Capstone Project Process Presentation

Capstone Project Process

PresentationNakia Thomas

Prof. Sandra GriffinNUR: 495 Capstone Project November 24, 2014

S.M.A.R.T Program

Stress Management,

Adversity,

&

Resiliency Training

Capstone Project ProcessPresentation Honesty Statement

The student name indicated on this title page signifies that the author

has read and understands the IWU Honesty Policy as outlined in the

Student Handbook and IWU Catalog. Affixing this statement to the title

page certifies that no cheating or dishonest use of information has

occurred in completing this assignment. The work submitted is original

work specific for this course. If cheating and/or plagiarism are

discovered in this paper, it is acknowledged that the university policy

will be followed, and may result in dismissal of the student from Indiana

Wesleyan University.

Problem StatementTo decrease work adversities, stressors, burnout, and turnover of

the nursing staff of Cincinnati Children’s Hospital Medical Centers’

(CCHMC), Bone Marrow Transplant (BMT) Unit; by improving health-

related quality of life (HRQOL), healthcare, and quality outcomes of

patients and staff by creating a thriving work environment with

improved interprofessional relationships (patients –staff & staff –staff),

communication, unit moral and self-care. By creating a Stress

Management, Adversity, & Resiliency Training (S.M.A.R.T) Educational

Program that promotes the goals of Healthy People 2020 in meeting,

promoting and improving HRQOL and well-being for all staff and patients

alike.

Resiliency Background Information

Nationally healthcare workers are exposed to many stressors and

adversity in the workplace; in addition nursing is noted to be a highly stressful career.

The many adversities that nurses face makes resiliency an essential

tool for nurses in their everyday work.

Stress and adversity has been known to negatively impact the well-

being of nurses’ mental and physical health.

Literature also has shown that highly perceived nursing stress levels

are linked with lower health-promoting behaviors scores.(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko, & Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; Mealer, et al., 2012; Pipe, et al., 2012; Sapolsky, 2004; Trauma Talk: JD Sexton, PhD; U.S. Department of Health and Human Services, 2014; Zander & Hutton, 2010)


Excessive workloads Time constraints Staffing shortage Lack of autonomy Interprofessional

relationships Bullying & violence Health & safety issues Death & dying Organizational

restructuring & reform Lack of support

Infectious disease exposure Needle stick injuries Exposure to work related

violence Sleep deprivation Psychological reactions Behavior problems Negative physical

symptoms Difficulties in dealing with

seriously ill patients

Workplace stress and adversity in nursing is associated with:

(Chesak, 2013; ; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008 Jackson, Firtko, & Edenborough, 2007; Pipe, et al., 2012)

These are a few of many factors that can be associated with high nursing turnover rates.

The Center for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) have also identified stress to be associated with:


Literature has shown that highly perceived nursing stress

levels are linked with lower health-promoting behaviors scores,

and that the transition from student to staff is also one of the most

stressful times in a nurses’ career; due to the many complex

changes and challenges they face as new nurses (Chesak, 2013;

Jones, 2013; Lombardo & Eyre, 2011). Additionally, significant

stress levels of nurses can put patients at risk, and has been linked

to job errors and safety issues (Chesak, 2013; Jones, 2013;

Lombardo & Eyre, 2011; Pipe, et al., 2012; U.S. Department of

Health and Human Services, 2014).


Research has shown that person –directed interventions for reducing occupational stress in healthcare workers can significantly reduce stress, burnout, and other issues that arise and affects people’s health, well-being, and productivity.

Literature has shown that Stress Management and Resiliency Training (S.M.A.R.T) Programs have been effective in reducing stress and instilling resiliency in nursing staff and healthcare workers in dealing with the complex challenges they face in and outside of the workplace that affects their well-being.

Research has noted that nurses who practice health promoting behaviors in areas of health responsibility, spiritual growth, and stress management have accounted for the majority of variances in perceived stress scores.

Literature has shown and proved that it is beneficial and essential to identify strategies to combat, reduce, and prevent occupational stress and help nurses to cope with stress in an effort to improve the quality of life of nurses and the patients they care for, and to prevent economic loss due to injuries, absenteeism, and job turnover.

(Chesak, 2013; Jones, 2013; Lombardo & Eyre, 2011; Pipe, et al., 2012; U.S. Department of Health and Human Services, 2014)

Environmental Impact Stakeholders are in agreement and collaborating toward a cost effective and efficient way to reduce risk and

vulnerability of patients and staff in a high risk environment such as the BMT unit of CCHMC.

External influencing factors: evidenced–based; best practice for individual and workplace health and life- balance resiliency programs at other hospitals and healthcare organization; promoted by Health People 2020 and other organization and associations that support and drive healthcare and their services; promotes quality outcomes for patients and community.

Financial considerations for this project have no major cost; if cost arises it will be absorbed in units’ operational budget.

(Chesak, 2013; Jackson, Firtko, & Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; U.S. Department of Health and Human Services, 2014)

Strengths Weaknesses Opportunities Threats

Strong organizational & unit management support

Population care focus Contributes to overall

program that unit is trying to start

Contributes to individual & unit HRQOL and promotes interventions to be applied by both BMT nursing staff & unit

Skilled coping workforce Resilience advisor Cost advantage

New staff

Staff buy-in

Lack of resources

Unskilled coping workforce

Burnout & turnover

Knowledge defect

Barriers

Promoting goals of Healthy people 2020

Maintaining Magnet Accredited

Promoting goals of Joint Commission Accreditation Healthcare Organization (JCAHO) of patient safety, quality care and outcomes, and job satisfaction

Organization competitors

Nursing shortage Rising cost of healthcare

Health reform

Economic decline

Capstone Project Outcome Statements

>70% of nursing staff at CCHMC’s BMT unit will complete the S.M.A.R.T Program pre-test by Nov. 24, 2014.

> 70% of nursing staff will complete the educational training presentation, survey, and post-test by Dec. 09, 2014.

50% of CCHMC’s BMT unit staff will be able to report at least four interventions that promote resilience in self and others by the end of the initial presentation on stress management, adversities, burnout, and resiliency, by Dec. 09, 2014

25% of CCHMC’s BMT unit nursing staff will report improved HRQOL by Jan. 05, 2015.

Decrease work adversity, stressors, burnout, by Jan. 05, 2015 and turnover of the nursing staff of

CCHMC’s BMT unit by 2% by April 05, 2015.

Capstone project manager will recommend five unit-based resiliency interventions based off survey data

related to improving HRQOL by Dec. 09-13, 2014.

Nurses: A Force for Change

A vital resource for health

Capstone Activities and Completion Timeline

Before the start of classes discussed students’ ideas: medication room redesign, integrating mental health into primary care of BMT patients, use of Clinical Nurse Leader (CNL) in primary care of BMT patients; and Unit Director’s ideas: resiliency program for unit capstone project 10/08/14-11/15/14.

Met with Capstone Facilitator and Unit Director to discuss topics more in-depth and to choose capstone topic idea 10/15/14.

Reviewed conference about resiliency which Unit Direct and Capstone Facilitator had previously attended, and some of the activities that took place: personality test, and learning how to communicate with different personality types.

Reviewed previous training that linked resiliency/therapeutic communication.

Established weekly meeting: every Wednesday; adjust as needed.

Met with Capstone Facilitator and Employee Support Specialist/ Resiliency Advisor who has been collaborating with Unit Director about Resiliency initiative for unit 10/22/14.


Met with Unit Educator and Capstone Facilitator to discuss plans and timeframes for the creation of pre –test, post-test, survey, and educational presentation, and the best methods for dissemination and data collection 10/24/14

Assess timeframes & deadline dates Collaborated in compiling pre –test, post-test, and survey questions Revised strategic plan and documented completion dates

Completed S.M.A.R.T pre and post-test as well as survey questions for rollout Nov. 07, 2014; completed 10/27/14; rolled out 11/07/14.

Sent complete version of documents out to Capstone Facilitator, Unit Direct, Unit Educators, and Resiliency Advisor for feedback.

Reminder to add to Staff meeting agenda 10/29/14 Met with above team to review, revise documents (pre-test, post-test, and survey .

Reviewed articles, outlined information, and created power point presentation education.

Completed 11/06/14, revised based off feedback 11/18/14; and rollout 11/25/14


Educate staff in remaining time; while collecting, analyzing, and evaluate any pre-test and survey data that has been submitted with continual collection of data. Assess effectiveness of education via post testing 11/07/14 -12/09/14.

Verify data analysis with Unit Educator and Capstone Facilitator 12/06/14-12/09/14.

Recommend at least five unit-based resiliency interventions to Unit Director, Educator, and Resiliency Advisor based on S.M.A.R.T Program survey data related to improving staff HRQOL 12/09/14-12/13/14.

Evaluation of Outcome Achievements

Outcome 1 >70% of nursing staff at Cincinnati Children’s Hospital Medical Center’s (CCHMC) Bone

Marrow Transplant (BMT) unit will complete the S.M.A.R.T Program pre-test by Nov. 24, 2014.

Evaluation method: As of Nov. 24, 2014 the goal has been met; collecting the total number of pre-test completed by nursing staff and

compare to the number of pre-test that have been distributed to nursing staff

Outcome 2 > 70% of nursing staff will complete the educational training presentation/module,

survey, and post-test which will be attached to the end of the presentation by Dec. 09, 2014.

Evaluation method: This outcome has not been evaluated at this time, but the method of evaluation for this will consist of collecting the amount of post-test and surveys and comparing them to the amount of staff that received the educational training presentation/ module.


Outcome 3 50% of nursing staff at CCHMC’s BMT unit will be able to report at least

four interventions that promote resiliency in self and others by the end of the initial presentation on stress management, adversities, resilience, and burnout by Dec. 09, 2014.

Evaluation method: Data collection and analysis from the post-test; which is based off of the educational training presentation which

has yet to be evaluated.

Outcome 4 25% of CCHMC’s BMT’s nursing staff report improved HRQOL by Jan. 09,

2014.

Evaluation method: Qualitative data collection via follow-up survey about the usefulness of the interventions, methods learned and applied;

staff stress levels and HRQOL before and after program implementation.


Outcome 5 To decrease turnover rates of the nursing staff at CCHMC’s BMT unit

by 2% by April. 30, 2015.

Evaluation method: Data collection, analysis and comparison of CCHMC’s, BMT unit turnover rates before and after

S.M.A.R.T program implementation.

Outcome 6 Capstone project manager will make five unit resiliency intervention

recommendations based off of survey data by Dec. 13, 2014.

Evaluation method: Data collection, analysis and comparison of staffs’ responses to create appropriate resiliency unit interventions for unit use to promote HRQOL.

Impact & Value of S.M.A.R.T Program

Provides savings for the unit and overall organization with long-term savings outweighing expenses.

No major project cost; all work is being completed during usual work hours and downtime.

Capstone project materials (printed paper, computerized technology)Increases unit moral, job satisfaction, work performance, and staffs’

health and well-being overall Increases retention

Savings of thousands in hiring and training of new employees and temporary staff

Decreases absenteeism and turnover ratesImprove patient care, safety, quality outcomes, and satisfactionFewer open beds (Chesak, 2013; Jones, 2013; Lombardo & Eyre, 2011; Pipe, et al., 2012;

U.S. Department of Health and Human Services, 2014).

Sustainability of S.M.A.R.T Program

Future sustainability has no major cost; if cost arises it will be absorbed in units’ operational budget.

Possible foreseen future cost in sustaining S.M.A.R.T Program Educational training for Unit Champions (unit-based resiliency coaches)

Hourly pay Cost of training classes (if fee applicable)

Sustaining S.M.A.R.T Program Educational program evaluation, and adjusted made as needed based on unit and staff needs Conduct thorough planning process for sustaining program Identify needed resources for sustaining program (Resiliency Advisor, Unit Champions

(volunteer staff), training courses) and work toward obtaining them Unit Director propose program plans with evidence from SMART program evaluation,

literature search (completed Oct. 31, 2012) (Best evidence statement: Building resiliency in nurses, 2012)

ReferencesBest evidence statement: Building resiliency in nurses. (2012, October 31). Retrieved October 20, 2014, from Cincinnati

Children's Hospital Medical Center:http://www.cincinnatichildrens.org/WorkArea/DownloadAsset.aspx?

id=101413

Chesak, S. (2013, December). Integration and impact of stress management and resiliency training (Smart) in a Nurse

Residency Program: A feasibility study. Retrieved October 16, 2014, from University of Wisconsin Milwaukee UWM

Digital Commons: http://dc.uwm.edu/cgi/viewcontent.cgi?article=1352&context=etd

Google. (n.d.). Project management, nursing change, health. Retrieved from https://www.google.com/search?

q=project+management&rlz=1T4TSNO_enUS479US492&source=lnms&tbm=isch&sa=X&ei=_Bp9VNm_IcOfNo2-

gtAP&ved=0CAoQ_AUoAw&biw=1366&bih=537

Guadalupe, G. M., & Ayala, C. J. (2011). Emotional exhaustion of nursing staff: Influence of emotional annoyance and

resilience. International Nursing Review, 59(1), 101-107. Retrieved October 18, 2014, from DOI: 10.1111/j.1466-

7657.2011.00927.x

Hodges, H. F., Keeley, A. C., & Troyan, P. J. (2008). Professional resilience in Baccalaureate-prepared acute care nurses: First

steps. Nursing Education Perspectives , 29(2), 80-89. doi:10.1043/1094-2831

Jackson, D., Firtko, A., & Edenborough, M. (2007, October ). Personal resilience as a strategy for surviving and thriving in

the face of workplace adversity: A literature review. Journal of Advance Nursing, 60(1), 1 -9. doi:10.1111/j.1365-

2648.2007.04412.x

ReferencesJones, B. (2013, August 05). Compassion fatigue and the challenge of developing resilience. Retrieved October 18, 2014,

from Oncology Nursing News: http://nursing.onclive.com/publications/oncology-nurse/2013/June-2013/

Compassion-Fatigue-and-the-Challenge-of-Developing-Resilience

Lombardo, B., & Eyre, C. (2011). Compassion fatigue: A nurse's primer. Online Journal of Issues in Nursing, 16(1). Retrieved

October 16, 2014, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/

OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html

Mealer, M., Jones, J., Newman, J., McFann, K. K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated

with a healthier psychological profile in ICU nurses: Results of a national survey. International Journal of Nursing

Studies , 49(3), 292-299. doi:10.1016/j.ijnurstu.2011.09.015

Pipe, T. B., Buchda, V. L., Launder, S., Hudak, B., Hulvey, L., Karns, K. E., & Pendergast, D. (2012). Building personal and

professional resources of resilience and agility in the healthcare workplace. Stress and Health, 28(1), 11-22.

doi:10.1002/smi.1396.

U.S. Department of Health and Human Services. (2014). Health- Related Quality of Life & Well-being. Retrieved October 17,

2014, from Healthy People.gov 2020: http://www.healthypeople.gov/2020/topics-objectives/topic/health-related-

quality-of-life-well-being

Zander, M., & Hutton, A. (2010). Coping and resilience factors in Pediatric Oncology Nurses. Journal of Pediatric Oncology

Nursing, 27(2), 94-108. doi:10.1177/1043454209350154

Capstone Project Process Presentation

Documents

physical health

lower health

department of health

health niosh

work adversities

addition nursing

stress management

everyday work