Stress has been associated with delivering healthcare to others, particularly in the nursing field. It is widely known that caregivers perform their duties under challenging conditions. In recent years, these fundamental difficulties have become worse by pressures connected to schedule, the pace of work, long shifts, quantified performance standards, transparency of treatment outcomes, an increased workload, and the amount of data now available due to technological advances. Most healthcare professionals worldwide are nurses, and it has been stated that 43% of hospital nursing staff suffer from stress, which can seriously negatively impact patient outcomes (Dutton & Kozachik, 2020). There are currently 19.7 million nurses worldwide; however, due to changes in the healthcare system and the extraordinary rise in the number of older adults, there will soon be an even greater need for nurses (Dutton & Kozachik, 2020). Some unique stresses exist for nurses who choose to work in primary care. They include time limits, sequential procedures that can take longer than expected and cause unforeseen delays to follow cases, and the risk for sicker patients to deteriorate rapidly.
The need for quality improvement (QI) programs is evident through statistical data analysis in nursing. According to it, 34% of nurses do not consider themselves emotionally healthy, and 42% suffer from COVID-19 trauma (ANF, 2021). The solution-seeking process contains two aspects, theoretical and practical. The focus first must be given to reducing environmental stressors and developing adaptability. It may start with evaluating the surroundings, and any stressors, much like the nursing practice does. Only after the evaluation could the sources of stress be reduced by developing and implementing a quality improvement (Waddill-Goad, 2018). When attempted methods demonstrate their capacity to reduce stress and be applied, lessons acquired about how to handle it can be conveyed. However, to change the way people perceive stress, one must first understand it. It is entwined with a cause-and-effect connection. A reduction in the stress reaction, which starts the cycle of unfavorable mental reflection and causes stress, exhaustion, and the possibility of burnout, may also arise from learning to embrace what one can and cannot manage.
Strategies for workplace stress regulation have been discovered to lower stress. Previous research illustrated that combined programs with cognitive behavior therapy, awareness, and stress reduction have the most promising effects in decreasing nurse stress out of all those provided. Evidence suggests that evidence-approached web-based stress management programs successfully minimize employee anxiety levels. Among the leading programs is Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATH), which was invented in 2014 and has shown significant improvement in healthcare (Dutton & Kozachik, 2020). This performance improvement program objective was to decrease stress levels among nurses who give care in a primary care unit at a health center. This program for quality improvement has several goals. The first is to evaluate how well a strategy for managing stress works by counting how many web-based modules members to access. The second is focused on assessing the stress management program’s acceptance by looking at how satisfied nurses are with it. Finally, the program’s impacts on nurses’ stress are examined using questions that were asked before and after they had access to the web-based initiative.
Several scholars have explored the benefits of the BREATH program throughout the last few years. The results of the Dutton and Kozachik research (2020) showed the undeniable advantages in the stress-level reduction in nurses, being a valuable fundament for new studies. The measurement of the pre-program test shows that the overall rate was 74.9 on the scale, while post-intervention indicates that the amount reduced to 62.1 of the full-scale factor (Dutton & Kozachik, 2020). Additionally, it must be considered that the full scale includes the components of stressors such as death situations, conflicts, disagreements, inadequate preparation, lack of support, workload status, and treatment mistakes.
Each aspect possesses a different range of stress sensibility, the support issue being the lowest one with a rate of 5.2, improving to 5.0, and death including the highest score of 16.2 on the stress scale, reducing to 12.7 (Dutton & Kozachik, 2020). Nurses’ extensive stress management system was used in this quality improvement process, and the outcomes were analyzed. The BREATH program offers segments on identifying and assessing stress, as well as tools and techniques for managing it. The BREATH web-based program can be an effective way to lessen nurses’ perceived stress related to concerns of death cases, conflicts with staff, workload, and anxiety therapy.
Regardless of the successful implementation of the quality program to the stress issues through the BREATH project, there is still a need to establish clear steps organization for the practice implementation. The initial step needed for the practice implementation is evaluating the current situation in the healthcare atmosphere. The pre-intervention methods can include individual sessions, such as face-to-face interviews, discussions, and offline protected approaches, such as questionaries and statistics based on analyzed the profile characteristics, including the demographics, background, and work history (Alenezi et al., 2018). Pre-intervention, immediately upon, and several months after-intervention qualitative data on the contentment with life scale, anxiety levels scale, and mindful focus consciousness scale must be accumulated using one of the existing techniques at three different times as a necessary step of integration.
The career opportunities support leaders who strive for improved health equity and advanced nursing leadership. According to the report, nurses are in a solid position to operate as thoroughly as possible, lowering obstacles to advanced nursing education and improving life-learning. Implementing skills development must be one of the steps for the new program arrangements. The research advises states to update their nurse practice laws to remove restrictions on the development of practice (Grand Canyon University, 2018). The suggestions included lowering obstacles to nursing education, such as increasing grants and scholarships. They also advocated increasing the number of nurses with bachelor’s degrees and creating nurse residency programs. It is necessary due to the need for practical skills that will help to embrace quality improvement initiatives through an evidence-based approach.
The quality improvement initiative must be evaluated through different methods to determine whether there was an improvement. A graph with a standard distribution curve must be adjusted to examine the implementation process’s distribution of algorithms. The mean of estimated mixed models with independent variables can be used to summarize data and take into consideration the correlation between measurements taken from the same subject. The Bonferroni process must be utilized when comparing two-time points opposed to one another, for instance, measuring the corresponding indicators of stress at three different times (Alenezi et al., 2018). To determine whether there are significant variations between the staff’s average stress levels and burnout before and after the intervention, the Wilcoxon signed-rank test must be performed.
Additionally, the findings of the previous theoretical works and practical analysis can be used to make comparisons and evaluate particularly controversial issues. For instance, work by Dutton and Kozachik stated that hospital nurses identified a lack of support as the least significant source of stress in their jobs. However, the researchers confirmed a higher negative connection between organizational support and nurses’ subjective stress (Alenezi et al., 2018). On the other hand, they suggested that medical centers create separate qualitative assistance programs for nursing staff. The results received in the particular hospital setting can prove one of the two statements; consequently, only one perspective must be applied to the obtained results.
Implementing a quality improvement initiative requires identifying variables, hypotheses, and statistical tests. The first point includes three categories we address prior to the evaluation process. It includes organizational procedures needed to implement QI discoveries and the QI context, represented by the tools, policies, or leadership environment where inventions are being adopted. These are all examples of content that an organization may be acquainted with. The tests will be evaluated through a paired samples t-test that analyzes two sets of information on a continuous dependent variable from one group of individuals. This statistical tool will be applied both before and after the intervention. Hypothesis testing is also to be used to ensure the success of the quality improvement initiative based on the measurement of the results involved in the framework of the stated hypothesis. The results based on comparative hypothesis testing can indicate the initiative’s relevance in the nursing field. Hence, applying t-test, observational hypothesis, and statistical comparison instruments to measure the research results.
Therefore, creating and implementing a quality-based program is required to manage the stress issue in the nursing profession. Understanding the theoretical base and research of the previous programs, such as BREATH, can help to determine goals and address problems possible through hypothesis testing. The continuous monitoring of the initiative implementation after initial evaluation can help to establish the tendencies of the workplace and possible changes as a result of the new practices.
Alenezi, A. M., Aboshaiqah, A., & Baker, O. (2018). Work-related stress among nursing staff working in government hospitals and primary health care centers. International Journal of Nursing Practice, e12676.
Dutton, S., & Kozachik, S. L. (2020). Evaluating the outcomes of a web‐based stress management program for nurses and nursing assistants. Worldviews on Evidence-Based Nursing. 1-7.
Grand Canyon University (Ed). (2018). Community & public health: The future of health care. Web.
Waddill-Goad, S. M. (2018). Stress, fatigue, and burnout in nursing. Journal of Radiology Nursing, 38(1). 44-46.
American Nurses Foundation (ANF). (2021). Mental Health and Wellness Survey Report. American Nurses Foundation. Web.