PAVING THE PATH TO MINDFULNESS: IMPLEMENTATION OF A PROGRAM TO REDUCE STRESS AND BURNOUT IN INPATIENT PSYCHIATRIC NURSES Kristin Elizabeth Rush A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice in the School of Nursing in the University of North Carolina. Chapel Hill 2018 Approved by: Grace Hubbard Cheryl Giscombe Robert Cameron
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PAVING THE PATH TO MINDFULNESS: IMPLEMENTATION OF A PROGRAM TO
REDUCE STRESS AND BURNOUT IN INPATIENT PSYCHIATRIC NURSES
Kristin Elizabeth Rush
A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice in the School
What we invest What we do Why this project: short-
term results
Why this project:
intermediate results
Why this project: long-term results
• Time • Materials –
modules • Technology
– Google based website
• Equipment - computer
• Educate • Develop
curriculum • Facilitate
access to information
• Conduct focus group
• Program evaluation survey
Learning
• Increase awareness of Langer’s tenets of mindfulness
• Knowledge gained from the program is demonstrated through integration of mindfulness in the work site
• Knowledge about impact of stress and burnout on health and quality of life
• New skills for mindfulness practice
• Motivation to engage in new behaviors
• Change in attitude
Action
• Willingness to practice new behaviors
• Integrate feedback from program evaluation and develop recommendations for future improvements
• Program repeated annually as part of required training
• Program added to hospital intranet
Conditions
• Successful program could influence attitudes about work, improve work environment, decrease callouts
Who we reach
• Nurses on psychiatric inpatient units
• Supervisors
Assumptions • Stress and burnout can be reduced through mindful
practice
External Factors • Understaffing, frequent
staff callouts • Limited time to complete,
not mandatory
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APPENDIX 2: WEEKLY TEMPLATE
Week 1
Key Topics:
• Discussion of key objectives of the program • Overview of stress and burnout consequences • Introduction to Langer’s approach to mindfulness vs. mindlessness, website and reminder
cues o Langer’s theory of mindfulness, central components, video of Ellen Langer
discussing mindfulness o Skill practice for considering multiple perspectives
Week 2
Key Topics:
• Novelty Seeking- ways to prevent mindlessness • Engagement- noticing details or changes in the environment • Using mindfulness in everyday life
o The rainbow walk- go for a walk and look for something red, orange, yellow, green, blue, indigo and violet (ROYGBIV)
o Counting sounds walk- go for a walk and count how many sounds you hear (ie: cars, animals, people, wind, footsteps on leaves etc.)
Week 3
Key Topics:
• Novelty Producing: process stimuli to create new categories or information • Flexibility: consider multiple perspectives & use environment as feedback • Rethinking Thinking Video
Week 4
Key Topics:
• Using mindfulness in the workplace setting- creative solutions to challenges o Example: 3M Post-It Notes
• Participants will practice noticing five new things o After returning to an interaction with a patient, notice five new things about how
that patient appears
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APPENDIX 3: FLYER
PAVING THE PATH TO MINDFULNESS We want your participation! The purpose of this program is to evaluate a four-week program
designed to help reduce stress and burnout in psychiatric-mental
health nurses through the use of mindfulness. To participate you
must be a registered nurse or licensed practical nurse and work
I invite you to partake in the opportunity to experience and evaluate a four-week program designed to help reduce stress and burnout in psychiatric-mental health nurses through the use of mindfulness. To be eligible to participate you must be either a registered nurse or licensed practical nurse and work in a part-time or full-time capacity. This program consists of four online modules designed to equip you with skills related to mindfulness that you can use in your everyday life and in the workplace. Each module takes approximately 30 minutes to complete and will be available via Google Sites so that you can access the information from anywhere—including desktops and smartphone devices. After completion of the four modules, you will be asked to participate in a brief anonymous survey (less than 15 minutes to complete) and attend a focus group (less than 30 minutes) to provide feedback about barriers to and facilitators of the program.
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APPENDIX 5: INFORMATION SHEET
You are being asked to participate in a research study being conducted by Kristin Rush. Purpose: To evaluate the effectiveness of a four-week mindfulness program designed to help reduce stress and burnout in PMH nurses working on locked inpatient units. Procedure: You will participate in the evaluation of a mindfulness program consisting of four modules that take approximately 30 minutes each to complete. After completing the modules, you will be asked to complete one survey that will take less than 15 minutes to complete. The survey asks questions regarding your experience of the program. You will also be asked to participate in a focus group that will take less than 30 minutes to discuss barriers and facilitators of the program. Voluntary participation: Participation in the research study is voluntary. Should you choose to participate in this research study, you have the right to withdraw at any time without consequence. Additionally, you have the right to refuse to answer any questions for any reason, without consequence. Risks and benefits: The researchers conducting this study have determined that participation in this study poses minimal risk to participants. If you, as an employee, experience any type of distress from participating in this study, please speak with either researchers, your nurse manager, or contact the Employee Assistance Program at Novant Health at 1-800-828-2778. The benefits associated with this research are possible improved employee satisfaction, retention rate, job performance, patient care and patient satisfaction. If you have any questions or want more information regarding the research and study, you may contact the researcher at [email protected]. If you have concerns about your rights or treatment, or the risks and benefits related to this study, you may contact the Presbyterian Healthcare IRB at 704-384-8898 and the Novant Health nurse scientist (Gloria Walters) at [email protected]. Confidentiality: Your participation and responses to the survey questions will be anonymous and confidential. Please do not disclose identifying information on the surveys. The surveys are electronic and will be submitted to an electronic database. Data collected through the focus group will be anonymous and used only for identifying common themes. Consent to Participate: Please retain a copy of this consent form for your records. By completing this survey and attending the focus group, you are voluntarily consenting to participate in this portion of the research study. If you do not wish to participate in this study, please disregard this email.
1) How many modules did you complete? a. None b. One c. Two d. Three e. Four
2) Did you utilize a phone application with reminder cues to help you remember to practice mindfulness techniques?
a. Yes b. No
3) What was the average amount of time you spent each week completing the modules? a. Less than 10 minutes b. 10-20 minutes c. 21-30 minutes d. 31-40 minutes e. Greater than 40 minutes
4) What is the average amount of days per week you practiced mindfulness during and after the program?
a. One b. Two c. Three d. Four e. Five f. Six g. Seven
5) What is your age? a. 20-30 years b. 31-40 years c. 41-50 years d. 51-60 years e. 61+ years
6) What is your gender? a. Male b. Female c. Other
7) What shift do you primarily work? a. 7a-3p b. 7a-7p c. 3p-11p d. 7p-7a e. 11p-7a f. Other
8) How many hours per week do you USUALLY work at your job? a. 21-30 hours b. 31-40 hours
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c. 41-50 hours d. 51-60 hours e. 61+ hours
9) How many years have you worked as a RN or LPN? a. 0-5 years b. 6-10 years c. 11-15 years d. 16-20 years e. 21-25 years f. 26-35 years g. 35+ years
10) How many years have you worked in the field of psychiatric-mental health? a. 0-5 years b. 6-10 years c. 11-15 years d. 16-20 years e. 21-25 years f. 26-35 years g. 35+ years
As a result of participating in this program, please indicate the degree to which you agree with each statement: Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree (Likert Scale 1-5)
11. I feel a curiosity to learn new things in situations.
12. I feel an increased ability to pay attention to small details in the environment.
13. I feel more open to considering new ways of doing things.
14. I feel more open to considering multiple perspectives.
15. I plan to use mindfulness in my everyday life.
End Results: Social, economic, environmental conditions (SEEC)--ultimate effect of the program
Practice Change: Practices adopted as a result of participation in program
KASA Change: Change in knowledge, skills, attitude, and aspirations
Reactions: Particpant reactions to involvement in the program
Participation: Types and number of persons involved
Activities: Program activties--meetings, newsletters etc.
Input: Resouces allocated to program--time, funds etc.
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APPENDIX 8: FOCUS GROUP QUESTIONS
1. What were the best things about the modules? 2. What could have been done differently that would have improved the modules? 3. What were the biggest barriers to participation? 4. What additional topics in the area of mindfulness would be helpful in future modules?
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APPENDIX 9: AVERAGE TIME SPENT COMPLETING MODULES
6%
38%
31%
25%
0%
Average Time Spent Completing Modules
Less than 10 minutes 10-20 minutes 21-30 minutes 31-40 minutes Greater than 40 minutes
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APPENDIX 10: TYPE OF DEVICE USED TO ACCESS WEBSITE
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