Clinical Problem Statement
Maintaining nursing services consistently effective and the extent of nurses’ responsiveness high is vital for handling public health concern, particularly, at the time of a health crisis, such as the Covid-19 pandemic observed currently. However, with the rise in the workload levels and a tremendous drop in the nurse-to-patient ratio, the deterioration of nursing service quality is expected to occur along with the exacerbation of the levels of stress, leading to mental health problems in nurses and the resulting threat of clinical and medical errors (Ross, 2020). Indeed, reports and studies in the subject matter connect the issue of nurse burnouts to an increasing number of medical errors and the related misunderstandings (Prapanjaroensin et al., 2017). In turn, the observed clinical errors are bound to delay the recovery process, at best, and lead to patients’ health deterioration, at worst (Ross, 2020). Therefore, introducing the tools for preventing burnout in nurses so that patient safety could improve is vital in the current setting of the pandemic.
Purpose
The purpose of this change proposal is to establish the causal relationships between nurse burnout caused by a rise in the workload and the drop in patient safety rates observed in the current healthcare setting. This project will seek to evaluate the extent of the effect that workplace burnout in nurses has on the levels of patient safety within the healthcare setting. As a result, the urgency for implementing a change and introducing a framework for increasing patient safety by bringing the rates of burnout in nurses down will be proven. The described change will be of tremendous importance in the present-day changing environment of healthcare since the range of health factors that nurses must take into consideration when tending to patients’ needs has been expanding (Al Ma’mari et al., 2020). Consequently, the strategies that nurses use to address multifaceted workplace environments are no longer efficient in the target setting. By examining the factors that define the connection between nurse burnouts and patient safety, one can introduce effective frameworks for preventing burnout and ensuring patient safety in the modern nursing setting as well.
PICOT Question
In nurses working in a diverse environment under increased workload, does the introduction of the relaxation approach cause a drop in the instances of workplace burnouts and the subsequent rise in patient safety compared to the strategy based on expert emotional support within a month?
Literature Search Strategy
To find valuable sources of reference for this project, several online search tools were utilized. Namely, to ensure that the papers to be incorporated into the analysis are academic, databases such as Medline, CINAHL, Cochrane Library, EBSCO, SAGE, and PsychINFO were used. Additionally, the search was limited to peer-reviewed articles published in 2017-2021 to ensure that the located sources are relevant and representative of the issue. Additionally, search terms such as “nurse burnout AND patient safety” were utilized to find the articles referring to the topic under analysis directly. The specified approach has helped to identify 53 relevant articles, of which six (6) were selected for this project.
Evaluation of the Literature
Overall, the sources found in the course of the search can be considered as highly credible and exceptionally informative. The study by Al Ma’mari et al. (2020) has outlined the presence of a correlation between the nurse-patient ratio and the rise in burnouts among nurses. The impressive sample and a strong sampling approach contribute to the reliability of the source. The proposed method is supported by Shin et al. (2018), who deploy a meta-analysis approach and, therefore, provide general yet still essential results.
In turn, the paper by Liu et al. (2018) blames the structural issues for the presence of burnouts in nurses, outlining that structural changes are necessary to manage the problem and, therefore, improve nurses’ performance. The use of the Practice Environment Scale of Nursing Work Index as the main measurement tool is the key advantage of the paper since it has helped minimize the extent of inaccuracy in the obtained results. However, the paper could use a more diverse sample size since it is primarily representative of the practices utilized in a confined location (Guangdong province, China).
A more current paper that addresses the problem of workplace burnout in nurses in the context of the Covid-19 pandemic, the study by Ross (2020) specifies that the tremendous number of patients affected by the coronavirus has aggravated the burnout issue, also being correlated with a rise in patient safety concerns, among other problems. The study offers robust arguments grounded in evidence-based research, which is why its contribution should be acknowledged as tremendous.
In turn, the research by Prapanjaroensin et al. (2017) establishes a link between workplace burnouts in nurses and patient safety, pointing to the core nature of burnouts in nurses. Specifically, the study explains that the phenomenon of a burnout occurs as a result of losing “objects, conditions, personal characteristics and energy” (Prapanjaroensin et al., 2017, p. 2558). Although the paper in question represents secondary research, it is still sufficiently valid for the further analysis. Namely, Prapanjaroensin et al. (2017) offer an amalgamation of research results on the phenomenon of burnout in nurses and the effects that they may entail.
Finally, the research by Garcia et al. (2019) connects the problem of nursing burnout to patient safety by examining the causes of workplace burnouts in the clinical setting. Namely, according to the study results, “In units with higher burnout scores, there was a deterioration of teamwork climate, safety, and job satisfaction” (Garcia et al., 2019, p. 561). The article can be considered credible and crucial in the discussion of patient safety and nurse burnouts since it provides a profound and accurate meta-analysis and statistical assessment of the available data, proving the correlation between the variables.
Nursing Theory
To address the issue, Orem’s theory of Self-Care along with Levine’s Conservation Model will be utilized. Orem’s theory establishes the necessity of self-care, whereas Levine’s framework shows how to adapt to the changing environment while doing so (Butts, 2017). Therefore, the application of both frameworks is justified in handling the problem of patient safety due to high workplace burnout rates in nurses. Thus, a platform for encouraging nurses to make an effort for a positive change and simultaneously convince them to accept counseling and training options will be possible.
Implementation Plan
The change in the nurses’ coping strategies will be implemented with the help of Lewin’s change management model. Specifically, the stages of unfreezing, changing and refreezing will be incorporated into the process (Abd El-Shafy, et al., 2019). The first step will involve assessing the situation in the target setting. Next, a new framework coping with high workload while maintaining patient safety (namely, the use of emotional support and counseling) will be implemented. Finally, at the refreezing stage, the model will be integrated into the nurses’ performance.
EBP Practice
To create the intervention, an assessment of the behaviors and attitudes observed in nurses in the clinical setting was made. Additionally, nurses were interviewed so that they could provide detailed descriptions of their coping mechanisms in the environment of high workload and the presence of emotional devastation. Thus, the possible avenues for improving nurses’ well-being and patients’ safety were discovered. Although interviews and their following analysis may result in obtaining slightly subjective data since the researcher may have certain biases, the application of an objective assessment based on quantifiable outcomes will help to adjust the accuracy and reliability of the data to be obtained.
Evaluation
To assess the outcomes of the proposed change, a comparison of the number of cases when patients were exposed to threats (pre-test and post-test) will be conducted. By using the quantitative analysis technique, such as Student’s t-test, one will be able to identify whether there will be a presence of positive correlation and, therefore, the possibility of causation between the proposed stress relief technique, the number of workplace burnouts, and the cases of medical errors.
Barriers
The suggested technique may imply overcoming several barriers, the time constraint being the key one. Since nurses are under tremendous pressure due to high workload rates, they may have no time for personal sessions and training. To handle the specified issue, the support options and tools will be provided as digital resources so that nurses could access them at any point in time and request them even with tight schedules.
References
Abd El-Shafy, I., Zapke, J., Sargeant, D., Prince, J. M., & Christopherson, N. A. (2019). Decreased pediatric trauma length of stay and improved disposition with implementation of Lewin’s change model. Journal of Trauma Nursing| JTN, 26(2), 84-88. Web.
Al Ma’mari, Q., Sharour, L. A., & Al Omari, O. (2020). Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses. British Journal of Nursing, 29(1), 28-34. Web.
Butts, J. B., & Rich, K. L. (2017). Philosophies and theories for advanced nursing practice (3rd ed.). Jones & Bartlett Publishers.
Garcia, C. D. L., Abreu, L. C. D., Ramos, J. L. S., Castro, C. F. D. D., Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019). Influence of burnout on patient safety: systematic review and meta-analysis. Medicina, 55(9), 553-565. Web.
Liu, X., Zheng, J., Liu, K., Baggs, J. G., Liu, J., Wu, Y., & You, L. (2018). Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis. International Journal of Nursing Studies, 86, 82–89. Web.
Prapanjaroensin, A., Patrician, P. A., & Vance, D. E. (2017). Conservation of resources theory in nurse burnout and patient safety. Journal of Advanced Nursing, 73(11), 2558-2565. Web.
Ross, J. (2020). The exacerbation of burnout during COVID-19: A major concern for nurse safety. Journal of Perianesthesia Nursing, 35(4), 439-440. Web.
Shin, S., Park, J. H., & Bae, S. H. (2018). Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nursing Outlook, 66(3), 273-282. Web.