Date of Conferral

8-8-2025

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Lilo Fink

Abstract

Executive Summary: Staff Education Project Preventing Nurse Burnout through Self-Care Strategies by Doris Iwuh MS, Walden University, 2022 BSN, Grand Canyon University, 2020 ADN, Radiance College, 2016 Executive Summary Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2025 Summary An outpatient mental health clinic identified a rise in burnout among psychiatric nurse practitioners, licensed therapists, and social workers. A gap in practice revealed that staff lacked knowledge of self-care strategies to manage burnout, leading to the project question: Does implementing an educational program for nurses and mental health specialists on self-care strategies improve staff knowledge on self-care strategies to reduce burnout, as evidenced from pre-intervention (education) to post-intervention (education) survey? This educational project utilized the ADDIE instructional design model and the Johns Hopkins Evidence-Based Practice (JHEBP) framework to review 10 peer-reviewed articles. The articles were retrieved from CINAHL, PubMed, and PsycINFO in collaboration with a Walden University librarian and used to develop a PowerPoint-based staff education session. Sixteen behavioral health professionals attended one of two in-person sessions and received an intervention on self-care and burnout prevention, supported by a validated 10-item pre- and post-assessment. All participants completed both surveys, with scores rising from 48.75% to 83.75%, a 35-point gain. A paired t test confirmed the significant improvement, t (15) = -27.112, p < .001, showing the intervention’s impact on staff knowledge of self-care strategies to manage burnout. Organizations can support workforce sustainability by prioritizing staff education on self-care, enhancing staff well-being and service delivery in psychiatric settings, and promoting social change. Background Burnout is a chronic occupational condition characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. It is highly prevalent in outpatient behavioral health settings, where mental health providers are exposed routinely to intense emotional demands, insufficient staffing, and minimal wellness resources (Weikel & Fisher, 2022). National data show that over 50% of nurses and nearly 60% of mental health professionals report symptoms of burnout, and its widespread impact across healthcare settings (American Nurses Foundation, 2023; U.S. Department of Health and Human Services, 2022). At the practicum site, core team members, including a psychiatric nurse practitioner, therapists, and a social worker, exhibited signs of burnout like stress, fatigue, and emotional strain. Despite these concerns, no formal self-care education or wellness support systems were in place, highlighting a significant gap in the organization’s approach toward burnout. An environmental scan and informal interviews revealed a knowledge gap in self-care strategies among staff, supported by human resource data on stress and absenteeism, indicating the need for targeted intervention. Input from clinical leadership, frontline staff, and content experts shaped the project focus. Peer-reviewed evidence further confirmed the effectiveness of education in reducing burnout among mental health providers. These steps collectively informed the formulation of the project question: Does implementing an educational program for nurses and mental health specialists on self-care strategies improve staff knowledge on self-care strategies to reduce burnout, as evidenced from pre-intervention (education) to post-intervention (education) survey? Staff Education Project Development This project followed the ADDIE model, consisting of analysis, design, development, implementation, and evaluation (Quigley, 2019), to guide the creation of a staff education program on self-care strategies. During the analysis, staff interviews and human resource data revealed burnout symptoms and knowledge gaps. In the design/development phases, project tools, including a validated 10-item pre-/post-survey, expert evaluation forms, and a PowerPoint presentation, were created using peer-reviewed evidence and approved by two mental health content experts. The implementation phase involved two in-person sessions delivered to 16 staff after obtaining project approvals. For evaluation, pre-/post-survey results were compared to assess knowledge gains. The project aligned with Walden University’s (2022) DNP Project Process Guide, using the JHEBP framework to organize evidence. Analysis Project analysis began with identifying a gap in practice through informal staff interviews and human resources records. The findings revealed high stress levels, absenteeism, and limited knowledge regarding self-care strategies among staff members, as the practicum site had no structured training on managing workload or emotional well-being. A critically appraised literature review using Walden University library databases and 10 peer-reviewed articles using the JHEBP research and non-research evidence appraisal tools. The evidence supported staff education as a practical approach to improving self-care-related knowledge and reducing burnout. An organizational readiness assessment, SWOT analysis, and stakeholder analysis indicated strong leadership support, alignment with institutional goals, and staff willingness to participate. These analyses supported the need for an educational project development to increase staff knowledge. Design/Development The design of the educational project addressed the identified gap in staff knowledge related to self-care strategies. Development of project tools was informed by evidence from the literature and aligned to improve staff knowledge. Project materials included a 10-item pre- and post-survey to measure staff knowledge (Appendix A), evaluation forms for content experts to assess clarity and relevance (Appendix B), and an evidence-based PowerPoint presentation (Appendix C). All tools were reviewed and approved by two experienced mental health content experts. The first content expert, Mr. CA, was a board-certified psychiatric nurse practitioner with over 10 years of experience in clinical education and burnout prevention. The second content expert, Mr. EU, a licensed therapist and supervisor at the practicum site, had extensive experience in professional development and mental health program implementation. The tools created are under Walden University’s requirements for staff education projects and reflect key themes identified in the literature review. Implementation These educational sessions were implemented after approval from the site preceptor and faculty advisor and completion of Walden University’s ethics pledge. Once approved, sessions were held through two in-person sessions to accommodate varying staff work schedules. A total of 16 outpatient mental health professionals participated in the sessions. At the start of each session, participants were informed of the project’s purpose and the voluntary nature of their participation, with implied consent granted upon completion of the survey tools. Each session began with a pre-intervention survey, followed by a PowerPoint-based presentation that covered self-care strategies such as boundary-setting, mindfulness, nutrition, and stress management. After the session, participants completed a post-intervention survey to assess changes in their knowledge. Evaluation The final step of the ADDIE model was the evaluation of knowledge outcomes. This evaluation involved comparing participants’ pre- and post-survey scores to assess changes in staff knowledge following the educational intervention, where a 10-item survey was completed anonymously and matched using participant-generated letter codes. The survey data were input manually into Microsoft Excel and analyzed using inferential statistics, specifically a paired one-tailed t test, to determine the statistical significance of changes in knowledge scores and evaluate the educational intervention’s effectiveness in improving staff knowledge of self-care strategies for burnout prevention. The evaluation process adhered to Walden University’s (2022) DNP Project Process Guide, which supports structured, evidence-based methods to evaluate outcomes in staff education projects. Results Participants included a diverse group of behavioral health professionals, psychiatric nurse practitioners, licensed therapists, and social workers, working in an outpatient mental health clinic. Content Expert Findings Two content experts completed a review of the educational PowerPoint and pre- and post-surveys using the content expert evaluation forms (see Appendix B). Both reviewers evaluated the educational content’s relevance, clarity, and alignment with the project’s goals. They rated all items on the survey tool as “very relevant,” resulting in a relevance score of four across all domains. Their feedback supported the appropriateness of the educational content in promoting staff knowledge of burnout and self-care strategies and confirmed that the material was explicit, informative, and well-organized. Pre- and Post-Survey Results The pre- and post-educational intervention survey results improved participants’ knowledge, with an average increase of 35 percentage points in scores (see Table 1). All 16 participants showed gains in knowledge, with notable improvements in areas such as recognizing signs of burnout and identifying resources for mental well-being. The pre-test average score was 48.75%, while the post-test average increased to 83.75%, indicating the effectiveness of the training. To assess whether this improvement was statistically significant, a paired one-tailed t test was conducted (see Table 2). The analysis yielded a t value of -27.112 with 15 degrees of freedom, and a p-value of < 0.001, confirming a statistically significant increase in knowledge. These findings indicate that the educational intervention significantly improved participants’ understanding of self-care strategies and burnout prevention. Table 1 Survey Results Participant Pre-Test (%) Post-Test (%) Change in Score (%) Participant 1 50 80 30 Participant 2 50 90 40 Participant 3 50 80 30 Participant 4 50 80 30 Participant 5 50 90 40 Participant 6 50 80 30 Participant 7 50 90 40 Participant 8 50 80 30 Participant 9 50 80 30 Participant 10 50 90 40 Participant 11 50 80 30 Participant 12 50 90 40 Participant 13 50 80 30 Participant 14 40 80 40 Participant 15 40 80 40 Participant 16 50 90 40 Average 48.75 83.75 35 Table 2 Paired One-Tailed T-Test Result Survey N Mean (%) SD (%) t Df P Presurvey 16 48.75% 3.416% -27.112 15 < 0.001 Postsurvey 16 83.75% 5.323% Qualitative feedback collected through open-ended survey responses supported the quantitative results. Participants described the education session as “timely” and “eye-opening.” They identified concrete takeaways such as boundary-setting, breathing techniques, and peer check-ins as valuable tools they had previously not used. One participant stated, “This session reminded me that burnout is not weakness; it’s a signal to care for myself better.” Others mentioned plans to incorporate daily breaks, use wellness apps, and initiate staff discussions about burnout. Implications and Limitations The primary impact of the project was a demonstrated increase in staff knowledge related to self-care strategies for burnout reduction. The immediate improvement in survey scores following the educational intervention highlighted the effectiveness of the PowerPoint session in addressing the identified knowledge gap. However, limitations included the small sample size of 16 participants, affecting the findings’ generalizability. Additionally, the brief duration of the project limited the ability to evaluate long-term knowledge retention. Despite these constraints, the project supports the value of brief, targeted education to address specific knowledge gaps among behavioral health staff. Importance Beyond the Local Site Although conducted at a single outpatient mental health clinic, this project addresses a broader issue faced across many behavioral health settings. Staff burnout and the lack of structured wellness support are common challenges. The structured, evidence-based nature of the intervention provides a replicable model for similar clinics seeking to improve staff knowledge through concise educational programming. The results support the relevance of staff education in outpatient settings where providers routinely face emotional demands and high stress. Conclusion This educational project highlights the need for ongoing staff education focused on burnout prevention and self-care strategies in outpatient psychiatric care. The project addressed an identified gap by improving staff knowledge of recognizing burnout and where to access wellness resources. Participants showed increased knowledge across all survey items after the intervention, confirming that structured educational sessions can efficiently raise awareness of burnout-related issues among mental health professionals. The implications for positive social change reflect how educational efforts like this can strengthen the mental health workforce through equitable access to knowledge. Expanding future sessions to include other staff groups, such as administrative personnel and interns, may extend the program’s impact. Offering flexible formats, such as asynchronous modules, can improve accessibility while ensuring continuity in learning. Regular follow-up assessments will be essential to reinforce knowledge retention. Organizations can support workforce sustainability by prioritizing staff education on self-care and improving staff well-being and service delivery in psychiatric settings.   References American Nurses Foundation. (2023). The American Nurses Foundation says action is still needed to address serious nursing workforce challenges. https://www.nursingworld.org/news/news-releases/2023/the-american-nurses-foundation-says-action-is-still-needed-to-address-serious-nursing-workforce-challenges/ 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 the Islamic Republic of Iran, 33, 77. https://doi.org/10.34171/mjiri.33.77 Chaisurin, P., & Yodchai, N. (2024). Measures to prevent and reduce healthcare worker burnout during the COVID-19 pandemic: A scoping review. SAGE Open Nursing, 10. https://doi.org/10.1177/23779608241272571 Cohen, C., Pignata, S., Bezak, E., Tie, M., & Childs, J. (2023). Workplace interventions to improve well-being and reduce burnout for nurses, physicians, and allied healthcare professionals: A systematic review. BMJ Open, 13(6), e071203. https://doi.org/10.1136/bmjopen-2023-071203 Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International. Ehsan, F., Iqbal, S., Younis, M. A., & Khalid, M. (2024). An educational intervention to enhance self-care practices among 1st year dental students—A mixed-method study design. BMC Medical Education, 24(1), 1304. https://doi.org/10.1186/s12909-024-05145-w Giordano, F., Cipolla, A., & Ungar, M. (2022). Building resilience for healthcare professionals working in an Italian red zone during the COVID‐19 outbreak: A pilot study. Stress and Health, 38(2), 234–248. https://doi.org/10.1002/smi.3096 Pahlevani, M., Ebrahimi, M., Radmehr, S., Amini, F., Bahraminasab, M., & Yazdani, M. (2015). Effectiveness of stress management training on the psychological well-being of the nurses. Journal of Medicine and Life, 8(4), 313. Romano, D., Weiser, N., Santiago, C., Sinclair, C., Beswick, S., Espiritu, R., & Bellicoso, D. (2022). An organizational approach to improve staff resiliency and wellness during the COVID-19 pandemic. Journal of Medical Imaging and Radiation Sciences, 53(4), S93–S99. https://doi.org/10.1016/j.jmir.2022.10.007 Saidel, M. G. B., Lima, M. H. M., Campos, C. J. G., Loyola, C. M. D., Esperidiao, E., & Rodriques, J. (2020). Mental health interventions for health professionals in the context of the Coronavirus pandemic. Enfermagem Uerj, 28. https://doi.org/10.12957/reuerj.2020.50782 Sist, L., Savadori, S., Grandi, A., Martoni, M., Baiocchi, E., Lombardo, C., & Colombo, L. (2022). Self-care for nurses and midwives: Findings from a scoping review. In Healthcare, 10(12), 2473. MDPI. https://doi.org/10.3390/healthcare10122473 U.S. Department of Health and Human Services, Office of the Surgeon General. (2022). Addressing health worker burnout: The U.S. Surgeon General’s advisory on building a thriving health workforce. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf Viswanathan, R., Myers, M. F., & Fanous, A. H. (2020). Support groups and individual mental health care via video conferencing for frontline clinicians during the COVID-19 pandemic. Psychosomatics, 61(5), 538–543. https://doi.org/10.1016/j.psym.2020.07.006 Walden University. (2022). Manual for staff education: Doctor of nursing practice (DNP) scholarly project. https://catalog.waldenu.edu/content.php?catoid=178&navoid=63595&hl=mission+statement&returnto=se   Appendix A: Pre/Post Survey Pre-Survey: Nursing Staff Burnout Prevention & Strategies Section 1: Demographics (Optional) 1. Current Role: ___________________________ 2. Years in Nursing Practice: [ ] <1 [ ] 1-5 [ ] 6-10 [ ] 11-20 [ ] 20+ 3. Unit/Department: _________________________ Section 2: Knowledge-Based Questions Below are the 10 multiple-choice or Likert-based items used in pre- and post-surveys. These focus solely on knowledge of burnout and self-care, not demographics. 1. What is burnout? a) Physical fatigue b) Emotional exhaustion, depersonalization, and reduced accomplishment c) Lack of interest in hobbies d) Depression 2. Which of the following is a key sign of professional burnout? a) Improved concentration b) Increased productivity c) Emotional detachment from work d) Interest in new tasks 3. Which strategy helps in setting boundaries at work? a) Working overtime regularly b) Saying yes to every request c) Communicating workload limits respectfully d) Avoiding all team meetings 4. What is one benefit of practicing mindfulness? a) Reduced empathy b) Increased stress c) Enhanced emotional regulation d) Suppressed feelings 5. Which of the following contributes most to emotional fatigue? a) Taking breaks b) Peer support c) Chronic exposure to emotionally charged situations d) Attending wellness seminars 6. Where should staff go to access mental health or well-being support resources? a) Human Resources or Employee Assistance Programs b) Social media platforms c) Personal diary d) Friends outside work 7. What does effective self-care look like in a workday? a) Ignoring breaks to finish early b) Taking regular breaks, using breathing techniques c) Skipping lunch to work more d) Checking emails during all free time 8. How can burnout be prevented in a high-stress role? a) Avoiding all emotional involvement b) Applying stress-management strategies regularly c) Isolating from coworkers d) Overcommitting to tasks 9. Which statement reflects confidence in recognizing burnout? a) “I am unsure what burnout looks like in others.” b) “I know what burnout looks like and can identify early signs.” c) “Burnout is only noticeable once severe.” d) “Burnout is not real.” 10. How can leadership support burnout prevention? a) By ignoring staff stress b) By fostering a culture of silence c) By providing wellness resources and listening to staff feedback d) By discouraging breaks Section 3: Awareness & Perceptions (Rate 1-5) ● I understand what burnout is and how it affects nursing staff. (1 = Strongly Disagree | 5 = Strongly Agree) ● I can recognize symptoms of burnout in myself or others. (1 = Strongly Disagree | 5 = Strongly Agree) ● I feel supported by leadership in managing stress and workload. (1 = Strongly Disagree | 5 = Strongly Agree) ● I use strategies to prevent or manage stress and burnout. (1 = Strongly Disagree | 5 = Strongly Agree) ● I know where to access mental health or well-being resources. (1 = Strongly Disagree | 5 = Strongly Agree) Section 4: Open-Ended Questions What are the top 2-3 factors contributing to burnout in your Role? ……………………………………………………………………. ……………………………………………………………………. ……………………………………………………………………. What strategies or tools do you currently use to manage burnout? ……………………………………………………………………. ……………………………………………………………………. ……………………………………………………………………. What would you like to learn or gain from this session/training? ……………………………………………………………………. ……………………………………………………………………. ……………………………………………………………………. Post-Survey: Nursing Staff Burnout Prevention & Strategies Section 1: Knowledge-Based Questions Below are the 10 multiple-choice or Likert-based items used in pre- and post-surveys. These focus solely on knowledge of burnout and self-care, not demographics. 11. What is burnout? a) Physical fatigue b) Emotional exhaustion, depersonalization, and reduced accomplishment c) Lack of interest in hobbies d) Depression 12. Which of the following is a key sign of professional burnout? a) Improved concentration b) Increased productivity c) Emotional detachment from work d) Interest in new tasks 13. Which strategy helps in setting boundaries at work? a) Working overtime regularly b) Saying yes to every request c) Communicating workload limits respectfully d) Avoiding all team meetings 14. What is one benefit of practicing mindfulness? a) Reduced empathy b) Increased stress c) Enhanced emotional regulation d) Suppressed feelings 15. Which of the following contributes most to emotional fatigue? a) Taking breaks b) Peer support c) Chronic exposure to emotionally charged situations d) Attending wellness seminars 16. Where should staff go to access mental health or well-being support resources? a) Human Resources or Employee Assistance Programs b) Social media platforms c) Personal diary d) Friends outside work 17. What does effective self-care look like in a workday? a) Ignoring breaks to finish early b) Taking regular breaks, using breathing techniques c) Skipping lunch to work more d) Checking emails during all free time 18. How can burnout be prevented in a high-stress role? a) Avoiding all emotional involvement b) Applying stress-management strategies regularly c) Isolating from coworkers d) Overcommitting to tasks 19. Which statement reflects confidence in recognizing burnout? a) “I am unsure what burnout looks like in others.” b) “I know what burnout looks like and can identify early signs.” c) “Burnout is only noticeable once severe.” d) “Burnout is not real.” 20. How can leadership support burnout prevention? a) By ignoring staff stress b) By fostering a culture of silence c) By providing wellness resources and listening to staff feedback d) By discouraging breaks Section 2: Reflection & Learning (Rate 1-5) ● I have a better understanding of the causes and signs of burnout. (1 = Strongly Disagree | 5 = Strongly Agree) ● I feel more confident in identifying burnout in myself and others. (1 = Strongly Disagree | 5 = Strongly Agree) ● I learned specific strategies to help reduce or prevent burnout. (1 = Strongly Disagree | 5 = Strongly Agree) ● I plan to apply new stress-management strategies in my routine. (1 = Strongly Disagree | 5 = Strongly Agree) ● I feel more supported and empowered in my nursing role. (1 = Strongly Disagree | 5 = Strongly Agree) Section 3: Open-Ended Feedback What strategy or takeaway from the session was most helpful to you? ……………………………………………………………………. ……………………………………………………………………. ……………………………………………………………………. What changes (if any) do you plan to make after this training? ……………………………………………………………………. ……………………………………………………………………. ……………………………………………………………………. What additional support or resources would help you manage burnout? ……………………………………………………………………. ……………………………………………………………………. …………………………………………………………………….   Appendix B: Content Expert Project Evaluation Forms 1 and 2 Content Expert Form 1 INSTRUCTIONS: Please review each item below to determine whether the question reflects the objectives of the educational intervention and accurately corresponds to the content covered in the project. These items were used in the pre-/post-surveys to evaluate staff knowledge on burnout awareness, prevention, and self-care strategies. Please check the box that best reflects your Evaluation of each test item. Pre/Post-Test Item # Not Relevant Somewhat Relevant Relevant Very Relevant Comments 1 ☐ ☐ ☐ ☒ Clear understanding of burnout signs. 2 ☐ ☐ ☐ ☒ Highlights the importance of recognizing symptoms early. 3 ☐ ☐ ☐ ☒ Effectively addresses leadership support roles. 4 ☐ ☐ ☐ ☒ Practical and applicable strategies introduced. 5 ☐ ☐ ☐ ☒ Promotes access to mental health resources. 6 ☐ ☐ ☐ ☒ Reinforces understanding of burnout causes. 7 ☐ ☐ ☐ ☒ Encourages awareness of systemic barriers. 8 ☐ ☐ ☐ ☒ Strong focus on communication and engagement. 9 ☐ ☐ ☐ ☒ Realistic commitment to applying strategies. 10 ☐ ☐ ☐ ☒ Directly supports self-efficacy and empowerment.   Content Expert Evaluation: Form 2 Below are the responses from Content Experts A & B about the educational intervention and project outcomes. I. Project Overview This DNP project implemented a staff education program to increase mental health providers’ knowledge and confidence in recognizing, preventing, and managing burnout through structured self-care strategies. a. Please describe this project’s effectiveness (or not) related to communication, motivation, and outcomes. Content Expert A: The training presented well-researched, easy-to-understand strategies that encourage meaningful reflection. It enhanced communication around burnout and gave staff tools to manage emotional fatigue more confidently. Content Expert B: The project was motivational and effective. It empowered clinicians to acknowledge burnout risks and motivated them to apply daily wellness strategies. The material also supported inclusive and practical applications across disciplines. b. How do you feel about your involvement as a content expert? Content Expert A: It was rewarding to contribute to a project that prioritized provider well-being. I appreciated the thoughtful structure of the session and the student’s commitment to improving clinical culture. Content Expert B: Being a content expert was meaningful. I appreciated the opportunity to collaborate and felt that the student demonstrated initiative, professionalism, and a passion for improving mental health support systems. c. What aspects of the project would you like to see improved? Content Expert A: Adding refresher modules or ongoing support would strengthen sustainability. More follow-up is needed to measure the long-term impact. Content Expert B: I suggest incorporating asynchronous or recorded content to reach part-time staff and those unable to attend in real-time. II. Pre/Post-Test Evaluation Was the pre-/post-test relevant to the content? Content Expert A: Yes, all items were aligned with the learning goals and measured relevant knowledge areas such as burnout indicators, leadership support, and resource awareness. Content Expert B: Yes, the test design effectively captured knowledge improvement and encouraged self-reflection among staff. Share how you might have changed the project. Content Expert A: I would include practical examples or mini-case studies to illustrate real-world burnout scenarios and coping responses during the training. Content Expert B: Interactive case-based discussions or brief role-playing could enhance understanding and encourage peer learning during sessions. III. Leadership Evaluation How did the student direct the team to meet the project goals as a team leader? Content Expert A: The student maintained excellent communication, managed logistics efficiently, and encouraged team feedback throughout the planning and delivery of the project. Content Expert B: She led with clarity and empathy, provided regular updates, and fostered a supportive environment where staff felt encouraged to participate and share insights. IV. Suggestions for Improvement Content Expert A: The student was well-prepared and professional. I suggest future projects explore ways to measure emotional well-being longitudinally post-training. Content Expert B: This project could be expanded by integrating digital wellness platforms or offering peer mentorship opportunities to reinforce self-care practices in clinical settings.   Appendix C: Education Presentation

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