Date of Conferral

2-19-2025

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Barbara Barrett

Abstract

Summary This Doctor of Nursing Practice (DNP) project focused on addressing burnout for staff nurses working in a psychiatric hospital. Evidence indicated that burnout among nurses, caused by emotional stress and heightened responsibilities, may result in increased medical errors, diminished patient satisfaction, and significant dangers to patient safety and care. The practice-focused question for this project addressed whether a mindfulness-based educational intervention program would increase staff knowledge and decrease burnout among nurses working in a psychiatric hospital. The program incorporated a pretest/posttest format, educational content delivered via a PowerPoint presentation that included an interactive mindfulness meditation training session, and a posteducation program satisfaction survey. Fourteen of 22 staff nurses participated in the in-person educational sessions. After the intervention, analysis of the project data was performed using descriptive statistics and an Excel spreadsheet for comparative analysis. Postintervention, all 14 nurses improved their scores, with eight achieving 100% and 93%, respectively. The project found that incorporating mindfulness techniques in a psychiatric hospital significantly enhanced staff knowledge about reducing burnout. This initiative has the potential to positively impact nursing practice and social change by fostering a healthier and more engaged nursing staff, which could result in superior patient outcomes. This program can promote diversity, equity, and inclusion by fostering empathy, self-awareness, and active listening, enabling individuals to comprehend and value differing perspectives and experiences without judgment, essential for establishing an inclusive environment. Background The objective of this DNP project was to develop and implement a staff education program that utilizes mindfulness interventions and techniques to address burnout and manage stress for staff nurses in an inpatient psychiatric hospital. Nurses’ daily work presents them with an elevated level of tension in understaffed environments (Copeland, 2020). Some staff nurses need an education program to mitigate stress-related burnout because they lack practical strategies and knowledge about interventions that would enhance their efficiency in psychiatric facilities (Copeland, 2020). Project Question and Project Purpose The practice-focused question for this project addressed whether a mindfulness-based educational intervention program would increase staff knowledge and decrease burnout among nurses working in psychiatric hospitals. This educational initiative was aimed at the nursing staff in a psychiatric hospital about mindfulness education to address burnout. The purpose of the program was to equip nurses with strategies to mitigate stress and burnout. Staff nurses experiencing stress and burnout without knowledge of techniques to alleviate their symptoms were appropriate candidates for the education program. Gap in Practice After analyzing de-identified staff data through the human resource department on documented stress, the nursing management team gave me data regarding the problem to determine whether the hospital employed a method to mitigate burnout that would address this practice gap. Nurses sometimes encounter more stress, diminished sleep, and a greater propensity for burnout than other health care personnel (Khatatbeh et al., 2021). Implementing a mindfulness education intervention to alleviate burnout among staff nurses could address knowledge gaps and improve the management of symptoms nurses and their unit peers face. Evidence Supporting the Change I used the Medline, CINAHL, EBSCOhost, Ovid Plus, and PubMed databases and the Google Scholar search engine in Walden University Library to gather evidence from sources used for the project. Supporting material was also obtained utilizing online resources, medical publications, the Centers for Disease Control and Prevention, and the World Health Organization. Peer-reviewed research articles published in English between 2020 and 2024 were analyzed to identify effective strategies for reducing nurse burnout and alleviating stress among staff nurses delivering direct patient care. The searched keywords included nurse, nurses, nursing, nursing staff, registered nurse, stress reduction, stress management, stress, coping strategies, stress interventions, stress management techniques, turnover, staff education, staff training, staff development, professional development, and staff knowledge. Key phrases were combined using the Boolean operators AND and OR. The key phrases included search terms such as stress and burnout, stress reduction strategies in healthcare, the impact of stress on long-term care units, inadequacies in stress management among nursing staff, and staff training on stress reduction. The clinical practice problem of staff burnout served as the primary focus of the literature review. My search was for peer-reviewed research articles published between 2020 and 2024 on effective strategies for minimizing nursing burnout and easing stress among staff nurses delivering direct patient care, which produced 1,364 results in CINAHL and 142 results in PubMed. After evaluating titles and s, I eliminated 1,220 articles due to duplication or lack of relevance to the designated population (patients, students, physicians, and other hospital staff) or subject matter. Twenty-five studies were chosen for comprehensive analysis, and 10 were included in the final literature review for the project. Strength of the Evidence The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) approach was employed to facilitate the incorporation of the best evidence for the project. The JHNEBP model provides assessment questions for several study types: quantitative research, systematic reviews, qualitative research, meta-synthesis, mixed techniques, and nonresearched (including clinical practice guidelines, literature reviews, and expert opinions). The JHNEBP research evidence appraisal tool was used to rate 10 evidence-based articles. Five articles had a Level I rating, five had a Level II rating, and all had a B (good quality) rating. Staff Education Project Development The participants in this staff education initiative were registered nurses working at a psychiatric hospital. The nurse participants were recruited voluntarily, and they were informed that completing the pretest would serve as their consent. Twenty-two staff nurses received a program invitation notification, including time and location details in the organization’s email portal. Fourteen staff nurses (N = 14) participated in the in-person educational intervention. The project lacked control and experimental groups. A background review of the hospital’s strategy for preventing burnout catalyzed this practice change project. A signed site agreement was obtained, approving the project to proceed at the facility. After I identified deficiencies in the facility’s existing procedures for combating burnout, I conducted a search of the literature for supporting evidence to formulate the educational session. Following permission from the Walden University Institutional Review Board, advertising and recruitment of the project began via company email with a program invitation, including the time and location details. The pre- and posttests were developed using evidence-based information. The tests were administered in paper format, utilizing unique identifiers, and were provided in English (see Appendix A). I created a postprogram survey for participants to evaluate the overall program after the posttest (see Appendix B). To assist me in developing the program, I used the Analyze, Design, Develop, Implement, and Evaluate approach, which is a proven instructional design model that aided me in developing the course’s structure (see Luo et al., 2024). This education program addressed the practice gap among staff nurses on burnout reduction in mental wards and yielded recommendations for the organizational partners to enable sustainable implementation. Fourteen registered nurses participated in a 60-minute in-person teaching session through a PowerPoint presentation and completed identical pre- and posttests. The pretest/posttest was utilized to assess academic outcomes, and the data were evaluated for comparison to measure the program’s effectiveness. The data were assessed and compared to identify potential improvements in understanding mindfulness approaches for mitigating stress-related burnout. The integrity of the evidence was preserved by ensuring anonymous completion of pre- and posttests and withholding individual remarks before the program to prevent biased responses. Results The staff education program examined the impact of implementing a staff educational intervention on mindfulness techniques on nurses’ knowledge of stress management and burnout prevention. After the program, I conducted a data analysis of the pretest scores and posttest scores using descriptive statistics and structured the results in an Excel spreadsheet. I used inferential statistics to determine whether there was a statistically significant difference between pre- and posttest scores and descriptive statistics to describe the sample. Results were demonstrated by a variation in the number of accurate responses from nurses before and after the training, indicating that participant knowledge improved after the implementation of this program. The pretest and posttest scores are presented in Table 1. Table 1 Pretest and Posttest Scores Participant Pretest Posttest Improvement Participant 1 53.3% 93.3% 40% Participant 2 60% 93.3% 33.3% Participant 3 73.3% 93.3% 33.3% Participant 4 73.3% 93.3% 20% Participant 5 73.3% 93.3% 20% Participant 6 73.3% 93.3% 20% Participant 7 40% 100% 40% Participant 8 60% 100% 33.4% Participant 9 66.6% 100% 33.4% Participant 10 66.6% 100% 33.4% Participant 11 66.6% 100% 33.4% Participant 12 73.3% 100% 26.7% Participant 13 73.3% 100% 26.7% Participant 14 80% 100% 20% A graphical depiction of the pretest and posttest scores is also presented in Figure 1. Significant weight can be attributed to the data results indicating that individuals possessed improved knowledge regarding mindfulness techniques after the delivery of the program content. An enhanced understanding of this knowledge acquisition could be beneficial for designing and implementing future DNP projects such as this staff education initiative. Figure 1 Knowledge Improvements Impact on the Organization This DNP initiative may positively impact the organization by equipping staff nurses with the necessary tools to prevent work-related stress and burnout. The education program emphasized traditional strategies and added novel ones. Although several nurses reported managing their stress, the leadership team’s findings indicated that nurses do not apply these approaches in their daily care practices. The project’s outcomes may positively impact employees and the company’s overall operations, structure, and performance, potentially resulting in extensive changes throughout all organizational levels. Given the findings that depression may affect burnout in nurses, educational interventions are essential for preventing burnout despite high workloads (Chen & Meier, 2021). Stress and burnout psychologically influence health care workers, leaving them worn out and leading to poor attitudes and performance (Conversano et al., 2020). The decreased performance could affect employee job satisfaction, increase absenteeism rates, and negatively impact the health care organization’s operations. Nurses often experience high stress levels, making them vulnerable to its effects (Conversano et al., 2020). Employers need to recognize work-related stressors and implement strategies to improve the quality of care. Mindful meditation is a valuable resource for employees with high stress levels because it improves adverse effects and reduces burnout (Lee & Cha, 2023). Limitations and Results The project highlighted the challenges faced by staff and the causes of work-related stress, promoting nurses’ interest in combating burnout. The project’s limitations included the small number of participants, which impacts the generalizability of the results. Fourteen of the 22 staff nurses completed the program, which was expected to include 22. Additionally, due to an unexpected site visit from the Joint Commission, I was not able to discuss the plan for implementation of the program once the project was completed; however, recommendations were provided after the project was completed. Influence Beyond the Local Site Mindfulness interventions such as meditation can lead to better patient care, reduced errors, improved relationships, and increased job satisfaction (Lee & Cha, 2023). Mindfulness techniques for staff could also improve patient experience scores, make the facility a preferred choice, and reduce regulatory costs. This educational intervention may benefit not only the current staff nurses and the hospital but also new hires who will have the opportunity to benefit from the PowerPoint presentation if shared with other sites. Conclusions This mindfulness education intervention aimed to improve nurses’ understanding of mindfulness techniques to reduce stress-related burnout. Data collected from staff training sessions showed increased nurses’ knowledge of mindfulness techniques, a tool used to improve cognitive resources, focus, awareness, empathy, efficiency, and team dynamics. The program reduced the knowledge gap among nurses. Recommendations Based on the findings from this DNP project, implementing an educational intervention focused on mindfulness methods should be considered to assist the staff in addressing burnout. This program could be administered to staff in various ways, including in person or via the hospital’s email portal with other required education. Based on participant feedback, the program could be offered in new employee orientation. Lastly, mindfulness techniques reminders could be displayed in breakrooms, restrooms, and other staff locations to encourage individuals to take a moment to be present. Implications for Nursing Practice This initiative may have implications for nursing practice by fostering a healthier and more engaged nursing staff. The positive impact on social change includes enhanced nurse well-being resulting in reduced burnout, which has the potential to enhance patient outcomes. Mindfulness techniques can promote diversity, equity, and inclusion by fostering empathy, self-awareness, and active listening, enabling individuals to comprehend and value differing perspectives and experiences without judgment, which is essential for establishing an inclusive environment (Campos et al., 2019). References Campos, D., Modrego-Alarcón, M., López-del-Hoyo, Y., González-Panzano, M., Van Gordon, W., Shonin, E., Navarro-Gil, M., & García-Campayo, J. (2019). Exploring the role of meditation and dispositional mindfulness on social cognition domains: A controlled study. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00809 Chen, C., & Meier, S. T. (2021). Burnout and depression in nurses: A systematic review and meta-analysis. International Journal of Nursing Studies, 124, 104099. https://doi.org/10.1016/j.ijnurstu.2021.104099 Conversano, C., Ciacchini, R., Orrù, G., Di Giuseppe, M., Gemignani, A., & Poli, A. (2020). Mindfulness, compassion, and self-compassion among health care professionals: What's new? a systematic review. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.01683 Copeland, D. (2020). Brief workplace interventions addressing burnout, compassion fatigue, and teamwork: A pilot study. Western Journal of Nursing Research, 43(2), 130–137. https://doi.org/10.1177/0193945920938048 Khatatbeh, H., Pakai, A., Al‐Dwaikat, T., Onchonga, D., Amer, F., Prémusz, V., & Oláh, A. (2021). 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 Lee, M., & Cha, C. (2023). Interventions to reduce burnout among clinical nurses: Systematic review and meta-analysis. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-38169-8 Luo, R., Li, J., Zhang, X., Tian, D., & Zhang, Y. (2024). Effects of applying blended learning based on the Addie model in nursing staff training on improving theoretical and practical operational aspects. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1413032 Appendix A: Pre- and Posttest for Mindfulness Thank you for volunteering and consenting to participate in this educational intervention. It is greatly appreciated. Please create a unique ID that only you know. You won’t be asked to disclose this ID to anyone, and I don’t think you should. Your ID will only be used to reconcile your pretest and posttest results. Please do not include any more information unrelated to the questions asked. All information collected is anonymous and will only be shared as a whole. My Unique ID: ______________ Date: _____________ 1. What is mindfulness? a) A keen concentration on the future b) A mental state of being fully present and aware of the present moment c) A technique of disregarding one’s thoughts and emotions d) A category of physical activity 2. What is the essential component of mindfulness? a) Anxiety for the future b) Concentrating on the past c) Being non-judgmental and accepting of experiences d) Reverie, Daydreaming 3. Mindfulness promotes the practice of attentiveness to: a) Prospective opportunities b) Previous experiences c) The present moment d) Hypothetical situations 4. What is the opposite of mindfulness? a) Daydreaming b) Anxiety-inducing c) Concentrating on assignments d) Mind wandering 5. Mindfulness entails the acceptance of thoughts and emotions: a) Without judgment or attachment b) Through severe critique c) Exclusively affirmative ideas and feelings d) Following a thorough analysis 6. Which of the following practices is commonly associated with mindfulness? a) Multitasking b) Meditation d) Delaying tasks d) Excessive overthinking 7. Mindfulness helps individuals become more aware of their: a) Regrets from the past b) Concerns for the future c) Habits and automatic responses d) Hypothetical situations 8. Mindfulness is often practiced through various techniques, including: a) Over planning b) Daydreaming c) Meditation d) Worrying about past and future mistakes 9. What is the role of mindfulness in managing stress? a) Mindfulness elevates stress levels b) Mindfulness enables individuals to evade stress completely c) Mindfulness can reduce stress by promoting relaxation and acceptance d) Mindfulness enhances people’s sensitivity to stressors. 10. Which of the following does NOT constitute a benefit of practicing mindfulness? a) Improved concentration and focus b) Increased emotional reactivity and worrying about the past c) Enhanced emotional well-being d) Enhanced self-compassion 11. How does mindfulness improve emotional well-being? a) Through the suppression of emotions and thoughts a) Evading emotional experiences c) Through the cultivation of awareness and acceptance of emotions d) Through excessive analysis of daily emotional experiences 12. In what ways might mindfulness be incorporated into everyday life? a) Through continuous multitasking a) By concentrating exclusively on prospective objectives c) Through mindful eating, ambulation, and attentive listening b) Through the avoidance of introspection. Response 13. What is the significance of being “non-judgmental” within mindfulness? a) Exhibiting excessive self-criticism and judgment towards others b) Assessing experiences as positive or negative c) Avoiding all decision-making d) Embracing experiences in their inherent form without assessment 14. Mindfulness can assist individuals in developing: a) Impractical anticipations a) Detrimental practices c) Emotional intelligence and resilience d) Intense connection to thoughts and feelings 15. In what way can mindfulness influence interpersonal relationships? a) It results in the evasion of social encounters. b) It promotes egocentric conduct. c) It fosters empathy and promotes active listening. d) It enhances individuals’ critical assessment of others. Appendix B: Mindfulness Program Satisfaction Survey My Unique ID: ___________________ Date: ____________________ 1. The program met the learning objectives. A· Strongly agree B· Agree C· Neutral D· Disagree 2. The quality of the information was beneficial to my practice. A· Strongly agree B· Agree C· Neutral D· Disagree 3. Meeting location was comfortable for this type of activity. A· Strongly agree B· Agree C· Neutral D· Disagree 4. The length of time of the program was sufficient for the information provided. A· Strongly agree B· Agree C· Neutral D· Disagree 5. The facilitator was knowledgeable about the subject. A· Strongly agree B· Agree C· Neutral D· Disagree 6. I plan to recommend this mindfulness practice program to others. A· Strongly agree B· Agree C· Neutral D· Disagree 7. I believe the organization should incorporate this program into the hiring practices for new staff. A· Strongly agree B· Agree C· Neutral D· Disagree

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