The Effect of Mindfulness Training Program on Nursing Staff Stress Level
Author Name (First, Middle Initial, Last)
College of Health Professions, Western Governors University
D219: Scholarship in Nursing Practice
Instructor’s Name
Date
The Effect of Mindfulness Training Program on Nursing Staff Stress Level
Impact of the Problem on the Patient
Stress has emerged as one of the significant concerns facing healthcare professionals in healthcare facilities. The frontline healthcare workers most likely to experience stressors are nurses. Nurses experience high-stress levels due to complex job needs and demands, excessive responsibility, and high expectations (Babapour et al., 2022). Increased stress level among the nursing staff has significant adverse effects on patients. Firstly, nurses’ stress adversely affects patient quality of care. Supporting this statement, Babapour et al. (2022) reveal that stress causes a loss of concern for patients and increases occurrences of medical errors, adversely affecting patients’ quality of care. On a different note, Lim et al. (2022) urge that job stress among nurses curtail nurses’ organizational commitment and work efficiency, thus, reducing patient satisfaction. Furthermore, nursing staff job stress affects patient outcomes. Supporting this statement, Babapour et al. (2022) urge that nurses’ job stress endangers nurses’ mental and physical health reduces work efficiency and results in the provision of poor healthcare, which adversely impacts patient outcomes.
Impact of the Problem on the Organization
Increased stress levels among nursing staff adversely the healthcare facilities. Firstly, nurses’ stress causes increased organizational turnover. Research reveals that increased stress among nurses causes burnout, which increases organizational turnover (Kelly et al., 2021). Also, nurses’ stress adversely impacts organizational efficiency. Ardıç et al. (2022) reveal that nursing staff job stress lowers nurses’ job motivation, decreasing their performance. Consequently, this adversely affects the overall organizational performance. Lim et al. (2022) urge that managing nurses’ job stress is a significant way of promoting work efficiency in healthcare facilities and advancing nursing organizations. From this, it can be logically inferred that nursing staff job stress negatively impacts healthcare organizations; efficiency.
Identify the PICO components.
P – Nursing staff
I – implementing mindfulness
C – Not implementing mindfulness
O – Reduced stress levels
Evidence-Based Practice Question
In hospital nurses, does implementing mindfulness reduce stress levels compared to not implementing mindfulness?
Research Article
Background Introduction
The chosen research article is a study by Ghawadra et al. (2020), which examined the impact of a four-week mindfulness-based training intervention on improving job satisfaction, depression, stress, and anxiety among nurses. Ghawadra et al. (2020) revealed that nurses have high stress, depression, and anxiety due to job-related challenges. Increased emotional distress increases nurse burnout, reduces job satisfaction, decreases nursing productivity, and reduces the quality of patient care. Ghawadra et al. (2020) revealed that although mindfulness is recognized as a psychological intervention for reducing stress among healthcare professionals, there is a scarcity of Randomized Controlled Clinical Trials (RCTs) examining the impact of mindfulness on stress levels. This study was aimed at filling this research gap.
Methodology
The researchers utilized a RCT for nursing staff who were considered to have a moderate level of either depression, stress, or anxiety using DASS-21 tool adopted from a past study. The researchers used stratified block randomization to randomly assign participants to the control and intervention groups. Participants included ward nurses serving in Critical Care Units (ICU), pediatric, medical, obstetrics and gynecology, and surgical departments. The mindfulness intervention used in the study was MINDFULGym. It entailed a two-hour workshop, which was followed by four weeks of self-practice. Data were collected using a survey questionnaire to ensure optimal understanding of nurses. The sample size was determined using a sample size calculator programme known as G*Power 3.1. Participants were evaluated prior to the workshop, immediately after the implementation of intervention, and eight weeks later. Evaluations were performed using the Mindful Attention Awareness Scale, DAS Scale-21, and Job satisfaction scale.
Level of Evidence
Usually, studies are assigned levels of evidence based on the study’s methodological quality, design, validity, and pertinence to patient care. The selected research article has Level I evidence. This is because the study adopts a well-designed RCT, where participants were assigned to control and intervention groups using stratified blocked randomization. According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, Level I evidence involves experimental study using RCT design (Dang et al., 2022).
Data Analysis
SPSS Version 25.0 was utilized to analyze the data. Independent T-tests, Descriptive statistics, and Chi-Square tests were performed to compare groups for study outcomes and participant characteristics. The Generalized Estimating Equation (GEE) was utilized to examine the impact of MBT over time between the control and intervention groups as well as withi interaction between groups and time. Furthermore, the effect size formula was used to calculate the size of the effect.
Ethical Considerations
This study had Institutional Review Board (IRB) approval. It was approved by the University of Malaya Medical Centre’s (UMMC) Ethical Review Committee. Also, potential participants were fully informed about the study before being recruited to take part in the study. Furthermore, participants were given informed consent form to sign before participating in the study, which served as proof of their voluntary participation.
Quality Rating
According to quality guides, there are three categories of quality ratings of evidence, where quality rating A is high quality, B is good quality, and C is low quality. The chosen research article has high-quality evidence and hence has a quality rating of A. This is because it uses a RCT design. Dang et al. (2022) reveal that RCT studies have high-quality evidence and belong to quality rating A because they have generalizable results, are consistent, have a sufficient sample size, have consistent recommendations, and have definitive conclusions.
Analysis of the Results / Conclusions
GEE analysis results showed that there was a significant effect over time on depression (p<0.001), anxiety(p=0.001), stress(p<0.001), and mindfulness levels (p<0.001). However, it was insignificant for job satisfaction. In regards to the difference between groups, findings revealed significant effects on job satisfaction and anxiety, but effects were not significant on stress, mindfulness, and depression. Furthermore, results showed significant effects on interactions between group and time for job satisfaction increase (p=0.04) and anxiety reduction (p=0.008), with a small effect size for job satisfaction (0.221) and moderate size for anxiety (0.465). Thus, the researchers concluded that mindfulness-based training effectively improves job satisfaction and reduces anxiety levels among nursing staff.
This article helps answer the EBP question, which examines whether implementing mindfulness as compared to not implementing mindfulness reduce stress levels among nursing staff because it provides empirical evidence on the impact of mindfulness-based training intervention on stress level among nurses.
Non-Research Article
Background Introduction
The chosen non-research article is by Anderson (2021). In the article, the author evaluates mindfulness-based intervention for reducing stress among nurses who serve in the Critical Care Unit. Anderson (2021) reveals that serving in the critical care unit is very stressful for nurses. Given that mindfulness-based stress reduction programmes have emerged as a way to manage stress among nursing staff, the author introduced a quality improvement initiative to examine how the mindfulness-based intervention for reducing stress impacts nurses in terms of their perceived stress, quality of life, and sickness and absence rates, and mindfulness awareness.
Type of Evidence
The type of evidence used in this non-research article is a quality improvement project. This is clear even in the topic of the article, where the author has indicated that the article is a quality improvement project.
Level of Evidence
The Level of evidence for the selected non-research article is Level V. Based on the JHNEBP model, quality improvement evaluation is non-research evidence and has Level V evidence (Dang et al., 2022). Therefore, since the chosen non-research article is a quality improvement evaluation, it has Level V evidence.
Quality Rating
The chosen non-research article has a quality rating of B. According to the JHNEBP model quality guide, articles with good quality have a quality rating of B and are characterized by reasonable, consistent findings, a sufficient sample size, fairly definitive conclusions, and rational, consistent conclusions based on a reasonable comprehensive literature review that entails some reference of scientific evidence (Dang et al., 2022). The chosen non-research article has fairly consistent findings and uses a sufficient sample size. Also, the chosen article has a well-developed conclusion, and recommendations are made based on the conclusion drawn from the study.
Author’s Recommendations
Anderson (2021) concludes that mindfulness training has a positive outcome for nursing staff and patients and recommends that critical care nurses use mindfulness training since it is an accepted and feasible intervention for reducing nurses’ perceived stress, improving quality of life, and increasing awareness. The recommendations made by Anderson (2021) clearly indicate that mindfulness training assists in reducing stress among nursing staff, which provides an answer to the ERP question, which seeks to uncover whether implementing mindfulness as compared to not implementing mindfulness reduces stress levels among nursing staff.
Recommended Practice Change
The recommended practice change is implementing mindfulness training among nurses in healthcare facilities. Based on the articles reviewed, it is evident that mindfulness training assists in reducing stress levels among nursing staff.
Key Stakeholders
The three key stakeholders who would be involved in supporting the practice change recommendation include mindfulness coach, suppliers, financial organizations, and policymakers. The mindfulness coach would be involved in helping the nurses to remain mindful in life. Usually, mindfulness coaches utilize various coaching tools and techniques to assist clients in focusing better and relaxing more. Thus, this stakeholder will use these tools to help nurses relax and focus better. Suppliers and financial organizations will support the recommended practice change by providing the financial help required to implement the training programme. The finances will be used to pay coaches and purchase training materials. Lastly, policymakers will be involved in the recommended change by setting a mandatory training attendance policy to ensure all nurses attend the mindfulness training sessions.
Barrier to Implementation
One specific barrier that may be encountered during the implementation of the recommended practice change is limited staff time to attend mindfulness training sessions. Nursing is demanding, and most nurses do not have free time (Nebhinani et al., 2020). Also, most healthcare facilities face nurse shortages which force nurses serving there to work longer hours in a shift. This may limit the nurses’ ability to attend mindfulness training sessions as sometimes these sessions may begin while they are still on duty.
Strategy to Overcome the Implementation Barrier
One strategy to overcome the barrier of limited staff time to attend mindfulness training sessions is the use of online training. Hospitals can ensure that mindfulness training sessions are conducted online. Online training is convenient and will allow nurses to learn at their place and at their convenient time. Also, online learning requires less time than physical learning, which will help overcome the barrier of limited time.
Indicator to Measure the Outcome
One tool that can be used to measure the outcome of the recommended practice change is Depression Anxiety Stress Scales-21 Items (DASS-21). This is a set of 3 self-report scales intended to measure an individual’s emotional states of Depression, Anxiety, and Stress. Notably, the levels of depression, anxiety, and stress will be measured pre- and post-implementation of the mindfulness-based intervention. The score for stress will be used to determine if the stress level reduces upon implementation of the mindfulness training programme.
References
Anderson, N. (2021). An evaluation of a mindfulness‐based stress reduction intervention for critical care nursing staff: A quality improvement project. Nursing in critical care, 26(6), 441–448. https://doi.org/10.1111/nicc.12552Ardıç, M., Ünal, Ö., & Türktemiz, H. (2022). The effect of stress levels of nurses on performance during the COVID-19 pandemic: the mediating role of motivation. Journal of Research in Nursing, 27(4), 330-340. https://doi.org/10.1177%2F17449871211070982Babapour, A. R., Gahassab-Mozaffari, N., & Fathnezhad-Kazemi, A. (2022). Nurses’ job stress and its impact on quality of life and caring behaviors: a cross-sectional study. BMC nursing, 21(1), 1-10. https://doi.org/10.1186%2Fs12912-022-00852-yDang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: model and guidelines. Sigma Theta Tau.
Ghawadra, S. F., Lim Abdullah, K., Choo, W. Y., Danaee, M., & Phang, C. K. (2020). The effect of mindfulness‐based training on stress, anxiety, depression and job satisfaction among ward nurses: A randomized control trial. Journal of nursing management, 28(5), 1088-1097. https://doi.org/10.1111/jonm.13049Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96–102. http://dx.doi.org/10.1016/j.outlook.2020.06.008Lim, J. Y., Kim, G. M., & Kim, E. J. (2022). Factors Associated with Job Stress among Hospital Nurses: A Meta-Correlation Analysis. International Journal of Environmental Research and Public Health, 19(10), 5792-5807. https://doi.org/10.3390/ijerph19105792Nebhinani, M., Kumar, A., Parihar, A., & Rani, R. (2020). Stress and coping strategies among undergraduate nursing students: A descriptive assessment from Western Rajasthan. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 45(2), 172. https://doi.org/10.4103%2Fijcm.IJCM_231_19
