Constructing the Written Evidence-Based Proposal: Final 8 NRS 441v.10R

Compassion Fatigue
Eunsook Kim
Grand Canyon University; NRS 441V
October 16, 2016
Dear writer. you have not followed what I asked you in the paper.1. my focus of the solution(physical empowerment) is on hiring a break nurse and one more resource nurse as we have talked before, can you add this to 'Abstract, Conclusion"? This was mentioned in our solution. Still no key words.2. Theory was not incorporated in the paper. Which area is good to insert theory? you can add it.3. Can you convert the file of brochure to Word from PDF?4. Can you create a feedback paper from the Director?
Thank you.
CUSTOMER > ME   2016-11-13 13:06:00
Dear writer. What is the reference of pre, post questionaire, brochure?Can you covert pamphlet to Word doc also?Thanks.
Abstract
The Institute of Medicine has taken some drastic measures aimed at improving the nursing profession in a bid to meet the needs of the healthcare industry. The Registered Nursing Organization has a higher population of newly professional and educated care providers ready for recruitment. However, there are expectations from different health facilities to address the job satisfaction and high-stress levels within the industry, an aspect that results in less patient care for the nurses who struggle to achieve optimal working environments. The heightened stress levels and job dissatisfaction are considered as the primary reasons why most nurses abandon and neglect their job positions. Sadly enough, there are relations between burnouts, job dissatisfaction, and risks to inpatients. High turnover rates lead to nursing shortages which consequently results in high nursing workloads for the nurses. High workloads have been revealed by a reliable research to have negative affect patient care and safety. It is evident that the high rate of nurses’ turnover in the Definitive Observation Unit results from a poor working environment in the premises. The DOU has few nurses taking care of the patients, which causes stressful conditions for nurses who have to strain to attend to various patients demanding adequate quality care. The primary solutions proposed in managing these issues include developing an empowered nursing environment that has a relation with the duration of stay and burnouts. Physical and structural empowerments encourage retention of nurses and reduce burnout.
Key Words: Compassion Fatigue, Stress, Nurses, Job Satisfaction, Care, Burnout, Nurse Turnover Rates, and Recruitment.
Introduction
The problem of compassion fatigue is the component of stress that nurses go through in their everyday life which is gained from nurses working with patients that are in constant pain and suffering. The nurses develop psychological and psychosocial distress that could lead to high turnover. Sabo insists that there should be more theoretical frameworks that should look into ways of addressing compassion fatigue and job satisfaction of nurses. The heightened stress levels and job dissatisfaction are considered as the primary reasons why most nurses abandon and neglect their job positions. Sadly enough, there are relations between burnouts, job dissatisfaction, and risks to inpatients, an aspect that this research study seeks to establish in a bid to find solutions.
Statement of the Problem
In DOU COU critical care unit, it has been observed that the nurses' turnover factor is high. This is attributed to poor working conditions observed in the unit. This has consequently led to poor patient care and low job satisfaction for the nurses who struggle to achieve optimal working environments. It is ironical that the nurses in a critical care unit are expected to provide care to patients and create a humane, healing and caring environment while the working conditions are deplorable. Intensive care units ought to be a decent environment that is life encouraging so as providing hope of breath to the patients under critical conditions (Acton, 2013).
Critical care unit in DOU COU is tortuous with the incidence of bed closure as a result of staff shortages anticipating accelerating high rates of turnover. There is no consistency in the definition of nurse turnover, but it can be defined as the situation in which a nurse leaves a station for another work station. The rate at which nurses are quitting this station is wanting. The nurses have clearly indicated dissatisfaction with the poor working environment, compassionate fatigue and distressing psychological conditions among other underlying causes (Acton, 2003). As the nurses quit, only a few are left worsening the situations they strain to serve the overwhelming numbers of the patients demanding their diligent services.
High turnover rates lead to nursing shortages which consequently result in high nursing workloads for the nurses. High workloads have been shown by research negatively affect patient care and safety. It has also been reported to contribute to declining job satisfaction among the nurses in intensive care units. Further, it reduces the motivation of the staff. Low motivated employees deliver sub-standard services to their clients. Patients, therefore, do not receive the intensive care owed by the nurses (Holzemer, 2011). The low nurse-patient ratio also impacted negatively on the ability of the nurses to deliver services to the patients. These factors also contribute to poor working conditions in the care unit brought about by deploring conditions of improperly attended patients.
Nursing turnover is a serious problem with high gravity manifested in the implications on the nurses serving at a critical care unit as noted earlier. Negative impacts on patient care and job dissatisfaction may be mentioned to stress the severity of this problem. It is significant to both the nurses and the patients (Graban, 2016). Nurses leaving the job forfeit their allowances and bonuses. There are also productivity losses as the experience that had been accumulated is lost as one move to another station that may not relate to critical care unit. The safety of nurses is also compromised as the number of nurse-patient ratios reduces as well as impaired job satisfaction (Graban, 2016). Nursing turnover also impacts negatively on career development because the heavy workload as a result of staff shortages leaves the nurses with little time for further learning. Inconveniences caused by leaving nurses also affect their learning options and the part-time courses they had already initiated.
High nursing turnovers lead to low workgroup learning which translates to high incidences of severe medication errors in critical nursing care units. Increase in patient falls in also another consequence of nursing turnovers. It also leads to imprecise detection of patient complications in the critical condition. The quantity of patient care is also reduced significantly. All these put together will reduce the effectiveness and efficiency of nursing care provided to the patients in critical conditions. The worst result is the high mortality rates reported in such situations.
Previous scholars who have conducted research related to this problem have suggested that the first step in approaching this problem would be exploring the reasons that have led to this scenario and focusing on the policy areas that can be amended to solve the problem (Huston, 2013). However, this study proposes an alternative approach to offer the solution to the problem. The research intends to establish ways of influencing the factors that lead to high turnovers such as reducing compassion fatigue, improving compassion satisfaction and empowerment of psychological and physical conditions in the nursing environment. Working conditions shall also be improved. According to Leineweber et al., a research showed that improvement of the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession (Leineweber et al., 2016).
The assumption behind the study is that by improving these factors, turnover rates shall be lowered and optimal work performance shall be achieved. Improved working conditions shall lead to higher job satisfaction and will counteract the nursing shortage across the nation. Thus, nurses will be able to stay in their current work place with healthy mind and body (Leineweber et al., 2016). Eventually, this empowerment of the refined working environment will be a driving force for nurses to promote better patient care and safety in their workforce area.
The Proposed Solution
One of the activities that would solve the problem of compassion fatigue is the provision of relevant training to nurses on various ways of coping with emotional and psychological trauma resulting from witnessing painful conditions of multiple patients at work (Boyle, 2011). The health organization should conduct periodic training, counselling, and interventions for nurses and other staff members to assist them cope with compassion fatigue and recover normalcy. Periodic trainings should be conducted after every two months of the initiation of the new plan. The organization’s manager should organize for training programs and invite motivational speakers to talk to all the nurses in shifts. The trainings can be done through conferences, forums, and internal and external meetings. During such trainings, nurses would find an opportunity to share their feelings and encourage one another. They would also get to learn how the other nurses (from the speakers) have managed to cope with compassion fatigue, as they would be able to meet with like-minded professionals to discuss mutual problems. In addition, training can also involve visiting other health organizations for bench marking.
The policy of cost rationalization in the hospital, which emphasizes on reducing the cost of hiring more registered nurses to maximize the outcome profit, should be revised. Freezing the number of caregivers in the health facility to make more profit has proven to be the primary cause of the shortage of nurses in the DOU and ICU leading to heavy workloads that nurses experience, which, in turn, result in high turnover and job dissatisfaction. For instance, our DOU department has a patient-nurse ratio of 3 to 1. There is neither a resource nurse nor a break nurse in the facility, making it difficult for the few available nurses who have to double their roles to meet the needs of the overwhelming patient volume. This situation makes it almost impossible for nurses to find time to visit the break room or washroom, and the environment causes many nurses to quit to other stations.
In result, as much as the organization needs to minimize expenses, hiring more nurses would reduce the workload pressure on the available few nurses and result in a better working environment. Eventually it will allow nurses to provide adequate and quality care to patients. When patients are satisfied with the care provided, it boosts the reputation of the facility, earning more profit.
Another solution to the problem is financial backing. The hospital administration management should assist with a monetary fund to facilitate training and programs that foster towards motivating nurses and helping them cope with compassion fatigue. Financial backing will also enable the Human Resource department to facilitate hiring and training of new employees within the facility.
Provision of social, emotional, and professional support for nurses is significant in any health care organization (Ward-Griffin, St-Amant & Brown, 2011). Such support reveals to the nurses that their employers appreciate and care for them. As a result, it provides a comfortable working environment, which motivates the nurses. Nothing steers an employee to produce adequate service more than knowing that his/her organization is concerned about her/his well-being. Therefore, an effective implementation plan for these solutions would result in the empowerment of the physical and psychological conditions, which would lead to optimal work performance, compassion satisfaction, and patient safety.
Rationale for Selecting Proposed Solution
Periodic training and counselling of nurses assist them to cope better with compassion fatigue because such training usually provides forums where nurses can share their feelings and encourage each other to give self-care in order to deal with it. According to Fetter (2012), social and professional supports enable the staffs to acknowledge that the organization is concerned about their welfare. It makes nurses feel gratification and self-assurance, creating in them the urge to give out their best regarding nursing care practice and help the organization achieve high outcomes.
Amending the policy of cost rationalization of the hospital is the best strategy towards achieving employee and patient satisfaction because the lack of adequate nurses in the DOU and ICU is primarily due to minimization of the cost associated with hiring of more registered nurses. Medical industry must invest in hiring skilled nurses and training them to acquire high patient safety and quality care. Without an amendment of this policy, the problem would continue to threaten the stability of the health care facility. Moreover, it is sensible to have a reliable financial backing to assist in the facilitation of training programs and hiring of new registered nurses. It will also help in improving the physical conditions of the wok.
Evidence from Review of Literature
An empowered nursing environment has a direct relationship with the duration of stay and burnout. According to Meng, Liu, Liu, Hu, Yang & Liu (2015), physical and structural empowerments encourages retention of nurses and reduces burnout. This kind of motivation would improve the services delivered by the nurses and performances on patients care to result in nurse job satisfaction (Lee, 2015). Moreover, the structure of an organization influences the satisfaction of nurses and any change in the style of management may affect nurses satisfaction positively or negatively (Slocum-Gori, Hemsworth, Chan, Carson & Kazanjian, 2013). The study findings demonstrate that health organizations can improve job satisfaction, compassion satisfaction and reduce turnover rates of nurses through implementing programs and policies that support and appreciate nurses’ work.
According to Shipley (2015), nursing turnover is a serious issue, which results in a decline of job satisfaction and inadequate care provision. This study conducted a survey of registered nurses in a nursing home and concluded that those trainee nurses who attended the program, which geared towards assisting them to cope with compassion fatigue, reduced the problem by up to 95% (Shipley, 2015; Thieleman & Cacciatore, 2014). In addition, Fortney et al. (2013) suggest that modified mindful trainings foster physicians’ well-being and high-quality care for patient safety.
Implementation Logistics
Taking into considerations all activities required for the success of the implementation plan, it should be done in six stages. The first phase would involve obtaining approval of the implementation plan from the IRB (Institutional Review Board) and the administration represented by the heads of departments. It is important to get approval from the IRB because, without it, the implementation of the plan would be ruined. Furthermore, seeking the permission of the administration would provide support for the program and assist in evaluating its capability. I would use a pilot test for this plan through pre-assessment survey of both nurses and stakeholders to help the stakeholders understand and evaluate the necessity of the new plan to curb compassion fatigue and job dissatisfaction among the health workers (nurses).
The next stage would include the planning and design of the program. It is the stage where the stakeholders would develop all the strategies required for the implementation and draw a budget. This step is critical, as it would act as a guide for the successful implementation of the plan. After the completion of the second stage, the third stage would involve critical analysis and evaluation of the feasibility of the program. In this phase, stakeholders would examine possible challenges to the implementation plan and their solutions, the sustainability of available resources, and assembling of relevant materials for the project (Schwulst, 2014).
The fourth phase would take place after the achievement of the third stage; it would involve convincing and educating the staff on the significance of the implementation plan and preparing them for the changes that the project will bring into the health care facility. The staff would play a vital role in carrying out the project; therefore, sufficient education lasting for around six months would be necessary (Schwulst, 2014). The next phase after this stage would be the implementation of the plan, which should take place after a minimum of one year from the approval date. It would watch over the official opening or launching of the project and supervise the early stages of its implementation. Lastly, the final stage would include plan analysis so far; the achievements, the benefits, and sustainability. It is this phase that the stakeholders would be able to make recommendations on whether to proceed or terminate the project (Gallagher-Ford, 2011).
Resources for Implementation
Resources needed for a successful implementation of this plan are vast. First, educational material including Power Point projector, stationeries, pamphlets, and others would be essential to facilitate the educational programs and training of nurses. Power Point projection outlining the process and various stages of the project would be used during meetings with all the stakeholders. All the nurses' staff and other stakeholders would be issued with pamphlets containing a detailed rationale for the implementation plan. Writing pads and pens will also be essential during educational forums that would gear towards convincing the staff on the significance of the new plan. Assessment tools such as questionnaires and surveys would also be required to conduct a successful evaluation of this project.
The funds to purchase appropriate equipment and tools, hire more nurses, and facilitate staff training would also be required to assist in the implementation plan. The administration would require monetary funds to pay the facilitators of the educational programs, funds to purchase or refurbish essential tools and equipment, and funds to hire and train more nurses' staff. I would also need some capital to enable me to conduct a pre-assessment survey of staff nurses and stakeholders. The capital would assist in printing and photocopying questionnaires for the survey and data analysis.
Finally, the implementation would require human expertise and labour resources. It will need human resources such as professional lawyers to help with the legal processes concerning the implementation plan, managers, physicians, and staff nurses who will be the primary implementers of this new plan. The new plan will require the skills of these various experts to operate and maintain the new system, without which the plan may fail.
Evaluation Plan
The evaluation of this project will require a full-time assessment team that will lead the development and execution of a comprehensive project evaluation (Brim & Schoonover, 2014). The purpose of the evaluation is to focus on the impact of the new plan intended to reduce nurse turnover, improve job satisfaction, and positively impact the overall delivery of care. The proposed plan involves periodic training of the nurses’ staff, hiring more nurses, and bringing on board a break nurse and a resource nurse (Boyle, 2011). The evaluation purposes to ensure that the proposed plan accomplishes proposed output and outcome measurements (CDC, 2011). The results of this assessment will be shared with the nursing staff, the program management staff, and all the health workers community within the hospital to assist with future planning and continuous improvement efforts.
The evaluation will address the following key questions:
• Does the new plan result in low nurse turnover rate within the hospital?
• Does the program lead to improved nursing staff job satisfaction?
• Are the improvements in job satisfaction positively influence the overall delivery of care?
Method
The assessment team will conduct a pre and post participant survey to evaluate the new program (CDC, 2011). A staff of 25 nurses will complete a member survey that evaluates their attitudes and contributions to job satisfaction and dissatisfaction before the initiation of change and after initiating change. The stakeholders such as the HR manager, CEO, CNO, and DOU and ICU director will also complete the participant survey. The survey research would enable the organization to measure the need for the proposed solution and the effectiveness of the new plan.
The evaluation team will also obtain turnover rates before and after the initiation of the new program. They will acquire this data from the human resource department database, which stores all information concerning the organization’s incoming and outgoing employees. In addition, the team will compare patient discharge surveys before and after the initiation of the plan. The patient discharge surveys would enable them to determine if the new program has resulted in improved care delivery or not.
Variables
The variables that the evaluation team will assess when evaluating project outcomes include staff attitudes and perceptions, patient attitudes and perceptions, and the rate of nursing staff turnover. The nursing staff is an important variable because they are the primary care providers who get in contact with the patients most of the times, and their well-being greatly influences patient outcomes. Patient attitudes and perceptions are also critical factors in the evaluation process, as they are the benchmarks from which the assessment team measures the quality of care delivery. The rate of nursing staff turnover is a variable that largely depends on the job satisfaction and dissatisfaction of nurses.
Tools Necessary to Educate Project Participants
The first tool is PowerPoint projection; all the components of the project will be summarized and prepared in PowerPoint slides to facilitate the teaching of the plan participants. Educating the nurses’ staff on the significance of the proposed solution is vital and it helps them to prepare for the change. PowerPoint slides will contain all the information about the project including the problem, proposed solution plan, implementation methods, evaluation methods, and the significance of the proposed program. Presentation of the PowerPoint will occur during meetings, conferences, and forums with the project participants.
Another tool necessary to educate project participants are the teaching materials, including writing pads, pens, flyers or brochures, and pamphlets. The flyers or brochures will have an outline of all the components of the new program. It will provide a quick way to scan through the project’s packages, which they would be able to read in detail from the pamphlets. The writing pads and pens will be useful during the teaching-learning process of the participants to note down any points needing further explanations or for future references.
Tools Necessary to Evaluate Project’s Outcomes
The evaluation team will use survey and questionnaires to analyse the project’s results. The participants of the project including the nurses’ staff and key stakeholders will complete an anonymous survey at two intervals. The first one will be done before the initiation of the program; it will aim at finding the level of dissatisfaction among the nurses and its causes, and the second survey will be done six months after the implementation to determine if the proposed solution is yielding any positive results. The survey responses will be anonymous, and the data will be reported in aggregate.
Each project’s participant will receive a copy of a nursing workplace questionnaire that the evaluation team will use in identifying the satisfaction of the staff in the ICU and DOU. The cover sheet of the questionnaire would indicate that the answers to the individual survey would remain anonymous, the results would be shared with all stakeholders and nurses, and than...