Abstract
Nurse staffing is one of the most burning issues in the American healthcare system. Burnout and low job satisfaction are central factors contributing to the high turnover among nursing practitioners especially when it comes to intensive care units (ICU). The purpose of this study is to evaluate the effectiveness of the intervention aimed at reducing burnout and increase ICU nurses’ job satisfaction. The intervention implies the use of expressive writing as a tool to develop resilience necessary to recover from burnout. 100 ICU nurses from local healthcare facilities will be recruited. The dependent variables will be the level of satisfaction and burnout. The independent variables will be nurses’ age, educational background, and working experience. The participants will be randomly divided into the control and experimental groups. The experimental group will write reflections (that will take 10-30 minutes) using the provided prompts on a weekly basis. The intervention will last 3 months. Before the start of the intervention and upon its completion the participants from the two groups will complete the job satisfaction scale, Maslach Burnout Inventory–Human Service. The experimental group will also complete brief surveys on the intervention. This survey will help in improving the intervention under analysis. SPSS will be used to analyze the obtained data.
Introduction
Problem & Significance
The lack of nurses is one of the most burning issues that have to be addressed within a short period of time due to the growing population of aging patients. Nursing practice is associated with various challenges many people are unprepared and unwilling to face. Burnout and associated low job-satisfaction are some of the most influential factors resulting in high turnover rate among nursing practitioners working in intensive care units (ICU) (Mealer, Shelton, Berg, Rothbaum, & Moss, 2007). Van Mol, Kompanje, Benoit, Bakker, and Nijkamp (2015) note that the prevalence of burnout among ICU nurses often reaches 70%. Certain interventions have been developed to address the problem. Some programs concentrate on the physical activity, while others imply the focus on psychological assistance to nurses, but the issues still persist (Mealer et al., 2017). The purpose of the proposed intervention is to evaluate the effectiveness of expressive writing as a tool decreasing ICU nurses’ burnout and increasing their job satisfaction. The project will potentially improve the working environment in the clinical setting.
The major concepts employed are burnout and expressive writing. Moss, Good, Gozal, Kleinpell, and Sesler (2016) note that burnout is associated with the imbalance of nurses’ personal traits and organizational factors. The factors contributing to nurses’ burnout include excessive workload, unfavorable working environment, and the like (Myhren, Ekeberg, & Stokland, 2013). The outcomes associated with burnout include depressive symptoms, irritability, emotional exhaustion, sleeping or eating disorders and so forth.
The present study will also have a theoretical significance as it will be associated with the development of an intervention and its evaluation. The evaluation instruments that will be utilized will be surveys exploring the participants’ degree of burnout, job satisfaction as well as perspectives concerning the intervention. Similar tools can be applied when implementing and evaluating similar projects.
Research Objectives
The objective of the present research is to evaluate the efficacy of an intervention aimed at decreasing nurses’ burnout and increasing their job satisfaction. Prior to identifying the research question, it is necessary to formulate the PICO question guiding this study. The PICO question is as follows: Among ICU nurses (P), does the participation in the expressive-writing-based intervention (I), as compared to no intervention (C), decrease burnout and increase job satisfaction? Therefore, the research question can be formulated in the following way:
Does ICU nurses’ participation in the expressive-writing-based intervention, as compared to no intervention, decrease burnout and increase job satisfaction?
The independent variables employed for the purposes of the proposed study are nursing professionals’ age, working experience, and educational background. Working experience is one of the most important variables as it has a direct effect on burnout. The longer nurses are exposed to certain challenges, the higher level of burnout and the lower level of job satisfaction they will have. The participants’ educational background and age can be influential factors affecting the way they feel about the intervention and their engagement (Mealer et al., 2017). The dependent variables are the level of burnout and job satisfaction. The research hypothesis is as follows:
- H1: The level of burnout of ICU nurses’ participating in the proposed intervention will decrease, and their level of job satisfaction will increase.
- H2: The level of burnout of ICU nurses’ who will not participate in the proposed intervention will not decrease, and their level of job satisfaction will not increase.
Background /Literature Review
Burnout is a common challenge nursing professionals face, so it has been well-researched. It has been acknowledged that this problem is closely related to high turnover rate (Genly, 2016). Job satisfaction has also acquired sufficient attention in the academia as it is one of the most influential factors affecting nurses’ performance and their overall well-being (Myhren et al., 2013). The major predictors of the increase in burnout levels and low job satisfaction are an unfavorable working environment, excessive workload, a high level of responsibility, exposure to stressful situations, and so forth (Epp, 2012). Ntantanaa et al. (2017) found that personality traits also have an effect on nurses’ job satisfaction and their burnout. At the same time, peers’ or managerial support has proved to correlate negatively with burnout levels and have a positive impact on nurses’ overall well-being and their job satisfaction (Hunsaker, Chen, Maughan, & Heaston, 2015; Khamisa, Peltzer, Ilic, & Oldenburg, 2016). Therefore, the primary factors associated with high burnout level and low job satisfaction in ICU nurses are known and described in detail.
The development and evaluation of interventions aimed at addressing the issues under analysis have been extensively researched. For instance, mindfulness practices and resilience are regarded as effective strategies to cope with burnout (Rushton, Batcheller, Schroeder, & Donohue, 2015). Mealer et al. (2017) found the effectiveness of resilience development and mindfulness practices implementation. The researchers evaluated the effectiveness of an intervention aimed at decreasing burnout among nursing practitioners. The intervention consisted of three components including physical activity, mindfulness practice, and expressive writing. However, the researchers also pointed at a limitation of their study as it was difficult to estimate the efficacy of each component of the intervention. There is certain research in this area as Evans, Mealer, Jooste, and Moss (2015) carried out a pilot study that evaluated the effectiveness of an expressive-writing-based program. Evans et al. (2015) note that the participants pointed at some weaknesses of the program, such as its focus on nurses’ general knowledge rather than ICU-specific experiences. Therefore, it can be beneficial to concentrate on expressive writing based on ICU experiences as a strategy to cope with burnout and improve ICU nurses’ job satisfaction.
Theoretical Framework
The focus of the projects is the evaluation of the effectiveness of a program aimed at building ICU nurses’ resilience that can help them cope with burnout and improve their job satisfaction. Polk’s four-dimensional model of resilience will be used as the theoretical framework for the present study (Haase & Phillips, 2016). Polk stresses that such dimensions as dispositional, relational, philosophical, and situational are critical when building resilience. The proposed program will include prompts developed on the basis of this approach that embraces such domains as physical, philosophical, social, and situational.
Protection of Human Subjects
The proposal will be submitted for IRB approval in order to ensure the adherence to the highest ethical norms in research. One of the most sensitive issues related to ethical aspects is participants’ confidentiality (Grove, Burns, & Gray, 2014). This project is associated with nurses’ reflection on rather traumatic experiences that require a certain degree of sincerity and commitment to the study’s goals. The participants will sign informed consent forms where they will be informed about the ways their data will be secured (see Appendix). Their names will be coded while their writings will be stored for a brief amount of time. The participants will also be informed about their ability to withdraw from the research at any point as well as their right to be assigned to the experimental group if necessary.
Methods
Research Design
Quasi-experimental design is chosen for the proposed study. The ICU nurses of several local healthcare facilities will take part in the research. The validity of the sample is compromised as it is unlikely to represent the entire population of ICU nurses. Nevertheless, the study will provide insights into the strengths and weakness of the proposed intervention, which makes it relevant.
Inclusion criteria
The inclusion criterion will be nurses’ working experience, or rather the years spent in the ICU setting.
Exclusion criteria
The exclusion criterion will be the recruited people’s participation in similar interventions that used expressive writing as an instrument to address burnout.
Sampling Plan
The overall number of participants will be 100. Once the required number of participants is reached, the recruitment process will stop. Convenience sampling will be utilized since all ICU nurses working for several healthcare facilities will be recruited. At that, they will be able to refuse to take part or withdraw from the study. The recruitment process will involve the close collaboration with the facilities’ administration that will encourage their employees to participate.
Intervention
The modified project evaluated by Evans et al. (2015) will be used. The intervention will include a workshop at the beginning of the program. Nurses will write brief reflection papers on a weekly basis. The writing will last for 10-30 minutes during which the participants will respond to a prompt. The overall duration of the intervention will be three months. On the completion of the program, the nurses who will take part in the project will complete short reports on the intervention.
Data Collection Methods
The participants of this study will be randomly divided into a control and experimental group. The former will not receive the intervention while the latter will be asked not to reveal the details of their writing. Pretest-posttest design will be employed to answer the research questions mentioned above. The level of burnout and job satisfaction of the participants will be measured before and after the implementation of the intervention.
Instruments/Measurements
In order to measure the participants’ burnout Maslach Burnout Inventory–Human Service (Rushton et al., 2015). The level of job satisfaction will be measured with the help of the job satisfaction scale (10-70) (Myhren et al., 2013). These tools will be provided to the participants through their facilities’ information systems. In addition, the participants in the experimental groups will complete a brief (3-question) survey on the weaknesses and strength of the intervention. The validity of the data can be ensured through the use of two variables that are closely connected. It can be expected that the participants who have a high level of burnout will be characterized by a low level of job satisfaction. Cronbach’s α will be utilized to check data reliability. The operational definitions can be formulated as follows:
Job satisfaction
Job satisfaction level will be the score the participants will get when completing the job satisfaction scale.
Burnout
The level of burnout will be the score the participants will get when completing Maslach Burnout Inventory–Human Service.
Intervention effectiveness
The effectiveness of the intervention will be measured with the help of the participants level of burnout and job satisfaction. The lower these levels are after the project completion, the more effective the intervention is.
Data Analysis
Descriptive statistics will be employed when analyzing the collected data. SPSS is one of the common statistical software. This instrument will be used to analyze the findings.
References
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Evans, J. F., Mealer, M., Jooste, K., & Moss, M. (2015). Expressive writing for caregiver resilience. In K. Thompson & K. Adams (Eds.), Expressive writing: Counseling and healthcare (pp. 43-62). New York, NY: Rowman & Littlefield.
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Grove, S. K., Burns, N., & Gray, J. (2014). Understanding nursing research: Building an evidence-based practice (6th ed.). St. Louis, MO: Elsevier Health Sciences.
Haase, J. E., & Phillips, C. R. (2016). Resilience. In S. J. Peterson & T. S. Bredow (Eds.), Middle range theories: Application to nursing research and practice (4th ed.) (pp. 259-278). Philadelphia, PA: LWW.
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Mealer, M., Shelton, A., Berg, B., Rothbaum, B., & Moss, M. (2007). Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. American Journal of Respiratory and Critical Care Medicine, 175(7), 693-697.
Moss, M., Good, V., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). An official critical care societies collaborative statement – Burnout syndrome in critical care healthcare professionals. CHEST, 150(1), 17-26.
Myhren, H., Ekeberg, Ø., & Stokland, O. (2013). Job satisfaction and burnout among intensive care unit nurses and physicians. Critical Care Research and Practice, 2013, 1-6.
Ntantana, A., Matamis, D., Savvidou, S., Giannakou, M., Gouva, M., Nakos, G., & Koulouras, V. (2017). Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational, multicenter, cross-sectional study. Intensive and Critical Care Nursing, 41, 11-17.
Rushton, C., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412-420.
Van Mol, M. M. C., Kompanje, E. J. O., Benoit, D. D., Bakker, J., & Nijkamp, M. D. (2015). The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: A systematic review. PLoS ONE, 10(8): 1-22.