Break habits of Registered Nurses working in the acute care setting during the COVID-19 pandemic

Background: Nurses report high levels of burnout and stress while working in the acute care setting, especially during the current COVID-19 outbreak. Evidence suggests that taking a restorative break during an extended, 12-hour shift may help mitigate stress and translate to better patient and caregiver outcomes. Yet, little is known about how Registered Nurses report taking breaks in the context of the pandemic. Purpose/Aims: The purpose of this project was to describe the frequency of breaks reported by nurses working 12-hour shifts during the COVID-19 pandemic, and to test for demographic differences between nurses reporting fewer compared to more breaks on average during a shift. Methods/Approach: Registered Nurses delivering direct patient care in a 12-hour full-time position in the hospital setting in two different regions in the United States (U.S.) were recruited for two different studies during the peak of the COVID-19 outbreak. Demographic data were collected via self-report in both studies. To measure quantity of breaks taken during a shift, participants in the Southern U.S. region were asked, “What is the frequency of breaks you normally take during your shift between 0 (no breaks) to 4 (all provided breaks)?”. Nurse participants in the Pacific Coast study were asked, “In a typical shift, how many 15- minute breaks do you take?” and “In a typical shift, how many 30-minute breaks do you take?”. The numbers of breaks reported were summed to yield a total frequency of breaks taken by the participants in both studies. Data were analyzed using descriptive statistics to quantify the number of breaks reported, and bivariate tests assessed group differences between reporting high or low frequency of breaks. Results: A total of 121 nurses working either in the Pacific Coast (n=31) or in the southern U.S. (n=90), were included. Across the dataset, the average number of breaks reported was 1.5 and nurses surveyed in the Southern U.S. were significantly more likely to report taking one or fewer breaks during their 12-hour shift compared to nurses working in states along the Pacific coast. There were no noted differences in education, age, gender, or shift type with respect to reported break frequency. Conclusion This project provides an initial glimpse into self-reported breaks of nurses delivering frontline care in the hospital setting during the COVID pandemic. Nurses may not be taking all break opportunities while working during the pandemic, and efforts should be made to support the ability of frontline caregivers to consistently take all restorative breaks each shift. Implications for Practice: Strategies for enhancing nurses’ abilities to take restorative breaks are critical, especially for nurses working on the front lines during the COVID-19 pandemic. Ensuring adequate quality and quantity of breaks for frontline caregivers may mitigate caregiver burnout and enhance well-being, potentially translating to delivery of optimal patient outcomes. Our findings are limited as strategies for measuring nursing breaks were not uniform across the two studies. Future work is needed to further characterize breaks and related outcomes among Registered Nurses providing direct patient care during COVID.https://digitalcommons.psjhealth.org/prov_rn_conf_all/1012/thumbnail.jp

Catheter-Associated Urinary Tract Infection (CAUTI) Prevention Strategy Using Education in an Intensive Care Unit (ICU)

Purpose: To measure clinical impact of an evidence-based educational strategy on urinary tract infection (UTI) rates in a 900+ bed acute care facility located in a southwestern state in the United States (US). Clinical Question: Will a focu son staff education in the ICU on proper placement techniques, care, and early removal of urinary retention catheters reduce incidences of CAUTIs in an ICU setting

Effects of Mindfulness Stress Reduction Program on Nurses: An Integrated Research Review

Background/Purpose: Prevalence of nurse burnout can be as high as 40% (Duarte & Pinto-Gouveia, 2016). Variations of mindfulness-based interventions (MBI) have been utilized to combat burnout among nurses. Many studies utilize an adapted version(s) of the eight week mindfulness-based stress reduction (MBSR) course develop by Dr. Kabat-Zinn, which aims to aid in the improvement of mindfulness through practice of linking one’s physical and mental state in a nonjudgmental way (Ghawadra et al., 2019). Multiple instruments to measure levels of burnout and other psychological effects job stressors may have on nurses have also been applied. Higher levels of burnout have been shown to have a negative impact on job satisfaction, patient outcomes due to quality of care; and in increase in nursing absenteeism and turn over (Green & Kinchen, 2018). Purpose/Aims A systematic integrative search of the literature was performed to evaluate the effectiveness of mindfulness-based interventions among nurses in hospital care settings. Methods: Methodology implemented for the integrative research review was derived from search design recommendations from Brown (2018), Whittemore & Knafle (2005) and “The Preferred Reporting Items for Systematic Review and Meta-Analysis” (PRISMA) guidelines (Page, et al., 2021). A comprehensive literature search was conducted with the following search terms: mindfulness based interventions, nurses, effects or impacts or consequences or influence outcomes; utilizing the Cochrane Library, Medline Complete, Cinahl and Pubmed databases. All databases were set with the same search terms, limitations, and publication year setting (2016-2022) with the exception of the Pubmed database, in which an additional filter was added to limit the search to systematic reviews and meta-analysis. Results: A total of 125 articles were found with thirty-three duplicates leaving ninety-two for review. Of the ninety-two remaining articles eighty were excluded for not meeting inclusion parameters. The remaining twelve articles were reviewed for critical appraisal, and was comprised of four level one, three level two, two level three, one level 4, one level five and one level seven study, which meet the inclusion criteria for the literature review. Appraisal of the studies was performed with the utilization of the evidence based research (EBR) tool, appraising checklist by Brown (2018) and the PRISMA checklist (Long & Gannaway, 2015; Page, et al., 2021). Conclusion: There was inconsistency found among the mindfulness based programs and interventions utilized in each study, as well as the instruments implemented to measure burnout and mental health of nurses. Although each study varied in interventions and data collection strategies each showed some form of positive impact on the overall wellbeing of nurses, however, the statistical significance of the impact varied among studies. As noted by Jung et al., (2021) there is no “gold standard” for primary outcomes for nursing mental health unlike the clear expectations for patient outcomes and may contribute to the heterogeneity of MBI/MBSR studies for nurses. Implication: In the future, researchers studying the effectiveness of an MBI or MBSR on nurses, should consider developing a standardized practice for data collection, which include but not limited to the use of selected validated and reliable measure instruments for example, the Maslach Burnout Inventory (MBI), mass attention awareness scale (MASS), etc. (Jung et a., 2021). In doing so this may potentially create a homogeneous environment in which the effectiveness of the applied MBI, MSBR or abbreviated programs may be measured more effectively and efficiently and may lead to more reliable and creditable findings. References Alkhawaldeh, J. M. A., Soh, K. L., Mukhtar, F. B. M., Peng, O. C., & Anshasi, H. A. (2020). Stress management interventions for intensive and critical care nurses: A systematic review. Nursing in Critical Care, 25(2), 84–92. https://doi.org/10.1111/nicc.12489 Duarte, J., & Pinto-Gouveia, J. (2016). Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: A non-randomized study. International Journal of Nursing Studies, 64, 98–107. https://doi-org.lcu.idm.oclc.org/10.1016/j.ijnurstu.2016.10.002 Fadzil, N. A., Heong, W. O., Kueh, Y. C., & Phang, C. K. (2021). The Effect of a Mindfulness-Based Intervention on Nurses in Kelantan, Malaysia. The Malaysian Journal of Medical Sciences : MJMS, 28(6), 121–128. https://doi-org.lcu.idm.oclc.org/10.21315/mjms2021.28.6.12 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.lcu.idm.oclc.org/10.1111/jonm.13049 Ghawadra, S. F., Abdullah, K. L., Choo, W. Y., & Phang, C. K. (2019). Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. Journal of Clinical Nursing, 28(21-22), 3747–3758. https://doi.org/10.1111/jocn.14987 Green, A. A., & Kinchen, E. V. (2021). The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association, 39(4), 356–368. https://doi-org.lcu.idm.oclc.org/10.1177/08980101211015818 Jung, S.-E., Ha, D.-J., Park, J.-H., Lee, B., Kim, M.-S., Sim, K.-L., Choi, Y.-H., & Kwon, C.-Y. (2021). The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review. International Journal of Environmental Research and Public Health, 18(16). https://doi-org.lcu.idm.oclc.org/10.3390/ijerph18168855 Kang, M.-J., & Myung, S.-K. (2021). Effects of Mindfulness-Based Interventions on Mental Health in Nurses: A Meta-Analysis of Randomized Controlled Trials. Issues in Mental Health Nursing, 1–9. https://doi-org.lcu.idm.oclc.org/10.1080/01612840.2021.1949765 Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2019). The Effects of a Modified Mindfulness-Based Stress Reduction Program for Nurses: A Randomized Controlled Trial. Workplace Health & Safety, 67(3), 111–122. https://doi.org/10.1177/2165079918801633 Sarazine, J., Heitschmidt, M., Vondracek, H., Sarris, S., Marcinkowski, N., & Kleinpell, R. (2021). Mindfulness Workshops Effects on Nurses’ Burnout, Stress, and Mindfulness Skills. Holistic Nursing Practice, 35(1), 10–18. https://doi-org.lcu.idm.oclc.org/10.1097/HNP.0000000000000378 Xie, C., Zeng, Y., Lv, Y., Li, X., Xiao, J., & Hu, X. (2020). Educational intervention versus mindfulness-based intervention for ICU nurses with occupational burnout: A parallel, controlled trial. Complementary Therapies in Medicine, 52, 102485. https://doi-org.lcu.idm.oclc.org/10.1016/j.ctim.2020.102485 Yi-Yan Chen, & Xiang-Shu Cui. (2020). Intervention effect of mindfulness-based stress reduction for psychological health among nurses: A meta-analysis. TMR Integrative Nursing, 4(5), 163–171. https://doi-org.lcu.idm.oclc.org/10.12032/TMRIN2020100

Mindfulness Bundle Impact on Nurse Burnout Study

Purpose: Nurse burnout is a widespread problem globally. Nurse burnout is not only exacerbating nurses’ physical and mental health, but also affects patient satisfaction as well as hospital performance. Due to negative outcomes of nurse burnout, high turnover rates, and excessive costs of hiring nurses, there is a growing body of literature about factors leading to burnout and interventions to control and reduce nurse burnout. Nurses working in Intensive Care Units (ICU) designated for SARS-CoV-2 infected patients during the height of the 2020 pandemic reported experiencing higher than usual levels of emotional exhaustion (EE), depersonalization (DP), physiological signs of stress and exhaustion, and lower levels of personal accomplishment (PA). Researchers observed changes in frontline nurse work patterns, mental and emotional health, and verbalization of frustrations and helplessness. Current literature does not have a definitive solution to combat individual burnout. The purpose of this study is to test the effectiveness of a mindfulness bundle toolkit on nurse EE, DP, PA, Nurse Work Index (NWI) and Stress Arousal Checklist (SACL) scores in nurses working in critical care units designated for the care of SARS-CoV-2 patients. Methods: A quantitative quasi-experimental repeated measures design was utilized in this IRB approved study. Study participants consisted of (N = 52) a convenient sample of front-line registered nurses caring for SARS-CoV-2 patients. Study participants were provided a mindfulness bundle toolkit with aims to decrease burnout over a twelve-week period by developing skills to manage clinical stress and improve their overall health. Interventions included approximately 1 – 1.5 hours per week of intervention including mindfulness, spirituality training, music therapy, resilience, yoga, and therapeutic rooms. Data was collected at three time periods from study participants: pre-intervention, six-weeks post intervention, and twelve-weeks post intervention using the Maslach Burnout Inventory (MBI), NWI, and SACL. Data was entered into SPSS version 27. Descriptive analysis was conducted on all study variables. Normality was examined for interval-level dependent variables. A one-way repeated measures analysis of variance (ANOVA) was conducted to determine the effects of the mindfulness bundle on EE, PA, DP, NWI, Stress and Arousal scores. Results: The results of the analysis indicated a statistically significant effect from the mindfulness bundle on front-line nurses in three areas pertaining to burnout: Emotional Exhaustion, Wilks’ Lambda = .657, F(1, 41) = 19.02, p \u3c .005, η2 = .31; Depersonalization, Wilks’ Lambda = .704, F(1, 41) = 7.93, p \u3c .007, η2 = .16; and Stress, Wilks’ Lambda = .81, F(1, 41) = 8.81, p \u3c .005, η2 = .17. Conclusion: Significant effects were not found from the mindfulness bundle on the measures of Personal Accomplishment, NWI and Arousal scores. Study findings in this population suggest the use of a 12-week mindfulness bundle is an effective intervention to mitigate emotional exhaustion, depersonalization and stress linked to burnout in critical care nurses caring for SARS-CoV-2 patients. Replication of the intervention with a larger, randomized sample of nurses is recommended. Authors: Gisele N Bazan, BSN, RN, CCRN-K, Jamie K Roney DNP, RN, NPD-BC, CCRN-K, Kelsey Sawyer BSN, RN, CCRN, NPD-BC, Tiffany Patterson BSN, RNC-NIC, Michelle Bradberry BSN, RN, CCRN, Deborah Wambui Kamau MSN, RN, FNP-BC, Cynthia Grissman BSN, RN, NE-BC, Sahar Mihandoust PhD, MArch,C Randall Stennett DNP, RN, NPD-BC, CHSE, JoAnn D Long PhD, RN, NEA-B