EBP Project for Advancement in Career Discussion Paper
The development of evidence based practice (EBP) knowledge and skills is accessible through a range of development opportunities: learning through formal avenues, learning on the job, and learning on one’s own. Through these opportunities, it is possible to improve the health care environment, delivery and outcomes (Lauseng, Howard & Johnson, 2019). These opportunities indicate a devotion to social inclusion and career development for nurses based on research projects. In fact, participating in EBP project allows nurses to better exploit the evidence of impact that interventions have on their practice, for the purposes of formulating health programs and policies. Indeed, there is a quantum of evidence indicative of the capacity of EBP projects to make significant changes in nursing practice and medical facilities, allowing them to achieve and maintain Magnet status. Accordingly, it is worth considering the ever-growing evidence-base can be extended to a specific facility or application, thereby going beyond the macro-level of nurse career development to other fundamental areas such as improving patient outcomes and work environment for nurses (Loversidge & Zurmehly, 2019)EBP Project for Advancement in Career Discussion Paper.
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What is presented in this document is a precis of an evidence-base that illustrates how EBP has currency and can be used at the institutional level to achieve and maintain Magnet status. In this particular case, the precis refers to how addressing compassion fatigue (CF) among nurses using a wellness program that incorporates social support, education and healthy behaviors presents an opportunity to improve the satisfaction levels of nurses and their practice outcomes – indeed a matter of significance given the nurses staff shortage and overwork exacerbated by Covid-19 pandemic.
Achieving Magnet status
Magnet status is awarded a medical facility considered a gold standard for nursing innovation and practice, a point to consider given the rewarding and challenging nature of nursing career. The American Nurses’ Credentialing Center (ANCC) certifies medical facilities for Magnet status, recognizing that the facility is an institution where nurses are empowered to be drivers of institutional health care innovation and change, even as they take the lead in patient care. The ANCC recognizes that medical facilities must continually focus on empowering nurses for patient benefit: presenting nurses with an environment in which they work in collaboration with others to elevate patient care by setting the standard for excellence through scientific discovery and dissemination, implementing new knowledge, and leadership. Through inquiry and participation on inter-professional teams, nurses lead and influence change in health care. This is in recognition that nurses play a big role in patient outcomes, alongside physicians and other medical personnel who influence quality of care. The support for effective collaborative care is linked to improvements in health outcomes through decreasing costs of care, improving employee and patient satisfaction, decreasing length of hospital stay, and reducing patient complications. Becoming a Magnet facility requires that the organization apply a model grounded in the core principles of innovation, discovery and flexibility to empower nurses to lead change and improve health outcomes (Murray, 2022)EBP Project for Advancement in Career Discussion Paper.
Magnet status is the highest credential for medical facilities offering nursing services in the USA and across the world. It is characterized by the facility having lower burnout rates and higher job satisfaction among nurses, as well as more supportive work environment. Achieving Magnet certification/credentials issued by ANCC through its Magnet Recognition Program requires that the facility satisfy a set of criteria with requirements organized into five primary components (Hall & Roussel, 2022).
First, transformational leaders in the face of tremendous changes taking place in the field of health care and nursing to include new therapies and medications, patient management becoming more data-driven, and technology advances. Achieving Magnet status goes beyond empowering staff, fixing broken systems and solving problems, to transforming the organization to meet the future. This allows the organization to strive for stabilization, balanced with controlled destabilization that births innovations and new ideas as part of reformation. The Magnet program examines the management style and quality of leadership, requiring that nurses (especially nurse leaders) have strong expertise, clinical knowledge, influence and vision. The fluid nature of nursing care requires that nurses be skilled leaders with high levels of clinical knowledge, influence and vision to move innovative care approaches forward and manage turbulent times with a focus on meeting future needs (Hall & Roussel, 2022).
Second, structural empowerment that focuses on empowering nurses to be innovate while putting the facility’s values, vision and mission into daily nursing practice. This component reviews the facility’s personnel practices and policies, professional development programs and collaborations among the medical personnel along with the community organizations. Magnet status designates nurses as key players in developing and updating institutional policies to improve nursing practice, as well as patient experiences and outcomes. This is a practice that not only benefits the organization, but also the patients. It has the added benefit of improving engagement and job satisfaction among nurses. besides that, it encourages collaborative decision-making that acknowledges the value and expertise of nurses while improving work satisfaction (Hall & Roussel, 2022)EBP Project for Advancement in Career Discussion Paper.
Third, exemplary professional practice that involves nurses demonstrating a clear understanding of the role of nursing and how it applies to other stakeholders who include inter-disciplinary teams, patients, families and communities. Magnet qualification looks at the quality of nursing, and what professional nursing practice can achieve. Towards this end, Magnet certification reviews professional nursing practice measures to include relationships between nurses and other professionals, and autonomy of the nursing staff. This understanding places a strong focus on the communication between nurses and with other medical personnel at all levels, from lab workers to physicians and pharmacists. This requires a practice shift away from compartmentalization that inhibits communication across teams and units, towards inter-professional and cross-team collaboration that improves patient outcomes (Hall & Roussel, 2022).
Fourth, new knowledge, innovations and improvements that involves displaying a commitment to evolving the future of nursing practice and patient care while using innovative contributions, new research and existing evidence to advance nursing as a science. Magnet status encourages a facility to base institutional advances and best practice on hard evidence, and not just conduct change for the sake of change. Every change must be made because there is evidence that the change will improve nursing practice and patient outcomes. The Magnet status asks the facility to look for new innovations, research and knowledge that can improve patient outcomes while allowing nurses to lead the charge (Hall & Roussel, 2022)EBP Project for Advancement in Career Discussion Paper.
Fifth, empirical quality results that shifts attention away from institutional practices and structures (as is the case with the previous four components), towards the impact of nursing practice on the facility, staff, patients and community. Facilities with Magnet status are expected to have higher standards of patient care and better patient outcomes. These (positive results) are attributed to a focus on regularly reviewing patient data, collaboration across medical teams, and improved nurse engagement. This component calls for nurses to act as change agents who look for something that needs change, look at the policies and processes in place, and lead efforts to make improvements and bring about change. The nurses must be able to make adjustments when they are not getting the desired outcomes (Hall & Roussel, 2022).
Achieving and maintaining Magnet status offers significant benefits. In today’s evolving and changing health care landscape, patients and communities are being offered more choices that every before in their medical care. Within this evolving environment, medical facilities must do what they can in order to stand out. Magnet status helps the organization in showing that it is committed to high quality patient care, excellence in nursing, and innovation. First, the Magnet status is beneficial to the organization through improving financial performance (greater proportion increase of revenue than expenses), and improved marketing position. Second, the Magnet status is beneficial to the patients through improved care outcomes (such as reduced falls and other injuries) resulting from high quality standards of care and higher nurse engagement. Third, the Magnet status is beneficial to nurses through presenting a workplace that values high quality professional nursing care and encourages innovation (Murray, 2022).
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Evidence-based practice
Compassion fatigue
A review of available literature leaves no doubt that the professional work nurses engage in takes a toll on their physical and psychosocial health as well as their wellbeing. Nurses working in high stress environments are particularly vulnerable to occupational stress. An analysis of this work related stress among nurses reveals that nurses are particularly vulnerable because of aspects of the therapeutic relationship, specifically engagement and empathy, which a fundamental components of nursing care. These components play a role in the onset of occupational stress among nurses (Upton, 2018). In addition to these relationship factors, there are non-relationship factors that could contribute to the stress as they cause nurses to experience a sense of conflict and ambiguity concerning their ability to provide the needed care. The non-relationship factors include perceived lack of time, continued emphasis on medical models supporting cure over care, reliance on advancing technology to prolong or sustain life, and increased patient complexity. Ongoing exposure to the relationship and non-relationship factors lead nurses to experience CF, one of the forms of occupational stress (Ishak, 2020)EBP Project for Advancement in Career Discussion Paper.
There is an understanding that exposure to trauma, suffering and pain is linked the health of nurses as the exposure causes CF that reflects adverse psychosocial consequences. In this case, CF among nurses presents as natural consequent emotions and behaviors that result from knowing about the traumatizing events that other known persons experience – stress resulting from wanting to help or helping a suffering or traumatized person. The phenomenon of CF is linked to the therapeutic relationship between nurses and patients, in that the patients’ suffering or traumatic experiences trigger multi-level responses in the nurses. In particular, a nurse’s ability to engage (enter into a therapeutic relationship) and capacity for empathy is central to CF. The expectation is that nurses who exhibit high levels of empathy and empathic response to a patient’s traumatic experience, suffering or pain is more vulnerable to experiencing CF (Cross, 2019).
CF is a concern among nurses who are particularly susceptible as a consequence of their increased workload even as they constantly witness others being sick and suffering. Their (nurses) desire to help others makes them susceptible to CF (Gustafsson & Hemberg, 2021). Nurses who are experiencing CF are characterized by irritability, anger and exhaustion, as well as negative coping behaviors (such as drug and alcohol abuse). Also, CF is characterized by reduced ability to feel empathy and sympathy, diminished satisfaction/enjoyment with work, impaired ability to care for patients and make decisions, and increased absenteeism from work. CF presents as stress resultant from exposure to traumatized persons. It involves the nurses experiencing stress resultant from being exposed to a traumatized individual, rather than the nurse experiencing the trauma (Aslan, Erci & Pekince, 2022). It is the convergence of cumulative burnout and secondary traumatic stress, causing the nurses to experience mental and physical exhaustion as their ability to cope with the traumatized patients is depleted. Empathy and compassion are key features in nursing care delivery. However, while they are helpful, they can also be burdensome when they cause negative effects on wellbeing, safety and physical and mental health among nurses dealing with patients experiencing distress and trauma while increasing turnover and decreasing productivity (Gustafsson & Hemberg, 2021). It is evident that working with patients who are experiencing suffering or pain may take a toll on the wellbeing and psychosocial health of nurses EBP Project for Advancement in Career Discussion Paper.
Wellness program
There is an anticipation that a wellness program presents an opportunity for reducing risk of CF among nurses. Schorch et al. (2021) supports the application of a wellness program in addressing CF by noting that such as program would decrease CF occurrence while increasing knowledge of CF and healthy behaviors. In addition, a wellness program would increase positive coworker interactions, social support, recognition, morale and level of teamwork. These are positive results achieved when the wellness program incorporates social support, education and healthy behaviors. This approach allows the program to focus on self-regulation (developing ability to control activity while engaged in work responsibilities), internally eradicating stress and shifting from reactive to intentional behavior, connection and support, and self-care and revitalization (Schorch et al., 2021).
Van Kirk (2020) concedes that implementing a wellness program is effective in reducing CF occurrence among workers. The wellness program included weekly seminars with workers, conducted during their lunchbreaks. The study was evaluated by subjecting the participants to Professional Quality of Life Scale version 5 (ProQOL5) that measured CF parameters before and after the program implementation. The results of the study revealed that a wellness program is a creative solution to addressing CF, especially within a resource-limited organization.
Ishak (2020) supports the use of a wellness program as an effective intervention to combat CF, noting that it is focus on teaching, bolstering resilience and promoting self-efficacy. A wellness program reduces CF occurrence by enabling the workers to feel more empowered, more energetic and have a stronger sense of self-worth. In addition, the program would enable workers to initiate a supportive aftercare plan, initiate conflict resolution, resolve any impediments to efficacy, master stress reduction methods, identify and utilize existing resources, recognize CF triggers, and identify CF symptoms. Besides that, the wellness program focuses on promoting self-compassion in order to encourage individuals to challenge negative internal dialogue while shifting automatic beliefs and thoughts to reflect a more positive outlook. Furthermore, the program promotes the combination of resiliency skills that lessen anxiety, improve quality of life and ensure greater job satisfaction (Ishak, 2020)EBP Project for Advancement in Career Discussion Paper.
CETEP model
The EBP project proposal is presented for using a wellness program in reducing CF occurrence among nurses. The proposed project is guided by Clinical Excellence Through Evidence-Based Practice (CETEP) model. CETEP model incorporates components that would be considered essential in implementing a nursing practice change. The model offers a five-step framework for an adaptable process that can be applied in an EBP project (Grove & Gray, 2022).
Step 1: Defining the clinical practice question
This is the first step in the CETEP model. It involves formulating a searchable question that focuses on the population of interest, intervention the project seeks to explore, a comparison of the intervention against a control, outcomes the project seeks to achieve, and timeframe in which the outcomes would be achieved. The PICOT format question is presented: For nurses (P) will implementing a self-care program and wellness activities (I) compared to no wellness program (C) result in reduced compassion fatigue (O) over a period of six months (T)?
The population (P) of interest is identified as nurses whose key feature of interest is that they are particularly susceptible to CF given their unique characteristics and nature of their work. The expectation is that nurses would be at high risk of developing CF.
The intervention (I) is wellness program. It is anticipated that subjecting nurses to a structured wellness program would help nurses to rejuvenate and reduce opportunities for them to develop CF thus resulting in reduced incidences of CF.
The comparison (C) is not subjecting nurses to a wellness program. This is considered standard practice since a wellness program is a deliberate intervention.
The expected outcome (O) is a significant reduction in the number of nurses who experience CF among the nurses subjected to the intervention when compared to their counterparts not subjected to the intervention.
The time (T) in which the results would be discernible is approximated at six months. This time is projected as enough time to make the effects of the intervention discernible for comparison against the standard practice.
Step 2: Assessing the critical appraisal components
As earlier indicated, CF among nurses is an issue of concern. Aslan, Erci and Pikence (2022) report that nurses are at high risk of developing CF because they work in a stressful environment that has increasing workload because of patients with complex needs and nurse staff shortages. Repeated and constant exposure to a stressful work environment causes nurses to go into a progressive process of stress compassion. Compassion is an important quality among nurses since it allows them to provide care needed by patients. However, constantly meeting patients who are traumatized and suffering, and being unable to help these patients can causes the nurses to become desensitized to care and patients, a situation identified as CF. The implication is that failing to address CF and reduce its incidences would compromise the ability to nurses to provide the care needed by patients (Aslan, Erci & Pikence, 2022).
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Gustafsson and Hemberg (2021) add to the discussion by noting that compassion is a necessary professional nursing value. Compassion is at the heart of caring, consisting of both the state of being and doing, guiding and allowing nurses to have the will to do good in terms of alleviating the suffering of patients. If well applied, compassion would allow nurses to perceive the pain and suffering of patients, and be motivated to practically intervene in alleviating the suffering and pain. While compassion is a necessary quality, it is challenged by nursing demands and constant exposure to patients’ suffering, irrespective of whether the nurse can actually intervene (Gustafsson & Hemberg, 2021) EBP Project for Advancement in Career Discussion Paper.
Paiva-Salisbury & Schanz (2022) report on the need to build CF resilience. The study notes that extreme stress and burnout from helping others can be harmful to the profession welling of nurses. This is because there is a lack of education and awareness around nurses. This awareness highlights the need for a targeted wellness program.
Schorch et al. (2021) concedes that although CF among nurses is a concern, a wellness program can help in reducing CF. Conducting a study that evaluated the effectiveness of the wellness program, the study reported reduced CF and increased compassion satisfaction, self-care, healthy behaviors and CF knowledge. Besides that, the wellness program was reported to increase perceived level of positive interaction among nurses, social support, recognition, moral and teamwork (Schorch et al., 2021).
Jean Watson’s Human Caring Theory (HCT) supports the use of a wellness program. The theory notes that caring behavior, as presented in the wellbeing program, can contributed to the wellbeing and satisfaction of nurses. The absence of caring results in non-caring consequences and dissatisfaction, where the nurse feels like an object. The carative factors presented in the theory support and enhance the caring experience of nurses. This implies that the carative factors can be employed to support and enhance the professional experience of nursing. In applying HCT, the nurse is expected to cultivate sensitivity to oneself and others in terms of implementing the practice of self-reflection, displaying willingness to explore and understanding personal values, morals, emotions and beliefs, and having a healthy outlet for stress relief and overall wellbeing (Smith, 2020).
Applied in the wellness program, the carative factors allow the program to focus on eleven processes. First, cultivate the practice of equanimity and loving-kindness towards self and others as foundation of a caritas consciousness. This focuses on promoting a non-judgmental outlook. Second, enable, sustain and honor the deep belief system, honor, faith and subjective life world of self and others. Third, cultivate one’s own transpersonal practices and spiritual self, while going beyond the ego-self. Fourth, develop and sustain a caring, trusting and helping relationship with others. Fifth, being present to and supportive of the expression of feelings, whether negative or positive. Sixth, creatively using the self and all ways of knowing in the caring process. Seventh, engage in the artistry of caritas nursing. Eighth, engage in genuine learning and teaching experiences that attend to subjective meaning and unity of being. Ninth, create a healing environment at all levels. Tenth, tend to basic human needs by administering nursing acts of caring and healing. Eleventh, open and attend to the spiritual and existential unknowns of life and death. These identified processes wholeness, honor and healing, as well as contributing to the evolution of the nurse as an individual (Pajnkihar, Štiglic & Vrbnjak, 2017)EBP Project for Advancement in Career Discussion Paper.
Step 3: Planning the implementation
The proposed EBP change involved subjecting nurses to a wellness program that involves applying caritas processes identified in HCT within a wellness program to reduce CF among nurses. Implementing the EBP change will require the approval of the facility administrators as the wellness program takes nurses away from their responsibilities. Ethical approval is not required as ethical safeguards are not appropriate or feasible for the EBP change (Hall & Roussel, 2022).
In addition, the program will require training resources for the nurses, allowing them to know what the program requires from them. This includes informing them about availability of confidential support for issues like anxiety, depression, substance abuse and stress, as well as guided support programs that rewards them for setting and accomplishing wellness goals. Besides that, nurses who require extra support initiatives will be offered access to professional support organization that communicate with them at a certain level of empathy and support to boost their confidence and satisfaction (Grove & Gray, 2022).
Communication with the program participants will be conducted through discussion forums, posters and presentations. These are appropriate methods for distributing the EBP change information to the nurse participants (Garcia-Dia, 2020).
There is an understanding that the wellness program must be continually improved. The process of improving the program requires that outcome data be used to determine its effectiveness. Towards this end, ProQOL-5 will be applied as the assessment tool to measure the level of CF the participants are exhibiting before and after the program implementation to determine its effectiveness in reducing CF among nurses. ProQOL-5 is appropriate because it focuses on the subscales of compassion satisfaction, burnout and secondary traumatic stress as the main components of CF. This makes ProQOL-5 an appropriate measure of change in CF over time (Van Kirk, 2020)EBP Project for Advancement in Career Discussion Paper.
Step 4: Implementing the practice change
The EBP practice change will be implemented through a wellness program that educates nurses on self-care and provides support in addressing the issues that contribute to CF, such as availing professional support to deal with workplace stress. The program will incorporate social support, education and healthy behaviors. This requires coordination with the facility administration who would avail the resources for implementing the program, to include availing training resources and support services as required. In addition, the nurse administrator and supervisors will be engaged in coordinating the implementation of the EBP change to ensure that the wellness program delivers on what it promised for the nurses within their units/departments (Garcia-Dia, 2019).
Step 5: Evaluating the practice change
The proposed EBP change focuses on implementing a wellness program with a view to reducing CF among nurses. This will make use of ProQOL-5 as the assessment tool. This is a self-assessment tool that is freely available in 28 different languages. This assessment tool uses a five-level Likert scale that evaluates performance from 30 questions based on experiences over the last 30 days. Based on the score interpretation for compassion satisfaction questions, a score of 22 or less will indicate high CF, score of between 23 and 41 will indicate moderate CF, and score of 42 or more will indicate low CF (Stamm, 2009). The assessment will be administered at the beginning, middle and end of change program to track changes in CF scores as well as compare performance of intervention group against comparison group (Garcia-Dia, 2019).
In addition to the ProQOL-5 assessment tool, feedback will be solicited from the participants. The feedback will be helpful in better understanding what the intervention does well and how it can be improved. The participant feedback will help in improving the wellness program, and make sure that it is adjusted to changes in the nurses’ population. In essence, the feedback will help with continuous improvement as it will highlight weaknesses and strengths in the intervention (Schmidt & Brown, 2019).
Meeting Magnet requirements
The focus of the EBP project is on applying a wellness program to reduce CF among nurses. Although the principal objective of the EBP project is on reducing CF among nurses, the secondary objective is to improve qualifications for achieving and maintaining Magnet qualifications. A review of the five primary components of a Magnet facility reveals that the project would achieve its secondary objective. First, it allows for transformational leadership to enable the facility meet the future. The EBP project is an opportunity for strong expertise, clinical knowledge, influence and vision to be applied in stabilizing staffing in the organization. The project is an opportunity for nurse leaders to manage the turbulent times occasioned by nurse shortage, turnover and compromised care due to CF. It is an innovative approaches to meet future needs. Second, it allows for structural empowerment by allowing the nurse staff to innovate and put the facility values, vision and mission into practice. The EBP project makes fundamental changes to the personnel practice and policies to improve practice, and patient experience and outcomes (Hall & Roussel, 2022) EBP Project for Advancement in Career Discussion Paper.
Third, it enables exemplary professional practice by empowering nurses and giving them greater autonomy in managing their own health and wellness. Through being part of the wellness program, nurses are able to gain greater awareness of CF, with greater capacity to prevent its occurrence. Fourth, it displays a commitment to evolving nursing practice by using existing knowledge and using innovative approaches developing new knowledge. The EBP project makes use of the knowledge that a wellness program can reduce CF among nurses, then goes on to evaluate the project outcomes with a focus on presenting new evidence. Fifth, it presents empirical quality results. The EBP project will be evaluated using ProQOL-5 assessment tool that will link the outcomes directly to the project thereby presenting an opportunity to make adjustments and improvements to get the desired outcomes (Hall & Roussel, 2022) EBP Project for Advancement in Career Discussion Paper
CONTRIBUTING AUTHOR TO MAGNET DOCUMENT TO SUBMIT TO COMITTE LEADER IN ORDER TO QUALIFY FOR ADVANCEMENT AS A RESEARCH PERSONNAL. “This can provide the evidence of the culture of excellence and innovation within an organization. This evidence increases the chances of achieving Magnet status while successfully attaining organizational goals. For example, an innovative perioperative documentation project that incorporates the PNDS and consistent, standardized perioperative content to manage perioperative patient care data can demonstrate the use of evidence-based practices and standards of perioperative nursing, while also providing the elements to compare patient outcomes. “Involving expert perioperative nurses as subject matter experts in policy and decision making within the perioperative clinical documentation improvement project can support effective documentation practices,” Kelly stresses. “This work can also serve to reinforce the value of consistent documentation in patients’ records as an essential part of nursing care.” She also stresses the critical role perioperative nurse executives must play in supporting a clinical documentation improvement project to advocate for appropriate resources and assist with establishing and ensuring the goals of the project are met. “Empower staff nurses to use data and to identify practice issues and use evidence-based findings to implement changes and measure those improvements,” Kelly advises. “All this information becomes sources of evidence to demonstrate perioperative nursing excellence.”