Powerpoint

Stress and Productivity in Nursing Working Environment

Stress and Productivity in Nursing Working Environment

In this era of increasing demand for health care and the increasing cases of chronic diseases, assisting the ill can take colossal physical and emotional tolls on the care providers. Consequently, the need to preserve the health and safety of the nurses is swiftly gaining attention. The nursing profession is highly stressful, with the unremitting emotional and physical strain that creates an unhealthy work environment and threatens the quality and safety of the patients (Hanson, Onasoga & Babalola, 2017). The key contributors to nurse stress and the overall satisfaction include quality of care, cultural safety, and the work environment. Several organizational factors influence nurse burnout, including the length of time they spend in a single work shift.

Stress is rated as among the leading work-related health problems by the National Institute for Occupational Safety and Health (NIOSH) (Hanson, Onasoga & Babalola, 2017). By definition, stress refers to the state of emotional or physical exhaustion that reduces personal identity and accomplishment. Health workers, especially the nurses, are at risk of developing stress, considering the nature of interactions at their workplaces (Moustaka & Constantinidis, 2010). Registered nurses (RN) are the largest affected group as they face more challenges than just addressing patient needs but also deal with administrative demands, unachievable deadlines, work speed, and coordinating the co-workers.

Several stress management techniques can be employed to help nurses. Stress management techniques can be those that one can do in isolation, and others involve group activities. This presentation focuses on the relaxation procedures that the RN nurses can perform at the hospital to reduce stress. The relaxation techniques are important in occupation-related stresses. Some of the relaxation techniques include taking deep breathing exercises, progressive muscle relaxation (yoga), and taking time to laugh (Madmoli et al., 2019). Breathing exercises involve long, slow, deep breaths that gently disengage the mind from the distracting thoughts and the exhaustion drawn from the work environment. Yoga is a good artistic technique for muscle relaxation since the physical aspects of the procedure distract the mind from the work exhaustion (Madmoli et al., 2019). The hospital to introduce a rest area where the nurses can take to rest as they focus on breathing and medicate. Besides, the rest area can be used for prayer sessions as prayers equally help one relax.

PICO (T) Question

PICOT (T): Does relaxation techniques for RN professionals working for Westchester General Hospital, decrease the stress associated with work assignments, and increase productivity, over six months' period?

P- Population is RN professionals working at Westchester General Hospital. The target population is Resident Nurses that is reduced to focus on those working for Westchester General Hospital.

I-Relaxation techniques. The intervention is a relaxation technique as a mitigation to reduce the level of stress drawn from the work environment for the RN professions.

C-Working without relaxing. The intervention compares to a population of RN professions at the same institution who work without relaxing.

O- Decreases the stress associated with work assignments and increased productivity. The outcome of the intervention is to reduce the level of stress among the RN professions that consequently improve their productivity.

T- Six months. The inquiry is to take six months.

Healthy People 2020 Preventive Services

Healthy People 2020 outlines measures for preventing occupational stress in healthcare professionals. The review considers the work-related stress that can lead to severe distress, physical illness, and burnout. The group targeted by the intervention includes the working population. The participants were 7188 in 58 related studies. The interventions highlighted strategies that are important in reducing stress among nurses to include mental and physical relaxation, combined cognitive-behavioral training, and organizational interventions. Organizational interventions include increased communication skills, change in work schedules, and changes in work conditions. Healthy People 2020 outlines the provisions in the OSH-9 (Occupation Safety and Health) that suggest that the increase in the proportion of employees who get access to the programs that are aimed at reducing stress and minimize the causes of low productivity.

Policy for Preventive Services

The design and implementation of primary preventive services in a health institution to help in mitigating a health problem like the case of stress among the RN professions necessitate the development of a policy framework. Public health policy developers work in support of measures that aim at improving the health of persons, communities, and health care providers (Yue et al., 2019). Robust public health policy in a healthcare facility is one that focuses on maximizing health, ensuring the healthcare providers achieve the values they uphold. The six fundamental elements in a preventive public policy include; innovation, effective performance, Technical set of a restricted number of high-priority interventions that are evidence-based, partnership, effective communication, and political commitment.

Innovation involves coming up with strategies that are evidence base for action (Yue et al., 2019). Effective performance management involves real-time monitoring, evaluation, and measures for health care improvement. A technical set of a restricted number of high-priority interventions must be evidence-based (Agarwal et al., 2017). Partnerships and coalitions of both the private and public sectors are important in coming up with a robust public policy. The process of design and implementation of the policy requires effective communication. Effective communication defines the accurate and timely pass of information to the various stakeholders, including the RN nurses, the hospital community, hospital management, and the policymakers (Agarwal et al., 2017). Getting political commitment is important in getting resources and support from the local and state government.

Steps in Developing Primary Health Plan

The process of developing sturdy primary healthcare involves eight steps, as discussed below.

Step 1: Situational Analysis

Situational analysis is getting the necessary information on the various stressors among the RN professionals (Owen et al., 2019). Explore the existing intervention set by the hospital in resolving the identified causes of stress, the strategies in addressing, and the team tasked with implementing the strategies. Establish how best the existing interventions have been effective in addressing the stressors and consider how to engage the hospital community and stakeholders in resolving the current needs.

Step 2: Identify the Problem

A Problem in a healthcare system defines the gap between the desired situation and the existing situation. The step involves engaging the RN professionals to discuss the stressors within their work environment and the various causes (Owen et al., 2019). Additionally, the problem identification step involves finding individuals to benefit from the recommended interventions.

Step 3: Prioritizing the Identified Needs

This step involves prioritizing the health needs and making a strategic choice on the criteria and order for implementation. The process of prioritization is important in determining the most important problem to focus on first (Owen et al., 2019). The most effective system for ordering is establishing a standard of measure. The evaluating standards of effects of stress on nurses include the extent of the effect on the RN population, the resultant cases of deaths that are linked to practitioner negligence, and the concerns raised by the community.

Step 4: Setting Goals and Objectives of the Plan

Clarity of the objective and the goals of the primary plan is an important aspect of its effectiveness. The relevant teams set by the organization to design program for releasing stress on the nurses must review what need to be covered and set priorities.

Step 5: Review the Set Objectives and Goals

The set goals and objectives need to be reviewed to ensure they solve the problem identified. The objectives of the plan must be able to reduce stress among nurses and improve productivity (Colvin & Sugai, 2017). A review of the objectives may suggest those to drop, change, or revise.

Step 6: Categorize and Ordering the Activities

Sequencing activities is important in pinpointing the dependencies between the actions to determine those which comes first to enable the other accomplished (Colvin & Sugai, 2017). Besides, it is significant to ascertain the activities that can be done concurrently.

Step 7: Identify the Necessary Resources

This stage involves determining the essential resources for actualizing the set objectives (Colvin & Sugai, 2017). The relevant resources in actualizing a primary health plan targeted at reducing stress at the workplace include staff, equipment, materials, power, and accommodation.

Step 8: Action Plan

The last stage includes setting up a practical action plan as to the objectives of the plan and the schedule of the various activities (Colvin & Sugai, 2017). It is important to ensure that the action plan achievable by the resources available.

Evaluation of Primary Health Plan

Criteria for Evaluating the Primary Health Plan

Evaluation of a primary health plan is described as a critical, rigorous, systematic, and ethical assessment of if the plan meets the objectives. The aspects of the plan to reduce stress among nurses assess the effectiveness, impartiality, efficiency, and suitability (Keleher et al., 2017). The effectiveness of this plan is measured by the improvement the nurses get from the activities outlined in the plan. The evaluation of efficiency compares the benefits of the plan and the cost involved in actualizing the plan. Acceptability of the plan is evaluated by measuring social, psychological, and ethical relevance to the RN professional at the hospital (Williams, Sevdalis & Gaughran, 2019). The primary healthcare plan must be impartial, where the benefits of the plan are distributed fairly among the hospital staff and the community.

The plan to improve the nursing environment at the hospital must be able to achieve the basic objectives, including improved healthcare standards, guaranteed financial impartiality, and improved responsiveness to the resident nurses. The level of insight into the plan objectives provides a critical reflection of the performance of the plan as a whole (Williams, Sevdalis & Gaughran, 2019). The framework for evaluating primary healthcare includes four main functions of a healthcare system, including access to services, comprehensiveness, continuity of care, and coordination of care.

Continuity of services is the access to care services over a longer period and in successive incidents of care (Keleher et al., 2017). Coordination of services in a primary healthcare plan is essential in determining the responsiveness of health services. Cross-sectional coordination of services refers to the harmonization of information and services with a chapter of care (Keleher et al., 2017). Comprehensiveness denotes the extent of the full range of care services either directly by the RN professionals or by other healthcare providers. In the primary care system, comprehensiveness provides that the services should be rehabilitative and supportive.

Measures for Evaluating Primary Health Plans

An evaluation process tracks the changes in the plan over time by collecting data at the initial stage of introducing the relaxation technique and on completion of the first phase. The choice of an evaluation measure for the primary healthcare plan should be based on the program's focus, the needs of the financiers or the audience, the time frame set for the program, and the available training for the implementers (Kardong-Edgren et al., 2010). The commonly used measures include; population data, program process measures, and participant outcome measures. Participant data includes an assessment of the demographics of RN professionals, health status, and training history. Besides, participation data include evaluation of health concerns, the response on the mitigation program, and the apparent risk.

Program process measures evaluate the number of participants who complete the program, the number of participants in the health education, number of participants enrolled, number of policies developed, the extent of implementation and the cost needed to complete the program (Kardong-Edgren et al., 2010). Participant outcome measure refers to the assessment of health status, healthy behaviors, and the predominance of stressors. Besides, it checks on the healthcare costs, the existing policies, the work environment, expertise of the implementation team.

Types of Evaluation

Different types of evaluation can be used in assessing the plan to introduce relaxation techniques for stress management amongst RN professionals. The different types include process evaluation, impact evaluation, outcome evaluation, and summative evaluation (Beaunoyer et al., 2017). Process evaluation measures the various activities of the healthcare program, the quality, and the people it reaches. Impact evaluation is used in measuring the immediate effect of the relaxation techniques and must be aligned with the objectives of the health program. According to Beaunoyer et al. (2017), the impact evaluation gives detail on how best the objectives and sub-objectives of the primary healthcare plan have been achieved. Outcome evaluation targets the long term effects of introduced relaxation exercises. Outcome evaluation is used in measuring the program goal and how well the goals of the program have been realized. Beaunoyer et al., (2017) described summative valuation as one done on completion of a program duration where the team considers the entire program cycle and help in decision-making.

Evaluation Tools for the Plan to Reduce Stress

The main tools used in the evaluation of primary healthcare plans to reduce stress at the institution include appraisals, observation, interviews, and focus group discussions. Appraisals refer to the systematic sampling of RN professionals through a set of questions that are to be answered specified set of responses. The sample group could be hospital community members, the target group, or the care providers (Beaunoyer et al., 2017). Focus group discussions refer to a small group of professionals in different ranks to take part in guided discussions of the predetermined set of questions on the healthcare plan.

The healthcare professional in a focus group is typical of given work schedules and tasks and or may have diverse characteristics. The questions presented to the focus can be responded to in any way they choose (Beaunoyer et al., 2017). Interviews describes set of questions to selected individuals or very small groups chosen because they have certain work experiences, have taken part in certain activity within the hospital facility or are likely to reflect on a particular aspect of the healthcare plan.

Prevention Intervention

The nursing career is among the most stressing profession that requires interventions to help minimize the cases as the outcome of such conditions affect the general healthcare services. There are three levels of preventive care, including primary prevention, secondary prevention, and tertiary prevention.

Primary Prevention of Stress in Nursing Environment

Primary prevention is a measure to reduce stress amongst the RN professionals, and the probable resulting complications are aimed at avoiding the development of stress or the resulting complications amongst the healthcare providers. Stress affects the body immunity that puts the body prone to diseases (Heard, Mutch & Fitzgerald, 2020). Primary intervention in reducing stress for nurses can be categorized into two sets that are organizational strategies and individual strategies. Individual strategies include the nurses adopting lifestyle management and taking part in workplace quality improvement activities. Organizational strategies include a clear definition of roles and responsibilities, having workloads that match available resources, allowing the nurses to take part in decision-making on matters that affect their jobs (Heard, Mutch & Fitzgerald, 2020). Besides, the organization can commit to having continuous teambuilding and variety ingenuities.

Secondary Prevention of Stress in Nursing Environment

Secondary prevention aims at early detection of the stressor within the nursing environment to help in preventing the condition from worsening and the emergence of severe complications. Besides, the intervention is to help minimize complications and limit the chances of RN professionals from developing chronic complications and the condition getting severe (Heard, Mutch & Fitzgerald, 2020). Secondary intervention in mitigating stress for nurses in their work environment includes both organizational strategies and individual strategies (Joyce et al., 2016). Organizational strategies include teambuilding initiatives, worker education and training programs, and the provision of fitness facilities (Heard, Mutch & Fitzgerald, 2020). Individual strategies include engaging in physical activities, having time for meditation, taking part in assertiveness training, good nutrition, and emotional outlets.

Tertiary Prevention of Stress in Nursing Environment

Tertiary prevention involves restoration and rehabilitation of the negative effects of stress on the RN professionals. Tertiary intervention include measures set in place to reduce the negative impact of already-determined stressors by reestablishing normal functions and reducing stress-related complications (Joyce et al., 2016). The intervention aims at improving the quality of life for the population with disease. Tertiary intervention in mitigating stress for nurses including coming up with employee assistance programs within the organization, medical care and treatment, debriefing on trauma, and having therapy sessions to help manage the psychological wellbeing of the staff.

Attain high quality; longer lives free of preventable disease, disability, injury, and premature death

The vision of every health system is to have robust primary care that ensures the population gets high quality, longer lives that are free of preventable illness, no or limited disability, minimum or no injuries, and low rates of premature deaths. Primary interventions that aim at improving the quality of healthcare must not only focus on the health of the population without having measures to protect the health of the healthcare providers. Stress in the healthcare department and especially the nursing environment is listed among the occupational-related challenges that, if not taken care of, can lead to preventable chronic diseases, poor health of the nurses, and in some severe cases, premature deaths.

Stress is in the nursing environment affects the quality of life for the nurses since it strains the adaptive capacity the causes psychological demands and the biological changes that put the nurses at risk of illness. Attaining high-quality health for nurses involve both personal and organizational strategies. Organizational strategies include quality of leadership, organizational structure, management style, policies and programs, consultation, and resources. Personal strategies include relaxation techniques that are important in occupation-related stresses. Some of the relaxation techniques include taking deep breathing exercises, progressive muscle relaxation, and taking time to laugh.

References

Agarwal, R., Mazurenko, O., & Menachemi, N. (2017). High-deductible health plans reduce health care cost and utilization, including the use of needed preventive services. Health Affairs, 36(10), 1762-1768.

Beaunoyer, E., Arsenault, M., Lomanowska, A. M., & Guitton, M. J. (2017). Understanding online health information: Evaluation, tools, and strategies. Patient Education and Counseling, 100(2), 183-189.

Colvin, G., & Sugai, G. (2017). Seven steps for developing a proactive schoolwide discipline plan: A guide for principals and leadership teams. Corwin Press.

Hanson, V. F., Onasoga, O. A., & Babalola, C. O. (2017). Self-Reported Occupational Stress, Environment, Working Conditions on Productivity and Organizational Impact among Nursing Staff in Nigerian Hospitals. International Journal of Translational Medical Research and Public Health, 1(2), 29-35.

Heard, E., Mutch, A., & Fitzgerald, L. (2020). Using applied theater in primary, secondary, and tertiary prevention of intimate partner violence: A systematic review. Trauma, Violence, & Abuse, 21(1), 138-156.

Joyce, S., Modini, M., Christensen, H., Mykletun, A., Bryant, R., Mitchell, P. B., & Harvey, S. B. (2016). Workplace interventions for common mental disorders: a systematic meta-review. Psychological medicine, 46(4), 683–697. https://doi.org/10.1017/S0033291715002408

Kardong-Edgren, S., Adamson, K. A., & Fitzgerald, C. (2010). A review of currently published evaluation instruments for human patient simulation. Clinical Simulation in Nursing, 6(1), e25-e35.

Keleher, H., Parker, R., Abdulwadud, O., Francis, K., Segal, L., & Dalziel, K. (2017). Review of primary and community care nursing.

Madmoli, M., Madmoli, M., Izadi, M., Khodadadi, M., & Ahmadi, F. P. (2019). A systematic review study on educational interventions to reduce nurses' job stress. International Journal of Drug Research and Dental Science, 1(1), 21-26.

Moustaka, E., & Constantinidis, T. C. (2010). Sources and effects of work-related stress in nursing. Health science journal, 4(4), 210.

Owen, R. R., Woodward, E. N., Drummond, K. L., Deen, T. L., Oliver, K. A., Petersen, N. J., Meit, S. S., Fortney, J. C., & Kirchner, J. E. (2019). Using implementation facilitation to implement primary care mental health integration via clinical video telehealth in rural clinics: protocol for a hybrid type 2 cluster randomized stepped-wedge design. Implementation science: IS, 14(1), 33. https://doi.org/10.1186/s13012-019-0875-5

Paula, W. K. A. S. D., Samico, I. C., Caminha, M. D. F. C., & Silva, S. L. D. (2016). Primary health care assessment from the users' perspectives: a systematic review. Revista da Escola de Enfermagem da USP, 50(2), 335-345.

Williams, J., Sevdalis, N., & Gaughran, F. (2019). Evaluation of a Physical health plan for people with psychosis: a protocol for a quality improvement study. Pilot and feasibility studies, 5(1), 8.

Yue, D., Pourat, N., Chen, X., Lu, C., Zhou, W., Daniel, M., ... & Ponce, N. A. (2019). Enabling Services Improve Access to Care, Preventive Services, And Satisfaction Among Health Center Patients. Health Affairs, 38(9), 1468-1474.