. (2022). The integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing. Journal of Advanced Nursing. https://doi.org/10.1111/jan.15430
Çeli̇k, A. S., & Kılınç, T. (2022). The effect of laughter yoga on perceived stress, burnout, and life satisfaction in nurses during the pandemic: A randomized controlled trial. Complementary Therapies in Clinical Practice, 49, 101637. DOI: https://doi.org/5656575790000
Clark-Snow, R. A., & Rittenberg, C. (2021). Oncology nursing supportive care during the COVID-19 pandemic: reality and challenges. Supportive Care in Cancer, 29(5), 2259-2262. https://link.springer.com/article/10.1007/s00520-021-06005-2
Curtin, M., Richards, H. L., & Fortune, D. G. (2022). Resilience among health care workers during a pandemic: A systematic review and meta-synthesis of qualitative studies. Clinical psychology review, p. 95, 102173. https://doi.org/10.1016/j.cpr.2022.102173
Dixon, E., Murphy, M., & Wynne, R. (2022). A multidisciplinary, cross-sectional survey of burnout and wellbeing in emergency department staff during COVID-19. Australasian Emergency Care, 25(3), 247–252. https://doi.org/10.1016/j.auec.2021.12.001
Farrell, T. W., Greer, A. G., Bennie, S., Hageman, H., & Pfeifle, A. (2022). Academic Health Centers and the Quintuple Aim of Health care. Academic Medicine, 10-1097. DOI: 10.1097/ACM.0000000000005031
Garmaise-Yee, J. S., & LeBlanc, R. G. (2022). Reducing stress and increasing mindfulness in nursing students: an online mindfulness intervention study. Nursing Education Perspectives, 43(6), 375-377. DOI: 10.1097/01.NEP.0000000000000887
Green, A. A., & Kinchen, E. V. (2021). The effects of mindfulness meditation on stress and burnout in nurses. Journal of Holistic Nursing, 39(4), 356-368. DOI: https://doi.org/10.1177/08980101211015818
Grigorovich, A., Kulandaivelu, Y., Newman, K., Bianchi, A., Khan, S. S., Iaboni, A., & McMurray, J. (2021). Factors affecting the implementation, use, and adoption of real-time location system technology for persons living with cognitive disabilities in long-term care homes: Systematic review. Journal of medical Internet research, 23(1), e22831. doi:10.2196/22831
Hassan, N. H. H. W., & Samy, N. K. (2022). Emotions and burnout in the workplace: Practical and research implications. http://hdl.handle.net/123456789/3749
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Helminski, D., Kurlander, J. E., Renji, A. D., Sussman, J. B., Pfeiffer, P. N., Conte, M. L., … & Landis-Lewis, Z. (2022). Dashboards in Health Care Settings: Protocol for a Scoping Review. JMIR research protocols, 11(3), e34894. https://preprints.jmir.org/preprint/34894,
Hegarty, H., Knight, T., Atkin, C., Kelly, T., Subbe, C., Lasserson, D., & Holland, M. (2022). Nurse staffing levels within acute care: a national day of care survey results. BMC Health Services Research, 22(1), 1–10. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07562-w
Jeamjitvibool, T., Duangchan, C., Mousa, A., & Mahikul, W. (2022). The Association between Resilience and Psychological Distress during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 19(22), 14854. https://doi.org/10.3390/ijerph192214854
Kavurmaci, M., Tan, M., & Bahcecioglu Turan, G. (2022). Determining the effect of yoga on job satisfaction and burnout of nurse academicians. Perspectives in Psychiatric Care, 58(1), 404-410.
https://doi.org/jgjr9990956565
Khatatbeh, H., Pakai, A., Al‐Dwaikat, T., Onchonga, D., Amer, F., Prémusz, V., & Oláh, A. (2022). Nurses’ burnout and quality of life: A systematic review and critical analysis of measures used. Nursing Open, 9(3), 1564-1574. https://doi.org/10.1002/nop2.936
Krumwiede, K. A., Eardley, D. L., DeBlieck, C. J., & Martin, K. S. (2023). Creating a quadruple aim model for nursing education. Public Health Nursing. https://doi.org/10.1111/phn.13172
Labrague, L. J., & Obeidat, A. A. (2022). Transformational leadership as a mediator between work–family conflict, nurse‐reported patient safety outcomes, and job engagement. Journal of Nursing Scholarship, 54(4), 493-500. https://doi.org/10.1111/jnu.12756
Manzano García, G., & Ayala Calvo, J. C. (2021). The threat of COVID‐19 and its influence on nursing staff burnout. Journal of Advanced Nursing, 77(2), 832-844. https://doi.org/10.1111/jan.14642
McHugh, M. D., Aiken, L. H., Windsor, C., Douglas, C., & Yates, P. (2020). The case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study. BMJ open, 10(9), e036264. http://dx.doi.org/10.1136/bmjopen-2019-036264
Molero Jurado, M. D. M., Perez-Fuentes, M. D. C., Barragan Martin, A. B., Soriano Sanchez, J. G., Oropesa Ruiz, N. F., Sisto, M., & Gazquez Linares, J. J. (2020, June). Mindfulness in family caregivers of persons with dementia: systematic review and meta-analysis. In Healthcare (Vol. 8, No. 3, p. 193). MDPI. https://doi.org/10.3390/healthcare8030193
Mulianda, D., Rahmanti, A., Margiyati, M., Sari, N. W., Haksara, E., & Pranata, S. (2022). Behavioral Activation, Mindfulness Exercises, and Loving-Kindness Meditation Exercises as Effective Therapies to Reduce Stress among Nursing Students’ during COVID-19 Pandemic. Open Access Macedonian Journal of Medical Sciences, 10(G), 228-232. DOI: https://doi.org/10.3889/oamjms.2022.8695
McNulty, D. S., LaMonica-Way, C., & Senneff, J. A. (2022). The impact of mindfulness on stress and burnout of new graduate nurses as a component of a nurse residency program. JONA: The Journal of Nursing Administration, 52(4), E12-E18. DOI: 10.1097/NNA.0000000000001137
National Academies of Sciences, E., Medicine, N. A. of, Nursing 2020–2030, C. on the F. of, Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021). Nurses are leading change. In www.ncbi.nlm.nih.gov. National Academies Press (U.S.). https://www.ncbi.nlm.nih.gov/books/NBK573918/
Nassim, M., Park, H., Dikaios, E., Potes, A., Elbaz, S., Mc Veigh, C., … & Rej, S. (2021, June). Brief mindfulness intervention vs. health enhancement program for dialysis patients: a randomized controlled trial. In Healthcare (Vol. 9, No. 6, p. 659). MDPI. https://doi.org/10.3390/healthcare9060659
O’Connor, S. (2022). Designing and using surveys in nursing research: a contemporary discussion. Clinical Nursing Research, 31(4), 567–570. https://journals.sagepub.com/doi/pdf/10.1177/10547738211064739
Paine, K., & Prochnow, J. A. (2022). Leadership strategies to support resilience. Nursing Management, 53(4), 12-19. DOI: 10.1097/01.NUMA.0000824024.53750.66
Penque, S. (2019). Mindfulness to promote nurses’ well-being. Nursing Management, 50(5), 38. 10.1097/01.NUMA.0000557621.42684.c4
Pogorzelska, K., Marcinowicz, L., & Chlabicz, S. (2023). A Qualitative Study of Primary Care Physicians’ Experiences with Telemedicine during the COVID-19 Pandemic in North-Eastern Poland. International Journal of Environmental Research and Public Health, 20(3), 1963. https://doi.org/10.3390/ijerph20031963
Roth, M., & Altmann, T. (2022). The interplay of acceptance and effectiveness in intervention studies: The example of the empCARE training to reduce burnout and distress symptoms in health care providers. Psychology & Health, 1–15. https://doi.org/10.1080/08870446.2022.2129053
Rushton, C. H., Thomas, T. A., Antonsdottir, I. M., Nelson, K. E., Boyce, D., Vioral, A., … & Hanson, G. C. (2022). Moral injury and moral resilience in health care workers during COVID-19 pandemic. Journal of palliative medicine, 25(5), 712–719. https://doi.org/10.1089/jpm.2021.0076
Saraswat, D., Bhattacharya, P., Verma, A., Prasad, V. K., Tanwar, S., Sharma, G., Bokoro, P. N., & Sharma, R. (2022). Explainable AI for healthcare 5.0: Opportunities and challenges. IEEE Access, pp. 1–1. https://doi.org/10.1109/access.2022.3197671
Sarıköse, S., & Göktepe, N. (2021). Effects of nurses’ individual, professional, and work environment characteristics on job performance. Journal of Clinical Nursing, 31(5-6). https://doi.org/10.1111/jocn.15921
Schwenker, M. (2022). Effects of Inadequate Nurse Staffing and Need for Standard Nurse-to-Patient Ratios to Increase Patient Safety in Acute Care Settings. https://scholarworks.uark.edu/nursuht/182/
Schmiedhofer, M., Derksen, C., Keller, F. M., Dietl, J. E., Häussler, F., Strametz, R., Koester-Steinebach, I., & Lippke, S. (2021). Barriers and facilitators of safe communication in obstetrics: Results from qualitative interviews with physicians, midwives, and nurses. International Journal of Environmental Research and Public Health, 18(3), 915. https://doi.org/10.3390/ijerph18030915
Sharma, S., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of Family Medicine and Primary Care, 9(6), 2631. https://doi.org/10.4103/jfmpc.jfmpc_248_20
Sinclair, S., Harris, D., Kondejewski, J., Roze des Ordons, A. L., Jaggi, P., & Hack, T. F. (2021). Program Leaders’ and Educators’ Perspectives on the Factors Impacting the Implementation and Sustainment of Compassion Training Programs: A Qualitative Study. Teaching and Learning in Medicine, pp. 1–16. https://doi.org/10.1080/10401334.2021.2017941
Sofia Di Mario, R. N., Cocchiara, R. A., & Giuseppe La Torre, M. D. (2023). The Use of Yoga and Mindfulness-based Interventions to Reduce Stress and Burnout in Healthcare Workers: An Umbrella Review. Alternative Therapies in Health and Medicine, 29(1), 29-35. https://www.proquest.com/openview/f351e3b2caf3b96a41afa7564123a629/1?cbl=32528&pq-origsite=gscholar
Sulosaari, V., Unal, E., & Cinar, F. I. (2022). The effectiveness of mindfulness-based interventions on the psychological well-being of nurses: A systematic review. Applied Nursing Research, 151565. https://doi.org/10.1016/j.apnr.2022.151565
Torti, J. M., Inayat, H., Inayat, A., Lingard, L., Haddara, W., & Sultan, N. (2022). Perspectives on physician leadership: The role of character‐based leadership in medicine. Medical Education. https://doi.org/10.1111/medu.14875
Urso, C., Laserna, A., Feng, L., Agnite, A., Jawe, N., Magoun, C., … & Gutierrez, C. (2022). Mindfulness as an antidote to burnout for nursing and support staff in an oncological intensive care unit: A pilot study. Holistic nursing practice, 36(5), E38-E47. DOI: 10.1097/HNP.0000000000000544
Wasson, R. S., Barratt, C., & O’Brien, W. H. (2020). Effects of mindfulness-based interventions on self-compassion in health care professionals: a meta-analysis. Mindfulness, p. 11, 1914-1934. https://link.springer.com/article/10.1007/s12671-020-01342-5
Wang, L., Lu, H., Dong, X., Huang, X., Li, B., Wan, Q., & Shang, S. (2020). The effect of nurse staffing on patient‐safety outcomes: A cross‐sectional survey. Journal of Nursing Management, 28(7), 1758-1766. https://doi.org/10.1111/jonm.13138
Weissner, D. R. (2020). Effect of the Affordable Care Act Medicaid Expansion on Labor Participation of Female Registered Nurses in Outpatient Care. DOI: https://academicworks.cuny.edu/hc_sas_etds/645
Witarto, B. S., Visuddho, V., Witarto, A. P., Bestari, D., Sawitri, B., Melapi, T. A. S., & Wungu, C. D. K. (2022). Effectiveness of online mindfulness-based interventions in improving mental health during the COVID-19 pandemic: A systematic review and meta-analysis of randomized controlled trials. Plos one, 17(9), e0274177. https://doi.org/10.1371/journal.pone.0274177
Wu, W. L., & Lee, Y. C. (2020). Do work engagement and transformational leadership facilitate knowledge sharing? A perspective of conservation of resources theory. International journal of environmental research and public health, 17(7), 2615. https://doi.org/10.3390/ijerph17072615
Viscardi, M. K., French, R., Brom, H., Lake, E., Ulrich, C., & McHugh, M. D. (2022). Care quality, patient safety, and nurse outcomes at hospitals serving economically disadvantaged patients: a case for investment in nursing. Policy, Politics, & Nursing Practice, 23(1), 5–14. https://doi.org/10.1177/1527154421106955
Verma, J. P., & Abdel-Salam, A.-S. G. (2019). Assumptions in survey studies. In Testing Statistical Assumptions in Research (pp. 45–64). Wiley Online Library. https://doi.org/10.1002/9781119528388.ch3
Voskuil, E. F. (2021). Nurse Practitioners and Community Health Workers Improve Community Health. https://idun.augsburg.edu/etd/1084
Yoong, S. Q., Xin, A. L. W., Sam, G. H., & Zhang, H. (2022). Educational effects of community service-learning involving older adults in nursing education: An integrative review. Nurse Education Today, 105376. https://doi.org/10.1016/j.nedt.2022.105376
Yoon, H. J. (2022). The Effect of Nurse Staffing on Patient Outcomes in Acute Care Hospitals in Korea. International Journal of Environmental Research and Public Health, 19(23), 15566. https://doi.org/10.3390/ijerph192315566
Zhuang, M., Concannon, D., & Manley, E. (2022). A framework for evaluating dashboards in healthcare. IEEE Transactions on Visualization and Computer Graphics, 28(4), 1715–1731. https://doi.org/10.1109/tvcg.2022.3147154
Zhang, X. J., Song, Y., Jiang, T., Ding, N., & Shi, T. Y. (2020). Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine, 99(26). DOI: 10.1097/MD.0000000000020992
Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years. CA: A Cancer Journal for Clinicians, 70(3). https://doi.org/10.3322/caac.21604
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