Stress In Post Anesthesia Care Unit Nurses since COVID

 This is for my Capstone. The PICOT question is in PACU nurses what is the effect of using stress management practices compared to non-use of stress management practices on their perceived stress levels since COVID-19?  Objectives of the study will be to see if there is a correlation between the practice of stress management and coping strategies, how effective those strategies are, and what area of their work is causing the stress. A questionnaire I am formulating for the study is attached for review.   
     During COVID-19, resources of both staff and supplies are limited, shifts are longer with overtime being required which leads to disruptions in sleep and work-life balance, and occupational exposure to COVID-19 have all added to physical and mental fatigue, stress and anxiety, and burnout to healthcare professionals worldwide (Adams, Walls, 2020). Stress before the pandemic throughout the profession was a factor in many problems that included poor working relationships among all levels of healthcare professionals, poor communication, poor relationships with patients and their relatives, shortage of staff, and lack of support from administration (Sasangohar, et al., 2020), In the midst of the pandemic, these problems can amplify along with additional stress brought on by pandemic related stresses.

The present COVID-19 outbreaks can be attributed to animal-human transfer of the causative agent with high person-to-person transmission rates including transmission among vulnerable populations, transmission from asymptomatic carriers, and individuals with pre-existing conditions (Adams & Walls, 2020). COVID-19 has posed a two-fold dilemma to healthcare providers; an expected and experienced overload on the capacity of the healthcare system to efficiently respond to the pandemic and increasing the risk of frontline healthcare providers with their respective families to constant exposure.

To help address this dilemma, WHO advices the public to assist in flattening the curve through behavioral and social changes that are key in decreasing the spread of COVID-19.Stress In Post Anesthesia Care Unit Nurses since COVID.  Although this strategy has proven to be efficient in numerous organizations in the US such as the Centers for Disease Control and Prevention (CDC), its implementation has fallen short of the expected goals,  increasing the burden of care of COVID-19 patients on healthcare providers.

Clinical Problem Statement

The COVID-19(Coronavirus Disease 2019) pandemic has contributed to a general increase in anxiety and depression incidences, and exacerbated mental problems with major effects on the physical and emotional health of healthcare providers. Longer working shifts, limited resources, and occupational hazards linked to the pandemic have contributed to anxiety, mental and physical fatigue, stress, and burnout among healthcare providers (Ardebili et al., 2020). Similar to most healthcare organizations in areas greatly affected by COVID-19, HCA Henrico Doctors Hospital – Forest Campus has been impacted negatively  by the pandemic.

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For instance, the leadership of HCA Henrico Doctors Hospital – Forest Campus observed an unprecedented number of post-anesthesia care unit (PACU) nursing staff requesting exemptions and taking time off work. Apart from increasing worry among nursing staff, other nurses are hesitant to go home for the fear of increasing the risk of infecting their loved ones. Although there has been an infl(COVID-19) ux of support from private and public acknowledgments, medical leadership, community support, and organizational support through counseling, work schedule accommodations, music therapy, and chaplain services, it is still common to see both emotional and physical exhaustion among PACU nursing staff. It is a common occurrence to see PACU nursing staff emotionally breaking down from additional pressure to choose between their professional/ethical duty towards patients and their families which negatively impacts care.

Purpose of Change Proposal

Stress and work-related burnout during the COVID-19 pandemic have contributed to poor working relations among healthcare providers at all levels of care, reduced quality of life(QoL) of nursing staff, lack of administration support, poor family and patient relations, and decreased patient satisfaction (Galehdar et al., 2020). Stress In Post Anesthesia Care Unit Nurses since COVID. There are numerous strategies to cope with COVID-19 work-related stress and burnout. Nurse leaders should consider implementing strategies to cope with stress and tools to identify passive coping strategies among nursing staff. These strategies will help PAC nursing staff to adopt active and more effective coping strategies, build personal resilience, and obtain organizational and social support. As a result, PACU nursing staff will have improved QoL, decreased physical, mental, and emotional burnout. They will also be efficient in delivering nursing services in the PACU unit and have decreased COVI-19 depression and anxiety among nurses.  Therefore, the primary purpose of this change proposal is to determine if there is a correlation between coping strategies and the practice of stress management,  the effectiveness of the strategies, and identifying the specific areas of work that cause stress.

PICOT Question

Among nurses practicing in the Post Anesthesia Care Unit (PACU) (P), does practicing stress management (relaxation techniques, counseling, and support) (I) compared to no stress management (C) result in lower levels of stress(O) within  12 weeks? (T).

Literature Search Strategy

Search Terms and Databases

The author conducted a search for literature in CINAHL, MEDLINE, and PubMed databases for both non-full text and full-text peer-reviewed journals using the following keywords, Post Anesthesia Care Unit nurses (PACU), COVID-19, stress, burnout, coping, counseling, and relaxation. For a highly refined search outcome, the author used the Boolean search operators ‘AND’, ‘OR’, and ‘NOT’. The search yielded 812 articles that discussed the effectiveness of stress management practices to manage stress among nurses working in the Post Anesthesia Care Unit (PACU). I used the following inclusion criteria to obtain the most appropriate and relevant articles; full-text articles published in English in the past five years (2016-2021), articles that discussed different stress management practices such as relaxation techniques, counseling, and support as the primary intervention compared to other interventions to decrease COVID-19 related stress and burnout. This inclusion criterion narrowed the number of peer-reviewed articles to 10. Stress In Post Anesthesia Care Unit Nurses since COVID.

Evaluation of Literature

Galehdar et al (2020) found that nurses were subjected to stress when they watched COVID patients die and regretted not being able to do anything at the time of a patient’s death. The researchers recommend that nurses should consider holding education programs about death as they decrease nursing-related anxiety. If nurses are unable to go home, nurse leaders should provide them with a platform for visual communication with their families, adequate PPEs, short working hours, and rest intervals. Arnetz et al (2020) emphasize the need for nurses to receive psychological help in absence of an effective response to COVID-19 to decrease nursing turnover and thoughts of leaving the nursing profession. Sun et al (2020) and Eftekhar et al., (2020) add to these findings by highlighting the following themes that are significant in managing COVID-19 related stress; personal life, self-care, and coping, adaptation to the pandemic, negative emotions in the initial stages of COVID-19 pandemic, gaining experience, positive emotions, and growth under pressure.Stress In Post Anesthesia Care Unit Nurses since COVID.  The researchers recommend the following management strategies to manage stress, music, relaxation, meditation, mindfulness, psychological growth, and self-copying styles.

The findings of the study by Khanam et al. (2020) revealed that nurses experienced more stress with regards to avoidance, feeling pessimistic and sad, change burden in the quality of work, and work-related stress from colleagues who tested positive. Khanam et al. (2020) suggest the need for nurse leaders to implement psychological interventions to manage work-related stress among nurses during the COVID-19 pandemic. An effective strategy towards implementing this intervention is by availing mental healthcare services and practitioners. Manzano & Ayala (2020) and Labrague & De Los (2020) add to this knowledge by proposing that, nurse administrators should provide nurses with access to PPEs, testing, treatment, and vaccinations, provide nurses with sufficient time offs to care for their loved ones and rest, increase social and organizational support, and promoting resilience.

Applicable Change or Nursing Theory

The most appropriate theory that will guide the implementation of this proposed change is the theory of change by Lewin. This theory has three stages of implementing change as follows; unfreezing, changing, and refreezing. The unfreezing phase includes creating awareness by examining current thoughts and processes, behaviors, and organizational structures and showing employees the essence of change to increase the efficiency and overall performance of nursing staff for the organization to have a competitive advantage (Hussain et al., 2018). The changing phase will involve the implementation of the proposed change where nursing staff begin to practice new processes, behaviors, and thought patterns. Therefore, in this phase, communication, education, and support will be the major critical factors for individuals to familiarize themselves with the change (Hussain et al., 2018).  Stress In Post Anesthesia Care Unit Nurses since COVID.The final step; the refreezing phase involves reinforcing change post-implementation to ensure that staff does not revert to old practices such as through acknowledgments and positive rewards for individualized efforts.

Proposed Implementation Plan with Outcome Measures

This change will be implemented and evaluated within six weeks.  The initial week will comprise of activities such as forming an implementation team, assigning each member of the team-specific roles and responsibilities. The second week will include creating awareness of the change among staff by examining current dysfunctional thoughts and processes, behaviors, and organizational structures that should be changed. Stress In Post Anesthesia Care Unit Nurses since COVID. In the third week, staff will undergo training as part of increasing their awareness about the proposed change and equipping them with the relevant skills and knowledge to manage stress. The fourth and fifth week will be left for staff to implement the acquired stress management skills and knowledge in practice and the sixth week will involve evaluations, formulation of policies, continuous monitoring, and evaluation to reinforce the implemented change. Therefore, the proposal seeks to attain the following outcome measures;

• Stress Reduction via self-help measures
• Within normal limits of vital signs
• Active coping strategies
• Increased efficiency among PACU nursing staff
• Decreased nursing turnover or intent to leave practice

Creating the Intervention Plan

The intervention will be in the form of organizational and mental health support.  Mental health support will include identifying highly skilled and trained mental healthcare staff and using them as facilitators and trainers to implement a support program for nursing staff. In this program, nursing staff will be taught different stress management skills, coping strategies, relaxation skills, breathing techniques and exercises, and how to identify and manage dysfunctional behaviors, routines, and coping strategies. The mental health services will also be available online and will be accessible through electronic devices such as smartphones and laptops for every nursing staff. Organizational support through the nursing administrator will be in the form of creating colleague peer-support groups, designing flexible work schedules, creating rest/break rooms and work-breaks. Stress In Post Anesthesia Care Unit Nurses since COVID. Stress In Post Anesthesia Care Unit Nurses since COVID.

Evaluation Plan

There will be a pre and post-assessment/evaluation. The pre-evaluation will be conducted before the implementation while the post-evaluation will be conducted after implementing the proposed intervention.  The evaluation will include conducting the following assessments among nursing staff;

• Knowledge of stress and stress management practices
• Job-related stress and dissatisfaction during COVID-19 pandemic
• Assessing and monitoring vital signs

Potential Barriers to Implementation Plan

The main implementation barriers for this change proposal include; unknown fear in failing to achieve the desired outcomes,  resistance from staff due to exhaustion, and a strong connection with routine practices and habits. To address these barriers, the author will use the following strategies; having an open communication strategy that articulates the change purpose clearly and aligns with the vision, goals, mission, and organization philosophy. To reinforce the new change and ensure consistency, nursing staff will undergo continuous training Education will also help to address fear as an implementation barrier and actively involve all stakeholders in each step during implementation.  Stress In Post Anesthesia Care Unit Nurses since COVID

References

Adams, J. G., & Walls, R. M. (2020). Supporting the health care workforce during the COVID-19 global epidemic. Jama, 323(15), 1439-1440. https://doi.org/10.1001/jama.2020.3972

Ardebili, M. E., Naserbakht, M., Bernstein, C., Alazmani-Noodeh, F., Hakimi, H., & Ranjbar, H. (2020). Healthcare providers’ experience of working during the COVID-19 pandemic: A qualitative study. American journal of infection control. https://doi.org/10.1016/j.ajic.2020.10.001

Arnetz, J. E., Goetz, C. M., Arnetz, B. B., & Arble, E. (2020). Nurse reports of stressful situations during the COVID-19 pandemic: a qualitative analysis of survey responses. International Journal of Environmental Research and Public Health, 17(21), 8126. https://doi.org/10.3390/ijerph17218126

Galehdar, N., Kamran, A., Toulabi, T., & Heydari, H. (2020). Exploring nurses’ experiences of psychological distress during care of patients with COVID-19: a qualitative study. BMC psychiatry, 20(1), 1-9. https://doi-org.lopes.idm.oclc.org/10.1186/s12888-020-02898-1

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. Stress In Post Anesthesia Care Unit Nurses since COVID.

Khanam, A., Dar, S. A., Wani, Z. A., Shah, N. N., Haq, I., & Kousar, S. (2020). Healthcare Providers on the Frontline: A Quantitative Investigation of the Stress and Recent Onset Psychological Impact of Delivering Health Care Services During COVID-19 in Kashmir. Indian journal of psychological medicine, 42(4), 359-367. https://doi.org/10.1177/0253717620933985

Labrague, L. J., & De Los Santos, J. A. A. (2020). COVID‐19 anxiety among front‐line nurses: Predictive role of organizational support, personal resilience and social support. Journal of nursing management, 28(7), 1653-1661. https://doi.org/10.1111/jonm.13121

Manzano García, G., & Ayala Calvo, J. C. (2020). The threat of COVID‐19 and its influence on nursing staff burnout. Journal of Advanced Nursing. https://doi.org/10.1111/jan.14642

Sasangohar, F., Jones, S. L., Masud, F. N., Vahidy, F. S., & Kash, B. A. (2020). Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit. Anesthesia and analgesia, 131(1), 106–111. https://doi.org/10.1213/ANE.0000000000004866

Shechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S.,  & Abdalla, M. (2020). Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General hospital psychiatry, 66, 1-8. https://doi.org/10.1016/j.genhosppsych.2020.06.007

Sun, N., Wei, L., Shi, S., Jiao, D., Song, R., Ma, L., … & Wang, H. (2020). A qualitative study on the psychological experience of caregivers of COVID-19 patients. American journal of infection control, 48(6), 592-598. Stress In Post Anesthesia Care Unit Nurses since COVID. https://doi.org/10.1016/j.ajic.2020.03.018

Change Project Outcomes

There are three outcomes I would like to see as a result of my Capstone project:

1. Stress Reduction via Self-help Measures

Will instruct staff on stress reduction activities such as deep breathing and guided imagery. Stress reduction techniques can aid in coping with life stress and aid the staff members in improving coping skills.

2. Vital Signs Assessment

Will assess via vital signs assessment of staff members. By monitoring vital signs such as blood pressure, stress levels can aid the staff member in identifying possible root causes of the stress they are experiencing and when it happens. Thereby, better interventions can be planned.

3. Stress Reduction via Co-Workers

Will encourage staff to discuss stresses with co-workers who will actively listen. Active listening to each other will help in feeling like they are able to discuss their stress openly. When stress is openly discussed, it can help in its reduction.

PICOT Question Paper

Dealing with stress as a nurse is part of the job. As a nurse, you either deal with the stress through coping mechanisms or burnout which could ultimately lead to you leaving the profession. In the time of COVID-19, nurses are needed more than ever, and they carry the bulk of care for patients. Stress In Post Anesthesia Care Unit Nurses since COVID. Healthcare organizations cannot risk losing them to burnout. During the COVID-19 pandemic, nurses are experiencing anxiety, distress, overtiredness, loneliness and ongoing emotional trauma. This ongoing stress and trauma impact their mental health, feelings of security, and ability to provide the best possible care to their patients. Taking steps to manage their stress is just as important as taking care of their physical health. Without managing their stress, their physical health could deteriorate leading them to be more suspectable to COVID-19. Since I am doing my Capstone within the area of the post anesthesia care unit (PACU), my project will consider the question as to whether PACU nurses practicing at HCA Henrico Dorctors Hospital – Forest Campus who are practicing some form of stress management since the onset of COVID-19 are having lower levels of stress as compared to those nurses that are not practicing stress management. Objectives of the study will be to see if there is a correlation between the practice of stress management and coping strategies, how effective those strategies are, and what area of their work is causing the stress. A questionnaire I am formulating for the study is attached for review.

During COVID-19, resources of both staff and supplies have been limited, shifts are longer with overtime being required which leads to disruptions in sleep and work-life balance, and occupational exposure to COVID-19 have all added to physical and mental fatigue, stress and anxiety, and burnout to healthcare professionals worldwide (Adams, Walls, 2020). Stress pre- pandemic throughout the profession was a factor in many problems that included poor working relationships among all levels of healthcare professionals, poor communication, poor relationships with patients and their relatives, shortage of staff, and lack of support from administration (Sasangohar, et al., 2020), In the midst of the pandemic, these problems can amplify along with additional stress brought on by pandemic related stressors. Stress In Post Anesthesia Care Unit Nurses since COVID.

From Rushdy’s (2016) study, there are many effective stress strategies for nurses to use prior to reaching burnout that may see them leave the profession. During COVID-19, the potential for an increased level of stress is higher than before COVID-19; therefore, nurse leaders should include training on stress coping strategies for their staff to help nurses cope with both role overload and burnout. Management should also be taught to identify passive coping in their staff so that it can be addressed. Finally, hospital administration has the ability to stress levels by making sure evidence-based practice is being used to both treat patients and address stress in staff.

Thankfully, pandemics the magnitude of COVID-19 only happen approximately every 100 years (Jernigan, 2021). Healthcare learns from each of them regarding the medical details, but perhaps from this pandemic they will learn more about the effects it has on the healthcare providers treating the ill.

References

Adams, J. G., & Walls, R. M. (2020). Supporting the Health Care Workforce During the COVID-19 Global Epidemic. JAMA, 323(15), 1439–1440. https://doi.org/10.1001/jama.2020.3972

Jernigan DB. Influenza Division, Centers for Disease Control; Available at: https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/pdfs/1918-pandemic-webinar.pdf. Accessed January 9, 2021. Stress In Post Anesthesia Care Unit Nurses since COVID.

Rushdy, M.F. (2016). Relationship among nurses role overload, burnout and managerial coping strategies at intensive care units. International Journal of Nursing Education, 8(2), 39-45.

Sasangohar, F., Jones, S. L., Masud, F. N., Vahidy, F. S., & Kash, B. A. (2020). Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit. Anesthesia and analgesia, 131(1), 106–111. https://doi.org/10.1213/ANE.0000000000004866

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Student Name: Erin E Spurrier

Change Topic (2-3 sentences):

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

1. Background
2. Clinical problem statement.
3. Purpose of the change proposal in relation to providing patient care in the changing health care system.
4. PICOT question.
5. Literature search strategy employed.
6. Evaluation of the literature.
7. Applicable change or nursing theory utilized.
8. Proposed implementation plan with outcome measures.
9. Discussion of how evidence-based practice was used in creating the intervention plan.
10. Plan for evaluating the proposed nursing intervention.
11. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
12. Appendix section, if tables, graphs, surveys, educational materials, etc. are created. Stress In Post Anesthesia Care Unit Nurses since COVID.